bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of quadriceps/hamstring strength, knee ligament stability, functional and sports activity levels five years after anterior cruciate ligament reconstruction
Authors: Seto Judy L. , Orofino Allison S. , Morrissey Matthew C. , Medeiros John M. , Mason Wendy J.
Published: June 2007

The purpose of this study was to examine individuals 5 years after ACL reconstruction and analyze changes involving strength, stability, function, and sports activi ties. Nineteen males and six females, mean age =31.4± 7.31 years, participated in this study. Fifteen subjects had received extraarticular and ten subjects had re ceived intraarticular ACL reconstructions. Subjects completed a 100 point subjective functional activity questionnaire and a sports participation survey. Knee ligament stability was assessed during an objective knee examination. Isokinetic quadriceps and hamstring muscle strength were tested at 240 and 120 deg/sec using the Cybex II dynamometer. Anterolateral rotatory instability and positive Lachman were elicited on the operated leg for 80% of the subjects. No significant relationship was found between objective instability and the functional activity score. For the intraarticular group, a significant correlation (P < 0.05) was found between increased quadriceps and hamstring strength on the operated leg and return to functional activities. Sub jects' functional activity score was positively correlated (P < 0.001) with their ability to participate in sports. Subjects participating in sports involving cutting and twisting motions were less successful in returning to their preinjury participation levels and reported more subjective complaints of pain, swelling, and/or instabil ity. These results indicate that long-term progressive rehabilitation emphasizing increased quadriceps and hamstring strength to approximate the nonoperated leg may enhance successful return to functional and sports activities after ACL reconstruction.
Menstrual irregularity and stress fractures in collegiate female distance runners
Authors: Barrow Gray W. , Saha Subrata
Published: June 2007

From 240 questionnaires, we investigated the preva lence of stress fractures in competitive collegiate female long distance runners and its relationship to menstrual history. The runners were divided into three groups according to their menstrual history: very irregular 69/ 240 (0 to 5 menses/year), irregular 51/240 (6 to 9 menses/year), and regular 120/240 (10 to 13 menses/ year). Stress fractures occurred in 49% of the very irregular runners, 39% of the irregular runners, and 29% of the regular runners. The majority of the stress fractures occurred in the tibia. Runners who had never used oral contraceptives were over twice as likely to have had a stress fracture when compared with runners who had used oral contraceptives for more than 1 year. These data suggest that female distance runners who have a history of irregular or absent menses and who have never used oral contraceptives may be at an increased risk for developing a stress fracture. When amenorrheal runners were separated from the very irregular group, an alarming trend was noted in eating behavior disorders. Forty-seven percent of the amenorrheal group, 20% of the one to five menses/ year group, 10% of the irregular group, and 7% of the regular group admitted to an eating behavior disorder.
The results of fasciotomy in the management of chronic exertional compartment syndrome
Authors: Rorabeck C.H. , Fowler P.J. , Nott Linda
Published: June 2007

Twenty-five patients with well-documented clinical his tory and elevated tissue pressures were subjected to surgical fasciotomy of the respective compartment (an terior, 13; anterior and posterior, 4; deep posterior, 8). The indications for surgery were resting pressures in excess of 15 mmHg and elevated postexercise pres sure measurements with delayed normalization. Twenty-two patients were satisfied with the procedure and were able to return to athletics. There were three failures, all of whom had decompression of the deep posterior compartment. This study has demonstrated that fasciotomy of the anterior compartment, when done with the correct indications, gives excellent relief of chronic anterior leg pain. It is recommended that fasciotomy of the deep posterior compartment include a formal release of the tibialis posterior at the time of decompression.
Concentric and eccentric torque comparisons for knee extension and flexion in young adult males and females using the Kinetic Communicator
Authors: Highgenboten Carl L. , Jackson Allen W. , Meske Neil B.
Published: June 2007

The purposes of this investigation were to establish average leg torque values as a proportion of body weight for both concentric and eccentric contractions for leg extension and leg flexion, to determine leg flexion/extension ratios for both concentric and eccen tric contractions, and to compare those values in males and females from ages 15 to 34 years.

The Kinetic Communicator (Kin-Com, Chattecx Corp., Chattanooga, TN), a relatively new computerized strength testing device, was used so that both concen tric and eccentric torques could be measured. Pilot study results indicated that Kin-Com results were reli able, r > 0.88. Average torque, across the full range of motion, and peak torque expressed in newton meters were divided by body weight in kilograms to produce torque values adjusted by body weight. No differences across age or sex were observed for floxion/extension ratios, but the males' weight-adjusted torque values were significantly (P < 0.01) greater than the females'. Younger (ages 15 to 24 years) male and female sub jects produced significantly (P < 0.01) greater torque for concentric contractions than older subjects (25 to 34 years). In rehabilitation programs using the Kin-Com, the weight-adjusted torque values and flexion/exten sion ratios will be useful in determining patients' strength recovery from knee or leg injury and/or sur gery.
Hand injury patterns in softball players using a 16 inch ball
Authors: Degroot Henry , Mass Daniel P.
Published: June 2007

Softball is a popular recreational and competitive sport among both men and women. The injury rate in softball players is as high as that in baseball and basketball players. We conducted a retrospective analysis of 119 hand injuries in 108 patients treated at the University of Chicago hand clinic. All of the injuries were caused by the impact of a 16 inch circumference softball.

