bluuebunny/crossref_metadata_2025 huggingface dataset:
Patellofemoral stress
Authors: O'Neill Daniel B. , Micheli Lyle J. , Warner Jon P.
Published: June 2007

Thirty patients, 13 skeletally immature individuals and 17 adults, participated in a prospective study designed to evaluate the effect of isometric quadriceps strength ening exercises on patellofemoral pain. Of the 30 pa tients with anatomically normal lower extremity align ment and no history of previous knee trauma or sur gery, there were 34 knees that had a decrease in peripatellar knee pain with a structured exercise pro gram. One additional patient had a decrease in pain after an arthroscopic lateral release and with continued exercises.

An equal number of skeletally immature patients and adults had a decrease in peripatellar knee pain. How ever, 5 of the 17 adults had to limit their activities, while no adolescent patient had to limit activity. Additionally, eight skeletally immature knees had greater than 5° change in their congruence angles, as measured on Merchant tangential radiographs, over the year-long course of this study. Only one adult knee had a similar radiographic improvement.

We recommend immediate action to alleviate patel lofemoral pain syndrome, even when extremity align ment is normal. An isometric, progressive resistance quadriceps program with iliotibial band and hamstring stretching exercises is the preferred initial treatment.
The incidence of healing in arthroscopic meniscal repairs in anterior cruciate ligament-reconstructed knees versus stable knees
Authors: Cannon W. Dilworth , Vittori Joyce M.
Published: June 2007

In this study, follow-up data was obtained in 90 of 117 consecutive meniscal repairs. In Group I, there were 68 meniscal repairs in conjunction with anterior cruciate ligament reconstruction, and in Group II, 22 isolated repairs in anterior cruciate ligament stable knees. Men iscal healing was assessed using the criteria estab lished by Henning, by either arthroscopy or arthrogra phy, at a mean of 7 months for isolated repairs and a mean of 10 months for repairs done in conjunction with anterior cruciate ligament reconstruction. Average time from injury to surgery was 19 months in Group I pa tients, and 14 months in Group II patients. The overall rate of successful healing was 82%. Group I repairs were successful 93% of the time compared to a 50% success rate in Group II (P < 0.00005). Lateral meniscal repairs fared better than medial repairs in both groups. Although a smaller rim width yielded better overall healing, there was no difference in the mean rim width of the two groups. Patients with anterior cruciate liga ment reconstruction did better than those with isolated meniscal repair, regardless of tear length. Older pa tients had better healing than younger ones. Overall, acute repairs were more successful than repairs of chronic tears. Even so, the chronic Group I patients had a 91 % successful healing rate.
The GORE-TEX anterior cruciate ligament prosthesis
Authors: Paulos Lonnie E. , Rosenberg Thomas D. , Grewe Scott R. , Tearse David S. , Beck Charles L.
Published: June 2007

The GORE-TEX anterior cruciate ligament prosthesis has been implanted in 268 patients at our institution since April of 1984. Follow-up for this study was avail able on 70% of these patients (188). Eighty-one percent (152) of these had the ligament for chronic injuries, 14% (26) for acute, and 5% (10) for subacute injuries. The patient population had an average age of 27.6 years (SD = 8.4) and a Tegner activity score of 6.05 (SD = 1.53). Prior procedures had been performed on 56% (105) of the patients. Concomitant procedures were performed in 73% (137) and included iliotibial band tenodesis, partial meniscectomy, posterior oblique lig ament advancement, or meniscal repair. Followup av eraged 48 months (range, 24 to 68). Evaluation included a questionnaire, physical examination, radiographs, KT- 1000 arthrometer testing, and an activity score.

Results were graded as excellent, good, fair, and poor. Acceptable results (good and excellent) were obtained in 83 patients (44%). Fifty-eight patients (32%) were rated excellent and 25 (13%) were rated good. Unacceptable results (fair and poor) were obtained in 105 patients (56%). Twenty-five patients (13%) were rated fair and 80 (42%) were rated poor. Subjective improvement was indicated by 166 patients (88%). Activity levels postoperatively as rated by the Tegner Scale improved in 2 (1 %), remained the same in 167 (89%), and decreased in 19 patients (10%). Effusions occurred in 63 patients (34%) and caused an unac ceptable result in 22 (12%). Rupture occurred in 23 patients (12%). Loosening greater than 3 mm occurred in 64 patients (34%) and led to unacceptable results in 37 (20%). Infection occurred in 5 patients (2.7%). Ex cellent results had a statistically significantly higher age and lower activity score than the poor results (P = 0.045 and 0.012, respectively). The patients with pre vious intraarticular reconstructions had a 76% unac ceptable rating (16 of 21).
Magnetic resonance imaging evaluation of the patellar tendon after use of its central one-third for anterior cruciate ligament reconstruction
Authors: Coupens Steven D. , Yates Carlan K. , Sheldon Carol , Ward Clark
Published: June 2007

