bluuebunny/crossref_metadata_2025 huggingface dataset:
Return of normal gait patterns after anterior cruciate ligament reconstruction
Authors: Timoney James M. , Inman Wayne S. , Quesada Peter M. , Sharkey Peter F. , Barrack Robert L. , Skinner Harry B. , Alexander A. Herbert
Published: June 2007

Individuals with anterior cruciate ligament deficiency typically do not have quadriceps activity during stance. This aberrant pattern has been termed "quadriceps avoidance" gait. We performed gait analysis during walking on 10 normal controls and 10 subjects 8 to 12 months after they had anterior cruciate ligament recon struction using autogenous middle third of the patellar tendon. All patients had good subjective and objective results at the time of analysis. Differences in gait be tween subjects and controls persisted up to 12 months after surgery. Specifically, subjects with anterior cru ciate ligament reconstructions demonstrated significant reductions in midstance knee flexion moments (P < 0.01) and tibially directed loading rates (P < 0.05) when compared with controls. However, the subjects had a net external flexion moment throughout most of the stance phase of gait, implying that quadriceps activity was present. After anterior cruciate ligament recon struction, there is a tendency toward gait normalization, and a quadriceps avoidance mechanism is no longer present.
Anterior Cruciate Ligament Injuries in Patients with Open Physes
Authors: Parker Andrew W. , Drez David , Cooper Jerald L.
Published: June 2007

From July 1988 to August 1989, six children with open physes and injuries to the anterior cruciate ligament were treated operatively. All injuries involved twisting episodes during sports activities. All six patients had meniscal abnormalities, and, additionally, one patient sustained a Grade III medial ligament tear and had a lateral patellar dislocation. Operative reconstruction used hamstring tendons and placed a groove over the front of the tibia and a groove over the top of the femur without violation of the growth plates. The anterior cru ciate ligament was primarily repaired (three patients) at the time of reconstruction, if possible. At 3 months, one patient underwent arthroscopic resection of adhesions for arthrofibrosis. There were no other complications. Five patients were evaluated with clinical examination, radiographs, magnetic resonance imaging, and func tional testing at an average followup of 33.2 months (range, 25 to 38). Four of the five had returned to their preinjury level of sports participation. Manual maximum KT-1 000 arthrometer side-to-side differences averaged 3.6 ± 1.9 mm. The average Lysholm knee score was 95.2 ± 2.5; the average Hospital for Special Surgery knee score was 96.6 ± 2.3. There were no growth plate injuries. Despite the overall clinical stability, magnetic resonance image scans of the five patients consistently demonstrated areas of increased signal in the anterior cruciate ligament grafts.
Cervical Spine Injury, Hockey Helmets, and Face Masks
Authors: Reynen Paul D. , Clancy William G.
Published: June 2007

Over the past 30 years hockey players began wearing helmets and face masks. Cervical spine injury, with an incidence of 15 cases per year, began to be re ported in the 1980s. Cervical spine trauma had not been reported before then. After review of the litera ture, there seems to be a consensus of opinion that the style of play that is allowed a player with head protection may actually increase the chances of cervi cal spinal trauma.
Posterior Ossification of the Shoulder: The Bennett Lesion
Authors: Ferrari James D. , Ferrari Dudley A. , Coumas James , Pappas Arthur M.
Published: June 2007

We report a series of ossific lesions of the posterior inferior glenoid in a group of elite baseball players. We hope to clarify the etiology, diagnosis, and treatment of the Bennett lesion. From August 1985 to August 1991, we identified six professional baseball pitchers and one college pitcher with evidence of ossification of the shoul der on plain radiographs, computed tomography, or magnetic resonance imaging. Arthroscopic examina tion was performed in all cases. All seven players had identifiable posterior labral injury on arthroscopic ex amination ; six of these seven also had varying degrees of undersurface posterior rotator cuff damage. No an terior tissue damage, anterior instability, or subacromial impingement was noted. No ossification was identified arthroscopically. Intraarticular labral and rotator cuff tears were debrided arthroscopically and patients un derwent rehabilitation for 4 to 6 months after surgery. Six of the seven athletes returned to preinjury perform ance levels; however, one pitcher is no longer playing competitive baseball.

The Bennett lesion is an extraarticular posterior os sification associated with posterior labral injury and pos terior undersurface rotator cuff damage. It is not, how ever, a result of traction stresses in the region of the triceps insertion. Recognition is important for identifi cation and treatment of the lesion and associated patho logic damage.
Atraumatic Osteolysis of the Distal Clavicle
Authors: Slawski Daniel P. , Cahill Bernard R.
Published: June 2007

A group of 14 patients underwent 17 consecutive open surgical excisions of the distal clavicle for atrau matic osteolysis after having failed conservative treat ment. All patients were men involved in weight train ing or heavy-lifting occupations. The diagnosis was based on no history of shoulder trauma, positive plain radiographs, and positive joint scintigraphy. All 14 pa tients were available for followup at an average of 25 months postoperatively. The UCLA Shoulder Rating Scale was used for evaluation. All patients reported full return to sports and employment at a satisfactory level. All results were rated as excellent (8) or good (9). Eleven of the 14 patients had bilateral involve ment to some extent. One patient had undergone open excision of the contralateral distal clavicle before the study and 3 patients presented with bilateral symptoms and underwent staged bilateral excisions during the study. Seven patients presented with con tralateral symptoms and radiographic involvement at latest followup after return to weight-lifting activities.
Use of a Modified Elmslie-Trillat Procedure to Improve Abnormal Patellar Congruence Angle
Authors: Shelbourne K. Donald , Porter David A. , Rozzi William
Published: June 2007

