bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Ankle Disk Training on Muscle Reaction Time in Subjects with a History of Ankle Sprain
Authors: Osborne Michael D. , Chou Li-Shan , Laskowski Edward R. , Smith Jay , Kaufman Kenton R.
Published: July 2017

The purpose of this study was to determine whether 8 weeks of ankle disk training alters ankle muscle onset latency of patients with a history of lateral ankle sprain. The training was completed by eight minimally symptomatic subjects with a history of nonrehabilitated, unilateral, inversion ankle sprain sustained between 6 and 16 months before entry into the study. Ankle inversion perturbations monitored by fine-wire electromyography were performed in four lower extremity muscles (anterior tibialis, posterior tibialis, peroneus longus, and flexor digitorum longus) of all subjects on both the injured (experimental) and noninjured (control) legs. Testing was performed at study entry and after 8 weeks of ankle disk training on the previously injured ankle. Results revealed a statistically significant decrease in the anterior tibialis onset latency in both the experimental (67.6 ± 20.3 to 51.7 ± 17.6) and control (65.5 ± 9.8 to 53.8 ± 23.7) ankles after the training period. These findings indicate that muscle onset latency decreases in specific ankle muscle groups after ankle disk training in previously injured ankles. Both the experimental and control ankles demonstrated a significant change, which raises the question as to whether a proprioceptive cross-training effect occurred.
Effects of Knee Bracing on the Sensorimotor Function of Subjects with Anterior Cruciate Ligament Reconstruction
Authors: Wu Gloria K. H. , Ng Gabriel Y. F. , Mak Arthur F. T.
Published: July 2017

The sensorimotor performance of the knee joint in 31 subjects who had undergone unilateral anterior cruciate ligament reconstruction at least 5 months previously was tested under three bracing conditions, 1) the DonJoy Legend brace, 2) a mechanical placebo brace, and 3) no brace, in random order. The accuracy of the subjects’ ability to reproduce specified knee joint angles was tested as well as the isokinetic performance of their knee muscles at 60 and 180 deg/sec. The results showed that subjects with the brace or placebo brace performed similarly in reproducing the knee joint positions, but both groups performed better than the subjects without a brace. Isokinetic tests revealed no difference among the three groups in extensor and flexor peak torque production at 60 deg/sec or total work done by the extensors and flexors at 60 and 180 deg/sec. These results suggest that knee bracing can improve the static proprioception of the knee joint, but not the muscle contractile function, in subjects with anterior cruciate ligament reconstruction under isokinetic testing conditions. The finding of similar performances for joint angle reproduction in the brace and placebo brace groups suggests that the apparent improvement in proprioception with knee bracing was not due to the mechanical restraining action of the brace.
Risk Factors for Early Failure after Thermal Capsulorrhaphy
Authors: Anderson Kyle , Warren Russell F. , Altchek David W. , Craig Edward V. , O'Brien Stephen J.
Published: July 2017

Thermal capsular shrinkage has rapidly become a common procedure for a variety of shoulder conditions usually associated with instability, although clinical data on outcomes are limited. The objective of this study was to identify risk factors for poor outcome after thermal capsulorrhaphy. Of 106 patients who underwent thermal shrinkage, 15 patients with treatment failures were identified. The mean time to failure after the procedure was 6.3 months (range, 1 to 16). Previous operations and multiple recurrent dislocations were associated with poor outcome at a highly significant level. Multidirectional instability and participation in contact sports did not attain statistical significance as risk factors. However, statistical power in these two comparisons was insufficient to exclude them as potential risk factors. A concomitant procedure at the time of thermal capsulorrhaphy was not associated with poor outcome. The data from early treatment failures can be useful in guiding patient selection for thermal capsulorrhaphy. This procedure may be of limited value for patients who have had prior operations or have a history of multiple dislocations. The data also suggest that thermal capsulorrhaphy should be used cautiously in patients with multidirectional instability or in those who are involved in contact sports.
Predicting Recurrence after Primary Anterior Shoulder Dislocation
Authors: Kralinger Franz S. , Golser Karl , Wischatta Ralph , Wambacher Markus , Sperner Gernot
Published: July 2017

We evaluated the factors influencing the recurrence rate after primary anterior traumatic shoulder dislocation, especially sports activity. A significant number of patients changed to athletic activities that produce less shoulder strain. The natural assumption would be that sports activity directly influences recurrence. However, age-adjusted logistic regression analysis revealed that the correlation between sports and recurrence rate was false. Our statistical findings also clearly showed that physical therapy and immobilization do not reduce the risk of recurrence. The only factor associated with recurrence was age between 21 and 30 years. Patients in this age group who participate in high-risk sports activities should undergo primary surgical stabilization because of the increased risk of recurrence.
A Comparison of Facial Protection and the Incidence of Head, Neck, and Facial Injuries in Junior a Hockey Players
Authors: Stuart Michael J. , Smith Aynsley M. , Malo-Ortiguera Susan A. , Fischer Tracy L. , Larson Dirk R.
Published: July 2017