Magnetic resonance imaging was used to evaluate the remaining patellar tendon after its central one-third had been harvested for anterior cruciate ligament recon struction. Twenty patients were studied at either 6 weeks, 4, 6, 9, or 18 months postoperatively. The average thickness, width, cross-sectional area, and signal intensity of the operated and contralateral non- operated tendons were calculated and compared for each magnetic resonance imaging scan. A significant increase in the thickness was noted at all periods of followup, but no change in width occurred despite the defect being closed at the time of surgery. High signal intensity was present in the early periods, which signi fied edema and scar tissue. Signal intensity decreased at subsequent follow-up periods until at 18 months the operated tendon appeared normal. These findings in dicate that the patellar tendon has the potential to regenerate and remodel in the postoperative period.
Avulsion fracture of the medial epicondyle caused by arm wrestling
Authors: Nyska Meir , Peiser Jochanan , Lukiec Franklin , Katz Tiberio , Liberman Naftali
Published: June 2007

Fractures occurring in teenagers during arm wrestling usually involve the distal humerus and appear as a fracture of the medial epicondyle. We studied eight male patients, aged 13 to 15 years, with such fractures. All fractures involved the right hand and occurred while the patients were in the final stages of winning a match in a formal competition. Three fractures occurred during an official competition and the other five occurred dur ing a match between friends. One patient suffered from ulnar nerve paresis that eventually recovered sponta neously. All of the patients were immobilized for 10 to 21 days, and progressed gradually to motion of the elbow. At 1-year followup, clinical and functional results were satisfying. Therefore, we recommend conserva tive management for fractures of the medial epicondyle sustained during arm wrestling.
The effect of exercise on patellar tracking in lateral patellar compression syndrome
Authors: Douciette Susan A. , Goble E. Marlowe
Published: June 2007

The influence of a physical therapy program on pain and patellar tracking was investigated clinically and radiologically with tangential views in 51 knees with lateral patellar compression syndrome. A pretest-post test design was used to evaluate physical measure ments of patellar alignment in subjects who had had patellofemoral pain for a minimum of 6 weeks. Eighty- four percent of the subjects were pain-free after an average of 8 weeks of rehabilitation or 11 physical therapy visits, with a mean qu adriceps strength to total body weight ratio of 61% in women and 86% in men. The pretest-posttest difference in Merchant's congru ence angle was significant at a probability of 0.0066 in the patients who were pain-free after exercise, dem onstrating less lateral patellar tracking. The pretest- posttest difference in iliotibial band flexibility was signif icant at a probability of 0.0017, with the patients who were pain-free after exercise becoming more flex ble. No significant differences were observed from before to after exercise in the patellofemoral index, Q angle, hamstring flexibility, thigh measurement, sclerotic sub chondral bone, or sulcus angle. We were unable to predict which subjects would become pain-free with exercise by patellar position because the group that improved began more laterally tilted. The results of this study indicate that patellar tracking is improved with vastus medialis oblique strengthening, iliotibial band stretching, and joint mobility exercise in the majority of subjects with lateral patellar compression syndrome.
Shoulder strength, power, and endurance in college tennis players
Authors: Chandler T. Jeff , Kibler W. Ben , Stracener Elizabeth C. , Ziegler Ann K. , Pace Beven
Published: June 2007

Twenty-four college tennis players were tested for bi lateral shoulder internal/external rotation strength on a Cybex 340 isokinetic dynamometer; they were posi tioned supine with the glenohumeral joint abducted to 90°. Subjects produced significantly (P < 0.01) more torque in internal rotation at 60 and 300 deg/sec in the dominant arm compared to the nondominant arm. Sub jects also produced significantly more power in internal rotation at 60 deg/sec in the dominant arm. No signifi cant differences between the dominant and nondomi nant arms were seen in internal rotation power at 300 deg/sec or in the internal rotation endurance ratio. No significant differences were seen in external rotation on any measurement. By significantly increasing the strength of the dominant shoulder in internal rotation without subsequent strengthening of the external ro tators, muscle imbalances may be created in the dom inant arm that could possibly affect the tennis player's predisposition to injuries caused by overloading of the shoulder joint. This study suggests that external rota tion strengthening exercises should be implemented in tennis conditioning programs to maintain muscle strength balance, and possibly reduce the chance of overload injury.
Quantitative evaluation of knee instability and muscle strength after anterior cruciate ligament reconstruction using patellar and quadriceps tendon
Authors: Yasuda Kazunori , Ohkoshi Yasumitsu , Tanabe Yoshie , Kaneda Kiyoshi
Published: June 2007

Anterior cruciate ligament reconstruction using an au tologous graft harvested from the central one-third of the patellar and quadriceps tendon was performed in 65 knees of 65 patients who were followed from 3 to 7 years. Mean anterior laxity of both knees was meas ured before and after surgery in each patient using the Styker Knee Laxity Tester. At 30° of knee flexion, 58 patients (89%) had differences of less than 2.5 mm between the operated and unoperated knees. Quadri ceps strength was measured with the Cybex II and was less than 50% of the uninjured knee at 3 months after surgery. In men, quadriceps strength returned to 78% of normal at 1 year and 85% at final followup. These values were equal to the preoperative level. In women, the quadriceps strength at final followup was 70%, significantly lower than preoperative strength. Ham string strength recovered to equal the normal strength. Although anterior cruciate ligament reconstruction using one-third of the patellar and quadriceps tendon achieves stability, postoperative quadriceps weakness is a disadvantage. This weakness may be caused by impairment of the knee extensor mechanism resulting from harvesting the graft. We do not currently recom mend this technique for anterior cruciate ligament re construction.
Arthroscopic treatment of sports-related synovitis of the ankle
Authors: Thein Rafael , Eichenblat Mario
Published: June 2007

