bluuebunny/crossref_metadata_2025 huggingface dataset:
Correctable elbow lesions in professional baseball players: a review of 25 cases
Authors: Indelicato Peter A. , Jobe Frank W. , Kerlan Robert K. , Carter Vincent S. , Shields Clarence L. , Lombardo Stephen J.
Published: June 2007

In a retrospective study, 20 of 25 professional baseball pitchers (mean age, 24 years; range, 19 to 28 years) who had had a reconstructive surgical procedure on the dominant elbow had satisfactory results (able to return to competitive throwing for one full season or more after surgery). Gentle motion was initiated 1 week after the operation on each patient. Exercises for mobilization and muscle strengthening of grip, arm, and shoulder were increased until throwing was initiated 10 to 12 weeks postoperatively. Throwing was gradually increased over several weeks from 30 feet at no more than half speed for 15 min to 60 feet at three-quarter speed. Pitchers were instructed to warm up before throwing and warm down and to continue this practice after they began competitive throwing. The longest period of follow-up has been 4 years (mean, 2.8 years). Four of the 25 pitchers had unsatisfactory results (released from their team in less than one full season because of ineffective pitching and were not picked up by another team). The cause of the release of the other patient-player is controversial. This 25- patient group is too small and the follow-up period is too short for definite conclusions. Our evidence does suggest that surgi cal procedures directed at medial soft tissue and posterior intra-articular changes carry better prognosis for competitive throwers than other procedures. The radiohumeral articular condition should be evaluated at surgery.
Hypotrophy of the soleus muscle in man after Achilles tendon rupture
Authors: Häggmark Tom , Eriksson Ejnar
Published: June 2007

Seven athletes (age range, 35 to 43 years), who sustained total subcutaneous ruptures of the Achilles tendon 2 to 5 cm above its distal insertion, were treated surgically with suturing of the tendon, immobilization of the leg and foot for 6 weeks, and cast changes so as to increase the dorsiflexion of the foot. Needle biopsies were obtained several times from the soleus muscles of both the injured and uninjured legs at a depth of about 5 cm. The cross-sectional area was measured by computed tomogra phy at the same level the tissue was obtained by biopsy. Results of morphologic studies revealed a selective Type I fiber atrophy of the soleus muscle. Computed tomography revealed a 23% decrease in the area of the calf muscles and a 11% total reduction in the cross-sectional area of the calf (about the middle, where the gastrocnemius muscle is transformed into a tendon and where the soleus lies superficially). Mere measure ment of the circumference of the calf is judged to be a poor criterion of muscle atrophy when compared with these other means of evaluation of atrophy. The evidence compiled during this study suggests that prompt surgical treatment of Achilles tendon ruptures, with cast changes several times during the period of immobilization and with tension maintained on the muscle, is the most effective treatment regimen we have found for this injury.
Surgical reconstruction of chronic anteromedial rotatory instability of the knee
Authors: Hunter Stephen C. , Andrews James R. , McLeod William D. , McCluskey George M. , Blackburn Turner A.
Published: June 2007

The clinical records were reviewed of 142 men and 7 women (average age 26.8 years; range, 15 to 58 years) who had surgical reconstruction for anteromedial rotatory instability of the knee. All were treated consecutively at the same clinic during a 15- year period (1960 to 1975). Preoperative and postoperative symptoms were rated both subjectively and objectively by de vised scales and analyzed by a computer program. Comparison of the three major surgical procedures show that the subjective success rate was 87% for the pes anserinus transfer, 70% for the posterior oblique ligament reconstruction, and 72% for the combination procedure. Of the 149 patients, 130 had been injured in sportive activities and 110 were able to return to some degree of athletics. Accurate and detailed recording of clinical data allowed construction of subjective and objective rating systems for computer analysis in review of a large series over a period of years. This approach enhanced our ability to obtain correlation and objective evaluation of the data. Com mercial equipment for evaluating the quadriceps and ham- strings is beneficial in determining that a patient has achieved complete rehabilitation or if there will be a permanent decrease in function after surgical intervention.
Exposure to injury in major college football
Authors: Cahill Bernard R. , Griffith Edwin H.
Published: June 2007

Five football teams from major colleges in the nation were surveyed during practices and games in the 1976 season. Data were collected on three packages of information designed as a computer program for tabulation, analysis, and storage of data. Investigators, with a thorough knowledge of football and trained in the use of the program, obtained the data from a given team during every drill, practice, and game of the season. Injury exposure rate was calculated as a ratio of injuries to minutes of exposure in 14 categories (12 specific drills, practice games, and other activities). Agility drills produced the fewest number of injuries for the amount of exposure time (exposure rate, 47,138; risk ractor, 1) and, therefore, it served as a base from which risk factors for all other categories would be calculated. No injuries were recorded in calisthenics. Practice games had the lowest injury exposure rate (1,009) and the highest risk factor (47). Analysis of data is incomplete at this time. The ultimate intent of the study is to help identify and eliminate harmful factors, establish norms, and provide a ser vice to other schools that may desire exposure rate/risk factor data analyzed at a reasonable cost.
Neck motion in the high school football player
Authors: Pearl Arthur J. , Mayer Paul W.
Published: June 2007

