bluuebunny/crossref_metadata_2025 huggingface dataset:
Maxillofacial Surgery and Obstructive Sleep Apnea: A Review of 80 Patients
Authors: Riley Robert W. , Powell Nelson B. , Guilleminault Christian
Published: July 2017

To determine the effectiveness of the surgical treatment of obstructive sleep apnea, we retospectively evaluated 80 patients. One group consisted of 55 patients who had undergone a limited osteotomy of the anterior mandible: Inferior sagittal osteotomy with hyold myotomy and suspension. Important criteria for the selection of these patients were normal pulmonary function, normal mandibular skeletal development, and the absence of morbid obesity. Polysomnography revealed that 37 patients (67%) had responded to the surgical treatment and 18 patients (33%) had not. The second group of 25 patients, selected for morbid obesity, severe mandibular deficiency, and failure of other surgical procedures, had undergone maxillomandibular osteotomy with hyold advancement. All patients in the second group showed good results, as determined by polysomnography.
Electrophysiologic Assessment of Low‐Frequency Hearing: Sedation Effects
Authors: Palaskas Constantine W. , Wilson Michael J. , Dobie Robert A.
Published: July 2017

Sixteen normal‐hearing adults were tested in both awake and sedated states for several evoked responses to low‐frequency stimuli. Responses obtained by cross‐correlation function, middle latency responses, and the 40‐Hz response proved most sensitive; all had mean thresholds of less than 20 dB normal hearing level for the awake‐alert state, but 40‐Hz and middle latency response mean thesholds were shifted about 10 dB under sedation. The cross‐correlation method seems to offer promise for pediatric auditory assessment.
Instant Slides of Radiographs for Lectures
Authors: Rothstein Stephen G. , Stewart Patricia L.
Published: July 2017

High quality slides of radiographs may be made with a simple, fast, and inexpensive technique using Kodak Rapid Process Copy film. Lecture presentations may include a slide of a pertinent plain radiograph, computed tomography (CT) scan, or magnetic resonance imaging (MRI). Although these slides may be made with a 35 mm SLR camera and flash or with a 35 mm SLR camera and a lighted viewbox, an alternative method is available that is easy to perform, inexpensive, and can produce quality slides in as little as 30 minutes.
Progesterone Receptors in Carcinomas of the Upper Aerodigestive Tract
Authors: Berg Nicholas J. , Colvard Douglas S. , Neel H. Bryan , Weiland Louis H. , Spelsberg Thomas C.
Published: July 2017

This study had three major goals: (1) to vigorously verify the presence of progesterone receptors in squamous cell carcinoma of the upper aerodigestive tract (HN‐SCC). Antiprogesterone receptor monoclonal antibodies revealed a distinct band at approximately 120 kilodaltons in samples taken from two of four patients with HN‐SCC. These results illustrate that progesterone receptor in HN‐SCC has the same molecular weight as progesterone receptor in normal human uterus and human breast cancer. Steroid specificity and saturability results support the evidence that it is true progesterone receptors that are measured and not other receptors or sex steroid‐binding globulins; (2) to confirm the biochemical function of progesterone receptors in HN‐SCC by assessing the binding of progesterone receptor to acceptor sites on chromosomes in the nucleus; and (3) to establish the clinical significance of progesterone receptor measurement. Patients with positive assays were more likely to be free of disease a mean of 6 months after resection. We used logistic regression to account for site of primary disease, grade of tumor, and stage of disease. This logistic regression was significant with a p = 0.014. Patients with a binding index greater than 2 (19 of 73 patients) were 4.34 times more likely to be free of disease than patients with negative assays.
Influence of Dietary Magnesium on the Amplitude of Wave V of the Auditory Brainstem Response
Authors: Cevette Michael J. , Franz Kay B. , Brey Robert H. , Robinette Martin S.
Published: July 2017

Thirty‐six weanling guinea pigs were fed either a low (600 ppm) or normal (3000 ppm) diet of magnesium for 8 weeks. One half of each diet group received intramuscular injections of magnesium‐depleting drugs, furosemide and gentamicin. The other half were controls and received equal intramuscular injections of saline. Auditory brainstem responses were obtained from all animals before and after 8 weeks of treatment of diet and drugs to examine the effects of treatment upon hearing and auditory brainstem function. A three‐way analysis of variance of dietary magnesium, by drug and by sex, showed no significant differences in auditory brainstem wave V thresholds, wave V latencies, or interpeak wave I‐V latencies between the control and experimental groups. The low magnesium diet group, which received drugs, had significantly greater wave V auditory brainstem response amplitudes. Results can be explained on the basis of magnesium influencing the uptake of calcium into both the hair cells and associated brainstem pathways.
Hyperthermia Effects on the Growth of a Laryngeal Squamous Cell Carcinoma Cell Line Treated with Recombinant Human Interferons α and γ
Authors: Park Robert I. , Richtsmeier William J.
Published: July 2017

