bluuebunny/crossref_metadata_2025 huggingface dataset:
The microvasculature of the meniscus and its response to injury
Authors: Arnoczky Steven P. , Warren Russell F.
Published: June 2007

The normal vascular anatomy of the menisci was inves tigated in five dogs by histology and tissue-clearing (Spalteholz) techniques. The vessels were found to originate in the perimeniscal capsular and synovial tis sues and penetrate the peripheral 25% of the meniscal tissues. The vascular response to complete midportion transection of the medial meniscus was evaluated in 15 dogs. This response originated from the peripheral synovial tissues and completely healed the lesion with fibrovascular scar tissue by 10 weeks. Longitudinal incisions in the avascular portion of the meniscus failed to heal. However, when these lesions were connected to the peripheral synovial tissues at their midportion by a vascular access channel, the entire lesion was healed with fibrovascular scar by 10 weeks.
Musculoskeletal injuries in theatrical dance students
Authors: Rovere George D. , Webb Lawrence X. , Gristina Anthony G. , Vogel Judith M.
Published: June 2007

Three hundred and fifty-two injuries in 185 theatrical dance students at the North Carolina School of the Arts were diagnosed and treated from September 1981 through May 1982, the most recent academic year.

The total number of dancers enrolled in the school was 218; thus, 84.9% of the dance students were evaluated for an injury by a physician, with 87.8% of the injuries sustained during dance.

Approximately one-fourth of the dance-related inju ries involved the foot or ankle. The injuries were usually not severe, and proved amenable to treatment by con servative measures.
Dismounts in gymnastics: Should scoring be reevaluated?
Authors: Hunter Letha Y. , Torgan Carol
Published: June 2007

Eleven high school and college gymnasts who sus tained 12 major knee injuries were surveyed. Seven were injured as the result of dismounts from the beam of the uneven bar. Five of the seven used a twist in the maneuver. Present dismounts scoring constitutes a significant amount of the total score of a gymnastic routine. We question the need to reevaluate gymnastic scoring to encourage less difficult dismounts in an attempt to reduce the number of significant knee inju ries.
Medial collateral ligament replacement with a partially absorbable tissue scaffold
Authors: Aragona J. , Parsons J.R. , Alexander H. , Weiss A.B.
Published: June 2007

The medial collateral ligaments and medial capsular structures of canines were resected and replaced with a carbon fiber-polylactic acid polymer tissue scaffold or allowed simply to "scar-in." After 4, 8, 12, and 26 weeks in vivo, the stability of the knees was quantitatively evaluated and the mechanical properties of the regrown structures determined. Histological sections of the re grown structures were examined after 26 weeks in vivo.

At all time periods, the knees receiving tissue scaffold ligaments were signifiicantly more stable than those knees allowed to stabilize with scar tissue. Initial strength, rapid ingrowth, and benign tissue reaction suggest this new composite material may be useful in the treatment of joint instability.
Effects of warming up, massage, and stretching on range of motion and muscle strength in the lower extremity
Authors: Wiktorsson-Moller Margareta , Öberg Birgitta , Ekstrand Jan , Gillquist Jan
Published: June 2007

The effects of general warming up, massage, and stretching on ranges of motion (ROM) and strength of quadriceps and hamstring muscles were measured in eight male volunteers. Thigh muscle strength was not influenced by the experimental procedures. Stretching resulted in a significantly increased range of hip flexion/ extension, hip abduction, knee flexion, and ankle dor siflexion; the effect was significantly greater than that obtained by massage and warming up separately or combined. Only ankle dorsiflexion was influenced by massage or warming up, whereas stretching affected all muscle groups tested. Stretching was, therefore, superior to the other methods tested for increasing flexibility in the lower extremity.
Arthroscopic meniscectomy: A follow-up report
Authors: Hershman Elliott B. , Nisonson Barton
Published: June 2007

Eighty patients who underwent arthroscopic meniscec tomy were interviewed and examined 12 to 24 months postoperatively. Twenty-seven (34%) of the patients rated their knees as normal, and 46 (58%) of the patients rated their knees as improved. Seventy-nine percent of the patients were pain free at the time of followup. Patients with poor results were likely to have significant degenerative disease or instability. Sixty-five percent of the patients returned to their original sport. Factors limiting patients' return to sports after menis cectomy included instability, patellofemoral disease, and degenerative arthritis.
Lateral reconstruction for anterolateral rotatory instability of the knee
Authors: Fleming Richard E. , Blatz Douglas J. , Mccarroll John R.
Published: June 2007

Sixty patients underwent surgery for correction of an terolateral rotatory instability using an extraarticular approach. Forty procedures were performed utilizing Hughston's technique which is outlined. This approach is shown to provide effective control of pivot shift and anterolateral rotatory laxity.
Evaluation of meniscus tears of the knee by radionuclide imaging
Authors: Marymont John V. , Lynch Mary A. , Henning Charles E.
Published: June 2007

