bluuebunny/crossref_metadata_2025 huggingface dataset:
Open and Closed Kinetic Chain Exercises in the Early Period after Anterior Cruciate Ligament Reconstruction
Authors: Hooper David M. , Morrissey Matthew C. , Drechsler Wendy , Morrissey Dylan , King John
Published: July 2017

Thirty-seven patients who had undergone anterior cruciate ligament reconstruction were tested in a gait analysis laboratory at 2 and 6 weeks after surgery. Between test sessions, patients were randomly assigned to a course of either closed or open kinetic chain resistance exercises (3 sessions per week for 4 weeks). Gait analysis consisted of bilateral calculations of knee joint angle, moment, and power during level walking, stair ascent, and stair descent. An analysis of variance on the effects of training group and test session indicated that the only variable to be significantly affected by the type of exercise program was the amount of knee flexion at the beginning of step-up (P<0.05). All other measures of knee angle, moment, and power (16 total variables) showed no significant difference between the exercise groups. All variables measured on the injured side showed significant improvement from test 1 to test 2 (P<0.05), but the injured leg remained functionally deficient when compared with the uninjured leg. These data suggest that there are no clinically significant differences in the functional improvement resulting from the choice of open or closed kinetic chain exercises in the early period after this surgery.
Stress Fractures of the Sacrum
Authors: Johnson Alan W. , Weiss Carl B. , Stento Kimberly , Wheeler Donald L.
Published: July 2017

Low back pain is a common finding in an athletically active premenopausal female population. We describe an unusual cause of persistent low back/sacroiliac pain: a fatigue-type sacral stress fracture. Plain radiographs, bone scans, computed tomography, and magnetic resonance imaging studies were obtained in the female athletes to determine the nature of the pathologic abnormality. The most significant risk factor for fatigue-type sacral stress fractures was an increase in impact activity due to a more vigorous exercise program. Potential risk factors such as abnormal menstrual history, dietary deficiencies, and low bone mineral density were examined. The clinical course was protracted, with an average 6.6 months of prolonged low back pain before resolution of symptoms. Sacral fatigue-type stress fractures did not preclude the athletes from returning to their previous level of participation once healing had occurred.
Progressive Loss of Knee Extension after Injury
Authors: Tonin Martin , Saciri Valdet , Veselko Matjaž , Rotter Aleksander
Published: July 2017

Cyclops syndrome has been defined as a loss of knee extension due to impingement of a pedunculated proliferative tissue mass after anterior cruciate ligament reconstruction. We describe four patients who were operated on for progressive loss of knee extension after minor knee injury. During the arthroscopic procedure, the consistent finding was a fibrous pedunculated nodule adhering to the anterolateral aspect of the original anterior cruciate ligament, obstructing extension by impingement in the anterior aspect of the knee. At least part of the anterior cruciate ligament was intact in all cases. These patients were compared with seven patients who developed cyclops syndrome after anterior cruciate ligament reconstruction. Clinical and arthroscopic findings were the same in both groups. An arthroscopic excision of the nodule, performed an average of 12 weeks after knee trauma or after reconstruction, gave very good results. Histologic examination of the excised nodules from both groups showed fibroelastic connective tissue proliferation, thromboangiitis, and areas of necrotic bone and foreign body giant cell granuloma. On the basis of our observations, we conclude that formation of a fibrous pedunculated nodule may occur after an anterior cruciate ligament injury as well as after surgical reconstruction of the anterior cruciate ligament.
The Posteromedial Impingement Lesion of the Ankle
Authors: Paterson Roger S. , Brown Jeremy N. , Roberts Simon N. J.
Published: July 2017

We report on a series of six cases of posteromedial impingement lesion of the ankle operated on during a 3-year period with excellent or good results and a return of the patients to preinjury levels of activity. This lesion occurs, on occasion, after a severe ankle-inversion injury in which the deep posterior fibers of the medial deltoid ligament become crushed between the medial wall of the talus and the medial malleolus. Initially, posteromedial symptoms do not predominate, compared with the symptoms of the lateral ligament disruption, and they usually resolve without specific treatment. Occasionally, however, thick, disorganized fibrotic scar tissue persists and impinges between the medial wall of the talus and the posterior margin of the medial malleolus. Clinically, the patient has persistent medial to posteromedial activity-related ankle pain after a severe inversion injury, despite a sound ankle rehabilitation program. There is deep soft tissue induration immediately behind the medial malleolus with localized tenderness and reproduction of symptomatic pain on provocative testing by palpating this site while moving the ankle into plantar flexion and inversion. The posteromedial impingement lesion has a distinct pathologic picture and can coexist with other ankle lesions that cause pain after lateral ligament injury.
The Efficacy of Wrist Protectors in Preventing Snowboarding Injuries
Authors: Rønning Roar , Rønning Irene , Gerner Tom , Engebretsen Lars
Published: July 2017