A cohort of 282 elite amateur ice hockey players were analyzed to 1) record the number, type, location, and severity of head, neck, and facial injuries sustained during games; 2) examine the relationship between injuries and the type of facial protection (none, partial, or full) according to individual playing time; and 3) determine whether full or partial facial protection is associated with an increased incidence of concussions, eye injuries, and neck injuries. Fifty-two injuries (158.9 per 1000 player-game hours) occurred in players wearing no facial protection, 45 (73.5 per 1000 player-game hours) in players wearing partial facial protection (half shield), and 16 (23.2 per 1000 player-game hours) in players wearing full facial protection (full cage or shield). Players wearing no protection were injured at a rate more than twice that of players wearing partial protection and almost seven times higher than those wearing full protection. Concussions occurred in four players wearing no protection, five players wearing partial protection, and two players wearing full protection; these differences were not significant. The risk of eye injury was 4.7 times greater for players wearing no protection compared with those wearing partial protection. No eye or neck injuries occurred in players wearing full protection. This study demonstrates that both full and partial facial protection significantly reduce injuries to the eye and face without increasing neck injuries and concussions.
Magnetic Resonance Imaging of the Shoulder in Asymptomatic Professional Baseball Pitchers
Authors: Miniaci Anthony , Mascia Anthony T. , Salonen David C. , Becker Edna J.
Published: July 2017

The purpose of this study was to evaluate the magnetic resonance imaging findings in both shoulders of asymptomatic professional baseball pitchers. Fourteen pitchers who were without significant prior injury underwent a blinded clinical assessment and magnetic resonance imaging of both shoulders. All images were interpreted by two experienced musculoskeletal radiologists. The appearance of the rotator cuff tendons was graded, with additional evaluation of the biceps, labrum, and osseous structures. Ten athletes were found to have stable shoulders and painless full range of motion. Clinically, four athletes had at least a 40° loss in internal rotation as compared with the nonthrowing arm. There were no significant differences in magnetic resonance imaging findings of the supraspinatus and infraspinatus tendons between the throwing and nonthrowing shoulders. The labrum was abnormal in 79% of the 28 shoulders. Enthesopathic changes of the posterior glenoid labrum were identified in the four pitchers who had loss of internal rotation. We conclude that unenhanced magnetic resonance imaging of the shoulder in asymptomatic high performance throwing athletes reveals abnormalities that may encompass a spectrum of “nonclinical” findings. These data can be useful in separating symptomatic pathologic findings from these variants. Enthesopathic changes of the posterior glenoid labrum in the throwing arm may represent an early Bennett-type lesion. The cause may be excessive traction on the posterior capsule during the pitching motion, with subclinical injury to this area.
Nonanatomic Location of the Posterior Horn of a Medial Meniscal Autograft Implanted in a Cadaveric Knee Adversely Affects the Pressure Distribution on the Tibial Plateau
Authors: Sekaran S. Vijay , Hull Maury L. , Howell Stephen M.
Published: July 2017

Nonanatomic placement of the posterior horn may occur during arthroscopic implantation of a meniscal transplant. The objective of this study was to determine whether nonantomic placement adversely affects the contact pressure distribution on the medial tibial plateau. Medial meniscal autografts were placed in eight cadaveric knees with the posterior horn tunnel in nonanatomic locations (5 mm medial and 5 mm posterior) and in the anatomic location. The contact pressure distribution of the medial articular surface of the tibia was measured with pressure-sensitive film under a 1200-N compressive load at 0°, 15°, 30°, and 45° of flexion. The maximum pressure, mean pressure, contact area, and anterior/posterior and medial/lateral locations of the centroid of contact area were compared. Placement of the posterior horn tunnel in the nonanatomic medial location caused a significant increase in the normalized maximum pressure over all flexion angles, an increase in the normalized mean pressure at 45°, and a posterior shift in the centroid of contact area over all flexion angles. Placement in the nonanatomic posterior location caused a significant posterior shift in the centroid of contact area over all flexion angles. Surgeons should place the posterior horn tunnel of a medial meniscal transplant within a tolerance tighter than 5 mm medial and 5 mm posterior to the anatomic location because nonanatomic placement significantly alters the contact pressure distribution.
Compaction versus Extraction Drilling for Fixation of the Hamstring Tendon Graft in Anterior Cruciate Ligament Reconstruction
Authors: Nurmi Janne T. , Järvinen Teppo L. N. , Kannus Pekka , Sievänen Harri , Toukosalo Jani , Järvinen Markku
Published: July 2017

Initial strength of quadrupled hamstring tendon grafts fixed with titanium interference screws was assessed in 30 pairs of porcine tibiae. Bone tunnels were drilled with either compaction drilling (stepped routers) or conventional extraction drilling (cannulated drill bits). Fifteen pairs of specimens were subjected to a single-cycle load-to-failure test, while the rest underwent a cyclic-loading test to further assess the quality of the fixation. No significant difference between the two drilling techniques was found with regard to yield load, displacement at yield load, stiffness, or mode of failure. Porcine trabecular bone mineral density was determined using peripheral quantitative computed tomography and compared with that of young women and men at a site corresponding to that of the tibial bone drill hole of an anterior cruciate ligament reconstruction. There was a significant difference between the two species (210 ± 45 mg/cm3 in porcine tibial bone versus 129 ± 30 mg/cm3 in women and 134 ± 34 mg/cm3 in men), suggesting that porcine knee specimens may have limitations in studies of graft fixation in anterior cruciate ligament reconstruction. We found no difference between extraction and compaction drilling in initial fixation strength of a hamstring tendon graft for anterior cruciate ligament reconstruction using a porcine model.
Long-Term Results of Meniscal Allograft Transplantation
Authors: Wirth Carl Joachim , Peters Gabriela , Milachowski Klaus A. , Weismeier Karl G. , Kohn Dieter
Published: July 2017

