bluuebunny/crossref_metadata_2025 huggingface dataset:
Iliotibial Band Tenodesis: A New Strategy for Attachment
Authors: Draganich Louis F. , Hsieh Yeou-Fang , Reider Bruce
Published: June 2007

We investigated the changes in distance between Gerdy's tubercle on the tibia and points on the posterior two thirds of the lateral surface of the lateral femoral condyle and adjacent lateral femoral shaft in 15 cadav eric knees. A three-dimensional digitizer was used to quantify motion of the knee during flexion ranging from full extension to 120° of flexion. Four load states were applied: internal, external, and neutral rotation, and quadriceps muscles loads based on one third of values in the literature for maximal isometric quadriceps muscles moments. The femoral location most isometric to Gerdy's tubercle was found to be strongly influenced by the load state.

A 1.0 cm wide iliotibial band tenodesis was mod elled by five straight lines arising from Gerdy's tu bercle and attaching to a simulated washer at the junction of the lateral femoral condyle and shaft. Using this model and the motion data obtained from the cadavers, we investigated the effects of quadri ceps muscles loading and external rotation of the knee on changes in the distances between these tibial and femoral attachments for each of the five lines. A 180° twist modelled into the tenodesis sig nificantly reduced the range of changes in distance (difference between the largest and smallest changes in distance among the lines for a given angle of flex ion) for both of these load states. Therefore, a 180° twist in the tenodesis can enhance isometry among the fibers of the tenodesis. This implies that a 180° twist can enhance load sharing among the fibers of the tenodesis and, therefore, enhance the overall strength of the tenodesis.
Resection and Repair for Medial Tennis Elbow
Authors: Ollivierre Carl O. , Nirschl Robert P. , Pettrone Frank A.
Published: June 2007

Fifty cases in 48 patients of intractable medial tennis elbow tendinosis (medial humeral epicondylitis) were treated surgically from 1985 to 1990 with identification and excision of the injured tendon, while retaining and closing the resection defect. All patients had symptoms that were aggravated by repetitive upper extremity ac tivities and had failed to improve with nonoperative therapy. At surgery, the flexor carpi radialis-pronator teres interval was involved in 28 cases. Histologic ex amination revealed angiofibroblastic tendinosis and fibrillary degeneration of collagen. Postoperative fol lowup averaged 37 months. An analog scale was used to analyze pain intensity, and pain occurrence was evaluated by a pain phase scale. All patients reported partial or complete pain relief postoperatively (improve ment in their pain phase and pain intensity scales). Pre operatively, 14 patients had pain at rest; all 14 had relief of this pain postoperatively. Ten patients did not return to their sporting or occupational activities. Objective dy namometer strength testing revealed a significant im provement postoperatively in all patients; no major com plications were seen in this series. A large percentage of patients who fail conservative treatment for medial humeral epicondylitis (tendinosis) can obtain pain relief and return to activities with the described operative technique.
Strategies for an Anterior Capsular Shift of the Shoulder
Authors: Speer Kevin P. , Xianghua Deng  , Torzilli Peter A. , Altchek David A. , Warren Russell F.
Published: June 2007

We evaluated the effect of two different anterior cap sular shift strategies on load-induced multidirectional glenohumeral motion. Nine cadaveric shoulders were tested on a special test apparatus in which three mo tions were constrained but which allowed simultaneous measurement of three translations: anteroposterior, mediolateral, and superoinferior. A simulated Bankart lesion was created by detaching the inferior glenohu meral ligament and labrum from the anterior glenoid from 5 mm superior to the anterior band of the inferior glenohumeral ligament to a point just posterior to the infraglenoid tubercle. The two types of medial-based anterior capsular shifts were performed sequentially using fixation via a transglenoid drill hole and No. 2 su ture. One shift medialized the anterior capsule on the glenoid by 5 mm; the other one shifted the anterior cap sule 5 mm superior on the anterior glenoid. Biomechani cal testing was done in two positions of humeral eleva tion in the scapular plane, three positions of humeral rotation, and with an externally applied joint compres sion load of 22 N. Glenohumeral motion was measured in the intact state, after creation of the simulated Bankart lesion, and after each of the two anterior capsular shifts. Both the superior and medial shifts of the capsule de creased anterior glenohumeral translation to equivalent extents. For posterior and inferior translation at 45° el evation, the superior shift significantly decreased trans lation to a greater extent than did the medial shift.
Outcome of Elbow Surgery in Professional Baseball Players
Authors: Andrews James R. , Timmerman Laura A.
Published: June 2007

We reviewed the records of 72 professional baseball players who underwent arthroscopic or open elbow sur gery. The most common diagnoses were posteromedial olecranon osteophyte (65%), ulnar collateral ligament injury (25%), and ulnar neuritis (15%). Intraarticular loose bodies were found in 39% of the patients. Fifty- nine patients (82%) were observed for a minimum of 24 months, with an average of 42 months' followup. Forty- seven players (80%) returned to play for a minimum of one season (73% at the same or higher level of play), and 17% of the players retired initially because of their elbow injury. One third of the players required two or more surgical procedures, with 25% of these patients requiring an ulnar collateral ligament reconstruction after removal of a posteromedial olecranon osteophyte. The patients with posteromedial olecranon osteophytes had the highest rate of reoperation, and patients who underwent ulnar collateral ligament reconstruction had a higher rate of return to play. The incidence of ulnar collateral ligament injuries was most likely underesti mated in this group of athletes, with initial treatment directed at the secondary injuries instead of the primary ulnar collateral ligament injury.
Tibial Stress Reaction in Runners
Authors: Fredericson Michael , Bergman A. Gabrielle , Hoffman Kenneth L. , Dillingham Michael S.
Published: June 2007