Injuries of the wrist are common among snowboarders and in-line skaters. Wrist protectors have been developed to protect against injury. Some studies support the use of such wrist protection, but others emphasize the fact that wrist protectors may transfer the injury to other locations in the forearm. We conducted a prospective, randomized, clinical study of 5029 snowboarders, 2515 in a braced group and 2514 in a control group. The primary endpoint was fracture or sprain of the wrist with loss of range of motion and pain of at least a 3-day duration. Concomitant injuries were also recorded. Eight wrist injuries occurred in the braced group and 29 occurred in the control group. This was a significant difference. Beginners (first 5 days on a snowboard) and snowboarders with rented equipment were more prone to injury than others. No injuries could be related to the use of the wrist brace. We conclude that wrist braces are effective in protecting snowboarders against wrist injury. Beginners are a high-risk group.
Motion Loss after Ligament Injuries to the Knee
Authors: Millett Peter J. , Wickiewicz Thomas L. , Warren Russell F.
Published: July 2017

Motion loss continues to be a difficult complication after ligament injury and surgery to the knee. A better understanding of the pathoanatomic causes of motion loss can lead to improved prevention and treatment strategies. When motion loss does occur, early recognition and appropriate treatment can be expected to restore motion and improve function in most patients. Treatment options, although varied, should improve outcome when implemented appropriately. This article is composed of two parts. The first part reviews the current concepts on definitions, incidence, and causes of motion loss. In the second part, to be published later, current strategies on prevention and treatment of motion loss after ligament injury to the knee are reviewed. Emphasis is placed on risk factors and prevention as well as on diagnosis and treatment. The article summarizes the latest information from the basic sciences as well as clinical studies on the problem of motion loss of the knee and attempts to provide a rational approach to these difficult clinical problems.
Sports Activity Level after Surgical Treatment for Chronic Anterolateral Ankle Instability
Authors: Krips Rover , van Dijk C. Niek , Lehtonen Hannu , Halasi Tamas , Moyen Bernard , Karlsson Jon
Published: July 2017

The objective of this retrospective multicenter study was to determine whether anatomic reconstruction or tenodesis produces better results in athletic patients with lateral ankle instability. Forty-one patients who underwent anatomic reconstruction and 36 patients who underwent tenodesis were followed up. The median preinjury Tegner score for both groups was 9 (range, 7 to 10). At follow-up, 2 to 10 years after surgical treatment, the median Tegner score for both groups was 8 (range, 4 to 10). In the tenodesis group, 17 patients had a lower Tegner score than before the operation, but in the anatomic reconstruction group only 4 patients had lower scores. Significantly more patients in the tenodesis group (15) had limited ankle dorsiflexion than in the anatomic reconstruction group (3). Plain radiographs revealed that 11 patients in the tenodesis group had medially located osteophytes, compared with only 2 patients in the anatomic reconstruction group. Stress radiographs revealed that more patients in the anatomic reconstruction group had normal laxity values than in the tenodesis group (38 and 28, respectively). According to the rating system developed by Good et al., 36 patients in the anatomic reconstruction group had a good or excellent result, versus 21 patients in the tenodesis group. Anatomic reconstruction was found to be superior to tenodesis in all of the investigated outcome measures.
Intramedullary Screw Fixation of Jones Fractures
Authors: Larson Christopher M. , Almekinders Louis C. , Taft Timothy N. , Garrett William E.
Published: July 2017

Treatment failures after screw fixation of Jones fractures are reported to be infrequent. Between 1993 and 1999, 15 patients (mean age, 21.7 years) underwent cannulated screw fixation of a Jones fracture at our institution. There were six treatment failures: four re-fractures and two symptomatic nonunions. The mean time to full activity was 6.8 weeks for the patients with failure compared with 9 weeks for patients who did not have complications. Although all patients were asymptomatic and radiographically progressing to union before return to full activity, only one of six patients with failures had complete radiographic union, compared with six of seven patients with no complications. There was a higher proportion of elite athletes (division I or professional level) among the failure group (83%) compared with those without complications (11%). There were no significant differences in age, sex, screw diameter, use of bone graft, or age of fracture between patients with failures and those without complications. Return to full activity, especially among elite athletes, before complete radiographic union was predictive of failure. Even though intramedullary screw fixation offers advantages over nonoperative treatment, a significant risk of postoperative complications exists.
No Evidence of Impaired Neurocognitive Performance in Collegiate Soccer Players
Authors: Guskiewicz Kevin M. , Marshall Stephen W. , Broglio Steven P. , Cantu Robert C. , Kirkendall Donald T.
Published: July 2017

A high incidence of cerebral concussion has been reported among soccer players. We studied whether long-term or chronic neuropsychological dysfunction was present in collegiate soccer players. Two hundred forty subjects from a National Collegiate Athletic Association division I institution were stratified into three groups: soccer athletes (91), nonsoccer athletes (96 women's field hockey, women's lacrosse, and baseball players), and controls (53 college students). Subjects completed a concussion history questionnaire and underwent preseason baseline neuropsychological testing before the start of either the freshman or sophomore year. Data were collected on the results of six neuropsychological tests and from a concussion history questionnaire for number of previous concussions, Scholastic Aptitude Test results, and exposure to soccer and heading. Despite an average of 15.3 seasons of soccer exposure and a higher prevalence of previous concussions, the soccer athletes did not demonstrate impaired neurocognitive function or scholastic aptitude when compared with the nonsoccer athletes or the student nonathletes. Additionally, there was no significant relationship between a history of soccer-related concussion and either neurocognitive performance or scholastic aptitude. Neither participation in soccer nor a history of soccer-related concussions was associated with impaired performance of neurocognitive function in high-level United States soccer players.
Epidemiologic Analysis of Injury in Five Years of Canadian Professional Rodeo
Authors: Butterwick Dale J. , Hagel Brent , Nelson Dexter S. , LeFave Mark R. , Meeuwisse Willem H.
Published: July 2017

