bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of arthroscopic anterior cruciate ligament reconstruction using magnetic resonance imaging
Authors: Maywood Robert M. , Murphy Brian J. , Uribe John W. , Hechtman Keith S.
Published: June 2007

Thirty-two patients who had arthroscopic anterior cru ciate ligament reconstruction using a bone-patellar ten don-bone autograft underwent subsequent magnetic resonance imaging of the knee. A total of 32 magnetic resonance imaging examinations were performed from 10 days to 39 months postoperatively. The anatomic plane of the autograft was determined by obtaining a coronal pilot scan of the graft fixation screws or screw and staple. T1-weighted, T2-weighted, proton density, and gradient-echo imaging sequences were then ob tained in the anatomic plane, as well as T1-weighted coronal images. The autograft was defined on the basis of visualization of fiber continuity on T2-weighted im ages as follows: 1) intact; 2) having a partial tear; or 3) having a complete tear. These results were then cor related with clinical examination and, in 10 cases, sub sequent arthroscopy. Magnetic resonance imaging cor related with clinical findings in 31 of 32 patients. In addition, of the 10 patients who underwent subsequent arthroscopy, magnetic resonance scanning correlated in all cases with arthroscopic findings. T2-weighted and, in some cases, proton density images were most useful in visualizing the autograft. T2-weighted magnetic res onance imaging in the anatomic plane of the anterior cruciate ligament autograft can be a useful diagnostic tool in the evaluation of patients with patellar tendon anterior cruciate ligament reconstructions when graft integrity is in question.
Cell survival after transplantation of fresh meniscal allografts
Authors: Jackson Douglas W. , Whelan Jeffery , Simon Timothy M.
Published: June 2007

Fibrochondrocytes synthesize and maintain the extra cellular matrix responsible for the distinctive material and structural properties of a normal meniscus. Viable meniscal cells are believed to be necessary for the long- term maintenance of these properties in meniscal allo grafts. The purpose of this study was to determine if the donor cells (fibrochondrocytes) survive after a fresh meniscal allograft transplantation.

A DNA probe technique was used to clearly distin guish the DNA patterns in donor cells from the host cells in the Spanish goat. No remaining donor DNA could be demonstrated at 4 weeks in transplanted meniscal tissue; it was all of host origin. The host DNA content at 4 weeks approached or exceeded the amount present in the contralateral control meniscus.

Clinical significance: The results of this study dem onstrate that viable cells in medial meniscal allografts transplanted from one animal to another do not survive. Host cells rapidly repopulate the transplanted menis cus. There is no evidence these new cells will maintain on a long-term basis the extracellular matrix of the meniscus. The evidence in this paper, that the fibro chondrocytes do not survive transplantation, suggests further justification is necessary for using grafts with living cells. Allografts with living cells have an increased expense, more complicated surgical logistics, and have a higher potential risk of disease transmission.
High- versus low-top shoes for the prevention of ankle sprains in basketball players
Authors: Barrett James R. , Tanji Jeffrey L. , Drake Christiana , Fuller David , Kawasaki Robert I. , Fenton Richard M.
Published: June 2007

Using a prospective, randomized experimental design, 622 college intramural basketball players were stratified by a previous history of ankle sprains to wear a new pair of either high-top, high-top with inflatable air cham bers, or low-top basketball shoes during all games for a complete season. Subjects were asked to complete a history questionnaire and were given a complete ankle examination. They were allowed to wear these shoes only during basketball competition. Followed over the course of a 2-month intramural season, 15 ankle injuries occurred during 39,302 minutes of player-time: 7 in high-top shoes, 4 in low-top shoes, and 4 in high-top shoes with inflatable air chambers. The injury rates (injuries per player-minute) were 4.80 × 10-4in high-top shoes, 4.06 x 10-4in low-top shoes, and 2.69 x 10-4in high-top shoes with inflatable air chambers. There was no significant difference among these 3 groups, leading to the conclusion that there is no strong rela tionship between shoe type and ankle sprains.
Comparison of arthroscopic and open reconstruction of the anterior cruciate ligament
Authors: Raab David J. , Fischer David A. , Smith J. Patrick , Markman Alan W. , Steubs John A.
Published: June 2007

The purpose of this study was to determine in a prospective, randomized, blinded design whether ar throscopically assisted anterior cruciate ligament reconstruction offered any significant immediate or short-term advantages over traditional open recon struction through a limited arthrotomy. Patients with a diagnosis of deficiency of the anterior cruciate ligament were randomly assigned to one of two treatment groups: the open group (limited open reconstruction) or the arthroscopic group (fully arthroscopic reconstruc tion). Postoperatively, both groups were treated iden tically. Intra- and postoperative observations included length of surgery, duration of hospitalization, and amount of pain medication. Follow-up evaluations were performed at 1, 6, 12, 16, 20, and 24 weeks to record crepitus, swelling, range of motion, ligament laxity, and thigh atrophy. Lysholm scores were obtained at the 16 and 24 week followups.