Medial tibial pain in runners has traditionally been di agnosed as either a shin splint syndrome or as a stress fracture. Our work using magnetic resonance imaging suggests that a progression of injury can be identified, starting with periosteal edema, then progressive mar row involvement, and ultimately frank cortical stress fracture. Fourteen runners, with a total of 18 sympto matic legs, were evaluated and, within 10 days, referred for radiographs, a technetium bone scan, and a mag netic resonance imaging scan. In 14 of the 18 symp tomatic legs, magnetic resonance imaging findings cor related with an established technetium bone scan grading system and more precisely defined the ana tomic location and extent of injury. We identified clinical symptoms, such as pain with daily ambulation and physical examination findings, including localized tibial tenderness and pain with direct or indirect percussion, that correlated with more severe tibial stress injuries. When clinically warranted, we recommend magnetic resonance imaging over bone scan for grading of tibial stress lesions in runners. Magnetic resonance imaging is more accurate in correlating the degree of bone in volvement with clinical symptoms, allowing for more ac curate recommendations for rehabilitation and return to impact activity. Additional advantages of magnetic reso nance imaging include lack of exposure to ionizing ra diation and significantly less imaging time than three- phase bone scintigraphy.
An Explanation for Various Rectus Femoris Strain Injuries Using Previously Undescribed Muscle Architecture
Authors: Hasselman Carl T. , Best Thomas M. , Hughes Charles , Martinez Salutario , Garrett William E.
Published: June 2007

We performed cadaveric dissection of the rectus femo ris muscle to correlate the various lesions of strain injury seen with imaging studies to the muscular anatomy. The proximal tendon is composed of a superficial, an terior portion from the direct head, and a deep intra muscular portion from the indirect head. The muscle fibers arising from the anterior superficial tendon of the direct head travel in a posterior and distal direction to insert on the posterior tendon of insertion, giving the proximal muscle a unipennate architecture. Muscle fi bers from the intramuscular tendon of the indirect head originate on both the medial and lateral sides of the tendon and insert on the distal posterior tendon to cre ate its bipennate structure. Three chronic strain injuries involving the midmuscle belly substance were explored grossly and microscopically. It appears that one type of acute strain injury occurs in the midmuscle belly with disruption of the muscle-tendon junction of the intra muscular tendon resulting in local hemorrhage and edema. More chronically, this hematoma organizes into a fatty, loose connective tissue encasement of the deep intramuscular proximal tendon. Serous fluid from the hematoma may remain within the connective tissue sheath, creating a pseudocyst with the deep intra muscular tendon of the indirect head at its center. The muscle's anatomy helps to explain a different rectus femoris strain injury.
Arthroscopic Findings After Shoulder Dislocation
Authors: Hintermann Beat , Gächter André
Published: June 2007

The purpose of this study was to evaluate prospectively the arthroscopic findings of the unstable shoulder, to provide insights into the causes and mechanisms of shoulder instability, and to establish a rationale for using special surgical procedures. Arthroscopic examination was performed on 212 patients who had at least 1 docu mented shoulder dislocation. Of these 212 patients, 184 (87%) patients had anterior glenoid labral tears, 168 (79%) patients had ventral capsule insufficiency, 144 (68%) patients had Hill-Sachs compression fractures, 116 (55%) patients had glenohumeral ligament insuf ficiency, 30 (14%) patients had complete rotator cuff tendon tears, 26 (12%) patients had posterior glenoid labral tears, 14 (7%) patients had superior labrum an terior and inferior lesions. As this prospective study shows, multiple morphologic changes are associated with instability of the glenohumeral joint; there is no single cause for an unstable shoulder. Arthroscopic ex amination of the shoulder before surgery revealed a sig nificant amount of information that would have been un detected without the aid of expensive diagnostic tools. For instance, the labrum and rim of the anteroinferior glenoid showed typical abnormalities corresponding to different entities of anterior instability.
Ligament Stability Two to Six Years After Anterior Cruciate Ligament Reconstruction with Autogenous Patellar Tendon Graft and Participation in Accelerated Rehabilitation Program
Authors: Shelbourne K. Donald , Klootwyk Thomas E. , Wilckens John H. , De Carlo Mark S.
Published: June 2007