Of the 119 injuries, 87 (73%) had bone involvement. Operative treatment was required in 26 (22%) injuries, 23 involving fractures and 3 involving soft tissue only. There was one (3.8%) operative complication. Of all injuries, 101 (86%) involved the finger joints, including 46 (39%) injuries to the distal interphalangeal (DIP) joint, 48 (40%) to the proximal interphalangeal (PIP) joint, and 7 (6%) to the metacarpophalangeal (MCP) joint.

The most common DIP joint injury was a mallet injury. This fracture, the most common single type of injury in our series, accounted for 27% of all injuries. Of all mallet injuries, 86% were fractures. The most common PIP joint injury was a volar plate fracture, the second most common injury in our series.

Variables such as the patient's sex, dominance or nondominance of hands, and early or late season play were not associated with a higher risk of injury. Certain parts of the hand, such as the more ulnar digits and the DIP and PIP joints, were at particularly high risk of injury.
The effect of differential training on isokinetic muscular endurance during acute thermally induced hypohydration
Authors: Caterisano Anthony , Camaione David N. , Murphy Robert T. , Gonino Vince J.
Published: June 2007

The purpose of this study was to test the effect of acute thermal hypohydration on the muscle endurance performance of three groups of differentially trained subjects. Group I consisted of six anaerobically trained athletes, Group II consisted of five aerobically trained athletes, and Group III consisted of six sedentary indi viduals. Experimental trials involved maximal leg exten sions performed on a Cybex II dynamometer under conditions of euhydration and hypohydration of minus 3% body weight. Integrated electromyographic data were also collected during each trial to factor out mo tivation as a variable. The maximum number of leg extension repetitions performed at or above 50% of each subject's peak torque output were compared between treatments and among the three groups. A 2 x 3 factorial analysis of variance (ANOVA) showed a significant decrease in muscle endurance when com paring euhydration to hypohydration among the anaer obically trained subjects as well as among the seden tary subjects (P < 0.05). The aerobically trained sub jects showed no significant decline in muscle endurance when comparing performance under both experimental conditions. It was hypothesized that the training adap tations that occur with aerobic conditioning and are primarily associated with increased plasma volume may be the key to explaining these results.
On the epidemiology of running injuries
Authors: Marti Bernard , Vader John Paul , Minder Christoph E. , Abelin Theodor
Published: June 2007

Using a survey questionnaire design, we investigated the incidence, site, and nature of jogging injuries among all participants of a popular 16 km race. The response rate was 83.6%. Of 4,358 male joggers, 45.8% had sustained jogging injuries during the 1 year study period, 14.2% had required medical care, and 2.3% had missed work because of jogging injuries. Occur rence of jogging injuries was independently associated with higher weekly mileage (P < 0.001), history of previous running injuries (P < 0.001), and competitive training motivation (P = 0.03). Higher mileage was also associated with more frequent medical consultations due entirely to jogging-related injuries. In 33 to 44 year olds (N = 1,757), the number of years of running was inversely related to incidence of injuries (P = 0.02). Injuries were not significantly related to race running speed, training surface, characteristics of running shoes, or relative weight. Achillodynia and calf muscle symptoms were the two most common overuse injuries and occurred significantly more often among older run ners with increased weekly mileage. We conclude that jogging injuries are frequent, that the number of firmly established etiologic factors is low, and that, in recom mending jogging, moderation should be the watchword.
Avulsion fractures of the tibial tuberosity in the adolescent athlete
Authors: Mirbey Joël , Besancenot Jacques , Chambers Richard T. , Durey Alain , Vichard Philippe
Published: June 2007

Based on a review of the literature and our study of six cases, we investigated avulsion fractures of the tibial tuberosity in the athletic adolescent. A study of the mechanism of this acute injury helps to explain the different types of avulsion fractures of the tibial tuber osity. An understanding of predisposing factors and the biomechanical conditions leading to this injury may help identify those young athletes at the highest risk and may help the surgeon determine the most effective treatment for such a fracture. No complications were experienced by the patients in our study. Displaced fractures underwent open reduction and fixation with screws. This method shortens the period during which athletic activities are restricted.
Femoral neck stress fractures
Authors: Fullerton LeRoy R. , Snowdy Harry A.
Published: June 2007

Fifty-four femoral neck stress fractures were studied prospectively to evaluate treatment methods. Fifty-four fractures in 49 patients were identified in a 4 year prospective study that included 1,049 stress fractures of all types. From our evaluation of treatment methods, a modification of existing classification systems was developed based on radiographic findings and treat ment. Differences from earlier studies were noted in racial diversity, in nonprogression of tension-side frac tures, and in return to function.
Orthotic treatment of sesamoid pain
Authors: Axe Michael J. , Ray Richard L.
Published: June 2007

