bluuebunny/crossref_metadata_2025 huggingface dataset:
Shoulder function in patients with unoperated anterior shoulder instability
Authors: Tsai LI , Wredmark Torsten , Johansson Christer , Gibo Karin , Engstrom Björn , Tornqvist Hans
Published: June 2007

A functional analysis, including Rowe score and meas urements of isokinetic peak torque and range of motion of the shoulder, and a subjective assessment were performed in 26 consecutive patients (23 males and 3 females) with unoperated anterior shoulder instability.

Patients experienced the initial dislocation at an av erage age of 23 ± 8 years and 58% occurred during sports activity. No patient had gone through any con trolled rehabilitation program. In this study, an average of 7 years (range, 1 to 28) had passed since the initial dislocation. Fifty-nine percent of the patients com plained of markedly reduced ability to perform in sports because of instability, impaired strength, decreased range of motion, and pain induced by activity. The majority (65%) of the patients reported instability only during physical activity. The average Rowe score was 68 ± 14 on a scale of 100. In comparison with the healthy side, the injured shoulder had a significantly lower isokinetic peak torque during abduction and in ternal rotation, as well as a reduced range of motion in extension, abduction, and external rotation, but not in flexion. The severity of impairment (Rowe score, deficit in range of motion, and peak torque) was not related to the number of dislocations sustained or to the du ration of instability.
Spinal cord concussion in rugby players
Authors: Scher Alan T.
Published: June 2007

During an analysis of a group of 40 rugby players who had sustained cervical spinal cord injury, 9 players were identified who had sustained only transient paralysis. These players showed no radiologic evidence of any injury to the cervical spine. We did a retrospective analysis of the clinical and radiological findings in this group of rugby players. The cervical spine radiographs were analyzed for evidence of spinal stenosis, congen ital anomalies, and degenerative disk disease. Using the ratio method of assessment for spinal stenosis, we found spinal canal narrowing maximally at C-3 and C-4 in five of the nine players. In the remaining four players, one showed evidence of osteoarthritic change at two levels while another had congenital fusion of two ver tebral bodies. In two players, no radiologic evidence of any abnormality was detected. The mechanism of tran sient disturbance of the spinal cord function after trauma is discussed here.
Arthroscopic evaluation of meniscal repairs after anterior cruciate ligament reconstruction and immediate motion
Authors: Buseck Mark S. , Noyes Frank R.
Published: June 2007

Sixty-six patients who had meniscal repair at the same time as an ACL reconstruction were followed-up with arthroscopy at an average of 12 months postopera tively. All patients underwent immediate postoperative range of motion from 20° to 90° and began partial weightbearing between the 1 st and 3rd postoperative weeks. The rate of meniscal healing was classified as complete, partial, or failed. We statistically analyzed the effect of rim width, length of the tear, type of meniscus, age of patient, length of time between injury and repair, length of time between surgery and follow-up arthros copy, and open versus arthroscopically assisted sur gical procedure on the rate of meniscal healing.

The overall results showed that 63 (80%) of the menisci completely healed, 11 (14%) partially healed, and 5 (6%) failed. The only factor that had a statistically significant impact on the rate of healing was rim width. Repairs in the outer one-third region had a higher incidence of healing (98% retained menisci) than those in the central one-third region (79% retained menisci, P < 0.01). Still, the ability to repair a majority of central one-third meniscus tears that occur in the avascular zone (including flap tears and double longitudinal tears) suggest repair be considered when clinical grounds warrant preserving the meniscus. There were no com plications, nor were there any deleterious effects from immediate knee motion or early weightbearing on the meniscal repairs. This allows an aggressive, immediate motion program to be followed with ACL reconstruction when concomitant meniscus repair is performed.
Nordic ski jumping injuries
Authors: Wright James R. , McIntyre Lynn , Rand Jay J. , Hixson Edward G.
Published: June 2007

Little data are available in the medical literature on nordic ski jumping injuries. Injury questionnaires were sent to all active American ski jumpers registered either with the United States Ski Association or with a jumping club registered with the United States Ski Association. One hundred thirty-three of 286 (46.5%) injury ques tionnaires were returned. Eighty-one of the 133 re spondents (60.9%) had been injured sufficiently to re quire examination by a physician at least once during their jumping careers. This report describes the types and frequencies of injuries sustained by this group of nordic ski jumpers as well as provides demographic data about American ski jumpers. The risk of injury per 100 participant years was 9.4, a rate less than that reported for most high school or college intermural sports.
Arthroscopic treatment of shoulder impingement in athletes
Authors: Burns Thomas P. , Turba John E.
Published: June 2007

Twenty-nine patients (1 high school athlete, 9 college athletes, and 20 recreational or nonathletes) with Neer stage II impingement syndrome were treated by ar throscopic subacromial decompression after their inju ries failed to improve with conservative therapy. Fol lowup averaged 32.2 months, and results were rated based on subjective responses and the UCLA Shoulder Rating Scale. Of the results, 82.2% were rated as satisfactory, while 17.2% were unsatisfactory. The greatest margin of improvement was in the pain rating. Postoperatively, 65.5% of the patients returned to their previous level of activity and 56% of the collegiate athletes returned to their previous competitive level. The average time to return to college-level competitive athletics for the recreational or nonathletes was 6.6 months (average 5.4). There were no infections or neurovascular complications in the series.
Incidence of lateral meniscus injury in professional basketball players
Authors: Krinsky Michael B. , Abdenour Thomas E. , Starkey Chad , Albo Robert A. , Chu Donald A.
Published: June 2007

