bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term functional results in patients with anterolateral rotatory instability treated by iliotibial band transfer
Authors: Vail T. Parker , Malone Terry R. , Bassett Frank H.
Published: June 2007

The purpose of this paper is to define the use of the extraarticular, lateral reconstruction in the spectrum of patients with cruciate deficiency. A review was con ducted of 112 consecutive patients with a Maclntosh type iliotibial band transfer done between 1972 and 1986. Fifty-six of the patients had a partial or complete meniscectomy, and 24% had failed a previous extraar ticular procedure. Eighty-one percent were men, with a mean age of 23. Twenty-five percent of the patients had radiographic degenerative changes at the knee at the outset. Ninety-eight percent had an anterior drawer of 1 + or greater; 97% had a pivot shift greater than trace. All patients had symptomatic knee instability. Seventy-seven of the 112 patients (69%) were available for followup (range, 24 months to 15.5 years; median, 7.6). Twenty-three patients (21 %) returned for exami nation, KT-1000 and Cybex testing, and radiographs. An additional 54 patients (48%) were seen by their local physicians or returned a detailed questionnaire that included the Cincinnati knee rating scale.

At final followup, 38% complained of some knee instability, 36% had recurrent effusions, 61 % had inter mittent pain, 79% had radiographic gonarthrosis, and 25% had undergone additional surgery. Forty-two per cent had a positive Lachman after surgery, and only 15% had a pivot shift. The mean knee score was 81.1. Previous extraarticular anterior cruciate ligament recon struction, meniscectomy, and generalized ligamentous laxity were associated with a significant decrement in the knee rating (P = 0.05). Ligamentous laxity strongly correlated with symptoms of giving way. Also, the incidence of pain, swelling, giving way, and activity modification correlated with meniscectomy and in creased as the length of followup increased for all patients.

In conclusion, this study suggests that extraarticular lateral reconstruction does not restore normal knee function, but does eliminate the pivot shift and may decrease the incidence of repeat knee injury in selected patients with symptomatic cruciate deficiency. Lateral reconstruction alone should be limited to low-demand patients without previous meniscectomy, or general ized ligamentous laxity in whom more anatomic recon struction is not possible.
Anterior cruciate ligament-medial collateral ligament injury: Nonoperative management of medial collateral ligament tears with anterior cruciate ligament reconstruction
Authors: Shelbourne K. Donald , Porter David A.
Published: June 2007

We present the results of a series of patients who had nonoperative management of the medial collateral lig ament with anterior cruciate ligament reconstruction. From February 1983 through December 1989, 84 of 90 consecutive patients were available for followup (mini mum, 1 year; mean, 3.1 years) with a combined anterior cruciate ligament-medial collateral ligament injury (an terior cruciate ligament rupture and medial collateral ligament tear) received surgical management by the same physician. The last 68 of these 84 patients who met the inclusion criteria underwent patellar tendon graft for anterior cruciate ligament reconstruction, with concomitant nonoperative management of medial col lateral ligament tears.

Follow-up evaluation consisted of physical examina tion for medial laxity, range of motion, and isokinetic and KT-1000 testing. Brace use and postoperative level of competition were also recorded. In addition, the patients completed a subjective assessment question naire rating pain, swelling, and stability. They also rated overall activity level, and any changes in their ability to do the activities tested: walk, climb stairs, run, jump, or twist. Our results indicate that proper reconstruction of the anterior cruciate ligament, in conjunction with nonoperative management of tears of the medial collat eral ligament in combined anterior cruciate ligament- medial collateral ligament injuries, can give excellent stability and good to excellent functional outcome in patients with combined anterior cruciate ligament-me dial collateral ligament injuries.
Evaluation of ultrasonography as a diagnostic technique in the assessment of rotator cuff tendon tears
Authors: Brenneke Stephen L. , Morgan Christopher J.
Published: June 2007

In this study we assessed the clinical usefulness of ultrasonography as a modality in the diagnosis of rota tor cuff tears. One hundred twenty patients with pre operative ultrasonography were analyzed by diagnostic arthroscopy to evaluate rotator cuff integrity. Two groups, 61 patients with a positive ultrasonogram and 59 patients with a negative ultrasonogram, were ana lyzed. The 61 patients with a positive ultrasonogram preoperatively were found to have 42 full-thickness tears and 19 partial-thickness tears. Diagnostic arthros copy confirmed a sensitivity of 95% for the full-thick ness tears and 41 % for the partial-thickness tears. In the 59 patients with negative ultrasonography, the specificity for full-thickness tears was 93% and in the 19 partial-thickness tears it was 91 %. Our conclusion is that ultrasonography is an effective modality for the assessment of full-thickness tears, but not partial-thick ness tears.
The subscapularis muscle and its glenohumeral ligament-like bands
Authors: Klapper Robert C. , Jobe Frank W. , Matsuura Peter
Published: June 2007

The subscapularis muscle and the distribution of its tendinous bands is of significance in the surgical man agement of the shoulder joint. This distribution pattern has not been previously described in detail. We feel that, in any anterior approach to the glenohumeral joint for fracture fixation, joint replacement, and soft tissue reconstruction, a thorough understanding of the distri bution pattern of the subscapularis bands is essential.