Clinical therapy with either interferon alpha or interferon gamma is associated with a febrile response. However, the effects of hyperthermia on the response to these interferons have not been elucidated fully. in this study, a cell line derived from a laryngeal squamous cell carcinoma (JHU‐011‐SCC‐L‐P) was grown in the presence of recombinant human interferon alpha (rHulFNα) or recombinant human Interferon gamma (rHulFNγ) and incubated at either 37° or 39° C, and cell growth rates were measured. Cells incubated with rHulFNα demonstrated no difference in growth rates from control cells. Cells treated with rHulFNγ showed significant inhibition of growth at both temperatures, and the ratio of decreased growth at 39° C was significantly greater than for the rHulFNα and control groups. This hyperthermic effect did not depend on the continued exposure to rHulFNγ, and the effect appeared to depend on the duration of hyperthermia instead of the time sequence of hyperthermic exposure. Moreover, initial treatment at 39° C for 24 hours was ineffective in producing the hyperthermic response produced with continuous hyperthermic exposure. These findings would indicate that the effect of rHulFNγ on this laryngeal squamous cell carcinoma cell line is enhanced significantly at 39° C compared with 37°C. There appears to be no similar hyperthermia‐augmented antiproliferative effect of rHulFNα‐treated cells.
Pathologic Correlation of the Unknown Solid Parotid Mass in Children
Authors: Camacho Alfonso E. , Goodman Max L. , Eavey Roland D.
Published: July 2017

A parotid mass in a pediatric patient is stated to have an approximately 50% likelihood of being malignant.1,2 To evaluate our experience in light of this suggested incidence, we conducted a retrospective study, which included 22 patients treated over an 8‐year period, 1979 to 1987. Patients' ages ranged from 16 months to 19 years, and all patients presented with an unknown, solid parotid mass. One patient had a malignancy, mucoepidermoid carcinoma. Eight patients were diagnosed with benign pleomorphic adenoma. Thirteen patients had an inflammatory process consisting of one of the following conditions: Cat‐scratch disease (4); atypical mycobacteria (4); benign follicular hyperplasia of a lymph node (4); and toxoplasmosis (1). The histologic findings in this series suggest that unknown solid parotid masses that occur in children or adolescents are frequently the result of inflammatory conditions and are not likely to be malignant. We therefore recommend a reconsideration of the reputed estimation of malignancy in the parotid gland in children. The majority of pathologic conditions discovered, however, are still best diagnosed and treated by surgical excision.
Nasal Polyps: A Manifestation of Allergy?
Authors: Perkins Jonathan A. , Blakeslee Don B. , Andrade Pierre
Published: July 2017

The cause of nasal polyps is speculative. In the 1930s nasal polyps were considered to be a manifestation of allergy. This theory was challenged in the 1970s. Many patients with nasal polyps have no Identifiable allergic disease. The purpose of this study is to better define the relationship between allergy and nasal polyps. Twelve patients with nasal polyps were evaluated by history, physical examination, skin testing, nasal smear for eosinophils, specific IgE determination from serum, nasal secretions, and nasal polyp fluid. Similar data were collected from three control groups: (1) 10 patients with allergic rhinitis, (2) 10 patients with nonallelic rhinitis, and (3) 10 patients with no known nasal disease. By comparing the Incidence of markers for allergic disease In patients with nasal polyposis to each of the three control groups, the role of allergic disease In nasal polyposis was delineated.
The Fine Structure of Intraepithelial Free Nerve Endings in the Canine Vocal Cord Mucosa
Authors: Wada Shigeru , Maeyama Tadatsugu , Shin Takemoto
Published: July 2017

Innervation of the epithelium on the undersurface of the canine vocal cords was investigated by transmission electron microscopy. In the subepithelial lamina propria, nerve bundles containing unmyelinated fibers were observed. The nerve bundles, encircled by basal lamina, were enclosed by a thin connective tissue layer and by flattened flbroblast‐like cells. With nerve bundles approaching the epithelium, the axons divided repeatedly and entered the epithelial layer. In the epithelial cells, nerve axons formed knob‐like swellings that contained a small number of large granular vesicles and a large number of small agranular vesicles. A sensory function responsive to irritant chemical stimuli and to mechanical stimuli is presumed for these vesicle‐containing nerve processes.
Women and Marketing Education: Bridging the Gap
Authors: Stern Barbara B. , Kellogg Diane McKinney
Published: July 2017

Modified experiential techniques enable educators to bridge gaps between classroom and corporation. The process is especially necessary for women, who comprise 50 percent of marketing students. Educators can bring corporations to classrooms via “vignettes” and guest speakers, and bring classes to corporations for interviews, field trips, and corporate panels. Methods can be integrated into existing courses.
The Psychological Contract: A Method for Increasing Student Satisfaction
Authors: Anderson Elizabeth Scott
Published: July 2017

The concept of the psychological contract, or set of expectations implicit in agreements between people, is explained. The contracting process is described in detail, and implications for student satisfaction as reflected on course evaluations are presented.
The Sales Blitz: An Experiential Exercise for Use in College-Level Courses in Professional Selling
Authors: Stevenson Thomas H.
Published: July 2017

This article discusses the use of a field exercise as a teaching tool in classes in professional selling. The benefits of such an exercise are discussed from the perspective of the author's more than five years experience with the technique. Details regarding the mechanics of the program are provided for those interested in adapting it to their classes.
White Scours in Piglets; II. Scanning Electron Microscopy of the Mucosa of the Small Intestine
Authors: Mouwen J. M. V. M.
Published: July 2017

