bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical and physiological considerations in triathlons
Authors: Hiller W. Douglas B. , O'Toole Mary L. , Fortess Eric E. , Laird Robert H. , Imbert Peter C. , Sisk T. David
Published: June 2007

Triathlons (races involving consecutive swimming, bi cycling, and running) have become commonplace in the United States. These races may involve from 30 min utes to 36 hours of continuous exercise, usually in warm or hot environments. Little has been published regarding the medical and physiological aspects of these events. This paper represents the first large study to date on the subject, including both an analysis of medical complications at six triathlons as well as a prospective electrolyte study conducted at two of these races.

Medical records were kept and examined for all ath letes requiring treatment during a typical United States Triathlon Series (USTS) race in 1986 (1,000 starters; finish times, 2 to 4 hours), a typical Ironman Qualifier (IQ) race in 1986 (622 starters; finish times, 4 to 8 hours), and the 1982 through 1985 Hawaii lronman World Championships (4,583 starters; finish times, 9 to 17 hours). At the USTS race, fewer than 2% (17/1,000) of the starters required aid, at the IQ, approximately 10% (61 /622) of the starters were treated, and at the Ironman, an average of 17% (794/4,583) received med ical attention. The most common diagnoses at the USTS and IQ were dehydration and heat exhaustion. At the lronman, dehydration and heat problems were complicated by hyponatremia.

Because hyponatremia has been reported as a com plication of ultraendurance events, a prospective study was performed on 36 athletes during a USTS race and 64 athletes at the 1984 lronman race. Prerace and postrace blood samples showed that no athletes were hyponatremic following the shorter USTS race, but 27% (17/64) of the athletes studied were hyponatremic fol lowing the lronman race.

Medical personnel should be prepared to treat a minimum of 2% and up to 10% of the athletes in races lasting up to 4 hours, 10% to 20% of those in races lasting 4 to 8 hours, and at least 20% of starters in races lasting between 9 and 17 hours. For races less than 4 hours, the IV fluid of choice should be D5 1/2 NSS (normal saline solution). For races longer than 4 hours, D5NSS should be used for IV resuscitation.
Anatomical observations on the acromioclavicular joint and supporting ligaments
Authors: Salter E. George , Nasca Richard J. , Shelley Brian S.
Published: June 2007

An anatomical study of the acromioclavicular (AC) joint and its supporting ligaments was performed using both macroscopic and microscopic methods. The project used 63 cadaver shoulders of unknown ages. Fifty- three joints were used for macroscopic and 10 for microscopic study. The data consisted of 1) micrometer measurements of the dimensions of the extrinsic and intrinsic ligaments of the AC joint; 2) measurement and description of the intraarticular meniscus and the su perior and inferior capsular ligaments of the AC joint; and 3) the anatomical course and relationship of the coracoacromial (CA) ligament to the supporting liga ments of the AC joint and a description of its insertion on the acromion process.

The following observations were made: The cor acoclavicular ligament, especially the trapezoid liga ment, provides significant soft tissue restraints to up ward displacement of the clavicle. A complete AC joint disc was found in only one, meniscoid discs in 25, remnants of discs in 16, and no discs in 11 of the 53 joints studied macroscopically. (No age correlation was made since the ages of the cadavers were unknown.) The CA ligament interconnects with the inferior capsular ligament of the AC joint as well as with the coracoclavic ular and coracohumeral ligaments. It also has a broad area of insertion on the inferior acromial surface.

The CA ligament appears to function as a buffer between the acromion and the rotator cuff, and to provide support for the AC joint. Transection of the CA ligament may result in loss of this buffering function.
Weight loss without dietary restriction: Efficacy of different forms of aerobic exercise
Authors: Gwinup Grant
Published: June 2007

Since obese patients with orthopaedic disabilities are often advised to undertake swimming as a part of a weight loss program, the effect of swimming on body weight was systematically studied. Minimally to mod erately obese, otherwise healthy young women seeking to lose weight through a program of exercise without dietary restrictions were randomly assigned to one of three groups in which only the type of daily exercise was different. The three types of exercise were brisk walking, riding a stationary cycle, and swimming laps in a pool. All women slowly but progressively increased the time spent in daily exercise to 60 minutes. After 6 months or slightly longer, the women assigned to walk ing lost 10% of initial weight, the women who cycled lost 12%, but the women who swam lost no weight. The thickness of the subcutaneous panniculus over the middle of the extensor surface of the upper arm was measured using a Lang skin-fold caliper (Graham Field Co, New York, NY) and showed equivalent substantial reductions in the walkers and cyclists, but no change in the swimmers. The results of this study show that both walking and cycling are effective methods of re ducing body fat, but that swimming is not.
A review of nonoperative treatment of Jones' fracture
Authors: Zogby Richard G. , Baker Bruce E.
Published: June 2007

Sir Robert Jones, in 1902, described a transverse fracture of the proximal diaphysis of the fifth metatarsal, which he treated conservatively with good results. Since that time, classification into acute and chronic categories by several authors has been proposed and most agree with the relatively high incidence of non- union. Controversy exists concerning operative versus nonoperative primary treatment especially in athletes. The purpose of this study was to determine if nonop erative treatment could be used effectively in treating these fractures.