We compare the accuracy of radionuclide imaging of the knee with Tc99m-pyrophosphate with arthrography for the evaluation of meniscus tears in young athletes with clinically suspected knee injury. All patients had arthroscopy which was used as the standard against which the other two diagnostic procedures were com pared. Radionuclide scintigraphy and arthrography were comparable in their ability to detect tears of the medial meniscus. Scintigraphy was superior for the detection of tears of the lateral meniscus and of both menisci.
Arthroscopy of the shoulder: Technique and normal anatomy
Authors: Andrews James R. , Carson William G. , Ortega Kenneth
Published: June 2007

We present our technique of diagnostic and surgical arthroscopy of the shoulder and describe the normal and normal variational arthroscopic anatomy of the structures within the shoulder joint. To ensure accu racy, strict attention is given to consistent patient po sition and technical detail. Posterior and anterior portals are consistently located with the aid of bony anatomic landmarks. Using a large diameter angled arthroscope, structures within the shoulder joint are identified and examined in sequential order. Diagnostic arthroscopy of the shoulder can be systematic and reproducible when the surgeon is knowledgeable of the normal and normal variational anatomy of the shoulder and when attention is given to accurate placement of the arthro scopic portals and to consistent surgical technique.
Prognosis in anterior shoulder dislocation
Authors: Simonet William T. , Cofield Robert H.
Published: June 2007

All patients treated for a first-time anterior glenohumeral dislocation in Olmsted County, Minnesota, from 1970 through 1979 were identified. Of these 124 patients, 116 were available for study at a mean followup of 4.63 years (range 2 to 11). Of the 116 patients, 38 (33%) had recurrence of dislocation: 21 of the 32 (66%) pa tients less than 20 years old,17 of the 43 (40%) patients 20 through 40 years old, and none of the 41 patients older than 40 years. Symptomatic instability remained a problem in 24 patients. Twenty-seven of 33 (82%) young athletes had recurrence of dislocation as com pared with only 8 of 27 (30%) nonathletes of similar ages. Patients restricted from resuming sports partici pation for 6 weeks or more had significantly better results than those restricted for less than 6 weeks.

The recurrence rate of dislocation is not as high as previously reported. However, the rate in athletes is much higher than that in nonathletes. Many patients continue to complain of symptomatic instability without actual redislocation. In our younger patients, we now advise immobilization for from 3 to 6 weeks, followed by extensive rehabilitation before return to athletic ac tivity.
Discoid medial meniscus: Two cases of tears presenting as locked knee due to athletic trauma
Authors: Hermann George , Berson Burton L.
Published: June 2007

Two patients with a rare, massive type of discoid medial meniscus have been described. Both presented with a locked knee due to athletic trauma in the third and fifth decade of life, respectively.

Clinically, discoid meniscus has only nonspecific signs. The arthrogram has proved to be a helpful pre operative diagnostic tool. Definitive diagnosis and treat ment can be made with arthroscopy.
Chronic calcaneal pain in athletes: Entrapment of the calcaneal nerve?
Authors: Henricson Anders S. , Westlin Nils E.
Published: June 2007

In 11 heels in 10 athletes with chronic heel pain unre lieved by conservative therapy, the symptoms and physical findings caused a suspicion of entrapment of the calcaneal branches of the tibial nerve. The nerves were, therefore, surgically decompressed. No macro scopic signs of compression of the nerves were noted, but an entrapment of the anterior calcaneal branch could occur where the nerve passes between the tight and rigid edge of the deep fascia of the abductor hallucis and the medial edge of the os calcis. Followup of 58 months after surgery revealed that 10 of the 11 heels were asymptomatic and the patients had re sumed athlete participation after an average of 5 weeks.
The acute pivot shift: Clinical correlation
Authors: Lucie R. Stephen , Wiedel Jerome D. , Messner Duane G.
Published: June 2007

The pivot shift test and its various modifications has been well described for evaluation of chronic antero lateral rotatory insufficiency of the knee. Fifty knees with acute traumatic hemarthrosis were examined un der general anesthesia to assess the reliability of the pivot shift in the acute injury. The pivot shift test as described by Galway and Maclntosh was employed. No patients with a history of previous knee injuries were included. Arthrotomy or arthroscopy was per formed following the examination in all cases. There were 38 knees with positive shifts, 35 with complete anterior cruciate tears, and 3 with significant partial tears or attenuation of the ligament. The 12 knees with negative shift demonstrated five normal anterior cru ciates, five partial tears and two complete tears of the anterior cruciate. Both of the complete tears were associated with complete medial collateral ligament tears and were clinically apparent by drawer and Lach man tests. A positive pivot shift in this study was very accurate for significant anterior cruciate tears. A nega tive pivot shift ruled out complete anterior cruciate ligament tears but did not preclude the presence of a partial tear. Partial tears associated with a negative pivot shift retained ligament competence.

We conclude that: (1) the pivot shift is a direct test of cruciate competence; (2) the pivot shift is present acutely in a very high percentage of cases and does not necessarily develop over time; (3) the pivot shift exam performed under general anesthesia is a very reliable test for significant tears of the anterior cruciate; and (4) the arthroscope remains a useful tool in the evaluation of acute traumatic hemarthrosis, but is not always necessary in establishing competence of the anterior cruciate ligament.
Quadriceps atrophy in the anterior cruciate insufficient knee
Authors: Baugher W. Hugh , Warren Russell F. , Marshall John L. , Joseph Alex
Published: June 2007

Atrophy of the quadriceps musculature is frequently associated with chronic knee instability. This atrophy may persist despite the patient's ability to return to athletic competition.

