bluuebunny/crossref_metadata_2025 huggingface dataset:
The tibialis posterior muscle compartment
Authors: Davey J.R. , Rorabeck C.H. , Fowler P.J.
Published: June 2007

Exertional compartment syndrome in the deep poste rior compartment of the leg is well recognized. This paper reports investigations which were performed to prove that the tibialis posterior muscle is contained in its own osseofascial compartment, separate from the rest of the deep posterior compartment. Radiographs following the injection of radio-opaque dye into the tibialis posterior muscle demonstrated the fluid-imper meable, osseofascial boundaries surrounding this mus cle. Compartment syndromes created in cadaver legs reveal that traditional techniques of fasciotomy of the deep posterior compartment are inadequate in decom pressing the tibialis posterior muscle. Intracompartmen tal pressure measurements in athletes with a clinical diagnosis of exertional compartment syndrome proved the existence of isolated exertional compartment syn drome in the tibialis posterior muscle. From these re sults we may conclude that the tibialis posterior muscle is contained in a separate osseofascial muscle com partment which may be the site of an isolated exertional compartment syndrome and that common techniques of fasciotomy of the deep posterior compartment do not decompress the tibialis posterior muscle.
The effects of ankle guards and taping on joint motion before, during, and after a squash match
Authors: Myburgh Kathryn H. , Vaughan Christopher L. , Isaacs Sedic K.
Published: June 2007

The effects of ankle guards and taping on joint motion before, during, and after exercise were studied. Twelve league squash players played two matches, each last ing 1 hour. Two different ankle guards, and two types of tape applied by the same method, served as sup ports. A specially designed goniometer with electronic digital display (accuracy 1 °) was used to determine joint range of motion: plantar-flexion and dorsiflexion, neutral inversion and eversion, plantar-flexed inversion and eversion. The results were statistically analyzed to de termine the significance of the restriction provided by the supports. This revealed that the two ankle guards provided no significant support. The two tapes, how ever, provided significant support before exercise and after 10 minutes but not after 1 hour of exercise. Nonelastic (zinc oxide) tape proved to be the most restrictive at all times measured, especially prior to exercise, when the ankle's range of motion was de creased between 30% and 50%. However, once exer cise commenced, the tape stretched, and restriction became less effective.
Anomalous muscle in the leg: Soleus accessorium
Authors: Percy E.C. , Telep G.N.
Published: June 2007

In the last 4 years we have had the opportunity to investigate an anomalous muscle mass on the medial aspect of the distal leg of three young athletes. A review of the clinical literature has revealed only nine reported cases of a similar muscle mass in this area. Surgical exploration was carried out in each of our three cases with relief of symptoms in two of the cases following decompression of the overlying fascial sheath.

We believe this muscle to represent the soleus ac cessorius and its presence, which may be rare. The presence of this muscle should be considered in the differential diagnosis of a symptomatic or asymptomatic mass of the posteromedial aspect of the distal leg. Surgical exploration and fascial release is recom mended.
Negative bone scans in impending tibial stress fractures
Authors: Milgrom C. , Chisin R. , Giladi M. , Stein M. , Kashtan H. , Margulies J. , Atlan H.
Published: June 2007

Three highly motivated military recruits who presented with tibial pain on exertion are reported. Their initial bone scan assessments to rule out stress fracture were normal, and the recruits were returned to demanding training. One month later, because of persistent and increasing tibial pain, they were rescanned and focal activity representative of tibial stress fractures was found in each case.

Until now it has been assumed that a negative bone scan ruled out a stress fracture unequivocally. Our reported cases show that bone pain may in fact precede scintigraphic evidence of a stress fracture. Persistent and increasing bone pain during demanding physical activity, even in the presence of a prior normal bone scan, may represent stress fracture and repeat bone scan may be indicated.
The surgical treatment of osteochondritis of the capitellum
Authors: Mcmanama George B. , Micheli Lyle J. , Berry Michael V. , Sohn Roger S.
Published: June 2007

This paper reviews 14 patients who underwent elbow arthrotomy for osteochondritis of the capitellum. The etiology in 7 of the 14 cases appears to be the result of repeated trauma from throwing sports. Five of the 14 described a singular significant traumatic episode, and in 2 of the 14, a clear etiology is uncertain. The diagnostic features including signs, symptoms, and el bow range of motion are examined. The operative findings are correlated with plain x-ray films of the elbow in all cases and with an elbow arthrogram in 11 out of 14 cases. The average length of followup was 24 months. The postoperative range of motion was in creased an average of 18°. Eighty-six percent (12 out of 14) patients returned to organized, competitive ath letic activity without restrictions.

The Little League background of those patients with apparent repetitive microtrauma to the elbow is exam ined in terms of length of pitching experience and types of pitches thrown. In addition, the throwing mechanism of these patients is evaluated with respect to the type of delivery at possible risk for the development of osteochondritis.