Longitudinal studies of rodeo injuries are rare. We prospectively investigated injuries in professional rodeo in Canada over a 5-year period. Our specific interests included injury incidence density in specific rodeo events, risk factors such as past injury, and the incidence of head injury. Of 323 professional rodeos from 1995 through 1999, 63 rodeos provided a convenience sample. These rodeos were selected because the Canadian Professional Rodeo Sport Medicine Team was in attendance at these events, thus providing both competitor health care and data collection. Four hundred fifty-one injuries were reported during 30,564 competitor-exposures. The greatest injury frequency and injury incidence density were in the rough stock events (bull riding, bareback riding, and saddle bronc). Bull riding accounted for the greatest injury frequency (141) and incidence density (32.2 injuries per 1000 competitor-exposures). Bull riding had a relative injury risk of 1.32 when compared with bareback riding; bareback riding had a relative injury risk of 1.39 when compared with saddle bronc riding. Concussions accounted for 8.6% of all reported injuries. Concussions and other head injuries (65) were second only to knee injuries (76) in frequency of injury to specific body parts. This concussion frequency is higher than has previously been reported.
Hamstring Muscle Strain Recurrence and Strength Performance Disorders
Authors: Croisier Jean-Louis , Forthomme Bénédicte , Namurois Marie-Hélène , Vanderthommen Marc , Crielaard Jean-Michel
Published: July 2017

We determined the frequency of strength disorders in 26 athletes with a history of hamstring muscle injury and recurrent strains and discomfort. We also assessed the effectiveness of rehabilitation to correct muscle performance. After concentric and eccentric isokinetic assessment, 18 athletes were found to have strength deficits, as determined by statistically selected cutoffs of peak torque, bilateral differences, and the flexors/quadriceps ratio. The discriminating character of the eccentric trial was demonstrated, combining a preferential eccentric peak torque deficit and a significant reduction of the mixed eccentric flexors/concentric quadriceps ratio. The athletes with muscle imbalances followed a rehabilitation program individually adapted from their strength profile. Treatment length was from 10 to 30 sessions and resulted in isokinetic parameter normalization in 17 of 18 subjects. Isokinetically corrected subjects were observed for 12 months after return to athletics. None sustained a clinically diagnosed hamstring muscle reinjury. Subjective intensity of pain and discomfort were significantly reduced, and they all returned to their prior level of competition. These results demonstrate that persistent muscle strength abnormalities may give rise to recurrent hamstring injuries and discomfort. An individualized rehabilitation program emphasizing eccentric training based on specific deficits contributes to a decrease in symptoms on return to sports.
A Prospective Randomized Comparison of Patellar Tendon versus Semitendinosus and Gracilis Tendon Autografts for Anterior Cruciate Ligament Reconstruction
Authors: Shaieb Mark D. , Kan Darryl M. , Chang Spencer K. , Marumoto Jay M. , Richardson Allen B.
Published: July 2017

Seventy patients with patellar tendon or hamstring tendon autografts for single-incision anterior cruciate ligament reconstruction were evaluated at least 2 years after surgery. All reconstructions were performed by the same surgeon, and metal interference screws were used for fixation of all grafts. No significant differences were noted between groups for Lysholm score, reduction in activity, KT-1000 arthrometer findings, quadriceps muscle size, return to sports, or ability to jump and do hard cuts and pivots. Significantly more patients in the patellar tendon group had patellofemoral pain at 6 months after surgery than did the hamstring tendon patients (48% versus 20%), and at last follow-up the incidence of patellofemoral pain was 42% and 20%, respectively. Fourteen patients in the patellar tendon group and seven in the hamstring tendon group had loss of motion (approximately 5°). Four patients (two in each group) had treatment failures and their results were not included in the clinical examination data. At 2 years’ follow-up, 97% of patients with patellar tendon grafts and 100% of patients with hamstring tendon grafts rated their results as good or excellent. We found that hamstring tendon grafts performed similarly to patellar tendon grafts, although fewer patients in the hamstring tendon group had patellofemoral pain and loss of motion.
Results of Arthroscopic Treatment of Posterosuperior Glenoid Impingement in Tennis Players
Authors: Sonnery-Cottet Bertrand , Edwards T. Bradley , Noel Eric , Walch Gilles
Published: July 2017

Twenty-eight tennis players with symptomatic posterosuperior glenoid impingement limiting their participation underwent arthroscopic debridement of the supraspinatus tendon and glenoid lesions associated with this diagnosis after nonoperative treatment had failed. The dominant extremity was affected in all patients; the patients’ average age was 26.9 years. Eighteen patients participated at the highest level of competition for their age, and the remaining patients participated at the intermediate level. Patients were evaluated at an average of 45.7 months after surgery by physical examination, an activities questionnaire, a subjective result questionnaire, and a questionnaire regarding their return to activity. Postoperatively, the patients averaged 26.9 of 30 possible points on the activities questionnaire. Twenty-three of the patients were subjectively satisfied with the surgical result. Twenty-two patients had returned to tennis. Despite their return, 20 of the 22 patients reported some persistent pain with participation. To our knowledge, this is the first report detailing the results of operative treatment for posterosuperior glenoid impingement in a population limited to tennis players. Even though the results are encouraging in terms of the high number of patients returning to tennis, the effects of this persistent pain with activity, although diminished in severity, on long-term participation is unknown.
Fatigue Testing of Suture Anchors
Authors: Rupp Stefan , Georg Thomas , Gauss Christian , Kohn Dieter , Seil Romain
Published: July 2017

