bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale
Authors: Lysholm Jack , Gillquist Jan
Published: June 2007

We have designed a scoring scale for knee ligament surgery follow-up emphasizing evaluation of symp toms of instability. Instability is defined as ''giving way" during activity. Our scoring scale was compared to a slightly modified Larson scale in patients with anteromedial and/or anterolateral instability, poster olateral and straight posterior instability, chondroma lacia patellae, and meniscus lesion. The two scales gave basically the same results in patients with menis cus rupture. In patients with unstable knees, the new scale gave a significantly lower total score. Thus, the new scale evaluates functional impairment due to clin ical instability better than the modified Larson scale. The total score, with the new scoring scale, corre sponded to the patients' own opinion of function and to the presence or absence of signs of instability.
Racquetball
Authors: Soderstrom Carl A. , Doxanas Marcos T.
Published: June 2007

One hundred fifty-seven racquetball injuries were identified. Eighty-two involved the face, but ocular injuries were probably underrepresented as a result of patient triage protocols. Facial trauma occurred more frequently among novice players. Only 9.9% of the players wore protective facial equipment and 23.1% had taken lessons before being injured. We propose that injuries could be reduced with proper player education, including the wearing of protective facial equipment. A modification in the design of con ventional facial equipment is suggested to further reduce injury.
The Medial Tibial Stress Syndrome
Authors: Mubarak Scott J. , Gould Robert N. , Yu Fon Lee  , Schmidt Donald A. , Hargens Alan R.
Published: June 2007

The medial tibial stress syndrome is a symptom com plex seen in athletes who complain of exercise-in duced pain along the distal posterior-medial aspect of the tibia. Intramuscular pressures within the posterior compartments of the leg were measured in 12 patients with this disorder. These pressures were not elevated and therefore this syndrome is not a compartment syndrome. Available information suggests that the medial tibial stress syndrome most likely represents a periostitis at this location of the leg.
Postmeniscectomy tourniquet palsy and functional sequelae
Authors: Dobner Joseph J. , Nitz Arthur J.
Published: June 2007

A pattern of variability was noted in the rehabilitative progress of patients undergoing knee surgery. Forty- eight patients who underwent routine medial or lateral meniscectomy were studied in a controlled, random ized, prospective investigation designed to identify electromyographic (EMG) and functional deficits as sociated with using a pneumatic tourniquet in knee surgery. The control group (24 individuals) underwent knee surgery without the use of a tourniquet. Six weeks postoperatively all patients were studied by EMG and functionally by determining the single leg vertical leap of the affected leg and expressing this as a percentage of that accomplished by the sound leg. The results were: (1) 17 of 24 (71 %) of the tourniquet group had EMG evidence of denervation and a func tional capacity of 39% of the normal leg. (2) 7 of 24 (29%) of the tourniquet group had no evidence of denervation and a 71 % functional capacity. (3) The control group had no evidence of denervation and a functional capacity of 79%.

Of the patients on whom a tourniquet was used, total tourniquet time and pressure did not vary signifi cantly between those patients who demonstrated EMG findings and those who did not. Arthrotomy in the absence of a tourniquet required more attention to hemostasis, but did not present overwhelming dif ficulty. Operative time was slightly prolonged. This investigation suggests that the ideal of early return to functional activity after knee surgery can best be accomplished by avoiding use of a pneumatic tourni quet.
Waterskiing-related injuries
Authors: Hummel Gregory , Gainor Barry J.
Published: June 2007

Twenty-six cases of waterskiing-related injuries, in cluding four deaths, were studied and the case histo ries classified into four categories. Injury was caused by a fall into unobstructed water, by boat propeller blades, by collisions with obstacles or a boat, and by the tow rope. Injuries sustained in falls were compa rable to trauma seen in vigorous contact sports. Boat propeller blades inflicted devastating battlefield-type wounds, and collisions produced trauma similar to that seen in motor vehicle accidents. The shearing action of an accelerating tow rope imparted trauma unique to this sporting activity. There is limited rec ognition of the potential for serious injury that attends this recreational sport, and it is concluded that the prevention of injury depends on the nuclear trio of participants: boat operator, observer, and skier.
Subtrochanteric stress fractures in runners
Authors: Butler James E. , Brown Stephen L. , Mcconnell Betty G.
Published: June 2007

Seven college track team members with stress frac tures in the subtrochanteric area of the femur were diagnosed using x-ray films and bone imaging. One, with repeated negative x-ray films, was considered to have a stress reaction. Suspected causes for this high incidence of subtrochanteric stress fractures include a change in running surfaces and an exercise called bounding (repetitive jumps with or without weights). The implementation of bone scanning and its useful ness after failure of conservative treatment is empha sized. A discussion of the continuum of stress reaction and the seven cases, diagnoses, treatments, and re sults are presented.
Prospective study of injuries in United States Ski Association freestyle skiing-1976-77 to 1979-80
Authors: Dowling Patrick A.
Published: June 2007

This report documents a prospective study of injuries in USSA (United States Ski Association) Freestyle competition undertaken during the four seasons from 1976-77 through 1979-80. In order to ensure ade quate reporting and documentation, the study was confined to actual observed competition days. Com petition and accident reports were prepared by a representative of the USSA-sanctioned organization conducting each of the competitions studied. Report forms were designed with reference to prior ski acci dent studies and included demographic information in addition to specific information related to the nature of freestyle ski competition. History and background relative to the disciplines of freestyle skiing is given, including the three disciplines of ballet, aerials, and moguls.