We conclude that after a failure of conservative ther apy, surgical treatment, including removal of the intraar ticular loose bodies, excision of capitellar lesions, and curettage to bleeding bone can be expected to produce pain relief and improvement in joint motion. A return to organized competitive sport activities can be expected.
An in vivo strain gage study of elongation of the anterior cruciate ligament
Authors: Henning Charles E. , Lynch Mary A. , Glick Karl R.
Published: June 2007

The purpose of this paper is to study the load-elonga tion characteristics of a Grade II sprain of the anterior cruciate ligament (ACL) at the time of local anesthesia arthroscopy. The data may be used to increase diag nostic and prognostic accuracy when evaluating Grade II ACL sprains and to structure properly a rehabilitation program following ACL injury.

This report is based on the data from two in vivo strain gage studies of Grade II ACL sprains. Following instrumentation of the ligament, several events com mon to physical examination and rehabilitation pro grams were tested.

The Lachman test produced greater elongation of the anteromedial fibers than did the anterior drawer or pivot shift test. A fairly high force of 80 pounds may be required by the examiner's hands to test satisfactorily the anteromedial fibers in the acutely injured large athlete.

The proper order for a rehabilitation program should be crutch walking, cycling, walking, slow running, and faster running. Patients should be cautioned to run on a perfectly level surface.

Cycling produced 7% as much elongation as an 80 pound Lachman test, and the one leg half squat 21 % as much. Quadriceps rehabilitation can be done more safely using these exercises.

Quadriceps exercises by knee extension against a 20 pound weight boot in the range of full extension to 22° flexion created peak elongation of the anteromedial fibers ranging from 87 to 121% of that produced by an 80 pound Lachman test. We recommend that quadri ceps exercises and testing by knee extension through a full range of motion not be done during the first year following ACL injury or reconstruction.

Quadriceps contraction against a 20 pound weight boot at 45° flexion produced 50% as much elongation as an 80 pound Lachman test. Beginning at 9 months post-ACL reconstruction, we do measure quadriceps strength isometrically with the knee flexed 45°.
Anterolateral dislocation of the head of the fibula in sports
Authors: Turco Vincent J. , Spinella Anthony J.
Published: June 2007

Traumatic anterolateral dislocation of the fibular head is an uncommon sports injury which is easily over looked. Seventeen cases have been collected during private practice over the years. The typical mechanism of injury is a fall on the affected flexed knee with the leg adducted under the body and the ankle inverted. On physical examination there is an obvious bony prom inence laterally of the fibular head and varying disability with activities; there is no significant effusion or signs of internal knee derangement or instability. Comparison identical radiographic views are necessary to confirm the diagnosis: on the anteroposterior view the fibular head is displaced laterally and the proximal interos seous space is widened; on the lateral view there is a greater overlap of the fibula on the tibia on the affected side. Peroneal nerve and ankle injuries can occur con comitantly with anterolateral proximal tibiofibular dislo cation. Treatment options are closed or open reduction acutely and local strapping or fibular head resection for chronic cases based upon time of presentation and disability.
The effect of muscle stimulation during resistive training on performance parameters
Authors: Wolf Steven L. , Ariel Gideon B. , Saar Dany , Penny M. Ann , Railey Peggy
Published: June 2007

This study compared changes in movement velocity, force, and work from bilateral quadriceps muscle stim ulation during resistive squatting exercise to identical exercise without stimulation. Both the group undergo ing resistive training over 24 sessions (N = 9) and the group receiving the same treatment in conjunction with stimulation during the last 12 sessions (N = 9) showed significant improvements in measures of movement velocity, force, total work, power, sprint time, and ver tical jump distance when compared to a control group receiving no treatment (N = 9). All subjects were base line tested and tested at 3, 6, and 7 week intervals. Both experimental groups improved significantly for all measures, but the electrical stimulation group did not produce more significant changes overall than those with resistive training alone. However, when compared to control measures, the effect of electrical stimulation- augmented responses among some measures was more pronounced than the effect of resistive training alone.
Prepatellar bursitis in wrestlers
Authors: Mysnyk M.C. , Wroble R.R. , Foster D.T. , Albright J.P.
Published: June 2007

As part of a larger retrospective study examining all knee injuries sustained by the University of lowa wres tling team over 6 years, prepatellar bursitis was found to be the most frequent injury and, therefore, was examined in depth.

Of the 136 wrestlers studied, 13 developed an initial case of prepatellar bursitis. This represented 21 % of all initial episodes of knee injuries. Five of these wrestlers had no recurrences, but the other eight together had 20 recurrences. Median time lost for the initial injury was only 4 days, but recurrences and surgeries added significantly to the total time lost. There were only two cases of septic prepatellar bursitis, but there have been six cases (in four wrestlers) in the three seasons since the end of the larger study period. The infecting orga nism in all but one case was Staphylococcus aureus and was penicillin-resistant in all but one. There was no clinical evidence of infection in 50% of the cases, em phasizing the need to do a Gram's stain and culture (and, therefore, an aspiration) on all cases of prepatellar bursitis. The prognosis appeared better if the wrestler had no previous history of bursitis, suggesting that pathologic changes in the bursal wall may impair its defense mechanisms.

In sharp contrast to all other knee injuries, most prepatellar bursitis cases occurred in the off-season. Most developed insidiously, but direct impact during a takedown maneuver is suspected as being the most frequent cause. The highest frequency was in the lighter weights, there was a slight decrease with increasing years of experience, and no relationship was seen with the wrestlers' lead leg during takedowns or with the use of knee pads.