In a group of 40 high school athletes (height: 166.37 to 189.57 cm, average, 174.40 cm; neck circumference: 35.56 to 41.91 cm, average, 39.12 cm), the neck motions were studied in flexion and extension, clinically, radiographically, and cineoradi ographically. Flexion ranged from 34 to 84° (average 72°) and extension from 21 to 64° (average 45°) without helmet and shoulder pads. In well-fitting equipment flexion ranged from 36 to 86° (average 73°) and extension from 12 to 56° (average 34°). No correlation was determined between the size of the athlete's neck and the range of motion. The size of the athlete's neck was important in the determination of maximum stresses in the neck. The helmets impinged on the shoulder pads or interscapular region; this impingement diminished tension on the anterior portion of the cervical spine in extension. The face masks impinged on the shoulder pads in flexion of the neck; this impingement diminished stress on the posterior muscula ture. Proper fitting equipment, conditioning neck exercises, and changes in the rules of the game so that abuse of the head and neck is not encouraged are some of the aspects that may reduce the risk of injury to the cervical region in football players.
Injury patterns in children and adolescent skiers
Authors: Garrick James G. , Requa Ralph K.
Published: June 2007

Over 3,500 students from five major high schools in the Seattle metropolitan area were studied as to skiing injuries. Each had skiied an average of 13.3 days. The average age of the group was 13.5 years, the ages ranging from 3 to 19 years. The students 10 years and under had the lowest incidence of injuries, those aged 11 to 14 years had the highest over-all injury rates, and the group 15 years of age and over laid midway between these two groups in injury rate. There was no evidence in the study that the open physis led to a higher incidence of epiphy seal injuries. The knee was more commonly involved than the ankle, and sprains, contusions, and fractures followed in that order as far as injury rates were concerned. The female was more prone to injury than the male. Skiiers with greater ability had fewer injuries than those with less skill in this particular sport.
Foot orthotic devices to modify selected aspects of lower extremity mechanics
Authors: Bates B.T. , Osternig L.R. , Mason B. , James L.S.
Published: June 2007

Fxcessive foot pronation has been speculated to be a cause of leg and foot problems among runners. Foot orthotic devices are often used to modify this condition. Examination of the records of 180 patients treated for various running injuries showed that 83 individuals (46%) were prescribed orthotic devices and that 65 of these runners (78%) were able to return to their previous running programs. In order to assess further the effects of this type of orthotic device, six runners were selected from this group and filmed using two cameras (200 frames/sec) under three conditions: (1) barefoot, (2) regular shoe, and (3) regular shoe plus orthotic device. Both the period of pronation and the amount of maximum pronation were significantly reduced by using the foot orthotic device. The data support the conclusion that foot orthotic devices can be successfully used to modify selected aspects of lower extremity mechanics during the sup port phase of running.
Tartan Turf® on trial
Authors: Keene J.S. , Narechania R.G. , Sachtjen K.M. , Clancy W.G.
Published: June 2007

We retro- and prospectively compared collegiate football inju ries that occurred on the grass and Tartan Turf®(3M Company, St. Paul, Minnesota) fields at the University of Wisconsin. Retrospective injury data were obtained from questionnaires returned by 235 of 450 athletes that competed from 1960 to 1973. Prospective injury data were obtained by examination of athletes injured from 1975 through 1977. Although the number of injuries occurring on each playing surface were not signifi cantly different, the type and severity of injuries were signifi cantly different. We found that significantly more serious sprains and torn ligaments occurred on grass than occurred on Tartan Turf®. There were significantly more scrapes (minor injuries) on the Tartan Turf® than on the grass. We conclude that we may be prematurely returning to natural grass playing surfaces, and—to the detriment of the athlete—ending produc tion of one synthetic turf that helped reduce major injuries.
Acute fracture simulating a symptomatic bipartite patella
Authors: Echeverria Thomas S. , Bersani Frank A.
Published: June 2007

A recent presentation by Weaver' has called attention to the entity of the symptomatic bipartite patella. In that paper, the symptom complex and treatment were discussed. The points of differentiation of an acute fracture from a symptomatic bipar tite patella were also briefly presented. We presented the following case, to underscore the fact that an acute fracture of the superolateral patella can clinically and radiographically simulate a symptomatic bipartite patella (Class III2).
Trends in skiing injuries
Authors: Johnson Robert J. , Ettlinger Carl F. , Campbell Robert J. , Pope Malcolm H.
Published: June 2007

The trends in skiing injuries showed a decrease during a study conducted over six seasons, 1972 to 1978, at a Vermont ski resort. Over 11,000 interviews were conducted and nearly 1,000 control skiers were evaluated. The injuries totaled 1,711 in 407,600 skier days. Upper body injuries (pelvis, trunk, neck, head, and upper extremities) totaled 713 (42%) and lower extremity injuries totaled 998 (58%). Eighty percent of the lower extremity injuries were classified as (potentially) equip ment related. The overall injury rate decreased 41 % (upper body, 25%; lower extremity equipment-related (LEER), 43%; and lower extremity nonequipment-related rate was down 71 %). Knee sprains did not decline as rapidly as the tibial fractures and ankle sprains. An increase in the relative frequency of properly functioning equipment is primarily responsible for the decline in LEER injuries. Although the relative frequency of properly adjusted bindings is increasing, more than one-half of the equipment in use is still set higher than recommended. Cooperation between all individuals responsible for equipment design, manufacture, installation, and use must continue, if further improvements in alpine skiing safety are to be realized.
The throw: biomechanics and acute injury
Authors: Gainor Barry J. , Piotrowski George , Puhl James , Allen William C. , Hagen Robert
Published: June 2007