We describe nine cases of sports-related synovitis of the ankle joint with a followup of 24 to 44 months (average, 30.9). It affects young athletes and occurs after episodes of acute or recurrent inversion ankle sprains or undisplaced ankle fractures. The patients complain of morning pain and stiffness along with in creased pain and swelling with attempted athletic par ticipation. All ankles were stable and all failed to re spond to at least 6 months of conservative treatment. The technetium bone scans were positive in eight of the cases. During arthroscopy, a hypertrophic anterior- chamber synovitis was found and treated by arthro scopic partial synovectomy. The results were excellent in eight of the patients in whom symptoms resolved, allowing full return to their previous sports, and fair in one case. The only complication was one superficial wound infection.
Quadriceps femoris muscle activity in patellofemoral pain syndrome
Authors: Boucher Jean P. , King Marjorie A. , Lefebvre Richard , Pépin André
Published: June 2007

To elucidate and attempt to dissociate the two mech anisms, neuromuscular and mechanical, underlying pa tellofemoral pain syndrome, 18 subjects, divided into two groups based on a diagnosis of patellofemoral pain syndrome and the knee Q angle, were studied. The control group was asymptomatic and exhibited a nor mal Q angle (mean, 8.25°), whereas the other group, diagnosed as patellofemoral pain syndrome patients, reported knee pain and had an above-normal Q angle (mean, 21.05°). All subjects were tested for isometric maximum knee extension at 90°, 30°, and 15° of knee flexion while they were seated in a special restraining chair. During testing, surface electromyography at the oblique and long fibers of the vastus medialis, and at the vastus lateralis were recorded along with the knee moment of force. The integrated electromyographic signals associated with the peak torque for all of the vastus muscles, along with the vastus medialis obli quus :vastus lateralis and vastus medialis longus:vastus lateralis activity ratios showed no significant differences between groups nor between the three angles, sug gesting that all vasti measured were consistently active throughout the studied range of motion. This suggests that the neural drive was not affected in the patellofem oral pain syndrome patients. However, when the five patients showing the largest Q angles were isolated, they revealed a significantly smaller vastus medialis obliquus:vastus lateralis ratio when compared to the other group. The same ratio was also significantly smaller at 15° compared to 90°. These results did demonstrate that in advanced cases of patellofemoral pain syndrome the vastus medialis may even be less active relative to the vastus lateralis in the last degrees of extension compared to 90°. Furthermore, one may suggest that in patellofemoral pain syndrome the me chanical disturbances are exhibited first, at which time the vastus medialis atrophy, if present, would have a mechanical origin.
Snow skiing injuries in physically disabled skiers
Authors: Laskowski Edward R. , Murtaugh Paul A.
Published: June 2007

This study, through retrospective review, examines the injury rate of selected disable skiing populations in general and as compared to able-bodied skiers in areas where comparison was possible. Data on disabled skiers gathered from instructional programs at multiple sites indicate that the disabled skier had a very low rate of injury occurrence. Where comparison could be make, it was found that there was no significant difference in overall injury rates between able-bodied and physically disabled skiers. Disabled skiers appear to sustain less severe injuries, and they do not show the trend in increasing injury rates that able-bodied skiers in this study show. In addition, the uphill transport of skiers with a disability who use sit- or mono-skis was exam ined in one large program and found to be efficient and exceedingly safe, with no injuries reported. A major limitation of this study is the inconsistency in methods of data collection and reporting. There is a need for further prospective studies in the general able-bodied and disabled skiing populations with direct comparisons of rate, location and severity of injury, type of disability, and experience level of the skier. We hope that this study will stimulate more ski areas to allow disabled skiers on their slopes, even it limited to participation in supervised, instructional programs.
In vitro comparison of over-the-top and through-the-condyle anterior cruciate ligament reconstructions
Authors: Brower Richard S. , Melby Arne , Askew Michael J. , Beringer Donald C.
Published: June 2007

Knee kinematics, during standard knee examination maneuvers, were measured on 15 fresh cadaveric knees in their normal state and after isolated sectioning of the anterior cruciate ligament using a six degree of freedom electrogoniometer. Proximal iliotibial band au tografts were used to perform two anterior cruciate ligament reconstructions on the cadaveric knees: an over-the-top reconstruction and a through-the-condyle procedure.