Data on 10,118 skier-days revealed incidence of injury to be 2.8 per 1,000 skier-days. The distribution of injury to location and type was not similar to that encountered in recreational skiers, and a relatively higher incidence of spine, head, and upper extremity injuries was noted. No incidence of cervical spine injury was encountered. All injured competitors were able to return to competition following recovery from their injuries.

This study directs attention to specific aspects of freestyle competition which will require changes in order to further reduce the incidence of injury.
Organization and support for a handicapped ski program
Authors: Frank L.L.
Published: June 2007

The purpose of this paper is to present a detailed approach to organization of a sports program for the handicapped. In this instance a ski program is de scribed but with some minor alterations, this protocol could apply to any activity for disabled persons.
Soft playing splint for protection of significant hand and wrist injuries in sports
Authors: Bergfeld John A. , Weiker Garron G. , Andrish Jack T. , Hall Rick
Published: June 2007

A simple custom-made soft splint has been devised to allow safe sports participation for significant hand and wrist injuries. Made from readily available materials, this "rubber splint" has been used successfully in 113 injuries reviewed in this report. This splint is a result of a modification of an original "Duke" splint described by Dobson, Davis, Lincoln, and Basset, (Exhibit at American Academy of Orthopaedic Sur geons, San Francisco, California, 1971) and the soft cast used at the University of Virginia by McCue and Gieck (personal communication).
Toe extensor weakness resulting from trivial athletic trauma
Authors: Streib Erich W. , Sun Sallie F. , Pfeiffer Ronald F.
Published: June 2007

Three patients exhibited variable weakness of toe extensors after trivial injuries. The first patient suffered an acute, partial anterior compartment syndrome dur ing a prolonged motorbike ride; the second a traction injury of the deep peroneal nerve while slipping during a racquetball game. The third patient developed a compression injury of the peroneal nerve on the basis of a generalized demyelinating polyneuropathy. The major clues for diagnosis and management came from electromyographic (EMG) examination.
Nerve supply of the human knee and its functional importance
Authors: Kennedy John C. , Alexander Ian J. , Hayes Keith C.
Published: June 2007

This investigation utilized gross dissections, histolog ical preparations, and neurophysiologic experiments to gain an improved understanding of the innervation of the human knee. Anatomical illustrations represent the findings of dissections of 15 fresh amputation specimens. Neurohistologic preparations using silver staining techniques demonstrate the rich innervation of the soft tissues of the knee, and a variety of spe cialized receptors are identified. In 10 subjects with normal knees, an experimentally produced knee ef fusion of 60 cc was found to result in profound inhi bition of reflexly evoked quadriceps contraction. Clin ical implications of the anatomical and physiologic data are discussed.
Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries
Authors: Jobe Frank W. , Moynes Diane Radovich
Published: June 2007

In the examination and rehabilitation of patients with shoulder injuries it is necessary to isolate the individ ual rotator cuff muscles as much as possible. We subscribe to the belief that, independent of the deltoid, the rotator cuff muscles can become fatigued, injured, or atrophied individually. Accordingly, we feel that these muscles must be considered separately during examination and rehabilitation.

This paper describes methods and positions to iso late the cuff and, thus, enable the examiner to be more precise in diagnosis and treatment. In addition, individual exercises for each component are de scribed.
Evaluation of hamstring strength following use of semitendinosus and gracilis tendons to reconstruct the anterior cruciate ligament
Authors: Brant Lipscomb A. , Johnston Robert K. , Snyder Robert B. , Warburton Mark J. , Pressly Gilbert P.
Published: June 2007

Reconstruction of the anterior cruciate ligament using the semitendinosus and gracilis tendons combined with the appropriate extraarticular procedures has been performed by the authors in 482 cases. In 321 cases both the semitendinosus and gracilis tendons were used and in 161 the semitendinosus alone. This retrospective study was done to determine if the use of these two tendons resulted in any significant loss of hamstring strength. Evaluation of quadriceps strength was also done as a measure of postoperative rehabilitation. Fifty-one patients with an average fol low-up time of 26.2 months were tested on the Cybex machine (Cybex Co., Ronkonkoma, New York) by two examiners using the same technique. The examiners had not participated in the surgery or rehabilitation of these patients. In the reconstructed knee in which both semitendinosus and gracilis were used, ham string strength was found to average 99% compared to the normal knee. When the semitendinosus alone was used there was no difference (102%) from the normal knee. Quadriceps strength in both groups averaged 96% in comparison to the normal quadri ceps. These results confirm that no significant loss of hamstring strength occurred when the semitendinosus and gracilis tendons were used to reconstruct the anterior cruciate ligament. Further, quadriceps strength of 96% as compared to the normal knee indicated a very acceptable degree of postoperative rehabilitation in this series.
Hemarthrosis treated by aspiration and casting
Authors: Mariani P.P. , Puddu G. , Ferretti A.
Published: June 2007