When open biopsies of the quadriceps muscle from unstable knees were compared with those from normal acutely injured knees, it was found that clinical evidence of atrophy correlated with a relative decrease in the size of Type II or fast twitch muscle fibers. This sup ports the subjective, clinical impression that the unsta ble knee is less effective in explosive push-off. The findings also indicate the necessity of including exercise specific for the training of Type II fast twitch fibers in any program designed to rehabilitate the injured knee.
The biomechanics of head-first versus feet-first sliding
Authors: Corzatt Richard D. , Groppel Jack L. , Pfautsch Eric , Boscardin James
Published: June 2007

The two basic sliding techniques, head-first and feet- first, were analyzed kinematically with high speed cin ematography. Four phases were identified with each technique: sprint, attainment of sliding position, air borne, and landing. The velocity and displacement of the center of gravity were measured with each tech nique. The study was primarily descriptive but demon strated potential for injury with each technique. Further studies are needed to determine which technique is safer and faster.
The effect of continuous passive motion on anterior cruciate ligament reconstruction stability
Authors: Burks Robert , Daniel Dale , Losse Gary
Published: June 2007

This study was undertaken to examine the immediate effect of continuous passive motion (CPM) on anterior cruciate ligament (ACL) reconstruction stability. Ca daver knees were tested with a knee arthrometer with the anterior cruciate intact and then with the anterior cruciate sectioned. One of three anterior cruciate re constructions was then performed and stability was restored to the knee and it was again tested with the knee arthrometer. Stability was defined as being within 2 mm of the intact measurement. The three operations selected were the Marshall-Maclntosh "over-the-top," (OTT) a patellar bone-patellar tendon-tubercle bone (BTB) graft, and a semitendinosis reconstruction. The specimens were placed on a CPM device in a cooler at 38°F and put through a range of motion of 20 to 70° at 10 cycles per minute for 3 days. A success was less than a 2 mm increase in the post-CPM measurement compared to pre-CPM. All three bone-tendon-bone op erations failed. The semitendinosis operation was suc cessful in only three out of eight specimens. The OTT operation was successful in eight out of nine speci mens. The possible reasons for success and failure are discussed.

Because of the potential problems with failure of an ACL with CPM it is suggested that the particular tech nique being used for an anterior cruciate reconstruction be tested prior to it being used with CPM clinically.
Nontraumatic injuries in amateur long distance bicyclists
Authors: Weiss Barry D.
Published: June 2007

All 132 participants in a 500 mile, 8 day bicycle tour were surveyed by questionnaire to characterize the demographics and bicycling experience of the riders, and to determine the frequency and severity of non traumatic injuries they experienced. Riders who devel oped significant symptoms were interviewed and/or examined. Eighty-six percent of ride participants re sponded to the survey.

The average age of the riders was 41.4 years (±11.7 years). They rode an average of 95.8 miles per week on a routine basis, but the majority were new to long distance touring. Most were healthy, but 5% had seri ous cardiovascular disease and bicycled as part of a rehabilitation program.

The most common nontraumatic injury was buttocks pain (experienced by 32.8% of riders); four had skin ulceration of the buttocks. Knee problems occurred in 20.7% of riders; patellar pain syndromes and lateral knee complaints were the most common knee prob lems. One cyclist withdrew from the tour because of knee pain.

Neck-shoulder pain occurred in 20.4% of the riders. Groin numbness and palmar pain or paresthesias each occurred in approximately 10%. Other less common problems were foot and ankle symptoms and sunburn.
Anteroposterior tibiofemoral displacements during isometric extension efforts
Authors: Jurist Kenneth A. , Otis James C.
Published: June 2007

Rehabilitation of knee extensors is a major considera tion in patients with cruciate injuries and repairs. Exten sion exercises, however, can produce undesirable loads on the injured or replaced anterior cruciate liga ment (ACL) resulting in permanent stretch of this re straint. Our study measures the tibiofemoral displace ments associated with proximal, middle, and distal lo cations of the external resisting force and knee flexion angles of 30°, 60°, and 90°.

Our results show that tibiofemoral displacements are dependent on both location of the external resisting force and knee flexion angle, with anterior displace ments being associated with distal displacement of the resistance pad. The results suggest that patients with ACL injuries or repairs conduct extension exercises with a proximal position of the resistance pad to mini mize loads and prevent stretching of this constraint.
Improvement of muscle flexibility
Authors: Wallin Dan , Ekblom Björn , Grahn Raymond , Nordenborg Thomas
Published: June 2007

Forty-seven male subjects were randomly assigned to 4 different groups. Three groups of 10 subjects trained three times a week with a modified contract-relax (CR) method for improving muscle flexibility. Seventeen sub jects trained during the same time with a traditional ballistic stretch (BS) method. After 30 days (14 training sessions) the latter group switched over to the CR method. The results showed that the CR method was significantly better than the BS method for improving muscle flexibility in the four different, bilateral muscle groups studied. After the initial 30 days the three groups of 10 subjects trained one, three, and five times a week, respectively, for another 30 days. The results showed that once a week was enough to maintain improved flexibility, while three and five times a week increased it further. The former BS group improved muscle flexibility between the 30th and 60th day, as expected from the results of the initial 30 days with the three CR groups, when training with the CR method three times a week.
Stress fracture of the ipsilateral first rib in a pitcher
Authors: Gurtler Robert , Pavlov Helene , Torg Joseph S.
Published: June 2007