Forty patients underwent 45 modified Elmslie-Trillat re alignment procedures (mean followup, 2 years) for re fractory patellar instability (34 knees) or painful patel lofemoral syndrome with malalignment (11 knees). The postoperative congruence angle (mean, +3.4°) was significantly improved compared with the preoperative value (mean, +21.5°). We considered the "normal" con gruence angle average as -8° (range, -20° to +4°). Overtime postoperatively, we detected no statistical dif ference in the congruence angle (5 months, 3.4°; 24 months, 6.3°). There were no patellar dislocations post operatively. Nine knees (20%) had some postoperative subluxation. Ninety-four percent of the patients without subluxation had congruence angles less than 15°, whereas 54% of patients with postoperative subluxation had postoperative congruence angles greater than 15°.

The evidence in this study population indicates that the modified Elmslie-Trillat procedure can predictably improve the patellar congruence angle. Adequate cor rection may eliminate patellar dislocation. Correction of the congruence angle to less than +15° will result in a decreased incidence of postoperative patellar instabil ity. Early full activity postoperatively did not affect the modified Elmslie-Trillat correction of the congruence angle being maintained over time.
An Analysis of Autograft Fixation After Anterior Cruciate Ligament Reconstruction in a Rabbit Model
Authors: Grana William A. , Egle Davis M. , Mahnken Robert , Goodhart Craig W.
Published: June 2007

Fixation and incorporation of a tendon implanted within the bone pose theoretical as well as practical concerns for the surgeon who treats instability problems of the knee. Understanding the physiology involved in graft- bone incorporation is necessary for the appropriate re habilitation of patients who undergo anterior cruciate ligament surgery. The purpose of the study was to ex amine the histologic and biomechanical changes of a semitendinosus autograft reconstruction of the anterior cruciate ligament in a rabbit model at the graft-bone tunnel interface in the femur. The results indicate that by 3 weeks, failure of the bone-graft-bone or construction is through the intraarticular portion of the graft, not as a result of pullout from the bone tunnel. Graft fixation of the bone tunnel occurs by an intertwining of graft and connective tissue and anchoring of connective tis sue to bone by collagenous fibers and bone formation in the tunnels. The collagenous fibers have the appear ance of the Sharpey's fibers seen in an indirect tendon insertion.
Electromyographic and Cinematographic Analysis of Elbow Function in Tennis Players with Lateral Epicondylitis
Authors: Kelley John D. , Lombardo Stephen J. , Pink Marilyn , Perry Jacquelin , Giangarra Charles E.
Published: June 2007

Lateral epicondylitis occurs frequently in tennis players and appears to be caused by tears in the extensor apo neurosis. The purpose of this study was to compare the electromyographic activities of 5 muscles in players with lateral epicondylitis with those of injury-free players dur ing the single-handed backhand tennis stroke. Fine- wire electrodes were placed into the extensor digitorum communis, extensor carpi radialis longus and brevis, pronator teres, and flexor carpi radialis muscles in com petitive tennis players; 8 players had lateral epicondy litis and 14 had normal upper extremities. The backhand stroke then was recorded on high-speed film and syn chronized with the electromyographic signal. The in jured players had significantly greater activity for the wrist extensors and pronator teres muscles during ball impact and early follow-through. This activity increase may have been caused by the abnormal mechanics evi dent on film, including a "leading elbow," wrist extension and an open racquet face near the time of ball impact, and ball contact in the lower half of the strings. These mechanics not only result in a lower level of play but also leave the wrist extensors and the pronator teres muscles vulnerable to injury. This is the first study that documents increased activity in muscles that have been previously injured.
Inferior Capsular Shift Procedure for Anterior-inferior Shoulder Instability in Athletes*
Authors: Bigliani Louis U. , Kurzweil Peter R. , Schwartzbach Cary C. , Wolfe Ira N. , Flatow Evan L.
Published: June 2007

Sixty-eight shoulders in 63 athletic patients with anterior-inferior glenohumeral instability underwent an anterior-inferior capsular shift procedure. Shoulders with glenoid fractures, predominantly posterior instabil ity, or routine, unidirectional anterior instability were not included in this study. There were 42 men and 21 women, with an average age of 23 years. Forty-two re pairs were performed on the dominant arm. All 31 over head throwing athletes had their dominant arms re paired. Forty-six shoulders had histories of recurrent anterior dislocations, while 22 shoulders had recurrent subluxation. All 68 shoulders had an anterior-inferior capsular shift, tailored to the degree of laxity found; in addition, 21 had repair of a Bankart lesion. Forty-two patients were rated excellent (67%), 17 good (27%), 2 fair (3%), and 1 poor (3%). Fifty-eight of 63 (92%) pa tients returned to their major sports, 47 (75%) at the same competitive levels. Only 5 of 10 elite throwing ath letes returned to their prior competitive levels. Loss of external rotation averaged 7°. Two patients (2.9%) re- dislocated postoperatively, after violent falls.
Immediate Free Ankle Motion After Surgical Repair of Acute Achilles Tendon Ruptures
Authors: Sölveborn Sven-A. , Moberg Anders
Published: June 2007