We reviewed National Basketball Trainers Association data over a 6-year period to determine the incidence of lateral meniscus injury among professional basketball players. Our results indicated that 58% of all injuries involved the lateral meniscus, while 42% involved the medial meniscus. This differs from what other authors have reported for basketball players. The lateral menis cus may be vulnerable to chronic injury and subject to microtrauma from repetitive submaximal stresses as sociated with cutting or changing direction while run ning, or from pivoting. A professional player is at more risk of injury during a game than practice, and thus is exposed to injury more than a collegian because the professional season has three to four times as many games. Also, magnetic resonance imaging may aid the physician in accurately diagnosing some tears that would otherwise have gone undetected or required arthroscopy for diagnosis. In addition, injury to the lateral meniscus could produce secondary symptoms such as instability or patellofemoral pain to structures other than the lateral meniscus.
EMG analysis of the scapular muscles during a shoulder rehabilitation program
Authors: Moseley J. Bruce , Jobe Frank W. , Pink Marilyn , Perry Jacquelin , Tibone James
Published: June 2007

The purpose of this study was to determine which exercises most effectively use the scapular muscles. Eight muscles in 9 healthy subjects were studied with indwelling electromyographic electrodes and cinema tography while performing 16 exercises. The 8 muscles studied were the upper, middle, and lower trapezius; levator scapula; rhomboids; pectoralis minor; and the middle and lower serratus anterior. Each exercise was divided into arcs of motion and the electromyographic activity was quantified as a percentage of the maximal manual muscle test. The optimal exercises for each muscle were identified based on intensity (greater than 50% maximal manual muscle test) and duration (over at least 3 consecutive arcs of motion) of the muscle activity. Twelve of the exercises qualified as top exer cises for all of the muscles. On further analysis, a group of 4 exercises was shown to make up the core of a scapular muscle strengthening program. Those 4 ex ercises include scaption (scapular plane elevation), row ing, push-up with a plus, and press-up.
Knee ligament injuries in volleyball players
Authors: Ferretti Andrea , Papandrea Paola , Conteduca Fabio , Mariani Pier Paolo
Published: June 2007

The authors report a series of 52 cases of serious knee ligament injuries in volleyball players. The most frequent mechanism of injury was landing from a jump in the attack zone. Women were more affected than men. Injuries were more frequent during games than training. Volleyball must then be considered among high-risk sports according to the frequency and gravity of our surgical findings. Results are similar to those obtained in athletes in other sports who underwent the same surgical procedure.
Stress changes of the distal radial growth plate
Authors: Caine Dennis , Roy Steven , Singer Kenneth M. , Broekhoff Jan
Published: June 2007

We conducted a radiographic survey to determine skel etal age and the nature and prevalence of stress-related changes affecting the distal radial growth plate in 60 young competitive gymnasts (39 females, 21 males). Comparison of results for chronological and skeletal age revealed a significant delay in maturation for girls (P < 0.001). Radiographic evaluation revealed 5 gym nasts (4 girls and 1 boy) with stress-related changes of the left wrist, and four of these were considered to be minimal.

These results, in conjunction with our previous find ings and the review of related literature, reveal three important observations. First, the widening and irregu larities of the distal radial physis that we described previously appear to be the first in a spectrum of abnormal changes secondary to overuse and probably represent a stress fracture of the distal radial growth plate. The radiographic changes associated with this injury are not the normal adaptive changes seen in young, competitive gymnasts.

Secondly, more serious long-term abnormality may result even though the injury may initially resemble a Salter-Harris type I or II stress fracture. Long-term complications may include symmetrical or asymmetrical retardation or halted growth at the affected site, posi tive ulnar variance, and associated pathoanatomic se quelae. Thirdly, the incidence of distal radial growth plate stress injury remains unclear; we recommend a further, large-scale prospective epidemiologic study in volving both male and female gymnasts. We urge that physicians and other health professionals associated with gymnastics clubs educate coaches about the pos sibility of significant injury to the distal radial physis, risk factors, and suggested preventive measures.
An electromyographic analysis of the elbow in normal and injured pitchers with medial collateral ligament insufficiency
Authors: Glousman Ronald E. , Barron Jerry , Jobe Frank W. , Perry Jacquelin , Pink Marilyn
Published: June 2007