Between May 1984 and December 1986, 23 patients with a history of medial meniscectomy and anterior knee instability were entered into a long-term prospective study of the results of medial meniscal transplantation combined with reconstruction of the anterior cruciate ligament. In 17 cases a lyophilized meniscal allograft was used and in 6 cases a deep-frozen meniscal allograft was used. The patients’ clinical outcomes were evaluated 3 and 14 years postoperatively by clinical assessment, Lysholm score, radiographs, magnetic resonance imaging, arthrography, and, in some cases, arthroscopy. Two anterior cruciate ligament reconstruction control groups were used for comparison, one group having previously undergone meniscectomy and one with intact menisci. The follow-up rate was 100% after 14 years. The Lysholm score was 84 ± 12 points at 3 years postoperatively and 75 ± 23 points at 14 years. Patients with deep-frozen meniscal transplants generally had better results than patients with lyophilized meniscal transplants. Magnetic resonance imaging evaluation showed good preservation of the deep-frozen meniscal transplants, even after 14 years. The lyophilized meniscal transplants were reduced in size at the second-look arthroscopy and as seen on magnetic resonance imaging examination. When the control groups were compared with the study group, the deep-frozen meniscal allografts were found to be more comparable with an intact meniscus and the lyophilized meniscal allografts were more comparable with the control group knees that had undergone meniscectomy.
A Comparison of Knee Kinetics between Male and Female Recreational Athletes in Stop-Jump Tasks
Authors: Chappell Jonathan D. , Yu Bing , Kirkendall Donald T. , Garrett William E.
Published: July 2017

We compared the knee kinetics of 10 male and 10 female recreational athletes (aged 19 to 25 years) performing forward, vertical, and backward stop-jump tasks. Three-dimensional videography and force plate data were used to record the subjects’ performance of the three stop-jump tasks, and an inverse dynamic procedure was used to estimate the knee joint resultant forces and moments. Women exhibited greater proximal anterior shear force than did men during the landing phase. All subjects exhibited greater proximal tibia anterior shear force during the landing phase of the backward stop-jump task than during the other two stop-jump tasks. Women also exhibited greater knee extension and valgus moments than did men during the landing phase of each stop-jump task. Men exhibited greater proximal tibia anterior shear force than did women during the takeoff phase of vertical and backward stop-jump tasks. These results indicate that female recreational athletes may have altered motor control strategies that result in knee positions in which anterior cruciate ligament injuries may occur. The landing phase was more stressful for the anterior cruciate ligament of both women and men than the takeoff phase in all stop-jump tasks. Technical training for female athletes may need to be focused on reducing the peak proximal tibia anterior shear force in stop-jump tasks. Further studies are needed to determine the factors associated with the increased peak proximal tibia anterior shear force in female recreational athletes.
Analysis of Pre- and Postexercise Compartment Pressures in the Medial Compartment of the Foot
Authors: Mollica Matthew B. , Duyshart Sarah C.
Published: July 2017

Growing awareness of chronic exertional compartment syndrome of the foot has led to the need for site-specific analysis of normative resting and postexertional intracompartment pressures. Thirty-four asymptomatic athletes underwent pressure testing of the medial foot compartment with an intracompartmental pressure measurement apparatus. Pressure measurements were recorded before exercise and after 20 minutes of running. Mean resting intracompartment pressure was 7.7 mm Hg, whereas mean pressures 1 and 5 minutes after exercise were 19.1 mm Hg and 10.7 mm Hg, respectively. These data were then compared with data from compartment pressure studies performed in nine symptomatic subjects, each with a clinical history suggestive of chronic exertional compartment syndrome of the medial foot compartment. The results demonstrated normative compartment pressures of the medial foot compartment are comparable with previously measured pressures of the leg. This study shows that previously defined criteria for diagnosis of chronic exertional compartment syndrome of the leg may also be used for diagnosis of chronic exertional compartment syndrome of the foot.
Histologic Evaluation of the Shoulder Capsule in Normal Shoulders, Unstable Shoulders, and after Failed Thermal Capsulorrhaphy
Authors: McFarland Edward G. , Kim Tae Kyun , Banchasuek Prachan , McCarthy Edward F.
Published: July 2017

Background:

Attenuation of the shoulder capsule has been noted during revision surgery for failed thermal capsulorrhaphy. Hypothesis: The attenuated capsule seen in patients who have undergone failed thermal capsulorrhaphy will show histologic characteristics distinguishing it from the capsule of normal shoulders and dislocating shoulders.

Study Design:

Case control study.

Methods:

The shoulder capsules were studied in 12 patients with traumatic anterior instability and in 7 patients who experienced recurrent instability after a thermal capsulorrhaphy. The capsules of six fresh-frozen cadavers with no shoulder lesions were used as controls.