We examined the subscapularis muscles from five cadavers. Four sections from the lateral one-half of each muscle were custom-mounted and stained with Masson's trichrome. We found a consistent pattern in which the tendinous bands were evenly interspersed in the midportion of the muscle and condensed laterally into a single large, flat tendon in the superior two-thirds of the muscle. The inferior one-third remained muscular.

Understanding this pattern should help the surgeon have confidence that he/she has obtained a more se cure repair in procedures involving the subscapularis muscle.
Strength testing after third-degree acromioclavicular dislocations
Authors: Tibone James , Sellers Richard , Tonino Peter
Published: June 2007

Twenty male patients with a grade III acromioclavicular joint dislocation were evaluated more than 2 years after their injury; the average followup was 4.5 years. Strength testing was performed with a Cybex II dyna mometer in three planes evaluating flexion, extension, internal rotation, external rotation, abduction, and ad duction at 60 and 120 deg/sec. Subjective complaints were minor and neither daily activities nor athletic par ticipation were impaired. Objectively, only one patient had tenderness over the acromioclavicular joint. All patients had full motion and negative impingement signs. Strength testing with the Cybex II dynamometer showed no significant difference (P < 0.05) between the injured and uninjured shoulder for strength in inter nal rotation, external rotation, abduction, adduction, extension, or flexion at speeds of 60 and 120 deg/sec. This study shows that the strength of the shoulder is not significantly affected by conservative treatment of grade III acromioclavicular dislocations. Conservative treatment results in minimal or no functional deficit. The authors recommend that grade III acromioclavicular dislocations be treated nonoperatively.
Measurements of length and tension patterns during reconstruction of the posterior cruciate ligament
Authors: Ogata Kosuke , Mccarthy John A.
Published: June 2007

The twofold purpose of this study was to develop an intraoperative technique to assess isometric positioning of posterior cruciate ligament grafts and to demonstrate the rationale for postoperative immobilization of the knee in full extension after a posterior cruciate ligament reconstruction. Multiple femoral fixation sites were se lected on the medial intercondylar notch and the pos terior cruciate ligament substitute was assessed for changes in length and tension at each of these sites during knee flexion from 0° to 120°. The most isometric and isotonic femoral fixation site was localized over a small area slightly distal to the center of the medial intercondylar notch surface. This isometric point can be identified intraoperatively using recognizable surface markers within the knee.

When a posterior stress was applied to the proximal tibia, the posterior cruciate ligament substitute showed the least increase in tension and length when the knee was locked in full extension for all of the potential femoral attachment sites assessed. This suggests that postoperative immobilization should be maintained in full extension to limit the stress placed on the posterior cruciate ligament reconstruction.
Osseous injury associated with acute tears of the anterior cruciate ligament
Authors: Speer Kevin P. , Spritzer Charles E. , Bassett Frank H. , Feagin John A. , Garrett William E.
Published: June 2007

Multiplanar spin-echo magnetic resonance imaging was performed on 54 patients with acute complete anterior cruciate ligament tears. Imaging was done within 45 days of index anterior cruciate ligament injury. Spin- echo T1- and T2-weighted images were used to deter mine the lesion morphology and location. Only the T2- weighted sagittal images were used for the incidence assessment; T2-weighted spin-echo imaging reflects free water shifts and best indicates the acute edema and inflammatory changes from injury.

Eighty-three percent (45 of 54) of the knees had an osseous contusion directly over the lateral femoral con dyle terminal sulcus. The lesion was highly variable in size and imaging intensity; however, the most intense signal was always contiguous with the subchondral plate. Posterolateral joint injury was seen in 96% (43 of 45) of the knees that had a terminal sulcus osseous lesion determined by magnetic resonance imaging. This posterolateral lesion involves a spectrum of injury, in cluding both soft tissue (popliteus-arcuate capsuloliga mentous complex) and hard tissue (posterolateral tibial plateau) injuries.

The consistent location of the osseous and soft tissue injuries underscores a necessary similar mechanism of injury associated with these acute anterior cruciate ligament tears. Based on these characteristic findings, several proposed mechanisms of injury are discussed.
An injection technique to create a bloodless field in arthroscopically assisted anterior cruciate ligament reconstruction
Authors: Furia John P. , Zambetti George J.
Published: June 2007

We did a retrospective study of 67 patients who had arthroscopically assisted anterior cruciate ligament re construction using the middle one-third of the patellar tendon to evaluate a technique for creating a bloodless field using a local anesthetic with epinephrine injection (the injection technique). For 37 patients, the bloodless field was created using the injection technique. In 30 others, hemostasis was achieved in the usual fashion with the pneumatic tourniquet.