Eighty-eight athletes treated for an acute hemarthrosis of the knee without any demonstrable ligament tear were evaluated. Analysis of the clinical data from these cases, all treated between 1970 and 1975 with aspiration and casting, revealed that the injury was apparently worse than had been thought at the time of first treatment. Surgery was subsequently per formed in 32 (37%) because of meniscus tear, and 28 demonstrated anterior cruciate ligament insuffi ciency. In the 56 who did not have surgical treatment, 38 (43% of the entire group) had significant symptoms and disability causing them to decrease sports partic ipation, and only 18 (20% of the overall group) re turned to sports without symptoms or disability. Ob jective findings at followup suggested that in 70% of the patients injury of the anterior cruciate ligament occurred during the original trauma. A precise diag nosis is needed in every knee ligament sprain with hemarthrosis before one decides upon conservative treatment such as aspiration and casting.
The efficacy of manual assessment of muscle strength using a new device
Authors: Marino Michael , Nicholas James A. , Gleim Gilbert W. , Rosenthal Philip , Nicholas Stephen James
Published: June 2007

The purpose of this study was to compare the manual assessment of muscle strength with a small, hand- held (by the examiner) force-measuring device devel oped by the Institute of Sports Medicine and Athletic Trauma (ISMAT). One hundred twenty-eight patients presented with a known lower extremity orthopaedic pathology. All patients were clinically evaluated for hip abductor and hip flexor weakness in standard positions using the "break test" technique. All 128 patients were then evaluated with the ISMAT Manual Muscle Tester, a small, hand-held device which re corded the peak force (kg) required to break a muscle contraction. Three bilateral measures of hip abduction and hip flexion were recorded, averaged, and com pared to the subjective clinical evaluation using a Chi square analysis. Bilateral values which were within 5% of each other were not considered significant and therefore not included in the calculations. The average hip abduction and hip flexion scores measured by the ISMAT tester were consistent with the examiner's perception of muscle weakness (P less than 0.001). The results demonstrate consistent detection of mus cle weakness by the ISMAT Manual Muscle Tester over a broad range of testing conditions.
Avulsion of lateral tibial condyle in skiing
Authors: Abdalla Fouad H. , Tehranzadeh Jamshid , Horton Joseph A.
Published: June 2007

The purpose of this article is to report four cases of avulsion of the lateral tibial condyle which occurred in one month of a skiing season at a large ski resort in West Virginia. This includes three women and one man who all complained of knee pain following ski injury and showed avulsion or "chip" fracture of the lateral tibial condyle on roentgenographic examina tion. Two of the injuries were associated with nonre lease of ski bindings. In all four cases the diagnosis of anterolateral rotary instability was not appreciated by the initial examiner, however, and the knee was treated with a splint. Avulsion fracture of the middle third of the lateral tibial condyle, the so called "lateral capsular sign," represents a serious ligamentous in jury which results in significant knee instability. Sur gical repair of this type of injury is generally recom mended.
The Prognosis of Meniscectomy in Athletes
Authors: Hoshikawa Y. , Kurosawa H. , Fukubayashi T. , Nakajima H. , Watarai K.
Published: June 2007

This study analyzes patient participation in athletic activities after meniscectomy. Seventy simple menis cus lesions in 68 patients without ligamentous insuf ficiency were studied by means of a detailed question naire and clinical and radiological examinations. Fol low-up ranged from 1 to 18.4 years, averaging 4.5 years. These cases are classified into two groups, depending on the intensity of athletic activities.

Group 1 consisted of international class athletes and Group 2 consisted of both competitive and rec reational athletes. None of those studied have given up sports following meniscectomy. Results were worse in Group 1 than in Group 2 in both clinical and subjective evaluation. In Group 1 volleyball players presented results worse than those of football (Amer ican style) players and wrestlers. In Group 2 there was no significant difference in results among athletes of various sports. We conclude that the results after meniscectomy are influenced by the quality and fre quency of postoperative athletic activities.
Transcutaneous neural stimulation use in postoperative knee rehabilitation
Authors: Smith Michael J. , Hutchins Richard C. , Hehenberger Debra
Published: June 2007

A prospective study of 100 patients who were oper ated on in 1979 and 1980 was performed to determine the effect of transcutaneous neural stimulation (TNS) on the patients' postoperative knee rehabilitation pro gram. The patients were then divided into four study groups. Fifty patients had a single incision arthrotomy with a meniscectomy. Of these surgical patients, Group A included 25 patients who were treated with a TNS unit postoperatively, and Group B includes 25 patients who did not use TNS. Fifty other patients had a total condylar-total knee replacement. Of these sur gical patients, Group C includes 25 patients who used TNS postoperatively and Group D includes 25 patients who did not use TNS. In the arthrotomy group the TNS patients (Group A) had a shorter average hospital stay (3.84 versus 5.40 days), initiated straight leg raises sooner (1.72 days versus 3.17 days) and began am bulation sooner (1.4 days versus 2.44 days) than the patients who did not use TNS (Group B). As compared to Group B, Group A had a reduction in number of meperidine injections of 42.75% and a reduction of meperidine dosage of 31.49%. In the total knee pa tients, the group treated with TNS (Group C) also had a shorter hospital stay (14.92 days versus 17.88 days) and performed straight leg raises sooner (4.92 days versus 7.54 days) than patients who did not use TNS (Group D). There was no difference in the ambulation times in Group C and Group D (4.96 days). There was a reduction of meperidine injections of 35.88% and a reduction of meperidine dosage of 44.48% in Group C.