We prospectively studied 17 consecutively treated pa tients (15 men and 2 women) who had surgically treated subcutaneous, complete and acute Achilles tendon rup tures. The patients underwent a new postoperative regi men that allowed free ankle motion in a patellar tendon bearing plaster cast with a protecting frame under the foot making weightbearing possible immediately after surgery. Evaluation was done using a patient question naire and a clinical examination recorded at 6 weeks (when the mobile ankle cast was removed), 3 months, and 1 year. Measurements of isokinetic and functional strength compared with the uninjured leg were per formed at the final followup. No rerupture or other com plications occurred. At 1 year, our patients were graded according to the Arner-Lindholm rating scale and there were 15 (88%) excellent, 2 good, and no poor results. Six patients had an excellent result already at 3 months, and there were no poor results at any evaluation. The patient evaluations showed range of motion, strength, and recovery time comparable with or better than re sults of previous studies.

Early free ankle motion after repair of Achilles tendon ruptures proved safe with very satisfactory clinical re sults, which justified a randomized, prospective study (now in progress) comparing it with traditional ankle immobilization.
Anterior Cruciate Ligament Reconstruction Using Gracilis and Semitendinosus Tendons
Authors: Karlson James A. , Steiner Mark E. , Brown Charles H. , Johnston Jack
Published: June 2007

Eighty-seven patients had anterior cruciate ligament re construction using one-limbed gracilis and semitendi nosus tendon graft. No extraarticular or associated liga mentous procedures were performed. A 44-patient subgroup was alternated on an every-other-case basis between 2 graft placements, either over the top or through the femoral condyle; 64 patients (32 of each type) returned for complete evaluations. Average fol lowup was 2.9 years. Groups were similar in age, gen der, injury chronicity, number of meniscectomies, and preoperative activity levels. No statistical differences between groups were seen in overall knee rating, range of motion, KT-1000 arthrometer measurements, isoki netic muscle testing, or one-legged hop test. Injured minus normal anterior laxity at 89 N was 2.1 ± 2.0 mm. Isokinetic testing demonstrated an average 95% normal knee extension strength and 106% normal flexion strength, measured at 60 deg/sec. Average hop index was 95%. Eight of 64 patients evaluated demonstrated injured minus normal differences of 4.5 mm or greater. Three of 8 had frankly positive 2+ and 5 had 1 + pivot shifts; however, 4 of these returned fully to sports, and 4 returned with modifications. Overall, 55 of 64 patients returned to preinjury sports.
A Muscle Contusion Injury Model
Authors: Crisco Joseph J. , Jokl Peter , Heinen Gregory T. , Connell Marc D. , Panjabi Manohar M.
Published: June 2007

We developed a reproducible muscle contusion injury and studied its effect on contractile function, histology, and passive failure. An instrumented drop-mass tech nique (mass, 171 g; height, 102 cm; spherical radius, 6.4 mm) delivered a single impact to the posterior sur face of the gastrocnemius muscle in one limb of 40 male Wistar rats. On Day 0, the impact significantly (N = 12, P < 0.01) decreased maximum tetanic tension to 63% of the contralateral control value. Histologic examina tion demonstrated extravasation of erythrocytes, edema, myofiber disruption, and vacuolation of myofi bers. Passive failure initiated at the site of injury. At 2 days, tetanic tension was 75% of controls (N = 11, P < 0.01). Histologically, acute inflammation and pha gocytosis were noted. Tetanic tension at 7 days was 81 % of controls (N = 8, P < 0.01). Vimentin staining indicated a dramatic increase in myoblast activity. Con tractile strength was near normal at 24 days. Histologic examination showed complete regeneration of normal striated muscle fibers. No vimentin activity was found. No passive failures initiated at the injury site. Contusion injury produced a significant deficit in contractile func tion that continually diminished with gross histologic evi dence of degeneration, regeneration, and normalization at the injured muscle fibers.
Stimulation of Bone Growth Through Sports
Authors: Krahl Hartmut , Michaelis Ulf , Pieper Hans-Gerd , Quack Gerhard , Montag Michael
Published: June 2007

This contribution addresses the following questions: Does unilateral sports-specific strain affect the skeletal system of the athlete? Specifically, can any differences be found in longitudinal growth of the bones of the fore arm and hand in professional tennis players between the stroke arm and the contralateral arm? An investi gation was conducted involving 20 high-ranking profes sional tennis players (12 male and eight female players) between 13 and 26 years of age as well as 12 controls of the same age range. The radiologic examinations of the bones of the forearm and hand yielded an increase in density of bone substance and bone diameter as well as length in the stroke arm as compared with the contralateral arm. Whereas the first results confirm previous findings, the stimulation of longitudinal growth has never been reported. This change in bone structure and size can be attributed to two factors: mechanical stimulation and hyperemia of the constantly strained extremity. It may thus be regarded as a biopositive adaptation process.
Arthroscopy-assisted Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Substitution
Authors: Bach Bernard R. , Jones Greg T. , Sweet Fred A. , Hager Cheryl A.
Published: June 2007