Treatment included one or more of the following: rest, immobilization, padding, aspiration, compressive dress ing, steroid injection, and surgery. Steroid injections appeared ineffective. There was a clear distinction be tween knees with recurrences and those that healed after the initial episode. Once a single recurrence oc curred, others were likely. Six of eight wrestlers with recurrences eventually had surgery. No recurrences or complications occurred after surgery (followup of 2 to 8 years). Therefore, in a highly motivated athlete want ing to return to competition as soon as possible, sur gery is recommended as the definitive treatment after the second, or certainly the third, recurrence.
Functional cast immobilization of thumb metacarpophalangeal joint injuries
Authors: Primiano George A.
Published: June 2007

A prospective study was performed on 40 patients who were treated with a modified thumb spica cast (MTSC) for injuries involving the region of the metacarpophalan geal joint of the thumb. Twenty-seven of these injuries occurred during sports participation. The immobilization consisted of a fiberglass cast which incorporated the thumb in a balanced position and allowed full flexion and extension of the wrist.

Twenty patients had injuries involving the ulnar col lateral ligament (five surgical). Three patients had radial collateral ligament injuries (two surgical). Fourteen pa tients had fractures of the proximal phalanx, including five epiphyseal plate injuries. Two patients had dorsal dislocations and one patient had a metacarpal fracture. One patient with a nondisplaced distal metacarpal frac ture was treated with simple immobilization.

All patients had successful completion of their treat ment within the usual time frame. There was no recur rence or increase in symptomatology during the treat ment. There was no residual discomfort, loss of position or malunion of the fractures treated.

The advantages of the MTSC include improved func tional capabilities during immobilization, good patient acceptance, and no period of limited wrist motion or atrophy of forearm musculature.

Our experience has been that the MTSC has been a reliable form of immobilization for treating injuries of the metacarpophalangeal joint of the thumb.
Talar compression syndrome
Authors: Brodsky Alexander E. , Khalil Momtaz A.
Published: June 2007

Ballet dancers frequently stand on the tips of their toes in the en pointe and demi pointe positions, resulting in compression of the posterior structures of the ankle during repeated plantar flexion of the foot, producing the talar compression syndrome. This mechanism may result in posterior block or impingement of an os tri gonum or Stieda's process. When the dancer attempts to force the foot into plantar flexion, the os trigonum or the Stieda's process may be impinged between the calcaneus and the posterior edge of the tibia. Pain and tenderness are localized at the posterolateral aspect of the ankle behind the peroneal tendons. In nondancing members of the population, these conditions are usually asymptomatic. It is the requirement of the classical dance for a well-pointed foot that produces symptoms. We are reporting up to 7 years' followup of six profes sional ballet dancers in whom we removed the os trigonum for symptomatic talar compression syndrome, caused by the trauma of the en pointe position of toe dancing. Two patients had bilateral operations. All six patients returned to professional dancing within a few months and remained asymptomatic. The anatomy of this condition is reviewed, as well as the diagnosis and treatment.
Surgical decisions in athletes' subcalcaneal pain
Authors: Lutter Lowell D.
Published: June 2007

A group of 182 patients with subcalcaneal pain related to sports activity was studied to determine injury types and patterns. Running/jogging produced the greatest percentage of subcalcaneal injuries, 76%. A survey was done of the specific types of heel pain, plantar fasciitis and median calcaneal neuritis. A review of each entity was given and surgical approach was detailed. Subcal caneal surgical decision making is based on six specific tenets: 1) correct diagnosis; 2) approximately 12 months of conservative treatment; 3) EMG for diagno sis and appropriate nerve blocks; 4) thorough knowl edge of the anatomy or complete review; 5) patient understanding that surgery may not give a good enough result to allow the return to high performance athletics; and 6) correct and appropriately directed sur gery.
Stress fractures in athletes
Authors: Matheson G.O. , Clement D.B. , Mckenzie D.C. , Taunton J.E. , Lloyd-Smith D.R. , Macintyre J.G.
Published: June 2007

We analyzed cases of 320 athletes with bone scan- positive stress fractures (M = 145, F = 175) seen over 3.5 years and assessed the results of conservative management. The most common bone injured was the tibia (49.1 %), followed by the tarsals (25.3%), metatar sals (8.8%), femur (7.2%), fibula (6.6%), pelvis (1.6%), sesamoids (0.9%), and spine (0.6%). Stress fractures were bilateral in 16.6% of cases. A significant age difference among the sites was found, with femoral and tarsal stress fractures occurring in the oldest, and fibular and tibial stress fractures in the youngest. Run ning was the most common sport at the time of injury but there was no significant difference in weekly running mileage and affected sites. A history of trauma was significantly more common in the tarsal bones. The average time to diagnosis was 13.4 weeks (range, 1 to 78) and the average time to recovery was 12.8 weeks (range, 2 to 96). Tarsal stress fractures took the longest time to diagnose and recover. Varus alignment was found frequently, but there was no significant difference among the fracture sites, and varus alignment did not affect time to diagnosis or recovery. Radiographs were taken in 43.4% of cases at the time of presentation but were abnormal in only 9.8%. A group of bone scan- positive stress fractures of the tibia, fibula, and meta tarsals (N = 206) was compared to a group of clinically diagnosed stress fractures of the same bone groups (N = 180), and no significant differences were found. Patterns of stress fractures in athletes are different from those found in military recruits. Using bone scan for diagnosis indicates that tarsal stress fractures are much more common than previously realized. Time to diagnosis and recovery is site-dependent. Technetium99 bone scan is the single most useful diagnostic aid. Conservative treatment of stress fractures in athletes is satisfactory in the majority of cases.
Meniscoid lesions of the ankle in soccer players
Authors: McCarroll John R. , Schrader John W. , Shelbourne K. Donald , Rettig Arthur C. , Bisesi Mark A.
Published: June 2007