The use of TNS in postoperative knee patients improved their rehabilitation performance and shortened their hospital stay. No side effects were noted.
Superior entrapment of the clavicle
Authors: Leonard Morton H. , Capen David A.
Published: June 2007

Three degrees of acromioclavicular separation are commonly recognized. A Type III separation with en trapment of the clavicle on the top of the acromion is frequently not recognized while in its acute phase and amenable to closed reduction. The sign of this type of acromioclavicular separation is an apparent Type III in which one cannot manipulate the clavicle. The acute case is treated by local anesthesia, manipulation, and splinting. The chronic case is treated by excision of the outer end of the clavicle. In 1979 we treated three acute and one chronic superior entrapment of the clavicle on the acromion. During this time interval 67 acromioclavicular separations of Grade I, II, and III were treated. This amounted to 6% of our acromiocla vicular separations treated during 1979.
Bilateral avulsion fracture of the triceps tendon insertion from skiing with osteogenesis imperfecta tarda
Authors: Match Ronald M. , Corrylos Elizabeth V.
Published: June 2007

Avulsion of the triceps tendon with fractures of the olecranon have been described in the literature.

This injury is frequently misdiagnosed or over looked. Bilateral avulsions are extremely rare.

A case of bilateral avulsions of the triceps tendon insertion caused by a skiing mishap was seen in a patient with osteogenesis imperfecta tarda.
Meniscectomy in children: A long-term follow-up study
Authors: Manzione Marc , Pizzutillo Peter D. , Peoples Alan B. , Schweizer Paul A.
Published: June 2007

In order to more accurately document the effects of meniscus removal, 20 children and adolescents with isolated meniscal tears were examined an average of 5.5 years after surgery. All patients with concomitant ligamentous injuries and a history of prior surgery on either knee, and those with bilateral knee pathology or knee pathology outside the meniscus, were excluded. At followup, 60% of the 20 study patients had unsat isfactory results. The clinical results did not correlate with the site of meniscectomy, the type of meniscal tear, the severity of radiographic changes, or whether the patient had total or partial meniscectomy. Evalua tion of lower extremity muscle function revealed a statistically significant (P < 0.05) decrease in hip ab ductor strength in patients with unsatisfactory results. This study indicates that meniscectomy in the child or adolescent is not a benign procedure, and that failure to rehabilitate hip abductor strength to normal levels significantly comprises the clinical end results.
Prevention of soccer injuries
Authors: Ekstrand Jan , Gillquist Jan , Liljedahl Sten-Otto
Published: June 2007

To study the efficacy of an injury prevention program in a randomized trial, 12 teams (180 players) in a male senior soccer division were followed up for 6 months. The 12 teams were allocated at random to two groups of six teams, one being given a prophylactic program and the other serving as control. The program was based on previous studies of injury mechanisms. It comprised (1) correction of training, (2) provision of optimum equipment; (3) prophylactic ankle taping; (4) controlled rehabilitation; (5) exclusion of players with grave knee instability; (6) information about the impor tance of disciplined play and the increased risk of injury at training camps; and (7) correction and supervision by doctor(s) and physiotherapist(s).

The injuries in the test teams were 75% fewer than in the controls. The most common types of soccer injuries, sprains and strains to ankles and knees, were all significantly reduced. It is concluded that the pro posed prophylactic program, including close supervi sion and correction by doctors and physiotherapists, significantly reduces soccer injuries.
The measurement of dynamic compartment pressure during exercise
Authors: Logan J.G. , Rorabeck C.H. , Castle G.S.P.
Published: June 2007

Anterior tibial compartment pressures have been ex amined during exercise in nine healthy university stu dents. Six male and three female subjects weighing 140 to 160 pounds and between 18 and 25 years of age were tested. A slit catheter was introduced into the muscle belly of the subjects' right anterior tibial compartment and dynamic compartment pressures measured using an F.M. telemetry system. Subjects were exercised on a treadmill at speeds from 1 to 6 mph and the variations in compartment pressure during one exercise cycle (one stride length) and over the course of the exercise period examined. Results have shown that both average and peak to peak pressures measured during exercise are much higher than those recorded at rest, and compartment pressures rose with increasing speed.
The effect of diagnostic and operative arthroscopy and open meniscectomy on muscle strength in the thigh
Authors: Hamberg Per , Gillquist Jan , Lysholm Jack , Oberg Birgitta
Published: June 2007