Both of these reconstructions reduced the abnormal anterior translation of the anterior cruciate ligament- deficient knee seen in Lachman testing. However, nei ther reconstruction restored the normal anterior trans lation. In addition, other motions remained uncorrected: 1) the internal rotation due to internal torque at full extension; 2) coupled anterior translation during internal rotation at full extension; and 3) coupled medial trans lation with anterior translation in Lachman testing. There were no statistical differences noted in the joint kinematics created by either reconstruction.
A prospective comparison of computerized arthrotomography and magnetic resonance imaging of the glenohumeral joint
Authors: Jahnke Arlon H. , Petersen Steve A. , Neumann Christian , Steinbach Lynn , Morgan Frank
Published: June 2007

Twenty-five patients with shoulder instability or shoul der pain of undetermined etiology were prospectively evaluated with magnetic resonance imaging and com puterized arthrotomography. Actual lesions were de termined by arthroscopy or at the time of open surgical repair. The images obtained were interpreted independ ently by three radiologists blinded to both surgical results and the results of previous diagnostic tests. Sensitivity, specificity, and accuracy were determined for each imaging technique for a variety of pathologic entities, including anterior and posterior labral abnor malities, capsular redundancy, biceps-labral complex abnormalities, humeral head (Hill-Sachs) impression le sions, and glenohumeral loose bodies. Analysis of im aging techniques also included construction of receiver operator curves for labral abnormalities.

Magnetic resonance imaging showed better diagnos tic results in the evaluation of glenoid labral and humeral head impression lesions (P < 0.05). Both imaging tech niques were equally successful in identifying biceps- labral lesions and intraarticular loose bodies within the glenohumeral joint. Neither imaging technique was con sistent in the evaluation of capsular redundancy. Re ceiver operator curve analysis confirmed that magnetic resonance imaging was the more accurate imaging study in evaluating anterior and posterior glenoid labral abnormalities.
Psychological moods and subjectively perceived behavioral and somatic changes accompanying anabolic-androgenic steroid use
Authors: Bahrke Michael S. , Wright James E. , Strauss Richard H. , Catlin Don H.
Published: June 2007

To assess physiological and psychological states ac companying anabolic-androgenic steroid use, male weight lifters 1) were interviewed regarding their phys ical training and the patterns and effects of any drug use; 2) completed a written physical and medical history questionnaire, a Profile of Mood States questionnaire, and the Buss-Durkee Hostility Inventory; and 3) were physically examined, including a blood sample and uri nalysis. Subjects were divided into current anabolic- androgenic steroid users (N = 12), previous users (N = 14), and nonusers (N = 24). Current and previous users reported the following changes associated with ana bolic-androgenic steroid use: increases in enthusiasm, aggression, and irritability; changes in insomnia, muscle size, muscle strength and density; faster recovery from workouts and injuries; and changes in libido. We were unable to confirm these interview and physical and medical history questionnaire responses using stand ardized and well-accepted psychological inventories. There were no significant differences among groups for any Profile of Moods factor, total mood disturbance, total Buss-Durkee Hostility Inventory score, or any subscale. For current users, there were no significant correlations between either total weekly drug dose or length of time on the current cycle of anabolic-andro genic steroids and any individual scale of the Profile of Mood States, Buss-Durkee Hostility Inventory, Profile of Mood States total mood disturbance, or composite Buss-Durkee Hostility Inventory score. Furthermore, anabolic-androgenic steroid users did not differ in their responses on these inventories from nonusers or from general population norms. The presence of subjectively perceived, anabolic-androgenic steroid-associated be havioral and somatic changes in the absence of signif icant differences in standard psychological inventory responses illustrates the complexity of these relation ships. Our data suggest that while perceived or actual psychological changes may occur in anabolic-andro genic steroid users, either the effects are too subtle or the inventories used were insensitive for detecting them.
Anterior compartment pressures in cross-country skiers
Authors: Lawson Susan K. , Reid David C. , Wiley J. Preston
Published: June 2007

This paper compares the pressure changes in the an terior compartment of the leg when cross-country skiing using the skating method on either skating skis or classic skis. Intracompartmental pressures of the right leg were recorded from the tibialis anterior muscle of 10 subjects at rest and 15 seconds after 10 to 12 minutes of cross-country skiing on a designated course. All subjects completed two trials on different days. In one trial, subjects used skating skis and for the other trial, classic skis were used for the skating technique. Although the average pressure increase was higher for the classic ski trials than for the skating ski trials, the difference was not significant. This finding indicates that cross-country skiers who skate on a classic ski as opposed to a shorter skating ski do not experience a significantly greater increase in their anterior compart ment pressure. Thus, it appears that the type of ski used is not the most significant factor contributing to chronic compartment syndrome.
Postoperative return of motion in anterior cruciate ligament and medial collateral ligament injuires
Authors: Robins Anthony J. , Newman Alan P. , Burks Robert T.
Published: June 2007

Twenty consecutive patients with combined anterior cruciate/medial collateral ligament injuries were ana lyzed to determine if a correlation exists between the location of medial collateral ligament disruption and postoperative return of motion. All patients were treated operatively by autogenous patellar tendon an terior cruciate ligament reconstruction and primary me dial collateral ligament repair. The mean followup was 379 days.

The patients (12 men and 8 women; mean age, 23 years) were divided into two groups based on the location of superficial medial collateral ligament rupture. Group P consisted of 13 patients with lesions at or proximal to the joint line; Group D consisted of 7 patients with disruptions distal to the joint line.

Group D patients had a more rapid return of motion for both flexion and extension. At the conclusion of followup, patients from Group D also achieved 8° more flexion and 3° more extension. There were eight addi tional procedures performed on five patients, all from Group P, required to treat difficulty regaining motion.