In a porcine tibia model, we subjected widely used anchor-suture combinations to a fatigue-testing protocol. The Ethibond No. 2 suture was the weakest part of the anchor-suture combinations when they were loaded to failure by a single pull. Under cyclic-loading conditions, fixation strength was decreased compared with single-pull tests. The suture/anchor interface was identified as the weakest link in the Mitek GII/No. 2 combination and in the Zimmer Statak 3.5/No. 2 combination. In most cases the suture was worn through at the eyelet. Threading the GII anchor with a No. 5 suture and use of larger anchors in combination with No. 2 sutures increased the fatigue strength. Suture breakage at the knot was the predominant failure mode for biodegradable anchors inserted into cortical bone. The highest fatigue strength was seen for the Super Anchor/No. 5 combination when the anchor was inserted in cortical bone. Fatigue testing is crucial for evaluation of suture anchors and should be performed along with single-pull testing. The mechanical performance of a suture anchor threaded with a defined suture depends on several key factors: the pullout strength of the anchor, the tensile strength of the suture, and the interaction of anchor and suture at the eyelet (suture/anchor interface).
Injury Incidence and Prevalence among Elite Weight and Power Lifters
Authors: Raske Åse , Norlin Rolf
Published: July 2017

The purpose of this study was to investigate the incidence and prevalence of injuries among elite weight lifters and power lifters, with a special focus on shoulder injuries and possible injury-provoking exercises. In 1995, a questionnaire was administered to 110 male and female elite lifters to evaluate injuries and training characteristics. A follow-up of the athletes from 1995 was conducted in 2000, and a new 2000 elite group was also queried. In 1995 and again in 2000, the athletes sustained, on average, 2.6 injuries per 1000 hours of activity. Most common in 1995 were low back injuries, with an injury rate of 0.43 per 1000 hours, and shoulder injuries, with a rate of 0.42 per 1000 hours. Shoulder injuries dominated in 2000, with an injury rate of 0.51 per 1000 hours of activity. There was a difference in injury pattern between weight lifters, who mostly sustained low back and knee injuries, and power lifters, in whom shoulder injuries were most common. No correlation was found between shoulder injuries and any specific exercise. Although the total injury rate was the same during the two periods of study, the rate of shoulder injuries had increased.
The Partial-Thickness Rotator Cuff Tear: Is Acromioplasty without Repair Sufficient?
Authors: Cordasco Frank A. , Backer Marianne , Craig Edward V. , Klein Dana , Warren Russell F.
Published: July 2017

We evaluated the clinical outcome of arthroscopic acromioplasty and debridement in 162 patients who had either normal rotator cuffs, grade 1 (frayed tendon) partial-thickness tears, or grade 2 (less than 50% of the tendon) partial-thickness tears. The mean time from surgery to the response to the L'Insalata outcome questionnaire was 52.7 months (4.5 years) among the 105 respondents (107 shoulders). The mean score was 90 points; eight patients (8%) scored less than 70 points (range, 30 to 65.5), and their treatment failed early on. The patients with grade 2B (bursal) partial-thickness rotator cuff tears had a significantly higher failure rate (38%). Although the clinical outcome of patients with partial-thickness tears of the rotator cuff comprising less than 50% of the tendon (grade 1 and 2) was not significantly different from that of patients without partial rotator cuff tears, the subgroup of patients with grade 2B partial tears had a statistically significantly higher failure rate and may have been better served with primary repair. With follow-up to 10 years, there was no evidence that clinically relevant or symptomatic intrinsic rotator cuff pathologic conditions progress in those patients with partial-thickness tears treated with arthroscopic anterior acromioplasty.
Arthroscopic Removal of Symptomatic Bennett Lesions in the Shoulders of Baseball Players: Arthroscopic Bennett-plasty
Authors: Yoneda Minoru , Nakagawa Shigeto , Hayashida Kenji , Fukushima Sunao , Wakitani Shigeyuki
Published: July 2017

Background:

Bennett lesions are often observed in throwing athletes, and, although usually asymptomatic, they can sometimes become painful and disturb an athlete's throwing ability. Because it is clinically difficult to determine whether a Bennett lesion is symptomatic or whether pain is from another lesion, the outcome of surgical treatment is variable.

Hypothesis:

Arthroscopic resection of Bennett lesions diagnosed according to our criteria and arthroscopic treatment of associated lesions performed simultaneously were effective for treatment of baseball players with symptomatic Bennett lesions.

Study Design:

Prospective cohort study.