Electromyography and high-speed film were used to examine the muscle activity in the elbows of pitchers with medial collateral ligament insufficiency compared to the activity in uninjured elbows. Ten competitive baseball pitchers with medial collateral insufficiency and 30 uninjured competitive pitchers were tested while throwing the fastball and the curveball. The extensor carpi radialis brevis and longus in the injured pitchers showed greater activity than in the uninjured pitchers for both pitches. The triceps, flexor carpi radialis, and pronator teres all showed less activity in the injured pitchers during the fastball, but only the triceps had less activity during the curveball. The differences were seen during the late cocking and acceleration phases, which place the greatest stress on the medial collateral ligament. If the flexor carpi radialis and pronator teres were substituting for the deficient medial collateral lig ament and functioning as dynamic stabilizers, one would expect enhanced muscle activity. However, the opposite was found. This pattern of asynchronous mus cle action with medial collateral ligament injury may predispose the joint to further injury. The muscular differences seen are critical to the understanding of the pathomechanics of patients with medial collateral liga ment deficiency, and provide a basis for rehabilitation.
European soccer injuries
Authors: Høy Kristian , Lindblad Bent Erling , Terkelsen Carsten Juhl , Helleland Haakon Einar , Terkelsen Christian Juhl
Published: June 2007

In 1 year, 715 patients with soccer injuries were regis tered and treated in the emergency department of Randers City Hospital. We did a prospective study of these patients using a questionnaire to determine the most common locations, types, mechanisms, and treat ments of injury. Financial costs for society and the individual were also examined.

Forty-nine percent of the injuries were to the joints; sprains and contusions were the most common types of injury, accounting for 46% and 25%, respectively. The majority of patients (64% of the men and 58% of the women) were injured during physical contact with another player. Most (63%) of the patients were treated in the emergency department and then released. Thirty- one percent had to be absent from work, but only 8% of the patients had a loss of income because of their injury. The average amount of work time lost was 5 days.
Posterior shoulder instability
Authors: Hurley John A. , Anderson Thomas E. , Dear William , Andrish Jack T. , Bergfeld John A. , Weiker Garron G.
Published: June 2007

We conducted a retrospective study on 50 patients with recurrent posterior shoulder instability. Twenty- five patients were treated conservatively with a specific rehabilitation program strengthening the rotator cuff. The other 25 patients, who did not improve with reha bilitation, underwent surgical reconstruction, the major ity of these being soft tissue repairs. Recurrence in the surgically treated group averaged 72% while that in the conservatively treated group was 96%. However, 50% of those patients treated surgically and 68% of those treated conservatively felt their symptoms were im proved.

In view of the high recurrence rate with soft tissue reconstruction, computed tomography scans were ob tained to evaluate glenoid version. Those patients with posterior shoulder instability were found to have in creased glenoid retroversion when compared to an uninjured population (P < 0.05). Our conclusions based on this study were that 1) specific therapy in the form of rotator cuff strengthening should be the initial form of treatment in patients with posterior shoulder insta bility, 2) soft tissue surgery has a high rate of recur rence, 3) the return to sports is variable, 4) there appears to be an increased incidence of glenoid retro version in this patient population, and 5) the incidence of posttraumatic arthritis is low.
Handball injuries
Authors: Lindblad Bent Erling , Høy Kristian , Terkelsen Carsten Juhl , Helleland Haakon Einar , Terkelsen Christian Juhl
Published: June 2007

A total of 570 injuries in handball players were pro spectively registered in a well-defined geographic area of 124,321 inhabitants. The incidence of handball inju ries was 46 per 10,000 inhabitants per year. The inci dence in women (61 per 10,000 per year) was double that of men (31 per 10,000 per year). Sixty-two percent of the injuries were ligament sprains and tears and 12% were fractures. A total of 7% of the patients were hospitalized and the total loss of income because of sick leave was $3870. Sixty-eight percent of the injured handball players were absent from handball more than 1 week. Surprisingly, 8% of the minor injuries resulted in a sick leave of more than 6 days.
Reconstruction of the lateral ankle ligaments
Authors: Colville Mark R. , Marder Richard A. , Zarins Bertram
Published: June 2007

The purpose of this study was to perform a biome chanical analysis of several commonly performed op erative procedures used to stabilize the lateral ankle. We performed the Evans, Watson-Jones, and Chris man-Snook procedures on 15 cadaveric ankles and tested the ankles for stability, motion, and isometry of graft placement. The Evans procedure allowed in creased anterior displacement, internal rotation, and tilt of the talus when compared to ankles with intact liga ments. Subtalar joint motion was restricted by the Evans procedure. The Watson-Jones procedure con trolled internal rotation and anterior displacement of the talus, but was less effective in controlling talar tilt and also restricted subtalar joint motion. The Chrisman- Snook procedure allowed increased internal rotation and anterior displacement of the talus when compared to ankles with intact ligaments. The procedure was effective in limiting talar tilt, but restricted subtalar joint motion.

Based on the biomechanical data obtained, we de vised a lateral ankle reconstruction with bone tunnels that reproduce the anatomic orientation of both the anterior talofibular and calcaneofibular ligaments. This ankle ligament reconstruction resists anterior displace ment, internal rotation, and talar tilt without restricting subtalar joint motion.