Among those patients with anterior cruciate/medial collateral ligament injuries there are two distinct groups, each with different prognoses related to return of mo tion based on the location of the medial collateral liga ment disruption. We suggest that patients with double- ligament injuries, where the medial collateral ligament lesion is proximal, should be managed very aggres sively to regain motion.
Effect of water running and cycling on maximum oxygen consumption and 2-mile run performance
Authors: Eyestone Edward D. , Fellingham Gilbert , George James , Fisher A. Garth
Published: June 2007

This study compared water running, cycling, and run ning for maintaining VO2max and 2-mile run perform ance over a 6-week training period. Thirty-two trained subjects between the ages of 18 and 26 were evaluated for maximum oxygen uptake (VO2max) and 2-mile run performance. Subjects were stratified by a 2-mile run pretest into high, medium, and low performance levels and then randomly assigned to water running, cycling, or running training. The three groups trained with similar frequency, duration, and intensity over a 6-week period. After 6 weeks of training, all of the groups made a small but statistically significant decrease in fitness (VO2max), but no change in 2-mile run time. However, there were no differences with respect to either training modality or pretraining performance level. It was concluded that over a 6-week period, runners who cannot run because of soft tissue injury can maintain VO2max and 2-mile run performance similar to running training with either cycling or water running.
Arthroscopic resection of the acromioclavicular joint
Authors: Gartsman Gary M.
Published: June 2007

Arthroscopic resection of the distal clavicle was used to treat 26 patients who had osteoarthritis of the acro mioclavicular joint. Twenty of these patients were avail able for review at a minimum followup of 2 years. The preoperative ratings for pain, activities of daily living, work, and sports improved markedly in 17 patients postoperatively. No intraoperative complications were noted. The operation was unsuccessful in 3 patients and all underwent a second, open surgery. The results show that arthroscopic resection was effective in the treatment of isolated acromioclavicular joint arthritis.
Intercollegiate ice hockey injuries
Authors: Pelletier Robert L. , Montelpare William J. , Stark Ryan M.
Published: June 2007

The lack of agreement on definition of terms and con sistent reporting strategies in sports epidemiology com plicates the determination of injury rates in any sport. This study describes Canadian Intercollegiate ice hockey injuries over a 6-year period by following a standardized reporting strategy and clearly defined ter minology. Overall, the data show that the knee is most susceptible to injury, that the forwards recorded the highest number of injuries, and that body contact caused the majority of injuries. Compared to other studies the results indicate a decreasing per game injury rate over the last 15 years and provide evidence that helmets and visors reduce the risk of head and facial injuries. Recommendations are propagated to ward the adherence of standardized reporting strate gies and uniform definitions to be used in future sports injury epidemiologic research.
A comparison of patellar tendon autograft and allograft used for anterior cruciate ligament reconstruction in the goat model
Authors: Jackson Douglas W. , Grood Edward S. , Goldstein Jack D. , Rosen Mark A. , Kurzweil Peter R. , Cummings John F. , Simon Timothy M.
Published: June 2007

Similar-sized patellar tendon autografts and fresh-fro zen allografts were used to reconstruct the anterior cruciate ligament of one knee in 40 female goats. Evaluations of the reconstructions and contralateral controls at the 6-week and 6-month postoperative pe riods included anterior-posterior translation, mechanical properties determined during tensile failure tests, meas urement of cross-sectional area, histology, collagen fibril size and area distribution, and associated articular cartilage degenerative changes.

Six months after anterior cruciate ligament recon struction, the autografts demonstrated a smaller in crease in anterior-posterior displacement, values of maximum force to failure two times greater, a significant increase in cross-sectional area, a more rapid loss of large-diameter collagen fibrils, and an increased density and number of small-diameter collagen fibrils compared to the allografts.

Clinical significance . More surgeons are allowing their patients to return to running and sports 6 months after anterior cruciate ligament reconstruction. While the structural and material properties of autografts and allografts at time zero are similar, in the goat model during the first 6 months they differ. The allografts demonstrate a greater decrease in their implantation structural properties, a slower rate of biologic incorpo ration, and the prolonged presence of an inflammatory response. At 6 months the autograft demonstrates a more robust biologic response, improved stability, and increased strength to failure values.
The effect of early versus late return to vigorous activities on the outcome of anterior cruciate ligament reconstruction
Authors: Glasgow Steven G. , Gabriel Josue P. , Sapega Alexander A. , Glasgow Michele T. , Torg Joseph S.
Published: June 2007

The effect of early (mean, 5 months) versus late (mean, 9 months) return to vigorous cutting activity on the long-term outcome of anterior cruciate ligament recon struction was evaluated retrospectively. Sixty-four re constructions, using a distally attached medial one-third patellar tendon, were reviewed on an average of 46 months postoperatively. After surgery, the timing of return to vigorous activity was based on biologic fixa tion of the graft, a negative Lachman test, absence of effusion, and the patient's desire to return to previous activity.