All patients underwent general anesthesia. Mean op erative time and length of hospital stay was similar for each group. Mean postoperative pain medication con sumption was significantly decreased for patients treated with the injection technique. No clinically rec ognizable complications could be attributed to either technique. We conclude that subcutaneous and intra articular injection of local anesthesia with epinephrine is a satisfactory method of establishing a bloodless field in arthroscopically assisted anterior cruciate ligament reconstruction operations.
Exercise performance of collegiate rodeo athletes
Authors: Meyers Michael C. , Wilkinson John G. , Elledge Jerry R. , Tolson Homer , Sterling James C. , Coast J. Richard
Published: June 2007

In this study we examined the physical, hematologic, and exercise response of 20 male and 10 female ath letes of the National Intercollegiate Rodeo Association, Central Rocky Mountain Region. Male subjects were grouped by roughstock, steer wrestling, and roping events. Female athletes were grouped separately. Max imal aerobic capacity, pulmonary ventilation, respiratory exchange ratio, energy expenditure, maximal heart rate, blood pressure, treadmill time, pre- and postex ercise lactate, percent body fat, lean body mass, blood chemistry, serum lipids, and reaction/movement time were analyzed by event. No significant differences (P > 0.05) were found in any of these categories between male events. Mean resting blood chemistry parameters of rodeo athletes were within normal ranges. Steer wrestling athletes possessed greater body size and lean body mass than other groups. When analyzing body composition, blood pressure, and total choles terol:high-density lipoprotein (HDL) cholesterol ratios, results indicate average to low risk for coronary heart disease. When compared to other intermittent-activity sport athletes, college rodeo athletes appear to have similar aerobic capacities, but possess lower lean body mass and greater percent body fat.
Stress fractures in ballet dancers
Authors: Kadel Nancy J. , Teitz Carol C. , Kronmal Richard A.
Published: June 2007

We surveyed 54 female dancers in two professional ballet companies. A total of 27 fractures were reported in 17 dancers. Metatarsal fractures were the most common (63%), followed by fractures of the tibia (22%) and spine (7%). Dancers who danced >5 hours per day were significantly more likely to have a stress fracture than those dancing <5 hours per day. Dancers in the stress fracture group also had a significantly longer duration of amenorrhea than those in the group with no stress fractures. No significant difference was found between the dancers who had stress fractures and those who did not with regard to any of the other variables examined. These data suggest that prolonged amenorrheic intervals and heavy training schedules may predispose ballet dancers to stress fractures. Of the 17 dancers with stress fractures, only 1 had neither of these risk factors.
Functional postoperative treatment of Achilles tendon repair
Authors: Carter Thomas R. , Fowler Peter J. , Blokker Cathy
Published: June 2007

Twenty-one patients with surgically repaired Achilles tendon tears that were treated postoperatively with a functional orthosis rather than routine cast immobiliza tion were evaluated. The orthosis allowed unrestricted plantar flexion and limited dorsiflexion to neutral. Toe- touch weightbearing crutch ambulation was allowed immediately and was gradually increased over the 6 to 8 weeks of treatment. Of the 21 patients, 14 were men and 7 were women; the average age at injury was 35.6 years (range, 19 to 65). The minimum followup was 2 years, with an average of 31 months. The repairs were acute in 18 of the patients and chronic in 3.

Subjectively, 16 patients felt they returned to their preinjury level of activity and only 1 was not satisfied with his result. Objectively, there were no significant alterations in ankle range of motion when compared to the contralateral limb, with plantar flexion unchanged and dorsiflexion increased an average of only 2°. The average plantar flexion and dorsiflexion strength, power, and endurance of the ankles as measured by isokinetic testing revealed no significant differences when comparing the operated leg to the nonoperated side: strength, 99% and 93%, respectively; power, 98% and 96%, respectively; and endurance, 93% and 91 %, respectively. The angles at which the peak torques occurred were similarly not statistically different. Two patients had superficial wound infections, and 1 had scar adherence of the skin to the tendon. No one had rerupture of the tendon.

In conclusion, while the many benefits of postopera tive early motion are well proven, there has been hesi tation to implement this after Achilles tendon surgery due to the concern of compromising the repair. As shown by this study, early controlled motion can safely and effectively be used following Achilles tendon repair in the motivated, reliable patient.
Nontraumatic clavicular osteolysis in weight lifters
Authors: Scavenius Michael , Iversen Bjørn Franc
Published: June 2007

In a previous study, we found an overrepresentation of weight lifters in patients who had a resection of the lateral end of the clavicle. To further investigate a possible association between competitive weight lifting and the development of nontraumatic osteolysis of the lateral end of the clavicle, we studied a group of 25 Danish weight lifters. This group was compared to an age-matched control group of 25 men who had never engaged in weight training procedures. None of the subjects had any history of trauma to the shoulder girdle. All 50 subjects underwent radiographic exami nation of both shoulder joints.

In the weight lifter group, seven cases (28%) dem onstrated classical radiographic findings of clavicular osteolysis, with loss of subchondral bone detail, tran slucency, and cystic changes, while four subjects (16%) had subjective symptoms but no radiographic changes. None of the individuals from the control group revealed similar symptoms or radiographic signs.