The mucosa of the small intestine of clinically normal piglets and of piglets with white scours was investigated, using a scanning electron microscope. No new findings on the rough villous pattern of the small intestinal mucosa could be added to those obtained with the stereomicroscope. In the high range of magnification, however, the surface of the different villous forms showed features that could barely be seen with the stereomicroscope. The findings indicate that in general the microstructure of the villous surface differs in the various types of villi.
Ectopic Thyroid Adenomas at the Base of the Heart of the Dog; Ultrastructural Identification of Dense Tubular Structures in Endoplasmic Reticulum
Authors: Thake D. C. , Cheville N. F. , Sharp R. K.
Published: July 2017

Three encapsulated tumors found at the base of the heart of the dog were classified as ectopic thyroid adenomas. The ultrastructural characteristics of normal thyroid follicular epithelium were seen: dense secretory-type granules, cell polarity with apical microvilli, and well-developed endoplasmic reticulum. Long, dense tubules were present within the cisternae of smooth endoplasmic reticulum of neoplastic cells; they were not seen in other tissues. These characteristics distinguish ectopic thyroid tumors from aortic body tumors.
Mesovarial Leiomyomas in Rats in a Chronic Toxicity Study of Soterenol Hydrochloride
Authors: Nelson L. W. , Kelly W. A.
Published: July 2017

In an 18-month oral toxicity study of soterenol hydrochloride, a stimulant of the β-adrenergic receptors, mesovarial leiomyomas were observed in three of 30 low-dose, six of 30 middle-dose and 10 of 30 high-dose rats. There was also an increase in the prevalence of ovarian cysts and of focal hyperplasia of smooth muscle in the mesovaria in the treated rats, especially in the high-dose group.
Primary Tumors of the Lung in Nonhuman Primates; Literature Review and Report of Peripheral Carcinoid Tumors of the Lung in a Rhesus Monkey
Authors: Giddens W. E. , Dillingham L. A.
Published: July 2017

Primary lung tumors in nonhuman primates are reviewed, and multifocal carcinoid tumors in the periphery of the lungs of a 6-year-old female Rhesus monkey (Macaca mulatto) are discussed. The tumors consisted almost entirely of neoplastic cells that were pleomorphic, had round to oval nuclei, 0 to two nucleoli, clear or slightly amphophilic cytoplasm, and indistinct cell boundaries. The cells generally formed solid sheets, supported by an elaborate network of reticulin. Electron microscopic examination showed distinct but irregular cell membranes and a paucity of electron-dense material in the cytoplasm of many cells.
Feline Infectious Peritonitis: Proteins of Plasma and Ascitic Fluid
Authors: Gouffaux M. , Pastoret P. P. , Henroteaux M. , Massip A.
Published: July 2017

Electrophoreses of sera, plasma and ascitic fluids of cats with natural or experimental infectious peritonitis show important modifications. Special stainings of electrophoreses and chromatographic and immunoelectrophoretic technics characterized some of the modified proteins. In the experimental disease, fibrinogen, haptoglobin, transferrin, and probably orosomucoid are increased; in the natural disease, in addition to these modifications, the γ-globulins are strongly increased; the immunoglobulins found in the often abundant ascitic fluid belong to the IgG class. Increased proteins such as fibrinogen, haptoglobin and orosomucoid and decreased albumin are aspecific aspects of inflammatory processes, whereas hypergammaglobulinemia appears in the course of immunological response. The rapid evolution of the experimental disease explains the fact that immunoglobulins do not increase.
Assessment of the Infraspinatus Spinal Stretch Reflex in the Normal, Athletic, and Multidirectionally Unstable Shoulder
Authors: Augé Wayne K. , Morrison David S.
Published: July 2017

To examine neural aspects of motor control in the glenohumeral joint, this study evaluates utilization of an innate spinal segmental pathway, the spinal stretch reflex, as an investigational tool that reflects neural circuitry. The purpose of this study was to determine if this reflex could be evoked from the infraspinatus muscle, if the testing apparatus and protocol for elicitation were reliable, and if the reflex response varies between groups of subjects and therefore could be useful clinically. These reflex characteristics were evaluated in the infraspinatus muscle, since rotator cuff muscle activity in subjects with glenohumeral instability exhibits differences in electromyographic activity and coordination patterns, implicating its role in dynamic stability. Normal shoulders were compared with athletic shoulders and shoulders with multidirectional instability. The spinal stretch reflex was elicited in a controlled and reliable manner. Shoulders with multidirectional instability exhibited a more-prominent spinal stretch reflex response than normal shoulders, whereas athletic shoulders exhibited a more-quiescent spinal stretch reflex response. As the spinal stretch reflex probably plays a role in motor control, variation in this reflex profile may reflect some differences in development that contribute to the variable expression of dynamic glenohumeral stability. This study suggests that the spinal stretch reflex profile may be a useful clinical tool to assist in discriminating between the normal and pathologic state. This information may also be useful in the evaluation of new treatment approaches exploiting spinal cord plasticity and spinal stretch reflex mutability through neuromuscular training.
A Radiographic and Histologic Evaluation of the Patellar Tendon after Harvesting Its Central Third
Authors: Kartus Jüri , Movin Tomas , Papadogiannakis Nikos , Christensen Lars Rostgård , Lindahl Sven , Karlsson Jon
Published: July 2017