The 64 patients were retrospectively separated into two groups. The early group consisted of 31 patients who returned to activity 2 to 6 months after reconstruc tion, and the late group consisted of 33 patients who returned to activity 7 to 14 months after reconstruction.

By clinical examination, KT-1000 arthrometer meas urements, subjective evaluation, and Cybex testing, there were no differences between the early and late return groups except for reestablishment of final range of motion.

At an average followup of 46 months, this study indicates that an early return to vigorous physical cut ting activities after ACL reconstruction does not predis pose patients to reinjury or a less satisfactory long- term result.
The role of the lateral extraarticular restraints in the anterior cruciate ligament-deficient knee
Authors: Wroble Randall R. , Grood Edward S. , Cummings John S. , Henderson Joel M. , Noyes Frank R.
Published: June 2007

We measured the increases in tibiofemoral motion when lateral structures were sectioned in anterior cru ciate ligament-deficient knees of 20 unembalmed ca daveric whole lower limbs. Motion was measured with a six degrees-of-freedom electrogoniometer. The lateral structures investigated were the iliotibial band and mid- lateral capsule, lateral collateral ligament, and popliteus tendon and the posterolateral capsule.

Cutting the anterolateral structures increased anterior translation and internal rotation, particularly in flexion. Increases in motions were highly variable, reflecting the variation in function in the lateral collateral ligament and posterolateral structures. Cutting the lateral collateral ligament produced small changes in anterior translation and external rotation and larger increases in adduction. Cutting the posterolateral structures produced small increases in external rotation. Large increases in exter nal rotation were found only if the lateral collateral ligament was also sectioned. The posterolateral struc tures act in concert with the lateral collateral ligament in restraining internal and external rotation. External rotation was affected at all flexion angles; internal ro tation was affected mainly in extension.

Our results can be used in the diagnosis of complex knee ligament injuries. Findings of increased anterior translation in both flexion and extension and increased internal rotation at 90° of flexion are consistent with combined injury to the anterior cruciate ligament and the anterolateral structures. The anterior cruciate liga ment-deficient knee with significant posterolateral com promise (posterolateral structures/lateral collateral lig ament) would exhibit larger anterior translation in ex tension than in flexion, increased adduction, and increased external rotation in both flexion and exten sion.
Women's gymnastics injuries
Authors: Sands William A. , Shultz Barry B. , Newman Alan P.
Published: June 2007

A 5-year prospective study on the time course of wom en's gymnastics injuries was conducted on a successful NCAA Division I team. Gymnasts recorded injuries on a computer terminal or via computer dot sheets imme diately before each training session, including the in jured body part, the event or activity, and the date of the injury. The definition of injury was "any damaged body part that would interfere with training." Athletes recorded injuries on the 1 st day of onset and subse quently until the injury was healed. The initial onset of injury was considered a new injury. Subsequent rec ords of the injury were considered continuing injury.

Thirty-seven athletes participated through five colle giate seasons. They accounted for 5602 total training exposures with an average of 151.4 exposures per athlete. The analyses showed that gymnasts trained with an injury approximately 71% of the exposures, and a new injury could be expected from a gymnast during approximately 9% of the exposures. The largest number of injuries were of the repetitive stress syn drome type. The time series information showed that total injuries tended to increase until the middle of the competitive season, while new injuries showed promi nent increases during specific training periods and dur ing competition preparation and performance.
Knee flexor and extensor strength during concentric and eccentric muscle actions after anterior cruciate ligament reconstruction using the semitendinosus tendon and ligament augmentation device
Authors: Kramer John , Nusca Deborah , Fowler Peter , Webster-Bogaert Susan
Published: June 2007

The purposes of this study were to compare operated and nonoperated knees after anterior cruciate ligament reconstruction using the semitendinosus tendon and a polypropylene ligament augmentation device, and to determine the interrelationships among strength, knee stability, and current activity levels. Isokinetic tests for knee flexion (prone position) and extension (sitting po sition) strength during concentric-eccentric muscle ac tion cycles were completed at 60 and 180 deg/sec angular velocities, and passive anterior displacement were determined for 15 male and 15 female patients (mean age, 27 ± 8 years; mean time since surgery, 21 ± 3 months). With the exception of eccentric muscle actions during knee extension, peak torque and work done were significantly greater on the nonoperated leg ( P < 0.05). Passive anterior displacement was signifi cantly greater in the operated than the nonoperated knee ( P < 0.01). Strength measurements tended to be modestly related to current activity level ( R > 0.40 in 24 of 32 correlations; P < 0.05), whereas anterior displacement was not related to current activity level ( R = -0.19, operated knee; R = - 0.09, nonoperated knee; P > 0.05). Greater emphasis should be directed toward strengthening the knee flexors and knee exten sors after this surgery. Although joint-specific tests (completed actively via isokinetic dynameter) are more related to activity levels than are knee laxity tests (completed passively via knee arthrometer), neither test should be relied on as the only predictor of activity level in this patient population.
Electromyographic analysis of the trunk in golfers
Authors: Pink Marilyn , Perry Jacquelin , Jobe Frank W.
Published: June 2007