A retrospective study of nine patients with 10 Jones' fractures was completed. The cases were categorized as acute or chronic by clinical history and radiographic appearance. The average age was 23.6 years. There were eight males and one female. In this group, com petitive athletes sustained chronic fractures, while acute fractures occurred in nonathletes. Treatment

consisted of a short leg nonweightbearing cast until radiographic and clinical healing occurred, followed by 6 weeks of limited activity.

Mean clinical and radiographic union of chronic frac tures was 9.4 weeks; acute fractures, 22 weeks. All competitive athletes returned to their preinjury level of competition at an average of 12 weeks following initia tion of treatment. There was one refracture.

Our data indicate that nonoperative treatment of early chronic or subacute fractures without intramedullary sclerosis can compare favorably with surgical treatment procedures reported in other studies in returning ath letes to play postinjury. We suggest serious consider ation be given to the method herein as a form of primary treatment of the early chronic Jones' fracture without intramedullary sclerosis.
Surgical management of Achilles tendinitis
Authors: Schepsis Anthony A. , Leach Robert E.
Published: June 2007

Inflammation of the Achilles tendon and its contiguous structures is one of the most common overuse prob lems seen in runners. There are actually several etiol ogies. Involvement of the tendon itself is secondary to areas of mucinoid or fibrotic degeneration, or may be a result of a partial rupture. The sheath (or mesotenon) may also become chronically inflammed. Retrocalca neal bursitis seems to be a separate entity with hyper trophy and fibrosis of the bursa usually occurring in conjunction with a prominent posterior superior angle of the os calcis. The vast majority of patients can be successfully treated nonoperatively; however, there is a group of patients who are refractory to nonoperative management who would like to continue running, par ticularly if they are competitive.

A retrospective review of 45 surgical cases in 37 patients was performed. All but two of these patients were competitive long-distance runners. There were 24 cases of Achilles tendinitis and/or tenosynovitis, 14 cases with retrocalcaneal bursitis, and 7 with a combi nation of both. Mean followup was 3 years (range, 1½ to 8 years). Overall there were 87% satisfactory results. Ninety-two percent of the patients with involvement with the tendon and/or sheath had a satisfactory out come as compared with 71 % of patients with retrocal caneal bursitis. Passive dorsiflexion in the 29 unilateral cases improved from a mean of 17° preoperatively to a mean of 25° postoperatively. We feel that surgery offers a solution for highly motivated runners with chronic posterior heel pain who would like to continue running when conservative measures have failed.
High school football injuries: Identifying the risk factors
Authors: Halpern Brian , Thompson Nancy , Curl Walton W. , Andrews James R. , Hunter Stephen C. , Boring John R.
Published: June 2007

This epidemiologic survey of the literature on the factors contributing to the high number of high school football injuries consolidates the current information on the characteristics and risk factors associated with these injuries. To reduce the incidence of knee sprains and strains, the most common injuries to this population, the following preventive recommendations are pre sented : 1) optimum maintenance of playing fields; 2) use of the soccer-style shoe; 3) noncontact and con trolled activities in practice sessions; and 4) increased vigilance over technique during injury-prone preseason practices. The authors conclude that more research into factors such as exposure time and activity at injury will further reduce the risk to the high school football player.
The patient with symptomatic chronic anterior cruciate ligament insufficiency
Authors: Fowler Peter J. , Regan William D.
Published: June 2007

Forty-nine patients with 51 chronic symptomatic ante rior cruciate deficient knees were studied retrospec tively by chart review and follow-up examination an average of 5.8 years postinjury and 1.5 years from arthroscopic evaluation, with or without arthroscopic surgery, and the institution of a conservative rehabili tation program. Subjective evaluation of function was obtained by questionnaire.

At arthroscopy, meniscal lesions were seen in 37 of 51 knees, and degenerative changes were noted in 24 knees. The ACL was absent in 43 knees. Partial men iscectomy or suturing was performed on 20 patients. All patients had an average of 3 weeks of supervised physical therapy stressing hamstring strengthening.

At followup, thigh girth measurements of injured and normal legs found thigh wasting in 40 patients. Seven of 33 patients radiographed showed evidence of de generative changes. About two-thirds of the patients returned to some level of athletics and had no problems with activities of daily living. Twenty were able to return to pivoting sports, but only five could return to their preinjury levels of competition. Of the 18 patients who did not return to athletics, only 8 were considering or had had a ligament reconstruction. Those patients who chose to continue rehabilitation beyond the prescribed period and who modified their activities had a better functional outcome.
Hand injuries in boxing
Authors: Noble Clive
Published: June 2007

Investigations of 100 consecutive hand injuries in box ing have shown that 39% occurred in the area of the thumb, including the radial carpals, metacarpals and phalanges and their joints. These injuries were mostly caused by forced abduction of the thumb. Thirty-five percent of the injuries occurred at the base of Meta carpals 2 to 5, including the wrist joint, and arose from forced flexion of the wrist. Twenty-six percent occurred in the phalanges and the rest of the metacarpals, excluding the bases.
Androgenic-anabolic steroid effects on serum thyroid, pituitary and steroid hormones in athletes
Authors: Alen Markku , Rahkila Paavo , Reinilä Matti , Vihko Reijo
Published: June 2007