This stress fracture of the left first rib in a 17-year-old, left-handed high school baseball pitcher represents the first of its type reported in the literature. Two similar cases have been reported in pitchers, but the fracture was on the nondominant side in both cases. In contrast to most cases of this rare lesion, the stress fracture we report occurred acutely and was documented roent genographically from onset to complete healing 9 months later.
Stress changes of the distal radial epiphysis in young gymnasts
Authors: Roy Steven , Caine Dennis , Singer Kenneth M.
Published: June 2007

Between 1980 and 1983, 21 young, high-performance gymnasts with stress changes related to the distal radial epiphysis, were treated and followed for a mean of 24 months (range, 6 to 42 months). Eleven of the gymnasts presented with roentgenographic changes of the distal radial epiphysis, and in these recovery took at least 3 months. This group was compared to a group of ten gymnasts who had similar symptoms but no roentgenographic changes, and who recovered within an average of 4 weeks.

The roentgenographic changes, which are de scribed in detail, are considered to represent stress changes, possibly stress fractures, of the distal radial epiphysis. No residual growth-related problems have been observed. Possible etiologic factors are dis cussed, and the literature as it pertains to stress-related adaptation and injury in the growing athlete is reviewed.
Chondral fractures of the knee
Authors: Hopkinson William J. , Mitchell William A. , Curl Walton W.
Published: June 2007

Knee pain in the athlete can pose difficulty in diagnosis. At the United States Military Academy at West Point we have had occasion to see a group of patients presenting with meniscal symptoms of locking, catch ing, giving way, and joint line tenderness who, on arthroscopic examination, have chondral fractures of the medial or lateral femoral condyle. These individuals have undergone arthroscopy and debridement of the chondral defect.

Both retrospectively and prospectively we have been unable to find any defects on radiographs and there appears to be purely cartilaginous involvement. These individuals appear to have a relatively poor prognosis for recovery after arthroscopy. Treatment has been a standard course of range of motion exercises, strengthening, and antiinflammatory medications. How ever, the mean rehabilitation time has been almost triple the time associated with a routine meniscal injury.

We feel that it is important to discuss the chondral fracture so that the orthopaedic surgeon can be aware of this possibility in the differential diagnosis of knee pain in the athlete.
Patellofemoral pain and the infrapatellar brace
Authors: Villar R.N.
Published: June 2007

Thirty-seven cases of patellofemoral pain in young, active military recruits were studied. All patients were provided with an infrapatellar brace as a method of treatment. Nine patients (24%) demonstrated some improvement in symptoms at 1 week following appli cation. Eight patients (22%) with maximum relief at 1 week were also shown to be symptom free at 1 year. Twelve patients (32%) with poor results were arthro scoped ; eleven of these (92%) were found to have chondromalacia of the patella. Our success rate for subjective symptoms, after using the infrapatellar brace in this study, does not compare favorably with those reported by Levine using the same device.
Patterns of knee injuries in wrestling: A six year study
Authors: Wroble R.R. , Mysnyk M.C. , Foster D.T. , Albright J.P.
Published: June 2007

Data on knee injuries sustained by the University of lowa wrestling team over a 6 year period were com piled. There were a total of 136 wrestlers during this time. Fifty-one different wrestlers sustained 136 injuries (64 knees). Multiple parameters were examined for each injury, including date of injury; days lost; diagnosis; side injured; mechanism; occurrence during competi tion or practice; whether the wrestler was in control, "on the bottom," or both wrestlers standing; type of move being made at the time of injury; how far into a match or practice the injury happened; initial versus recurrent injury; principal form of management; weight- bearing status; and presence of knee pads. Each wres tler's weight class, years of experience, rank on the team, lead leg, and compliance were noted.

We found an incidence of 30 knee injuries per 100 wrestlers per year. There were 11.5 knee injuries per 100 wrestlers per year requiring a week or greater time loss. This comprises over one third of all serious wres tling injuries. Exposure data revealed injury rates in matches to be almost 40 times those of practice. Wres tlers with previous knee injuries were at high risk for reinjury. Early season competition is an extremely high risk period.

The most frequent injuries were prepatellar bursitis, lateral and medial sprains, and lateral and medial men iscal tears. We noted a relatively higher rate of lateral versus medial meniscal tears compared to other sports and a somewhat common presentation of a meniscal tear resulting from minimal trauma. The lead leg was injured most often. The takedown was the most fre quent situation where any injury occurred. Defensive wrestlers appeared to be at higher risk during take downs. The wrestler "underneath" was also injured more often.

Compliance correlated with decreased recurrence of injury. Approximately 50% of wrestlers were found to be noncompliant with medical recommendations.