Results:

Among patients who had a history of traumatic instability, a denuded synovial layer was present in 58%, subsynovial edema in 58%, increased cellularity in 25%, and increased vascularity in 83%. At the time of surgery, five of seven shoulders in the failed thermal capsulorrhaphy group (71%) were subjectively felt to be thin and attenuated. Denuded synovium was found in 100% of these patients, subsynovial edema in 43%, and changes in the collagen layer in 100%. Changes in the collagen layer in these patients included a “hyalinization” appearance in five cases (71%), increased collagen fibrosis in two cases (29%), and increased cellularity in two cases (29%).

Conclusions:

There was no one characteristic observable on histologic evaluation that would explain the attenuation of the capsule in cases of failed thermal treatment. Morphologic collagen structure can be histologically abnormal for up to 16 months after thermal capsulorrhaphy.
Biomechanical Analysis of an Anatomic Anterior Cruciate Ligament Reconstruction
Authors: Yagi Masayoshi , Wong Eric K. , Kanamori Akihiro , Debski Richard E. , Fu Freddie H. , Woo Savio L-Y.
Published: July 2017

Background:

The focus of most anterior cruciate ligament reconstructions has been on replacing the anteromedial bundle and not the posterolateral bundle.

Hypothesis:

Anatomic two-bundle reconstruction restores knee kinematics more closely to normal than does single-bundle reconstruction.

Study Design:

Controlled laboratory study.

Methods:

Ten cadaveric knees were subjected to external loading conditions: 1) a 134-N anterior tibial load and 2) a combined rotatory load of 5-N·m internal tibial torque and 10-N·m valgus torque. Resulting knee kinematics and in situ force in the anterior cruciate ligament or replacement graft were determined by using a robotic/universal force-moment sensor testing system for 1) intact, 2) anterior cruciate ligament deficient, 3) single-bundle reconstructed, and 4) anatomically reconstructed knees.

Results:

Anterior tibial translation for the anatomic reconstruction was significantly closer to that of the intact knee than was the single-bundle reconstruction. The in situ force normalized to the intact anterior cruciate ligament for the anatomic reconstruction was 97% ± 9%, whereas the single-bundle reconstruction was only 89% ± 13%. With a combined rotatory load, the normalized in situ force for the single-bundle and anatomic reconstructions at 30° of flexion was 66% ± 40% and 91% ± 35%, respectively.

Conclusions:

Anatomic reconstruction may produce a better biomechanical outcome, especially during rotatory loads.

Clinical Relevance:

Results may lead to the use of a two-bundle technique.
Lavage Solution Temperature Influences Depth of Chondrocyte Death and Surface Contouring during Thermal Chondroplasty with Temperature-Controlled Monopolar Radiofrequency Energy
Authors: Lu Yan , Edwards Ryland B. , Nho Shane , Cole Brian J. , Markel Mark D.
Published: July 2017

Background:

Although radiofrequency energy can smooth and contour cartilage surface, it has deleterious effects on chondrocyte viability.

Hypothesis:

Monopolar thermal chondroplasty in a 37°C lavage solution, as compared with a 22° lavage solution, will reduce chondrocyte death and result in greater smoothing of the articular cartilage surface.

Study Design:

Controlled laboratory study.

Methods:

Sixteen chondromalacic samples from patients undergoing total knee arthroplasty were divided into two groups: 22°C and 37°C lavage solution. Each sample was divided into two equal parts and half of each group was treated for 10 seconds and the other half for 15 seconds.

Results:

Confocal laser microscopy demonstrated that the depth of chondrocyte death in the 37°C lavage solution group was significantly less (range, 200 to 340 μm) than that in the 22°C solution group for both 10- and 15-second treatment times. Scanning electron microscopy demonstrated that the cartilage surface in the 37°C lavage solution group was smoother than that in the 22°C solution group for the 10-second treatment time. Energy delivery power in the 37°C lavage solution group was significantly lower than in the 22°C solution group for both treatment times.

Conclusions:

Thermal chondroplasty with 37°C lavage solution resulted in less depth of chondrocyte death and produced smoother surfaces than with 22°C solution for 10 seconds of treatment.

Clinical Relevance:

Less chondrocyte death would permit increased use of thermal chondroplasty.
Back Pain in Intercollegiate Rowers
Authors: Teitz Carol C. , O'Kane John , Lind Bonnie K. , Hannafin Jo A.
Published: July 2017

Background:

Back pain is prevalent among intercollegiate rowers.

Purpose:

We conducted a large-scale study to determine the rate of and the potential etiologic factors for clearly defined back pain that developed during intercollegiate rowing.

Study Design:

Survey.

Methods:

Surveys from 1632 former intercollegiate rowing athletes were analyzed. These surveys concerned training methods and back pain before and during intercollegiate rowing. Back pain was defined as pain that lasted at least 1 week.

Results:

Five hundred twenty-six subjects reported that back pain developed during intercollegiate rowing. Factors significantly associated with the development of back pain included age at the time of the survey; history of rowing before age 16; use of a hatchet oar blade; training with free weights, weight machines, and an ergometer; midline ergometer cable position; and ergometer training sessions longer than 30 minutes. Back pain while in college also was associated with higher mean college weight and height.