We studied patients who participated in our accelerated rehabilitation program after anterior cruciate ligament reconstructive surgery to determine if they showed signs of patellar tendon graft stretching. This program initiated in 1987 emphasizes early full hyperextension, early weightbearing as tolerated, and closed-chain functional activities with rapid return to sports when the patient has attained full range of motion, approximately 65% of strength, and has accomplished the running and agility drills prescribed. A total of 209 patients met the criteria of KT-1000 arthrometer followup at the time full range of motion (5°/0°/135°) was attained and at 2 years or more after surgery. The KT-1000 arthrometer manual maximum difference between the reconstructed and normal knees was used as the indicator of change in the graft length. All patients completed postoperative sub jective questionnaires. The mean KT-1000 arthrometer value was 2.06 mm (SD, ±2.2) at full range of motion and 2.10 mm (SD, ±1.9) at more than 2 years of fol lowup (P = 0.7961). The patients' subjective stability scores averaged 19.6 with 97% reporting no instability episodes. Based on our findings, we conclude that an accelerated rehabilitation program after this type of re construction does not affect long-term stability as meas ured by the KT-1000 arthrometer.
Effects of an Accelerated Rehabilitation Program after Anterior Cruciate Ligament Reconstruction with Combined Semitendinosus-Gracilis Autograft and a Ligament Augmentation Device
Authors: MacDonald Peter B. , Hedden David , Pacin Ondrej , Huebert David
Published: June 2007

Forty patients with anterior cruciate reconstructions using semitendinosus and gracilis autografts and a liga ment augmentation device were reviewed at a minimum of 20 months postoperatively to determine if an accel erated rehabilitation program was detrimental to inter mediate follow-up results. The rehabilitation program included immediate full weightbearing, using crutches as aids for 2 weeks only, and a Generation II rehabili tation brace set at full range of motion for 2 weeks fol lowed at 2 weeks by bicycle riding and strengthening exercises. Return to sports was allowed at 4 months for nonpivoting sports and at 6 months for level 1 sports involving pivoting. Thirty-seven patients were available for followup. At followup, three grafts were determined to be nonfunctional (KT-1000 arthrometer testing indi cating >4 mm of side-to-side difference). The other 34 patients had good or excellent results, with all returning to their preinjury levels of sport with a brace. Early ac celerated rehabilitation after anterior cruciate ligament reconstruction with semitendinosus and gracilis tendon autograft and a ligament augmentation device does not seem to affect the results adversely. Results in this se ries were as good as or better than other series using the same reconstructive technique.
Long-term Results of Arthroscopic Meniscal Repair
Authors: Eggli Stefan , Wegmüller Herbert , Kosina Jana , Huckell Cameron , Jakob Roland P.
Published: June 2007

From 1984 through 1986 we performed 54 arthroscopic meniscal repairs on patients with anterior cruciate ligament-stable knees. We evaluated the repair results of 52 of these patients at an average followup of 7.5 years. In 40 patients the meniscal repairs had not failed and these patients were examined clinically and radio- graphically ; in 25 cases, magnetic resonance imaging was also performed. Significantly more failures ( P ≤ 0.05) occurred when the rim width of the tear was greater than 3 mm and when the tear was repaired with resorbable sutures. Conversely, the following factors were found to favorably influence meniscal healing (P > 0.05): time from injury to surgery less than 8 weeks, patient age less than 30 years, tear length less than 2.5 cm, and tear in the lateral meniscus. The overall failure rate after 7.5 years was 27% (14 of 52); 64% (9 of 14) of the failures occurred in the first 6 months after repair. The clinical and radiographic evaluation of the success fully repaired knees showed that 90% (36 of 40) had normal knee function; the remaining 10% (4 patients) had nearly normal knee function. Magnetic resonance imaging, however, showed a persisting grade 3 or 4 lesion in 96% (24 of 25) of the successfully repaired menisci and is therefore not reliable in assessing me niscal healing.
The Effect of Cast Immobilization on Meniscal Healing
Authors: Dowdy Paul A. , Miniaci Anthony , Arnoczky Steven P. , Fowler Peter J. , Boughner Derek R.
Published: June 2007

A 1.5-cm longitudinal, full-thickness incision was made in the vascularized portion of the medial meniscus in 20 adult dogs and anatomically repaired. Postoperatively, the animals were either placed in a long leg cast (N = 9) or mobilized immediately (N = 11). The animals were sacrificed at 2 weeks (6 dogs), 4 weeks (6 dogs), or 10 weeks (8 dogs). Five medial menisci from the nonop erated side were used as controls. Collagen content was measured using a digital image analysis system, and the collagen percentage in the repair tissue in each postoperative treatment group was compared. In the 2-week and 4-week groups, there was no statistically significant difference in the percentage of collagen be tween those animals immobilized versus those that had early mobilization. The animals in the 10-week group that were mobilized had a significantly greater collagen percentage in the healing meniscal incision than those that were cast immobilized (44.6% ± 10% versus 27.0% ± 11 %, P < 0.0001). There was no significant difference in the collagen percentages between the mo bilized 10-week group and the contralateral control me nisci group. All other menisci had a decreased collagen percentage compared with the controls. Prolonged im mobilization decreases collagen formation in healing menisci. Thus, our results suggest that patients under going isolated meniscal repair either be immediately mobilized after surgery or immobilized for short periods only.
The Effect of Ankle Stabilizers on Athletic Performance
Authors: Pienkowski David , McMorrow Meredith , Shapiro Robert , Caborn David N. M. , Stayton Jeffrey
Published: June 2007