Junior varsity wrestlers lost significantly more time than varsity wrestlers with equivalent injuries. There was no correlation of injury rate with weight class, period of match, timing in practice, or years of experi ence.
Arthroscopic management of lateral meniscal cysts
Authors: Seger Bernard M. , Woods G. William
Published: June 2007

This study presents seven cases of lateral meniscal cysts treated arthroscopically. All were noted to have meniscal lesions at the time of surgery; there were five flap tears and two radial tears. Partial arthroscopic meniscectomy was performed and the contents of the cysts were manipulated into the joint in six of seven cases. One patient underwent open cyst excision in addition to partial arthroscopic meniscectomy. Fol lowup ranged from 18 months to 4 years with an average of 28 months. There were no cyst recurrences. The pathologic basis of the meniscal cyst is controver sial, but recent work suggests the etiology is infiltration of joint fluid through micro and macro tears in the meniscus. Partial meniscectomy retains valuable men iscal function while minimizing the likelihood of cyst reformation. We found arthroscopic partial meniscec tomy with manipulation of the contents of the cyst into the joint to be a successful alternative to complete open meniscectomy.
The tennis stroke: An EMG analysis of selected muscles with rackets of increasing grip size
Authors: Adelsberg Stanley
Published: June 2007

The purpose of this study was to analyze the effect of different racket grip sizes on the muscle activity of the forearm and shoulder. Telemetry EMG was used to assess the muscle activity of the anterior deltoid and the forearm extensor muscles during the forehand and backhand strokes of tennis in a selected group of test subjects. The EMG activity of the subjects' anterior deltoid muscle and the forearm extensor muscle group was recorded with the subjects using racket grip sizes of 4¼, 4½, 4 3/4 inches. A specific pattern of sequence phasing was seen in all subjects, and amplitude ratio between the muscles was constant. Changes in grip size demonstrated a change in amplitude of both the anterior deltoid and the forearm extensor muscle group.
Outdoor and indoor soccer: Injuries among youth players
Authors: Hoff Gerald L. , Martin Theresa A.
Published: June 2007

The incidence of injuries among youth soccer players (under age 16) participating in indoor soccer was 4.5 times that of youth players in outdoor soccer when calculated per 100 hours of team play, and 6.1 times greater when calculated per 100 hours of player game participation. Injuries were few among players under age 10 in either game, and the number of injuries increased with age in the older players. Medical assist ance was required for 6.5% of the injuries among outdoor players and for 24.3% among indoor players. Overall, 66.6% of the injuries were the result of physical contact between players. No relationship was observed between the risk of injury and playing position, conduct of warm-up exercises, or the team having a licensed coach.
Meniscal tears: The effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee
Authors: Baratz Mark E. , Fu Freddie H. , Mengato Richard
Published: June 2007

The role of the meniscus in load transmission across the knee has long been a subject of debate. In this study, we examined the biomechanical consequences of the operative treatments for bucket-handle and pe ripheral meniscal tears. Contact areas and instanta neous intraarticular pressure distributions were meas ured in two groups of human cadaver knees.

In Group I, consisting of four knees, we created a bucket-handle tear involving the inner one-third of the meniscus, followed by partial, and then total meniscec tomy. Knees were tested in an Instron testing machine after each procedure, using a 400 pound load at 0° or 30° flexion. Contact areas and local stresses were measured using Prescale, a pressure-sensitive film. After partial meniscectomy, contact areas decreased approximately 10%, and peak local contact stresses (PLCS) increased approximately 65%. After total men iscectomy, contact areas decreased approximately 75%, and PLCS increased approximately 235%.

In Group II, consisting of three additional knees, we created a 2 cm peripheral tear of the posterior meniscal horn, followed by open repair, arthroscopic repair, seg mental, and then total meniscectomy. Repair of the tear was accomplished with either vertically placed sutures by an open technique or horizontally placed sutures by an arthroscopic technique. Knees were tested in the neutral position in the Instron machine and contact areas and local stresses measured using Prescale. PLCSs and contact areas were found to be the same using either repair technique. There was, however, a 110% increase in PLCS after segmental meniscectomy of that portion of the meniscus involved in the peripheral tear.

These data suggest that the meniscus does have a weightbearing role. Contact stresses increased in pro portion to the amount of meniscus removed and the degree to which the structure of the meniscus was disrupted. Furthermore, there was no difference in the weightbearing characteristics of the meniscus when repaired by open versus arthroscopic technique when the knee is loaded at 0° flexion.
Functional analysis of anterior cruciate ligament instability
Authors: Tibone James E. , Antich T.J. , Fanton Gary S. , Moynes Diane R. , Perry Jacquelin
Published: June 2007

Eighteen males and two females (mean age, 26.5 years) underwent biomechanical assessment and Cybex eval uation prior to ACL reconstruction. Clinically, all patients had at least a 1+ grade with the Lachman, anterior drawer, and pivot shift tests, the majority being graded as 2+. Footswitch, high speed photography, force plate, and indwelling wire electrode data were collected while each subject performed free and fast walking, running, cutting, and stair climbing activities.