In this study we measured the effect on the muscle strength in the thigh in connection with diagnostic ar throscopy with central approach, arthroscopy with ar throscopic operation of bucket-handle ruptures, flap tears, total arthroscopic meniscectomy, and open men iscectomy. Thirty-seven patients were tested preoper atively and 1, 4 and 8 weeks postoperatively with a Cybex ll isokinetic dynamometer. The extensor mus cles of the knee joint were most affected. The flexor muscles were generally recovered in all groups within a month. Diagnostic arthroscopy and arthroscopic op erations for bucket-handle ruptures showed no signifi cant effect on the thigh muscle torque. With the other arthroscopic operations there was a 40% decrease of quadriceps function 1 week after operation. After 8 weeks normal function returned. Open meniscectomy had a much more negative effect on the quadriceps muscle with a decrease of about 70% after 1 week. After 8 weeks, the rehabilitation was still not complete.
Karate: Historical perspective and injuries sustained in national and international tournament competitions
Authors: Stricevic Milorad V. , Patel Mukund R. , Okazaki Teruyuki , Swain Braja K.
Published: June 2007

Karate injuries sustained in three national and three international tournaments were reviewed. Two hundred and eighty-four athletes participated in 309 matches. Athletes had an average age of 25.5 years, average years of karate practice of 7.7 years, and average years of competitive experience in tournaments of 3.1 years. Athletes were mostly black belts with gradation from brown belt to fourth degree black belt. There were 82 injuries sustained by 76 athletes within 309 matches, with an incidence of one injury in every 3.7 matches or 0.3 injuries per match. There were more injuries among the lower ranked and less experienced athletes, indi cating that injuries became less frequent with increased tournament experience. Punches caused more injuries than kicks. Only 16 of the 76 injured athletes were forced to discontinue competition; one athlete was admitted to the hospital for 1 week due to a cerebral concussion.
99m-Technetium phosphate compound joint scintigraphy in the management of juvenile osteochondritis dissecans of the femoral condyles
Authors: Cahill Bernard R. , Berg Ben C.
Published: June 2007

The known sensitivity of joint scintigraphy in following the course of fracture healing caused the authors to believe that this radiologic technique might be valuable in the management of osteochondritis dissecans (OCD). Accordingly, 99mTc-diphosphonate joint scintigraphy was used on 18 patients with OCD of the knee. The average age was 13½ years. The scintigrams were repeated at 6-week intervals until healing had occurred. When the diagnosis of OCD was established by stan dard roentgenograms and joint scintigraphy, the pa tients were placed on an activity restriction program, attempting to reach a symptom-free level. The patients were followed for an average of 18 months. Ninety-five scans were categorized according to their level of scin tigraphic activity. This led to a discrete four-part scinti graphic classification that is indicative of the extent of healing or progression of this condition, and precedes changes seen on standard x-rays by months. Joint scintigraphy also rules out anomalies of ossification in the diagnosis of OCD since an anomaly should have a normal scintigraphic appearance. We have concluded that joint scintigraphy is valuable in the management of OCD because of its superior sensitivity to changes in the activity of the lesion. As experience is gained with this technique, those cases that should be prophylact ically surgically stabilized may be indicated.
Posttraumatic sports-related musculoskeletal abnormalities: Prevalence in a normal population
Authors: Raskin Richard J. , Rebecca George S.
Published: June 2007

The prevalence of posttraumatic musculoskeletal (MS) abnormalities attributable to athletics within general populations has not been identified. In this study, com prehensive athletic histories and MS examinations were performed on 127 medical students, aged 23 to 32. A total of 158 separate congenital, developmental, and acquired MS abnormalities were detected among 93 subjects (73.2%). Forty-seven subjects (37.0%) dem onstrated 64 separate sports-related abnormalities, in cluding decreased joint range in motion (ROM), articular laxity, synovitis, tendinitis, and bursitis. Participants in contact sports had the highest prevalence, runners were intermediate, and participants in noncontact sports had the lowest prevalence of posttraumatic MS abnormalities. Ninety subjects (70.8%) had previous history of sports-related injuries. Participation in specific sports correlated with predictable injury patterns and with their sequelae as noted on physical examination. The data presented suggest a high incidence of sports injury in general populations, and demonstrate that posttraumatic MS abnormalities attributable to athletics are highly prevalent in otherwise normal young adults.
The Lenox Hill Brace in anterolateral rotatory instability
Authors: Bassett George S. , Fleming Bryan W.
Published: June 2007

We evaluated the efficacy of the Lenox Hill Brace in controlling anterolateral rotatory instability (ALRI) of the knee. Thirty-six patients with ALRI previously fitted with the Lenox Hill Brace were examined and graded using standard clinical laxity tests. A comparison was made of the degree of instability with and without the brace applied. Of the 20 patients with ALRI, 89% of the knees with Grade 1 instability and 45% of those with Grade 2 instability were improved. Sixteen patients had com bined anteromedial-anterolateral rotatory instability (AM-ALRI). Although AMRI was improved in all, ALRI was unchanged in 69%, in spite of proper brace spec ifications and fit.
Sports and peripheral nerve injury
Authors: Hirasawa Yasusuke , Sakakida Kisaburo
Published: June 2007

Peripheral nerve injury is one of the serious compli cations of athletic injuries; however, they have rarely been reported. According to the report by Takazawa et al.,6 there were only 28 cases of peripheral nerve injury among 9,550 cases of sports injuries which had been treated in the previous 5 years at the clinic of the Japanese Athletic Association.

