bluuebunny/crossref_metadata_2025 huggingface dataset:
Aging of the rotator cuff
Authors: Brewer Bruce J.
Published: June 2007

The many years of challenge in treating athletes disabled by tendinitis stimulated a study of the aging of tendons. Autopsy specimens, representing tendons from 20- , 50- , and 70-year- old subjects, were obtained. Each specimen, consisting of a wedge of the greater tuberosity with the attached supraspinatus tendon, was examined roentgenographically to study the mor phologic features of the greater tuberosity and was decalcified and stained with Safranin O to evaluate the amount of fibro cartilage, with van Gieson to identify Sharpey's fibers, and with hematoxylin and eosin to determine cellularity, fiber integrity, and vascularity of the tendon. The comparisons related to chronological age documented a morphologic change of the greater tuberosity and progressive degeneration of all elements of the tendinous structures with progressive (1) osteitis of the greater tuberosity, cystic degeneration, and irregularity of the cortical margin; (2) degenerative sulcus between the greater tuberosity and the articular surface; (3) disruption of the integ rity of the attachment of the tendon to the bone by Sharpey's fibers; (4) loss of cellularity, loss of staining quality, and fragmentation of the tendon; (5) diminution of the vascularity of the tendon; and (6) diminution of fibrocartilage.
National football head and neck injury registry: report on cervical quadriplegia, 1971 to 1975
Authors: Torg Joseph S. , Quedenfeld Theodore C. , Burstein Albert , Spealman Alan , Nichols Claude
Published: June 2007

Data on cervical spine injuries resulting from participation in football have been compiled by a national registry established in 1975. Information has been collected retrospectively by defined criteria since 1971. Efforts have been made to establish the mechanism of injury responsible in the majority of instances on the basis of epidemiologic evidence and recognized biome chanical principles. During the 5-year period, 77 deaths resulted from severe neck injuries. During this period, 1,275,000 players were exposed. Ninety-nine cervical fracture-dislocations result ing in permanent quadriplegia and 259 cervical fractures-dis locations occurred. There may be a "trend" towards an increase in permanent quadriplegia resulting from serious cervical spine injuries sustained while playing football. Apparently, the cause can be attributed to the helmet-face mask that has encouraged the use of the head as the primary point of contact in blocking, tackling, and head butting. The figures clearly identify defensive backs, linebackers, or specialty team members making tackles by using the head as the initial point of contact, as the individ uals at greatest risk to sustain cervical spine injuries resulting in permanent quadriplegia.
The saphenous nerve: its course and importance in medial arthrotomy
Authors: Hunter Letha Y. , Louis Dean S. , Ricciardi James R. , O'Connor Gerald A.
Published: June 2007

Both lower extremities of 10 cadavers (20 specimens) were dissected to delineate the course of the saphenous nerve and its two major divisions (sartorial and infrapatellar branches). The course of the saphenous nerve followed the standard text description, except at the point in the sartorius muscle where the infrapatellar branch exited to become a subcutaneous structure. The location of this branch varied slightly in each cadaver but was the same for both lower extremities in the same cadaver. The location of the sartorial nerve and its relationship to the tendons of the pes anserinus was consistent in all 20 specimens. Since 69% of a group of 75 patients found altered sensation significant after routine sectioning of the infrapatellar nerve following medial meniscectomy, a group of surgeons at the University of Michigan is now protecting the infrapatellar branch of the saphenous nerve at operation. Early results on a small number of patients indicate that no alteration in sensation occurs if the nerve is carefully retracted.
An epidemiologic study of tennis elbow
Authors: Gruchow H. William , Pelletier Douglas
Published: June 2007

An epidemiologic study of the incidence and recurrence of tennis elbow among over 500 tennis players (278 men, 254 women; age range, 20 to 50 years) indicated that age and amount of playing time per day were contributing factors to the injury. Both incidence and recurrence rates increased with age. An interactive effect of playing time and age was observed with increased playing time associated with higher incidence at younger ages. Larger grip size was also associated with higher incidence in the older group. These findings were interpreted as being consistent with the hypothesis that tennis elbow is a degenerative disease, the onset of which is hastened by overuse of the arm and elbow. Changes in stroke technique and types of racket were successful in preventing recurrence. Least suc cessful was the forearm brace.
Injuries in women's gymnastics
Authors: Snook George A.
Published: June 2007

In this 5-year study of women gymnasts, 70 participants (i.e., one woman for one season) sustained 66 major injuries (i.e., brought to the attention of a physician and produced disability). Forty-seven of the 70 athletes sustained injuries. The trunk had the lowest incidence of injuries (11), the upper extremity had 20, and the lower extremity had the highest incidence (35 injuries). Two categories, stress or trauma, segregated the injuries and provided rationale for the high incidence of injuries on this team. These athletes were of national caliber. They were constantly trying to improve performance. They engaged in intensive practice and difficult maneuvers. The self-motiva tion of these women increased the number of injuries caused by stress (a total of 21); the combination of intensive practice and the maneuvers is responsible for the traumatic injuries (45). From this evidence, women's gymnastics should be rec ognized as a hazardous sport for the competitor. Risk factors should be evaluated constantly by her, the coach, and the team physician.
Hand and wrist injuries in the athlete
Authors: McCue Frank C. , Hugh Baugher W. , Kulund Daniel N. , Gieck Joseph H.
Published: June 2007