Clinical relevance: We found considerable mechanical differences among the more commonly performed lat eral ankle reconstructions. It is possible to locate bone tunnels and graft placement so that a more anatomic configuration is achieved.
Meniscal transplantation using fresh and cryopreserved allografts
Authors: Jackson Douglas W. , McDevitt Cahir A. , Simon Timothy M. , Arnoczky Steven P. , Atwell E. Allan , Silvino Nicholas J.
Published: June 2007

A comparative study of three subgroups of meniscal transplants was undertaken in the goat model: Group 1 (autograft) involved removal and immediate reimplan tation of the meniscus; Group 2, fresh meniscal allo grafts ; and Group 3, cryopreserved (30 days) meniscal allografts. Six months after surgery, tissues were eval uated for gross degenerative changes, proteoglycan concentration (as assessed by uronic acid), water con tent, vascularity, histology, and cell viability. The con tralateral knee served as control for all comparisons. There was no statistical difference in the amount of arthritis present and all transplants demonstrated an essentially normal peripheral vascularity compared to controls. Sections revealed reduced numbers of cells in the central portions of the transplanted menisci and these viable cells demonstrated different behavior in multiplication in tissue culture compared to contralateral controls.

Grossly and microscopically, the implanted menisci differed little from the controls. The measurement of proteoglycan concentration and water content of the transplanted meniscal cartilage suggest alterations that may affect the long-term mechanical properties. The autograft specimens showed the water content was very slightly increased (3% to 6%), while the proteogly can concentration was increased (42% in terms of uronic acid). In contrast, the water content of the fresh allograft group and the cryopreserved group was in creased 12% to 24%. Proteoglycan concentration in these groups was decreased up to 56% in portions of some menisci compared to controls.

Fresh and cryopreserved meniscal allografts showed peripheral healing, revascularization, cellularity, and in corporation, and grossly appeared good at 6 months in the goat model. The biochemical changes in the extra cellular matrix at 6 months raises questions on the long- term function of these transplanted menisci.
The anterior cruciate ligament-deficient knee with varus alignment
Authors: Noyes Frank R. , Schipplein Owen D. , Andriacchi Thomas P. , Saddemi Stephen R. , Weise Marc
Published: June 2007

Thirty-two patients with an ACL-deficient knee and lower limb varus alignment and 16 healthy controls were analyzed during level walking using a force-plate and optoelectronic system. The forces and moments of the lower limb and knee joint were measured and knee joint loads and ligament tensile forces were cal culated using a mathematical model.

The majority of patients (20 of 32) had an abnormally high adduction moment at the affected knee. The ad duction moment showed a statistically significant cor relation to high medial tibiofemoral compartment loads and high lateral soft tissue forces, but not to the degree of varus alignment on standing roentgenograms. Fif teen of 32 knees had abnormally high lateral soft tissue forces. We interpreted these gait findings as indicative of a medial shift in the center of maximal joint pressure and an increase in lateral soft tissue forces to achieve coronal plane stability. Further, there is the likelihood of separation of the lateral tibiofemoral joint and "con dylar lift-off" during periods of the stance phase. If this occurs, all of the load-bearing forces would shift to the medial tibiofemoral joint and relatively large tensile forces would occur in the lateral soft tissue restraints.

The flexion moment, as related to the quadriceps muscle force, was significantly lower than the control knees in 40% of the involved knees, and the extension moment, as related to the hamstring muscle force, was significantly higher in 50% of the involved knees. We interpret this finding as a gait adaptation tending to diminish quadriceps muscle activity and enhance ham string muscle activity to provide dynamic anteroposte rior stability of the knee joint.

The fundamental assumption of this paper is that any combination of conditions leading to higher medial joint forces is associated with factors leading to more rapid degeneration of the medial compartment in patients with ACL deficiency, varus deformity, and lax lateral ligaments.
Characteristics of the isokinetic performance of patients with injured cruciate ligaments
Authors: Shirakura Kenji , Kato Kazuo , Udagawa Echi
Published: June 2007

The torques of the quadriceps muscle in patients with cruciate ligament injuries were evaluated under isoki netic contraction. There were 30 patients with anterior cruciate ligament injuries, 19 with posterior cruciate ligament injuries, and 30 controls.

The torques of concentric and eccentric contractions in anterior cruciate ligament-injured knees showed a significant difference from those in the uninjured sides at extension angles of less than 45°, yet the values of the peak torques for concentric and eccentric contrac tions were the same as those for the uninjured sides. The torques of concentric and eccentric contractions in posterior cruciate ligament-injured knees showed a sig nificant difference from the uninjured sides at flexion angles of more than 36°. The peak torques for concen tric and eccentric contraction also showed a significant difference from the uninjured sides. The concentric and eccentric peak torque angles of the injured knees were similar to those of the uninjured sides in all subjects. The ratios of eccentric to concentric peak torque of the contralateral knees in the anterior cruciate ligament- injured groups did not show a significant difference from those of the controls. The evaluation of the bio mechanical change in these categories is of great ad vantage in determining proper methods of treatment and rehabilitation.
High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees
Authors: Noyes Frank R. , Barber Sue D. , Simon Richard
Published: June 2007

We assessed short-term treatment results of younger patients with varus malalignment and chronic anterior cruciate ligament deficiency. Forty-one patients (mean, 32 years; range, 16 to 47) underwent a high tibial osteotomy. Because of giving way symptoms, 14 also had a lateral iliotibial band extraarticular procedure at the time of the osteotomy and 16 had an intraarticular anterior cruciate ligament allograft reconstruction after the osteotomy. All returned for followup (mean, 58 months; range, 23 to 86), which included KT-1000 arthrometer testing and evaluation by our knee rating system.