Endocrine responses in seven power athletes were investigated during a 12 week strength training period, when the athletes were taking high doses of andro genic-anabolic steroids, and during the 13 weeks fol lowing drug withdrawal. During the use of steroids significant decreases (P < 0.05 to 0.001) in the serum concentrations of thyroid stimulating hormone, thyrox ine, triidothyronine, free thyroxine, and thyroid hor mone-binding globulin (TBG) were found, whereas the value of triidothyronine uptake increased (P < 0.001). In relation to the changes in the thyroid function param eters measured, we suggest that the primary target of androgen action was TBG biosynthesis. In five of the seven subjects, serum concentrations of growth hor mone increased at some point of the study 5 to 60- fold. Because of the use of exogenous testosterone, serum testosterone concentration tended to increase. This increase was associated with a corresponding increase (P < 0.001) in serum estradiol. Furthermore, there were major decreases in serum LH (P < 0.01) and FSH (P < 0.01) concentrations, and testicular tes tosterone production was therefore decreased. This was characterized by a very low serum testosterone concentration (5.1 ± 1.8 nmol/l) 4 weeks following drug withdrawal. Cessation of drug use resulted in return of all the variables measured to the initial values, except for serum testosterone, which was at a low level (14.6 ± 8.8 nmol/l) 9 weeks after drug withdrawal, indicating prolonged impairment of testicular endocrine function. No consistent changes were found in the eight control athletes.
Anterior cruciate ligament repairs in world class skiers
Authors: Higgins R.W. , Steadman J.R.
Published: June 2007

From 1979 to 1984, 27 skiers who were either present or past members of the United States Ski Team or professional skiers had 30 ACL tears that were repaired primarily. Only two of the repairs were augmented with autogenous patellar tendon grafts. Five patients had complete knee dislocations, including tears of both cruciate ligaments. Nineteen patients had a concomi tant extraarticular iliotibial band tenodesis. Twenty- seven knees (24 patients) were followed an average of 57.6 months postoperatively. Recreational skiing was resumed at 5.4 months on average, and in ski racing and pivot-requiring sports all but three patients re sumed participation at an average of 9.1 months. In 78% of the knees there was pain-free function. Mild pain was reported in 19%, the majority of which (4/5) was related to vigorous activity. Of the total, only two knees were reported to have a sensation of giving way.

On clinical examination 85% (23/27) had normal pivot shift examination with no evidence of abnormal motion. Four percent (1 /27) had a 1 + test and 11 % (3/27) had "glides." Arthrometer measurements revealed an aver age of 7.76 mm anterior displacement with 20 pounds of force on the knee with an ACL repair as compared to 5.56 mm on the uninjured knee. The laxity measure ments of knees with repaired ACLs fell within the range reported for uninjured knees in the normal population.

Five patients had reinjuries to the ACL at an average time of 28 months postoperatively, with two of five undergoing rerepair. Only one patient had an iliotibial band tenodesis to supplement the original ACL repair.

With proper surgical technique and rehabilitation, ACL repair can be statically and functionally successful in elite skiers. The use of the iliotibial band tenodesis is essential for successful ACL repair and the institution of immediate postoperative motion.
Biomechanical comparison of stimulated and nonstimulated skeletal muscle pulled to failure
Authors: Garrett William E. , Safran Marc R. , Seaber Anthony V. , Glisson Richard R. , Ribbeck Beth M.
Published: June 2007

We compared the biomechanical properties of passive and stimulated muscle rapidly lengthened to failure in an experimental animal model. The mechanical param eters compared were force to tear, change in length to tear, site of failure, and energy absorbed by the muscle- tendon unit before failure. Paired comparisons were made between 1) muscles stimulated at 64 Hz (tetanic stimulation) and passive (no stimulation) muscles, 2) muscles stimulated at 16 Hz (wave-summated stimu lation) and passive muscles, and 3) muscles stimulated at 64 Hz and at 16 Hz.

Both tetanically stimulated and wave-summation con tracted muscles required a greater force to tear (at 64 Hz, 12.86 N more, P < 0.0004; and at 16 Hz, 17.79 N more, P < 0.003) than their nonstimulated controls, while there was no statistical difference in failure force between muscles stimulated at 16 Hz and 64 Hz. The energy absorbed was statistically greater for the stim ulated muscles than for the passive muscles in Groups 1 and 2 (at 64 Hz, 100% more, P < 0.0003; and 16 Hz, 88% more, P < 0.0002). In Group 3, the tetanically contracted muscle-tendon units absorbed 18% more energy than the wave-summated stimulated muscles (P < 0.01). All muscles tore at the distal musculotendi nous junction, and there was no difference in the length increase at tear between muscles in each group. These findings may lead to enhanced understanding of the mechanism and physiology of muscle strain injuries.
Prophylactic knee bracing
Authors: Garrick James G. , Requa Ralph K.
Published: June 2007