Conclusions:

Intercollegiate rowers in the last 10 years covered by this study were larger, started rowing at an earlier age, trained more intensely, and developed more back pain during college than their predecessors.
Long-Term Prognosis for Jumper's Knee in Male Athletes: Prospective Follow-up Study
Authors: Kettunen Jyrki A. , Kvist Martti , Alanen Erkki , Kujala Urho M.
Published: July 2017

Background:

Little information is available on the long-term outcome of jumper's knee, a common problem among athletes.

Purpose:

Our aim was to determine the 15-year prognosis of jumper's knee.

Study Design:

Prospective case control.

Methods:

The prognosis for jumper's knee was studied using two groups: athletes with jumper's knee and nonsymptomatic control athletes. At baseline, all subjects participated in standardized clinical examinations and measurements, and 15 years later they were asked to respond to a questionnaire.

Results:

Twenty athletes with jumper's knee and 16 athlete control subjects responded (response rate 74% and 84%, respectively). The jumper's knee group reported significantly more knee symptoms according to their Kujala score and more knee pain after repeated squatting. Fifty-three percent of the subjects in the jumper's knee group (9 of 17) reported that they had quit their sports career because of their knee problem, compared with 7% of the control athletes (1 of 14). Patellar height was associated with knee symptoms at follow-up.

Conclusion:

Jumper's knee causes mild but long-lasting symptoms after an athletic career.
Partial Tears of the Anterior Cruciate Ligament in Children and Adolescents
Authors: Kocher Mininder S. , Micheli Lyle J. , Zurakowski David , Luke Anthony
Published: July 2017

Background:

The functional outcome after partial anterior cruciate ligament tears in children and adolescents treated without reconstruction has not been established.

Hypothesis:

Nonreconstructive management of partial anterior cruciate ligament tears can be effective in certain pediatric patients.

Study Design:

Prospective cohort study.

Methods:

We studied 45 skeletally mature and immature patients 17 years of age or less who had an acute hemarthrosis, magnetic resonance imaging signal changes, grade A or B Lachman and pivot shift result, and an arthroscopically documented partial anterior cruciate ligament tears. All patients were treated without reconstruction, underwent a structured rehabilitation program, and were followed up for a minimum of 2 years.

Results:

Fourteen patients (31%) underwent subsequent reconstruction. Significant associations with subsequent reconstruction included tears that were greater than 50%, predominantly posterolateral tears, a grade B pivot shift test result, and older chronologic and skeletal age. Among patients who did not require reconstruction, those with tears that were greater than 50% or predominantly posterolateral had significantly lower Lysholm, satisfaction, and Cincinnati Knee Scale scores.

Conclusions:

Nonreconstructive management is recommended for partial anterior cruciate ligament tears in children and adolescents 14 years of skeletal age or younger with normal or near-normal Lachman and pivot shift results. Reconstruction is recommended in older athletes or in those with greater than 50% or predominantly posterolateral tears.
Effort Thrombosis in the Elite Throwing Athlete
Authors: DiFelice Gregory S. , Paletta George A. , Phillips Barry B. , Wright Rick W.
Published: July 2017

Background:

Upper extremity vascular injuries are uncommon in the elite throwing athlete. However, the extreme stresses that are placed on the upper extremity of elite baseball players, especially pitchers, puts them at risk for such injuries. One such injury is upper extremity venous thrombosis or “effort thrombosis.”

Purpose:

We wanted to review the common initial clinical symptoms and physical examination findings of effort thrombosis in elite baseball players and to review the associated clinical conditions such as hypercoagulable states and pulmonary embolism.

Study Design:

Retrospective review of a series of cases.

Methods:

A retrospective review of the medical records of a Major League Baseball organization and a Division I college was performed for the period 1987 to 1997.

Results:

We located four cases of effort thrombosis involving elite baseball players. Contrast venography was used to confirm the diagnosis in all cases. All patients were successfully treated with transluminal catheter-directed urokinase thrombolysis followed by first rib resection and systemic anticoagulant therapy for up to 3 months. All four players returned to play at or above their previous level of competition with no long-term chronic sequelae.

Conclusions:

Prompt clinical recognition, diagnosis, and treatment of effort thrombosis in the elite baseball player provides the player with an excellent prognosis for return to the previous level of play.
A Surgical Treatment for Unstable Osteochondritis Dissecans Lesions of the Humeral Capitellum in Adolescent Baseball Players
Authors: Takeda Hideaki , Watarai Koji , Matsushita Takashi , Saito Takao , Terashima Yuichiro
Published: July 2017

Background:

Various methods of surgical treatment for unstable osteochondritis dissecans lesions of the humeral capitellum have shown the potential to lead to osteoarthritis and poor functional results in throwing activities.

Purpose:

The purpose of this study was to evaluate the results of surgical treatment with pull-out wiring and bone grafting (as established by Kondo in 1989) in patients with unstable osteochondritis dissecans lesions of the humeral capitellum.

Study Design:

Retrospective review.

Methods:

Eleven male baseball players (average age, 14.7 years) with unstable osteochondritis dissecans lesions underwent internal fixation with pull-out wiring and bone grafting. Follow-up was an average 57 months. At an average 17 weeks after surgery, bony union of the osteochondritis dissecans lesion was radiographically confirmed and the wires were removed. Throwing was allowed beginning at 6 months after surgery.

Results:

At follow-up, all patients had obtained pain relief, and all except one had returned to previous throwing levels. Radiographs showed good healing, and minimal degenerative changes were found in only three joints.