Statistically significant ( P < 0.05) improvements were found in the mean overall rating scores for pain, swell ing, and giving way. Preoperatively, 30 (73%) had pain with activities of daily living or with any sports activity; 11 (27%) could perform only light sports activities with out pain. At followup, 32 patients (78%) had no pain with activities of daily living or light sports.

Ten of 15 patients with advanced medial tibiofemoral arthrosis (subchondral bone exposure) had significant improvements in symptoms.

Patient satisfaction was high: 88% stated they would undergo the procedure again and 78% felt their knee condition was improved.

Patients who had the allograft reconstruction had significantly lower ( P < 0.05) anterior-posterior dis placements at followup than those who had the extraar ticular procedure.

We concluded that osteotomy should be performed early in the disease process for younger athletes who experience symptoms with activity. It may be unrealis tic, however, to expect continuation of sports beyond light recreational, given the joint arthrosis that is usually present and the high in vivo joint loadings with athletes. Anterior cruciate ligament reconstruction should be considered when giving way previously occurred and the patient plans to resume athletics. However, patients with advanced arthrosis can avoid anterior cruciate ligament surgery by reducing athletic activities.
Acute repair of injury to the anterior cruciate ligament
Authors: Cross Mervyn J. , Wootton J.R. , Bokor Desmond J. , Sorrenti Sam J.
Published: June 2007

We reviewed 30 patients at an average of 7.4 years after acute repair of the anterior cruciate ligament aug mented with a loop of iliotibial tract. A noncontact twisting had been the mechanism of injury in 18 of these patients, with 28 having been injured in sports. At followup, 25 patients had not experienced symptoms of instability and 23 were able to return to unrestricted athletic activity; only 5 had been unable or unwilling to return to sporting activity at all. There had been no swelling in 23 patients; however, 17 suffered from pain on exertion. The average Lysholm score was 93.2.

Joint laxity was assessed and anteroposterior tibial translation quantified with a KT-1000 arthrometer. Eighteen patients had a normal or 1+ Lachman test and 27 had an absent or 1 + pivot shift. When compared with the results of a similar study performed on this group of patients at 2 years after surgery, there had been little subjective change in knee function. However, objectively there had been significant deterioration of the anteroposterior stability of the knees at 7 years, suggesting failure of the integrity of the repaired liga ment with time. An associated medial collateral ligament injury had a significant adverse effect both on the integrity of the anterior cruciate ligament repair and the incidence of postoperative stiffness.
A review of allograft processing and sterilization techniques and their role in transmission of the human immunodeficiency virus
Authors: Asselmeier Marc A. , Caspari Richard B. , Bottenfield Scott
Published: June 2007

Human immunodeficiency virus (HIV) infection via vas cular organ and tissue transplantation is well docu mented. The majority of these transmissions occurred before the development of HIV antibody testing, which is now a routine screening tool used before organ and tissue procurement and transplantation. There exists what is commonly referred to as a "window" of sero negativity after HIV infection. Potential donors may be infectious with the HIV virus but not yet detected with available HIV antibody tests. Bone and soft tissue retrieval may be done in either a sterile or clean, non- sterile manner. Deep freezing and freeze-drying (lyoph ilization) are two commonly used modes of preserving bone and soft tissue allografts.

In 1985, a screened donor who was in the window of seronegativity underwent vascular organ and mus culoskeletal tissue harvest. The bone and soft tissue procured underwent a variety of processing and pres ervation techniques. There have been no known cases of HIV transmission from the processed freeze-dried tissues.

Evidence now exists that early HIV infection, before HIV antibody production, may be the most infectious period. The HIV antigen testing may allow earlier detec tion of an infectious donor, thus closing the window of seronegativity. It is unknown whether this nontransmis sion of HIV to the recipients of the processed and freeze-dried tissue was due to the processing or the nature of the tissue itself.
Sports and osteoarthrosis of the hip
Authors: Vingård Eva , Alfredsson Lars , Goldie Ian , Hogstedt Christer
Published: June 2007

To investigate if participation in sports increases the risk of developing osteoarthrosis of the hip, we did a case-control study on the sports activities of 233 men (up to age 49) who were recent recipients of a prosthe sis because of severe idiopathic osteoarthrosis of the hip and 302 men randomly selected from the general population. Assessments of sports, job history, and health status were made by an interview.

Men with high exposure to sports of all kinds com bined (in hours) had a relative risk to develop osteoar throsis of the hip of 4.5 compared to those with low exposure. Track and field sports and racket sports seemed to be the most hazardous to the hip joint. Men who had been exposed to high physical loads both from their occupation and sports had a relative risk of 8.5 to develop osteoarthrosis of the hip compared to those with low physical load in both activities. Potential confounding factors, such as age, body mass index, and smoking, were considered.