At 24 weeks, 86% of the open group and 89% of the arthroscopic group had good-to-excellent results. Intra operative, postoperative, and follow-up findings indi cated no statistically significant differences or relation ships between the two groups in any of the variables measured, except that operative time was 13 minutes longer in the arthroscopic group (P < 0.001). The results do not substantiate a clinical advantage for either technique.
Surgical management of exertional compartment syndrome of the lower leg
Authors: Schepsis Anthony A. , Martini Douglas , Corbett Michael
Published: June 2007

Forty-six limbs in 28 patients were surgically treated for exertional compartment syndrome. One group of 16 patients (26 limbs) underwent a fasciotomy for ex ertional anterior compartment syndrome (Group 1). A second group of 12 patients (20 limbs) underwent a fasciotomy for exertional deep posterior compartment syndrome (Group 2). Patients in Group 2 experienced symptoms for a significantly longer time than those in Group 1:16 versus 6.8 months (P < 0.01). All three of the pressure measurements used in this study (resting pressure, 1 minute after exercise, and 5 minutes after exercise) were significantly higher in both groups than in normal controls (P < 0.01). The 1 minute after exercise values were significantly higher in Group 1 (mean, 36.5) than in Group 2 (mean, 29.1) (P < 0.01). In Group 1, 25 of 26 limbs (96%) had excellent results. In Group 2,13 of 20 limbs (65%) had satisfactory results (5 excellent and 8 good) and 7 (35%) had unsatisfactory results (4 fair and 3 poor). Those patients who had an unsatisfactory outcome did so within 6 months. Pa tients in Group 1 had a significantly higher rate of satisfactory results than those in Group 2 (P < 0.05).
Achilles tendon allograft reconstruction of the anterior cruciate ligament-deficient knee
Authors: Linn Richard M. , Fischer David A. , Smith J. Patrick , Burstein David B. , Quick Donald C.
Published: June 2007

Thirty-five patients had reconstruction of the anterior cruciate ligament with intraarticular fresh-frozen Achilles tendon allograft and extraarticular tibial band tenodesis. Patients were followed 2 to 4 years (mean, 2.5). Evaluation included clinical and functional exami nations, measurement of tibiofemoral displacement, and anteroposterior and lateral radiographs. Clinical results were considered satisfactory in 85% of the patients; 16 had arthroscopic examination after the allograft; allograft biopsies in 9 at this time showed cellular and vascular tissue without evidence of immune reaction. Clinical, arthroscopic, and biopsy results were favorable, but radiologic results were not. In most pa tients there was a significant size increase in femoral and tibial bone tunnels, as measured from radiographs. In the 6 most extreme cases, bone tunnels measured 20 mm or more in diameter, twice the initial size. Etiology and clinical significance of these bone tunnel changes remain unknown. Enlargement appears to oc cur early after operation; it stabilizes within 2 years. No statistical correlation was seen between tunnel enlarge ment and results of clinical and functional examinations; nevertheless, unexplained tunnel enlargement is cause for concern, and allograft replacement of the anterior cruciate ligament with fresh-frozen Achilles tendon al lograft should be considered a salvage procedure.
Complications of arthroscopic meniscal repair
Authors: Austin Kenneth S. , Sherman Orrin H.
Published: June 2007

The results of 101 consecutive arthroscopic meniscal repairs were studied to determine the nature and fre quency of associated complications. All arthroscopic repairs were done by the senior author (OS) between November 1984 and June 1991. Our data include 65 patients with associated anterior cruciate ligament in juries, of which 49 underwent concurrent arthroscopic anterior cruciate ligament reconstruction. There was an overall complication rate of 18%.

There was a 20% risk of complication with meniscal repair when associated with anterior cruciate ligament injury and 14% without anterior cruciate ligament injury. There was a 10% incidence of arthrofibrosis when meniscal repair was performed with anterior cruciate ligament reconstruction and a 6% incidence when per formed in an anterior cruciate ligament-deficient, non- reconstructed knee. Overall, there was a 13% risk of complication with lateral repairs compared with 19% with medial repairs. In the subset of patients with intact anterior cruciate ligaments and isolated meniscal le sions, there were no complications associated with lateral repair and an 18% risk of complication with medial repair. Female patients demonstrated a higher likelihood of complication (29%) than male patients (13%). Excluding repair failures, there was an 8% re operation or rehospitalization rate.
Arthroscopically Enhanced "Miniapproach" to Rotator Cuff Repair
Authors: Paulos Lonnie E. , Kody Michael H.
Published: June 2007

The results of rotator cuff repair through a lateral deltoid splitting approach combined with arthroscopic subacro mial decompression are presented in 18 patients with an average followup of 46 months. Sixteen patients (88%) scored good or excellent on the University of Cali fornia at Los Angeles shoulder rating scale. Pain scores improved from an average of 1.6 to 7.6. Function scores improved from 2.5 to 8.4. Two patients had poor results; both had workers' compensation cases pending. One patient with a poor result had 2 complications: super ficial infection and failure of repair that required reop eration. No other complications were encountered. Sev enteen patients (94%) were satisfied with their results. This surgical technique, when used for patients with chronic impingement and rotator cuff tear, provides ac ceptable clinical results with minimal morbidity.
Preoperative Evaluation of the Ulnar Collateral Ligament by Magnetic Resonance Imaging and Computed Tomography Arthrography
Authors: Timmerman Laura A. , Schwartz Martin L. , Andrews James R.
Published: June 2007

A prospective study was completed on 25 baseball play ers with medial side elbow pain. They were evaluated preoperatively with both computed tomography arthro gram and magnetic resonance imaging examinations of the elbow to assess the ulnar collateral ligament. At surgery, 16 of 25 patients had an abnormal ulnar col lateral ligament and 9 patients had a normal ulnar col lateral ligament. The computed tomography arthrogram detected abnormalities in 12 of the 14 patients with ulnar collateral ligament tearing (sensitivity, 86%). The mag netic resonance imaging scan indicated abnormalities in 8 of 14 patients (sensitivity, 57%). The specificity of the computed tomography arthrogram was 91 % and the magnetic resonance imaging was 100%.