The throw and its modifications are integral components of many sports. This study correlates case histories of acute injuries in throwing with a biomechanical analysis of the throw ing mechanism. Comparisons are made with a similar analysis of the kick analyzed by the same film technique and computer program. Just prior to ball release, the pitching arm extends through an arc of about 73 degrees in 40 msec, beginning with the elbow flexed at 80 degrees. This produces an axial load on the humerus and coincides with a pulse of external torque at the shoulder. This acts as stress protection to the humerus which is developing an internal torque of 14,000 inch-Ib prior to ball release. The change in angular velocity, or the angular acceleration, during the throw is acquired in a much shorter time than in the kick. Torque is directly proportional to angular acceleration. This necessitates the development of substantially higher torques in the humerus during the throw than about the knee during a kick. The kinetic energy in the arm is 27,000 inch-Ib during the throw. This is much higher than the kinetic energy in the kicking leg because the kinetic energy varies proportionally with the square of the angular velocity of the extremity. The angular velocity of the arm is about twice that of the leg. Thus, the pitching arm contains about four times as much kinetic energy as the kicking leg. These severe overload ing conditions predispose the upper extremity to injury in the throwing mechanism.
Breaststroker's knee: pathology, etiology, and treatment
Authors: Stulberg S. David , Shulman Keith , Stuart Steven , Culp Peggy
Published: June 2007

Twenty-three breaststroke swimmers (ranging in age from 6 to 30 years old) with painful knees were examined. Underwater movies of these swimmers were taken. Eighteen swimmers had tenderness under the medial facet of the patella and over the medial femoral intercondylar ridge. Five of these 18 swimmers also had tenderness along the tibial collateral ligament. Five swimmers had tenderness just along the tibial collateral liga ment. The onset of knee pain usually occurred within 3 years of the swimmers' beginning the breaststroke. Initially, the knees were only symptomatic when the swimmers performed the whipkick. As the swimmer continued the breaststroke, in spite of discomfort, the knees became symptomatic during other athletic and nonathletic activity. Breaststrokers who had been using the whipkick for more than 8 years had clinical evidence of patellofemoral osteoarthritis. The site of pain in the knee was related to the way in which the whipkick was performed. Breaststrokers without knee pain used a whipkick with characteristics that were consistently different than those of the symptomatic swimmers. Treatment of breaststroker's knee should be directed toward correcting the swimmer's whip kick. This approach is most likely to be successful if applied as soon as the swimmer becomes symptomatic.
Occult knee ligament injuries associated with femoral shaft fractures
Authors: Walker Dennis M. , Kennedy J.C.
Published: June 2007

Recognition of ligamentous injuries of the knee in the acute phase is essential for optimum treatment and prognosis. A multitraumatized patient with a fractured femur and occult knee ligament damage presents a difficult diagnostic challenge.

This paper retrospectively reviews 52 patients with 54 mid- shaft femoral fractures. The high incidence (48%) of ipsilateral knee ligament damage, particularly of a severe nature (30%) evident at followup (mean 24.5 months) is alarming. In the 26 cases of knee ligament damage, the mean time from injury to documentation of instability is 12.8 months.

Motor vehicle and athletic injuries and falls account for all of the injuries. The majority are dashboard impacts treated in balanced traction with subsequent case bracing. The anterior cruciate ligament (50%) is most often injured followed by the medial collateral ligament (31%), lateral collateral ligament (13%), and posterior cruciate ligament (6%).

A Lachman test, aspiration of the effusions, examinations under anesthesia including stress films, and arthroscopy are recommended as diagnostic procedures.

Acute ipsilateral knee instability is a strong relative indica tion for primary rigid immobilization of the fracture femur to allow early ligamentous repair.
Biomechanics of knee rehabilitation with cycling
Authors: McLeod William D. , Blackburn T.A.
Published: June 2007

The bicycle provides quadriceps rehabilitation while controlling the stresses to the knee ligaments. With pedaling on the bicycle, forces are applied to the anterior cruciate ligament, the cap sular ligaments, and the posterior structures of the knee joint as the tibial plateau is posteriorly tilted. The knee muscles can modify their forces. Therefore, by controlling the mode of cycling with varying seat heights and pedal positions, the ligaments can be relieved from these forces during the initial stages of the rehabilitative process. An exercise program can then be designed to apply controlled stress to these structures to enhance the healing and recovery processes.
Neurophysiologic inhibition of strength following tactile stimulation of the skin
Authors: Nicholas James A. , Melvin Meredith , Saraniti Anthony J.
Published: June 2007