The cause of pain and tenderness beneath the first metatarsal in an athlete is often very difficult to deter mine. When the symptoms originate from the sesamoid bone, exact diagnosis of the pathologic process may not be necessary in order to institute effective treat ment. In this retrospective study, 8 of 10 athletes with this problem were successfully treated with custom- fitted orthoses which relieve sesamoid pain. The major benefit of this method of treatment is that it enables an athlete to continue participation without loss of valuable practice and competition time.
Long-term evaluation of knee stability and function following surgical reconstruction for anterior cruciate ligament insufficiency
Authors: Harter Rod A. , Osternig Louis R. , Singer Kenneth M. , James Stanley L. , Larson Robert L. , Jones Donald C.
Published: June 2007

Currently used measures of knee stability and function for ACL reconstructed knees have not gained universal acceptance. Clinical test results often are given more value than the patient's subjective evaluation of the surgical outcome. This study was designed to identify specific knee stability and function variables that were most predictive of the patient's rating of knee function following one of two types of combined (intraarticular and extraarticular) ACL reconstruction procedures. In dividual measures of knee stability and function were also evaluated for differences between contralateral operated and nonoperated limbs. Postoperative and healthy contralateral knees of 51 male and female patients aged 18 to 49 years (mean, 23.7 years) were evaluated on a battery of tests at an average of 48.0 months after surgery (range, 24 to 101 months). All subjects possessed a normal contralateral knee for comparative purposes. The results of this retrospective study indicated that the variables selected were not highly correlated with, nor could they effectively predict, the patients' perceptions of postoperative knee status as measured by the Knee Function Rating Form (KFR). Statistically significant differences (P < 0.001) between operated and nonoperated knees were found for 9 of 11 variables analyzed. The data suggest that patients' perceptions of postoperative knee status were inde pendent of the results of static and dynamic clinical tests commonly used to assess knee stability and function. Postoperative deficits of up to 30% between the surgically reconstructed and normal contralateral knees on specific measures of knee stability and func tion did not greatly influence the patients' perceptions of knee function. Development of new, more specific dynamic tests may be necessary before stronger rela tionships between clinical test results and patients' perceptions of knee status in the ACL reconstructed knee can be realized.
Comprehensive functional analysis of shoulders following complete acromioclavicular separation
Authors: MacDonald Peter B. , Alexander Marion J. , Frejuk John , Johnson Garth E.
Published: June 2007

The purpose of this study was to examine the results of the two major methods of treatment of complete acromioclavicular separation: surgery and nonsurgical techniques. Twenty male patients with complete acro mioclavicular separation within the preceding 13 months were retrospectively examined and tested for recovery of shoulder strength and function. Compari sons were conducted between 10 of the patients who had been treated nonsurgically (Group 1), and 10 who had been treated surgically (Group 2). An additional group of 10 uninjured male subjects as controls was also tested for comparison of strength between domi nant and nondominant limbs (Group 3). All of the pa tients were tested for strength of both shoulders using the Kin-Com isokinetic dynamometer, for shoulder flex ibility using the Leighton flexometer, and for grip strength using a standard grip dynamometer. A ques tionnaire concerning patient evaluation of the injury was also administered to all of the subjects. The majority of strength and flexibility tests showed no significant dif ferences between the nonsurgical and surgical groups. The nonsurgical group was statistically superior to the surgical group in the following test scores: eccentric abduction (fast speeds), concentric external rotation (slow speeds), eccentric external rotation (fast), eccen tric abduction (slow), and flexibility in external rotation. These findings generally indicated that the nonsurgical treatment of a third-degree acromioclavicular separa tion is superior in restoring normal shoulder function in the 1 st year following injury.
The hamstring syndrome
Authors: Puranen J. , Orava S.
Published: June 2007

A series of 59 patients was treated and operated on for pain felt over the area of the ischial tuberosity and radiating down the back of the thigh. This condition was labeled as the "hamstring syndrome." Pain was typically incurred by assuming a sitting position, stretch ing the affected posterior thigh, and running fast. The patients usually had a history of recurrent hamstring "tears." Their symptoms were caused by the tight, tendinous structures of the lateral insertion area of the hamstring muscles to the ischial tuberosity. Upon divi sion of these structures, complete relief was obtained in 52 of the 59 patients.
Ipsilateral carpal, metacarpal, and ankle fractures resulting from an attempted basketball slam-dunk
Authors: McClelland Shearwood J. , Fithian Donald C.
Published: June 2007

A 23-year-old male recreational basketball player sus tained an open ankle fracture and ipsilateral carpal and metacarpal fractures as a result of a fall while attempt ing a slam-dunk. The wrist and hand fractures were treated nonoperatively. The open ankle fracture re quired irrigation, debridement, and open reduction/in ternal fixation. In addition to the prerequisite leaping ability, long-term success in "playing above the rim" requires experience, exceptional physical agility, and the mental discipline to anticipate and avoid slam-dunk opportunities with high risk for personal injury.
The biochemical and histological effects of artificial ligament wear particles: In vitro and in vivo studies
Authors: Olson Eric J. , Kang James D. , Fu Freddie H. , Georgescu Helga I. , Mason Gregg C. , Evans Christopher H.
Published: June 2007