Injuries to the hand and wrist are probably among the most common injuries incurred by the athlete. Neglect of such injuries may result in irreparable damage to the hand or wrist. This summary of the more common injuries to these areas seen in the athlete, with a description of the recognition and treat ment, gives the reader insight into the multiple considerations the athlete and coach must have. Even seemingly minor injuries must be carefully evaluated and treated by a physician. Early diagnosis, accurate precise treatment, and proper rehabilitation are extremely important to regain optimal function after these injuries. They may have a significant impact not only in athletic competition but also in the athlete's selection of an occupation. It is psychologically important also that the participant be returned to his particular sport as soon as possible. Most of the injuries can be controlled by conservative means. However, when surgical repair is indicated, it is important for the surgeon to be trained and familiar with the anatomy and techniques of surgery of the hand and wrist.
Preoperative psychologic testing as a predictor of success in knee surgery
Authors: Wise Arnold , Jackson Douglas W. , Rocchio Patrick
Published: June 2007

Preoperative psychologic test scores derived from the Minne sota Multiphasic Personality Inventory (MMPI) were evalu ated as predictors of success after elective knee surgery. The patients were examined 1 to 3 years after surgery and were evaluated in terms of subjective improvement, pain, level of activity, work restrictions, swelling, and strength. Patients that had scored high on the hysteria and hypochondriasis scales of the MMPI showed less improvement after surgery than those patients scoring lower on these scales. The results indicate that personality factors may play an important part in the sympto matic success after elective knee surgery.
Women in sports: the naval academy experience
Authors: Cox Jay S. , Navy United States , Lenz Heinz W.
Published: June 2007

Women were first admitted to the United States Naval Acad emy with the Class of 1980. The physical performance of 63 women in that class along with 69 in the Class of 1981 and 78 in the Class of 1982 is compared to the performance of a random sample of male midshipmen in the same Classes. The Department of Physical Education made some adjustments in the fitness program for women but did not change the objec tives. The number of hours of physical education was the same for the men and women. Performance tests show that the women have scored better than had been anticipated and that the scores have improved with each Class. The women have averaged three times as many visits to the orthopaedic clinic for stress-related injuries than the men, but as the women have become acclimated to a more active life, they have sought medical attention for these problems less often. The women in these three Classes have had no trauma-related orthopaedic surgery. It is anticipated that when women midshipmen begin to participate in the same vigorous sports as men, e.g., soccer, lacrosse, and others, that injuries will increase. We conclude that physical fitness requirements for women will become in creasingly similar to the men's requirements. At this time, the performance of women is often a result of society's conditioning rather than apparent physiologic differences between the sexes.
Presidential address
Authors: Kennedy John C. , Roth J.H. , Mendenhall H.V. , Sanford J.B.
Published: June 2007

For years there has been a struggle for a satisfactory intraar ticular replacement in the anterior cruciate-deficient knee. This paper summarizes our basic and clinical research over the last decade and presents a potential solution to the problem.

Instron testing reveals that the anterior cruciate ligament fails at 51.2 kg. Scanning electron microscopy demonstrates that there is little difference whether the ligament is tested just to the point of failure or taken to visible rupture.

The technique of the MacIntosh quadriceps-patellar tendon transfer is outlined. Two modifications in the form of a new approach through the defect in the quadriceps mechanism, as well as a new instrument to aid in the passage of the transfer are described.

The strength of the tissues about the knee that have been used to substitute for the anterior cruciate ligament are pre sented. Only the distal iliotibial band seems suitable on strength characteristics alone.

Intraarticular semitendinosus transfers in rabbits revealed degeneration and a marked decrease in tensile strength at 6 months. We conclude from this experiment and the data from Instron testing on autopsy specimens, substantiated by our clinical impressions, that the long-term success of autogenous intraarticular transfers seems unlikely.

We introduce the ligament augmentation device (LAD) as a possible answer. A polypropylene, diamond-braided device is sutured to the prepatellar tissue in the MacIntosh repair to increase its tensile strength. It will sustain the host tissue during the period of degeneration and weakening, and thus allow eventual collagenization. We present our animal work with regard to the LAD and early human clinical application.
Diagnosis of acute knee injuries with hemarthrosis
Authors: Dehaven Kenneth E.
Published: June 2007

One hundred thirteen consecutive athletes, who had sustained significant acute trauma to the knee with immediate disability and the early onset of hemarthrosis but who did not have demonstrable clinical laxity, were examined under anesthesia and had arthroscopy within 3 weeks of injury (the majority within 10 days). Lesions of surgical significance were found in 102 of the 113 cases (90%). Anterior cruciate ligament tears were present in 81 (72%), of which two-thirds also had associ ated meniscus lesions. Major meniscus tears with no associated cruciate lesions were found in 17 cases (15%), osteochondral fractures in 7 cases (6%), posterior cruciate ligament tears in 3 cases (3%), and no internal derangement in 5 cases (4%). Acute knee injuries with hemarthrosis, rather than being a contraindication to arthroscopy, are in fact one of the best indications for use of this procedure.
Nutrient pathways in transferred patellar tendon used for anterior cruciate ligament reconstruction
Authors: Ginsburg Jordan H. , Whiteside Leo A. , Piper Terrence L.
Published: June 2007