A newly described "T-sign" was seen on the com puted tomography arthrogram in the patients with an undersurface tear of the ulnar collateral ligament. This represented the dye leaking around the detachment of the ulnar collateral ligament from its bony insertion but remaining contained within the intact superficial layer of the ulnar collateral ligament and capsule.

Both the computed tomography arthrogram and the magnetic resonance imaging scan were accurate in di agnosing a complete tear of the ulnar collateral ligament preoperatively in all cases. The main advantage of the computed tomography arthrogram was in evaluating the partial undersurface tear.
Patellofemoral Malalignment in Adolescents
Authors: Guzzanti Vincenzo , Gigante Antonio , Di Lazzaro Antonio , Fabbriciani Carlo
Published: June 2007

Twenty-seven adolescents with anterior knee pain with or without patellar instability were studied by comput erized tomography to detect patellofemoral malalign ment. The examination was performed with and without quadriceps contraction with the knee flexed to 15°. Con gruence angle, patellar tilt angle, sulcus angle, and trochlear depth were measured. This investigation showed the well-known types of patellofemoral mal alignment with quadriceps relaxed (tilted, lateralized, lateralized, and tilted patella) and, in 52% of cases, re vealed changes in type and severity with quadriceps contraction (in 41 %, lateralization and tilting were mark edly more evident; in 11 %, the type of malalignment changed). The results demonstrate that, in addition to assessment with quadriceps relaxed, computerized to mography with quadriceps contraction is a useful ad junct to diagnose and define the type of malalignment in particularly difficult circumstances.
An Evaluation of the Shoulder Relocation Test
Authors: Speer Kevin P. , Hannafin Jo A. , Altchek David W. , Warren Russell F.
Published: June 2007

The purpose of this study was to evaluate the sensitivity, specificity, negative and positive predictive values, and accuracy of the shoulder relocation test in 100 patients who underwent shoulder surgery. Based on operative data and examination under anesthesia, the diagnoses were grouped into six categories: anterior instability (without cuff disease), posterior instability, rotator cuff disease (without associated anterior instability), acro mioclavicular disorder, osteoarthrosis, and instability of the biceps tendon. The test was performed on the day of surgery by placing the arm in a position of 90° of humerothoracic abduction and 90° of external rotation (90°/90°). Patient responses of pain and apprehension (considered separately) were assessed in this position both with and without application of an anterior force to the proximal humerus. The relocation test assessed diminution of pain and apprehension after application of a posteriorly directed force to the proximal humerus relative to the position of 90°/90° alone and to the po sition of an anterior force being applied to the proximal humerus.

Overall, 63 patients reported pain with 90°/90°; 74 reported pain when an anterior force to the proximal humerus was applied: the anterior instability group alone had 46 and 63 reports of pain, respectively; the rotator cuff group alone had 82 and 88 reports of pain, respectively. The only positive responses for apprehen sion were in the anterior instability group, of which 63% had apprehension with 90°/90° alone and 74 had ap prehension when an anterior humeral force was ap plied. The overall accuracy of the shoulder relocation test was <50% when the response of pain alone was considered and >80% when the response of apprehen sion alone was considered. The performance of the test was contrasted within the anterior instability and rotator cuff disease groups. A positive relocation test for pain was observed in 30% (14 of 46) of the anterior instability group and in 44% (15 of 34) of the rotator cuff disease group; this increased to 54% (25 of 46) and 56% (19 of 34), respectively, with reference to the position of an anterior force on the proximal humerus.
The Prevalence of Gonarthrosis and Its Relation to Meniscectomy in Former Soccer Players
Authors: Roos Harald , Lindberg Hakan , Gärdsell Per , Lohmander L. Stefan , Wingstrand Hans
Published: June 2007

The prevalence of radiographic signs of gonarthrosis and its relation to knee injuries were studied in 286 former soccer players—215 nonelite and 71 elite players—and were compared with 572 age-matched controls with a mean age of 55 years. The prevalence of gonarthrosis among the nonelite players was 4.2%, among the elite players 15.5%, and among the controls 1.6%. Seven of the soccer players had known anterior cruciate ligament injuries, and 40 had had meniscec tomies. Of the 32 nonelite players with knee injuries, 4 (13%) had gonarthrosis, and of the 183 without known knee injuries 5 (3%) had gonarthrosis. Among the elite players, the prevalence of gonarthrosis in knees without diagnosed injuries was 11 %. We conclude that soccer, especially at an advanced level, is associated with an increased risk for gonarthrosis. After excluding subjects with known knee injuries, there was no difference be tween nonelite players and controls, but we found a higher rate of gonarthrosis among the elite players.
The Development of Suture Anchors for Use in Soft Tissue Fixation to Bone
Authors: Goble E. Marlowe , Somers W. Karl , Clark Ron , Olsen Raymond E.
Published: June 2007