Thus, based on this limited material, the prevalence of the disorder is about 27%.
Anterior cruciate ligament reconstruction using a composite collagenous prosthesis
Authors: Dunn Michael G. , Tria Alfred J. , Kato Y. Pedro , Bechler Jeffrey R. , Ochner Robert S. , Zawadsky Joseph P. , Silver Frederick H.
Published: June 2007

We evaluated a prototype composite collagenous an terior cruciate ligament replacement device designed to possess the advantages of biological grafts and syn thetic materials. Collagenous anterior cruciate ligament prostheses were made by embedding 225 reconsti tuted type I collagen fibers in a type I collagen matrix, and placing polymethylmethacrylate bone fixation plugs on the ends. The collagenous prosthesis was used to replace the anterior cruciate ligament of 31 mature rabbits. At 4 and 20 weeks postimplantation, histologic and mechanical studies were performed on the devel oping neoligament tissue, and compared to values for the contralateral sham-operated control.

At 4 weeks, neoligament tissue infiltrated the collagen fibers of the prostheses. The tibial bone tunnel attach ment site contained new bone approaching the fibrous neoligament. The glutaraldehyde-treated prosthetic fi bers appeared intact, while the carbodiimide-treated prosthetic fibers began to resorb. The ultimate load and ultimate tensile strength of femur-neoligament-tibia complexes had decreased.

At 20 weeks, glutaraldehyde-treated fibers appeared partially intact; in contrast, the carbodiimide-treated prostheses appeared to be completely degraded, and were replaced by organized, crimped neoligament tis sue. The ultimate tensile strength and ultimate load increased substantially due to deposition and remod eling of neoligament tissue. The neoligament ultimate load was 2 to 4 times the initial load value of the prosthesis.

Implantation of a resorbable, composite collagenous anterior cruciate ligament prosthesis encourages the development of functional neoligament tissue. Studies are underway to optimize the mechanical and biological properties of the prostheses.
Meniscal repair using fibrin sealant and endothelial cell growth factor
Authors: Hashimoto Jun , Kurosaka Masahiro , Yoshiya Shinichi , Hirohata Kazushi
Published: June 2007

The effect of fibrin sealant and endothelial cell growth factor on the healing of defects of the avascular portion of canine menisci was investigated in 30 menisci of 15 adult mongrel dogs. The defects were treated in one of three ways: Group 1, the defect was left empty; Group 2, the defect was filled with fibrin sealant; and Group 3, the defect was filled with fibrin sealant and endothelial cell growth factor. The healing process was evaluated macroscopically and histologically at intervals of 1, 2, 6, 12, and 24 weeks. The average percentage of each defect that was filled with connective tissue was 5% in Group 1, 76.6% in Group 2, and 89.4% in Group 3. In the early phase of this repair, the extrinsic pannus-like tissue that contained many capillary vessels extended from the meniscosynovial junction into the defect. Sub sequently, organized fibrous connective tissue was formed, which had changed to cartilaginous tissue at 12 to 24 weeks. The combination of fibrin sealant and endothelial cell growth factor enhanced the neovascu larization and formation of granulation tissue, which accounted for the increased healing level in the avas cular portion of the meniscus.
Healing of the patellar tendon autograft after posterior cruciate ligament reconstruction— a process of ligamentization?
Authors: Bosch Ulrich , Kasperczyk Werner J.
Published: June 2007

Forty-eight skeletally mature sheep underwent poste rior cruciate ligament reconstruction with free patellar tendon autografts in one knee; the contralateral knee served as a control. Immediate rehabilitation without immobilization followed. Autograft healing was evalu ated by histologic, roentgenographic, and biomechani cal techniques up to 2 years postoperatively. After implantation, the autograft tissue underwent necrosis and degeneration, followed by a gradual healing proc ess comprising revascularization, cellular migration, and formation of an extracellular matrix. The autograft bone pegs were osseously incorporated by 6 weeks. After an initial loss of strength, the material properties of the operated knee recovered to only about one-third that of the control. Better alignment of the collagen fiber bundles resulted in increased material properties, up to approximately 50% of the control at 52 weeks. After 2 years, the autograft tissue was found to differ structur ally and mechanically from a ligament, suggesting that the autograft may never approach normal ligament characteristics. Degenerative alterations, the wide spread presence of type III collagen, and abnormal accumulations of glycosaminoglycans in the autograft correlated with a maximum stress of 60% and an elastic modulus of 70% of the control. Although ligamentiza tion was not seen, the staging of autograft healing into different phases based on distinct morphologic mani festations (necrosis, revitalization, collagen formation, and remodeling) and correlating with changing mechan ical properties may provide a rationale for rehabilitation protocols with a realistic evaluation of the loading ca pacity of the replacement tissue.
Incidence of injury in Texas high school football
Authors: DeLee Jesse C. , Farney William C.
Published: June 2007

This study was undertaken to determine the incidence of injury in high school football based on evaluation of 100 high schools in the State of Texas during a single football season (1989). Certified athletic trainers were the initial medical professionals providing on-site diag nosis and treatment of all injuries. An injury was defined as: 1) an incident causing an athlete to miss all or part of a single practice or game; 2) any incident treated by a physician; and 3) all head injuries reported to the athletic trainer. Data were collected that allowed cal culation of the time of exposure to injury per athlete in the sample.