Six studies to determine the effectiveness of prophy lactic knee braces in preventing medial collateral liga ment (MCL) injury in football are compared. Criteria useful in evaluating studies are discussed, such as the probability of confounding factors, bias in selecting cases and controls, and variations in defining injury and exposure. Cost, as well as some ethical issues asso ciated with mandated use are discussed. While four of these studies found a reduction in MCL injuries asso ciated with using a brace, two of them reported in creases. No consensus arises from these studies, con flicting results as well as methodological problems in some make it impossible to state with assurance the role of prophylactic knee bracing in football at this time.
Nervous system sports-related injuries
Authors: Lehman L.B.
Published: June 2007

With the evolution of sports medicine as a subspecialty comes a redirection of attention to the medical and athletic communities to the prompt recognition and timely treatment of many potentially serious conditions. Nervous system complications of sports injuries have gone largely unaddressed in the literature. It is the goal of this communication to review the wide range of nervous system injuries due to sports activities, discuss the mechanisms of such injuries, and focus attention on their prevention and management. The role of the neurologist and neurosurgeon as a sports medicine team member will be discussed, as will their roles in planning and development of programs and equipment at the secondary school, collegiate, and professional levels.
Cruciate reconstruction using freeze dried anterior cruciate ligament allograft and a ligament augmentation device (LAD)
Authors: Jackson D.W. , Grood E.S. , Arnoczky S.P. , Butler D.L. , Simon T.M.
Published: June 2007

One ACL in each of 11 mature goats was replaced with a freeze dried bone-ACL-bone allograft and a ligament augmentation device (LAD). The LAD was released from its tibial fixation at 3 months postoperation. Bio mechanical, microvascular, and histological changes were evaluated 1 year following implantation. The re constructed knees had a significantly greater total AP translation (3.1 ± 0.5 mm) (mean and SEM) than the contralateral controls (1.0 ± 0.1 mm). Differences in primary AP translation were responsible for 59% of the difference in total translation, with only a 0.6 mm differ ence in secondary translation. Neutral stiffness in the reconstructive knee was 22% of control, while stiffness at 30 N of anterior force was approximately 35% of controls. Ligament stiffness in the linear region for the ACL allograft/LAD was 53% of the control value of 691 N/mm. The maximum load of the allograft/LADs was 1,052 ± 145 N, or 43% of the contralateral ACL control strength (2,448 ± 144 N). Five of the six allografts failed at the femoral insertion. Energy (39%) to maximum load was less for allograft/LADs than controls but elongation to maximum load was the same as control. Histologic evaluation of the allograft/LADs revealed soft tissue cellular ingrowth into the LAD in the extraarticular por tions. No bony growth into the LAD was observed. The collagen fibers of the graft appear to be arranged in a longitudinal orientation although some areas show cha otic collagen fibers. Microangiography revealed a peri- ligamentous and endoligamentous vascular pattern reminiscent of a normal ACL and complete revascular ization of the bone plugs.
A biomechanical study of the static stabilizing effect of knee braces on medial stability
Authors: Baker Bruce E. , V Edward , Orthotist Cert , Bogosian Stephen , Werner Frederick W. , Mech Eng M. , Murphy Dennis
Published: June 2007

The purpose of this project was to determine if com mercially available braces could be shown to produce objective evidence of medial stabilization of the knee. Commercially available athletic braces were evaluated for their effect on abduction forces applied to a cadaver knee with no instability and with experimentally created medial instability. Under computer control, abduction forces were applied while simultaneous data were ob tained from an electrogoniometer and transducers ap plied to the anterior cruciate ligament and the superficial medial collateral ligament at 0°, 15°, and 30° of flexion. Our results showed a reduction in abduction angle using functional braces, whereas prophylactic braces demonstrated little or no protective effect.
Objective knee evaluation using the Genucom Knee Analysis System
Authors: Oliver John H. , Coughlin Larry P.
Published: June 2007

The Genucom Knee Analysis System was used in a clinical setting to study the clinical practicality of the Genucom instrument, and the degree of correlation between Genucom and clinical knee examinations. The Genucom evaluation performed by an experienced ex aminer required 25 to 30 minutes for a 14 test bilateral examination. The instrument provided detailed graphi cal and tabular data of the test results.

One hundred "normal knees" were examined in a series of seven Genucom tests. Normal "laxity bands" for both males and females were generated for a range of load applications for the seven tests. There was no significant difference observed between the male and female laxity distributions. However, a slightly lesser laxity was observed for the male population in general.

A group of 38 subjects with 1 injured knee were assessed concurrently using clinical and instrument techniques. Comparisons were made for the 90° an terior-posterior (AP) drawer, the 30° AP drawer (Lach man), and the varus/valgus stress test. For the 90° AP drawer test, 16 subjects were found clinically to have less than or equal to 5 mm of excess laxity based on comparison with the opposite normal knee. The instru mented measurement concurred in 10 cases. In the other six cases it was noted that laxity on the uninjured knee reached the maximum of the "normal" instru mented population, that is with higher than normal laxities. Fifteen subjects were clinically tested with greater than 5 mm of excess laxity. The instrumented test concurred in all but one.