The ankle is the site of more than one third of all in juries that occur to male basketball players. Although ankle bracing may prevent injury, many players be lieve that braces restrict athletic performance. This belief discourages use of braces and obviates the injury protection that bracing provides. The objectives of this study were to 1) determine whether athletic performance (in four basketball-related activities) was affected by three ankle brace designs (Universal, Kallassy, and Air-Stirrup ankle training brace), 2) de termine whether specific braces are better for specific athletic activities, and 3) determine whether athletic performance changes with brace use. Twelve high school basketball players wore each brace type while vertical jumping, standing long jumping, cone run ning, and 18.3-meter shuttle running at two test times (initially and after 1 week of acclimation). Our data showed that these braces had no significant effects on athletic performance. No brace affected athletic performance in one specific activity more than an other, and athletic performance did not change with brace use. We concluded that prophylactic ankle bracing does not inhibit athletic performance.
Anterior Tibial Compartment Pressures During Intermittent Sequential Pneumatic Compression Therapy
Authors: Gilbart Michael K. , Oglivie-Harris Darrell J. , Broadhurst Christopher , Clarfield Michael
Published: June 2007

We studied the anterior tibial compartment pressures during the application of a JOBST sequential intermit tent pneumatic compression device on 5 healthy human volunteers (10 legs). Intracompartmental pressures were measured using a slit catheter. The measure ments of interstitial pressures were highest at maximal calf inflation, and pressures were increased for approxi mately 120 seconds during each cycle. Pressure mea surements in the inflated pressure sleeve varied less than 10% with the measured anterior tibial compartment pressures during intermittent pneumatic compression therapy. This intermittent pneumatic compression de vice may elevate intramuscular pressure significantly above that necessary to render muscle ischemic. How ever, these periods of pressure elevation are not long enough to produce any significant adverse effects, and the beneficial effects of decreased edema fluid may be safely realized.
Arthroscopic Treatment of Osteoarthritis of the Knee: A Prospective, Randomized, Placebo-Controlled Trial
Authors: Moseley J. Bruce , Wray Nelda P. , Kuykendall David , Willis Kelly , Landon Glenn
Published: June 2007

The reasons why many patients seemingly benefit from arthroscopic treatment of osteoarthritis of the knee remain obscure. The purpose of this pilot study was to determine if a placebo effect might play a role in arthroscopic treatment of this condition. After giving full informed consent, including full knowledge of the pos sibility and nature of a placebo surgery, five subjects were randomized to a placebo arthroscopy group, three subjects were randomized to an arthroscopic lavage group, and two subjects were randomized to a standard arthroscopic debridement group. The physi cians performing the postoperative assessment and the patients remained blinded as to treatment. Patients who received the placebo surgery reported decreased frequency, intensity, and duration of knee pain. They also thought that the procedure was worthwhile and would recommend it to family and friends. Thus, there may be a significant placebo effect for arthroscopic treatment of osteoarthritis of the knee. The small num bers in this preliminary study preclude a valid statistical analysis, and no conclusions can be drawn regarding the superiority of one treatment over another. A larger study is needed to evaluate fully the efficacy of an arthroscopic procedure for this condition and to decide if it is reasonable to expend health care resources for
Full-Thickness Rotator Cuff Tears
Authors: Reed Stephen C. , Glossop N. , Ogilvie-Harris Darrell J.
Published: June 2007

We performed a biomechanical comparison of two ro tator cuff repair techniques using fresh-frozen human cadavers. Nine pairs of cadaveric shoulders had stan dardized full-thickness tears made at the supraspina tus tendon insertion. One of each pair of the cadaveric shoulders was repaired by pulling the tendon into a bone trough in the humeral head using standard su tures. The remaining half of the pairs was repaired using anchor sutures. The repairs were tested using a servohydraulically operated material testing system. The anchor suture repair was significantly stronger than the standard suture technique irrespective of bone quality. Failure occurred predominantly through bone in the suture repairs and as a result of suture breakage in the anchor repairs. The anchors should be placed into the edge of the subchondral bone adjacent to the articular surface. The surgeon should direct the anchor so that the direction of the pull is approximately 90 degrees to the anchor, with the humerus at 30 degrees of abduction.
Acute Dislocation of the Patella
Authors: Sallay Peter I. , Poggi Jeffery , Speer Kevin P. , Garrett William E.
Published: June 2007

The objective of our study was to elucidate the char acteristic pathoanatomy associated with patellar dislo cation and report the preliminary results of early surgi cal repair. Twenty-three patients with documented patellar dislocation had standard radiographs and a magnetic resonance imaging scan. Intraarticular le sions were evaluated and treated arthroscopically fol lowed by an open exploration of the medial aspect of the knee in 16 patients. Twelve patients were observed for a minimum of 2 years after surgical repair (average, 34 months). Eleven patients returned for a follow-up examination. Magnetic resonance imaging revealed ef fusion (100%), tears of the femoral insertion of the medial patellofemoral ligament (87%), increased signal in the vastus medialis muscle (78%), and lateral fem oral condyle (87%) and medial patellar (30%) bone bruises. Arthroscopic examination revealed osteo chondral lesions involving the patella and the lateral femoral condyle in 68% of cases. Open surgical explo ration revealed tears of the medial patellofemoral liga ment off the femur in 15 of 16 patients (94%). After medial patellofemoral ligament repair, none of the pa tients experienced recurrent dislocation. Overall 58% of the results were considered to be good or excellent and 42% were fair. Fifty-eight percent of the group returned to their previous sport with no or minor limitations.
Patellar Taping in the Treatment of Patellofemoral Pain
Authors: Kowall Mark G. , Kolk Gina , Nuber Gordon W. , Cassisi Jeffrey E. , Stern Steven H.
Published: June 2007