Conclusion:

Healing of osteochondritis dissecans lesions of the elbow can be achieved after fragment fixation with pull-out wiring and a bone grafting technique.
Stress Injury of the Proximal Ulna in Professional Baseball Players
Authors: Schickendantz Mark S. , Ho Charles P. , Koh Jason
Published: July 2017

Background:

To date, stress injury of the proximal ulna has been infrequently reported as a cause of elbow pain in the throwing athlete.

Purpose:

We describe a syndrome of osseous stress injury of the proximal ulna in the professional throwing athlete.

Study Design:

Retrospective review.

Methods:

We evaluated the clinical, radiographic, and magnetic resonance imaging findings of seven professional baseball players with osseous stress injury of the proximal ulna.

Results:

Plain radiographs of the involved elbows failed to demonstrate any significant findings. All of the clinically significant lesions were detected with magnetic resonance imaging. In addition, magnetic resonance imaging was found to be of value in following the course of healing of the injuries. All of the lesions originated on the posteromedial aspect of the proximal ulna. The ulnar collateral ligament was intact in all seven athletes. One athlete had two occurrences of this injury. Six of the seven athletes returned to their previous level of play after a nonoperative course of treatment.

Conclusions:

We believe that this injury should be considered in the differential diagnosis of elbow pain in the throwing athlete. Magnetic resonance imaging is the diagnostic test of choice when this injury is suspected.
The Unstable Shoulder in the Adolescent Athlete
Authors: Walton Judie , Paxinos Anastasios , Tzannes Anthony , Callanan Mary , Hayes Kimberley , Murrell George A. C.
Published: July 2017

Shoulder dislocation and subluxation occur frequently in athletes, with peaks in the second and sixth decades. The majority of traumatic dislocations are in the anterior direction. The most frequent complication of shoulder dislocation is recurrence—a complication that occurs much more often in the adolescent population. The dynamic (muscular) and static (predominantly capsuloligamentous and labral) restraints to shoulder instability are now well defined. Recent surgical procedures for shoulder instability have become less interventional and have focused on restoring disrupted static restraints. The aim of rehabilitation is to enhance the dynamic muscular and proprioceptive restraints to shoulder instability.
Operative versus Nonoperative Management of Acute Achilles Tendon Rupture
Authors: Kocher Mininder S. , Bishop Julius , Marshall Ryan , Briggs Karen K. , Hawkins Richard J.
Published: July 2017

Background

The optimal management strategy for acute Achilles tendon rupture is controversial.

Purpose

To determine the optimal management by using expected-value decision analysis.

Study Design

Cross-sectional study.

Methods

Outcome probabilities were determined from a systematic literature review, and patient-derived utility values were obtained from a visual analog scale questionnaire. A decision tree was constructed, and fold-back analysis was used to determine optimal treatment. Sensitivity analyses were used to determine the effect of varying outcome probabilities and utilities on decision-making.

Results

Outcome probabilities (expressed as operative; nonoperative) were as follows: well (0.762; 0.846), rerupture (0.022; 0.121), major complication (0.030; 0.025), moderate complication (0.075; 0.003), and mild complication (0.111; 0.005). Outcome utility values were well operative (7.9), well nonoperative (7.0), rerupture (2.6), major complication (1.0), moderate complication (3.5), and mild complication (4.7). Fold-back analysis revealed operative treatment as the optimal management strategy (6.89 versus 6.30). Threshold values were determined for the probability of a moderate complication from operative treatment (0.21) and the utility of rerupture (6.8).

Conclusions

Operative management was the optimal strategy, given the outcome probabilities and patient utilities we studied. Nonoperative management was favored by increasing rates of operative complications; operative, by decreasing utility of rerupture. We advocate a model of doctor-patient shared decision-making in which both outcome probabilities and patient preferences are considered.
Clinical Assessment of Three Common Tests for Superior Labral Anterior-Posterior Lesions
Authors: McFarland Edward G. , Kim Tae Kyun , Savino Richard M.
Published: July 2017

Background

Three tests (active compression, anterior slide, and compression rotation) are commonly used to diagnose superior labral anterior-posterior lesions.

Hypothesis

We hypothesized that the accuracy, sensitivity, and specificity for these tests was less than that previously reported and that a click in the shoulder during manipulation was not specific for the study lesion.

Study Design

Case-control study.

Methods

The three tests were performed on 426 patients who subsequently underwent shoulder arthroscopy. The results of physical examination were compared with the arthroscopic findings and analyzed for sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy.

Results

At arthroscopy, 39 patients had type II to IV lesions (study group); the remaining 387 patients had type I lesion or no lesion (control group). The incidences of positive results were not statistically different between the groups (P > 0.05). Our findings were as follows: most sensitive test, active compression (47%); most specific test, anterior slide (84%); highest positive predictive value, active compression (10%); highest overall accuracy, anterior slide test (77%); lowest overall accuracy, active compression test (54%). The presence of a click and the location of the pain were not reliable diagnostic indicators.

Conclusions

The results of such tests should be interpreted with caution when considering surgery for a possible superior labral anterior-posterior lesion.
Anterior Cruciate Ligament Reconstruction with and without a Ligament Augmentation Device
Authors: Drogset Jon Olav , Grøntvedt Torbjørn
Published: July 2017

Background

Ligament augmentation devices have been used in anterior cruciate ligament reconstruction since the suggestion of Kennedy et al. in 1980 that such devices would allow grafts to heal faster and more safely.