Methods:

The following criteria for diagnosis of a symptomatic Bennett lesion were used to identify 16 baseball players who later underwent arthroscopic removal of the symptomatic Bennett lesion (arthroscopic Bennett-plasty): 1) detection of a bony spur at the posterior glenoid rim on radiographs; 2) posterior shoulder pain during throwing, especially in the follow-through phase; 3) tenderness at the posteroinferior aspect of the glenohumeral joint; and 4) relief of pain by injection of local anesthesia. Results: After a minimum follow-up of 1 year, there was no tenderness at the posteroinferior aspect of the glenohumeral joint in any of the patients. Throwing pain disappeared in 10 shoulders and was mitigated in 6 shoulders. Eleven patients returned to baseball at their previous level of competition.

Conclusions:

Accurate diagnosis and minimally invasive arthroscopic surgery are important for appropriate treatment of baseball players with symptomatic Bennett lesions.
The Crank Test, the O'Brien Test, and Routine Magnetic Resonance Imaging Scans in the Diagnosis of Labral Tears
Authors: Stetson William B. , Templin Kevin
Published: July 2017

Background

Tears of the superior labrum of the shoulder, anterior to posterior, are difficult to diagnose clinically.

Purpose

We examined whether the crank or O'Brien tests were reliable tools for detecting glenoid labral tears.

Study Design

Nonrandomized prospective study.

Methods

Results of diagnostic shoulder arthroscopy were compared with those of the preoperative tests and magnetic resonance imaging for 65 patients who had symptoms of shoulder pain.

Results

The crank test result was positive in 29 patients (45%), and the O'Brien test was positive in 41 patients (63%). The crank test had a positive predictive value of 41%, was 56% specific, 46% sensitive, and had a negative predictive value of 61%. The O'Brien test had a positive predictive value of 34%, was 31% specific, 54% sensitive, and had a negative predictive value of 50%. Magnetic resonance imaging had a positive predictive value of 63%, was 92% specific, 42% sensitive, and had a negative predictive value of 83%.

Conclusions

The O'Brien and crank tests were not sensitive clinical indicators for detecting glenoid labral tears and other tears of the anterior and posterior labrum. Results were often falsely positive for patients with other shoulder conditions, including impingement or rotator cuff tears.
Changes in Bone Scans after Anterior Cruciate Ligament Reconstruction
Authors: Hogervorst Tom , Pels Rijcken Tammo H. , Rucker Diana , van der Hart Cor P. , Taconis Wybren K.
Published: July 2017

Background

Whether anterior cruciate ligament reconstruction retards the progression of osteoarthrosis is not established. Bone scintigraphy can be useful for monitoring the course of osteoarthrosis. Bone scan findings are abnormal in the majority of patients with anterior cruciate ligament deficiency. Three uptake patterns can be distinguished.

Hypothesis

Reconstruction corrects the three abnormal bone scan patterns seen in patients with anterior cruciate ligament deficiency.

Study Design

Prospective cohort study.

Methods

We performed bone scintigraphy in 80 patients, before and 2 years after anterior cruciate ligament reconstruction.

Results

Reconstruction consistently corrected type 2 bone scan pattern (meniscus scan) but not type 1 and 3 patterns (osteoarthrosis and cartilage ulcer scan). Correction of all three patterns decreased among patients who had longer duration of anterior cruciate ligament deficiency and was more reliable for the combined uptake of all three patterns among patients who had less than 6 months of deficiency.

Conclusion

These findings indicate anterior cruciate ligament reconstruction protects the menisci. Reconstruction may be best performed within 6 months after injury.
Head-First versus Feet-First Sliding: A Comparison of Speed from Base to Base
Authors: Kane Steven M. , House Hugh O. , Overgaard Kristi A.
Published: July 2017

Background

Two basic baseball sliding techniques, feet-first and head-first, are taught at all levels of play. Because of the risk for injury to the upper extremities and the cervical spine during head-first sliding, it is potentially more dangerous than feet-first sliding. There is an assumption among coaches that head-first sliding is more aggressive and faster, but there has been no scientific study to prove this claim.

Purpose

The purpose of this study was to determine which technique provides a faster slide into the base.

Study Design

Controlled field study.

Methods

A total of 60 players ranging from Little League to college level was analyzed. Each athlete was evaluated three times from a standing start at first base to either a head-first or feet-first touch of second base. Each athlete was also timed in a 40-yard sprint and his or her preferred sliding technique was recorded.

Results

We found no statistically significant difference in speed between head-first and feet-first sliding at all levels of play in this study.
Posterior Instability of the Shoulder with Secondary Impingement in Elite Golfers
Authors: Hovis W. David , Dean Mark T. , Mallon William J. , Hawkins Richard J.
Published: July 2017

Background

Shoulder injuries in golf are related to the biomechanics of the golf swing and typically occur in the lead arm at the top of the back swing.

Purpose

We report a newly recognized entity in a series of elite golfers: posterior glenohumeral instability associated with subacromial impingement.

Study Design

Retrospective review.

Methods

Eight elite golfers were treated between March 1991 and July 1998 for pain occurring in the nondominant, lead shoulder at the top of the back swing. Posterior instability was diagnosed in all eight patients; six of the eight also demonstrated signs of subacromial impingement. Initial treatment consisted of rehabilitation. For patients in whom rehabilitation failed, surgery was performed.