During walking, single limb support times did not differ between the subject's involved and uninvolved limbs. Knee joint angles were similar between limbs during walking, running, and stair climbing maneuvers. Dynamic EMG tracings during walking demonstrated similar quadriceps and calf activity between limbs, while greater variation in hamstring firing was evident among subjects. During running, the involved limb had a longer duration of medial hamstring activity compared to the lateral hamstring.

No significant differences were seen in either vertical or sagittal shear forces during free walking. During fast walking, higher midstance vertical forces (F2) were present in the involved limb (P < 0.05). During running, the involved limb experienced lower vertical forces (P < 0.05), while both anterior and posterior sagittal shear differences were insignificant. Straight cut maneuvers demonstrated significantly lower lateral shear and ver tical forces in the involved limb (P < 0.05). Lower lateral and sagittal shear forces in the involved limb (P < 0.01 and P < 0.05, respectively), combined with a reduced angle of the cut during the cross-cut maneuver, may be the first means to assess the functional pivot shift phenomenon ever documented.

Isokinetic Cybex strength testing demonstrated a mean 14% quadriceps deficit and a mean 4% hamstring deficit in the involved limb. Achieving quadriceps and hamstring torque of 86% and 96%, respectively, was not sufficient to eliminate the subjective need for sur gical reconstruction.
Lumbar spondylolysis and spondylolisthesis in college football players
Authors: McCarroll John R. , Miller John M. , Ritter Merrill A.
Published: June 2007

A prospective study was done on Indiana University freshman football players to determine if the incidence of lumbar spondylolysis and spondylolisthesis followed the pattern of previous studies. Using x-ray film evalu ation, 145 freshman players were followed through their careers from 1978 to 1983. As in previous studies, a higher percentage (15.2%) of the defect was found than exists in the general population. However, only 2.4% of these players developed the problem in college, a much lower figure than previously found. Affected team members played a variety of positions. In addition to spondylolysis, some other problems, such as spina bifida occulta, were found. Theories on the cause of spondylolysis and spondylolisthesis are reviewed, and preventive suggestions such as more careful training and weight lifting are presented.
The practical biomechanics of running
Authors: Adelaar Robert S.
Published: June 2007

The foot and ankle is a complex structure made of many small bones with capsular and ligamentous con straints. The physiology, kinematics, and muscle inter action of the walking, jogging, and running cycles will be discussed and the current biomechanical literature reviewed. To analyze the pathologic state, one must be aware of the normal stresses and functions of the running cycle. This knowledge establishes a rational basis for the interpretation of problems in providing medical and orthotic treatment.
Treatment of the medial collateral ligament injury
Authors: Woo Savio L.-Y. , Inoue Masahiro , McGurk-Burleson Erin , Gomez Mark A.
Published: June 2007

In order to assess the healing of the medial collateral ligament (MCL) and to detect the various effects of treatment regimens, in vivo animal experiments using a canine model were performed. Thirty-five canine MCLs were surgically transected and treated using three clinically popular regimens, e.g., no repair with cage and farm activities (Group 1), repair with 3 weeks immobilization (Group 2), and repair with 6 weeks im mobilization (Group 3). The varus-valgus laxity of the knee joint, structural properties of the femur-MCL-tibia (FMT) complex and the mechanical properties of the MCL substance (healing site) were quantitatively meas ured at 6, 12, and 48 weeks postoperatively. It was found that Group 1 animals had the best results. The varus-valgus laxity of the knee joint and the structural properties of the FMT complex returned to values comparable with the contralateral control by 12 weeks. The recovery of the mechanical properties of the MCL substance was slower and not complete, even at 48 weeks. In confirmation with previous studies, prolonged immobilization was shown to have deleterious effects on MCL healing. The results of this study indicated that early mobilization is the treatment of choice in cases of isolated MCL injury. Also, this study emphasized the importance and effectiveness of using various biome chanical parameters in addition to the conventional ultimate values at failure to evaluate the progress of soft tissue repair.
Functional management of stress fractures in female athletes using a pneumatic leg brace
Authors: Dickson Thomas B. , Kichline P. Donald
Published: June 2007

Thirteen consecutive female athletes complaining of activity-induced lower extremity pain were evaluated. Ten of the 13 athletes had either an x-ray film or bone scan positive for stress fracture of the tibia or fibula. Three athletes with classic signs and symptoms of tibial stress fractures and negative x-ray films refused the bone scan. Three athletes had bilateral tibial stress fractures. The athletes were treated by the application of a pneumatic leg brace to the affected leg or legs. Following this, all 13 athletes were able to return to their sport and participate at a high level of competition with little or no symptoms.
The intercondylar notch in acute tears of the anterior cruciate ligament: A computer graphics study
Authors: Houseworth Stephen W. , Mauro Vincent J. , Mellon Barbara A. , Kieffer David A.
Published: June 2007