Growing evidence suggests that biochemical mecha nisms play a role in the pathogenesis of arthritis. Car tilaginous wear particles have been shown to induce destructive enzymes and cytokines. To assess the biocompatibility of artificial ACL replacements, the ef fects of wear particles from the following ligaments were analyzed biochemically and histologically: GORE- TEX, Stryker Dacron Ligament Prosthesis, Versigraft carbon, Kennedy LAD, Xenograft, Leeds-Keio, and hu man patellar tendon allograft. Ligaments were frozen and ground to produce wear particles similar to those seen clinically and were added to lapine synovial cell cultures. The resulting conditioned medium was ana lyzed for collagenase, gelatinase, and chondrocyte ac tivating factor (CAF) production.

All of the ligaments induced significantly elevated enzyme and CAF production by the synoviocytes, with Xenograft and carbon inducing significantly higher en zyme levels than those of the other five ligaments. Five milligrams of wear particles were injected into the knees of 4 kg to 5 kg rabbits that were analyzed histologically after 14 weeks. Wear particles accumu lated in the periarticular synovial folds and induced modest to severe macrophage infiltration in the syno vium. A hypothetical model explaining the role of artifi cial ligament wear particles in the pathogenesis of arthritis is presented.
The pivot shift phenomenon: Results and description of a modified clinical test for anterior cruciate ligament insufficiency
Authors: Bach Bernard R. , Warren Russell F. , Wickiewicz Thomas L.
Published: June 2007

Clinical evaluation of knee instability is often difficult to reproduce, and several different physical tests have become popular. In an attempt to elucidate reasons for variations in the degree of pivot shift phenomenon seen with the use of the various tests, we have prospectively evaluated a group of 37 patients with surgically docu mented ACL injuries, noting the effects of hip position and tibial rotation. The patients were examined under anesthesia, and the pivot shift was graded as 0 (absent, or negative), 0.5+ (trace), 1 +, 2+, or 3+ (with locking). All knees were tested in hip abduction, neutral, and hip adduction, and with the tibia in external and internal rotation, so that six positions were evaluated.

Hip position strongly correlated with the degree of pivot shift regardless of tibial rotation. Overall, abduc tion produced the greatest degree of pivot shift, fol lowed by neutral and finally adduction. External tibial rotation increased the pivot shift score in abduction and neutral, but not in adduction. A grading system for the subject population showed that abduction/external ro tation (ABDER) resulted in the highest pivot shift scores, and that adduction/external rotation (ADDER) and adduction/internal rotation (ADDIR) resulted in the lowest scores. Nine patients out of 20 with a 3+ pivot shift in ABDER were negative in ADDER. The pivot shift score was dampened at least one grade from ABDER to ADDER in 92% of the patients.

We conclude that hip position and tibial rotation affect the degree of pivot shift phenomenon, and it is our impression that the iliotibial band plays a significant role in controlling the degree of pivot shift observed. When examining a knee for ACL insufficiency, it is critical to pay attention to the position of the leg because varia tions in hip position and tibial rotation affect the gra dation of the pivot shift sign and a false negative test may be elicited.
Upper extremity range of motion and isokinetic strength of the internal and external shoulder rotators in major league baseball players
Authors: Brown Larry P. , Niehues Sandra L. , Harrah Andrew , Yavorsky Patricia , Hirshman H. Paul
Published: June 2007

Forty-one professional baseball players volunteered for upper extremity range of motion measurements and isokinetic testing for internal and external shoulder ro tation. Pitchers demonstrated 9° more external shoul der rotation with the arm abducted, 5° more forearm pronation, and 9° less shoulder extension on the dom inant side compared with the dominant side of position players. Pitchers also demonstrated 9° more external rotation in abduction, 5° less shoulder flexion, 11 ° less horizontal extension, 15° less internal rotation in ab duction, 6° less elbow extension, 4° less elbow flexion, and 5° less forearm supination on the dominant side compared with their nondominant side. Position players demonstrated 8° more external rotation in abduction, 14° less horizontal extension, and 8° less elbow exten sion on the dominant side compared with their nondom inant side. Greater torque was produced by pitchers compared with position players for the dominant and nondominant arm at all test speeds for both mean peak and mean average torque. Greater torque was pro duced by the dominant arm compared with the non dominant arm also at all test speeds for both of these measurements. No difference was found between the rotation ratios for either arm, for either group, for all speeds.
Arthroscopic partial meniscectomy in the anterior cruciate deficient knee
Authors: Aglietti P. , Buzzi R. , Bassi P.B.
Published: June 2007