There was 75.5% participation in the study by the certified athletic trainers in the 100 schools. A total of 4399 athletes in varsity football programs participated in the study. There were 2228 injuries, as defined in the study, during the period of study, giving an inci dence of injury of 0.506 injury per athlete per year. Severe injuries—those requiring hospitalization—were found in 137 cases, for an incidence rate of 0.031 injury per athlete per year. The incidence of reportable defined injury was calculated to be 0.003 injury per hour of exposure per student athlete. The knee was found to be the most commonly injured anatomic site; the ankle ranked second.
Ruptures of the pectoralis major muscle
Authors: Wolfe Scott W. , Wickiewicz Thomas L. , Cavanaugh John T.
Published: June 2007

We evaluated 12 patients with 14 ruptures of the pectoralis major muscle to compare surgical and con servative management of this injury. Because 9 of the injuries occurred while weight lifting, we performed an anatomic study on human hemithorax specimens dur ing a simulated bench press to determine the mecha nism of this rare occurrence.

Excursion of individual pectoralis muscle fibers was measured at seven points along the broad muscle origin by the use of fine wires connected to the humeral insertion and to dial gauges on the study apparatus. Excursions in the concentric and eccentric phases of the lift were expressed as a percentage of resting fiber length. The short, inferior fibers of the muscle length ened disproportionately during the final 30° of humeral extension. We concluded that the inferior fibers have a mechanical disadvantage in the final portion of the eccentric phase of the lift, and application of high loads to these maximally stretched fibers produces rupture.

We repaired five acute and two chronic ruptures, and measured peak torque and work production against the contralateral side using Cybex isokinetic testing. Surgically treated patients showed comparable torque and work measurements, while conservatively treated individuals demonstrated a marked deficit in both peak torque and work/repetition. We recommend repair of complete pectoralis muscle ruptures in active patients who require maximum strength in vocational or avoca tional activities.
Echographic and Doppler screening of the forearm arteries in professional volleyball players
Authors: Rosi Gianluigi , Pichot Olivier , Bosson Jean Luc , Calabrese Giuseppe , Carpentier Patrick
Published: June 2007

We evaluated nine professional volleyball players by clinical, echographic, and Doppler technique examina tion of the forearm and digital arteries to determine vascular damage caused by repeated trauma. The re sults of these tests showed that one-third of the sub jects had vascular lesions in the right hand; only one of these was symptomatic. This suggests that noninva sive screening should be recommended and included in the regular medical check-ups of professional ath letes in whom repeated trauma to the hand is likely, such as volleyball players.
Ultrasonography of chronic tendon injuries in the groin
Authors: Kälebo Peter , Karlsson Jon , Sward Leif , Peterson Lars
Published: June 2007

Ultrasonography was used in the diagnosis of 36 pa tients with chronic groin pain localized to the tendons of the rectus abdominis, rectus femoris, adductor mus cles, hamstring muscles, and the gluteal muscles. Ab normal findings, such as focal sonolucent areas and discontinuity of tendon fibers, that are indicative of nonhealed partial ruptures were found in 28 patients. These findings differed clearly from the asymptomatic contralateral side, which was used for comparison. The abnormalities were located in three different sites: at the tendon insertion, within the tendon, and at the tendomuscular junction. Ten patients were treated sur gically and the findings at surgery correlated well with the ultrasonographic findings of partial tendon tears: 9 were true-positive and 1 was a true-negative. Ultraso nography appears to be a valuable method in the diagnosis of chronic groin pain.
Augmented repair and early mobilization of acute anterior cruciate ligament injuries
Authors: Paessler Hans H. , Deneke Jörn , Dahners Laurence E.
Published: June 2007

This paper describes a technique for repair of the anterior cruciate ligament with protection of that repair by a synthetic augmentation device. Of 61 patients who underwent surgery 24 to 57 months (mean, 38.3) be fore data accumulation, 57 returned for followup. Sub jectively, 53 (93%) patients reported a good or excellent functional result; however, only 29 (51 %) of the patients returned to their preinjury sports level. Objectively, a radiographic Lachman test was performed on both the injured and the noninjured knee of all 57 patients. The preoperative mean difference between the knees was 8.6 mm (range, 4.6 to 17.2) and at followup it was 2.4 mm (range, -0.9 to 11.8). Radiographic abduction and adduction stress tests demonstrated stable healing of the (unrepaired) collateral ligament lesions (varus stress = 0.1 mm and valgus stress = 0.4 mm mean side-to- side difference), indicating that suturing of ruptured collateral ligaments is not necessary when the knee is centrally stabilized with the augmentation device. These results indicate that successful repair of the anterior cruciate ligament is frequently possible when enhanced with an augmentation device.
Static capsuloligamentous restraints to superior-inferior translation of the glenohumeral joint
Authors: Warner Jon J.P. , Deng Xiang-Hua , Warren Russell F. , Torzilli Peter A.
Published: June 2007

The purpose of this study was to determine the contri butions of specific capsuloligamentous structures to restraining superior-inferior translation of the glenohu meral joint. Eleven cadaveric shoulders were tested using a four degrees-of-freedom test apparatus. The humerus was free to translate in three planes and free to flex and extend when a superior and inferior force of 50 N was applied. Testing was performed in three positions of abduction (0°, 45°, and 90°) and three positions of rotation (neutral, maximum internal, and external). Shoulders were tested intact, vented, and after division of specific capsuloligamentous structures. The primary restraint to inferior translation of the ad ducted shoulder was the superior glenohumeral liga ment. The coracohumeral ligament appeared to have no significant suspensory role. With progressive abduc tion, the anterior and posterior portions of the gleno humeral ligament become the main static stabilizers resisting inferior translation: the anterior portion was the primary capsular restraint at 45° of abduction, while the posterior portion was the primary restraint at 90° of abduction, neutral rotation.