In 1950, Wolin and his colleagues described nine pa tients who exhibited a "meniscoid" lesion of the ankle. He used this term to describe a mass of hyalinized tissue that formed following an inversion sprain of the ankle. This band of tissue was predisposed to trapping between the fibula and the talus. His patients presented with persistent pain and swelling over the anterior aspect of the ankle.

In the last 3 years, four patients have presented with this lesion at the Methodist Sports Medicine Center in Indianapolis. They were all soccer players who had experienced repeated ankle sprains accompanied by persistent pain, swelling and trapping. Initially, these patients were treated with physical therapy, taping, and antiinflammatory medication. After 6 months of treat ment, they continued to have symptoms and underwent arthroscopic examination. In each case a band of white, fibrous tissue was found during surgery and was re moved. After an appropriate period of rehabilitation, all four patients returned to competition with a cessation of symptoms. However, one patient reported recurrent pain on rare occasions.
Flexor digitorum profundus avulsions with associated distal phalanx fractures
Authors: Buscemi Michael J. , Page B.J.
Published: June 2007

A review of the current literature reveals that avulsions of the flexor digitorum profundus tendon, with a sepa rate and concomitant intraarticular fracture of the distal phalanx, is an uncommon and easily misdiagnosed injury that has been infrequently described. This report encompasses a review of four patients with such an injury, and includes treatment recommendations for this complex injurious pattern.

A classification system for flexor digitorum profundus avulsions is reviewed and it is proposed that the avul sion of the flexor digitorum profundus tendon with concomitant and separate intraarticular fracture of the distal phalanx, be added to the classification as a Type IV injury.
The biomechanics of lateral knee bracing
Authors: France E. Paul , Paulos Lonnie E. , Jayaraman Gopal , Rosenberg Thomas D.
Published: June 2007

In Part I of our study on lateral knee bracing, we evaluated brace effectiveness using cadaveric knees and two commercially available braces (McDavid and Omni). The results indicated that for low-rate dynamic valgus loading, neither brace provided significant pro tection against MCL injury. Also, four potentially ad verse effects were noted. The goals in Part II were to: 1) determine the clinical significance of brace induced MCL preload; 2) define the functional character of an "ideal" brace; 3) design and validate a surrogate knee model for testing brace effectiveness; and 4) determine brace performance under impact loading using the sur rogate knee and six commercially available brace types (manufactured by DonJoy, McDavid, Mueller, Omni Sci entific, Stromgren-Scott, and Tru-Fit). Knee braces, modified to measure varus/valgus bending force, were used to determine MCL preload effects in 13 human volunteers. An anatomically correct surrogate knee model, instrumented to measure ligament/tendon ten sion and medial joint opening, was developed and validated using information from our previous cadaver studies and results of analyses on the effects of high strain rates (100% versus 1000% strain/sec) on MCL failure. Over 500 impact tests were performed on the surrogate knee in unbraced versus braced conditions. Tests were conducted for three impactor masses, two flexion angles, and free or constrained limb positions. Impact safety factors (ISF) were calculated for each test condition and brace type. An ISF of 1.50 (MCL load reduction of 30%) was considered significant. The results were: 1) brace induced MCL preload in vivo was negated by joint compressive forces; 2) the "ideal" brace should increase the lateral force at MCL injury by 80%; 3) at a 1000% strain/sec strain rate, MCL failure force was increased by 28%; and 4) on the average, only one brace exceeded the minimum ISF (DonJoy, average ISF = 1 .51 ).
Magnetic resonance imaging of knee hyaline cartilage and intraarticular pathology
Authors: Wojtys Edward , Wilson Mark , Buckwalter Kenneth , Braunstein Ethan , Martel William
Published: June 2007

Injuries to the hyaline cartilage of the knee joint are difficult to diagnose without invasive techniques. Even though these defects may be the most important prog nostic factors in assessing knee joint injury, they are usually not diagnosed until arthrotomy or arthroscopy. Once injuries to hyaline cartilage are found and/or treated, no technique exists to follow these over time. Plain radiographs, arthrograms, and even computed tomography fail to detail most hyaline cartilage defects.