The authors have encountered 1,167 cases of pe ripheral nerve injury during the past 18 years. Sixty-six of these cases were related to sports (5.7%). The nerves most frequently involved were: brachial plexus, radial nerve, ulnar, peroneal, and axillary nerves (in their order of frequency). The most common causes of such injuries were mountain climbing, gymnastics, and base ball. More often, peripheral nerve injury seemed to be caused by continuous compression and repeated trauma to the involved nerve. Usually it appeared as an entrapment neuropathy and the symptoms could be improved by conservative treatment. Some of the cases were complicated by fractures and surgical exploration became necessary. Results of treatment produced ex cellent to good improvement in 87.9% of the cases. With regard to compartment syndrome, the authors stress the importance of early and precise diagnosis and a fasciotomy.
Computerized tomography in the evaluation of peroneal tendon dislocation
Authors: Szczukowski Myron , St. Pierre Rick K. , Fleming Lamar L. , Somogyi James
Published: June 2007

Dislocation or subluxation of a peroneal tendon is a relatively uncommon entity, and the diagnosis is rarely made at the time of initial injury. If untreated, chronic lateral instability and pain may develop which can be a diagnostic dilemma. These patients usually will have a history of frequent episodes of ankle instability and may be aware of a pop or snap just prior to the episode of instability. There is usually no significant anterior drawer or inversion laxity present on stress testing. Unfortu nately, it is often difficult to passively or actively dislo cate the involved peroneal tendon. Surgical treatment may have to be recommended on strong suspicion alone. Two patients with chronic lateral ankle pain underwent computerized tomography preoperatively and postoperatively. In addition, eight normal ankles were scanned for comparison.

In the two cases of peroneal tendon dislocations presented, computerized tomography was found to be a very beneficial aid in making the diagnosis, and may be of significant value in those with suspected peroneal tendon subluxation/dislocations.
Shoulder posterior subluxation
Authors: Norwood Lyle A. , Terry Glenn C.
Published: June 2007

The records of 21 patients with chronic recurrent pos terior subluxation were reviewed to document postop erative stability and level of athletic participation after opening wedge posterior scapular osteotomy and as sociated soft tissue procedures. At an average of 39.9 months after surgery, we objectively reevaluated 17 males and 2 females (from 16 to 46 years old). Patients with posterior instability caused by a direct trauma stabilized and effectively returned to athletic participa tion following osteotomy. Patients with posterior stabil ity resulting from muscular contraction required addi tional soft tissue procedures for stability and effective return to athletics. Congenitally or habitually lax shoul ders did not stabilize in this series.

This study suggests that opening osteotomy is indi cated for single plane, posterior instability which results from direct trauma or muscular contraction, and for combined anterior-posterior instability. Opening oste otomy is contraindicated in congenitally or habitually lax shoulders. A descriptive classification system which groups shoulders according to injury force and direction of instability facilitates preoperative prediction of sub sequent glenohumeral joint stability and athletic partic ipation or level of nonsportive activity.
Dynamic double tendon replacement of the posterior cruciate ligament
Authors: Wirth C.J. , Jager M.
Published: June 2007

Reconstruction of the posterior cruciate ligament com bined with medial capsular repair was performed in eight men and four women whose average age was 29 years. In an effort to simulate the tensile behavior of the two major divisions of the posterior cruciate liga ment, i.e., the anterolateral and posteromedial portions, we used the gracilis and semitendinosus tendons as substitutes. Since we consider this a dynamic opera tion, we feel its full benefits are measured better by functional parameters than by purely objective param eters. Accordingly, followup between 1 and 4 years (averaging 32 months) revealed all patients were sub jectively pleased with their operative results. Postop erative objective evaulation still demonstrated a positive posterior drawer sign (although decreased) in all cases and a diminished medial joint space opening in most cases. Thigh girth differences were found at followup in most cases, probably as a result of disproportionate activity of the contralateral extremity. We feel that our dynamic reconstruction is an excellent alternative when one is considering surgery for a torn posterior cruciate ligament.
The marathon: Dietary manipulation to optimize performance
Authors: Sherman William M. , Costill David L.
Published: June 2007

Despite pronounced involvement of the cardiovascular and respiratory systems during the marathon, the lim iting factor for this event revolves around the supply and utilization of intramuscular and extramuscular fuel reserves. The single most consistently observed factor contributing to fatigue at work intensities selected by marathon runners is the depletion of muscle's endog enous carbohydrate, glycogen. Dietary manipulations which reduce the rate of muscle glycogen degradation will, therefore, spare this important fuel and delay fa tigue. The purpose of this paper will be to review dietary factors which are pertinent to fuel utilization in order to optimize marathon performance.
The Cybex II evaluation of lateral ankle ligamentous reconstructions
Authors: St. Pierre Rick K. , Andrews Larry , Allman Fred , Fleming Lamar L.
Published: June 2007

Chronic lateral ankle instability is a costly disability to the athlete. The Chrisman-Snook and Evans lateral ligamentous reconstructions are two procedures fre quently performed to correct ligamentous instability. The entire peroneus brevis tendon is transected in the Evans procedure, thus sacrificing its eversion strength and power. The importance of preserving the eversion function of the peroneus brevis muscle is speculative, but may be of significance for good long-term results.