The purpose of this retrospective study was to evaluate clinically, functionally, and objectively our initial expe rience using free, autogenous middle third patellar ten don for anterior cruciate ligament reconstruction without extraarticular augmentation in 62 of 75 patients (80% followup) who were available for clinical review at a minimum 2-year followup. Subjective, clinical, func tional, Cybex dynamometer, and KT-1000 arthrometer tests were performed along with modified tests of the Hospital for Special Surgery, Noyes Cincinnati, Tegner, and Lysholm knee rating scales. Ninety-two percent had a negative pivot shift at followup. The mean Cybex dynamometer extension deficits postoperatively were 9% and 7% at 180 and 240 deg/sec. Mild patellar pain symptoms were noted in 18%. The reoperation rate was 10% with a mild flexion contracture as the most common reason. The Hospital for Special Surgery scoring scale postoperatively was 88; Noyes, 86; Lysholm, 88; and Tegner, 6. Mean postoperative single-legged and ver tical jump indices were 88% and 87%, respectively. The KT-1000 arthrometric evaluation postoperatively revealed a mean maximum manual difference of 0.3 mm; 92% of the patients had a maximum manual dif ference of ≤3 mm. Subjectively, 95% indicated that they would undergo the procedure again. Early results demonstrate excellent stability, preservation of motion, and encouraging evaluations by scoring scales and arthrometric evaluation.
Effects of a Functional Knee Brace on Leg Muscle Function
Authors: Styf Jorma R. , Lundin Olof , Gershuni David H.
Published: June 2007

The effects of a functional knee brace on local intra muscular pressures and on calculated blood perfusion pressure in the tibialis anterior muscle of the legs of six volunteers were determined. Torque generation during dorsiflexion of the ankle joint was measured with a Ki netic Computerized ergometer, and the time to elicit muscle fatigue during exercise was recorded. For each experimental subject studies compared right with left unbraced legs, then right braced with left unbraced legs, and finally right unbraced with left braced legs. In the braced leg, intramuscular pressure at rest and muscle relaxation pressure during exercise were significantly higher, and the time to elicit muscle fatigue was 35% shorter. The calculated local blood perfusion pressure was lower because of the increased muscle relaxation pressure. We conclude that the increased muscle re laxation pressure during exercise caused by a knee brace is a possible explanation for the premature development of muscle fatigue in the braced leg.
Comparison of Various Icing Times in Decreasing Bone Metabolism and Blood Flow in the Knee
Authors: Ho Sherwin S. W. , Illgen Richard L. , Meyer Richard W. , Torok Peter J. , Cooper Malcolm D. , Reider Bruce
Published: June 2007

In a previous study we used technetium-99m bone scans to show that cooling a knee for 20 minutes with a standard ice wrap will decrease soft tissue blood flow by a mean of 26%, and skeletal blood flow and me tabolism by 19%. The present study examined the ef fects of shorter and longer icing periods to determine minimum cooling time for a measurable and consistent decrease, and time to produce maximal decrease within a safe period of icing (<30 minutes). Thirty-eight sub jects were studied. An ice wrap was applied to one knee for an assigned time (5, 10, 15, 20, or 25 minutes). Triple-phase bone scans of knees were obtained; mean percentages of decrease in the iced knee for each of the five time groups at each of the three phases of the bone scan were calculated and compared. Mean decreases of 11.1 % in soft tissue blood flow, and 5.1% in skeletal metabolism and blood flow were measured at 5 min utes ; maximums of 29.5% and 20.9%, respectively, were obtained at 25 minutes. A small but consistent decrease in soft tissue blood flow and skeletal blood flow and metabolism in a knee appear to be obtained with as little as 5 minutes of ice application. This effect is time-dependent and can be enhanced three- to four fold by increasing the ice application time to 25 minutes.
Acromioclavicular Separation
Authors: Morrison David S. , Lemos Mark J.
Published: June 2007

A total of 110 patients with a diagnosis of acromiocla vicular joint separation were seen at our clinic between 1986 and 1991. Of these, 14 patients (12.7%) with grade III, IV, or V injuries required surgical reconstruc tion and were examined 2 years after surgery. All 14 patients underwent acromioclavicular reconstruction using a synthetic loop passed through drill holes in the base of the coracoid and the anterior third of the clavicle. When the loop is tightened, the clavicle is reduced ana tomically without the anterior subluxation caused by simple clavicular cerclage. At an average followup of 44.2 months, patients were evaluated using the Uni versity of California, Los Angeles, rating scale. Twelve of the 14 had good or excellent results and returned to normal sport and work activities at 6 months. Of the two initial poor results, one required revision 1 month post operatively because the patient was noncompliant, and the other required manipulation under anesthesia 3 months after surgery. The results in these two patients at 2 years were good and excellent, respectively. We concluded that, when medically indicated, fixation of the clavicle to the coracoid using this technique yields sat isfactory results in an athletic population.
The Synergistic Action of the Capsule and the Shoulder Muscles
Authors: Guanche Carlos , Knatt Theodore , Solomonow Moshe , Yun Lu  , Baratta Richard
Published: June 2007

The existence of a reflex arc from the glenohumeral capsule to several muscles crossing the shoulder joint was determined in the feline model. Three branches of the axillary nerve terminating in the glenohumeral cap sule were identified and electrically stimulated with su pramaximal, 100-μsec pulses using bipolar hook elec trodes. Stimulation of the anterior and the inferior axillary articular nerves elicited electromyographic ac tivity in the biceps, subscapularis, supraspinatus, and infraspinatus muscles. Stimulation of the posterior ax illary articular nerve elicited electromyographic activity in the acromiodeltoid muscle. Transection of the three articular nerves just distal to their emergence from the main axillary nerve resulted in the absence of any elec tromyographic activity in the muscles on stimulation, confirming the afferent nature of the articular branches. The time from application of the stimulus to the appear ance of a response in the muscles varied from 2.7 msec in the biceps to 3.1 msec in the supraspinatus.