Soft tissue fixation to bone is a basic technique of or thopaedic surgery for which a multitude of devices have been developed. A new class of orthopaedic devices termed "suture anchors" has been developed to secure soft tissues to bone using suture material. The suture anchor is designed to allow quick and secure fixation without the need for extensive exposure. This device was tested using in vitro and in vivo models and found to be comparable with standard transosseous and two- pronged staple techniques. This device should prove useful in allowing the versatility of suture fixation of soft tissues to bone without the technical requirements of constructing transosseous suture tunnels.
Anterior Cruciate Ligament Graft Fixation
Authors: Steiner Mark E. , Hecker Aaron T. , Brown Charles H. , Hayes Wilson C.
Published: June 2007

This study assessed the tensile properties of hamstring and patellar tendon anterior cruciate ligament recon structions in older cadaveric knees (age range, 48 to 79 years). Mechanical testing to failure was conducted by translating the tibia anteriorly at 1 mm/sec with the knee in 20° of flexion. The strongest gracilis-semitendinosus graft fixation technique (103% of intact anterior cruciate ligament) had the tendons doubled and secured with soft tissue washers (P < 0.01 ). However, all reconstruc tions using gracilis-semitendinosus grafts were signifi cantly less stiff than the intact anterior cruciate ligament specimens regardless of fixation technique (P< 0.01 ). The highest strength patellar tendon graft fixation tech nique (84% of intact anterior cruciate ligament) was ob tained with a combination interference screw and suture technique. The difference in stiffness between a patellar tendon graft and an intact anterior cruciate ligament was not significant when interference screws were placed at both ends of the graft (P > 0.05). Both types of grafts failed most often on the tibial side. With appropriate fixa tion, both grafts approximated the intact anterior cruci ate ligament in strength, but only patellar tendon grafts secured with interference screws were comparable in stiffness.
Electromyographic Analysis of Hip and Knee Musculature During Running
Authors: Montgomery William H. , Pink Marilyn , Perry Jacquelin
Published: June 2007

The purpose of this study was to describe the firing pat tern of 11 hip and knee muscles during running. Thirty recreational runners volunteered to run at 3 different paces with indwelling electromyographic electrodes while being filmed at 100 frames per second. Results demonstrated that medial and lateral vasti muscles acted together for knee extension during terminal swing and loading response, possibly providing a patella sta bilizing role. The vastus intermedius muscle functioned with the other vasti, plus eccentrically controlled knee flexion during swing phase. The rectus femoris muscle fired with the vastus intermedius muscle and assisted the iliacus muscle with hip flexion. The hamstrings fired primarily to eccentrically control hip flexion. The adduc tor magnus, tensor fascia lata, and gluteus maximus muscles afforded pelvic stabilization while assisting with hip flexion and extension. Forward propulsion was provided mainly by hip flexion and knee extension, which is contrary to the view that posterior calf muscles provide propulsion during toe off. Faster running paces lead to increased activity in the muscles. This may lead to more injuries, primarily in the muscles that were con tracting eccentrically.
Healing Characteristics of a Type I Collagenous Structure Treated with Corticosteroids
Authors: Wiggins Michael E. , Fadale Paul D. , Barrach Hans , Ehrlich Michael G. , Walsh William R.
Published: June 2007

One hundred twenty-eight skeletally mature New Zea land White rabbits were used to study the effect of a single corticosteroid injection on the biomechanical, biochemical, and histologic aspects of ligamentous healing. Two steroid dosages were used. The amount of the low-dose steroid was calculated by determining the corticosteroid concentration at which fibroblastic synthesis of collagen was inhibited in vitro. A human equivalent dose of betamethasone was used as the high-dose steroid injection. These two steroid doses and a saline control were injected around a transected medial collateral-ligament. At 10 days all groups showed significantly inferior biomechanical properties relative to noninjected controls. By 3 weeks the human equivalent steroid dose group continued to demonstrate signifi cantly inferior properties. Histologic and biochemical analyses confirmed the biomechanical results. The clinical relevance of the study was that the delivery of a human equivalent steroid dose into an acutely injured ligament significantly impairs the healing process rela tive to a noninjected ligament at 10 days and at 3 weeks after injury. This implies that a corticosteroid-treated in jured ligament may not be able to withstand the me chanical loads of early vigorous rehabilitation.
The Acromion-splitting Approach for Large and Massive Rotator Cuff Tears
Authors: Paulos Lonnie E. , Meislin Robert J. , Drawbert John
Published: June 2007