Long-term exposure to sports among men seems to be a risk factor for developing severe osteoarthrosis of the hip; this is increased when combined with heavy load from occupation.
Roofplasty requirements in vitro for different tibial hole placements in anterior cruciate ligament reconstruction
Authors: Berns Gregory S. , Howell Stephen M.
Published: June 2007

In this study we sought both to quantify the forces that result in anterior cruciate ligament graft impingement and the amount of roofplasty necessary to prevent it. The perpendicular force of the intercondylar roof against an anterior cruciate ligament graft was meas ured in seven fresh-frozen cadaveric knees. Two tibial hole placements were evaluated: an anterior/eccentric hole (26.6% ± 3.1% of the sagittal depth) and a cus tomized hole aligned 4 to 5 mm posterior and parallel to the slope of the intercondylar roof in the extended knee (42.0% ± 2.6% of the sagittal depth). A transducer that measured the contact force with the graft was implanted in the roof. An extensive roofplasty was performed so that the sensor would bear all of the roof force. Graft tension was also measured. Extension moments were applied to 20 N-m with a six degree of freedom load application system. Load cycles were repeated with the roof force sensor backed out in 0.8 mm increments. The sensor backout represented a corresponding amount of bone removal in a roofplasty. The flexion angle at roof-graft contact was consist ently greater using the anterior tibial hole than the customized one. This held true for all increments of sensor backout. With the anterior hole, the roof sensor (no backout) contacted the graft at 12.8° ± 6.7° of flexion, whereas the customized hole resulted in con tact at 4.1° ± 4.2° ( P = 0.020). With zero impingement defined as no contact between the roof and the graft throughout the range of motion, the anterior hole re quired 4.6 ± 1.0 mm of roof removal, and the custom ized hole required 1.3 ± 1.1 mm of roof removal ( P ≤ 0.0001).
Effects of postoperative immobilization on the reconstructed anterior cruciate ligament
Authors: Muneta Takeshi , Yamamoto Haruyasu , Takakuda Kazuo , Sakai Hiroshi , Furuya Kohtaro
Published: June 2007

To investigate the effects of postoperative immobiliza tion and limited motion on reconstructed anterior cru ciate ligaments, 28 rabbits received an anterior cruciate ligament reconstruction using autogenous Achilles ten don and were then divided into three groups: fully immobilized, 4 weeks immobilized, and limited motion. Two rabbits from each group were evaluated macro scopically, histologically, and microangiographically at 4-week intervals until 12 weeks postoperatively. An additional six rabbits in the 4 weeks immobilized and limited motion groups were studied biomechanically at 12 weeks postoperatively.

Macroscopically, both immobilized groups showed more proliferation of the infrapatellar fat pad, which was adherent to the reconstructed anterior cruciate liga ment. Histology revealed more rapid regeneration of reconstructed anterior cruciate ligaments in the limited motion group, with no findings of necrosis in the mid- substance. Microangiography indicated faster normali zation of vascularity in the limited motion group. The biomechanical study showed no significant difference in laxity between the 4 weeks immobilized and limited motion groups. The graft stiffness and maximum load to failure were greater for the limited motion group, although the increase was not statistically significant. The histologic and microangiographic results from the limited number of animals in this study support limited postoperative motion in the anterior cruciate ligament reconstructed knee. However, there were no differ ences in terms of the biomechanical parameters at 12 weeks postoperatively between the immobilized and limited motion treatment modes.
Dacron ligament reconstruction for chronic anterior cruciate ligament insufficiency
Authors: Wilk Richard M. , Richmond John C.
Published: June 2007

We report the 5-year follow-up results of a prospective, multicenter study evaluating the use of a Dacron pros thetic ligament in reconstruction of anterior cruciate- deficient knees. The study group consisted of 84 pa tients, followed for at least 5 years. The patients were divided into 2 groups: 50 patients with isolated anterior cruciate ligament laxity (Group 1) and 34 patients with a failed previous anterior cruciate ligament surgery or combined laxities (Group 2). Two surgical techniques were employed: reconstruction through drill holes in the tibia and femur (30 patients) and reconstruction using the over-the-top position with the Dacron ligament wrapped in a strip of iliotibial band (54 patients).

The overall failure rate was 35.7% at 5 years. The failure rate at 2 years was 20%, illustrating a significant deterioration of results between the two follow-up in tervals. Evaluation of subjective criteria using the Lysh olm score showed an improvement from preoperative status at the 2-year followup; however, there was a slight decline when 5-year results were evaluated. Teg ner activity levels increased from a mean of 2.9 ± 2.1 at the preoperative visit, to a mean of 4.9 ± 2.0 at the 2-year followup and a mean of 5.0 ± 2.0 at the 5-year visit.

These results show that the Dacron ligament pros thesis achieves the short-term goal of restoring stability and improving function and may be sufficient to provide long-term stability for the anterior cruciate-deficient knee.
Posterior subluxations of the medial and lateral tibiofemoral compartments
Authors: Noyes Frank R. , Stowers Stewart F. , Grood Edward S. , Cummings John , VanGinkel Laura A.
Published: June 2007

We report for the first time the abnormal increases in posterior subluxation of the medial and lateral tibial plateaus after sectioning the posterolateral structures and posterior cruciate ligament. We applied specific forces and moments to the knees of seven cadaveric whole lower limbs and measured the position of the tibia at which the ligaments and the geometry of the joint limited motion.