For the Lachman test (30° AP drawer), 19 subjects were found with an excess laxity of less than or equal to 5 mm. The instrument concurred in all cases but one. Fifteen subjects had a clinical Lachman of greater than 5 mm of excess laxity. The instrumented meas urements concurred in all cases. For the varus/valgus stress test, five subjects were found with excess lateral joint opening of less than or equal to 5 mm. The instrumented test concurred in all but one case in which the varus laxity was clinically described as "subtle." Four clinical cases of medial joint opening of less than or equal to 5 mm were found in the group. The instru ment concurred in all cases.

It was also found that 17 of 18 patients with a clinically positive pivot shift demonstrated a greater than 5 mm of excess laxity on the 30° AP drawer Genucom test. In this study, it was found that the results of the instrument evaluation correlated to a high degree with the clinical evaluations of the knees of the subjects. It appears that the computer-based instrument provides a significant contribution to objective measurement of knee joint stability (laxity).
A comparative electromyographic analysis of the shoulder during pitching
Authors: Gowan Ivan D. , Jobe Frank W. , Tibone James E. , Perry Jacquelin , Moynes Diane R.
Published: June 2007

Dynamic, fine-wire, intramuscular electromyography (EMG) was performed on 12 different shoulder muscles in 13 normal male subjects as they pitched a baseball. Seven were major league baseball pitchers and six were amateur pitchers. The act of pitching a fast ball was filmed at 450 frames per second with the EMG signals recorded synchronously. The subscapularis, su praspinatus, and infraspinatus muscles were tested in 13 subjects, the biceps brachii muscle was tested in 12, and other shoulder muscles were tested variously among the subjects.

Two groups of muscles were identified. Group I mus cles, the supraspinatus, infraspinatus, teres minor, del toid, trapezius, and biceps brachii, served primarily to position the shoulder and elbow for the delivery of the pitch. These muscles were found to have greater activ ity during the early and late cocking stages, with less activity during acceleration. Group II muscles acceler ated the arm and baseball forward in space. These muscles, the pectoralis major, serratus anterior, sub scapularis, and latissimus dorsi, had stronger activity during the propulsive phase of the pitch.

The professional pitchers were able to use the mus cles about the shoulder in an efficient manner to achieve greater pitching velocities. The subscapularis and latis simus dorsi muscles of Group II had stronger activity among the professionals, whereas the supraspinatus, teres minor, and biceps brachii muscles of Group I had only minimal activity. The amateurs, on the other hand, continued to use all of the rotator cuff muscles and the biceps brachii muscle of Group I through the accelera tion stage of the pitch. These data may provide a basis for understanding improved performance and an ad junct for sport-specific rehabilitation programs.
A prospective comparison study of double contrast computed tomography (CT) arthrography and arthroscopy of the shoulder
Authors: Callaghan John J. , McNiesh Lawrence M. , Dehaven James P. , Savory Carlton G. , Polly David W.
Published: June 2007

Thirty consecutive patients who underwent double con trast CT arthrography prior to shoulder arthroscopy were prospectively studied. Results from both studies were recorded with the radiologist blinded to the ar throscopic findings when making the final CT reading. The sensitivity, specificity, and accuracy, respectively, of CT arthrography findings compared to arthroscopy were 50%, 100%, 96% for rotator cuff; 66%, 100% 96% for bicipital labral complex; 100%, 100%, 100% for loose bodies; 50%, 100% 93% for Hill-Sachs le sions ; 90%, 73%, 83% for anterior labral defects; and 100%, 100%, 100% for posterior labral defects. We conclude that shoulder arthroscopy accurately deline ates abnormalities of the anterior and posterior labrum, bicipital labral complex, rotator cuff, joint synovium, and humeral head. CT arthrography accurately delineates capsular redundancy, loose bodies, hardware around joints, and bony glenoid rim abnormalities.
Magnetic resonance imaging of the knee
Authors: Jackson D.W. , Jennings L.D. , Maywood R.M. , Berger P.E.
Published: June 2007

Magnetic resonance imaging (MRI) is an accepted non invasive modality for evaluation of soft tissue pathology without exposure to ionizing radiation. Current appli cations demonstrate excellent visualization of the anat omy and pathology of various organs. Preliminary stud ies in the knee reveal fine resolution of anatomy and pathology involving the meniscus. The purpose of this study is to determine a prospective correlation between MRI scans and actual meniscal pathology as docu mented at the time of arthroscopy. MRI scans were obtained in 155 patients, on 156 knees (one patient with bilateral scans), with 86 patients (87 knees) even tually undergoing diagnostic and operative videoar throscopy performed by the same surgeon (DWJ). All images were obtained on the same high-resolution 1.5 Tesla GE Signa Magnetic Resonance Scanner with the same radiologist performing all readings (PEB). The knees were studied in the coronal and sagittal plane using a spin echo sequence and 5 mm slice thick nesses. The menisci were described as having Grade 1, 2, or 3 changes, with Grade 3 reserved for complete tears. Using arthroscopy as the diagnostic standard, the accuracy of MRI in diagnosing medial and lateral meniscal tears was 93.1 % and 96.6%, respectively with a Grade 3 MRI reading. For tears of the ACL, the accuracy was 96.6% as confirmed at arthroscopy. Five tears of the PCL were also documented by MRI and correlated with clinical evaluation. Other abnormalities seen were articular cartilage and osteochondral de fects, bone tumors, tibial plateau fractures, Baker's cysts, and meniscal cysts. The MRI scan is a highly accurate, noninvasive modality for documentation of meniscal pathology as well as cruciate ligament tears in the knee.
Lower trunk brachial plexus compression neuropathy due to cervical rib in young athletes
Authors: Rayan Ghazi M.
Published: June 2007