A modified shoulder abduction manual muscle test was incor porated in this study to demonstrate strength changes following tactile stimulation of the skin. Resistance was applied to the distal radioulnar joint and the stimulus (scratching) was applied inferior to the clavicle on the clavicular head of the pectoralis major muscle after maximum contraction. An electromechani cal device quantified the isotonic (eccentric) measurements. A standard dynamometer system (Cybex II) was used to measure isometric strength. The nondominant side was used as the "control." Two populations, a normal (random) and a strong (athletic) group, were studied. Twenty-three persons (52% women, 48% men; mean age, 27 years; mean height, 67 inches (170 cm); and mean weight, 147 Ib (66.7 kg)) were in the "normal" group and 17 persons (100% men; mean age, 25 years; mean height, 74 inches (188 cm); and mean weight, 215 Ib (97.5 kg)) were in the "strong" group. The random population showed a 19% decrease in strength following tactile stimulation as measured by the manual muscle testing unit; the athletic pop ulation showed a 17% decrease in strength. With the isometric measurements, the random population had an 8% decrease in mean strength following the scratch but the athletic population showed no significant decrease. The capability to quantify objectively manual muscle tests is discussed in relation to the importance of the proximal musculature.
Digital perfusion of handball players
Authors: Buckhout Bradley C. , Warner Mark A.
Published: June 2007

The effect of repeated ball impacts on the handball player's hands was studied by using thermography and routine roent genography to determine evidence of altered perfusion or other tissue changes. Seventeen of 22 players had multiple areas of decreased perfusion, 12 of these 17 were symptomatic and 8 showed definite correlation between symptoms and thermo graphic findings. No skeletal or articular changes were noted. Players with more than 200 hr of accumulated playing time had increased risk of developing symptomatic, although nonpro gressive, alterations in perfusion of their hands but did not have evident skeletal changes.
Treatment of acromioclavicular separations
Authors: Park John P. , Arnold James A. , Coker Tom P. , Harris Walter Duke , Becker David A.
Published: June 2007

A retrospective study of 134 patients with Types I, II, and III acromioclavicular separations was carried out. The average followup was 6.3 years, with the longest being 19 years, and the shortest being 1 year. The mechanism of injury was a direct blow in 92% of the patients. The average age of the patients was 30.1 years, with a range from 13 to 68 years. All patients were evaluated using a standard rating system for the shoulder and humerus, the total for perfect recovery being 100. Twenty- four patients with Type I separations were immobilized 19.5 days, with a disability period of 6 weeks, and rated 94 points. Twenty-five patients with Type II separations were immobilized 27 days for the conservative groups, had a disability period of 6 weeks, and rated 90 points. Eighty-five patients with Type III acromioclavicular separations were followed. Seven patients had conservative treatment, were immobilized an average of 22 days, with a disability period of 13 weeks, and rated 82. Of those patients who underwent surgical repair, excluding Dacron graft substitution, the immobilization period was 6 weeks, with a disability period of 12 weeks, and a rating of 80. Fifty-eight patients underwent repair with double velour Dacron prosthetic substitution for the coracoclavicular ligaments, combined with distal clavicular resection in all but two patients. The average immobilization period was 1 week, with the average disability period being 3 weeks. The average rating was 96, with 24 patients rating 100. The major cause for a rating less than 100 was light to moderate pain that persisted in a few cases, which was only occasional and associated with a particular activity. One infection occurred requiring graft removal 5 months after surgery. Calcification in the area of the coracoclavicular liga ments did not affect the final rating and recurrence of deformity was not noted.
Pitcher's elbow in adolescents
Authors: Grana William A. , Rashkin Alan
Published: June 2007

Intraarticular and periarticular changes of the elbow secondary to the throwing motion have been documented in pitchers of all ages. Although others have focused attention on children, this study evaluates a group of 73 older pitchers (average age 17 years).

Forty-two (58%) players reported pain while throwing at the time of evaluation (before interscholastic play) or developed pain during the season. However, only four (5%) missed one or more pitching rotations. No significant relationships were found between occurrence of symptoms and number of seasons played, individual pitching traits, asymmetry on physical ex amination, or asymmetry on radiographic evaluation of the elbow. In the symptomatic group there tended to be a slightly greater number of seasons' experience (average 7.8 seasons vs. 6.0 seasons) and more players with asymmetry upon physical examination.

We believe this study supports the concept that increasing age and exposure, along with other factors as yet unquantitated, may determine the occurrence of symptoms in pitchers.
Bicycle accidents and injuries
Authors: Kruse Diana L. , McBeath Andrew A.
Published: June 2007

To determine the incidence of bicycle-related accidents and injuries in a given population 1,200 questionnaires were sent to a random sample of college students. Seventy-one percent of the students responded. Of the responders, 62% were bicyclists and 13% of these had been involved in an accident in the previous 1-year period. Sixty-two percent of those involved in an accident sustained an injury and 32% were significant enough to require medical attention. Only 8% of accidents were police-reported. If these trends hold true for other populations, studies based on hospital or police records fail to give a true picture of bicycle-related accidents and injuries.
The uniqueness of the young athlete: medical considerations
Authors: Strong William B.
Published: June 2007