Our results indicate that clinical assessment of glenohumeral translation in the superior-inferior plane should be performed in multiple positions of abduction and rotation.
The effect of harvesting the central one-third of the patellar tendon on patellofemoral contact pressure
Authors: Eilerman Michael , Thomas Joseph , Marsalka David
Published: June 2007

This study assessed whether removing the central one- third of the patellar tendon, with or without side-to-side repair of the patellar tendon defect, would alter patel lofemoral pressure. Patellofemoral pressure was as sessed by testing five stable knees from five different cadaveric donors on a specially designed hydraulic knee machine. Patellofemoral joint pressures were measured by placing pressure-sensitive film into the patellofemoral articulation. The joint was loaded in a static fashion, with quadriceps forces consistent with walking (647 N) and stair climbing (1923 N), at 30°, 60°, and 90° of knee flexion. Using the same knees, the central one-third of the patellar tendon was then sectioned, and patellofemoral joint pressure measure ments were repeated at identical knee flexion angles and quadriceps forces. Side-to-side repair of the patel lar tendon defect was performed and patellofemoral joint pressure measurements were repeated.

There were no statistically significant differences be tween the control and sectioned values or between the control and repaired defect values. These results sug gest that harvesting the central one-third of the patellar tendon—with or without side-to-side repair of the pa tellar tendon defect—does not alter patellofemoral pressures.
A biomechanical evaluation of the iliotibial tract screw tenodesis
Authors: Lipscomb A. Brant , Woods G. William , Jones Alan
Published: June 2007

Biomechanical testing of the iliotibial tract screw teno desis was performed in 10 cadaveric knees under forces approximating in vivo conditions. Force versus displacement curves at various flexion angles were generated with the anterior cruciate ligament intact, with the anterior cruciate ligament sectioned, and after the iliotibial tract screw tenodesis had been performed. Displacement force was measured to 5, 10, and 15 mm. The iliotibial tract screw tenodesis was ineffective in reducing anterior translation of the tibia in the anterior cruciate ligament-deficient knee at forces approximat ing in vivo conditions.
The predictive value of radiographs in the evaluation of unilateral and bilateral anterior cruciate ligament injuries
Authors: Schickendantz Mark S. , Weiker Garron G.
Published: June 2007

A review of 250 cases of surgical reconstruction of the anterior cruciate ligament identified 24 patients with bilateral complete tears of the anterior cruciate liga ment. Twenty of these patients had previous recon struction of one anterior cruciate ligament before rup ture of the opposite ligament. Twelve injuries occurred during the same activity that was responsible for the initial opposite injury. The average time between sur gical reconstruction and rupture of the opposite liga ment was 29.3 months (range, 3 to 103). No significant demographic differences existed between patients with unilateral or bilateral ruptures of the anterior cruciate ligament.

Standardized measurements of intercondylar notch height and width and medial and lateral femoral condyle height and width were performed on routine notchview radiographs of 31 knees of patients with bilateral inju ries, 30 with unilateral injury, and 30 with no anterior cruciate ligament injury. Statistical analysis revealed no significant differences between the three groups when comparing absolute measures or any of eight mathe matical ratios calculated from these measurements. We concluded that measurements of the intercondylar notch made from radiographs may not be reliable pre dictors of injury to the anterior cruciate ligament. We found no significant clinical or demographic differences between patients with unilateral or bilateral complete ruptures of the anterior cruciate ligament.
Nonoperatively treated isolated posterior cruciate ligament injuries
Authors: Keller Paul M. , Shelbourne K. Donald , McCarroll John R. , Rettig Arthur C.
Published: June 2007

To evaluate the theory that isolated posterior cruciate ligament injuries do well when treated nonoperatively, we reviewed 40 patients (mean age, 33 years at fol lowup ; average interval from injury, 6 years) who com pleted a modified Noyes knee questionnaire and were reevaluated by physical examination, radiographs, and isokinetic testing. Thirty of the injuries to the posterior cruciate ligament were sports-related. On the question naire, 65% of the patients revealed that their activity level after injury was limited and 49% stated that the involved knee had not recovered fully despite rehabili tation. Ninety percent complained of knee pain with activity and 43% complained of problems with walking. The longer the interval between injury and this followup, the lower the knee questionnaire score and the greater the radiographic degenerative changes. The patients as a group exhibited excellent muscular strength with a mean isokinetic score of 99% of the contralateral extremity. There was no correlation between isokinetic testing and knee questionnaire score. Patients with greater posterior laxity, as measured by the posterior drawer examination, appeared to have greater subjec tive complaints. Our study suggests that patients with isolated posterior cruciate ligament injuries treated non operatively may maintain excellent muscle strength, but significant symptoms and degenerative changes in crease with increasing interval from injury.
Deterioration of patellofemoral articular surfaces after anterior cruciate ligament reconstruction
Authors: Shino Konsei , Nakagawa Shigeto , Inoue Masahiro , Horibe Shuji , Yoneda Minoru
Published: June 2007