Results

Two patients improved with nonoperative treatment and returned to play immediately. Six patients underwent shoulder arthroscopy with posterior thermal capsulorrhaphy. Four of the six also underwent arthroscopic subacromial decompression. The six surgically treated patients returned to play at an average 4 months after surgery. At an average 4.5 years of follow-up, all eight patients were playing at their previous level of competitive play. One patient had complications that led to the need for subsequent arthroscopic subacromial decompression; she eventually returned to competitive play.

Conclusion

Clinicians should be aware of posterior shoulder instability and the associated secondary diagnosis of rotator cuff impingement as a possible cause of shoulder pain in elite golfers.
Arthroscopic Repair for Traumatic Posterior Shoulder Instability
Authors: Williams Riley J. , Strickland Sabrina , Cohen Matthew , Altchek David W. , Warren Russell F.
Published: July 2017

Background:

The role of arthroscopic repair in the treatment of posterior shoulder instability remains poorly defined.

Purpose:

To evaluate the results of arthroscopic repair of posterior Bankart lesions.

Study Design:

Retrospective review.

Methods:

Records were reviewed of 27 shoulders (26 patients). All of the patients were male with a mean age of 28.7 years; in all cases symptoms were preceded by a traumatic event. Fourteen of the patients had 2+ to 3+ posterior translation noted under preoperative anesthesia. The posterior capsulolabral complex was found to be detached from the glenoid rim in all cases; bioabsorbable tack fixation was used for repair.

Results:

At a mean follow-up of 5.1 years, no patients demonstrated a range of motion deficit. Muscle weakness (grade 4/5) in external rotation was noted in two patients (8%). There was no instability greater than 1+ in the anterior, posterior, or inferior directions. The mean L'Insalata shoulder score was 90.0 ± 13.9. The mean SF-36 physical and mental component scores were 50.4 ± 7 and 53.9 ± 9, respectively. Symptoms of pain and instability were eliminated in 24 patients (92%). Two patients (8%) required additional surgery after arthroscopic repair of the posterior Bankart lesion. Radiographs demonstrated that there had been no progressive glenohumeral joint degeneration.

Conclusions:

Arthroscopic repair of the posterior capsulolabral complex is an effective means of eliminating symptoms of pain and instability associated with posterior Bankart lesions of traumatic origin.
Lack of Hormonal Influences on Mechanical Properties of Sheep Knee Ligaments
Authors: Strickland Sabrina M. , Belknap Thomas W. , Turner Simon A. , Wright Timothy M. , Hannafin Jo A.
Published: July 2017

Background:

The number of anterior cruciate ligament injuries in female athletes exceeds that in male athletes at similar competitive levels. This difference has been attributed by some authors to hormone-mediated alteration in knee laxity in women.

Hypothesis:

Sheep anterior cruciate and medial collateral ligament strength and stiffness are not altered by administration for 6 months of estrogen or a selective estrogen receptor agonist (raloxifene).

Study Design:

Controlled laboratory study.

Methods:

Thirty-eight mature ewes were divided into five groups: sham operation (N = 6), ovariectomy (N = 9), ovariectomy and estradiol implant (N = 7), low-dose raloxifene (N = 9), and high-dose raloxifene (N = 7). After 6 months, the animals were sacrificed and ligaments were tested along with those from five rams’ knees.

Results:

No differences were found between treatment groups for maximum force, stiffness, energy to failure, or failure site. The ultimate stress of the rams’ anterior cruciate ligaments was significantly higher than that of the ewes.

Conclusions:

Estrogen and estrogen receptor agonists at physiologic levels do not lead to decreased knee ligament strength.

Clinical Relevance:

The female hormonal milieu may not be responsible for the increased incidence of anterior cruciate ligament injury in female athletes compared with their male counterparts.
Repair of Locked Bucket-Handle Meniscal Tears in Knees with Chronic Anterior Cruciate Ligament Deficiency
Authors: O'Shea John J. , Shelbourne K. Donald
Published: July 2017

Background:

Large bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency have been considered avascular and, thus, irreparable.

Hypothesis:

The rate of meniscal healing is higher than previously reported.

Study Design:

Prospective cohort study.

Methods:

Fifty-nine patients underwent staged surgical procedures of meniscal repair followed at an average of 77 ± 58 days by ligament reconstruction once full range of motion was obtained.

Results:

Fifty-two patients with 55 meniscal repairs were available for follow-up. At reconstruction, 30 menisci (55%) appeared healed; 19 (34%), partially healed; and 6 (11%) showed no healing (only 4 were removed). Of 43 tears in the white-on-white zone, 21 appeared healed; 17, partially healed; and 5 showed no healing. Of 11 in the red-on-white zone, 8 appeared healed; 2, partially healed; and 1 showed no healing. One meniscal tear in the red-on-red zone appeared healed. At an average follow-up of 4.3 ± 3.1 years, 36 of the 43 (83.7%) white-on-white meniscal repairs remained asymptomatic; all repairs in the other zones remained asymptomatic.

Conclusion:

Locked bucket-handle meniscal tears heal at a high rate when repaired as an isolated procedure, even when full weightbearing and activity before reconstruction is allowed and when the tear is in the white-on-white zone.
Jump Landing Strategies in Male and Female College Athletes and the Implications of Such Strategies for Anterior Cruciate Ligament Injury
Authors: Fagenbaum Ray , Darling Warren G.
Published: July 2017

Background:

Female athletes are more likely than male athletes to injure the anterior cruciate ligament. Causes of this increased injury incidence in female athletes remain unclear, despite numerous investigations.