With the use of the hydrogen washout technique, nutrient pathways of a Jones-type anterior cruciate substitution in the dog were examined. There was no hydrogen uptake by the graft of patellar tendon left attached to the tibia but isolated from the synovium. However, when the graft was placed against synovium in the intercondylar notch, hydrogen uptake and washout were not significantly different than when the patellar tendon was completely intact (control). We conclude that, at least initially, direct blood flow does not contribute to nutrition and that synovial diffusion may play a significant role in the sustenance of the graft.
Shoulder arthroscopy
Authors: Wiley A.M. , Older M.W.J.
Published: June 2007

Ten patients with frozen shoulders and 13 other patients with derangements of the shoulder were examined by arthroscopy. The procedures were performed under anesthesia. A fibrooptic instrument was introduced posteriorly. All patients with frozen shoulders were relieved of their symptoms by the combined procedure of joint distention (with as much as 60 ml of saline) and arthroscopy, with or without manipulation of the shoulder. Three of the 13 cases of imprecisely diagnosed shoulder de rangement are described in detail to illustrate refinements in the diagnosis which determined surgical repair in 2 cases and precise local treatment in the other one. All patients, whose shoulders were not manipulated, were discharged to their homes on the day of the procedures. A sling was worn for the first 24 hr and then the patient was placed on a regimen of supervised physical therapy. There was no significant morbidity in these patients. Additional refinements in arthroscopy for the shoulder and increasing expertise in using the techniques will firmly establish arthroscopy as a means for establishing precise diagnoses for shoulder conditions.
Ankle instability: evaluation of the lateral ligaments
Authors: Seligson David , Gassman Jeffrey , Pope Malcolm
Published: June 2007

Bilateral ankle stress testing was performed on 25 subjects in a device which controlled position of the foot and the amount of force applied during the examination. Both inversion testing in the anteroposterior plane and anterior drawer testing in the lateral plane were performed in the same group of symptom- free patients. The reproducibility of the test was demonstrated. Previous history of injury, left vs. right handedness, side and anthropometric measurements did not affect the test. There was no difference in the inversion test between ankles tested in neutral and plantar flexion. In functionally normal ankles, the range of inversion "talar tilt" was 0 to 18° while the maximum of anterior displacement on drawer testing was 3 mm. The effective stiffness of the anterior talofibular ligament was thus computed as 65 ± 34 N/m. Anterior drawer testing appears to evaluate lateral ligamentous integrity of the ankle more criti cally than the talar tilt test.
Exercise effects on the strength of the rat anterior cruciate ligament
Authors: Cabaud H. Edward , Chatty Aida , Gildengorin Virginia , Feltman Robert J.
Published: June 2007

Seventy-five rats were divided into a control and four exercise groups of differing frequency and duration. After 8 weeks of endurance-type exercise on a motorized treadmill, the rats were sacrificed and the anterior cruciate ligaments were tested to failure on an Instron materials testing machine at a strain rate of 95% sec-1.

Of the 121 ligaments tested, 119 failed by pure interstitial failure. There was significant increase in both the strength and stiffness of the anterior cruciate ligaments in the exercised rats but those rats exercised more frequently (daily vs. every other day) and for shorter duration (30 min rather than 60 min) had the greatest increase in strength.

This study has shown that endurance-type exercise is bene ficial to the anterior cruciate ligament as both strength and stiffness are increased and functionally the ligament remains unchanged by exercise.
A comparison between the transpatellar tendon and the lateral approach to the knee joint during arthroscopy
Authors: Eriksson Ejnar , Sebik Ahmet
Published: June 2007

The cental transpatellar tendon arthroscopic approach and the standard lateral approach were compared in 200 unselected cadaver knees. A 5-mm arthroscopic dummy was used in the investigation. In 198 knees, using the transpatellar tendon approach, the dummy passed through the infrapatellar fat pad. In 7 cases with the transpatellar approach and in 22 cases with the lateral approach, we were unable to reach the medial posterior compartment of the knee joint. It was usually easier to insert the arthroscopic dummy into the posterior fossa if the knee joint was held at 35 to 40° of flexion of the knee than at 90° of flexion. In 88 of 100 knees, the dummy could be passed from the transpatellar approach into the lateral posterior fossa and in 77 of 100 knees from the lateral approach. Patella baja was found in 16 knees (8%). Since the transpatellar tendon approach should not be used in these cases, it means that this technique cannot be used in all cases. From an anatomical point of view, the transpatellar tendon method thus does not offer any major advantages compared to the standard lateral one.
Metatarsal stress fractures
Authors: Drez David , Young John C. , Johnston Roy D. , Parker William D.
Published: June 2007