We used magnetic resonance imaging (MRI) to eval uate five fresh frozen cadaver limbs and 10 patients whose pathology was known from arthrotomy or ar throscopic examination. Using a 0.35 Tesla supercon ducting magnet and spin-echo imaging technique with a head coil, we found that intraarticular fluid or air helped to delineate hyaline cartilage pathology. The multiplane capability of MRI proved to be excellent in detailing small (3 mm or more) defects on the femoral condyles and patellar surface. Cruciate ligaments were best visualized on sagittal oblique projections while meniscal pathology was best seen on true sagittal and coronal projections.

MRI shows great promise in providing a noninvasive technique of evaluating hyaline cartilage defects, their response to treatment, and detailed anatomical infor mation about cruciate ligaments and menisci.
The effect of muscle architecture on the biomechanical failure properties of skeletal muscle under passive extension
Authors: Garrett William E. , Nikolaou Pantelis K. , Ribbeck Beth M. , Glisson Richard R. , Seaber Anthony V.
Published: June 2007

This study investigates the biomechanical failure prop erties of five architecturally different skeletal muscles and examines the role muscle structure plays in the passive extension characteristics of musculotendinous units. The muscles used in this study fall into four morphologic categories: fusiform, unipennate, bipen nate, and multipennate.

Each muscle was pulled to failure at three different rates of strain (1, 10, and 100 cm/min). Specimens of fusiform, unipennate, and bipennate muscles were pulled from their proximal as well as distal attachments. The relationship of elongation to failure of the entire musculotendinous unit to resting muscle fiber length was examined to determine the effect of angle of pennation and fiber length on the failure properties.

Our results demonstrate that all four muscle types tested show injury and rupture at the musculotendinous junction whether pulled from proximal or distal attach ment, regardless of muscle structure and rate of strain. There was a statistically significant difference (P < 0.005) in the degree of elongation to failure relative to resting muscle fiber length, with a tendency to greater elongation relative to fiber length for muscles with more pennate structure (tibialis anterior, 72.7% ± 1.0%; ex tensor digitorum longus, 113.1% ± 3.5%; rectus fem oris, 225.5% ± 3.7% elongation in percent resting fiber length).
The effects of processing techniques on the mechanical properties of bone-anterior cruciate ligament-bone allografts
Authors: Jackson D.W. , Grood E.S. , Wilcox P. , Butler D.L. , Simon T.M. , Holden J.P.
Published: June 2007

There has been a growing interest in the use of allo grafts as ACL substitutes. Allografts are often freeze dried to increase shelf storage time and sterilized with ethylene oxide. This study was conducted to determine the effect of a specific ethylene oxide sterilization pro cedure and freeze drying process on the initial mechan ical properties of femur-ACL-tibia preparations. Twelve knees (stifle joints) from six mature goats were divided into two groups (one knee of pair to each group). Knees were cleaned of all soft tissue except for the anterior cruciate, posterior cruciate, and collateral ligaments. Group 1 was sterilized with ethylene oxide (simulating clean procurement) then freeze dried. Group 2 was freeze dried only (simulating sterile procurement). The knees were rehydrated and then tested in tension to failure to determine their structural mechanical proper ties. The ethylene oxide-freeze dried specimens (Group 1) had a mean maximum load before failure of 2059 ± 273 newtons (N) (± SE) which was not statistically different than the maximum load of the freeze dried specimens (Group 2) of 2023 ± 214 N. The average strength of Group 1 and 2 combined was not signifi cantly different than a third group of 12 normal femur- ACL-tibia controls which had an average maximum force of 2403 ± 133 N. No significant differences be tween the groups were observed for stiffness, energy to maximum strength, or elongation to maximum force. It appears the freeze dry processing, with or without ethylene oxide sterilization, using the procedure we used, has, at most, a small effect on the initial mechan ical properties of the preparations. The low mechanical properties of implanted and revascularized allografts, as compared to normal femur-ACL-tibia complex ap pears to be related more to fixation strength and alter ations which occur in the ligament substance after implantation.
The role of warmup in muscular injury prevention
Authors: Safran Marc R. , Garrett William E. , Seaber Anthony V. , Glisson Richard R. , Ribbeck Beth M.
Published: June 2007

This study is an attempt to provide biomechanical sup port for the athletic practice of warming up prior to an exercise task to reduce the incidence of injury. Tears in isometrically preconditioned (stimulated before stretching) muscle were compared to tears in control (nonstimulated) muscle by examining four parameters: 1) force and 2) change of length required to tear the muscle, 3) site of failure, and 4) length-tension defor mation. The tibialis anterior (TA), the extensor digitorum longus (EDL), and flexor digitorum longus (EDL) mus cles from both hindlimbs of rabbits comprised our ex perimental model.