The common acute and chronic illnesses that may influence a youths' participation in sports are discussed. Conditions dis cussed include fever, upper and lower respiratory infection, infectious mononucleosis, and dermatoses (viral, fungal, bac terial and parasitic, and traumatic). The chronic diseases pre sented include asthma, epilepsy, diabetes, and cardiovascular problems, especially congenital and rheumatic lesions as well as arrhythmias and hypertension. The cardiovascular evalua tion of the young athlete is detailed because, along with the orthopaedic examination, it probably is the area to yield the most abnormal or questionable findings.
Acute anterior cruciate ligament injury and augmented repair
Authors: Cabaud H. Edward , Feagin John A. , Rodkey William G.
Published: June 2007

Eleven dogs underwent transection of the anterior cruciate ligament at the femoral origin of the stifle (knee) joint. The anterior cruciate ligaments were repaired in a conventional manner and augmented by transferring the medial one-third of the patellar tendon and inserting it into the lateral femoral condyle. The repairs were evaluated either 4 or 8 months postoperatively. All repaired and augmented anterior cruciate ligaments in this series healed satisfactorily to provide clinical and functional stability to the knee joints. Instron testing of the repaired and augmented anterior cruciate ligaments showed maximum strength at 4 months of 46.2 ± 10.9 kgf and at 8 months of 64.3 ± 14.3 kgf as compared to the control of 122.7 ± 11.6 kgf. Histologic evaluation showed that by 8 months the repaired and augmented anterior cruciate ligaments had healed by bony ingrowth. Thus, interstitial failure occurred during Instron testing. The transferred patellar tendon provided ad ditional blood supply, splinted the anterior cruciate ligament to allow healing, and increased the strength of the repaired com plex.
Electrocardiographic and echocardiographic characteristics of long distance runners
Authors: Mumford Michael , Prakash Ravi
Published: June 2007

Nineteen long distance runners and 19 age- and sex-matched sedentary controls were evaluated by echocardiography and electrocardiography (ECG) at rest and after 12 minutes of treadmill exercise. Seven of ten male athletes exhibited ECG abnormalities of prominent precordial voltage, early repolarization, and one had right ventricle hypertrophy; only three of nine females had ECG abnormalities.

The resting and postexercise heart rates and blood pressures were lower in athletes than controls ( P < 0.001). The athletes increased their left ventricular end-diastolic volume and stroke volume and had a moderate increase in heart rate. Controls markedly increased only their heart rate to the same level of exercise. One female athlete and one female control had 1 mm of ST segment depression with exercise.

The right ventricular wall thickness was equal to or greater than 6 mm in athletes versus equal to or less than 5 mm in controls. The left ventricular wall was thicker in athletes than controls, the resultant left ventricular mass was 60% more in athletes due to left ventricular hypertrophy ( P < 0.001). We concluded left ventricular hypertrophy is present in athletes as a result of endurance running.
Arthroscopy training
Authors: Fullerton Leroy R. , Protzman Robert W. , Wincheski Joseph
Published: June 2007

Skill in arthroscopy is accepted by most surgeons as being directly related to experience. Therefore, we feel a method to permit arthroscopy training on in vivo knees is useful. A mount called the Walter Reed knee stand was devised to facilitate arthroscopy training in a laboratory setting. Above-the-knee amputation or cadaver amputation specimens can be easily inserted in this stand. As the specimen is held firmly repeated flexion and extension, as well as varus and valgus stresses, can be applied with a minimum of tissue handling for four or more hours per specimen. Utilizing this mount, initial resident instruction, motor skill train ing, multiple portal approaches, operative arthroscopy training, and workshops have been conducted on knee specimens. We feel the knee stand permits a didactic approach, without patient risk, to arthroscopy training.
Surgical repair of ruptured lateral ankle ligaments
Authors: Brand Robert L. , Collins Myron D.F. , Templeton Tom
Published: June 2007

Fifty-two of 86 repaired lateral ankle ligaments were reevaluated 3 to 53 months after surgery. Ninety-eight percent were functionally stable. Mechanical stability was determined by talar tilt measurement on "stress roentgenographs". This was found to be a reliable predictor of degree of injury and postoperative symp tomatology. Surgical repair in selected cases is rec ommended to assure mechanical and functional sta bility.
Cost of high school soccer injuries
Authors: Pritchett James W.
Published: June 2007

This study examines the cost of high school soccer injuries. Data was collected from the files of the largest single insurer of secondary school students in six western states. Analysis was made through a specially programmed Qantel 1300 computer (Empire Com puter Systems, Seattle, Washington).

The average claim cost was $127.29 for injuries in 1976 to 1977, ranging from the lowest in Washington to the highest in California. During this period 436 claims from 10,634 players were reported.

Relatively minor injuries (sprains, strains, contu sions, and abrasions) accounted for 75.9% of all injuries but only 49.4% of all costs; lower extremity injuries accounted for more than one-half of all injuries and costs. Knee injuries alone represented 11.7% of all injuries—28.2% of all medical costs paid by the insurance companies.