We evaluated metatarsal lengths from roentgenograms in a group with metatarsal stress fractures and compared them with those of a control group having no foot symptoms to determine if a short first metatarsal could be implicated as a cause for metatarsal stress fractures. By statistical analysis we showed that the lengths of the first and second metatarsals in the group with stress fractures did not differ from those in a randomly selected control group. In addition, we determined that to be "short," the first metatarsal must be less than 73% of the length of the second metatarsal, and to be "long," the first metatarsal must be more than 94% of the length of the second metatarsal.
Impingement syndrome in athletes
Authors: Hawkins R.J. , Kennedy J.C.
Published: June 2007

Athletes, particularly those who are involved in sporting activ ities requiring repetitive overhead use of the arm (for example, tennis players, swimmers, baseball pitchers, and quarterbacks), may develop a painful shoulder. This is often due to impinge ment in the vulnerable avascular region of the supraspinatus and biceps tendons. With the passage of time, degeneration and tears of the rotator cuff may result. Pathologically, the syndrome has been classified into Stage I (edema and hemor rhage), Stage II (fibrosis and tendonitis), and Stage III (tendon degeneration, bony changes, and tendon ruptures). The im pingement syndrome may be a problem for the young, active, competitive athlete as well as the casual weekend athlete. The "impingement sign" which reproduces pain and resulting facial expression when the arm is forceably forward flexed (jamming the greater tuberosity against the anteroinferior surface of the acromion) is the most reliable physical sign in establishing the diagnosis. Flexibility exercises, strengthening programs, and special training techniques are a preventive and treatment requirement. Rest and local modalities such as ice, ultrasound, and antiinflammatory agents are usually effective to lessen the inflammatory reaction. Surgical decompression by resecting the coracoacromial ligament or a more definitive anterior ac romioplasty may rarely be indicated.
Fitting of protective football equipment
Authors: Gieck Joe , McCue Frank C.
Published: June 2007

As no other guide was found to illustrate and describe protec tive equipment and its fitting, we have prepared this treatise. Properly fitted protective equipment for football is a must to prevent injury from occurring. Many injuries result from im properly fitted equipment. The helmet and shoulder pads are the most important pieces of equipment that require proper fit. Adequate face masks and jaw pads are essential to the helmet. Cantilever shoulder pads are necessary for most positions, with straps for those with subluxating or dislocating shoulders. Other pieces of equipment that need attention are cervical collars, hip pads, thigh pads, knee pads, pants, and shoes. Elbow, forearm, wrist, hand, and mouthpieces are essential to the player and care must be taken to see that they are compat ible with proper fit. Special materials such as Ensolite,@ Hex- celite,® RTV-11,® Orthoplast, Lightcast, or Therm-O-Foam® may be utilized to construct special pads. Today's modern football equipment provides adequate protection. It is impera tive that all personnel involved in fitting equipment be knowl edgeable about the subject.
Breaststroke swimmer's knee
Authors: Keskinen Kari , Eriksson Ejnar , Komi Paavo
Published: June 2007

The cause of the breaststroke swimmer's knee with medial pain of the knee joint has not been clearly identified. Breaststroke swimmers with knee pain were, therefore, examined arthros copically. None showed any other disorders of their knees than medial synovitis in seven of nine swimmers. Since structural abnormalities could be ruled out, biomechanical analyses utiliz ing cinematographic techniques were used to study patients swimming in a special flume with the speed set at 90% of their best competitive performance. The results indicate that the extension and flexion and also in some cases the hip abduction and adduction movements of the whip kick were performed with high peak angular velocities. No significant differences in swimming technique among the six patients studied and three controls could be observed. It is concluded that a combination of high angular velocities at the hip and knee and external rotation of the tibia relative to the femur repeated in excessive amounts might be the primary cause for the medial synovitis documented in these patients. The breaststroker's knee thus seems to be an overuse syndrome.
Epidural cortisone injections in the young athletic adult
Authors: Jackson Douglas W. , Rettig Arthur , Wiltse Leon L.
Published: June 2007

The lumbar epidural cortisone injection can be a useful adjunct in the conservative management of the athlete with a sympto matic lumbar disc and associated irritated neural elements. Thirty-two young athletes (ages ranging from 17 to 30 years) with a clinical diagnosis of a symptomatic lumbar disc and sciatica were treated with lumbar epidural cortisone injections. All had had disabling symptoms persisting for a minimum of 2 weeks, with an average duration of 3.6 months. Dramatic abatement of symptoms and a significantly hastened return to competition (a positive response) was seen in 14 (44%) of the 32 athletes following injection. Although the results were en couraging, we found the success rate of this study group to be less dramatic than larger reported series in the general popu lation.
Surgical repair of the ruptured Achilles Tendon
Authors: Quigley Thomas B. , Scheller Arnold D.
Published: June 2007