One hundred ACL insufficient knees were followed for an average of 3.5 years after arthroscopic partial men iscectomy had been performed. Fifty-two percent of the patients obtained a satisfactory result and 41 % were able to participate in strenuous sports activities. The arthroscopic partial meniscectomy reduced pain and swelling in a high proportion of cases, but stability was only marginally improved. Negative prognostic fac tors were: sex (female), generalized laxity, contralateral recurvatum of more than 10°, complete as opposed to partial ACL lesions, Grade III tibiofemoral or patellar chondromalacia, associated peripheral ligamentous lax ity, pivot shift of Grade II or greater, and anterior tibial displacement of more than 5 mm as measured with the KT-1000 knee arthrometer.
Comparison of maxillofacial and dental injuries in four contact team sports: American football, bandy, basketball, and handball
Authors: Sane Juha
Published: June 2007

Maxillofacial and dental injuries were studied in regis tered players of American football, bandy, basketball, and handball in Finland between 1979 and 1985. In American football, where facial protection is complete and mandatory, maxillofacial and dental accidents ac counted for only 1.4% of all accidents. In bandy, where facial protection was inadequate during the time of study (only the helmet and extraoral mouth protector were mandatory), the respective figure was 10.6%. The most frequent causes of injury were a blow from an other player (in American football, basketball, and hand ball) or a blow from the stick (in bandy).

In American football, the mean cost of treatment related to maxillofacial and dental injuries was only 60% of the mean total cost of all injuries. In contrast, the mean cost of treatment for maxillofacial and dental injuries in basketball and bandy was twice and three times as high, respectively, as that for all injuries. The need for adequate facial protection in contact sports is also discussed.
Comparison of diclofenac sodium and aspirin in the treatment of acute sports injuries
Authors: Duncan John J. , Farr James E.
Published: June 2007

A randomized, double-blind, parallel-group clinical trial compared diclofenac sodium (Voltaren, Ciba-Geigy Summit, NJ) with aspirin for the treatment of acute sprains and/or strains of the knee or ankle. One hundred thirty-nine patients were admitted to the study. Patients received either 150 mg (75 mg twice daily) of diclofenac (N = 69) or 3.6 g (1.2 g three times daily) of aspirin (N = 70) for 3 to 10 days. Forty-seven diclofenac patients and 49 aspirin patients, mean age for both groups 25 years, were evaluated to determine the efficacy of each treatment. Both groups experienced significant (P < 0.001) improvements for all efficacy variables measured. Treating sprains and strains with diclofenac rather than with aspirin allowed an earlier return to activity. Of those patients who achieved play ing fitness, those in the diclofenac group resumed athletic activities in a mean of 4.7 days, compared with a mean of 5.9 days for patients in the aspirin group. Although the overall multivariate F was nonsignificant (P = 0.19), the univariate F for days required to resume playing fitness was significantly (P = 0.025) shorter in the diclofenac group. While the nonsignificant multivar iate result suggests that the significance may be due to chance, it is also possible that there was a trend toward earlier resumption of activities with diclofenac treatment compared to aspirin, but an insufficient sam ple size to demonstrate the trend statistically. Since others have reported such a trend without the greater controls of a multivariate analysis, this area warrants further research.
Grappling with herpes: Herpes gladiatorum
Authors: Becker Thomas M. , Kodsi Robert , Bailey Paula , Lee Francis , Levandowski Richard , Nahmias Andre J.
Published: June 2007

Initial reports of herpes gladiatorum, a skin infection of wrestlers caused by herpes simplex virus (HSV), fo cused on case histories and clinical presentations of this disease. To more adequately address broader ep idemiologic questions concerning this skin infection, we surveyed members of four southeastern college wres tling teams, sampled high school and college athletic trainers nationwide, and obtained serum specimens from members of one college wrestling team for HSV antibody studies. Nine of 48 (18.8%) college wrestlers in the southeastern athletic conference reported histo ries of herpes gladiatorum. Wrestlers with a prior history of oral HSV infection (cold sores) were less likely to report HSV skin infection than wrestlers without cold sores (RR = 0.25; 95% C.I. 0.03 to 1.8), while wrestlers with exposure to opponents with cutaneous HSV le sions were at high risk to develop herpes gladiatorum (RR = 9.4; 95% C.I. 2.2 to 40.0). The national survey of athletic trainers indicated that 7.6% of college wres tlers and 2.6% of high school wrestlers had HSV skin infection during the 1984-85 season. Herpes gladiato rum is a common problem among college wrestlers, and morbidity associated with this skin disease can be significant.
Proprioception in the anterior cruciate deficient knee
Authors: Barrack Robert L. , Skinner Harry B. , Buckley Steven L.
Published: June 2007

Proprioception was quantified in a group of patients who had documented complete ACL tears. Threshold to detection of passive change in position of the knee was measured using a well-described test. Eleven pa tients with arthroscopically proven complete ACL tears and findings consistent with moderate to severe anter olateral rotatory instability were tested. Testing was done within the 30° to 40° range of knee flexion. Patients were blindfolded and the injured and uninjured knees were tested in random sequence so that the normal knee could serve as an internal control. Testing was also done in a blind manner, i.e., the examiner did not know which knee had been injured. An age- matched control group underwent identical testing. Po tentially significant variables such as age, time from injury, and degree of rehabilitation as measured by thigh circumference and isokinetic testing of the knee were included in a multivariate analysis.