Nineteen consecutive patients undergoing anterior cruciate ligament reconstruction using the central third of the ipsilateral patellar tendon were included in the study. Serial magnetic resonance images revealed that the donor-site gap in the tendon decreased with time (mean follow-up, 26 months). The thickness was significantly increased compared with the intact contralateral patellar tendon, regardless of when the magnetic resonance imaging was performed. Ultrasonography showed the same findings at a mean follow-up of 26 months. Histologic evaluation of the repair tissue in the central part of the tendon, as well as the tissue in the peripheral part of the patellar tendon at the donor site, revealed a significant increase in cellularity and vascularity as compared with normal control tendons. Thus, 2 years after the harvesting procedure, the patellar tendon displayed significant radiographic and histologic abnormalities. On the basis of these findings, reharvest of the patellar tendon, at least up to 2 years after primary harvest, cannot be recommended.
Inferior Capsular Shift Procedure in Athletes with Multidirectional Instability Based on Isolated Capsular and Ligamentous Redundancy
Authors: Bak Klaus , Spring Blake J. , Henderson Ian J. P.
Published: July 2017

Twenty-five athletes (26 shoulders) who underwent an inferior capsular shift procedure for multidirectional glenohumeral instability based on isolated capsular and ligamentous redundancy were evaluated at a median of 54 months (range, 25 to 113) after the operation. Twenty-one athletes (84%) returned to their preinjury activity level at a median of 5 months after surgery. Of 21 athletes involved in sports using overhead motions, 16 (76%) returned to their previous sport after the operation, and 12 (57%) were still active in this sport at the preinjury level at follow-up. According to the Rowe score, 23 shoulders (88%) were excellent or good. The University of California at Los Angeles score for 24 shoulders (92%) was excellent or good. The operations on two shoulders (8%) failed. One patient had a spontaneous redislocation, and one had recurrent subluxations. Nine contralateral shoulders had a history of significant instability; four of these had undergone Bankart repair. We concluded that athletes who have multidirectional instability based on isolated capsular and ligamentous redundancy can be successfully treated by an inferior capsular shift preserving the subscapularis tendon insertion. We found a high rate of return to demanding upper extremity sports in our patients, range of motion was restored in the majority of shoulders, and the failure rate after a median of 54 months was acceptable.
The Association between Athletic Training Time and the Sagittal Curvature of the Immature Spine
Authors: Wojtys Edward M. , Ashton-Miller James A. , Huston Laura J. , Moga Paul J.
Published: July 2017

Strenuous physical activity is known to cause structural abnormalities in the immature vertebral body. Concern that exposure to years of intense athletic training may increase the risk for developing adolescent hyperkyphosis in certain sports, as well as the known association between hyperkyphosis and adult-onset back pain, led us to examine the association between cumulative hours of athletic training and the magnitude of the sagittal curvature of the immature spine. A sample of 2270 children (407 girls and 1863 boys) between 8 and 18 years of age were studied. An optical rasterstereographic method was used to measure the mid-sagittal curvatures of the surface of the back while the subject was in the upright standing position to quantify the angles of thoracic kyphosis and lumbar lordosis. These data were then correlated with self-reported hours of training measured by interview and questionnaire. The possible effects of age, sex, sport, and upper and lower body weight training were investigated. The results in these young athletes showed that larger angles of thoracic kyphosis and lumbar lordosis were associated with greater cumulative training time. Gymnasts showed the largest curves. Lack of sports participation, on the other hand, was associated with the smallest curves. Age and sex did not appear to affect the degree of curvature.
The Distribution of Injuries in Men's Canada West University Football: A 5-year Analysis
Authors: Meeuwisse Willem H. , Hagel Brent E. , Mohtadi Nicholas G. H. , Butterwick Dale J. , Fick Gordon H.
Published: July 2017

We conducted a prospective cohort study from 1993 to 1997 to determine the frequency and severity of injury in men's Canada West university football. The Canadian Intercollegiate Sport Injury Registry was used to document baseline preseason data, daily athlete participation, and subsequent injury from five varsity football teams. An injury was defined as “any injury resulting in one or more complete or partial sessions of time loss” or “any concussion or transient neck neurologic injury.” The annual proportion of injured athletes ranged from 53.5% to 60.4%, with a 5-year total of 1811 injuries. Regression analysis indicated that the rate of nonconcussion, nonneck neurologic injuries increased. Concussion (N 110), hamstring strain (N 88), and brachial plexus (N 84) injuries were the most common, specific injury diagnoses. Knee injuries resulted in the highest rate of severe (greater than or equal to 7 sessions of time loss) injury and resulted in the most time loss (3350.5 sessions). Ligament sprains and muscle strains and spasms accounted for approximately half of all injury diagnoses. A total of 1173 injuries (65%) were related to contact between players or between players and other obstacles. Future studies should be conducted to identify risk factors for the ultimate purpose of implementing injury prevention strategies.
Repair of Chronic Ruptures of the Distal Biceps Tendon Using Flexor Carpi Radialis Tendon Graft
Authors: Levy Howard J. , Mashoof A. Allen , Morgan Daniel
Published: July 2017