Removal of only the posterolateral structures resulted in an average increase in posterior translation of the lateral tibial plateau of 8.0 mm (range, 5.7 to 10.6) at 30° of flexion over the intact state (P < 0.01), but no significant increase at 90° of flexion (mean, 2.7 mm). Knees with underlying physiologic cruciate ligament laxity (high anterior/posterior displacement in the intact knee) had the greatest lateral tibial plateau subluxation (P < 0.01). There was no abnormal posterior translation of the medial tibial plateau. After sectioning the poste rior cruciate ligament and the posterolateral structures, statistically significant increases in posterior translation of both the medial and lateral tibial plateaus occurred at 30° and 90° of flexion (P < 0.01). The increase in posterior translation of the lateral tibial plateau over the intact state averaged 17.8 and 23.5 mm at 30° and 90° of flexion, respectively; for the medial tibial plateau this increase averaged 7.6 and 12.3 mm at 30° and 90° of flexion, respectively.

The diagnosis of abnormal tibiofemoral rotatory sub luxations requires knowledge of the anteroposterior direction and magnitude of each tibial plateau under both low flexion and high flexion knee angle positions.
Patellar tendon length change after anterior cruciate ligament reconstruction using the midthird patellar tendon
Authors: Shaffer Benjamin S. , Tibone James E.
Published: June 2007

The purpose of this study was to determine if use of the midthird patellar tendon autograft contributes to or causes patellar tendon shortening or patella baja in anterior cruciate ligament reconstruction. Thirty-six pa tients undergoing arthroscopically assisted midthird pa tellar tendon autograft anterior cruciate ligament recon struction were studied prospectively. Intraoperative pa tellar tendon length changes were measured. Half of the patients had the tendon defect closed and half had it left open (closing peritenon only). Radiographic ten don length changes and patella baja were assessed using Insall-Salvati and Blackburne-Peel ratios meas ured on 45° lateral knee radiographs using an adjust able polypropylene jig. Bilateral films were obtained preoperatively and at 2 weeks, 3 months, and 6 months postoperatively.

No patients demonstrated evidence of patellar tendon shortening greater than the 5.5% measurement error. Tendon defect closure resulted in negligible tendon shortening intraoperatively, averaging 2.28% (1.11 mm). Of the 18 patients whose defects were closed, 5 showed no shortening. The remaining 13 patients had measurable tendon shortening less than 4% (2 mm). No patients developed patella baja.
Partial meniscectomy and anterior cruciate ligament rupture in soccer players
Authors: Neyret Philippe , Donell Simon T. , Dejour David , Dejour Henri
Published: June 2007

A retrospective review of 77 soccer players with 91 affected knees that had undergone the same operation, a rim-preserving meniscectomy, was made with a min imum followup of 20 years and an average followup of 27 years. The patients were divided into groups based on the presence of an intact (Group 1) or ruptured (Group 2) anterior cruciate ligament.

At 5 years after meniscectomy, 75% of Group 1 and 52% of Group 2 were still playing soccer, and 13% in Group 1 as opposed to 28% in Group 2 had given up sports. The sporting class assessment was good in 80% of the Group 1 knees and 62% in the Group 2 knees.

By followup, 5% of Group 1 and 32% of Group 2 required further meniscectomies, and 2% of Group 1 and 16% of Group 2 required operations for osteo arthritis. Radiologically diagnosed osteoarthritis was present in 24% of Group 1 knees compared with 77% of Group 2. Functionally, 60% of the Group 1 knees were excellent at followup as opposed to 9% in Group 2 knees. In Group 1, 49% were still involved in sports compared with 22% in Group 2. However, 97% of Group 1 were satisfied with their knees compared with 74% of Group 2. All of these differences were statisti cally significant.
Isolated posterior cruciate ligament reconstruction
Authors: Lipscomb A. Brant , Anderson Allen F. , Norwig Emily D. , Hovis W. David , Brown David L.
Published: June 2007

From 1973 to 1987, 28 patients seen at our institution sustained isolated posterior cruciate ligament tears. Of these 28 patients, 25 were reevaluated at an average followup of 7 years and 1 month after secondary recon struction of the posterior cruciate ligament using the semitendinosus and gracilis tendons alone or with an extraarticular procedure.

Subjectively, 22 of 25 patients related no restrictions regarding activities of daily living, with 14 of 25 patients being able to return to their previous competitive level in sports. Objective evaluation after reconstruction re vealed no change in the preoperative and postoperative posterior drawer examination in 13 of 25 patients, a finding confirmed by KT-1000 arthrometer measure ments. Radiographic evaluation revealed degenerative changes predominantly involving the medial and patel lofemoral compartments in 15 of 25 patients.