The existence of a reflex arc from mechanoreceptors within the glenohumeral capsule to muscles crossing the joint confirms and extends the concept of synergism between the passive (ligaments) and active (muscles) restraints of the glenohumeral joint. This provides new information in orthopaedic sciences that has direct application in modification of surgical repairs and therapeutic modalities of shoulder injuries.
Vascular Density at the Myotendinous Junction of the Rat Gastrocnemius Muscle After Immobilization and Remobilization
Authors: Kvist Martti , Hurme Timo , Kannus Pekka , Järvinen Teppo , Maunu Vesa-Matti , Jozsa Laszlo , Järvinen Markku
Published: June 2007

Muscle injuries often occur at or near the myotendinous junction. Immobilization decreases the tensile strength of the myotendinous junction and predisposes it to strain injury. However, there are no data available on whether physical training or remobilization can lower the susceptibility of the myotendinous junction to strain injuries. We investigated the effects of three different remobilization programs (8 weeks) after immobilization (3 weeks) by evaluating the vascular density at the myo tendinous junction of the rat gastrocnemius muscle.

The myotendinous junctions had a portal system vas cularity, or capillary-arteriole-capillary system, which probably protects the blood supply against pathologic conditions. The vascular density at the myotendinous junction decreased about 30% after immobilization (P< 0.001). After free cage remobilization for 8 weeks, the mean vascular density returned to the level of the con trols. After progressively increasing running programs the vascular density was slightly higher in the immobi lized myotendinous junction and about 50% higher than controls in the contralateral myotendinous junction ( P < 0.001). The capacity of the vascular bed of the rat myo tendinous junction to recover from immobilization atro phy seems to be good. Progressively increasing physi cal training improves the process of revascularization and probably protects an injured and immobilized muscle from reinjury.
Lateral Traction During Shoulder Arthroscopy: Its Effect on Tissue Perfusion Measured by Pulse Oximetry
Authors: Hennrikus William L. , Mapes Randall C. , Bratton Michael W. , Lapoint John M.
Published: June 2007

We studied the effect of three methods of shoulder trac tion during arthroscopy on arterial oxygen saturation measured by a pulse oximeter applied to the fingertip of the arm in traction. Simple longitudinal traction ablated the oxygen saturation in only 1 of 30 patients. Adding vertical traction perpendicular to the arm ablated the oxygen saturation in 25 of 30 patients when a 2-inch wide sling was used and in 7 of 30 patients when a 4-inch sling was used. In this series, the pulse oximeter did not demonstrate gradual gradations in arterial oxy gen saturation loss. Rather, the pulse oximeter provided an all-or-none warning signal for tissue hypoxia.
Incomplete, Intrasubstance Strain Injuries of the Rectus Femoris Muscle
Authors: Hughes Charles , Hasselman Carl T. , Best Thomas M. , Martinez Salutario , Garrett William E.
Published: June 2007

Rectus femoris muscle strain injuries commonly occur at the distal muscle-tendon junction of the quadriceps tendon. However, we have recently recognized a pat tern of strain injury that consists of an incomplete in trasubstance tear at the muscle-tendon junction formed by the deep tendon of the muscle's indirect head and those muscle fibers originating from this tendon. These injuries are found more proximally within the thigh than the "classic" distal rectus femoris muscle strain. We re viewed 10 athletes with these intrasubstance tears, all of whom had diagnostic imaging performed using com puted tomography or magnetic resonance imaging or both. Two of these patients required surgical interven tion. The mechanism of injury usually involved kicking or sprinting. All patients had chronic thigh pain or an anterior thigh mass or both. Physical examination re vealed thigh asymmetry and a nontender to mildly ten der intrasubstance muscle mass. Magnetic resonance imaging demonstrated abnormal signal intensity cen tered about the intramuscular tendon of the indirect head of the muscle. Surgical findings included a mass of fibrous scar and fatty tissue encasing the deep ten don. Surgical removal of this fibrous mass appears curative. We contrast this injury from distal strains of the rectus femoris muscle, as well as from soft tissue neoplasms.
Long-Term Followup of Bankart Reconstruction
Authors: Rosenberg Benjamin N. , Richmond John C. , Levine William N.
Published: June 2007

We identified 52 patients (56 shoulders) who underwent Bankart reconstructions for recurrent anterior instability between 1970 and 1983. We wanted to determine the prevalence of late degenerative arthrosis of the gleno humeral joint. Thirty-one patients (33 shoulders) re turned for evaluation consisting of a questionnaire, physical examination, and radiographs, at an average 15-year followup. A true anteroposterior view and an axillary lateral view of both shoulders were obtained to identify signs of glenohumeral degenerative disease. The Bankart rating score devised by Rowe et al. was used to determine the subjective and objective out come. The average Bankart score was 84. Average re striction of external rotation was 18° with the arm at the side and 15° with the arm abducted 90°. Radiographic evaluation showed that 13 operated shoulders had nor mal radiographs, 14 had minimal degenerative changes, 3 had moderate changes, and 1 had severe changes. The patient with severe degenerative changes had marked restriction of external rotation of his operated shoulder. Statistical analysis using Spear- man correlation coefficients revealed that there was a relationship between degenerative radiographic changes and restriction of external rotation with the arm abducted 90° and length of followup, although correla tions were limited because of the small number of pa tients with degenerative changes.
Test-Retest Reliability of Ankle Injury Risk Factors
Authors: Baumhauer Judith F. , Alosa Denise M. , Renström Per A. F. H. , Trevino Saul , Beynnon Bruce
Published: June 2007