Compression by a cervical rib may result in neurologic and/or vascular symptoms. Two patients are reported with thoracic outlet syndrome (TOS) secondary to cer vical rib. Both patients had vague shoulder pain as well as neurologic manifestations due to compression neu ropathy of the lower trunk of the brachial plexus. One patient was suspected initially to have carpal tunnel syndrome.
The arthroscopic meniscal repair
Authors: Jakob R.P. , Stäubli H.U. , Zuber K. , Esser M.
Published: June 2007

Conservative meniscal repair should limit resection to only pathologic portions of the meniscus. The periphery of the meniscus is well vascularized, enabling healing of longitudinal tears. Sutures that perforate the menis cus vertically usually lead to stable healing. In arthros copic meniscal surgery, isolated tears are sutured from within the joint, usually using techniques related to specially developed instrumentation. Our system uses three curved cannulas of various radii and a specific needle of 1.2 mm thickness, and can be operated by one hand while the joint is distracted with an AO/ASIF femoral distractor. In our series of 54 arthroscopic meniscal repairs, 42 (78%) healed without reinjury. Retears occurred in 12 patients, and were refixed again using the same techniques.

Our experience has led us to conclude that the type of meniscal tear most suitable for arthroscopic repair is a vertical longitudinal lesion that involves the vascular ized zone; abrading the synovial surfaces is helpful, as is positioning the sutures tightly together; the repair should be checked at 4 months by arthroscopy or by arthrogram; and a combination of nonabsorbable and resorbable sutures is most satisfactory. We believe that with experience arthroscopic meniscal repair becomes a less involved procedure than open repair, and that in the future such repair will be successfully extended to the more centrally located lesions.
The effect of exercise and anabolic steroids on the mechanical properties and crimp morphology of the rat tendon
Authors: Wood T.O. , Cooke P.H. , Goodship A.E.
Published: June 2007

The administration of anabolic steroids is believed to be widespread among athletes, but convincing evi dence relating to the beneficial effect of such com pounds on collagenous structures of the locomotor system is not available. Since it has not been possible to analyze relevant human tissue, an animal model was used to investigate the change in particular mechanical and morphological properties of rat tendon after a period of controlled exercise, with or without anabolic steroid supplementation. A significant difference (P < 0.001) was found between the crimp angles and lengths of collagen fibrils and theoretical toe limit strains of the four groups under study. No other significant differ ences (P > 0.05) were observed. Controlled exercise and anabolic steroid administration produced the great est change in crimp parameters and the largest theo retical toe limit strain. This implies that muscle contrac tion will be greater for a given stress and thus alter the normal biomechanics of limb movement. Further stud ies are required to determine more definitively the ef fects of anabolic steroids on a connective tissue such as tendon.
Tibial plateau fractures in alpine skiing
Authors: McConkey J.P. , Meeuwisse Winne
Published: June 2007

Tibial plateau fractures are uncommon in sports. Be tween 1977 and 1986, the authors studied 18 skiers who suffered tibial plateau fractures. Fracture patterns were diverse and displacement minimal. Hyperexten sion-valgus displacement caused compression fracture of the anterolateral tibial plateau in a characteristic form in 44%. Detection of these fractures is difficult by clinical and plain radiograph assessment, thus diagnosis may require acute awareness and special imaging tests. Although tibial plateau fractures are uncommon in skiers, early detection and treatment is important for best result in this sports population.
Accident prevention in competitive cycling
Authors: McLennan Jon G. , McLennan James C. , Ungersma John
Published: June 2007

A prospective study of risk factors and injury patterns of competitive cyclists in 10 races at altitudes over 1,500 meters was carried out over 4 years. In 1986, 1,500 licensed racers were compared to a similar group of over 3,900 racers in the 3 previous years to deter mine if the incidence and severity of injury could be lessened. Factors addressed were the use of helmets, binding-type pedals, equipment inspection, improved medical coverage, and the prevention of acute moun tain sickness and exposure. The injury rate and injuries per 100 hours of racing competition were half of that seen in prior years. Severity of injury was lessened as over 80% of the injured racers returned to competition within 1 week in contrast to only 66% during the period from 1983 to 1985. A successful program for injury prevention and the lessening of the severity of injury at altitudes is proposed.
Plasma bupivacaine levels following single dose intraarticular instillation for arthroscopy
Authors: Meinig Richard P. , Holtgrewe Jeffrey L. , Wiedel Jerome D. , Christie D. Beau , Kestin Kathryn J.
Published: June 2007

Arthroscopy of the knee was performed using 30 ml single dose intraarticular instillations of 0.5% or 0.25% solutions of bupivacaine (Marcaine). A total of 18 pa tients (mean age, 34 years), divided into two groups, participated in this study. Venous plasma levels were measured at 0, 10, 20, 30, 45, 60, 90, 120, and 240 minute intervals following a single instillation into the knee joint. All patients had suspected traumatic internal derangement of the knee.