Control subjects demonstrated virtually identical threshold values between their two knees, the mean variation being less than 2%. The test group, however, showed a significantly higher mean threshold value for the injured versus the noninjured knee (P < 0.01), the mean variation being over 25%. Multivariate analysis demonstrated that changes recorded in the propriocep tion of the injured knee were attributable to the loss of the ACL rather than to other variables. Patients who have complete ACL tears and moderate to severe rotatory instability may also experience a decline in proprioceptive function of their knee.
Early osteophyte formation after chemically induced articular cartilage injury
Authors: Williams James A. , Thonar Eugene J.-M.A.
Published: June 2007

We examined the early changes that follow injection of sodium iodoacetate (IA) into the guinea pig knee joint, using Safranin-O (SO) to stain the proteoglycan (PG)- rich matrix and the incorporation of Na 35 SO4 to deter mine which cells have maintained, lost, or developed the ability to synthesize significant amounts of PGs. Within 24 hours following injection of IA, articular chon drocytes exhibited a marked loss in ability to synthesize PGs; this inhibition was complete after 2 weeks. Focal loss of SO staining of the interterritorial matrix was noted after 24 hours, progressing to a complete loss of staining after 2 weeks. In sharp contrast to the degenerative changes in the habitually loaded articular cartilage, cells at the chondrosynovial junction began incorporating Na 35 SO4 and producing a matrix that stained with SO as early as 72 hours following injection. With time, this resulted in the development of prominent osteophytic cartilage that involved bone remodeling beneath the overlying cartilaginous cap after 3 weeks.
Isokinetic muscular performance of the quadriceps in elite ice hockey players
Authors: Johansson Christer , Lorentzon Ronny , Fugl-Meyer Axel R.
Published: June 2007

On four occasions during a period of 17 months, iso kinetic maximum knee extensor output (peak torque and contractional work) and input (integrated electro myographic activity) during single and repetitive con tractions were measured in 10 male elite ice hockey players. The tests were performed in the middle and at the end of the competitive season, and after two off ice training periods involving different types of training.

No significant changes in peak torque at single max imum contractions occurred for the whole group of players during the investigation. Nor did the slope of decline in contractional work or the plateau level of the ratio of contractional work:integrated electromyo graphic activity during repetitive contractions change significantly. The most obvious finding was great inter individual differences in muscular performance. Intrain dividually, changes in both peak torque as well as in slope of decline in contractional work and in plateau level of the ratio of contractional work:integrated elec tromyographic activity occurred during the different training periods. We conclude that local muscle adap tations, measured by isokinetic procedures, occur in the quadriceps as a result of ordinary training and games in elite ice hockey players. Because of the great interindividual differences in muscular performance and the different responses to similar training, we suggest individual programs for leg muscle training in ice hockey players.
Acute repair of the anterior cruciate ligament with lateral capsular augmentation
Authors: Cross Mervyn J. , Paterson Roger S. , Capito Charles P.
Published: June 2007

Forty-seven patients had primary repair and extraarti cular augmentation with a lateral loop of the iliotibial tract for acute rupture of the ACL. (All of these patients had anterolateral rotatory instability (ALRI) preopera tively as diagnosed by a positive jerk test.) Of these 47 patients, 36 were available for follow-up evaluation. Followup ranged from 6 to 68 months (average, 21.6 months). Twenty-three of the patients (64%) were rated as excellent or good. Ten of the patients (27.8%) were rated as fair, and three patients (8%) were rated as poor. Thirty-three of the 36 patients (91 %) were objec tively free of ALRI as tested by the jerk test and had 1 + or less result in a Lachman test, with a firm end point. Only one patient felt his knee to be unstable (he had a positive pivot jerk). More than 90% of the patients returned to sport, and 72% returned at their preinjury level.
Articular mobility in ballet dancers
Authors: Klemp Patrick , Chalton Derek
Published: June 2007

A follow-up study of ballet dancers was conducted to determine the influence of 4 years additional training on articular mobility using Beighton's method. The score increased in 25 (45.5%) of the 55 dancers reexamined. Acquired forward flexion accounted for this increase in 21 (84%) of the 25 dancers. These 21 dancers had had significantly less training than had the 30 dancers who could forward flex when examined initially (P < 0.0001), showing that forward flexion is acquired through train ing. There were significantly more hypermobile individ uals among dancers who had continued dancing than among those who had stopped (P < 0.03). However, only 2 (16.7%) of 12 dancers who had progressed in their careers were hypermobile. We conclude that 1) most ballet dancers are able to forward flex, 2) forward flexion is usually acquired and develops after 4 or more years of training, 3) the mobility score may assist in predicting who will continue dancing, but that 4) there is no association between hypermobility and dancing excellence.
Extraarticular reconstruction of the anterior cruciate ligament insufficient knee
Authors: Durkan John A. , Wynne Garnet F. , Haggerty Joseph F.
Published: June 2007

This paper reports an analysis for treatment of antero lateral rotatory instability by the Ellison procedure, a technique involving rerouting a portion of the iliotibial band posterior to the fibular collateral ligament. A de tailed description of the operative procedure is pre sented.