A retrospective review of 42 patients in whom a rotator cuff injury was diagnosed and who subsequently un derwent surgery with the superior acromion-spitting ap proach technique was conducted. The average size of the tear was 4.2 cm with an average tear retraction of 4.1 cm. Thirty-seven (38 shoulders) of the 42 patients underwent a physical examination, interview, and ra diographs at an average followup of 33.4 months (range, 15 to 66). Using the University of California, Los Angeles Shoulder Rating Scale, 27 shoulders were graded as excellent or good, and 11 shoulders were graded as fair or poor. Radiographic examination dem onstrated bony union in 29 shoulders. The remaining 9 shoulders had evidence of fibrous union that could be characterized as clinically asymptomatic. Twenty pa tients had computed tomography scans that demon strated decompression where the bony or fibrous union had occurred. In addition, some increased decompres sion in several patients with fibrous union indicated that the anterior acromion sought its appropriate level. Based on the results of this study, the acromion-splitting approach, used as an extension of the miniapproach for rotator cuff tears, can be successfully used when a large or massive rotator cuff tear is identified.
Comparison of Lateral Ankle Ligamentous Reconstruction Procedures
Authors: Liu Stephen H. , Baker Champ L.
Published: June 2007

The static restraints of various surgical procedures for chronic lateral ankle instability were compared. Forty cadaveric ankles were divided equally into the follow ing five groups: 1) ankles with intact anterior talo fibular and calcaneofibular ligaments, 2) ankles with incised anterior talofibular and calcaneofibular liga ments, 3) ankles with Chrisman-Snook procedure, 4) ankles with Watson-Jones procedure, or 5) ankles with modified Broström procedure. All ankles were placed in a mechanical apparatus for anterior drawer stress and inversion stress tests. After each applica tion of force, a radiograph of the ankle joint was taken, and the anterior talar displacement and the ta lar tilt angle were measured.

All procedures reduced anterior drawer and talar tilt when compared with the ankles with incised anterior talofibular and calcaneofibular ligaments. Significant differences were found among the groups for both in version and anterior drawer stress at all forces, except for the third and fourth groups. The modified Broström group had the least amount of anterior talar displace ment and talar tilt angle at all forces. There were no significant differences between the Watson-Jones and the Chrisman-Snook procedures in anterior talar dis placement and talar tilt. The modified Broström proce dure produced a greater mechanical restraint than either of the other procedures.
The Effects of Donor Age and Strain Rate on the Biomechanical Properties of Bone-Patellar Tendon-Bone Allografts
Authors: Blevins Field T. , Hecker Aaron T. , Bigler Gregory T. , Boland Arthur L. , Hayes Wilson C.
Published: June 2007

Over 50% of all knee injuries involve partial or com plete tear of the anterior cruciate ligament. Surgical reconstruction of this ligament using an isometrically placed bone-patellar tendon-bone autograft is the cur rent technique of choice; however, harvest of patellar tendon as a free graft can lead to increased morbidity. To address this issue, allogenic patellar tendon grafts have been introduced as alternatives to autogenic graft material. The purpose of this study was to exam ine effects of age and strain rate on tensile strength, modulus, and failure mode of bone-patellar tendon- bone allografts from a typical population of tissue do nors. Eighty-two, fresh-frozen, bone-patellar tendon- bone allografts were harvested from 25 different donors, aged 17 to 54. Paired grafts from individual patellar tendons were assigned randomly to tensile testing at either 10% or 100% elongation per second. Tensile strength, modulus, and failure mode were not significantly different for tests conducted at these 2 strain rates. Correlations between tensile strength and age were not significant for tests conducted at either strain rate. Specimens tested at a strain rate of 100% per second exhibited weak but significant negative correlation between modulus and age, with modulus decreasing 25% over the age range examined.
Role of the Medial Structures in the intact and Anterior Cruciate Ligament-Deficient Knee
Authors: Haimes Jonathan L. , Wroble Randall R. , Grood Edward S. , Noyes Frank R.
Published: June 2007

We measured motion limits in human cadaveric knees before and after sectioning the anterior cruciate liga ment and the medial structures. Sectioning the medial collateral ligament in an anterior cruciate ligament- deficient knee increased the anterior translation limit at 90° of flexion but not at 30° of flexion. The tibia displaced straight anteriorly without exhibiting the coupled internal rotation that occurred in intact and anterior cruciate ligament-deficient knees.

A lateral 15 N-m abduction moment produced a coupled external rotation in the medial collateral ligament-deficient knee. This was in marked contrast to intact, anterior cruciate ligament-deficient, or combined medial collateral ligament and anterior cruciate ligament-deficient knees, in which an abduction mo ment produced a coupled internal rotation. Sectioning only the medial collateral ligament caused a small but significant increase in the abduction rotation limit, whereas larger increases in the abduction rotation limit occurred when the posterior oblique ligament and pos terior medial capsule were cut in addition to the medial collateral ligament.