Electrocardiogram tracings, blood pressure, and neu rologic assessment were monitored at each venous sampling interval or more often if clinically indicated. The type and amount of supplemental anesthesia were also recorded. None of our 18 patients required a general anesthetic because of pain although the follow ing procedures were performed: meniscectomy, plica release, abrasion chondroplasty, loose body retrieval, and limited meniscal repair. A new methodology for the measurement of plasma bupivacaine using the gas chromatograph mass spectrometer is described. Mon itoring specific molecular mass fragments allows the measurement of picogram per milliliter levels of bupi vacaine.

The highest peak plasma concentration occurred 20 minutes after instillation of 30 ml of 0.5% bupivacaine. The 625 ± 225 ng/ml level was well below the 2,500 to 4,000 ng/ml reported to elicit early subjective CNS symptoms of bupivacaine toxicity. Thus, a single dose intraarticular instillation of 30 ml 0.5% or 0.25% bupi vacaine is convenient, efficacious, and pharmacologi cally safe for routine clinical arthroscopy.
Spontaneous rupture of the plantar fascia
Authors: Ahstrom James P.
Published: June 2007

In this study, rupture of the plantar fascia was seen in five feet, of which four had had plantar fasciitis. At the time of the injury, which is an acceleration type of motion, there is severe pain in the heel followed by the development of ecchymosis in the sole and toward the heel of the foot. With conservative symptomatic care, the acute symptoms as well as the plantar fasciitis symptoms subside, generally allowing full activity in 3 to 4 weeks.
A biomechanical analysis of anterior cruciate ligament reconstruction with the patellar tendon
Authors: Tibone James E. , Antich T.J.
Published: June 2007

Eleven patients, 2 years after ACL reconstruction with a patellar tendon graft, returned for follow-up testing consisting of: 1) subjective assessment and functional analysis, 2) objective examination for residual ligamen tous instability, 3) isokinetic quadriceps and hamstrings strength assessment, 4) radiographic assessment, 5) instrumented measurement of anterior shear displace ment via a knee arthrometer, and 6) force plate and film analysis while performing cutting maneuvers in a laboratory setting. All 11 patients had been tested preoperatively through all steps except the fifth. The group subjectively rated the postoperative knee as 83% of the preinjury status, an increase from a 53% mean prior to reconstruction. Six of 11 patients were able to return to their full preinjury level of competition, with or without a brace. Four patients had positive drawer tests, five had positive Lachman examinations, and all subjects had negative pivot shifts. Significant quadri ceps torque deficits remained ( P < 0.0005), with the postoperative knee extensors approximately 85% of the contralateral limb. The involved limb hamstrings were equal in strength to the nonoperated limb. Radio graphic evaluation revealed four, five, and four patients with positive findings of the patellofemoral joint, medial joint space, and lateral joint space, respectively. Only one patient had normal radiographs. Instrumented knee laxity testing revealed the operated knee to be signifi cantly looser only during maximum passive displace ment (7.2 mm versus 5.3 mm, P < 0.01) and not during the other measurements. Biomechanical analysis of the straight cut maneuver revealed no significant differ ences between the nonoperated and operated limbs at the 2 year postoperative mark. Values for the cross cut were now similar between limbs, abolishing the deficit that had existed preoperatively.

This study confirms, in a laboratory setting, that a patellar tendon reconstruction of the ACL can improve the functional status of the knee and enhance athletic performance.
Cineradiographic studies with shoulder instabilities
Authors: Maki Neil J.
Published: June 2007

Thirty patients with shoulder disorders were examined with fluoroscopy under general anesthesia. Prior to this cineradiography, 20 shoulders had diagnoses of insta bility and 10 had diagnoses of other stable-shoulder disorders.

Three patients (10%) had changes in their shoulder diagnoses after imaging: 1) One patient with an im pingement syndrome also had an unstable shoulder; 2) One patient suspected of having anterior subluxations prior to imaging, demonstrated posterior subluxations instead with imaging; and 3) One patient with recurrent posterior dislocations demonstrated a multidirectional instability pattern with imaging.

Fluoroscopic examination or the shoulder under anesthesia provides useful diagnostic information. Its use is recommended for documentation, especially when there is uncertainty about a diagnosis, or to confirm the proper placement of metal after reconstruc tive surgery.
Bilaterality in anterior cruciate ligament injuries
Authors: Souryal Tarek O. , Moore Howard A. , Evans J. Pat
Published: June 2007

Nonsimultaneous, bilateral ACL injuries are not uncom mon. We studied a group of patients with these injuries to determine possible predisposing factors that could aid in early detection and prevention of contralateral ACL injury.

Retrospective analysis of 1,120 patients with ACL ruptures who were treated between 1983 and 1987 revealed 45 patients with bilateral ruptures. Complete follow-up data were available for 41 of these patients. We examined age at initial injury, sex, interval between initial and contralateral ACL injury, mechanism of injury, activity at injury, medical and family histories, treatment of initial injury, and radiographic measurement of inter condylar notch width.