One hundred eighty-seven patients who had undergone intraarticular anterior cruciate ligament reconstruction using either a fresh-frozen allogeneic tendon or central third autogenous patellar tendon 3 to 89 months pre viously were arthroscopically evaluated. The focus was on secondary changes of the patellofemoral joint at the time of second-look arthroscopy. Overall, 93 knees deteriorated, 74 knees remained unchanged, and 14 improved. The deteriorative changes were predomi nantly located around the central ridge of the patellae, although all but two knees remained free from anterior knee pain. Statistical multivariate analysis showed sur gical approach by conventional medial parapatellar in cision and use of the central one-third of the autoge nous patellar tendon graft as possible risk factors for the deterioration, although chi-square analysis failed to demonstrate statistical significance for the latter.
"Bone bruises" on magnetic resonance imaging evaluation of anterior cruciate ligament injuries
Authors: Graf Ben K. , Cook David A. , De Smet Arthur A. , Keene James S.
Published: June 2007

Magnetic resonance imaging of the knees of 98 con secutive patients with clinically diagnosed anterior cru ciate ligament injuries revealed 47 patients (48%) with focal signal abnormalities consistent with the diagnosis of a "bone bruise." Seventy-one percent of the magnetic resonance images taken within 6 weeks of injury dem onstrated a bone bruise, whereas no scans done longer than 6 weeks after injury showed a bruise ( P < 0.0001). Also significant was the tendency for lesions to be located in the lateral compartment ( P < 0.0001). In the sagittal plane, lesions were most likely to be in the middle third of the lateral femoral condyle and the posterior third of the lateral tibial plateau ( P < 0.0001). In 31 patients evaluated arthroscopically, there was no correlation between the presence or location of a bone bruise and articular alterations or meniscal tears ob served at surgery.
Women's intercollegiate gymnastics
Authors: Wadley Gail Hudash , Albright John P.
Published: June 2007

A prospective study was established to record the patterns of injury incurred by all members of a women's college gymnastics team. Twenty-six women were fol lowed over a 4-year period (53 gymnast seasons) from 1983 to 1987. To identify which injuries resulted in persisting impairment, these same athletes were con tacted again 3 years later. The 26 athletes sustained 106 injuries. Sixty (57%) of these were of acute onset and were related to an identifiable gymnastics event. The remaining 46 (43%) were of gradual onset or overuse injuries. For the follow-up phase, 22 of the 26 women were contacted from 10 to 70 months (38.5 average) after completion of their gymnastics careers. Forty-five percent of the injuries recorded in their com petitive years still bothered them at the time of followup, especially low back, ankle, great toe, shoulder, and knee injuries. Athletic and recreational activity exacer bated the complaints. Twenty-nine percent felt that their sports activity level was now limited. Forty-six percent felt that their injury was at less than full recovery, yet most felt that they were capable of strenuous physical activity and continued to be active despite complaints such as pain and stiffness.
Arthroscopic Bankart suture repair
Authors: Grana William A. , Buckley Peter D. , Yates Carlan K.
Published: June 2007

The purpose of this paper was to report our experience with an arthroscopic technique of repair for the Bankart lesion following shoulder instability. Twenty-seven pa tients (average age, 21.7 years) were followed for an average of 36 months after arthroscopic suture stabili zation of anterior shoulder instability. Patients were excluded if instability was multidirectional or voluntary and if there was radiographic evidence of a significant loss of glenoid bone stock. Clinical evaluation using a functional grading system showed that 10 patients were rated as excellent, 5 good, and 12 poor. Fourteen patients returned to their previous level of activity. There were 12 patients rated as failed; all had recurrent instability of the shoulder. Success was associated with a period of immobilization of 3 weeks or longer and a history of acute injury, especially subluxation. Failures were associated with shorter immobilization periods after surgery and in patients who had recurrent dislo cations. The younger patient, who may not have com plied with the immobilization protocol, also seemed to be associated with failure. Contact sports seem to leave a patient at high risk for recurrence. We recommend caution in the use of arthroscopic procedures for the competitive athlete in whom a second surgery and rehabilitation might mean loss of more sports partici pation.
Reconstruction of old anterior cruciate ligament tears with a Dacron prosthesis
Authors: Gillquist Jan , Odensten Magnus
Published: June 2007

Seventy patients with chronic anterior instability under went anterior cruciate ligament reconstruction with a Dacron prosthesis pretensioned to 60 N. Of these patients, 49% (34) had combined medial instability, 32% (22) had failed previous anterior cruciate ligament sur gery, and 37% (26) had previous meniscectomy. At reconstruction, 12 patients had their medial instability treated; 22 did not. Follow-up intervals were 3, 6, and 12 months and then each year to 5 years.