Five patients with chronic distal biceps tendon ruptures underwent tendon repair using double-looped flexor carpi radialis tendon graft. Fixation was performed with suture anchors through a single anterior incision. All patients had excellent functional results at a minimum 2-year follow-up.
Comparison of Knee Joint Cartilage Thickness in Triathletes and Physically Inactive Volunteers Based on Magnetic Resonance Imaging and Three-Dimensional Analysis
Authors: Mühlbauer Roland , Lukasz Susanne , Faber Sonja , Stammberger Tobias , Eckstein Felix
Published: July 2017

The objective of this study was to employ quantitative magnetic resonance imaging for the analysis of knee joint cartilage thickness in triathletes and physically inactive volunteers. The right knee joints of nine male triathletes (10 hours training per week for at least 3 years) and nine inactive male volunteers (1 hour of physical activity per week throughout life) were imaged with a previously validated fat-suppressed gradient echo sequence. The cartilage plates were reconstructed three-dimensionally, and the cartilage thickness was computed independently of the original section orientation with a three-dimensional Euclidian distance transformation. There was a high interindividual variability of the mean and the maximal cartilage thickness values in all surfaces, both in the triathletes and in the inactive volunteers. In the patella, the femoral trochlea, and the lateral femoral condyle, the mean and maximal cartilage thickness values were slightly higher in the triathletes, but they were somewhat lower in the medial femoral condyle, and in the medial and lateral tibial plateau. However, the differences did not attain statistical significance. These results are unexpected in view of the functional adaptation observed in other musculoskeletal tissues, such as muscle and bone, in which a more obvious relationship with the magnitude of the applied mechanical stress has been observed.
Comparison of Tibial Tunnel Enlargement after Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Autograft or Allograft
Authors: Zijl Jacco A. C. , Kleipool Arthur E. B. , Willems W. Jaap
Published: July 2017

This retrospective study was designed to compare tibial tunnel enlargement in patients with autograft or allograft anterior cruciate ligament reconstructions. The changes were related to position of the tibial tunnel and clinical outcome. Twenty-six patients with autograft reconstructions and 41 with allograft reconstructions were studied at a mean follow-up of 59 months (range, 41 to 84) after surgery. The average tunnel enlargement on the anteroposterior view was 2.2 mm (SD, 2.5) for autografts and 2.8 mm (SD, 2.1) for allografts. On the lateral view, the tunnel enlargement was 2.6 mm (SD, 2.4) and 3.4 mm (SD, 2.6) for autografts and allografts, respectively. No significant differences were found between the autograft and allograft groups. A trend was found in the correlation between the position of the tibial tunnel and the tunnel enlargement: more anteriorly placed tunnels had more enlargement. The changes in tunnel diameter did not relate to knee functional score or laxity. There was a significant correlation between malposition of the tibial tunnel and poor clinical scores. A significant negative correlation was found between postoperative follow-up time and tunnel enlargement in both groups. We conclude that placement of the tibial tunnel is a determining factor in tibial tunnel enlargement and clinical knee scores after anterior cruciate ligament replacement with an autograft or allograft. Tunnel enlargement tends to be less at a longer postoperative follow-up.
Two-Bundle Posterior Cruciate Ligament Reconstruction
Authors: Mannor Dana A. , Shearn Jason T. , Grood Edward S. , Noyes Frank R. , Levy Martin S.
Published: July 2017

This study had two purposes: first, to determine how femoral attachment location affects the load sharing between the two bundles of a Y-type posterior cruciate ligament reconstruction, and second, to determine how the bundles, separately and in combination, control posterior tibial translation throughout the full range of knee flexion. One and two-bundle reconstructions were performed in 12 cadaveric knees. The one-bundle reconstructions were attached within the femoral posterior cruciate ligament footprint at one of three locations, high and shallow (S 1), mid and shallow (S2), or mid and deep (D). The two-bundle reconstructions comprised an S1 bundle with either an S2 or a D bundle. Posterior translation and bundle tension were measured as the knee was flexed from full extension to 120° of flexion while a posterior force of either 50 or 100 N was applied to the proximal tibia. The shallow one-bundle reconstruction restored posterior translation to within 2 mm of that of the intact knee over the entire range of knee flexion. The deep reconstruction did not control abnormal posterior translation above 45°. The tension in the shallow bundles increased with knee flexion, and the deep bundle tension remained nearly constant throughout knee flexion. Both two-bundle reconstructions controlled posterior translation, but with different load-sharing characteristics. The S1-S2 configuration resisted posterior tibial translation as both bundles became taut in flexion. In contrast, the S1-D configuration resisted posterior translation in a reciprocal fashion with the D bundle tension being the greatest in extension and the S1 bundle tension being the greatest tension in flexion.
Effects of Interference Fit Screw Length on Tibial Tunnel Fixation for Anterior Cruciate Ligament Reconstruction
Authors: Black Kevin P. , Saunders Marnie M. , Stube Keith C. , Moulton Mark J. R. , Jacobs Christopher R.
Published: July 2017