Ligamentous instability, ankle muscle weakness, foot ankle alignment, and generalized joint laxity may be predisposing factors for ankle ligament injuries. The purpose of this study was to examine the reliability of these risk factors before and after the season in healthy individuals and to determine if any significant differ ences developed during the athletic season (range, 12 to 16 weeks). Twenty-one healthy college-aged ath letes were tested for generalized joint laxity, anatomic alignment of the foot and ankle, ligamentous stability, and isokinetic strength of the ankle muscles. This study showed that generalized joint laxity, ankle ligamentous stability, and ankle strength measurements demon strated high correlation coefficients ( r > 0.75). The high correlation coefficients suggested reliable measures. Some of the range of motion measurements had lower correlation coefficients, which suggested more variabil ity in these measurements. After establishing the reli ability in 24 of the 28 measurements with standardized methods, further work is underway to evaluate the role of these factors in inversion ankle sprains.
Anterior Cruciate Ligament Reconstruction as an Outpatient Procedure
Authors: Tierney Gregory S. , Wright Rick W. , Patrick Smith J. , Fischer David A.
Published: June 2007

During a 27-month period, 222 patients with 227 ante rior cruciate ligament-deficient knees underwent arthro scopically assisted reconstructions as outpatient pro cedures. Bone-tendon-bone autografts were used for 169 of these reconstructions; the other 58 were done with bone-tendon-bone allografts. Additional proce dures were performed on 180 of the patients. The in terval from injury to reconstruction averaged 29 months. The protocol developed at our clinic employs a general anesthetic administered with the intent of same-day dis charge, infiltration of the skin and joint with bupivacaine, a cold compressive dressing, and the use of both ke torolac tromethamine and a Schedule III narcotic (ac etaminophen with codeine or with propoxyphene) for postoperative pain control. At an average followup of 10 months, no readmissions in the immediate postopera tive period had been required and no short- or long-term postoperative complications could be attributed to the protocol. This safe and effective technique offers the patient the advantage of anterior cruciate ligament re construction as a same-day procedure and allows the surgeon to implement its use in any outpatient setting without additional discharge planning.
Knee Hyperextension Galt Abnormalities in Unstable Knees
Authors: Noyes Frank R. , Dunworth Laura A. , Andriacchi Thomas P. , Andrews Michelle , Hewett Timothy E.
Published: June 2007

Five patients with symptomatic knee hyperextension thrusting patterns due to posterolateral ligament com plex injury underwent gait analysis before and after a gait retraining program. Patients were trained to avoid knee hyperextension by 1) walking with their knees slightly flexed throughout stance, 2) maintaining ankle dorsiflexion in early stance, and 3) maintaining an erect trunk-hip attitude during stance. Kinematic and kinetic measurements were obtained using automated gait analysis. Four of the five patients significantly reduced hyperextension at the knee and abnormal motion pat terns at the hip and ankle. Patients showed increases in knee flexion throughout stance conversions of knee flexion-extension moments to more normal biphasic patterns with a 79% decrease in extension moments at terminal extension, and a 22% decrease in knee ad duction moments. Posttraining values also showed a 30% decrease in the calculated medial tibiofemoral loads ( P < 0.05). At the hip, there were significant decreases in abduction and adduction moments (36% and 18%, respectively, P < 0.01). Ankle plantar flexion motion decreased significantly by 42% ( P < 0.01). Gait retraining can alter the biomechanics of hip, knee, and ankle function to approximately normal levels, and therefore is recommended before ligament reconstruc tion because abnormal knee motions, if resumed post operatively, can stretch soft tissue reconstructions.
Stress Fractures of the Ribs in Golfers
Authors: Lord Michael J. , Kwon Ick Ha  , Kwang Soon Song
Published: June 2007

During a collaborative review at three institutions, we documented 19 cases of stress fractures of the ribs in golfers. There were 13 men and 6 women with an average age of 39 years (range, 29 to 51). The 4th to 6th ribs were the most commonly injured. All fractures occurred along the posterolateral aspect of the ribs, and nine patients had fractures in more than one rib. Sixteen golfers sustained injury on the leading arm side of the trunk. Eighteen golfers were beginners, and the one experienced golfer had dramatically increased his practice time on the driving range before injury. Plain radiographs were usually diagnostic. However, bone scintigraphy was necessary to reach a diagnosis in three cases. A delay in diagnosis of 6 to 8 months occurred in two cases that were originally misdiag nosed as back strains. Stress fractures of the ribs in golfers may be more common than previously realized and may be incorrectly diagnosed as recalcitrant back strains. Based on the findings of other studies, we think fatigue of the serratus anterior is the mechanism of injury. We recommend strengthening the serratus an terior as rehabilitation after this injury and in a general conditioning program for golfers.
Football Cleat Design and Its Effect on Anterior Cruciate Ligament Injuries
Authors: Lambson Rick B. , Barnhill Bill S. , Higgins Robert W.
Published: June 2007