Isometrically preconditioned TA (P < 0.001), EDL (P < 0.005), and FDL (P < 0.01) muscles required more force to fail than their contralateral controls. Precondi tioned TA (P < 0.05), EDL (P < 0.001), and FDL (P < 0.01) muscles also stretched to a greater length from rest before failing than their nonpreconditioned con trols. The site of failure in all of the muscles was the musculotendinous junction; thus, the site of failure was not altered by condition. The length-tension deforma tion curves for all three muscle types showed that in every case the preconditioned muscles attained a lesser force at each given increase in length before failure, showing a relative increase in elasticity, although only the EDL showed a statistically significant differ ence. From our data, it may be inferred that physiologic warming (isometric preconditioning) is of benefit in pre venting muscular injury by increasing the and length to failure and elasticity of the muscle-tendon unit.
The role of tissue pressure measurement in diagnosing chronic anterior compartment syndrome
Authors: Rorabeck C.H. , Bourne R.B. , Fowler P.J. , Finlay J.B. , Nott Linda
Published: June 2007

Pressure studies were performed in 55 patients (24 with chronic anterior leg pain and 31 asymptomatic recreational athletes). Pressure measurements were recorded at rest, during, and after exercise, using the slit catheter system. Seventeen of the twenty-four pa tients with symptomatic anterior leg pain were diag nosed on the basis of tissue pressure studies as having chronic exertional compartment syndrome. The in creased tissue pressures at rest and after exercise are most helpful in distinguishing those patients likely to benefit from a surgical fasciotomy.
The natural history and treatment of delayed union stress fractures of the anterior cortex of the tibia
Authors: Rettig Arthur C. , Shelbourne K. Donald , McCarroll John R. , Bisesi Mark , Watts Jennifer
Published: June 2007

This study presents eight patients with stress fracture of the anterolateral cortex of the midshaft of the tibia. All of the patients, ranging in age from 14 to 23 years, were competitive basketball players who experienced pain while running or jumping for an average of 4.4 months before the diagnosis was made.

Eight patients were treated with rest and/or pulsing electromagnetic field therapy. Although one of the pa tients required bone grafting procedure, all eight of these patients showed complete healing and were able to return to full activity after an average of 8.7 months of treatment. They have remained asymptomatic for an average of 14.7 months. The overall time from initial symptoms to return to competition averaged 12.5 months in this group of athletes.

The results presented in this paper suggest that rest and pulsing electromagnetic field therapy may result in healing in some patients with delayed union stress fractures of the anterolateral cortex of the midshaft of the tibia. Although this injury is associated with a pro longed healing period, seven of eight patients with adequate followup in our study were able to return to competition without complications following treatment. One patient was asymptomatic for 33 months before experiencing a reinjury.

In conclusion, we feel that diagnosis of stress fracture should be a primary consideration in basketball players presenting with a prolonged history of pain on the anterolateral aspect of the midthird of the tibia. Once the diagnosis is made we recommend initial treatment consist of rest and external electrical stimulation for a minimum time of 3 to 6 months prior to considering surgical intervention.
Gore-Tex prosthetic ligament in anterior cruciate deficient knees
Authors: Glousman Ronald , Shields Clarence , Kerlan Robert , Jobe Frank , Lombardo Stephen , Yocum Lewis , Tibone James , Gambardella Ralph
Published: June 2007

Reconstruction for symptomatic anterior cruciate defi cient knees has yielded varying success rates. Pros thetic cruciate replacement has recently become a po tentially attractive alternative. The results of the Gore- Tex polytetrafluoroethylene ligament, which is intended as a permanent replacement, are reported.

Eighty-two patients were followed prospectively, mean age was 28 years (range, 16 to 51 years) and mean followup was 18 months (range, 12 to 30 months). Subjective scores improved in all categories, including pain, swelling, giving way, locking, and stair climbing. All patients without complications had no episodes of actual giving way, considered themselves improved, and returned to activities of daily living at 3 weeks and athletics at 8 months. Range of motion lacking at 3 months was 2° of extension and 10° of flexion, and at 12 months was 0° of extension and 4° of flexion. All mean objective data, including the anterior drawer, Lachman, and pivot shift, demonstrated im provement at final followup. Cybex testing revealed improvement in relative quadriceps strength from 88% to 99%. The KT-1000 Arthrometer showed improve ment in the injured-normal knee difference score throughout the follow-up period.

Of importance is that while final objective data was improved over initial data, an early nonprogressive shift toward loosening was indicated by worsening of the drawer, Lachman, pivot shift, and KT-1000 scores. This shift may be attributed to resorption of interposed soft tissue, creep, or loosening of the graft. Subjective scores remained stable after improving.

Complications included four ruptures, four chronic sterile effusions with partial attenuation, one infection, and one symptomatic loose body. There were 14 re- operations (17%), a total of 15 complications (18%), and 7 permanent complications (8%). There were no deaths, pulmonary emboli, or medical complications.

We feel that the Gore-Tex ligament may become a rational alternative for anterior cruciate reconstruction in selected cases of prior reconstructive failure or older, less active individuals with symptomatic instability. Sur gical dissection is minimal, with maintenance of autog enous tissues yielding rapid recovery and low morbidity. The results presented are based upon preliminary data, and indications for expanded use of the ligament and definitive conclusions regarding the natural history of the graft will have to await further long-term followup.
Semimembranosus tendinitis: An overlooked cause of medial knee pain
Authors: Ray J. Michael , Clancy William G. , Lemon Richard A.
Published: June 2007