Hypothesis:

Female athletes will exhibit lower hamstring muscle activation and smaller knee flexion angles than male athletes during jump landings, especially when the knee muscles are fatigued.

Study Design:

Controlled laboratory study.

Methods:

Eight female and six male varsity college basketball athletes with no history of knee ligament injury performed jump landings on the dominant leg from a maximum height jump and from 25.4 cm and 50.8 cm high platforms under nonfatigued and fatigued conditions. Knee joint angle and surface electromyographic signals from the quadriceps, hamstring, and gastrocnemius muscles were recorded.

Results:

Women landed with greater knee flexion angles and greater knee flexion accelerations than men. Knee muscle activation patterns were generally similar in men and women.

Conclusion:

As compared with male college basketball players, female college basketball players did not exhibit altered knee muscle coordination characteristics that would predispose them to anterior cruciate ligament injury when landing from jumps. This conclusion is made within the parameters of this study and based on the observation that hamstring muscle activation was similar for both groups. The greater knee flexion we observed in the female subjects would be expected to decrease their risk of injury.

Clinical Relevance:

Factors other than those evaluated in this study need to be considered when attempting to determine the reasons underlying the increased incidence of anterior cruciate ligament injuries consistently observed in elite female athletes.
The Soleus Muscle Acts as an Agonist for the Anterior Cruciate Ligament: An in Vitro Experimental Study
Authors: Elias John J. , Faust Alfred F. , Chu Yung-Hua , Chao Edmund Y. , Cosgarea Andrew J.
Published: July 2017

Background:

Although the quadriceps muscles are known antagonists for the anterior cruciate ligament and the hamstring muscles are known agonists, the influence of the calf muscles on knee stability is not well understood.

Hypothesis:

The soleus muscle acts as an anterior cruciate ligament agonist and the gastrocnemius muscle acts as an anterior cruciate ligament antagonist.

Study Design:

Controlled laboratory study.

Methods:

Six cadaveric knees were tested with individual and combined activation of the gastrocnemius and soleus muscles to determine the influence of simulated muscle contraction on tibiofemoral motion.

Results:

At all flexion angles, applying the soleus muscle force tended to translate the tibia posteriorly, whereas applying the gastrocnemius muscle force tended to translate the tibia anteriorly. Applying the soleus and gastrocnemius muscle forces together also tended to translate the tibia anteriorly. The average anterior and posterior tibial translations were greatest at 50° of flexion.

Conclusions:

The soleus muscle is capable of acting as an agonist for the anterior cruciate ligament and the gastrocnemius muscle can act as an antagonist.

Clinical Relevance:

A better understanding of the agonistic behavior of the soleus muscle on the anterior cruciate ligament may lead to the development of training and rehabilitation strategies that could reduce the incidence of injury and improve function in both patients with anterior cruciate ligament deficiency and patients who have undergone anterior cruciate ligament reconstruction.
Radiofrequency Thermal Effects on the Human Meniscus: An in Vitro Study of Systems with Monopolar and Bipolar Electrodes
Authors: Vangsness C. Thomas , Polousky John D. , Parkinson Andrew B. , Hedman Thomas P.
Published: July 2017

Background:

No data exist on the cutting efficiency of monopolar versus bipolar radiofrequency energy application systems on human meniscal tissue.

Purpose:

To compare the effects of monopolar and bipolar thermal energy systems on human meniscal tissue.

Study Design:

Controlled laboratory study.

Methods:

Fresh-frozen menisci were cut in cross-section into 180 pie-shaped specimens. A specially designed jig was used to consistently apply radiofrequency energy to the tissue under a constant 30-g force. Three different systems were tested at the low, middle, and high ranges, with application times of 1 and 3 seconds. Thermal effects were measured by image analysis microscopy.

Results:

No significant differences in thermal effects were found with respect to energy output for each system. Both the individual system tested and the application time had statistically significant effects on thermal damage, with the individual system tested having a greater effect. The mean depths of thermal change produced by the Mitek (bipolar) device were 564 and 648 μm at 1 and 3 seconds applications, respectively. The Arthrocare device (bipolar) produced depths of 1444 and 1697 μm at 1 and 3 seconds. The Oratec device (monopolar) produced depths of 895 and 1057 μm, respectively.

Conclusions:

A differential thermal effect was created in the meniscal tissue by three commercially available radiofrequency systems. Within the parameters of the experiment, all three systems limited thermal damage to a depth of less than 2 mm. The results appeared to depend more on the particular system used, not whether it had monopolar or bipolar electrodes.

Clinical Relevance:

These data imply reasonably safe (less than 2 mm) thermal changes in the meniscus after radiofrequency energy application from these three systems.
Acute Grade III Medial Collateral Ligament Injury of the Knee Associated with Anterior Cruciate Ligament Tear: The Usefulness of Magnetic Resonance Imaging in Determining a Treatment Regimen
Authors: Nakamura Norimasa , Horibe Shuji , Toritsuka Yukiyoshi , Mitsuoka Tomoki , Yoshikawa Hideki , Shino Konsei
Published: July 2017

Background:

The appropriate management of acute grade III medial collateral ligament injury when it is combined with a torn anterior cruciate ligament has not been determined.