Cutting the medial collateral ligament increased the external rotation limit. The increase was independent of whether the anterior cruciate ligament was intact or sec tioned. Subsequent cutting of the posterior oblique liga ment and posterior medial capsule further increased the external rotation limit.
Infrapatellar Contracture Syndrome
Authors: Paulos Lonnie E. , Wnorowski Daniel C. , Greenwald Ann E.
Published: June 2007

Infrapatellar contracture syndrome is an uncommon but recalcitrant cause of reduced range of motion after knee surgery or injury. The results and conclusions pre sented here are based on a retrospective clinical study evaluating the long-term outcome in 75 patients who developed infrapatellar contracture syndrome. These 75 patients (76 knees) were evaluated at an average followup of 53 months after the index (inciting) proce dure or injury. Comparing subgroups within the study population, factors that correlated with poorer results or more severe infrapatellar contracture syndrome were found to be acute anterior cruciate ligament repair or reconstruction, the use of patellar tendon autograft for anterior cruciate ligament reconstruction, nonisometric graft placement, multiple surgical procedures, use of closed manipulation, and the development of patella infera. We concluded that appropriate procedures can substantially increase the range of motion in patients with infrapatellar contracture syndrome. However, re sidual functional morbidity persists in many patients, and the outcome, as determined by subjective knee function scores, is only fair. The natural history of an anterior cruciate ligament-deficient knee appears to be more benign than the natural history of a knee that de velops infrapatellar contracture syndrome.
Arthroscopically Treated Tears of the Glenoid Labrum
Authors: Terry Glenn C. , Friedman Shep J. , Uhl Timothy L.
Published: June 2007

Labral tears and associated glenohumeral ligament in juries were classified and treated arthroscopically in 83 patients. Transverse labral tears were the most com mon. Subtle increased glenohumeral translation was noted in 24% of patients. Glenohumeral ligament injury was present in 58% of the shoulders, with the middle and superior ligaments or middle ligaments alone most commonly involved. These ligament injuries were clas sified into different groups based on severity. Partial excision of the torn labrum was the primary treatment in all patients and was combined with glenohumeral liga ment repair in 9 patients. Seventy-eight patients were available for subjective follow-up evaluation (average, 3.2 years), while 53 patients were objectively evaluated (average followup, 2.8 years). There were 14% excel lent, 71 % satisfactory, and 15% poor results. The main factor associated with poor results was a grade III gle nohumeral ligament injury in which only partial excision of the torn labrum was performed. There was a positive correlation between injury to both the superior and middle glenohumeral ligaments and increased anterior translation demonstrated by preoperative stability test ing at 60° of humeral abduction in neutral rotation. We believe glenohumeral ligament injury is often as sociated with labral tears and arthroscopic partial labral excision is only effective in those patients who have grade I or II (less severe) glenohumeral ligament injuries.
The Ligament Augmentation Device in Hamstring Grafts for Reconstruction of the Anterior Cruciate Ligament
Authors: Santi Mark D. , Richardson Allen B.
Published: June 2007

Twenty-eight patients who had reconstructions of the anterior cruciate ligament with a ligament augmentation device in the semitendinosus and gracilis tendons were compared with 32 patients who had reconstructions with semitendinosus and gracilis tendons alone. Pre operatively, there was no significant difference between the 2 groups with respect to age, sex, Tegner activity level, and time from injury to operation. Mean postop erative followup was 31.4 months for the augmentation group and 32.3 months for the nonaugmentation group. At postoperative evaluation, there was no difference in the 2 groups with respect to Lysholm knee scores, re turn to activity as measured by Tegner levels, KT-1000 arthrometer laxity testing, presence of pivot shift or Lachman sign, range of motion, and the patient's sub jective overall rating of the surgery. Twenty-six of the 28 patients (93%) with augmentation rated their results as either "good" or "excellent" compared with 30 of the 32 patients (94%) with no ligament augmentation who rated their results as good or excellent. Four patients with the ligament augmentation devices needed re- operation for recurrent effusions and pain. No patients in the nonaugmentation group had recurrent effusions.
The Effect of Physiotherapy on Standing Balance in Chronic Anterior Cruciate Ligament Insufficiency
Authors: Zätterström Rose , Friden Thomas , Lindstrand Anders , Moritz Ulrich
Published: June 2007

Body sway movements in the frontal plane in a single- limbed stance test were used to assess postural control in 26 patients with chronic anterior cruciate ligament insufficiency. The injured and the noninjured legs were tested before the patients were committed to physio therapy for 3 to 6 months. Follow-up tests were made after 3, 12, and 36 months. Significant disturbance of the balance of both legs was found before training, com pared with a reference group of normal subjects. Values of the noninjured leg were normalized after 3 months of training, but the injured leg still showed an increased body sway. Normal balance parameters on the injured side were found at examination after 12 months. Follow-up examination after 36 months proved persis tent normalization of the single-limbed balance on both sides.
The Effects of Ice on Blood Flow and Bone Metabolism in Knees
Authors: Ho Sherwin S. W. , Coel Marc N. , Kagawa Robert , Richardson Allen B.
Published: June 2007

The effects of an ice wrap, applied to a knee for 20 minutes, on blood flow and bone metabolism were measured using triple-phase technetium bone scans. Twenty-one subjects between 29 and 63 years of age were studied. A commercially available ice wrap was applied to one knee 20 minutes before scanning, while an identical wrap left at room temperature was applied to the opposite knee to act as a control. Scans of the knees were obtained at the completion of cooling, and the images were quantified by computer image analysis for each knee at each phase of the scan. Percentage of decrease in blood flow and subsequent bone uptake of technetium for the iced knee as compared with the op posite knee were calculated. All iced knees demon strated decreased arterial and soft tissue blood flow as well as decreased bone uptake, which is a reflection of changes in both bone blood flow and metabolism. The average decrease was 38.4% ± 4.97 in arterial blood flow, 25.8% ± 2.04 in soft tissue blood flow, and 19.3% ± 2.0 (standard error of the mean in each) in bone up take. This "ice effect" was not related to age, sex, knee circumference, or skin temperature after cooling. By de creasing blood flow and cell metabolism, ice theoreti cally can limit hemorrhage and cell death in the setting of acute traumatic injury. This study thus provides a scientific rationale for the use of ice as tested for such injuries to a large joint, whether in the soft tissues or bones.
Lower Extremity Range of Motion in the Recreational Sport Runner
Authors: Pink Marilyn , Perry Jacquelin , Houglum Peggy A. , Devine Dennis J.
Published: June 2007