The ankle eversion strength and power of 10 patients with Chrisman-Snook and 10 patients with Evans lat eral ligamentous reconstructions were objectively eval uated with the Cybex II Isokinetic Dynamometer. The mean postoperative time to testing was 4.2 years. The uninvolved ankle was also tested and used as the normal strength of the patient. Twenty normal controls matched for age, sex, and physical activity were tested to assure maximum test reproducibility. The eversion strength was tested at several speeds, but torque values at speeds of 30 and 120 deg/sec were selected for analysis.

At slow speeds, 30 deg/sec, and ankles that had Evans and Chrisman-Snook reconstruction were 4% and 7% weaker, respectively, than the contralateral normal ankles. At 120 deg/second the ankles were 8% and 9% weaker with the Evans and Chrisman-Snook reconstructions, respectively. A three factor analysis of variance with repeated measures on two of the factors was used to analyze the data. The analysis indicated that the estimated mean difference in peak torque values between the control and surgical ankles for the Evans procedure at 30 deg/sec, the Chrisman-Snook procedure at 30 deg/sec, the Evans procedure at 120 deg/sec, and the Chrisman-Snook procedure at 120 deg/sec were not significantly different (F = 0.49, df = 1/18, P = 0.491).

Thus, the surgical loss of the peroneus brevis muscle in the Evans lateral ligamentous reconstruction does not appear to result in a significant loss of eversion strength and power when compared to the contralateral normal ankle. Therefore, the authors contend that the loss of the peroneus brevis tendon should not be a factor in the selection of an operative procedure for lateral ankle instability.
Symptomatic dislocation of the anterior horn of the medial meniscus
Authors: Clancy William G. , Keene James S. , Goletz Ty H.
Published: June 2007

Anteromedial joint line pain of the knee represents both a diagnostic and therapeutic challenge. Dislocation of the anterior horn of the medial meniscus as a cause of anteromedial joint line pain is uncommon. O'Connor has reported this finding on internal and external rota tion of the tibia during arthroscopy and Dashefsky has demonstrated a shadow sign associated with dislocat ing anterior horns. We have noted these findings plus anteromedial femoral condylar articular erosion asso ciated with persistent anteromedial joint line pain in 13 patients. All 13 patients had persistent anteromedial joint line tenderness on physical examination present from 3 months to 3 years prior to surgery. Six of the 13 patients had a click in the knee with activity and only 4 of the 13 patients reported "giving away" epi sodes. Arthroscopic examination demonstrated a com plete anterior horn dislocation of the medial meniscus as described by O'Connor and Dashefsky as well as degeneration of the anteromedial femoral condyle. De finitive treatment was performed in the 13 patients after arthroscopic confirmation of the diagnosis of dislocating anterior horn of the medial meniscus. The first four patients had traditional medial meniscectomies, the next four patients had repair of the anterior horn, and the last five patients had partial resection of the menis cus through the arthroscope. Excellent results occurred in three of four patients with repair of the anterior horn, and four of five patients with partial resection through the arthroscope. The one failure of repair subsequently underwent a complete medial meniscectomy with an excellent result. Thus, 11 of 13 patients had excellent final results. No method of treatment proved to be significantly superior to any other method in this small series. However, the theoretical advantages of partial meniscectomy through the arthroscope led us to prefer this method of treatment for symptomatic dislocating anterior horns of the medial meniscus.
Sports injuries during one academic year in 6799 Irish school children
Authors: Watson A.W.S.
Published: June 2007

Details of the sports injuries occurring in 6799 children between the ages of 10 and 18 were recorded during the course of one academic year (September to June). One hundred sixteen injuries were noted: 29 sprains, 20 fractures, 18 strains, 14 contusions, 10 wounds, 7 dislocations, and 18 other injuries. On average these injuries resulted in 0.47 days of hospitalization, 18 days of incapacity, and 28 days before full recovery. The activities at which the injuries occurred were: football, 24; athletics, 15; rugby and gymnastics, 11 each; hockey, 10; basketball, 9; hurling and soccer, 8 each; indoor soccer, 5; camogie, 4; swimming, 3; tennis, 1; and others, 7. The rugby and indoor soccer injuries tended to be of above average seriousness. Eighty- eight injuries occurred in males and 28 in females. Males over 14 were three and half times as likely to be injured as younger boys. In girls the incidence of injury dropped after the age of 15. In both sexes the likelihood of injury increased with the physical standing of the individual. In outstanding males over the age of 15 the incidence of injury was one in six. The factors which contributed most frequently to injury were recklessness on the part of the injured party and foul or illegal play by another player. Lack of fitness and defects in sports gear, playing area, and equipment were other common causes.
Detection of intraarticular loose osteochondral fragments by double-contrast wrist arthrography
Authors: Tehranzadeh Jamshid , Labosky David A.
Published: June 2007