Although the intercondylar notch becomes narrowed with a failed repair of the ACL or with chronic instability of the knee, narrowed intercondylar notches have fre quently been observed during arthrotomy for an acute ACL tear in previously uninjured knees. In order to determine whether the structure of the intercondylar notch predisposes a knee to anterior cruciate tears, a computer graphics study was designed. Notch view roentgenograms of 50 patients with an acute ACL injury and 50 "normal" patients without history of significant knee injury were compared. An interactive graphics design station was used to obtain the area of the anterior opening (ANT) and posterior arch (POST) of the intercondylar notch. A "total" (TOTAL) area was obtained by tracing the distal 7.5 cm of the femur. Only the ratios of areas obtained from each roentgenogram were used for comparison because of varying femur sizes among patients and possible slightly varying tech niques of taking the notch view roentgenogram itself. The following ratios were developed: ANT/POST, POST/TOTAL, and (POST-ANT)/TOTAL. The differ ence between the means of the ratio POST/TOTAL for knees with acute ACL tears and those for normal knees was statistically significant (P < 0.005). This study suggests that a narrowed posterior arch of the inter condylar notch may predispose a knee to ACL tear.
Thermography in posttraumatic pain
Authors: Pochaczevsky Rubem
Published: June 2007

Posttraumatic pain is often associated with complex disturbances of the sympathetic nervous system which also controls microcirculation of the skin. Circulatory skin changes are in turn reflected by altered superficial thermal emission, which can be reliably imaged by thermography. Examples of classic thermographic pat terns associated with commonly occurring injuries and detected along cutaneous distributions of peripheral nerves or spinal root dermatomes are presented. Ther mographic abnormalities may also occur in onderma tomal distributions to involve an entire hand, foot, or extremity as observed in reflex sympathetic dystrophy. Such thermographic findings often appear before skin or roentgenographic changes become manifest and lead to earlier diagnosis. Prompt and more effective treatment, particularly in reflex sympathetic dystrophy, may thereby be initiated so that full blown, difficult to manage, chronic disability may be averted. The diag nosis of malingering may also be strengthened or sus pected if thermographic studies together with other examinations are normal.
Incidence of injuries in high school track and field athletes and its relation to performance ability
Authors: Watson Michael D. , D Paul P.
Published: June 2007

Two hundred fifty-seven high school track athletes from 17 teams were observed prospectively for one com plete season (77 days) to study the incidence and types of injuries and to establish the relationship among inju ries, duration of training, and individual performance ability. One hundred seventy-four (68%) of the athletes were male and 83 (33%) were female. A total of 41 injuries was observed over this period of time.

One injury occurred for every 5.8 males and every 7.5 females. On the average, an injury resulted in 8.1 days of missed practice, 8.7 days for males and 6.6 days for females. Sprinting events were responsible for 46% of all injuries. The majority (83%) of injuries in volved the lower extremities. Management of these injuries varied greatly.

A direct correlation was noted between performance level of the athlete and incidence of injuries. The aver age noninjured athlete ranked at the 57.4 percentile based on best seasonal performance while the average injured athlete ranked at the 75.4 percentile. This direct relationship was present for both sexes and within all events, although some variation was noted within these separate groups.
Infrapatellar contracture syndrome
Authors: Paulos Lonnie E. , Rosenberg Thomas D. , Drawbert John , Manning James , Abbott Paul
Published: June 2007

Infrapatellar Contracture Syndrome (IPCS) is an infre quently recognized cause of posttraumatic knee mor bidity. Unique to this group of patients is the combina tion of restricted knee extension and flexion associated with patella entrapment. IPCS can occur primarily as an exaggerated pathologic fibrous hyperplasia of the anterior soft tissues of the knee beyond that associated with normal healing. It can also occur secondarily to prolonged immobility and lack of extension associated with knee surgery, particularly intraarticular ACL recon struction. IPCS follows a predictable natural history which is divided into three stages. Symptoms, diagnos tic findings, and recommended treatment are deter mined by the stage at presentation. Once beyond its early presentation, IPCS is best treated by an anterior intraarticular and extraarticular capsular debridement and release, followed by extensive rehabilitation. The authors review 28 consecutive cases of IPCS. At fol lowup 3 months to 4 years postoperation, the patients had averaged 2.3 additional surgical procedures follow ing their index procedure or injury.

The average increase in extension at followup was 12° with the average increase flexion 35°. Eighty per cent of patients demonstrated signs and symptoms consistent with patellofemoral arthrosis; 16% of the patients demonstrated patella infera. The authors con clude that prevention or early detection and aggressive treatment are the only ways of avoiding complication in these problem cases.
Sports tumors
Authors: Lewis Michael M. , Reilly John F.
Published: June 2007

We present 36 patients who initially were thought to have sports-related injury but ultimately were diag nosed with a primary bone or soft tissue tumors or tumor-like condition. The awareness of this possibility in the individual with a sports-related complaint, who does not respond to standard management, may assist in earlier diagnosis and treatment of the suspected neoplasm.
The relationship of the femoral attachment site to the isometric tracking of the anterior cruciate ligament graft
Authors: Melhorn J. Mark , Henning Charles E.
Published: June 2007

The large number of reconstructive procedures in the treatment of ACL reflect a lack of consistent clinical success, thus creating the current controversy over the treatment of ACL injuries. The purpose of this study on the relationship of the femoral attachment site to the isometric tracking of the ACL graft was three-fold: 1) to develop a method for evaluating the femoral attach ment site for the ideal isometric graft tracking pattern; 2) to develop a reference table comparing femoral attachment sites to graft excursion; and 3) to apply this information to the surgical procedure to allow for step wise refinement of the attachment site for improved clinical results.