Injuries occur only one-fifth as frequently in soccer, compared with football. It is anticipated that medical expenses for soccer players will be less than 16% of expenses incurred by an equal number of football players.
The technique of cruciate ligament reconstruction
Authors: Brant Lipscomb A. , Johnston Robert K. , Snyder Robert B.
Published: June 2007

Our technique of reconstruction of the anterior and posterior cruciate ligament in both acute and chronic tears, using both the semitendinosus and gracilis ten dons, is described in detail. Combined rotatory insta bilities were carefully evaluated and corrected during the same operation. Reefing of the posteromedial capsular ligament was done for anteromedial rotatory instability, and for significant valgus instability, the O'Donoghue medial reconstruction was performed. The Ellison procedure was initially done for associated anterolateral rotatory instability, but has been re placed by the Losee procedure. This combination of anterior cruciate ligament reconstruction with the ap propriate extraarticular procedures has produced our most stable knee joints.

Posterior cruciate ligament reconstruction was also performed through an anterior incision using both the semitendinosus and gracilis tendons. When both cru ciates were found to be incompetent, the gracilis was used to reconstruct the posterior cruciate and the semitendinosus for the anterior cruciate. In addition, all associated rotatory instabilities were corrected at the same operation.

This technique has been performed on 372 patients (342 anterior and 30 posterior cruciate ligament tears) by one surgeon over a period of five years. The average follow-up was 22 months. Objective compar ison of the reconstructed knee with the sound knee showed 84% good results.
Preparticipation health screening of young athletes
Authors: Linder Charles W. , D Robert H. , Seklecki Roger M. , Strong William B.
Published: June 2007

The major purpose of the preparticipation physical examination of athletes is to screen for conditions that could predispose the athlete to injury or death. How ever, the examinations offered to many of the athletes in this country fail to adequately accomplish this. This study analyzed the preparticipation health exams of prospective sports participants from all public schools in Richmond County, Georgia for two consecutive years. We sought to identify the components of a preparticipation exam which most accurately identi fied athletes who were at risk of sustaining injury.

The most frequently reported problems on the health history were previous injuries, previous hospitaliza tions, and joint problems. These were consistent over the two years. The problems recorded most frequently on the physical exam involved the lower extremities, mouth, teeth, heart, eyes, and genitalia. However, the prevalence of abnormalities found during the first year of the study was significantly lower than that identified in the second year. Analysis of the findings resulted in a more standardized approach to the examination and in an improved examination form.
Knee motion in a long leg cast
Authors: Krackow Kenneth A. , Laughlin Vetter William
Published: June 2007

Five principles to reestablish static ligamentous sta bility are introduced, including secure, temporary, ti biofemoral fixation to protect against early postoper ative stretch or disruption. The necessity for empha sizing this point is demonstrated by a cadaver study. Knee motion in and out of long leg plaster casts was carefully studied in necropsy specimens. Casts ap plied over minimal or no padding allowed significant varus-valgus, anterior, posterior, and rotatory motion at the knee when manipulated manually. Medial open ing to valgus stress ranged from 64 to 100% after casting as compared to the amount of instability pres ent prior to casting. Legs with normally contoured thighs were not protected against anterior instability after casting, and an average of 48% of precasting rotational instability remained after casting.

We believe that these results are relevant to much knee ligament surgery. Current means for solving the problems posed by cast immobilization alone, includ ing case examples, are discussed.
Cryotherapy and nerve palsy
Authors: Drez David , Faust Donald C. , Evans J. Pat
Published: June 2007

Ice application is one of the most extensively used treatments for athletic injuries. Frostbite is a recog nized danger. Five cases of nerve palsy resulting from ice application are reported here. These palsies were temporary. They usually resolve spontaneously with out any significant sequelae. This complication can be avoided by not using ice for more than 30 minutes and by guarding superficial nerves in the area.
Proximal approaches to arthroscopic surgery of the knee
Authors: Patel Dinesh
Published: June 2007

Arthroscopic surgery of the knee has become more popular recently because of better optics and instru mentation. The currently available techniques and ap proaches for doing surgery as well as their drawbacks are summarized. The author's new technique is de scribed.

The anterior and lateral compartments and popliteal tunnel could not be adequately visualized with the existing techniques. Distortion of image, magnifica tion, crowding, and collision were found in the distal approaches during surgery.

Injuries to the anterior compartment of the knee as the instruments come blindly in and out can also cause damage to the fat pad and the menisci. By inserting the arthroscope proximally (midpatellar lateral, mid patellar medial) and using inferomedial and inferola teral portals for instruments, the surgery and the above problems have been minimized.

The drawbacks of this technique are initial confusion in orientation and proper placement of the arthro scope. The posterior cruciate ligament cannot be seen using this technique. The posterolateral portion of the lateral meniscus and to some extent the posteromedial portion of the medial meniscus are, in inexperienced hands, somewhat difficult to see. The technique of menisectomy is described.
Lateral patellar retinacular release
Authors: Micheli Lyle J. , Stanitski Carl L.
Published: June 2007

Forty-one lateral knee retinacular releases were per formed in 33 patients over a 27-month period. This group represented 6.9% of patients seen during that time with symptomatic patellalgia. A retrospective analysis was done on 24 patients from that group who returned for follow-up examination 8 to 16 months after surgery. Thirty-three knees in these patients were operated upon by one of the authors and as sessed independently by the other author.