Hypothesis

Patients who had augmentation will have better outcomes after 8 years.

Study Design

Prospective randomized case control study.

Methods

Between 1991 and 1993, 100 patients were randomized to groups undergoing anterior cruciate ligament reconstruction with bone-patellar tendon-bone grafts with (49) or without (51) use of a Kennedy ligament augmentation device. Of these 100 patients, 94 were examined at an average of 8 years after surgery. Fifteen patients were excluded because of rupture in the other knee and 11 because of rerupture in the same knee.

Results

Of the remaining 68 patients, the mean Lysholm function score was 84 in the augmentation group and 87 in the control group. There was a statistically significant relationship between preoperatively detected cartilage injury and osteoarthritis. Almost half of the patients had developed osteoarthritis. We observed no significant difference between the two groups concerning rerupture rate, Lysholm or Lachman test scores, or KT-1000 arthrometer measurements.

Conclusions

We found no positive long-term effects supporting the use of augmentation in anterior cruciate ligament reconstruction.
The Role of Biomechanical Shoe Orthoses in Tibial Stress Fracture Prevention
Authors: Ekenman Ingrid , Milgrom Charles , Finestone Aharon , Begin Michal , Olin Carin , Arndt Toni , Burr David
Published: July 2017

Background

Biomechanical orthoses have been shown to lower stress fracture incidence in infantry recruits. However, these results may not be applicable to running athletes.

Hypothesis

Training in either running shoes or military boots with custom biomechanical shoe orthoses lessens tibial bone strains and strain rates during walking and running.

Study Design

Randomized controlled laboratory study.

Methods

In vivo strain measurements were made in nine subjects to determine whether the use of biomechanical orthoses lowers tibial strains during both walking and running and whether such lowering depends on the type of shoe worn. Measurements were made during treadmill walking at 5 km/hr and then during serial 2-km treadmill runs at 13 km/hr with running shoes, with and without the orthoses, and during serial 1-km runs with army boots, with and without the orthoses.

Results

When soft or semirigid biomechanical orthoses were worn with boots, the tibial peak-to-peak strains were significantly lowered. Soft orthoses also significantly lowered the tension and compression strain rates when worn with boots. During running, semirigid orthoses significantly increased the compression and tension strain rates when worn with boots.

Conclusions

The use of biomechanical orthoses may be warranted for tibial stress fracture prevention during training in which boots are worn and that mostly involves walking, but they are not warranted for activities that primarily involve running or are performed in running shoes.
The Fixation Strength of Six Hamstring Tendon Graft Fixation Devices in Anterior Cruciate Ligament Reconstruction: Part II: Tibial Site
Authors: Kousa Petteri , Järvinen Teppo L. N. , Vihavainen Mika , Kannus Pekka , Järvinen Markku
Published: July 2017

Background:

Tibial fixation is more problematic than femoral fixation in anterior cruciate ligament reconstruction.

Hypothesis:

There is no difference in initial fixation strength among hamstring tendon graft tibial fixation devices.

Study Design:

Randomized experimental study.

Methods:

Each of six devices used to fix 120 quadrupled human semitendinosus-gracilis tendon grafts into porcine tibiae was tested 10 times with a single-cycle load-to-failure test and 10 times with a 1500-cycle loading test. Specimens surviving cyclic loading were subjected to a single-cycle load-to-failure test.

Results:

Intrafix (1332 N) was the strongest in the single-cycle load-to-failure test, followed by WasherLoc (975 N), tandem spiked washer (769 N), SmartScrew ACL (665 N), BioScrew (612 N), and SoftSilk (471 N). After cyclic-loading tests, Intrafix showed the lowest residual displacement (1.5 mm) and was also strongest (1309 N) in the single-cycle load-to-failure test after the cyclic-loading test, followed by WasherLoc (3.2 mm; 917 N).

Conclusion:

The Intrafix provided clearly superior strength in the fixation of hamstring tendon grafts to the tibial drill hole.

Clinical Relevance:

Some caution may be warranted when using the implants that showed increased residual displacement, especially if aggressive rehabilitation is to be used. Preconditioning of the hamstring tendon graft-implant complex before tibial fixation is needed.
Iontophoretic Administration of Dexamethasone Sodium Phosphate for Acute Epicondylitis: A Randomized, Double-Blinded, Placebo-Controlled Study
Authors:   MPT, for the DEX–AHE–01–99 Study Group, Nirschl Robert P. , Rodin Dennis M. , Ochiai Derek H. , Maartmann-Moe Craig
Published: July 2017

Background:

A better treatment modality is needed to control the pain of medial or lateral epicondylitis (tennis elbow).

Hypothesis:

Dermal iontophoretic administration of dexamethasone sodium phosphate will be significantly more effective in controlling pain than a placebo in patients with medial or lateral elbow epicondylitis.

Study Design:

Randomized, double-blinded, placebo-controlled study.

Methods:

On six occasions, 1 to 3 days apart within 15 days, 199 patients with elbow epicondylitis received 40 mA-minutes of either active or placebo treatment.