Golf is a popular sport for both men and women. The trunk is the most common area of injury during the golf swing. The purpose of this study was to describe and compare the muscle firing patterns in the trunk during the golf swing. Twenty-three golfers with handicaps of five or below volunteered for this study. Surface elec tromyographic electrodes were placed on the abdomi nal oblique and erector spinae muscles bilaterally. High- speed cinematography was used in conjunction with the electromyographic electrodes. The results demon strated relatively low activity in all muscles during tak eaway (below 30% of maximal muscle test), and rela tively high and constant activity throughout the rest of the swing (above 30% maximal muscle test, with the exception of the contralateral erector spinae during late follow-through, which was 28% maximal muscle test). This high and constant activity demonstrated the im portance of the trunk muscles during a golf swing. These results indicate the need for an effective preven tive and rehabilitative exercise program for the golfer.
Comparison of symptomatic versus nonsymptomatic patients with chronic anterior cruciate ligament insufficiency
Authors: Friden Thomas , Egund Niels , Lindstrand Anders
Published: June 2007

The sagittal anterior displacement of the tibia, induced by weightbearing, in chronic anterior cruciate ligament- insufficient knees was measured radiographically in 2 groups of patients. All patients in both groups had an increased laxity when assessed with the Lachman and flexion-rotation-drawer test. Sixteen patients were functionally improved and were relatively asymptomatic after a neuromuscular rehabilitation program, while the second group consisted of another 16 patients with persistent functional instability, despite the same reha bilitation program, who eventually had ligament recon struction. The mean radiographic anterior displacement during weightbearing in the nonsymptomatic group was 4.3 mm, and 8 patients had a displacement ≤ 2 mm. In the symptomatic group, the corresponding value was 8.1 mm (P < 0.05), and 3 patients had a displacement ≤ 2 mm. No correlations to meniscal injuries, age, or time from injury were found between the patients hav ing a displacement >2 mm and those with ≤ 2 mm. The findings should be explained by differences in neuro muscular control of the increased laxity in the injured knee.
Anterior cruciate ligament reconstruction
Authors: Romano Victor M. , Graf Ben K. , Keene James S. , Lange Richard H.
Published: June 2007

In 111 patients who had anterior cruciate ligament reconstructions, postoperative radiographic measure ments of anterior to posterior and medial to lateral location of the tibial tunnels were correlated with the final range of motion achieved. In the 25 patients with extension deficits of 10° or more, placement of the tibial tunnel was more anterior (average, anterior 23% of the tibia) than in the remaining 86 patients with extension deficits of <10° (average, anterior 29% of tibia). This difference was statistically significant with P < 0.001. Logistic regression analysis revealed that the more anterior the placement of the tibial tunnel, the greater the loss of both flexion (P = 0.01) and extension (P = 0.002). In the 21 patients with full extension but flexion <130°, placement of the tibial tunnel tended to be more medial (average, medial 40% of the tibia) than in the 65 patients without flexion deficit (average, medial 45% of the tibia). We conclude that placement of the tibial tunnel in the "eccentric," anteromedial position may contribute to the development of flexion and ex tension deficits after anterior cruciate ligament recon struction.
Iliotibial band syndrome in cyclists
Authors: Holmes James C. , Pruitt Andrew L. , Whalen Nina J.
Published: June 2007

Iliotibial band syndrome is an overuse injury caused by repetitive friction of the iliotibial band across the lateral femoral epicondyle. Once considered an injury indige nous to runners, it is now frequently being seen in cyclists. The purpose of this paper is to identify iliotibial band syndrome as a significant problem in cyclists and to propose both operative and nonoperative measures for treating cyclists. Nonoperative measures specific to cyclists consist of bicycle adjustments and training modifications. These are adjunctive therapies to stretching, icing, rest, and oral nonsteroidal antiinflam matory drugs. For cyclists requiring operative interven tion, a new surgical technique for excising or releasing the distal iliotibial band is presented. This technique, used by the senior author (JCH) since 1984, involves excision of an elliptical piece of the distal posterior band off the lateral femoral epicondyle.
Arthroscopic treatment of glenoid labral tears
Authors: Cordasco Frank A. , Steinmann Scott , Flatow Evan L. , Bigliani Louis U.
Published: June 2007

We reviewed 52 consecutive patients who had under gone arthroscopic labral debridement. The average age was 29 and there were 35 men and 17 women. At operation, 27 patients had superior labrum anterior and posterior (SLAP) lesions, 20 patients had anteroinferior labral lesions, and 5 patients had posterior labral le sions.