Eighteen females and six males had surgery at an average age of 18 years (range 13 to 32). All patients had at least three months of supervised, nonoperative management that emphasized flexibility and static strengthening of the quadriceps and hamstrings.

The preoperative history of injury, pain pattern, and pseudolocking were evaluated. Roentgenograms were checked for patella alta. Follow-up examination included assessment of pain factors, Q angle, patellar tracking, ligamentous laxity, and range of motion of hip, knee, ankle, and foot joints. Hamstring and quad riceps power was measured with a Universal testing machine. Intensive postoperative physical therapy emphasized obtaining and maintaining a painless range of motion prior to strengthening.

Results assessed functional and anatomic criteria. Overall, 76.7% of patients had excellent or good results and improved following surgery. Males had a higher proportion of excellent results. The benefits of the procedure tended to remain at the level noted three months postoperatively.

Although increased ligamentous laxity, increased Q angle, or patella alta did not preclude a good or excellent result, all patients in this series with fair or poor ratings had increases in Q angle, ligamentous laxity, knee valgus, genu recurvatum, and body weight.

Lateral knee retinacular release, a noncomplex pro cedure, does not interfere with the permanent align ment of the extensor mechanism in the skeletally immature individual. It is recommended for patients who do not have evidence of significant patellar mal alignment but fail a supervised, conscientious, non operative therapeutic program.
Fractures and refractures in intercollegiate athletes
Authors: Whiteside James A. , Fleagle Samuel B. , Kalenak Alexander
Published: June 2007

This report on fractures and refractures in intercolle giate athletes covers an 11-year period from the early Fall of 1968 through the Spring of 1979. Two hundred thirty-one fractures occurred in 219 athletes. Of these athletes, 185 were male and 34 were female.

Fractures occurred in 18 sports. Of these 18, foot ball, basketball, wrestling, and soccer led in number for Men's (M) teams, and gymnastics, lacrosse, and volleyball led for Ladies' (L) teams. (Because of this institution's early involvement with Title IX, and the strong position taken by our administration, our teams are designated Gentlemen (Men for short), which con stitute the LIONS, and Ladies, which make up the LADY LIONS.) No fractures were noted in the other 11 intercollegiate teams of cheerleading (M and L), bowling (M and L), golf (M and L), fencing (L), rifle (coed), tennis (M and L), and volleyball (M). Boxing, ice hockey, rugby, soccer, and synchronized swim ming are club sports at the Pennsylvania State Uni versity and are not included in this study.

The most common of the 17 fracture sites were the finger, hand, face, foot, nose, and leg, regardless of sport or gender. Fourteen of fifteen refractures oc curred in collision /contact sports, and essentially the same mechanical forces caused both fractures.

In football most fractures occurred during highly successful seasons.
Magnification and high-resolution radiography in sports-related injuries
Authors: Griffiths Harry J. , DeHaven Kenneth E.
Published: June 2007

Magnification, or high-resolution radiography, is a widely accepted technique and is currently used in angiography, mammography, and pediatric chest ra diographs. Small avulsion fractures of the bones of the hand and stress fractures of the tibia are examples of two areas where the fracture may not be apparent on conventional films, although in many cases mag nification radiography will demonstrate the lesions. Six representative case histories are provided to illus trate the use of magnification radiography in sports- related injuries.
Simplified technique for posterior knee arthroscopy
Authors: Lewicky Roman T. , Abeshaus Merrill M.
Published: June 2007

Diagnostic and surgical knee arthroscopy occasion ally requires a posterior knee puncture. Unfortunately, posterior arthroscope insertion can be a difficult and frustrating experience. The technique described at tempts to obviate some of these problems. The merits of the technique include speed, safety, and consist ency, while at the same time not requiring the pur chase of yet another expensive arthroscopic device.
Performance of baseball headgear
Authors: Goldsmith Werner , Kabo J. Michael
Published: June 2007

An experiment was conducted to ascertain the effec tiveness of commercially available baseball headgear in a simulated environment where the head of the batter is struck. Using a compressed air cannon, baseballs were fired at an instrumented headform at frontal and temporal locations with and without a helmet. Striking velocities ranged from 50 to 120 mph and rebound velocities were 1/3 to ½ of that of the initial speed. Additional impact tests were conducted on equivalent flat helmet sections backed by a rigid steel plate, the results of which seemed to indicate that the materials and configurations currently em ployed do little to dissipate the energy of the striker. Head accelerations in excess of 1,000 G were mea sured, but quantitative injury potential could not be assessed since no applicable tolerances currently ex ist. We concluded that the incorporation of additional external padding on the plastic shell of the helmet and/or modifications of the suspension would signifi cantly improve the energy absorption capabilities of the helmet and further minimize the possibility of head trauma.
Recurrent compartment syndrome in the posterior thigh
Authors: Raether Paul M. , Lutter Lowell D.
Published: June 2007