The purposes of this study in the recreational runner were to describe and compare lower extremity sag ittal range of motion and vertical body displacement for slow and fast paces during treadmill and over ground running, and to compare timing of the running phases at the two paces. Vertical displacement of the body, and flexion and extension of the hip, knee, and ankle were measured with a motion analysis system at 200 hertz as the subjects self-selected the two paces. No statistically significant differences were seen when comparing sagittal motion on a treadmill with overground running. Statistically more vertical displacement during overground running was re corded when compared with treadmill running. Peak vertical force was near midstance when the ankle, knee, and hip approached maximum flexion. Results demonstrated that during a slow pace the approxi mate arcs of motion were: ankle, 50°; knee, 95°; and hip, 40°. During running at a fast pace, the hip re quired more extension in early swing; the hip and knee required more flexion in middle and late swings. The fact that ankle motion did not change with the different speeds gave credence to the belief that push-off, or toe-off, is not the source of power in running.
A Fivefold Reduction in the Incidence of Recurrent Ankle Sprains in Soccer Players Using the Sport-Stirrup Orthosis
Authors: Surve Iqbal , Schwellnus Martin P. , Noakes Tim , Lombard Carl
Published: June 2007

A study was undertaken to evaluate the effect of a semi rigid ankle orthosis (Sport-Stirrup) on the incidence of ankle sprains in soccer players during 1 playing season. Senior soccer players were divided into 2 groups: play ers with previous ankle sprains (N = 258) and players without such history (N = 246). The players in these groups were each randomly allocated to either a semi rigid orthosis or a control group at the start of the playing season. All subsequent injuries during the season and the total number of playing hours were documented. There was a significant reduction in the incidence of ankle sprains (injuries/1 000 playing hours) by ankles in the orthosis group with previous sprains (0.14) com pared with the nonbraced group with previous sprains (0.86). The incidence of ankle sprains was significantly higher in the nonbraced group with previous sprains (0.86) compared with the nonbraced group without pre vious sprains (0.46). Thus, in this study, a semirigid or thosis significantly reduced the incidence of recurrent ankle sprains in soccer players with previous history of ankle sprains.
Histology and Arthroscopic Anatomy of the Ulnar Collateral Ligament of the Elbow
Authors: Timmerman Laura A. , Andrews James R.
Published: June 2007

The histology and arthroscopic anatomy of the ulnar collateral ligament of the elbow were studied in cadav eric specimens. The capsule consists of two layers of collagen fibers, with two distinct ligamentous bundles corresponding to anterior and posterior portions of the ulnar collateral ligament. The posterior bundle consists of distinct collagen bundles within the layers of the cap sule ; the anterior bundle consists of a similar thickening within the capsular layers, with an additional ligament complex superficial to the capsular layers. With arthros copy only the anterior 20% to 30% of the anterior bundle of the ulnar collateral ligament could be visualized via the anterior portal. Only the posterior 30% to 50% of the posterior bundle could be seen via the posterior portals. After sectioning of the anterior bundle, joint instability was noted arthroscopically by an increased opening in the ulnohumeral joint with application of valgus stress. At arthroscopy ulnar collateral ligament tears may be visualized in part or not at all. To diagnose a tear or laxity in the ulnar collateral ligament, a demonstration of an increase in the opening of the ulnohumeral joint in re sponse to valgus stress is useful.
Isolated Rupture of the Patellar Tendon in Athletes
Authors: Kuechle David K. , Stuart Michael J.
Published: June 2007

The purpose of this study was to review patellar tendon ruptures in athletes treated with surgical repair. Six pa tellar tendon ruptures in five athletic patients were iden tified at our institution between 1980 and 1990. All pa tients had operative debridement and primary repair of the ruptured patellar tendon using nonabsorbable su tures passed through patellar drill holes at an average of 2.5 days after injury. Personal interview, physical ex amination, roentgenographic evaluation, and isokinetic strength testing were performed at an average of 6 years after surgery. At final followup, no patient had complaints referable to the patellar tendon repair; all were able to achieve their premorbid levels of sports at an average of 18 months after injury. No patient thought that the surgically repaired knee was unstable or activity-limiting. All patients demonstrated full range of motion and strength equal to or greater than that of the noninjured side. One patient required an arthroscopic lateral release for lateral patellar facet pressure syn drome with an excellent result. No complications oc curred ; no other reoperations were required. Complete disruption of the patellar tendon is an uncommon injury in athletic individuals without predisposing medical con ditions. After acute operative repair and aggressive re habilitation, an excellent and enduring functional outcome can be expected.
Effect of Bone Block Removal and Patellar Prosthesis on Stresses in the Human Patella
Authors: Friis Elizabeth A. , Cooke Francis W. , McQueen David A. , Henning Charles E.
Published: June 2007