The 5-year followup included 69 patients; the other 1 had the ligament removed because of a synovial fistula at 8 months. Results were 23% prosthesis ruptures, 3% poor, 17% fair, 16% good, and 39% excellent. The 2-year results showed the same distribution, but a lower rupture rate, which was affected by placement of the tibial tunnel within the anterior one-third of the tibia (9 times increase) and coexisting nonrepaired me dial instability (5 times increase). Those patients with perfect placement of the ligament who also had good medial stability and no previous ligament surgery had no rupture at 5 years. The stability that was gained at surgery was gradually lost (-11.2% per year). At 5 years, the uninjured knee also had lost 41% of the preoperative stability; the mean laxity difference was within ±2 mm. The mean improvement in subjective knee function (Lysholm score 74.5 to 91.9) was main tained during the followup. The mean preoperative ac tivity level improved significantly, but did not reach the preinjury level. These results show that the Dacron prosthesis will not give acceptable results in salvage cases where other instabilities are left untreated.
The Dacron ligament prosthesis in anterior cruciate ligament reconstruction
Authors: Barrett Gene R. , Line Lawrence L. , Shelton Walter R. , Manning James O. , Phelps Ray
Published: June 2007

We studied 40 patients who underwent reconstruction for chronic anterior cruciate ligament deficiency with a Dacron ligament prosthesis using a modified MacIntosh over-the-top technique, augmented with iliotibial band. Thirty patients had undergone at least 1 prior surgical procedure on the affected knee, but only 7 patients had previous anterior cruciate ligament reconstruction.

All patients were followed for a mean of 47.5 months. The results at final followup demonstrated an average side-to-side arthrometer difference of 1.0 mm. The Lysholm score improved from 65 preoperatively to 89 at the end of the review; the Tegner activity level score improved from 3 to 5. Objectively, 75% of the patients had a negative Lachman test result and 95.1% of the subjects had negative or trace pivot shift results at review. Mild knee pain was still present with day-to-day activity in 87.7% of the patients.

Complications occurred in 27.5% of patients, includ ing five who had implant ruptures and two who had their grafts removed. Synovitis was a significant prob lem.

Based on our failure criteria, 47.5% (19) of the sub jects had failed results. In this study, radiologic evidence of tracer separation greater than 1 cm was a criterion of failure. With inclusion of tracer separation, the failure rate increased to 60.0% (24).

Multiple previous surgeries of any type had an ad verse effect on results. Damage to secondary stabiliz ers in these cases increased failure rate. Based on the high complication and failure rates, and relatively poor end result in this retrospective review, we cannot rec ommend this procedure.
An evaluation of pre- and postoperative nonsteroidal antiinflammatory drugs in patients undergoing knee arthroscopy
Authors: Nelson William E. , Henderson Richard C. , Almekinders Louis C. , DeMasi Ralph A. , Taft Timothy N.
Published: June 2007

The potential benefits of a nonsteroidal antiinflamma tory drug to 67 patients undergoing knee arthroscopy were evaluated in a prospective, randomized, placebo- controlled, double-blinded study. Group A received the drug (diclofenac, 75 mg twice daily) for 3 to 5 days before and for 7 days after surgery. Group B received a placebo preoperatively and the drug postoperatively. Group C received a placebo at both times. Codeine was available postoperatively for all patients if needed. Outcomes reported by the subjects included pain, crutch use, and return to activities. Outcomes assessed by physicians included knee effusion, range of motion, and gait. Knee flexion and extension strengths were measured isokinetically pre- and postoperatively.

Pain scores on the 1 st postoperative day were higher in Group C than in Group A. Pain scores at all other time points were not significantly different in the three treatment groups. Groups A and B required less co deine during the first 72 hours after surgery than Group C (mean, 2.9 ± 1.0 versus 6.8 ± 1.0 pills). Recovery of function, recovery of strength, and physical examina tion parameters were not significantly different in the three treatment groups.

Diclofenac was an effective analgesic in the immedi ate postoperative period. Recovery from arthroscopy, however, was not enhanced by taking the drug.
Australian snowboard injury data base study
Authors: Bladin Christopher , Giddings Patrick , Robinson Mark
Published: June 2007

Information on the rate and spectrum of snowboarding injuries is limited. This 4-year prospective study at 3 major Australian ski resorts assesses incidence and patterns of snowboarding injuries, particularly in rela tion to skill level and footwear. Ski injury data were collected for the same period. In a predominantly male study population (men:women, 3:1), 276 snowboarding injuries were reported; 58% occurred in novices. Fifty- seven percent of injuries were in the lower limbs, 30% in the upper limbs. The most common injuries were sprains (53%), fractures (24%), and contusions (12%). Comparing skiers' versus snowboarders' injuries, snowboarders had 2.4 times as many fractures, partic ularly to the upper limbs (21 % versus 35% of upper limb injuries), fewer knee injuries (23% versus 44% of lower limb injuries), but more ankle injuries (23% versus 6% of lower limb injuries). Ankle injuries were more common with soft-shell boots, worn most by interme diate and advanced riders. Knee injuries and distal tibial fractures were more common with hard-shell boots, worn most by novices. Overall, novices had more upper limb fractures and knee injuries; intermediate and ad vanced riders had more ankle injuries. Falls were the principal mode of injury. To prevent injury, beginners should use "hybrid" or soft-shell boots and take les sons.