A significant number of patients presenting with non- traumatic chronic medial knee pain have been found, after careful examination, to have chronic semimembra nosus tendinitis. Of 115 patients diagnosed and treated for semimembranosus tendinitis over a 5 year period, 10 patients were refractory to conservative treatment. The purpose of this paper is to discuss the symptom atology and diagnosis of semimembranosus tendinitis, and to relate the treatment that these 10 patients underwent, i.e., surgical exploration, drilling of the in sertion site, and semitendinosus tendon transfer. Most cases of semitendinosus tendinitis respond to conserv ative therapy; however, if surgical treatment is consid ered, arthroscopy should probably be performed at the time of surgery. In this way, it is possible to determine the presence of significant intraarticular abnormalities that may have a causal relationship with the onset of semimembranosus tendinitis.
A comparison of body and organ weights, physiologic parameters, and pathologic changes in target organs of rats given combinations of exercise, anabolic hormone, and protein supplementation
Authors: Bauman David H. , Richerson Joan Taylor , Britt A.L.
Published: June 2007

This study was engineered to closely mimic the training protocol of a competitive athlete using repetitive exer cise sessions, dietary protein supplementation, and anabolic steroids. The length of the study was 37 days. Thirty-four Sprague Dawley male rats Crl:CD(SD)BR in the weight range of 150 to 175 grams were used. These were randomly divided into four exercise groups, varying protein consumption and anabolic hormone administration. Eight nonexercised control rats were kept separate from the study to act as a comparison for organ weight, hematology, and serology. Exercise consisted of a 30 minute swim three times a week. Parameters recorded were total body weight and per cent gain, wet and dry muscle weight of the isolated anterior tibialis, weights of designated organs, hema tologic profiles, and serum chemistries including triglyc erides, high density and low density lipids. Histopathol ogy of known "target organs" was performed and bone marrow aspirates were taken.

Body weights of rats given anabolic steroid, protein supplement, and exercise were the lowest of all groups. Testicular weight was significantly decreased in the anabolic groups. Anabolic groups had the lowest hem atocrits of the exercised groups. All serology values were within normal ranges and no pathologic changes were seen in any of the tissues taken from specific "target organs."
Anatomy of the posterior cruciate ligament
Authors: Van Dommelen Bruce A. , Fowler Peter J.
Published: June 2007

PCL injuries are major injuries of the knee. Most of the literature on PCL injury has focused on mechanism of injury, diagnosis, and treatment. We are presenting a review of the anatomy of the PCL. Different portions of the PCL are taut at different degrees of knee flexion and extension. The PCL, thus, along with the ACL, contributes to the "screwhome mechanism" of the knee. The anatomy of the meniscofemoral ligaments (ligaments of Wrisberg and Humphrey) reveals the inti mate relationship among the PCL, the popliteus muscle, and the lateral meniscus. Understanding the anatomy of the PCL is important in the diagnosis and treatment of ligamentous injuries and also in total knee arthro plasty.
Dynamic EMG analysis of anterior cruciate deficient legs with and without bracing during cutting
Authors: Branch Thomas P. , Hunter Robert , Donath Max
Published: June 2007

crease in quadriceps activity found during the subjects' stance phase could have a protective effect on the unstable knee due to the increased activity of muscles that work synergistically with the ACL to control ante rior tibial translation. The reduced activity of antagonist muscles could enhance this effect. Bracing did not alter the relative EMG activity nor did it change firing patterns compared to the unbraced situation. All muscles showed a similar reduction in activity, suggesting that these braces did not have a proprioceptive influence.
Tibiofemoral joint forces during isokinetic knee extension
Authors: Nisell Ralph , Ericson Mats O. , Nemeth Gunnar , Ekholm Jan
Published: June 2007

Using a Cybex II, eight healthy male subjects performed isokinetic knee extensions at two different speeds (30 and 180 deg/sec) and two different positions of the resistance pad (proximal and distal). A sagittal plane, biomechanical model was used for calculating the mag nitude of the tibiofemoral joint compressive and shear forces. The magnitude of isokinetic knee extending moments was found to be significantly lower with the resistance pad placed proximally on the leg instead of distally. The tibiofemoral compressive force was of the same magnitude as the patellar tendon force, with a maximum of 6300 N or close to 9 times body weight (BW). The tibiofemoral shear force changed direction from being negative (tibia tends to move posteriorly in relation to femur) to a positive magnitude of about 700 N or close to 1 BW, indicating that high forces arise in the ACL when the knee is extended more than 60°. The anteriorly directed shear force was lowered consid erably by locating the resistance pad to a proximal position on the leg. This model may be used when it is desirable to control stress on the ACL, e.g., in the rehabilitative period after ACL repairs or reconstruc tions.
Arthroscopic "second look" at the GORE-TEX ligament
Authors: Ferkel Richard D. , Fox James M. , Wood David , Del Pizzo Wilson , Friedman Marc J. , Snyder Stephen J.
Published: June 2007

We performed an arthroscopic "second look" in 21 knees (20 patients) that had arthroscopic implantation of the GORE-TEX prosthesis for chronic ACL insuffi ciency. Arthroscopy was done on eight knees at the time of screw removal, eight for knee pain, two for giving way, and three for recurrent effusions. The de gree of synovial joint reaction, graft synovial ingrowth, and graft rupture was graded. Microscopic examination was carried out on all biopsies of the GORE-TEX liga ment.