Graft-tunnel mismatch during arthroscopically assisted anterior cruciate ligament reconstruction using the central-third patellar tendon results in less than 20 mm of bone plug remaining in the tibial tunnel. We decided to evaluate the strength of bone plug fixation using interference fit screws that were less than 20 mm in length. Biomechanical testing was performed on 48 porcine hindquarters using 9-mm diameter interference fit screws that measured 12.5, 15, and 20 mm in length. No significant difference was noted between the different-length screws for insertion torque, divergence, stiffness, displacement, or load to failure. We believe, therefore, that comparable graft fixation can be achieved in the tibial tunnel using 9-mm diameter interference fit screws that are less than 20 mm long, and that these shorter screws may be useful in cases of graft-tunnel mismatch.
A Prospective Study of Modified Ottawa Ankle Rules in a Military Population
Authors: Springer Barbara A. , Arciero Robert A. , Tenuta Joachim J. , Taylor Dean C.
Published: July 2017

To determine the necessity of ankle and foot radiographs, we used modified Ottawa Ankle Rules to evaluate all cadets seen with an acute ankle or midfoot injury at the United States Military Academy. This scoring system determines the need for radiographs. Each patient was independently examined and the decision rules were applied by a physical therapist and an orthopaedic surgeon. Ankle and foot radiographs were obtained for all subjects. Sensitivity, specificity, and the positive predictive value were calculated in 153 patients. There were six clinically significant ankle fractures and three midfoot fractures, for a total incidence of 5.8%. For physical therapists, the sensitivity was 100%, the specificity for ankle injuries was 40%, and the specificity for foot injuries was 79%. For orthopaedic surgeons, the sensitivity was also 100%, the specificity for ankle injuries was 46%, and the specificity for foot injuries was 79%. Interobserver agreement between the orthopaedic surgeons and physical therapists regarding the overall decision to obtain radiographs was high, with a kappa coefficient value of 0.82 for ankle injuries and 0.88 for foot injuries. There were no false-negative results. Use of the modified Ottawa Ankle Rules would have reduced the necessity for ankle and foot radiographs by 46% and 79%, respectively.
Boxer's Knuckle in the Professional Athlete
Authors: Hame Sharon L. , Melone Charles P.
Published: July 2017

Injuries to the extensor mechanisms of the fingers can be career-ending in professional athletes if not treated appropriately. We identified 8 professional athletes who underwent 11 direct metacarpophalangeal joint extensor mechanism repairs including centralization of the extensor tendon and sagittal band repair between 1989 and 1994. Success of the operative procedure was determined by the athlete's attainment of full range of motion, return to professional sports, and no need for additional surgical intervention. The metacarpophalangeal joints of the long and little fingers were most commonly involved. The position of the extensor mechanism disruption and the direction of the tendon subluxation varied. Capsular tears were identified in seven joints and none were repaired. At follow-up, each athlete had regained full range of motion and each had returned to professional sport an average of 5 months postoperatively. No patient required additional surgery. In this series, the principal lesion in metacarpophalangeal joint injury was extensor mechanism disruption with a predictable sagittal band tear and either a radial or ulnar subluxation of the central tendon. We recommend centralization of the extensor tendon and sagittal band repair without capsular repair as a treatment of choice for this injury, particularly in the athlete.
The Pathophysiology of Shoulder Instability
Authors: Levine William N. , Flatow Evan L.
Published: July 2017

Over the last several decades there has been an improved understanding of the intricate anatomy that provides stability to the glenohumeral joint. In addition, significant advances in identifying the pathologic etiology of the unstable shoulder have occurred because of basic science glenohumeral ligament cutting studies, clinical evaluation, and the advent of arthroscopic evaluation and treatment of the unstable shoulder. This article will review the pertinent anatomy of the normal glenohumeral joint and will carefully review the pathoanatomy found in the unstable shoulder. Sports medicine specialists who treat athletes with unstable shoulders should have a firm understanding of both the normal and pathologic shoulder conditions to be able to provide the best care for these athletes.
Risk Factors for Recurrent Stress Fractures in Athletes
Authors: Korpelainen Raija , Orava Sakari , Karpakka Jarmo , Siira Pertti , Hulkko Antero
Published: July 2017

Our aim was to identify factors predisposing athletes to multiple stress fractures, with the emphasis on biomechanical factors. Our hypothesis was that certain anatomic factors of the ankle are associated with risk of multiple stress fractures of the lower extremities in athletes. Thirty-one athletes (19 men and 12 women) with at least three separate stress fractures each, and a control group of 15 athletes without fractures completed a questionnaire focusing on putative risk factors for stress fractures, such as nutrition, training history, and hormonal history in women. Bone mineral density was measured by dual-energy x-ray absorptiometry in the lumbar spine and proximal femur. Biomechanical features such as foot structure, pronation and supination of the ankle, dorsiflexion of the ankle, forefoot varus and valgus, leg-length inequality, range of hip rotation, simple and choice reaction times, and balance in standing were measured. There was an average of 3.7 (range, 3 to 6) fractures in each athlete, totaling 114 fractures. The fracture site was the tibia or fibula in 70% of the fractures in men and the foot and ankle in 50% of the fractures in women. Most of the patients were runners (61%); the mean weekly running mileage was 117 km. Biomechanical factors associated with multiple stress fractures were high longitudinal arch of the foot, leg-length inequality, and excessive forefoot varus. Nearly half of the female patients (40%) reported menstrual irregularities. Runners with high weekly training mileage were found to be at risk of recurrent stress fractures of the lower extremities.
Outcome of Surgery for Chronic Achilles Tendinopathy
Authors: Tallon Cheryl , Coleman Brett D. , Khan Karim M. , Maffulli Nicola
Published: July 2017