Hypothesis:

Magnetic resonance imaging grading of grade III medial collateral ligament injury in patients who also have anterior cruciate ligament injury correlates with the outcome of their nonoperative treatment.

Study Design:

Prospective cohort study.

Methods:

Seventeen patients were first treated nonoperatively with bracing. Eleven patients with restored valgus stability received anterior cruciate ligament reconstruction only, and six with residual valgus laxity also received medial collateral ligament surgery.

Results:

Magnetic resonance imaging depicted complete disruption of the superficial layer of the medial collateral ligament in all 17 patients and disruption of the deep layer in 14. Restoration of valgus stability was significantly correlated with the location of superficial fiber damage. Damage was evident over the whole length of the superficial layer in five patients, and all five patients had residual valgus laxity despite bracing. Both groups had good-to-excellent results 5 years later.

Conclusions:

Location of injury in the superficial layer may be useful in predicting the outcome of nonoperative treatment for acute grade III medial collateral ligament lesions combined with anterior cruciate ligament injury.
Risk Factors for Injury in Middle School Football Players
Authors: Turbeville Sean D. , Cowan Linda D. , Asal Nabih R. , Owen Willis L. , Anderson Mark A.
Published: July 2017

Background:

Little is known about the frequency of or risk factors for injuries in middle school or junior high school football players.

Purpose:

To examine the associations of player characteristics (injury history, conditioning, player position, special equipment) and physical parameters (body mass index, weight, height, grip strength) with risk of injury.

Study Design:

Prospective cohort study.

Methods:

We documented risk factors for injury in 646 middle school football players, 10 to 15 years of age, in the Oklahoma City, Oklahoma, school district during the 1998 and 1999 seasons. Player characteristics and physical parameters were measured at the beginning of both seasons. Logistic regression methods were used to determine whether baseline variables were associated with the odds of subsequent injury.

Results:

More playing experience was the only variable significantly associated with the risk of injury in multivariate analyses. This association was observed regardless of the type of injury and even after indirectly controlling for time at risk of injury by restricting analyses to first-string players. Increasing age was significantly associated with the risk of fractures.

Conclusions:

Results suggest that physical characteristics play a minor role in risk of injury from football in this age group.
Repair of Pars Interarticularis Defect by Segmental Wire Fixation in Young Athletes with Spondylolysis
Authors: Nozawa Satoshi , Shimizu Katsuji , Miyamoto Kei , Tanaka Mizuo
Published: July 2017

Background

Although segmental wire fixation has been successful in the treatment of nonathletes with spondylolysis, no information exists on the results of this type of surgery in athletes.

Purpose

To evaluate the outcome of surgical repair of pars interarticularis defect by segmental wire fixation in young athletes with lumbar spondylolysis.

Methods

Between 1993 and 2000, 20 athletes (6 women and 14 men; average age, 23.7) with lumbar spondylolysis were treated surgically with this technique. They were actively engaged in sports such as baseball, tennis, and golf. Nineteen athletes had one level of spondylolysis and one athlete had two levels. The level of spondylolysis was L4 in 2 athletes and L5 in 19. The average follow-up period was 3.5 years (range, 1.3 to 8.6). Surgical outcome was evaluated by radiographic examination, the Japanese Orthopaedic Association score, preoperative and postoperative sports activity levels and intensities, and the presence of complications.

Results

Bony fusion at the site of spondylolysis was obtained in all cases, and the Japanese Orthopaedic Association score was increased significantly after surgery (preoperatively, 21.2 ± 3.9; postoperatively, maximum 27.7 ± 1.0; recovery rate, 80.4%). All of the patients returned to their sports activities, although at varying degrees. No severe complications were noted.

Conclusion

We recommend this technique in cases of lumbar spondylolysis in athletes who hope to resume their sports activities.
Tibial Eminence Fractures in Children: Prevalence of Meniscal Entrapment
Authors: Kocher Mininder S. , Micheli Lyle J. , Gerbino Peter , Hresko M. Timothy
Published: July 2017

Background

Meniscal entrapment under a displaced tibial eminence fragment may be a rationale for arthroscopic or open reduction in type 2 and 3 tibial eminence fractures.

Purpose

To determine the prevalence of meniscal entrapment in children with type 2 and 3 tibial eminence fractures.

Study Design

Case series.

Methods

Records of a consecutive series of 80 skeletally immature patients (mean age, 11.6 years; range, 5 to 16) who underwent arthroscopic (71), open (5), or combined arthroscopic and open (4) reduction and internal fixation of type 3 tibial eminence fractures (57) or type 2 fractures that did not reduce in extension (23) from 1993 to 2001 were reviewed.

Results

Entrapment of the anterior horn of the medial meniscus (36), intermeniscal ligament (6), or anterior horn of the lateral meniscus (1) was seen in 26% (6 of 23) of type 2 fractures and 65% (37 of 57) of type 3 fractures. An associated meniscal tear was seen in 3.8% of patients (3 of 80).

Conclusions

Meniscal entrapment is common in patients with type 2 and 3 tibial eminence fractures. Arthroscopic or open reduction should be considered for type 3 fractures and for type 2 fractures that do not reduce in extension to remove the incarcerated meniscus, allowing for anatomic reduction.