Gravity was used in a case of double-contrast wrist arthrography to demonstrate the intraarticular loose nature of osteochondral fracture fragments. These cal cified loose bodies were successfully removed surgi cally.
Repair and reconstruction of rotatory instability of the knee
Authors: Simonet William T. , Sim Franklin H.
Published: June 2007

We studied the results of treatment in 110 of 129 consecutive patients who had knee instability for which they underwent reconstruction of the knee ligaments at the Mayo Clinic. Thirty-one patients underwent dif ferent types of extraarticular reconstruction. Nine (29%) had recurrence of the knee giving way, and 11 (36%) had objective signs of instability on examination. Fifty- five patients underwent combined extraarticular and intraarticular reconstruction with either the Lam-Jones patellar tendon (PT) procedure (21 knees) or the Zarins- Rowe semitendinosus and iliotibial band (ST & ITB) procedure (34 knees). Only two knees (10%) with PT procedures and three knees (9%) with ST & ITB pro cedures continued to have giving way. Three patients in each group had recurrence of instability. Twenty-four knees with acute instability had either primary repair (17 knees) or primary reconstruction with ST & ITB procedures (7 knees). The results in these knees were superior to the results in the knees reconstructed for chronic instability. On the basis of our 2 year results, we believe that a combined intraarticular and extraar ticular reconstruction is the procedure of choice in chronic knee instability and is a useful procedure in acute knee instability with irreparable tears of the an terior cruciate ligament.
Deep vein thrombosis in a jogger
Authors: Ali Mir Sadat , Kutty M. Sankaran , Corea J.R.
Published: June 2007

Deep vein thrombosis is rare in young and healthy athletes. A case of venous thrombosis is reported in a young, physically fit jogger.
Acute combined posterior cruciate and posterolateral instability of the knee
Authors: Baker Champ L. , Norwood Lyle A. , Hughston Jack C.
Published: June 2007

This report concerns 13 consecutive patients (13 knees) who underwent operative treatment for acute combined posterior cruciate and posterolateral instabil ity due to combined injury to the posterior cruciate ligament and the arcuate ligament complex. Our pur pose was to examine the method of diagnosis and the results in these patients. There were 12 males and 1 female (average age, 26 years). Five patients were injured in a motor vehicle accident, four in sports activ ities, and four in nonsports activities. The mechanism of injury was an anteromedial blow to the flexed knee in six patients, a fall onto the knee in two, and unknown in five patients. Eleven patients were available for fol low-up evaluation (average, 56 months), and in each the result was rated as good, fair, or poor. In 10 patients (90%) the results were rated as good subjectively, in 11 (100%) as good functionally, and in 8 (73%) as good objectively. Injury to both the posterior cruciate liga ment and the arcuate ligament complex can result from rotational force that can be due to a blow to the anteromedial aspect of the knee. Diagnosis can be made by a combined positive response to the posterior drawer test, the anterior drawer test performed with the tibia in internal rotation, the abduction and adduc tion stress tests performed with the knee in full exten sion, the posterolateral drawer test, and the external rotation-recurvatum test. In a knee with concomitant injury to the posterior cruciate ligament and the arcuate ligament complex that requires surgical repair, all in jured structures should be explored and repaired to ensure a subjectively, objectively, and functionally good result.
Hamstring/quadriceps ratios in college football players: A high velocity evaluation
Authors: Stafford Maureen G. , Grana William A.
Published: June 2007

Hamstring/quadriceps ratios were assessed on 60 in tercollegiate football players at functional speeds of 90, 180, and 300 deg/sec on the Cybex II. The ratio rose as velocity of exercise increased and the quadriceps was stronger than the hamstrings at all speeds. The flexor/extensor ratio differed bilaterally at all speeds with ratio lower for the dominant knee.

The study helped establish normative data on ham string/quadricep ratios on football players at functional speeds. Furthermore, the ratio provides a guide to observe muscle imbalances which could be a factor in injury.
Enzymatic adaptation in ligaments during immobilization
Authors: Gamble James G. , Edwards Charles C. , Max Stephen R.
Published: June 2007

Ligaments are a composite of fibroblasts and collagen in a proteoglycan matrix. Seventy-five percent of the organic solid is collagen and 23% is proteoglycan. Fibroblasts are responsible for the overall composition of the ligament, that is the synthesis and the degrada tion of macromolecular components. Like muscle and bone, ligaments are dynamic, undergoing hypertrophy with exercise and atrophy with immobilization. This paper reviews the structure and composition of liga ments and discusses the cellular events responsible for atrophy of ligaments with immobilization. As an exper imental model, one knee of New Zealand White rabbits was immobilized with a pin. After 2, 4, and 8 weeks of immobility, the medial collateral ligaments were isolated and enzyme analysis was performed. Gross and micro scopic changes were apparent after 2 weeks. As for enzyme changes, lactic dehydrogenase and malic de hydrogenase decreased in activity. The lysosomal hy drolases responsible for glycosaminoglycan degrada tion increased in activity, suggesting that enzymatic adaptations mediate the physical and chemical changes in the ligament. The cells switch from an anabolic synthetic state to a catabolic, degradative state during immobility. It would seem from the biochemical view point that, whenever possible, cast-bracing and func tional splints may be preferable to rigid plasters in many sports-related ligamentous injuries.