Despite optimistic subjective reporting, this long-term retrospective study reveals that this procedure incon sistently limits posterior instability and therefore cannot be recommended.
Arthroscopy of the knee
Authors: Highgenboten Carl L. , Jackson Allen W. , Meske Neil B.
Published: June 2007

A prospective study was conducted to determine 10- day pain and analgesic use profiles of outpatients after arthroscopic surgery of the knee and to examine the effects of oral corticosteroid use on analgesic intake, perceived pain, and functional outcomes. Sixty-two patients who underwent a variety of arthroscopic pro cedures of the knee were matched on level of injury and surgical repair, and were assigned to two groups. The experimental group received a standard dosage of oral postoperative corticosteroids. The placebo group received the same dosage of a placebo (sugar pill). Both groups received the same prescription of an an algesic for pain relief after surgery. Results indicated that there were no significant differences for any de pendent variables between the experimental and pla cebo groups. There were significant (P < 0.001) de creases in analgesic use and perceived pain throughout the 10 days. Conclusions were that most patients who have undergone arthroscopic surgery of the knee per ceive pain at low levels, use limited amounts of anal gesics, and return to work within a week. The addition of oral corticosteroids does not influence this profile.
Magnetic resonance imaging of injury to the lateral ankle ligaments
Authors: Rijke Arie M. , Goitz Henry T. , McCue Frank C. , Dee Paul M.
Published: June 2007

To establish the value of magnetic resonance imaging in determining which patients with ankle sprains will benefit from surgical treatment, 1 uninjured volunteer and 15 patients with acute, subacute, and chronic injuries of the lateral ankle ligaments were imaged at 1.0 tesla using a fast imaging with steady-state preci sion three-dimensional technique and 1.5-mm slice thickness. A dedicated knee coil was used to hold the foot in a neutral or plantar-flexed position. In cases of acute, low-grade injuries, fraying of the anterior talofib ular ligaments with intact calcaneofibular ligaments was observed in the presence of edema and hemorrhagic fluid. In cases of acute, high-grade sprains, the calca neofibular ligament appeared wavy or was visualized only partially or not at all. Subacute injuries showed ligament disruption; chronic lesions, on occasion, showed atrophy of the calcaneofibular ligament but no edema or hemorrhagic fluid. These findings showed a good qualitative correlation with the results of graded stress radiography.

Magnetic resonance imaging can definitely determine the ligaments involved in lateral ankle sprains and pro vide useful anatomic information in cases in which acute or reconstructive surgery is contemplated. However, the magnetic resonance imaging findings do not directly correlate with degree of instability and do not replace those of physical examination or routine radiographic studies.
Anterior shoulder instability in weight lifters
Authors: Gross Michael L. , Brenner Stephen L. , Esformes Ira , Sonzogni John J.
Published: June 2007

Occult instability is recognized as a major cause of shoulder dysfunction in throwing athletes. Few studies have characterized the findings of occult instability in nonthrowers. The purpose of this study was to examine shoulder instability in a group of weight lifters. The symptoms, physical findings, and results of treatment for 23 shoulders in 20 athletes are presented. All ath letes presented with a complaint of progressive inability to perform exercises with the upper extremity in the abducted, externally rotated position (the "at-risk" po sition) because of pain. One hundred percent of the athletes experienced posterior shoulder pain when the shoulder was placed in forced abduction and external rotation. Thirteen shoulders in 10 patients responded to conservative management including aggressive re habilitation and modification of technique to avoid the at-risk position. The other 10 shoulders, which did not respond to conservative treatment, required surgical treatment to alleviate the symptoms. All 20 patients have successfully returned to their previous weight lifting activities.
Injuries in professional rugby league
Authors: Gibbs Nathan
Published: June 2007

In this 3-year prospective study, the incidence and nature of injuries incurred by a professional rugby league football club were investigated. During the 1989, 1990, and 1991 season games, 141 injuries occurred throughout the first, second, and under-21 age teams, which resulted in players missing subsequent games.

The incidence of injury was 44.9 per 1000 player- position game hours, which is high when compared with other sports. Of these injuries, 37.6% were clas sified as minor, 34.8% as moderate, and 27.6% as major. The classification was based on the number of subsequent games missed: minor injuries caused a player to miss one game; moderate, two to four games; and major, five or more games.

Ligament and joint injuries comprised 53.9% of all injuries, and the knee was the most common area injured (24.1 %). The commonest specific injuries were to the medial collateral ligament of the knee and to the groin musculotendinous unit (10.6% each).
Operative versus nonoperative treatment of Achilles tendon rupture
Authors: Cetti René , Christensen Steen-Erik , Ejsted Rolf , Jensen Niels Melchior , Jorgensen Uffe
Published: June 2007

One hundred eleven patients with acute rupture of the Achilles tendon were included in a prospective trial and randomly assigned to groups for operative (56 patients) or nonoperative (55 patients) treatment.

All of the patients were followed with clinic evalua tions at 4 months and 1 year after the rupture. The major complications in the operative treatment group were three reruptures and two deep infections as com pared with seven reruptures, one second rerupture, and one extreme residual lengthening of the tendon in the nonoperative group. There were fewer minor com plications in the nonoperative group than in the opera tive group.

The operatively treated patients had a significantly higher rate of resuming sports activities at the same level, a lesser degree of calf atrophy, better ankle movement, and fewer complaints 1 year after the ac cident.

The conclusion we reached through this randomized prospective study is that operative treatment of rup tured Achilles tendons is preferable, but nonoperative treatment is an acceptable alternative.