One hundred four patients were evaluated for subjec tive improvement. The average length of followup was 51 months (range, 24 to 100 months). Eighty-one pa tients (80%) had a good or excellent result, 15 patients (14%) were rated fair, and 6 patients (6%) were rated poor. Sixty-three patients returned for a detailed clinical examination (average followup was 53 months; range, 24 to 100 months). An excellent or good objective rating was achieved in 49 patients (78%). Ten patients (16%) were rated as fair, and four patients (6%) were rated as failures.

We recommend the Ellison procedure for the recre ational athlete as a safe and effective mode of treatment for anterolateral rotatory instability.
Analysis of rehabilitation techniques after anterior cruciate reconstruction
Authors: Anderson Allen F. , Lipscomb A. Brant
Published: June 2007

Numerous postoperative therapies have been advo cated for the rehabilitation of patients who have under gone ACL reconstruction. The effectiveness of these various methods, many of which are based on sound scientific principles, has yet to be documented. The purpose of this study was to determine the efficacy of five commonly used rehabilitation programs. Five groups of 20 patients, all of whom underwent the same method of ACL reconstruction, were compared in order to determine the effects of the following treatments (some in combination): transcutaneous electrical nerve stimulation (TENS), immobilization in flexion, immobili zation in extension, electrical muscle stimulation (EMS), and continuous passive motion (CPM). Clinical evalua tion, volumetric thigh measurements, instrumented varus-valgus stress testing, KT-1000 arthometer (Med metric, San Diego, CA) measurements, and Cybex II (Cybex, Division of Lumex, Ronkonkoma, NY) muscle evaluation were used to examine the patients.

TENS did not reduce the amount of pain medication required, nor was there improvement in any other clin ically measurable parameter of performance. There was no clear difference in stability between those treated in extension and those treated in flexion; however, since three patients who were treated in extension required manipulation, there may be some advantage to treating patients with early limited range of motion in flexion. EMS did not reduce atrophy but it did minimize strength decrease during immobilization. EMS also resulted in significantly greater range of motion than those treated with extension or flexion with early limited motion. Compared to all groups, EMS patients had a significant reduction in the incidence of patellofemoral crepitation. As compared to immobilization in extension, CPM re duced the need for manipulation, but was not as effec tive as early limited range of motion.

The optimal rehabilitation program included EMS and immobilization in flexion with early limited range of motion.
The effect of knee braces on lateral impact loading of the knee
Authors: Baker Bruce E. , V Edward , Orthotist Cert , Bogosian Stephen P. , Werner Frederick W. , Mech Eng M. , Murphy Dennis
Published: June 2007

Disruption of the medial supporting structures of the knee occurs commonly in contact sports such as Amer ican football and lacrosse. A limited number of clinical and laboratory studies currently document the effec tiveness of bracing. The purpose of this project was to determine if commercially available bracing could be shown to produce objective evidence of medial stabili zation of the knee. Our model involves the use of a cadaver lower extremity with a fixed foot and sus pended femur with a free knee and a lateral impact load applied simulating a clipping injury. Force transducers were placed on the ACL and medial collateral ligament (MCL) and an electrogoniometer was attached to the extremity.

The prophylactic braces studied had a limited capac ity to protect the MCL from direct lateral stress with the knee in full extension. In flexion or with a change in direction of the load, the protective effect is greatly reduced. The functional braces had a capacity to limit abduction and rotational stresses on the MCL in flexion and extension.
Management of orbital blow-out fractures
Authors: Forrest L. Arick , Schuller David E. , Strauss Richard H.
Published: June 2007

Blow-out fractures are fractures of the orbital floor or medial wall that occur as a consequence of blunt trauma. Impact increases the intraorbital pressure, forc ing the nondistensible orbital contents through the or bital floor. The fracture is commonly caused by impact from a baseball or tennis ball. However, any blunt trauma to the orbit, as from a knee or elbow, can result in a blow-out fracture. The characteristic clinical findings include double vision, a sunken globe, and numbness in the distribution of the infraorbital nerve. Sometimes, the only sign of a blow-out fracture is the abrupt inflation of periorbital tissue with air when the patient blows his nose. Standard evaluation of these fractures includes history, physical examination, and radiographs. Some patients benefit from computed tomography (CT), which can be both diagnostic and prognostic. Blow-out fractures do not often produce serious sequelae, and the current trend is toward no treatment. However, it is imperative to rule out any serious injury to the eye itself that would require emergency treatment.
Sports injuries in school-aged children
Authors: Backx Frank J.G. , Erich Wietze B.M. , Kemper Alfons B.A. , Verbeek Andre L.M.
Published: June 2007