Despite the fact that, preoperatively, none of these patients had a history of dislocations or clinically evident instability, 70% of the patients with superior labral lesions, and all of those with anteroinferior and posterior lesions had instability on examination under anesthesia. The average followup was 36 months. At 1 year after arthroscopy, 78% of the patients with superior lesions had excellent relief compared with 30% of the patients in the anteroinferior group. At 2 years followup, these results decreased to 63% and 25%, respectively, and only 45% of the patients with superior labral lesions and 25% of those with anteroinferior lesions had re turned to their previous athletic performance level. Four patients required a reoperation: 2 for instability and 2 for impingement. We conclude that occult instability is frequently present in patients with glenoid labral tears. The overall results are not encouraging, but this pro cedure may have an indication for short-term goals in competitive athletes or those who are willing to accept some compromise in function.
Isolated arthroscopic partial meniscectomy
Authors: Bolano Luis E. , Grana William A.
Published: June 2007

Fifty patients who underwent isolated arthroscopic par tial meniscectomy with a minimum followup of 5 years were analyzed retrospectively. To analyze the factors associated with a satisfactory or an unsatisfactory clin ical result, we looked at the patient's age, duration of symptoms, type of meniscal lesion, and articular carti lage abnormalities. The patients were graded with a functional knee score (Lysholm-Gillquist), and activity level before surgery and at followup was determined. The data also included radiographic evaluation of 29 of the 50 patients. Tibiofemoral alignment was measured, and osteoarthritic changes were graded and correlated with the type of meniscal abnormality and functional result.

Eighty-two percent of our patients had satisfactory knee function, and the activity level was maintained. The factors associated with a satisfactory result after a partial meniscectomy included age less than 40 years, symptoms less than 12 months duration, type of tear, and chondromalacia less than grade II. Fairbank's changes were present in 50% of the patients, with significant grade III and IV changes identified in 30%. Although the radiographic changes did not necessarily correlate with the functional result, we felt that the changes were significant and indicative of abnormal stress transfer to articular cartilage and bone.
Injuries in recreational adult fitness activities
Authors: Requa Ralph K. , DeAvilla L. Nicole , Garrick James G.
Published: June 2007

Volunteers (986) from fitness clubs and studios were recruited and followed for a 3-month period to docu ment the injury consequences of adult recreational fitness participation. Participants were telephoned each week and their activities as well as any injuries that occurred were recorded.

Of the 525 injuries and complaints reported during 60,629 hours of activity, 475 occurred as a result of sports participation for an overall rate of 7.83 per 1000 hours of participation. Seventy-six percent of these episodes caused the patient to alter or miss 1 or more activities, while 9.5% involved a physician visit. The rate for time-loss injuries was less than 2 per person per year (1.76 per 298 hours) or 5.92 per 1000 hours. Running had a higher risk of injury compared with most other individual sports. Cardiovascular fitness activities had low to medium rates, as did weight work; compet itive sports were higher. For 6 of the most commonly injured areas, the reinjury rate was about twice that reported for those with no history of previous injury.

The risks of injury from most recreational fitness activities were relatively modest, particularly if the ac tivities were not competitive. Physicians might help patients reduce their risks of injury by encouraging suitable activities and by reducing the risks of reinjury by implementing appropriate rehabilitation programs.
Tarsometatarsal joint injuries in the athlete
Authors: Curtis Mark J. , Myerson Mark , Szura Brian
Published: June 2007

This is a retrospective review of the presentation, di agnosis, treatment, and outcome of 19 patients who injured the tarsometatarsal joint of the foot during ath letic activity. Diagnosis by clinical and radiographic ex amination was supplemented by stress fluoroscopy of the articulation under anesthesia. Injuries were classi fied as either a first- or second-degree sprain of the tarsometatarsal joint, a third-degree sprain (with dias tasis between the metatarsals or cuneiforms), a frac ture, or frank dislocation. Poor functional results were seen in those for whom diagnosis was delayed and for whom the injury was not treated adequately. Three patients were unable to return to sports, one of whom eventually required fusion of the tarsometatarsal joint. The third-degree sprains were indistinguishable from fracture and fracture-dislocations in that good results were not reliably obtained by nonoperative treatment, and both classes of injury seem to require open reduc tion and internal fixation for optimal return to function. The delay in return to full activity is a marker of the severity of this injury despite an often benign appear ance on radiograph.
Thermal effects on skeletal muscle tensile behavior
Authors: Noonan Thomas J. , Best Thomas M. , Seaber Anthony V. , Garrett William E.
Published: June 2007

The effect of temperature on the mechanical failure properties of rabbit skeletal muscle (tibialis anterior and extensor digitorum longus) was examined. For all tests, one leg was maintained at 25°C and the contralateral leg at 40°C. Muscles were pulled to failure according to assignment into one of three groups: 1) passive failure at 10 cm/sec, 2) passive failure at 1 cm/sec, or 3) active (muscle is stimulated to contract as it is pulled) failure at 10 cm/sec. Load to failure was higher in the cold muscle for all groups tested. Total deformation was the same except in Group 1, when the warm muscle had a greater deformation. Energy absorbed before failure was greater in the cold muscle in Groups 2 and 3. Stiffness was higher in cold muscles for all muscles except the extensor digitorum longus in Group 1. In this study, temperature had a significant effect on the tensile properties; these thermal effects were de pendent on both loading rate and contractile state. Comparing loading rates, warm muscle tested at 10 cm/sec had higher failure loads than that tested at 1 cm/sec. Comparing stimulated versus unstimulated muscle (Group 1 versus Group 3), the stimulated tibialis anterior muscle absorbed more energy than unstimu lated ones. Stimulated extensor digitorum longus mus cles had higher failure loads, absorbed more energy, and were stiffer than nonstimulated muscles. This study offers experimental data to support the theory that warming muscles can aid in injury prevention and im provement in athletic performance.