Achilles tendinopathy is often treated surgically after failure of nonoperative management, but results are not uniformly excellent. We critically assessed the methods of 26 studies that reported surgical outcomes of patients with this condition. Using 10 previously published criteria, and blinded to study outcomes, we derived a “methodology score” (0 to 100) for each study. This score was highly reproducible (r=0.99, P<0.01). Scores were generally low concerning the type of study, subject selection process, and outcome measures, which indicates methods deficiency in the way the study was designed, performed, and analyzed. We found a negative correlation between reported success rate and overall methods scores (r=0.53, P<0.01), and a positive correlation between year of publication and overall methods score (r=0.70, P<0.01). Study methods may influence reported surgical outcome, and we suggest guidelines for improving study design in this area of clinical research. We acknowledge that study methods have improved over the course of the past 20 years.
Anterior Cruciate Ligament Function after Tibial Eminence Fracture in Skeletally Mature Patients
Authors: Ahmad Christopher S. , Shubin Stein Beth E. , Jeshuran Winston , Nercessian Ohannes A. , Henry Jack H.
Published: July 2017

We compared anterior cruciate ligament function in skeletally mature patients after treatment of tibial eminence fractures with that of patients in two other groups: patients who had anterior cruciate ligament deficiency and patients who had undergone anterior cruciate ligament reconstruction using bone-patellar tendon-bone autografts. The Lysholm questionnaire was used to evaluate symptoms and KT-1000 arthrometry was used to determine objective knee laxity at an average follow-up of 5.2 years. Knee joint proprioception was assessed with a new method designed to test joint position sense. The Lysholm score for the tibial eminence group was 94±7. Only the patients in the anterior cruciate ligament-deficient group demonstrated statistically significantly increased laxity and inferior proprioception when the injured leg was compared with the uninjured leg. Both laxity and proprioception were statistically inferior for the anterior cruciate ligament-deficient group when compared with both the treated tibial eminence fracture group and the anterior cruciate ligament-reconstructed group. No statistically significant difference was observed between the anterior cruciate ligament-reconstructed and treated tibial eminence fracture groups. Correlation was observed between laxity and proprioception when all patients were analyzed. The results demonstrate that appropriate treatment of tibial eminence fractures restores stability and proprioception to the knee.
A Prospective Evaluation of Untreated Acute Grade III Acromioclavicular Separations
Authors: Schlegel Theodore F. , Burks Robert T. , Marcus Robin L. , Dunn Harold K.
Published: July 2017

We prospectively studied the natural history of untreated acute grade III acromioclavicular separations. Twenty-five patients were treated nonoperatively with a sling for comfort through progressive early range of motion as tolerated. Ten additional uninjured subjects underwent strength testing to evaluate the difference between the dominant and nondominant sides so that patient data could be standardized. The patients were examined at intervals of 6, 12, 24, 36, and 52 weeks after injury, at which time they completed a subjective questionnaire and underwent isometric dynamometer testing as well as military press and bench press strength testing. One patient underwent a surgical procedure at 2 weeks after injury because of cosmetic concerns. Twenty of the 25 patients completed the 1-year evaluation and strength-testing protocol. Subjectively, 4 of the 20 patients (20%) thought that their long-term outcome was suboptimal, although for 3 of them it was not enough to warrant surgery. Objective examination and strength testing of the 20 patients revealed no limitation of shoulder motion in the injured extremity and no difference between sides in rotational shoulder muscle strength. The bench press was the only strength test that showed a significant short-term difference, with the injured extremity being an average of 17% weaker. This study documents the natural history of patients with an untreated acute grade III acromioclavicular separation and provides a reference with which to judge all other proposed methods of treatment.
Tuberculum Intercondylare Tibiae Tertium as a Predictive Factor for Anterior Cruciate Ligament Injury
Authors: Pe\ćina Marko , Bajok Irenko , Pećina Hrvoje Ivan
Published: July 2017

The aim of this study was to assess the presence of tuberculum intercondylare tibiae tertium, also known as Parsons’ knob, and to determine its prominence. Knee radiographs of 171 patients operated on for anterior cruciate ligament injury were examined. The control group included 120 sex- and age-matched patients who underwent orthopaedic examination for knee pain, in whom anterior cruciate ligament injury was ruled out. Knee radiographs revealed the presence of tuberculum intercondylare tibiae tertium in 55 (32.2%) and 16 (13.3%) patients from the study and control groups, respectively. The between-group difference was statistically significant. The authors developed their own method of tuberculum intercondylare tibiae tertium measurement using proportional coefficients based on the length of the tibial plateau to compare the values of the tuberculum intercondylare tibiae tertium. The results showed tuberculum intercondylare tibiae tertium to be not only more common but also more pronounced, especially in height, in the patients with anterior cruciate ligament lesions.
A History of Low Back Injury is a Risk Factor for Recurrent Back Injuries in Varsity Athletes
Authors: Greene Hunter S. , Cholewicki Jacek , Galloway Marc T. , Nguyen Carolyn V. , Radebold Andrea
Published: July 2017