The purpose of this prospective study was to evaluate the efficacy of a patellar taping program in the conser vative management of patellofemoral pain. Twenty-five patients with patellofemoral pain were randomized into two groups. One group underwent a standard physical therapy program for patellofemoral pain. The other group underwent the same physical therapy program, but use of a patellar taping technique was added to this program. Results of a subjective visual analog scale and changes in isokinetic strength and electromyo graphic activity of the quadriceps muscle were ana lyzed. Both the tape and no-tape groups experienced a statistically significant decrease in symptoms ( P < 0.05), but no difference in improvement of patellofemo ral pain was noted between the groups. Likewise, both groups demonstrated significant improvement in quad riceps muscle isokinetic strength ( P < 0.05) and activ ity ( P < 0.001), but no difference in improvement was noted between groups. The results of this study sug gest no beneficial effect of adding a patellar taping program to a standard physical therapy program in the conservative treatment of patellofemoral pain. Larger prospective studies are warranted to support this opinion.
Anterior Cruciate Ligament Graft Rotation
Authors: Samuelson Thomas S. , Drez David , Maletis Gregory B.
Published: June 2007

The purpose of this study was to determine normal rotation of the anterior cruciate ligament and to provide a technique for reproduction of this rotation. Ten fresh- frozen knees were dissected of all soft tissue except for the anterior cruciate ligament. Specimens were se cured in a vise in 60° of flexion. Each tibia was allowed to spin freely on the femur, and rotation was recorded. Anterior cruciate ligament reconstructions, using bone- patellar tendon-bone grafts, were then performed on all specimens using four graft rotations. Each specimen was then tested to assess how the graft twist affected tibial rotation. The average tibial rotation of the normal anterior cruciate ligaments was 55° internally. Previous descriptions of anterior cruciate ligament reconstruc tions have advocated medial or internal rotation of the graft to reproduce normal anatomic rotation of the an terior cruciate ligament. Our cadaveric dissections have demonstrated that the anterior cruciate ligament normally produces internal rotation of the tibia in rela tion to the femur. Reproduction of this anatomic rota tion is accomplished with 90° of lateral rotation of the tibial plug toward the fibula.
Radiographic Evaluation of Native Anterior Cruciate Ligament Attachments and Graft Placement for Reconstruction
Authors: Lintner David M. , Dewitt Sarah E. , Moseley J. Bruce
Published: June 2007

We examined seven cadaveric knees to determine the radiographic location of the native anterior cruciate ligament insertion sites as well as the location of tun nels used in anterior cruciate ligament reconstruction. Posteroanterior and lateral views at several flexion angles were taken with radiopaque markers around the insertions of the native anterior cruciate ligament and subsequent reconstruction tunnels. The femoral inser tion was best seen on the 60° notch view. On the lateral view, the femoral tunnel was easily seen as it crossed the roof of the intercondylar notch; however, because of the angle of the tunnel, the actual entrance into the knee may be well distal and anterior to this location. The tibial insertion and tunnel were easily seen at any flexion angle. The center of the insertion was 40% of the tibial diameter from the anterior mar gin. The lateral view in extension allowed determina tion of the tibial tunnel's location in relation to the intercondylar notch roof, but by itself did not allow accurate determination of the femoral tunnel's position. Notch and extension lateral radiographs together pro vided sufficient information for evaluation of anterior cruciate ligament graft position in a convenient, cost- effective format. Neither view by itself provides enough information to evaluate the position of the graft.
Acute Injuries in Off-Road Bicycle Racing
Authors: Kronisch Robert L. , Chow Tony K. , Simon Lauren M. , Wong Parthenia F.
Published: June 2007

A descriptive study was conducted to investigate inju ries sustained at a major off-road bicycling race at Mammoth Mountain, California, July 6 to 10, 1994. A total of 4027 individual starts in five events during the race were reported. Overall, the total number of com petitors in the 5 events was 3624, with some cyclists participating in multiple events. Injuries were consid ered significant if they occurred during competition and prevented the rider from completing the event. Sixteen cyclists had injuries that met these criteria for an over all injury rate of 0.40%. These 16 cyclists had 44 injuries. Abrasions were the most common injury, fol lowed by contusions, lacerations, fractures, and con cussions. The mean injury severity score was 3.0 (range, 1 to 5) with 81.2% of the injuries resulting from cyclists going downhill. Injuries were more severe when the riders were thrown from the bicycles ( P = 0.03). We observed different mechanisms of injury in various events, suggesting that the risk factors for sustaining a traumatic injury may vary according to the type of competition involved.
Magnetic Resonance Imaging of Knee Disorders
Authors: Gelb Howard J. , Glasgow Steven G. , Sapega Alexander A. , Torg Joseph S.
Published: June 2007