Results:

Dexamethasone produced a significant 23-mm improvement on the 100-mm patient visual analog scale ratings, compared with 14 mm for placebo at 2 days and 24 mm compared with 19 mm at 1 month. More patients treated with dexamethasone than those treated with placebo scored moderate or better on the investigator's global improvement scale (52% versus 33%) at 2 days, but the difference was not significant at 1 month (54% versus 49%). Investigator-rated pain and tenderness scores favored dexamethasone over placebo at 2 days. Patients completing six treatments in 10 days or less had better results than those treated over a longer period.

Conclusions:

Iontophoresis treatment was well tolerated by most patients and was effective in reducing symptoms of epicondylitis at short-term follow-up.
Codominance of the Individual Posterior Cruciate Ligament Bundles: An Analysis of Bundle Lengths and Orientation
Authors: Ahmad Christopher S. , Cohen Zohara A. , Levine William N. , Gardner Thomas R. , Ateshian Gerard A. , Mow Van C.
Published: July 2017

Background:

It is unclear how each bundle of the posterior cruciate ligament contributes to posterior knee stability.

Hypothesis:

Changes in bundle orientation and length occur such that neither bundle dominates in restraining posterior tibial motion throughout knee flexion and extension.

Study Design:

Controlled laboratory study.

Methods:

Six fresh-frozen cadaveric knees were studied in a joint-testing rig with individual quadriceps and hamstring muscle loading. Kinematic data for the tibia and femur were obtained at knee flexion angles from 0° to 120°. The joint was then disarticulated, and the insertions of the two bundles on the tibia and femur were digitized.

Results:

Length of the anterolateral bundle increased with increasing knee flexion angle from 10° to 120°. Length of the posteromedial bundle decreased with increasing knee flexion angle from 0° to 45° and increased slightly from 60° to 120°. Length of the anteromedial bundle was significantly less than that of the posteromedial at 0°, 10°, and 20° of knee flexion. The anterolateral bundle was significantly more horizontal at flexion angles of 0°, 10°, 20°, 30°, and 45° (P < 0.05). The posteromedial bundle was more horizontal at 120°.

Conclusions:

Changes in orientation take place such that neither bundle dominates in restraining posterior tibial motion throughout knee flexion and extension.

Clinical Relevance:

Double-bundle reconstructions achieve more physiologic knee function.
Anatomy of the Superior Glenoid Rim: Repair of Superior Labral Anterior to Posterior Tears
Authors: Lehtinen Janne T. , Tingart Markus J. , Apreleva Maria , Ticker Jonathan B. , Warner Jon J. P.
Published: July 2017

Background:

Successful placement of a fixation device on the superior glenoid rim during superior labrum repairs requires accurate knowledge of the glenoid rim anatomy.

Purpose:

To investigate the normal bony anatomy of the superior glenoid rim.

Study Design:

Descriptive anatomic study.

Methods:

Twenty cadaveric glenoid specimens were scanned to obtain cross-sectional images with peripheral quantitative computed tomography in three different positions, each perpendicular to the articular surface. Two straight lines were drawn along the interior bony margins of the articular surface and cortex, and image analysis software was used to calculate the angle between these lines. Three bony angles were measured.

Results:

The bony angles from the 10:30-, 12-, and 1:30-o'clock cross-sections were 55° ± 5°, 64° ± 5°, and 62° ± 8°, respectively. The posterosuperior angle (at the 10:30-o'clock position) was statistically significantly lower than the superior and anterosuperior angles. Intraobserver variation was less than 3%.

Conclusions:

The most superior point of the glenoid rim (12-o'clock position) seems to provide the most bone stock for anchor insertion. The available bone support was found to decrease posteriorly on the glenoid rim.

Clinical Relevance:

During superior labral repairs, the anchor or fixation device should be inserted at approximately a 30° angle in relation to the articular surface for maximal bone support.
Determination of Time of Biologic Fixation after Anterior Cruciate Ligament Reconstruction with Hamstring Tendons
Authors: Uchio Yuji , Ochi Mitsuo , Adachi Nobuo , Kawasaki Kenzo , Kuriwaka Masakazu
Published: July 2017

Background

It has been unclear when a hamstring tendon graft becomes biologically fixed in the bone tunnel after anterior cruciate ligament reconstruction.

Hypothesis

Postoperative biomechanical testing and magnetic resonance images can indicate biologic fixation of the graft in the femoral bone tunnel.

Study Design

Prospective cohort study.

Methods

Sixty-four patients were evaluated by serial biomechanical testing, magnetic resonance imaging, and second-look arthroscopy 2 years after surgery. Biologic fixation of the graft was confirmed radiographically by injecting a contrast medium into the femoral bone tunnel.

Results

Forty-two stable knees with graft fixation maintained a high stiffness (120% of normal) and showed low signal intensity in an early postoperative magnetic resonance image (12 ± 8 months). Fourteen stable knees without graft fixation had gradually increased anterior displacement with nearly normal stiffness and high signal intensity. Five unstable knees with graft fixation retained low stiffness (70%) and showed late low signal intensity at 20 ± 9 months. Three unstable knees without biologic fixation had rapidly increased anterior displacement, with half the stiffness of a normal knee.

Conclusion

Postoperative low stiffness and high signal intensity might indicate late biologic graft fixation, predicting a possibility of postoperative anterior knee instability.