Forty patients with acute ruptures of the Achilles tendon were treated surgically by the same physician (T.B.Q.) during a period of 1947 to 1971. The average followup was 19 years. Ninety percent of the patients were men (average age 37.5 years) who were engaged in recreational sport activities. The majority denied a physical conditioning program. The acute ruptures were treated by a surgical procedure which consisted of a 15-cm incision on the medial aspect of the tendon with either the plantaris muscle being woven through the Achilles tendon in a clockwise fashion or a pull-out wire, supplemented with silk mattress sutures, being used to repair the ruptured tendon. The wound was closed and the patient's leg was im mobilized. The wire was removed at 6 weeks. The rehabilitation plan consisted of ambulation with a heel lift and elastic stocking (the height of the lift was gradually reduced) and toe exercises. The patients began walking downstairs backwards at 3 months and continued exercises until full range of motion was attained. Subjectively, the results were excellent as graded by the pa tients. Objectively, there were some minor deficits but they did not impede the overall function. On a scale of 1 (poor) to 4 (excellent), the clinical results were rated excellent (42%), good (36%), fair (15%), and poor (6%). This review has supported our contention that a positive Thompson test is a reliable indicator for a rupture of the Achilles tendon and that surgical treatment of complete ruptures is a successful mode by the procedure described followed by our rehabilitation program.
Nature and causes of injuries in women resulting from an endurance training program
Authors: Kowal Dennis M.
Published: June 2007

Women entering the Army are exposed to considerable physical stress due to the intense physical training program encoun tered. At the beginning of a basic training cycle, a prospective study was initiated to identify exercise-related injuries and performance-limiting conditions that resulted from an 8-week physical training program and to identify some of the factors that may contribute to their occurrence. Four hundred women recruits (age 18 to 29 years) participated in the study. All had passed an initial physical examination and were without any limiting disabilities. An initial assessment of physical fitness was accomplished to determine the current status of body composition, strength of the major muscle groups (e.g., legs, trunk, arms, and upper torso), aerobic capacity, previous ath letic history, self-perception of physical fitness, and psychoso matic predisposition. The training and conditioning program (1 hr daily, five to six times a week) involved a series of standard warm-up calisthenics and stretching exercises fol lowed by a run, beginning at 3/4 mile at a 10 min per mile pace and increasing to 2 miles at 9½ min per mile by the end of training. Extensive road marches and military training activities were also included. At the end of training, a self-report injury questionnaire was used to collect injury data. These data were documented with the records from the unit dispensary and data provided by the installation physical therapy, orthopaedic, and podiatry clinics. Fifty-four percent (215) of the women sustained some reportable injury. These injuries resulted in an average training time loss of 13 days. Forty-one percent of these injuries prevented participation in all activity, 31% resulted in only limited participation. Early training "overuse syndrome" ac counted for 42% (92) of the reported injuries. Significant injuries were: tibial stress fracture (45), chondromalacia of the patella (21), hip or neck of femur stress fracture (20), sprains (12), Achilles tendinitis (10), calcaneous or metatarsal stress fracture (8), and fascial and anterior compartment strains (6). The injury data were correlated with prior-fitness measures. The results indicated that a major cause of injury in women can be attributed to the lack of prior conditioning, greater body weight and fat percent, and limited leg strength. These factors, coupled with some inherent physiologic characteristics of women (i.e., wide pelvis, less strength, and greater joint flexi bility), probably contributed to the increased risk of injury in these women. It is concluded that susceptibility to these poten tial orthopaedic and medical conditions can be identified before the beginning of training and minimized through proper reme dial activity before a strenuous physical training program is initiated.
Cineradiographic study of football helmets and the cervical spine
Authors: Virgin Herbert
Published: June 2007

A total of 16 men (4 professional football players, 5 high school athletes, and 7 hospital personnel) was studied by cineradiog raphy to evaluate the possible roles of the posterior rim of the football helmet in causing neck injuries. The men ranged from tall elongated neck individuals to short chunky neck individuals. Moving picture (16-mm) films were produced from a series of lateral view cineradiograms that were taken to document the path and position of the posterior rim of the helmet relative to the spinal column as the subject moved his head from the fully flexed to the fully extended positions under several loading conditions. Five different helmets, all from different companies, were used in the studies. No contact existed at any time between the posterior rim of any of the five helmets worn and the fourth cervical vertebral spinous process; in fact, it did not come close to the spinous process of vertebrae C1 through C6. The notion of the posterior rim of the helmet being capable of striking the cervical spine about the C4 to C5 level is without foundation.
Sports-related injuries in school-aged children
Authors: Zaricznyj Basilius , Shattuck Lola Jean M. , Mast Terrill A. , Robertson Ramon V. , D'Elia Gabrielle
Published: June 2007

Most studies of sports-related injuries have been investigations of specific injuries resulting from specific, organized sports at the high school, college, or professional level. This study doc umented all types of sports-related injuries received by all school-aged children in a midwestern community of 100,000 for a 1-year period. Public and private schools, community sports programs, hospital emergency rooms, the schools' accident insurance company, and local physicians provided initial acci dent reports. Injuries were sustained by 3% of all elementary school students, 7% of all junior high school (grades 7 and 8) students, and 11% of all high school students. Nonorganized sports and physical education classes each produced nearly twice as many injuries as organized sports. One-fifth of the injuries were considered serious and one-fourth of all injuries could have been avoided had nominal safety precautions been observed.
Evaluation of injuries in youth soccer
Authors: Sullivan J. Andy , Gross Richard H. , Grana William A. , Garcia-Moral Carlos A.
Published: June 2007