To prospectively evaluate the clinical value of magnetic resonance imaging of the knee in a referral sports medicine practice, we performed a three-part study. First, we asked 72 consecutive patients a series of clinically relevant questions regarding the ordering of their magnetic resonance imaging scans. Second, we asked the treating physicians at our center if the mag netic resonance imaging findings changed the diagno sis or treatment. Third, we compared the clinical eval uation with the findings on magnetic resonance imaging scans for 37 patients who had arthroscopic confirmation. From the physician's perspective, in only three cases would the results of the scan have changed the diagnosis. Information from the scans was judged to contribute to patient treatment in only 14 of 72 patients. Finally, comparison of clinical evaluation and magnetic resonance imaging findings with findings during arthroscopic procedures showed that clinical evaluation had a sensitivity and specificity of 100% for diagnosis of anterior cruciate ligament injuries, whereas magnetic resonance imaging was 95% sen sitive and 88% specific. For isolated meniscal lesions, the clinical assessment had a sensitivity and specificity of 91 % compared with 82% and 87%, respectively, for magnetic resonance imaging. For evaluation of articu lar surface damage, the predictive value of a positive test was 100% for clinical assessment and 33% for the
The Diagnostic Accuracy of History, Physical Examination, and Radiographs in the Evaluation of Traumatic Knee Disorders
Authors: O'Shea Kevin J. , Murphy Kevin P. , Heekin R. David , Herzwurm Paul J.
Published: June 2007

We prospectively looked at the diagnostic accuracy of clinical examination of the knee in patients with arthro scopically documented knee injuries. The study in cluded 156 patients with 156 knee injuries (72 acute and 84 chronic) who were seen during 1 year at Martin Army Hospital at Fort Benning Georgia. All patients were given a primary diagnosis based on their history, physical examination, and routine radiographs. Fifty- seven patients were also given one or more secondary diagnoses. Magnetic resonance imaging scans and arthrograms were not used in the evaluation of these patients. The primary diagnosis was correct in 83% of the knees. Of 57 secondary diagnoses given, 54% were correct and 31 % were incomplete. An incorrect diagnosis was made in 14% of knees for both primary and secondary diagnoses. There were four patients with no identifiable lesion other than synovitis. With the increasing cost of medical care, the need for expensive diagnostic studies such as magnetic resonance imag ing needs to be evaluated. The cost of a magnetic resonance image scan ranges between $600 to $1200 depending on the institution. The use of magnetic res onance imaging as a routine diagnostic aid in the clin ical examination of the knee is unnecessary. Arthro scopic surgery of the knee should be based on the patient's history, physical examination, and radio graphs.
Internal Fixation of Acute Stable Scaphoid Fractures in the Athlete
Authors: Rettig Arthur C. , Kollias Stephen C.
Published: June 2007

Our study evaluated the results of surgical repair of acute carpal scaphoid fractures in athletes and the time required for the athletes to return to play. Although playing casts are a nonsurgical option, they reduce the effectiveness of the athlete in sports that require max imal manual dexterity; thus, the management of scaph oid fractures is challenging when early return to sports is desired. Twelve athletes with 12 acute midthird scaphoid fractures were treated with Herbert screw fixation. All patients were in-season athletes in sports that precluded the use of a playing cast. Return to sports averaged 5.8 weeks. Nine of the 12 athletes had range of motion equal to the uninjured side. The grip strength was equal to the unaffected side in 10 of the 12 athletes. Clinical and radiographic union was evi dent in 11 subjects at an average followup of 2.9 years. The healing rates were comparable with other treat ment modalities. We concluded that internal fixation of a scaphoid fracture allows safe and early return to sports when a playing cast is not an acceptable option and when an athlete accepts the risks of surgery.
The Use of a Generic, Patient-Based Health Assessment (SF-36) for Evaluation of Patients with Anterior Cruciate Ligament Injuries
Authors: Shapiro Eric T. , Richmond John C. , Rockett Sean E. , McGrath Margaret M. , Donaldson William R.
Published: June 2007

The MOS 36-item short-form health survey is a ge neric, patient-based health assessment tool. It has been used to assess functional outcome for many medical conditions, both acute and chronic. The use of this survey in evaluating the effects of treatment of any specific disease or injury allows comparison of treat ments across a broad spectrum of disease categories. The purpose of this study was to see if this assessment tool could 1) be used to identify those patients requiring anterior cruciate ligament reconstruction, 2) detect changes in the patients with treatment over time, and 3) correlate with the commonly used knee assessment scales. The short-form health survey could not identify those patients requiring anterior cruciate ligament re constructive surgery. However, it did show important and significant changes with treatment (surgical and nonsurgical) over time. There was a significant corre lation between the short-form health survey and the Lysholm and International Knee Documentation Com mittee scores during this study. The addition of the MOS 36-item short-form health survey to our traditional knee ligament evaluation tools is encouraged. Its use will permit the orthopaedic community to demonstrate the value of our treatment of anterior cruciate ligament injuries to health care planners and generalist physi cians.
Soft Tissue For Allograft Reconstruction of the Human Knee: A Survey of the American Association of Tissue Banks
Authors: Vangsness C. Thomas , Triffon Mark J. , Joyce Michael J. , Moore Tillman M.
Published: June 2007