A 3-year prospective study was initiated to evaluate torsional resistance of modern football cleat designs and the incidence of surgically documented anterior cruciate ligament tears in high school football players wearing different cleat types. We compared four styles of football shoes and evaluated the incidence of ante rior cruciate ligament tears among 3119 high school football players during the 1989 to 1991 competitive seasons. The four cleat designs were 1) Edge, longer irregular cleats placed at the peripheral margin of the sole with a number of smaller pointed cleats positioned interiorly (number of players wearing this shoe, 2231); 2) Flat, cleats on the forefoot are the same height, shape, and diameter, such as found on the soccer- style shoe ( N = 832); 3) Screw-in, seven screw-in cleats of 0.5 inch height and 0.5 inch diameter ( N = 46); and 4) Pivot disk, a 10-cm circular edge is on the sole of the forefoot, with one 0.5-inch cleat in the center ( N = 10). The results showed that the Edge design produced significantly higher torsional resistance than the other designs ( P < 0.05) and was associated with a significantly higher anterior cruciate ligament injury rate (0.017%) than the other three designs combined (0.005%).
Patellar Height Ratios
Authors: Berg Eugene E. , Mason Steven L. , Lucas Michael J.
Published: June 2007

Three blinded observers on three separate occasions calculated four commonly employed patellar height ra tios on the knees of 15 patients who had three lateral radiographs each. The observers used the same mea surement instrument, a hand-held goniometer ruler, to determine the relative reliability of each patellar height ratio. The measurements by the three observers were examined, and the error and reliability of the four meth ods of measurement were tested statistically. Among the four methods of measuring patellar height that we studied, the Blackburne-Peel method most consis tently reproduced the patellar height index. Interob server measurement error averaged 0.06 for all ratios. Values greater than 0.06 represented real patellar height changes. The ratios were not significantly af fected by the change of knee flexion angle from 30° to 50°. Side-to-side patellar height measurement differ ences averaged 0.16, which suggests that the healthy contralateral limb is not reliable as a control. Mild ar thritic changes decreased variability of measurements by an average of 24% because small osteophytes better defined the articular margins of the patella.
Arthroscopic Anterior Labral Reconstruction Using a Transglenoid Suture Technique
Authors: Mologne Timothy S. , Lapoint John M. , Morin William D. , Zilberfarb Jeff , O'Brien T. Jeff
Published: June 2007

We report the clinical outcome of arthroscopic labral reconstruction using a transglenoid suture technique in a young, active-duty military population. Forty-eight patients (49 shoulders) with varying degrees of gleno humeral instability underwent arthroscopic labral re construction using a transglenoid suture technique. All patients had traumatic injuries to their shoulders and all patients had magnetic resonance imaging scans dem onstrating anterior labral tears. Postoperatively, the patients' shoulders were immobilized for up to 6 weeks. At a mean followup of 30 months (range, 12 to 49), 17 of the 41 patients (41%) with preoperative dislocation or subluxation had recurrent instability. Nine of these patients subsequently underwent open reconstruction procedures for recurrent instability. On the basis of the Rowe rating system, 53% had excel lent or good results and 47% had fair or poor results. The overall perioperative complication rate was 14%. Suprascapular nerve palsy occurred in three cases (6%). Using the Fisher exact test, we determined that immobilization for 6 weeks postoperatively correlated with a lower recurrence rate in the patients with a history of glenohumeral dislocation (P = 0.007). The results of arthroscopic labral reconstruction using transglenoid sutures in the military patient are inferior to the reported 3% to 5% recurrence rate with open Bankart procedures, and the transglenoid pin tech nique jeopardizes the suprascapular nerve.
Strategies for Attachment Site Locations and Twist of the Intraarticular Anterior Cruciate Ligament Graft
Authors: Draganich Louis F. , Hsieh Yeou-Fang , Reider Bruce
Published: June 2007

We modeled an intraarticular anterior cruciate ligament graft and investigated the effects of attachment orien tation and twist of the graft on its isometry during quadriceps muscle loading. Physiologic levels of quad riceps muscle loads were applied to 15 intact cadaveric knees. We measured the changes in distance between points on the tibia and femur for knee flexion angles between 0° and 120° using a three-dimensional digi tizer. Selected points on the tibia and femur, represent ing graft attachment sites, allowed us to model the graft as a broad band. Distance was used to approximate graft fiber length. A 180° twist in the graft significantly reduced the maximal range of changes in distance when the graft was attached in the anteroposterior direction. Range is defined as the difference between the largest and smallest changes in distance among the fibers of the graft for a given angle of flexion. This reduction enhanced isometry among the fibers of the graft. Enhanced isometry would be expected to en hance load sharing among these fibers, thereby in creasing the overall strength of the graft. For a graft 10 mm wide and 4 mm thick, the dimensions of a typical patellar tendon graft, the best overall isometry was found when the breadth of the graft was attached to the tibia in the mediolateral direction, to the femur along the most isometric line, and with a 180° twist in the graft.
An Electromyographic Analysis of the Shoulder During a Medicine Ball Rehabilitation Program
Authors: Cordasco Frank A. , Wolfe Ira N. , Wootten Mary E. , Bigliani Louis U.
Published: June 2007