The overall incidence of bilaterality was 4.01 % in the 28 male and 13 female patients. Their average age was 19 years and 10 months. The average interval between initial and contralateral injury was 47 months. A non contact cutting maneuver was the most common mech anism of injury.

We devised a method to measure and compare in tercondylar notch widths on plain radiographs. We com pared the mean notch width index (NWI) of the bilateral group to the mean NWI of a group of 50 consecutive patients with "normal" knees and to the mean NWI of 50 consecutive patients with acute ACL ruptures. The mean NWI for the normal group was .2338, for the acute ACL group, .2248, and for the bilateral group, .1961. We noted a statistically significant difference when we compared the bilateral group to the normal and acute groups (P < 0.0001, respectively). There was no statistically significant difference between the NWI of the normal and acute ACL groups. None of the other variables studied were found to be significant.

We identified a large subgroup of patients (59%) in the bilateral group who had sustained their initial injury at a relatively young age (average, 16 years) through noncontact mechanisms and who had a low NWI. These patients sustained their contralateral injury within 2 years of their initial ACL injury (average interval, 15 months) regardless of their initial treatment.

We believe that young individuals who sustain an ACL tear by noncontact mechanisms and have a low NWI, carry a significant risk for contralateral ACL rup ture and should be strongly counseled regarding that possibility.
A long-term retrospective study of the modified Bristow procedure
Authors: Ferlic Donald C. , Digiovine Nick M.
Published: June 2007

A retrospective follow-up study is presented on the results in 51 patients who underwent the modified Bristow procedure for recurrent anterior shoulder dis location or subluxation between 1972 and 1982. The average follow-up period was 95 months. Postopera tively, 6% of the patients had recurrent anterior dislo cation and 4% had recurrent anterior subluxations. Another 4% of the patients developed posterior sublux ation after surgery. Seventy-six percent of the patients felt that there was no postoperative limitation in their activities. Eighteen percent felt limited in throwing sports and 4% felt limited in swinging sports. Fourteen percent of the patients had screw complications that involved screws causing pain (6%), fractured screws (4%), bent screws (2%), and loose screws (2%). Addi tional surgical procedures were required in 14% of patients: screw removal (8%), hematoma drainage (2%), and reoperation using the modified Bristow pro cedure (4%). Ninety-two percent of the patients as sessed their surgical results as excellent or good.
Surgical treatment of lateral ankle instability syndrome
Authors: Sammarco G. James , Diraimondo Charles V.
Published: June 2007

Lateral ankle instability syndrome is defined by pain and instability caused by ligament laxity. Anterior talo fibular ligament laxity, with or without calcaneofibular laxity and other abnormalities, is often present in con junction with peroneus brevis tendon tears, abnormal ligament placement, tibialis posterior tendon tears, os teochondritis dissecans, arthritis, synovitis, loose bod ies, and tarsal coalition. Surgical reconstructions were performed on 43 ankles using a split peroneus brevis tendon graft routed through osseous tunnels in the talus, fibula, and calcaneus and resutured to the recon structed anterior talofibular and calcaneofibular liga ments. The tunnel locations, transfer routes, and ten don reinforcement were modifications based on the Elmslie procedure. Good and excellent results were achieved in 91% of the patients. Ninety-eight percent of the patients achieved stability. Followup was from 9 months to 11 years. Twenty-one patients had preop erative and intraoperative findings that required addi tional procedures.

Thorough evaluation of patients with lateral ankle instability syndrome increases the frequency of finding associated abnormalities, which if left uncorrected, may adversely affect the outcome of surgery.
Ethyl chloride: An ineffective bacteriostatic or cidal agent for arthrocentesis
Authors: James W. Scott , Drez David
Published: June 2007

The local and general anesthetic properties of ethyl chloride have been well delineated. The purpose of this study was to determine if ethyl chloride, when used as a local anesthetic, had any bacteriostatic or cidal effects on the normal array of skin flora. Fifteen different aero bic bacteria or fungi were collected from pure cultures. A total of 30 specimens were sprayed; 2 specimens of each of the 15 bacteria were sprayed with ethyl chloride for both 5 and 10 seconds. These specimens then were restreaked once the ethyl chloride had evaporated, and were incubated for 24 hours. At 24 hours the cultures were checked and found to have no significant growth inhibitions. It is thus concluded that ethyl chloride alone does not have any bacteriostatic or cidal effects on these commonly found skin flora.
The effect of exercise on laxity in the anterior cruciate ligament deficient knee
Authors: Grana William A. , Muse Gene
Published: June 2007

Twenty-five ACL deficient patients (12 males, 13 fe males) were compared with 20 normal controls (10 males, 10 females) to assess the effect of a known workload on AP laxity in the ACL deficient knee. The workload was predetermined, and the exercise was performed for 20 minutes on a bicycle ergometer. Both the control and ACL deficient knees demonstrated sig nificantly increased averaged laxity after exercise. The percentage increase was less in the ACL deficient knees than in the control knees; the difference was not statistically significant. Nor was there a significant sex effect. We believe that an ACL stress test would be useful to predict which patients with documented knee instability would consequently be "at risk" of suffering disability during activity. Further investigation should be carried out to establish a stress test that would accu rately define a threshold for ACL disability and indicate the need for early reconstruction in those patients at risk.