With increasing use and availability of musculoskeletal soft tissue allografts, orthopaedic surgeons need cur rent knowledge about allograft processing, costs, and availability. In conjunction with the American Associa tion of Tissue Banks, a comprehensive survey consist ing of specific questions on several topics in tissue banking was sent to 42 member banks or banks un dergoing accreditation review that distribute musculo skeletal tissues. Donors came from organ procurement organizations, coroners' offices, hospital morgues, and donations; the average age of the donors was 35. Most of the 36 tissue banks responding to the questionnaire harvest patellar and Achilles tendons. Patellar tendon demand exceeded supply. Tissue processing was done by outside organizations approximately 50% of the time. Of the four types of tissue sterilization pro cesses performed, gamma irradiation was the most common. Doses of sterilizing gamma irradiation varied from 1 to 3.5 mrad. The average approximate costs of fresh-frozen tissue were $800 for patellar tendon al lograft, $615 for Achilles tendon, and $640 for menisci. There was no consensus of opinion of how to size or sterilize meniscal allografts. As demand increases for soft tissue allografts, it is essential that the orthopaedic surgeon is knowledgeable about the clinical impact of tissue banking.
Injuries in Indoor Soccer
Authors: Putukian Margot , Knowles William K. , Swere Scott , Castle Nick G.
Published: June 2007

We conducted a prospective study of soccer injuries during the Soccer America Dawn to Dark Indoor Soc cer Tournament, which was organized by the Lake Placid Soccer Center, Lake Placid, New York, 1993. Eight hundred twenty-four players competed in open men's, open women's, over-30 men's, and mixed divi sions. The overall rate of injury per 100 player hours was 4.44, with a rate of 5.79 in the open men's, 4.74 in the open women's, 2.73 in the over-30 men's, and 1.54 for the mixed divisions. The differences in injury rates for men versus women and men versus older men were not statistically significant. Twenty-five of the 38 injuries (65.8%) were mild, with 27 injuries (71.4%) occurring in the lower extremities. Ankle sprains were the most common injuries and combined ligamentous injuries to the knee were the most common severe injuries. As the injuries increased in severity, they were more likely to be noncontact injuries. The data demon strate the low incidence of injury in male and female indoor soccer participants. The data also show the similarity in the types of injuries sustained by indoor and outdoor soccer players.
Characteristics of the Leg Extensors in Male Volleyball Players with Jumper's Knee
Authors: Lian Øystein , Engebretsen Lars , Øvrebø Rune V. , Bahr Roald
Published: June 2007

The aim of the present study was to characterize the performance ability of the leg extensor apparatus in a group of athletes with jumper's knee and to compare the results with those of a matched control group with out knee symptoms. Patient and control groups (12 players in each) were selected from a population of 141 well-trained male Norwegian volleyball players, of which 55 (39%) satisfied the diagnostic criteria for jumper's knee. The testing program consisted of a standing jump, a countermovement jump, a 15-second rebound jump test, a standing jump with a 20-kg load, and a standing jump with a load corresponding to one-half of the subject's body weight. Jump height and power were measured using a contact mat connected to an electronic timer. The test results of the patient group were significantly higher than those of the con trol group for the countermovement jump (15% in crease), power during rebound jump (41 %), work done in standing jump (12%) and countermovement jump (22%), and the difference between countermovement jump and standing jump (effect of adding eccentric component). Athletes with jumper's knee demon strated better performance in jump tests than uninjured athletes, particularly in ballistic jumps involving eccen tric force generation.
Activation of the Rotator Cuff in Generating Isometric Shoulder Rotation Torque
Authors: Jenp Yue-Nan , Malanga Gerard A. , Growney Eric S. , An Kai-Nan
Published: June 2007

This study compared and quantified electromyographic muscle activation of the rotator cuff with the isometric torque generated by performing shoulder rotation in various positions. Twenty healthy volunteers were tested in 29 shoulder positions. Using a Cybex II dy namometer synchronously with electromyography, surface electrodes were placed over the pectoralis major muscle and three parts of the deltoid muscle. Intramuscular wire electrodes were inserted into the four rotator cuff muscles. We found that the greatest external rotation isometric force is generated in the frontal and scapular planes in the neutral or full internal rotation positions. The sagittal, dependent, and the scapular plane with 45° of elevation in rotational posi tions of either full or half external rotation generated the greatest torques for internal rotation isometric force. The rotator cuff muscles generated greatest electro myographic activity in neutral to midrotational posi tions. The scapular plane with 90° of shoulder eleva tion in neutral rotation best isolated the subscapularis muscle. The infraspinatus-teres minor muscles were isolated in the sagittal plane with 90° of shoulder ele vation in a half externally rotated position. We were unable to isolate the supraspinatus muscle in any of these tested positions. These positions are recom mended for manual muscle testing and for strengthen ing these muscles.
Surgical Correction of Medial Subluxation of the Patella
Authors: Hughston Jack C. , Flandry Fred , Brinker Mark R. , Terry Glenn C. , Mills James C.
Published: June 2007