Thermoelastic stress analysis was used to examine stresses on the anterior surface of patellae after patellar bone block excision for autogenous graft anterior cru ciate ligament reconstruction. Complications of anterior cruciate ligament injury often lead to degenerative changes in the knee that can require total knee joint replacement. It was hypothesized that stresses in a bone block-compromised patella may be increased even further by insertion of a patellar prosthesis. All pa tellae were first tested intact and then were retested after a sequence of surgical modifications including pa tellar prosthesis implantation, tapered bone block ex cision, square bone block excision, and both shapes of excised bone blocks with a patellar prosthesis in place. Stresses in patellae with bone blocks excised were sig nificantly greater than stresses in intact patellae. The anterior surface stress pattern in the loaded patella was significantly altered by excision of a bone block. There were no significant differences between maximum stress in patellae with tapered and square bone blocks excised. A finite element analysis showed that excision of a larger trapezoid-shaped bone block greatly in creased maximum stress levels. Insertion of a patellar prosthesis did not significantly alter stress patterns or maximum stress levels in the patella.
Upper Extremity Physical Factors Affecting Tennis Serve Velocity
Authors: Cohen David B. , Mont Michael A. , Campbell Kevin R. , Vogelstein Barry N. , Loewy John W.
Published: June 2007

Forty1 tournament-level tennis players with expert serve technique volunteered to have their serve evaluated to determine relationships between anthropometric data, extremity strength, and functional serve velocity. All players underwent a complete physical examination, a video taped serve analysis, a radar measurement of serve velocity, and a series of upper extremity strength measurements. Statistical analysis was performed to determine which factors were related to serve velocity. Statistically significant relationships were found be tween serve velocity and several flexibility measure ments including increased dominant wrist flexion (P < 0.05), increased dominant shoulder flexion (P < 0.05), and increased dominant shoulder internal rota tion at 0° of abduction (P < 0.05). Several strength mea surements were also related to serve velocity including elbow extension torque production (P < 0.01) and the ratios of internal to external rotational torque production for both low- and high-speed measurements (P < 0.01 concentrically and P < 0.05 eccentrically).

These findings relate strength and flexibility to serve ve locity, suggesting that it may be possible to increase a tennis player's serve velocity through specifically directed muscular strengthening or stretching regimens. However, prospective studies must be undertaken to demonstrate these possibilities.
The Effect of the Squat Exercise on Anterior-posterior Knee Translation in Professional Football Players
Authors: Panariello Robert A. , Backus Sherry I. , Parker Johnny W.
Published: June 2007

Although the squat exercise is considered essential for optimal athletic performance, controversy exists re garding the effect on knee stability. The purpose of this prospective study was to determine the effect of squat exercises on in vivo knee joint stability of professional football players. Thirty-two subjects with normal knees participated in a 21-week off-season training program. Subjects performed power squat exercises with barbell loads of 130% to 200% body weight twice weekly. Both knees of each subject were tested by a single examiner with a knee ligament arthrometer before the training program and at 12 and 21 weeks. Passive displace ments were recorded at 67, 89, and 133 N with the knee at 30° and 90° of flexion. Active testing was performed with the knee in the same positions. Student's paired t-tests were used to compare pre- and postexercise measures. For all subjects, no significant differences were found between pre- and postexercise results for active and passive tests. Of the 2440 measurements taken, only 8 demonstrated increased excursions greater than 2 mm.

This study demonstrates no significant increases in anterior-posterior tibiofemoral translation in athletes using the squat exercise as part of their off-season training program.
Excursion of the Rotator Cuff Under the Acromion
Authors: Flatow Evan L. , Soslowsky Louis J. , Ticker Jonathan B. , Pawluk Robert J. , Hepler Matthew , Ark Jon , Mow Van C. , Bigliani Louis U.
Published: June 2007

Nine fresh-frozen, human cadaveric shoulders were el evated in the scapular plane in two different humeral rotations by applying forces along action lines of rotator cuff and deltoid muscles. Stereophotogrammetry deter mined possible regions of subacromial contact using a proximity criterion; radiographs measured acromio humeral interval and position of greater tuberosity. Con tact starts at the anterolateral edge of the acromion at 0° of elevation; it shifts medially with arm elevation. On the humeral surface, contact shifts from proximal to dis tal on the supraspinatus tendon with arm elevation. When external rotation is decreased, distal and poste rior shift in contact is noted. Acromial undersurface and rotator cuff tendons are in closest proximity between 60° and 120° of elevation; contact was consistently more pronounced for Type III acromions. Mean acro miohumeral interval was 11.1 mm at 0° of elevation and decreased to 5.7 mm at 90°, when greater tuberosity was closest to the acromion. Radiographs show bone- to-bone relationship; stereophotogrammetry assesses contact on soft tissues of the subacromial space. Con tact centers on the supraspinatus insertion, suggesting altered excursion of the greater tuberosity may initially damage this rotator cuff region. Conditions limiting ex ternal rotation or elevation may also increase rotator cuff compression. Marked increase in contact with Type III acromions supports the role of anterior acromioplasty when clinically indicated, usually in older patients with primary impingement.