The average patient age was 30 years and the aver age time interval from original implantation to second look was 11 months. The GORE-TEX was intact in 11 knees, 10% ruptured in 6, and completely ruptured in 4. There was no correlation between number of GORE- TEX strands ruptured and synovial reaction. No parti cles of the graft were noted in the synovium if the implant was intact, but particles were noted with graft rupture.

We conclude that the intact GORE-TEX ligament is an inert substance and does not cause significant joint reaction. Impingement in the intercondylar notch ap peared to be the most common cause of graft failure. Further study is critical to determine the natural history of the GORE-TEX ligament and the knees' response to this prosthetic device.
Mechanics of the healed meniscus in a canine model
Authors: Newman Alan P. , Anderson D. Ron , Daniels A.U. , Dales Mark C.
Published: June 2007

The mechanical behavior of the intact canine stifle joint was studied, using a surgical model of meniscal injury and repair. Thirty-eight animals were divided into five study groups: Group S received only a sham arthro tomy (without a meniscal incision), Groups P13 and P26 received peripheral medial meniscal incisions, and Groups R13 and R26 received radial medial meniscus incisions. All meniscal incisions were repaired anatom ically with absorbable suture. Groups P13 and R13 were sacrificed at 13 weeks following surgery and Groups P26 and R26 at 26 weeks. Following sacrifice, the joints were subjected to gross and histologic ex amination, and structural and material properties test ing.

All meniscal repairs healed, and the peripheral repairs were virtually invisible, with no articular damage. The radial repairs healed with 3 to 5 mm wide fibrovascular scars, and several joints demonstrated articular ero sions. The radial repair tissue contained unorganized collagen bundles and ground substance deficient in mucopolysaccharides.

Groups S, P13 and P26 demonstrated no statistically significant differences between test and control limbs in compressive force-displacement behavior, input en ergy (EI), and ratio of dissipated to input energy (ED/EI). There were significant test-control differences in the load-displacement characteristics of Groups R13 (P < 0.05) and R26 (P < 0.05), with the repaired joint stiffer than the control. El decreased 26% in Group R13 (not significant) and 34% in Group R26 (P < 0.05), while the ratio ED/El increased from 27% to 44% in Group R13 (not significant) and from 31 % to 38% in Group R26 (P < 0.05).

Medial compartment contact area did not change significantly in either peripheral repair group, but de creased by 25% in Group R13 (P < 0.05) and by 13% in Group R26 (P< 0.05). Yield stress, maximum stress, and Young's modulus decreased significantly (P < 0.05) relative to the controls in tensile tests of the radial repair tissue. There were no significant changes in these properties from 13 to 26 weeks.

We concluded that in this animal model, the mechan ical function of the meniscus is restored following repair of peripheral longitudinal lesions ; however, it appears that in the radial repairs, progressive spreading at the repair site (filled by a fibrovascular scar) altered normal meniscal geometry and structure, adversely influencing mechanical function. Future studies may document whether protective measures (immobilization, limited weightbearing, etc.) can preserve normal mechanical function following repair of radial lesions.
Nonsurgical treatment of ankle sprains using the modified Sarmiento brace
Authors: Carne Pierre
Published: June 2007

The Sarmiento brace, originally designed by Dr. Au gusto Sarmiento for treatment of tibial fractures, was used in this study as a nonsurgical treatment for ankle sprains. The brace allows sufficient immobilization of the ankle while leaving it accessible for local therapy. The fast relief of pain and early reeducation associated with our method permits a much more rapid resumption of normal physical activity. We have been using this method for 5 years and still remain firm believers in it.
Soccer injuries to the brain
Authors: Tysvaer Alf T. , Storli Odd-Vebjørn
Published: June 2007

Sixty-nine football players from six Norwegian First Division League Clubs underwent a neurologic and EEG examination to investigate the incidence of head inju ries. A significantly increased incidence of EEG disturb ances were found in the football players compared to matched controls. The disturbances were most pro nounced among the youngest players. The higher inci dence of EEG disturbances found in the football players is most likely due to neuronal damage caused by re peated minor head traumas.
Patellofemoral problems after anterior cruciate ligament reconstruction
Authors: Sachs Raymond A. , Daniel Dale M. , Stone Mary Lou , Garfein Richard F.
Published: June 2007

Between 1982 and 1986, 126 patients who had under gone ACL reconstruction were followed in a prospec tive manner. One year follow-up statistics were re viewed for the presence of 13 different complications. The most prevalent complications were quadriceps weakness, flexion contracture, and patellofemoral pain. Quadriceps weakness (strength less than 80% of the normal side) was present in 65% of patients and cor related positively with flexion contracture, patellar irrit ability, and ACL reconstructions using patellar tendon grafts. Flexion contracture of 5° or more was present in 24% of patients and correlated positively with in creased age and patellar irritability. Patellofemoral pain was present in 19% of patients and correlated positively with flexion contracture.

Clinical relevance: The three most common compli cations of knee ligament surgery are shown to be strongly interrelated. It is likely that a causal relationship is present in which flexion contracture causes patello femoral irritability, and that both of these factors, alone or in combination, result in quadriceps weakness. If this theory is correct, then it is crucial that postoperative rehabilitation programs place a major emphasis on the avoidance of flexion contracture.