Soccer has rapidly gained in interest in the United States. A paucity of available data on soccer injuries led us to formulate this study to quantitate and categorize injuries acquired during a program of youth soccer (under age 19). A prospective study of 1,272 players showed an injury rate of 2.6 injuries per 100 participants. The injury rate for girls was twice as great as for boys. The under 10-age group was seldom injured (less than 1 injury per 100 participants), but the overall injury rate in the players of secondary school age was 7.7 injuries per 100 partic ipants. Most injuries were not serious. Soccer appears to be a safe activity for adolescents and children.
The Hill-Sachs lesion
Authors: Danzig Larry A. , Greenway Guerdon , Resnick Donald
Published: June 2007

The Hill-Sachs lesion is an important indication of previous anterior shoulder dislocation. We created Hill-Sachs lesions by using cadaveric humeri. Roentgenographs of these cadaveric humeri in the standard projections were then taken. Under fluoroscopy, new projections of the cadaveric humeri were obtained. In a clinical study, 15 patients (14 men and 1 woman; age range, 23 to 63 years; mean, 30 years) with known recurrent anterior shoulder dislocations were evaluated by using standard and new roentgenographic projections. On the basis of the cadaveric and clinical studies, the optimal methods for detect ing Hill-Sachs lesions include the following three roentgeno grams : anteroposterior view of the glenohumeral joint with the humerus in 45° internal rotation, the notch (Stryker) view, and the modified Didiee view.
Biomechanics of walking, running, and sprinting
Authors: Mann Roger A. , Hagy John
Published: June 2007

A biomechanical study of 13 runners which consisted of 2 male sprinters, 5 experienced joggers, and 6 elite long-distance runners were studied. We obtained hip, knee, and ankle joints motions in the sagittal plane and electromyographic data from specific muscle groups.

As the speed of gait increased, the length of stance phase progressively decreased from 62% for walking to 31% for running and to 22% for sprinting. The sagittal plane motion increased as the speed of gait increased. Generally speaking, the body lowers its center of gravity with the increased speed by increasing flexion of the hips and knees and magnifying dorsiflexion at the ankle joint. Electromyographic activity about the knee demonstrated increased activity in the quadricep muscle group and hamstring group with increased speed. Mus cle function about the ankle joint demonstrated that the pos terior calf musculature which normally functions during the midstance phase in walking became a late swing phase muscle and was active through the first 80% of stance phase, as compared to 15% in walking.

Beside the changes in the electromyographic activity of the muscles, the anterior compartment muscles of the calf undergo a concentric contracture at the time of initial floor contact during running and sprinting but undergo an eccentric contrac tion during walking.
The athlete's mouthpiece
Authors: Schwartz Robert , Novich Max M.
Published: June 2007

This article points out several needs. The first is the need to have research on the design of the athlete's mouthpiece. This study demonstrates that the most frequently used athlete's mouthpieces alter the relationship of the lower jaw to the upper jaw. Second, this article expresses the need for design change in the present mouthpiece. It shows statistics that indicate a design change could be very advantageous to the athlete's performance.

A strong case is made for viewing the mouthpiece as an aid as well as a protector.
Competitive sports for the disabled
Authors: Clark Mary Williams
Published: June 2007

A full life experience for people with and without physical disabilities usually includes some form of recreation or sport. Competition adds to enjoyment of sport for many people and can improve morale. This paper reviews some of the competitive opportunities available for people with a physical disability. These include competition within existing "able-bodied" orga nizations with or without adaptive devices and competition in separate organizations for those with disabilities. The latter include the National Wheelchair Basketball Association and the National Wheelchair Athletic Association.
The uniqueness of the young athlete: psychologic considerations
Authors: Martens Rainer
Published: June 2007

Through a review of the major reasons young athletes drop out of sports the basic psychologic needs of young sters are identified. Although young athletes are not unique in these psychologic needs, each youngster is unique in how these needs are met. The paper concludes by countering some of the negative publicity youth sports programs have received.
Method for reconstruction of the anterior cruciate ligament using the semitendinosus tendon
Authors: Puddu Giancarlo
Published: June 2007

There is still considerable difference of opinion as to the advisability of reconstructing the anterior cruciate ligament in chronic rotatory instability. This paper presents a simple method of anterior cruciate reconstruction using the semiten dinosus tendon in 12 cases of chronic combined anteromedial anterolateral rotatory instability along with preliminary results. In all cases the reconstruction of the anterior cruciate was associated with extraarticular reconstruction. Posterior oblique ligament and semimembranosus advancement was used for the medial compartment and biceps advancement for the lateral compartment. The initial results, with an average followup of 8 months, showed an anterior drawer sign with the tibia in neutral rotation of less than 1+ in all cases compared to a previous series in which, at the same point in time, 36 of 42 patients had a 2+ drawer sign and 6 had a 3+. There has been inadequate time for evaluation of the long-term results. Further comparison with longer followups are needed to determine how well this type of anterior cruciate ligament reconstruction works for extraarticular reconstructions.
Intraarticular substitution for anterior cruciate insufficiency
Authors: Ivey F. Martin , Blazina Martin E. , Fox James M. , Del Pizzo Wilson
Published: June 2007