We evaluated the results of a surgical procedure to correct medial subluxation of the patella in 63 patients (65 knees), most of whom had undergone a lateral retinacular release. We performed a direct repair or a reconstruction of the lateral patellotibial ligament using locally available tissue such as strips of iliotibial band or patellar tendon. Followup averaged 53.7 months (range, 24 to 99). Outcome was based on the exam iner's inability to clinically reproduce the patient's pain ful medial subluxation and on the patient's general impression of his or her improved functional status. Forty-four patients (68%) reported improvement in their functional levels and 49 (75%) reported that they were subjectively improved by the procedure. Overall, 50 patients (80%) had a rating of good or excellent. Six knees required a second surgical reconstruction be cause of failure to improve or because of a reinjury. Analysis of overall clinical outcome revealed no signif icant relationships based on the patient's age at the time of the initial procedure, sex, or length of followup ( P > 0.10). Reconstitution of the lateral patellotibial ligament effectively corrected medial subluxation of the patella and long-term results of this salvage procedure were satisfactory.
Anterior Cruciate Ligament Reconstruction with Multistranded Autogenous Semitendinosus Tendon
Authors: Maeda Akira , Shino Konsei , Horibe Shuji , Nakata Ken , Buccafusca Giancarlo
Published: June 2007

We evaluated 41 knees 24 to 48 months after anterior cruciate ligament reconstruction was performed using multiple autogenous semitendinosus tendons. The ip silateral free semitendinosus tendon was tripled or quadrupled to make a graft 7 to 10 mm in diameter and more than 60 mm long. When the diameter of the graft was less than 7 mm, an ipsilateral doubled gracilis tendon was also used (in seven cases). Twenty-three patients (56%) returned to their preinjury activity levels. According to the patients' subjective assessment, 34 (83%) graded themselves as normal or nearly normal. No patient reported giving way of the knee or limitation of knee motion. The average anterior laxity difference between the involved knee and contralateral uninjured knee was 1.5 mm at 200 N. Twenty-nine patients (71 %) demonstrated an anterior laxity difference of 3 mm or less when the involved knee was compared with the contralateral uninjured knee. Quadriceps muscle strength was 90% compared with the contralateral healthy limb, and hamstring muscle strength was equivalent to the contralateral limb. In our study, tripled or quadrupled semitendinosus free tendons were ex cellent anterior cruciate ligament grafts for restoring knee stability, recovering thigh muscle power, and pre serving knee motion.
Meniscal Repair Supplemented With Exogenous Fibrin Clot and Autogenous Cultured Marrow Cells in the Goat Model
Authors: Port Joshua , Jackson Douglas W. , Lee Thay Q. , Simon Timothy M.
Published: June 2007

This study was undertaken to evaluate the placement of fibrin clot and cultured autologous marrow cells in surgically created, full-thickness, meniscal lesions in the avascular zone in 32 female Spanish goats. The menisci were repaired with two vertically oriented su tures ( N = 8), exogenous fibrin clot was placed into the meniscal defect before placement of the two sutures ( N = 8), fibrin clot plus cultured adherent bone marrow cells were placed in the defect ( N = 8), or the meniscal lesions were left unrepaired ( N = 8). On gross and manual inspection, meniscal lesions showed some de gree of healing in all animals except for the eight unrepaired lesions. All the experimental specimens had decreased tensile strength compared with the con tralateral control medial menisci. Ultimate load to fail ure, energy absorbed to failure, and stiffness were less than 40% of the controls for all groups. Histologic sections demonstrated focal cellular areas consisting of giant cells and macrophages in the repair sites. Our observations failed to demonstrate a statistically signif icant enhancement of healing with the use of exoge nous fibrin clot compared with vertically oriented su tures alone. The addition of cultured adherent autologous bone marrow-derived cells in conjunction with the fibrin clot did not enhance the meniscal healing.
Anterior Knee Laxity and Loss of Extension After Anterior Cruciate Ligament Injury
Authors: Muneta Takeshi , Ezura Yoichi , Sekiya Ichiro , Yamamoto Haruyasu
Published: June 2007

This study was performed to examine the relation ship between knee extension loss and the length of time after injury. We also wanted to compare anterior laxity in anterior cruciate ligament-injured knees in the early and late stages of injury. Loss of knee extension was measured in 81 patients with anterior cruciate ligament injury using lateral radiography with the injured leg relaxed and elevated. Extension loss was defined as the difference in maximal exten sion angle between the injured and uninjured knees. Average loss of extension was 3.6° in the 17 knees in which the anterior cruciate ligament had been torn 3 weeks or less before examination (the acute injury group) and 0.6° in the 64 knees in which the anterior cruciate ligament had been torn more than 3 weeks before examination (the chronic injury group). The extension loss in the acutely injured knees was sig nificantly greater compared with that in the uninjured knees and in the chronically injured knees. Arthro metric measurements using the KT-1000 arthrom eter were reliable to diagnose an acute tear. There was no correlation between the degree of extension loss and arthrometric anterior knee laxity measure ments. In 12 patients, the initial extension deficit in the early stage of injury significantly resolved with time, and manual maximum arthrometric measure ments of anterior knee laxity improved spontane ously with time.