To aid in graphic representation, the attachment sites were identified from radiographs by the sclerotic margin of the drill hole in the bone or the bone trough. These attachment sites were transferred to a trace diagram and compiled to form a composite diagram. Three distinct graft tracking patterns were identified. Group I represented the modified "over-the-top" technique with a deep cancellous bone trough and represented the most isometric tracking. Group II represented the mod ified over-the-top technique with a shallow or no can cellous bone trough and Group III the drill hole tech nique. Groups II and III were nonisometric.

In surgery, palpation of the graft for excursion while performing a range of motion allows for review of isometric graft tracking. Stepwise intraoperative refine ment of the femoral attachment site can result in iso metric graft tracking.
Sports injuries at the 1985 Junior Olympics
Authors: Martin Robert K. , Yesalis Charles E. , Foster Dan , Albright John P.
Published: June 2007

The XIX Junior Olympic Games, hosted in lowa City, lowa, in August of 1985, involved 3,028 athletes who participated for 7 days in 13 different sports at 8 separate sites. Medical coverage for the Games was provided by the University of lowa Sports Medicine Service. Staffing for the events involved approximately 75 physicians, 60 athletic trainers, and other health care personnel.

A triage protocol was established prior to the Games whereby the athletic trainer would make first contact with the injured athlete and would evaluate and treat the injury based on standing orders. If in the judgment of the trainer, the athlete needed to be referred to a physician, one would be available, either on site or on call.

During the Games, 1,113 medical encounters were recorded, 121 of those being deemed serious enough to withhold an athlete from competition pending further evaluation and treatment. The 121 significant injuries and illnesses involved 116 athletes (66% male, 34% female). Thirty-four percent of the significant injuries only required treatment by the trainer, while 46% were referred to an on site physician and 20% needed a specialty consultant. Seventeen percent of the signifi cant injuries resulted in the athlete being medically disqualified for the remainder of the event.

The most common injuries/illnesses were contusions (26%), sprains (21 %), heat (17%), strains (9%), and other illnesses (12%). According to body region, 44% of the 121 injuries were to the lower extremity, 26% to the head, neck, and trunk, and 12% to the upper extremity. Eighteen percent were heat-related illnesses requiring intravenous administration of fluids. Twenty- six percent of the injuries were to body sites injured prior to competition. Athletes who had a history of previous injury to a body part were much more likely to sustain another injury to that body part than were those athletes with no record of previous injury (relative risk = 9.33).
Diagnosis of exercise-induced pain in the anterior aspect of the lower leg
Authors: Styf Jorma
Published: June 2007

Ninety-eight patients with chronic exercise-induced pain in the anterior compartment of the lower leg under went extensive clinical and laboratory investigations to establish the diagnosis. They all were referred because of a putative chronic compartment syndrome (CCS). Intramuscular pressure was recorded bilaterally during exercise in the anterior tibial muscle in all of them. Conduction-velocity recordings of the deep and super ficial peroneal nerves were performed in 29 patients. Other investigations included radiography, plethysmog raphy, and scintigraphy. CCS was diagnosed in 26 of the 98 patients. Other diagnoses included periostitis in 41 patients, compression of the superficial peroneal nerve in 13, and miscellaneous other diagnoses in 18. CCS seems to be an uncommon reason for anterior pain in the lower legs.
A study of urban bicycling accidents
Authors: Tucci James J. , Barone James E.
Published: June 2007

This study was undertaken because of the large num ber of bicycle accident victims treated in our emergency room. Its aim was to assess the type, frequency, and mechanism of occurrence of bicycle accidents as well as characterization of the type of injuries sustained and the expense incurred by such accidents.

One hundred seventy-two patients injured over a 10 month period were studied. The upper extremity was found to be particularly at risk of injury. Fractures accounted for 20% of all injuries. The most common accident mechanisms were being struck by a motor vehicle, falling from a bicycle, or being struck by a bicycle. Eleven percent of the patients studied were pedestrians. Increasing pedestrian-cyclist awareness and modification of currently used protective gloves are proposed to prevent injuries associated with urban cycling.
Retrospective comparison of taping and ankle stabilizers in preventing ankle injuries
Authors: Rovere George D. , Clarke Theodore J. , Yates C. Steven , Burley Katie
Published: June 2007

The effectiveness of taping and the effectiveness of wearing a laced stabilizer in preventing ankle injuries and reinjuries over six seasons of collegiate football practices and games were assessed retrospectively. For 1½ years the players all had taped ankles, and for the remaining 4½ years the players chose their type of ankle support. Over the entire period, the players chose high-top or low-top shoes as preferred. During 51,931 exposures to injury (46,789 practice-exposures and 5,142 game-exposures), the 297 players sustained 224 ankle injuries and 24 reinjuries. Tape was worn during 38,658 exposures to injury (233 players), stabilizers during 13,273 exposures (127 players). Tape had been worn when 159 of the injuries and 23 of the reinjuries occurred; a stabilizer had been worn when 37 of the injuries ( P = 0.003) and one of the reinjuries occurred. The combination allowing the fewest injuries overall was low-top shoes and laced ankle stabilizers.