Forty two patients with functionally incapacitating 2+ or 3+ anterior instability underwent anterior cruciate ligament sub stitution using a meniscus (25 patients) or central third of the patellar tendon (17 patients). Subjective and objective evalua tions were personally performed on all patients with an average followup of 15 months. Seventy-nine percent of the patients were objectively graded successful. Objective results were pri marily based on the surgeon's technical ability to correct completely all components of anterior instability at the time of surgery. Subjective results were multifactorial and were cor related primarily with patient expectations, the presence or absence of continued buckling and the ability to return to recreational activities.

The only observed difference between the two types of cru ciate substitutions was the average loss of 6° of flexion in the central third of the patellar tendon group. Both the patellar tendon and meniscus clinically appeared to be successful in traarticular cruciate substitutes which can predictably correct moderate to severe anterior instability of the knee in a high percentage of patients.
Acute medial elbow ruptures
Authors: Norwood Lyle A. , Shook James A. , Andrews James R.
Published: June 2007

Disruption of the ulnar collateral ligament, flexor mus cles, and anterior elbow capsule may result from valgus vector forces and subsequently cause difficulty in throwing, pulling, pushing and catching. Complete medial elbow tears were diagnosed acutely in four elbows by abduction stress tests at 15° of flexion. Three elbows had associated ulnar nerve compres sion. We repaired torn medial structures by direct suture without ligamentous reconstruction. We also decompressed ulnar nerves and performed one an terior transposition. Full range of motion, strength, and return to previous functional level was attained without infection, neurovascular compression, or my ositis ossificans.
Spontaneous partial subcutaneous ruptures of the tendo achillis
Authors: Skeoch Daniel U.
Published: June 2007

Partial subcutaneous rupture of the Achilles tendon has been considered a rare condition. Physical signs and symptoms have not been well established. The current review of 11 patients with 16 involved subcu taneous ruptures of the Achilles tendon treated at Southwestern Orthopedic Medical Group between the years 1971 and 1976 is intended to delineate the entity more clearly. Preoperative and postoperative symptoms and physical findings were evaluated and operatively and nonoperatively treated groups were compared. All tendons treated demonstrated either a palpable, partial defect in the Achilles tendon or were found at surgery to have a partial rupture. Thompson's test was negative in all patients. Eighty-one percent of injuries occured in males (13 of 16). The average age at diagnosis was 47.6 years. Pretherapy symp toms existed an average of 6½ months before defini tive therapy was instituted. Eighty-one percent of in juries were incurred during athletic activity (13 of 16). Forty-four percent had had from one to five prior injections of corticosteroid into the Achilles tendon area (7 of 16). The most common pretherapy symp toms were pain after variable degrees of activity (100%), limping (100%), the sensation of weakness (81 %), and intermittent or continuous swelling (35%). Seven of 16 tendons were treated with nonoperative therapy. The remaining nine tendons underwent sur gical exploration and repair. Those treated surgically were repaired by excision of the defect, suture of the opposing ends, and reinforcement of the repair with fascial strips turned down from the posterior gastroc nemius. All patients completed detailed question naires after therapy.

This study concludes (1) Partial subcutaneous rup ture of the tendo achillis occurs predominantly in young and middle-aged males involved in strenuous athletic activities; (2) predominant symptoms are pain, limping, weakness, and intermittent swelling; (3) pal pation of the Achilles tendon will generally reveal a palpable partial defect but Thompson's test will remain negative; (4) ablation of symptoms can usually be obtained nonoperatively but if symptoms persist be yond six months surgical exploration and repair is indicated; (5) the majority of patients can be expected to return to their preinjury level of activity.
Pathomechanics of the pivot shift maneuver
Authors: Tamea Conrad D. , Henning Charles E.
Published: June 2007

This paper analyzes changes in instant centers of motion and joint surface velocity vectors in knees demonstrating a positive pivot shift test.

Eight patients were studied on the basis of a sus pected tear of the anterior cruciate ligament. Clinical evaluation consisted of a history and examination with special attention to the anterior drawer test, Lach mann's test, and the pivot shift test. Control knees chosen had a negative history of injury and a normal examination.

Serial roentgenograms were obtained on all knees through a range of motion from 0 to 90° of flexion, at increments of 7 to 10°. Internal rotation and valgus stress were applied to duplicate the pivot shift maneu ver during the filming. These serial studies were used to determine instant centers of motion, modifying the method of Rouleaux. Arthrography and arthoscopy were performed to document the pathologic anatomy.