We used dynamic electromyography and a motion analysis system to describe the muscle firing patterns in 10 shoulder muscles and the basic kinematics of a two-handed overhead medicine ball throw. Ten healthy male subjects with no history of shoulder injury were evaluated. The two-handed medicine ball throw was divided into three phases for analysis: cocking, accel eration, and deceleration. The average duration of the throw was 1.92 seconds; the cocking phase repre sented 56%, the acceleration phase 15.5%, and the deceleration phase 28.5% of the throw. In the cocking phase, the upper trapezius, pectoralis major, and an terior deltoid muscles showed high activity (>40% to 60% maximum manual test), and the rotator cuff mus cles had moderate activity (>20% to 40%). In the acceleration phase, five of the muscles demonstrated high levels of activity (>40% to 60%) and the upper trapezius and lower subscapularis muscles had very high levels of activity (>60%). Analysis of the deceler ation phase revealed high activity in the upper trape zius muscle and moderate activity in all other muscles except the pectoralis major. Our findings support the use of medicine ball training as a bridge between static resistive training and dynamic throwing in the rehabil itation of the overhead athlete. This training technique provides a protective method of strengthening that closely simulates portions of the throwing motion.
The Manual Muscle Examination for Rotator Cuff Strength
Authors: Kelly Bryan T. , Kadrmas Warren R. , Speer Kevin P.
Published: June 2007

The electromyographic activity of eight muscles of the rotator cuff and shoulder girdle (supraspinatus, in fraspinatus, subscapularis, pectoralis, latissimus dorsi, and the anterior, middle, and posterior deltoid) was measured from the nondominant shoulders of 11 sub jects during a series of 29 isometric contractions. The contractions simulated different positions used for strength testing of the rotator cuff and involved eleva tion, external rotation, and internal rotation at three degrees of initial humeral rotation (-45° of internal rotation, 0°, +45° of external rotation) and scapular elevation (0°, 45°, 90°). Isolation of the supraspinatus muscle was best achieved with the test position of elevation at 90° of scapular elevation and +45° (exter nal rotation) of humeral rotation. Isolation of the in fraspinatus muscle was best achieved with external rotation at 0° of scapular elevation and -45° (internal rotation) of humeral rotation. Isolation of the subscap ularis muscle was best achieved with the Gerber push- off test. This study used four criteria for identifying the optimal manual muscle test for each rotator cuff mus cle : 1) maximal activation of the cuff muscle, 2) minimal contribution from involved shoulder synergists, 3) min imal provocation of pain, and 4) good test-retest reli ability. Based on the results of this study and known painful arcs of motion, an objective identification of the optimal tests for the manual muscle testing of the cuff was elucidated.
Development of a Distance-Based Interval Throwing Program for Little League-Aged Athletes
Authors: Axe Michael J. , Snyder-Mackler Lynn , Konin Jeff G. , Strube Michael J.
Published: June 2007

We developed a distance-based interval throwing pro gram for Little League-aged athletes (9 to 12 years) to be used in training and rehabilitation. The timing and repetition parameters were developed from data col lected during 400 innings of organized baseball during a single season, and short toss distance from Little League rules for field dimensions. There were 1022 boys from organized baseball teams in the four stud ies. Maximal distance and speed measurements were recorded for 853 boys. We developed a mathematical model from these data to predict maximal throwing distance from maximal throwing speed. This model was then tested on a second sample of 114 players. We compared the predicted distance with the actual maximal throwing distance; the correlation coefficient was 0.92. Forty players aged 9 to 12 participated in a study to assess degradation of speed and distance. The average variability of the speed was small (<5 mph), but the variability in distance was large (22.4 feet). Fifteen boys then threw the entire throwing pro gram as designed. These results show that healthy young athletes can be expected to be able to throw the predicted value of this practical progressive interval throwing program for Little League-aged athletes. The appropriate program can be assigned from age and known preinjury pitch speed.
Chondral Delamination of the Knee in Soccer Players
Authors: Levy Andrew S. , Lohnes John , Sculley Sean , LeCroy Michael , Garrett William
Published: June 2007

This study reports on the diagnosis and treatment of chondral delamination in the knees of soccer players. The authors attempted to provide a clinical standard for comparison with emerging cartilage repair techniques. Twenty-three consecutive chondral fractures in a ho mogeneous population of athletes were evaluated us ing physical examination, magnetic resonance imag ing, and arthroscopic examination. All knees were treated with debridement to a stable border and re moval of the calcified cartilage base. Results were graded using the scoring system advocated by propo nents of chondral transplant. All patients reported pain that limited soccer activities. Effusions occurred in 48%, joint line tenderness in 33%, and crepitus in 19% of the knees. Results from magnetic resonance imag ing correlated with arthroscopic examination in 21 % of the knees. Arthroscopic examinations revealed lesions on the medial femoral condyle in eight patients, the patella in six, the lateral femoral condyle in six, and the trochlea in three. Athletes returned to play at an aver age of 10.8 weeks. Repeat arthroscopic procedures in eight cases revealed fibrocartilage at the initial site. There were 6 excellent, 9 good, 0 fair, and 0 poor results at their 1-year followup examinations (15 knees). The definitive diagnosis of chondral delamina tion relies on a thorough arthroscopic probing of the articular surface. The early functional results of this treatment compare favorably with the autologous transplantation technique. Caution, however, is recom mended when treating articular cartilage injuries be cause no long-term data exists on whether any treat ment modality can prevent the development of degenerative joint disease.