In November 1982, epidemiologic data were collected in a unique, large scale, population-based survey on sports injuries in school-aged children living in Holland. A total of 7,468 pupils, aged 8 to 17, completed ques tionnaires covering a retrospective period of 6 weeks. Seven hundred ninety-one sports injuries were regis tered, amounting to an incidence of 10.6 sports injuries per 100 participants. In 31% of the cases, medical consultation was needed. Injuries incurred during the study period caused 36% of the children to miss one or more physical education classes and caused 6% to miss school for at least 1 day. Contusions and sprains were the most common lesions (77%). Three of four injuries involved the lower extremity, in particular the ankle. Sixty-two percent of all the injuries occurred in organized sports, 21% in physical education classes, and 17% in unsupervised sports activities. The highest injury rates were found in basketball and field hockey. In this study population, 15 and 16-year-old boys who had a high sports activity index and played team sports, particularly contact team sports, formed a high risk group.
Electromyographic analysis of elbow function in tennis players
Authors: Morris Michael , Jobe Frank W. , Perry Jacquelin , Pink Marilyn , Healy Bitte S.
Published: June 2007

Muscle activity about the elbow during tennis strokes in nine professional and collegiate level players was studied using indwelling EMG and high speed photog raphy. Eight muscles were evaluated for the serve, forehand, and backhand strokes. The serve was di vided into six stages and the ground strokes into four stages. EMG tracings were subjected to analog-to- digital conversion and a relative measure of quantity was obtained. Analysis of variance and Tukey tests were then done to assess statistical significance (P < 0.05).

The ground strokes showed low activity in all muscles tested during the preparation phase. During the accel eration phase, both the backhand and forehand showed a generalized increase in all muscle activity. Both strokes showed marked activity of the wrist extensors and, in addition, the forehand showed high activity in the brachialis and biceps. In the follow-through phase, there was a generalized decrease in muscle activity.

The serve showed low activity in all muscles tested during the wind-up phase. The wrist extensors in creased their activity in the cocking phase, with marked activity in late cocking. The pronator teres and the triceps showed increased activity in the acceleration phase. Follow-through phase showed low muscle activ ity except for the biceps, which increased in late follow- through.

In conclusion, the muscles of the elbow help stabilize the elbow as a unit during the ground strokes in these high level players. Power in the serve comes from increased activity in the triceps and pronator teres. The predominant activity of the wrist extensors in all strokes may be one explanation for predisposition to injury.
Metabolic costs and heart rate responses to treadmill walking in water at different depths and temperatures
Authors: Gleim Gilbert W. , Nicholas James A.
Published: June 2007

Treadmill walking/jogging in water is a potentially useful therapeutic modality. Since energy costs of this activity are unknown, we compared oxygen consumption (VO2) of treadmill walking/jogging in water to a dry treadmill at speeds of 40.23 to 160.9 meters/min (m/m) in 13.4 m/m increments in 11 subjects. At speeds ≥53.6 m/m, ankle depth, below knee, midthigh, and waist depth walking/jogging in water significantly elevated VO2 and heart rate (HR) above dry treadmill walking (P < 0.05). At speeds ≥134.1 m/m, VO 2 of waist depth jogging was not significantly greater than dry jogging. These findings showed no gender specificity. Treadmill walk ing/jogging in waist depth water at temperatures of 30.5°C and 36.1 °C was compared to dry treadmill walking in five subjects. The rate of increase of HR compared to VO2 was significantly greater at 30.5°C than dry walking, and greater at 36.1° C than 30.5°C (P < 0.05).

Treadmill walking in water can double the oxygen cost of movement depending on the depth and speed, and the response to increasing speed is nonlinear. Water temperature affects the relationship of HR to VO2 at waist depth, suggesting that water temperature can add a significant thermal load to the cardiovascular system. Metabolic and cardiovascular demands of treadmill walking/jogging in water must be considered when using this modality since greater external work results at much lower speeds than on land.
Quality assessment of athletic trainers
Authors: Foster Danny T. , Yesalis Charles E. , Ferguson Kristi J. , Albright John P.
Published: June 2007

This paper reports the first published assessment of the quality of services provided by athletic trainers. Medical coverage for the 1985 Junior Olympic Games was provided by certified athletic trainers (ATC), phy sicians, and other health care personnel. This study assessed the services of the 30 attending ATCs who managed 121 significant injuries. Standard injury infor mation was collected by the ATCs and separately col lected by their physicians. Nine months after the Games, phone interviews were conducted with the injured participants and assessment questionnaires were given to the attending physicians. Results re vealed that young, injured, Junior Olympic participants generally did not inform their parents about their injuries or medical contact while at the Games. Athletes and physicians overwhelmingly agreed that they were pos itively impressed with the capabilities of the ATCs with whom they had contact. About 70% recovered from the symptoms and limitations of injury, as determined by the athlete, within the month following the Games. About 17% sustained some type of injury recurrence to the same body part, and at 9 months about 97% of the athletes had fully recovered from their injuries.

These data not only indicate that athletic trainers can accurately identify minor athletic injury but signify the importance of long-term followup in our athletic popu lations. Multisport events, such as the Junior Olympic Games, impose considerable problems to a communi cation effort. The athletic trainer, as an ever-present figure in collegiate and professional circles, can be the central focus of an adequate communication effort re garding the patient care of other athletic populations.