Alterations in instant center progression were noted in all patients with a clinically positive pivot shift as compared with the control group and a general pattern of progression was observed. From 0 to 20° of flexion the instant centers were located too near the joint line and displaced anteriorly. During the shift phase (from 20 to 45°) the instant centers were located posteriorly and proximally on the femur. These findings indicate that from 0 to 20° rolling predominated followed by a sudden change to gliding as the shift occurred. In a few cases the initial instant centers were actually located below the joint line, indicating a backwards glide phenomenon. From 50 to 90° the instant center progression was near normal.

Surface velocity vectors were likewise abnormal in patients with pivot shift. During the initial phase of flexion the velocity vector was not tangential to the joint surface, indicating excessive friction and com pressive forces were present during knee motion. These findings demonstrate a possible mechanism for the development of posttraumatic arthritis of the tibial- femoral joint in patients with a positive pivot shift test.

A quantitative analysis.of the pivot shift maneuver is shown which aids in understanding the pathomechan ics of the pivot shift maneuver.

The method is also suggested for long-term evalu ation of anterior cruciate reconstructive procedures.
The fate of the acromioclavicular joint in athletic injuries
Authors: Cox Jay S.
Published: June 2007

Of 164 acromioclavicular joint injuries to midshipmen at the US Naval Academy between July 1973 and November 1978, 99 were Type 1, 52 were Type 2, and 13 were Type 3. Follow-up examinations revealed that 36% of Type 1, 48% of Type 2, and 69% of Type 3 patients had residual symptoms. Positive physical findings were present in 43% of Type 1, 77% of Type 2, and 100% of Type 3 injuries. Roentgenographic changes were noted in 70% of Type 1, 75% of Type 2, and 100% of Type 3 patients.

This evaluation suggests aggressive treatment and rehabilitation are indicated in acute acromioclavicular injuries. Residual problems from Types 1 and 2 inju ries are much more frequent than indicated in the literature. Symptoms in Type 1, but not in Type 2, injuries are directly related to the presence of positive physical findings. Roentgenographic changes are ex tremely common and are not correlated with symp toms. Treatment of Type 2 injuries with the acromio clavicular immobilizer resulted in fewer complications than symptomatic treatment.
Posterior problems in the knee
Authors: Fleming Richard E. , Blatz Douglas J. , McCarroll John R.
Published: June 2007

During a recent three-year period, 39 patients under went surgical procedures for lesions of the posterior complex of the knee. The results in 28 followed for greater than six months (average followup, 16 months) are reported; eight are presently in the early rehabili tative phase and three have been lost to followup.

In reconstruction for chronic laxity, a semitendino sus replacement of the posterior cruciate ligament with anterior advancement of the lateral arcuate com plex is recommended. Use of the medial gastroc nemius tendon is still advised in selected cases. Re construction for posterolateral rotatory laxity with an intact posterior cruciate is performed with anterior advancement of the popliteus tendon and the arcuate complex. Pes anserinus transfer, imbrication of the posterior oblique ligament, and biceps tenodesis may be performed as supplemental procedures.
Stress fractures through the distal femoral epiphysis in athletes
Authors: Godshall Richard W. , Hansen Carl A. , Rising David C.
Published: June 2007

Stress fractures in many portions of the lower extrem ities have been discussed. This is a case report of two occurrences of stress fractures through the distal femoral epiphysis—a previously undescribed entity.
Anterior compartment syndrome: A case report
Authors: Pearl Arthur J.
Published: June 2007

The chronic form of the anterior compartment syn drome can be overlooked if the symptoms of leg pain are attributed to shin splints. Herein is presented a case report which I feel represents an acute exacer bation of the chronic form of anterior compartment syndrome in a long-distance runner secondary to bleeding into the extensor digitorum longus muscle. Chronic anterior compartment syndrome can be a disabling injury which may require a fasciotomy, de pending upon the severity and duration of the patient's symptoms and the intracompartmental pressures. The lay term "shin splints" should be separated from medical use, and a more reliable assessment of the etiology of the patient's symptoms should be made. The term shin splints should be utilized only for pain localized to the posterior medial border of the tibia at the origin of the posterior tibialis muscle.
The measured effect of taping on combined foot and ankle motion before and after exercise
Authors: Fumich Robert Mark , Ellison Arthur E. , Guerin Gary J. , Grace Paul D.
Published: June 2007

The Inman ankle machine was modified to determine plantarflexion, dorsiflexion, inversion neutral, eversion neutral, plantarflexion inversion, and plantarflexion eversion before taping, immediately after taping, and with tape after a 2.5- to 3-hour football practice. The previously uninjured feet and ankles of 16 college- age football players were used. All were taped by the same method.

A single-tailed paired-sample t-test was done to determine the minimum amount of restriction that could be expected for each motion after the exercise period. Ninety percent confidence intervals between untaped versus taped preexercise, untaped versus taped postexercise, and taped preexercise versus taped postexercise for all motions were determined. Inversion neutral, plantarflexion inversion, and ever sion neutral had an average residual restriction after exercise of 50%, or greater than the initial restriction prior to exercise. Plantarflexion, dorsiflexion, and plantarflexion eversion loosened significantly greater than 50%.