In this prospective study, we investigated whether a history of previous low back injury and dissatisfaction with a coach and teammates could predict future low back injury in varsity athletes during a 1-year follow-up period. Of 679 Yale varsity athletes surveyed in 1999, 18.3% (124) reported that they had sustained a low back injury within the past 5 years, and 6.8% (46) sustained a low back injury in the follow-up season. There were no differences in incidence rates between men and women or between athletes involved in contact or noncontact sports. A history of low back injury was the significant predictor for sustaining low back injury in the following year, and athletes who reported previous low back injury were at three times greater risk. Athletes who still had pain at the time of the survey were six times more likely to sustain a low back injury than were athletes without a history of low back injury. These results suggest that some risk factors associated with a history of low back injury predispose athletes to sustain recurrent injury. They may be congenital or a result of insufficient recovery time after the first low back injury episode.
A Biomechanical Comparison of Tibial Inlay and Tibial Tunnel Posterior Cruciate Ligament Reconstruction Techniques
Authors: McAllister David R. , Markolf Keith L. , Oakes Daniel A. , Young Charles R. , McWilliams Justin
Published: July 2017

Background

Most posterior cruciate ligament reconstruction techniques use a tibial bone tunnel, which results in an acute bend in the graft as it passes over the posterior portion of the tibial plateau.

Hypothesis

The tibial inlay technique will result in lower graft pretensions, less laxity, and less stretch-out after cyclic loading.

Study Design

Controlled laboratory study.

Methods

Graft pretensions necessary to restore normal laxity at 90° of knee flexion (laxity match pretension) and anteroposterior laxities at five knee flexion angles were recorded in 12 fresh-frozen knee specimens with bone-patellar tendon-bone posterior cruciate ligament graft reconstructions using both techniques and two femoral tunnel positions.

Results

When the graft was placed in a central femoral tunnel, the tibial tunnel reconstruction required an average 15.6 N greater laxity match pretension than the tibial inlay reconstruction. There were no significant differences in mean knee laxities between the tibial tunnel and tibial inlay techniques at any knee flexion angle; both reconstruction techniques restored mean knee laxity to within 1.6 mm of intact knee values over the entire flexion range.

Conclusions

There was no important advantage of one technique over the other with respect to the biomechanical parameters measured.
Arthroscopic Laser-Assisted Capsular Shift in the Treatment of Patients with Multidirectional Shoulder Instability
Authors: Favorito Paul J. , Langenderfer Matthew A. , Colosimo Angelo J. , Heidt Robert S. , Carlonas Richelle L.
Published: July 2017

Background

In recent years, various investigators have begun using lasers in the treatment of shoulder instability.

Hypothesis

Arthroscopic laser-assisted capsular shift is an effective treatment for patients with multidirectional shoulder instability.

Study Design

Retrospective cohort study.

Methods

We retrospectively identified 28 patients (30 shoulders) with multidirectional shoulder instability who were unresponsive to nonoperative management and who had undergone the laser-assisted capsular shift procedure. Twenty-five patients (27 shoulders) with an average follow-up of 28 months were available for review. All patients underwent a physical examination and completed a general questionnaire; the University of California, Los Angeles, shoulder rating scale; the Western Ontario Shoulder Instability Index; and the Short-Form 36 quality of life index.

Results

In 22 shoulders, results of the procedure were considered a success because the patients had no recurrent symptoms and at latest follow-up had required no further operative intervention. In five shoulders, results were considered a failure because of recurrent pain or instability and the need for an open capsular shift procedure. With recurrent instability as a measure of failure, the overall success rate was 81.5%.

Conclusions

Our results with laser-assisted capsular shift are comparable with the results of other open and arthroscopic techniques in relieving pain and returning athletes to their premorbid function.
Differences in Femoral Notch Anatomy between Men and Women
Authors: Charlton William P. H. , John Thomas A. St. , Ciccotti Michael G. , Harrison Nichol , Schweitzer Mark
Published: July 2017

Background

Research has shown that variations in femoral intercondylar notch morphometry may be a predisposing factor for noncontact anterior cruciate ligament injury.

Hypothesis

There are anatomic differences in the anterior cruciate ligament and femoral notch between men and women.

Study Design

Descriptive anatomic study.

Methods

Using magnetic resonance imaging, we performed a three-dimensional analysis of the femoral intercondylar notch morphometry to look for differences in femoral notch and anterior cruciate ligament volumes between men and women. Axial plane magnetic resonance imaging scans were performed on 96 knees in 48 asymptomatic subjects. Digital measurements were taken of femoral notch area, anterior cruciate ligament area, notch width, and bicondylar width, within defined parameters of the femoral notch. The notch and anterior cruciate ligament volumes were then calculated. Analysis of variance was performed using sex, height, and weight as covariates.

Results

The volume of the femoral notch was found to be statistically smaller in women compared with men; this difference was primarily related to height. A similar relationship was found for anterior cruciate ligament volume. A statistically significant correlation was found between femoral notch volume and anterior cruciate ligament volume; patients with smaller notches also had smaller anterior cruciate ligaments.

Conclusions

Our results suggest that there is a difference in femoral notch and anterior cruciate ligament volume between men and women, which, in turn, is related to differences in height and weight.