Recurrent compartment syndromes of the lower ex tremity, which usually occur in conjunction with in tense use of muscle groups, can be briefly defined as an uncomfortable circulatory disturbance associated with a pathologic increase in total intramuscular pres sure. This syndrome has been reported in each of the four compartments of the leg but not in the thigh. Characteristic features of clinical presentation and physical examination are reviewed in this report. We have found that an intracompartmental pressure test (Whitesides Jr, TE, Haney TC, Morimoto K, et al: Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop 1 13: 43-51, 1975) is an invaluable diagnostic aid. A case involving the medial hamstring groups, with characteristic his torical presentation, intracompartmental pressure el evation, and excellent response to fasciotomy, is pre sented and discussed. The only effective treatment in this case was fasciotomy.
The frequency of muscle tightness and injuries in soccer players
Authors: Ekstrand Jan , Gillquist Jan
Published: June 2007

One hundred-eighty players in a male, senior soccer division were examined for past injuries, persisting symptoms from past injuries, and muscular tightness in the lower extremities.

Soccer players were in general less flexible than a group of nonplayers of the same age (n = 86). No correlation was found between past injuries and ex isting muscle tightness. Sprains of the lower extremity, especially of knees and ankles, predominated among the injuries.

Persistent instability symptoms were common se quels to knee and ankle injuries. It is proposed that intensive care of acute injuries will improve the late results.
Monitoring dynamic anterior compartment pressures during exercise
Authors: McDermott A.G.P. , Marble A.E. , Yabsley R.H. , Phillips Major B.
Published: June 2007

This report presents the early results of a new tech nique, using a solid-state transducer intracompart mental (STIC) catheter, developed to measure dy namic pressure changes in the anterior compartment of the leg in patients with exercise-induced anterior compartment syndrome. Nine male volunteers (15 limbs) with a history of exercise-induced anterior com partment pain were studied and compared to eleven asymptomatic male controls matched for age, weight and height. After catheter insertion, anterior compart ment pressures were recorded with the subjects walk ing and running on a treadmill and performing several static maneuvers before and after the exercise period. The most statistically significant value between the two groups was the difference in mean pressure dur ing running (P < 0.001). Presently, all mean running pressures greater than 85 mm Hg are considered abnormal. This new technique offers the investigator the opportunity to measure dynamic intracompart mental pressures in symptomatic patients and pro vides an objective measurement for selection of pa tients for fasciotomy.
A statistical study of physician care patterns in high school football injuries
Authors: Pritchett James W.
Published: June 2007

This study examines the specialty background, rela tive activity, role, and cost of care among physicians treating high school football injuries in six western states.

There were 1000 injuries (in 1000 players) in the 1980 football season. Among the players, 30.7 and 17.9% were treated solely by general practitioners and emergency room physicians, respectively. Or thopedic surgeons exclusively managed 17.1% of players, and 6.8% were seen initially by the emer gency room physician and referred to an orthopedic surgeon. Osteopaths solely treated 6.4% of players. Chiropractic was the exclusive care for 6.4%.

Four and nine-tenths per cent of players were seen initially by general practitioners and referred to an orthopedic surgeon. Emergency room physicians re ferred 3% of their injured high school football players to general practitioners. The remaining 6.8% of play ers were cared for by dentists, pediatricians, general surgeons, naturopaths, neurosurgeons, urologists, otolaryngologists, and ophthalmologists.

General practitioners referred 14% of their patients, and emergency room physicians referred 73.6% of their patients. The most common referral was to an orthopedic surgeon. Two hundred ninety-eight players ultimately received care from an orthopedist, including 82% of all patients with fractures. For patients with the same diagnosis, costs for care by orthopedic surgeons were 54% higher than the fees charged by a general practitioner.
Primary surgical treatment of anterior cruciate ligament lesions
Authors: Marshall John L. , Warren Russell F. , Wickiewicz Thomas L.
Published: June 2007

Seventy patients who underwent primary repair of the anterior cruciate ligament are reviewed in follow-up. The surgical technique consisted of multiple loop- varying depth sutures in both cruciate stumps in 61 patients. Nine patients had additional fascial augmen tation done primarily. Follow-up was from 12 to 90 months, the average being 29 months. All patients were scored on a 50-point normal knee score sheet. Average score at follow-up was 42.7. No patient was bothered by giving way, which is defined as an unpre dictable instability. No patient has required subse quent meniscal surgery. Ninety-three percent of the patients were active in sports. Anterior drawer sign at 90° showed increased excursion compared to the unaffected leg in all patients. However, Lachman's test showed a firm end point to excursion in all knees tested, and, in addition, 52% were rated as normal compared to the unaffected knee. We conclude that primary repairs of mid-substance tears are technically possible and recommended in an athlete.
Kinesiology
Authors: Miller Wallace E.
Published: June 2007

A series of articles to develop a better awareness of the broad involvement of kinesiology in our lives, and in sports in particular, has been constructed. These articles are concerned with the basic hallmarks of the study of kinesiology, or human body motion. In Part IV, there will be a delineation of rules and guidelines, as opposed to laws, concepts, and principles in kine siology, with special emphasis on sports. To under stand this distinction, we will look at some current literature on muscles and movements which relates to kinesiology.