bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Anabolic Steroids on Rat Tendon
Authors: Inhofe Perry D. , Grana William A. , Egle Davis , Min Kyung-Whan , Tomasek James
Published: June 2007

Forty-eight male rats were randomly separated into four groups: a control group, a group treated with anabolic steroids, a group treated with daily exercise, and a group treated with both steroids and exercise. At 6 weeks, biomechanical, ultrastructural, and biochemical testing was performed on the Achilles tendons of half of the rats in each group. The remaining rats continued in the experimental protocol, but steroid administration was discontinued. Similar testing was then performed on the remaining rats at 12 weeks. Testing showed ana bolic steroids produced a stiffer tendon that absorbs less energy and fails with less elongation; tendon strength was unaffected. Effects were entirely revers ible on discontinuation of the steroids. Light microscopic analysis revealed no changes in the appearance of the fibrils. No change in fibril diameter or shape was noted on electron microscopic analysis. Biochemical testing revealed no change in qualitative immunofluorescence staining with Type III collagen or fibronectin. Abuse of anabolic steroids is a widespread problem among com petitive athletes; consequently, complications after their use are seen with increasing frequency. Knowledge of the effects of these drugs on tendon and the muscu lotendinous unit may prove helpful in counseling ath letes who use anabolic steroids.
Arthroscopic Bankart Procedure: Two- to Five-Year Followup With Clinical Correlation to Severity of Glenoid Labral Lesion
Authors: Green Michael R. , Christensen Kevin P.
Published: June 2007

We report our results using the arthroscopic Bankart technique described by Morgan (transglenoid suture) on 60 consecutive patients with anterior instability. All had detachment of the glenoid labrum at surgery. Forty- seven patients were available for final followup, which ranged from 2 to 5 years. Of these patients, 18 had experienced recurrent dislocation and 3 had experi enced episodes of subluxation after surgery, for an overall failure rate of 42%. Partway into the study, we began to correlate severity of glenoid labral lesion with outcome. We classified the labral lesion in 37 patients using stringent criteria at the time of surgery. Followup among these patients averaged 37 months. Of 22 cases of simple detachment of the labrum with no other sig nificant lesion (Type II labrum), there was one failure (4.5%). Of the 15 cases with significant or complete degeneration of the glenoid labrum-inferior glenohu meral ligament complex (Types IV or V labra), 13 failed (87%). Of the patients without recurrent instability, loss of external rotation averaged 1.5°, strength was 5+/5+ in abduction and external rotation. Average postopera tive function was 94% of preinjury levels subjectively, and most patients were able to return to previous ac tivities, including throwing and other overhead sports. Our findings indicate that rates of redislocation after this arthroscopic Bankart procedure correlate directly with the degree of glenoid labrum-inferior glenohumeral liga ment complex lesion.
Degenerative Joint Disease in Female Ballet Dancers
Authors: Niek van Dijk C. , Lim Liesbeth S. L. , Poortman Alina , Strübbe Ernst H. , Marti Rene K.
Published: June 2007

The relationship between long-term ballet dancing and eventual arthrosis of the hip, ankle, subtalar, and first metatarsophalangeal joint was examined in 19 former professional female dancers, aged 50 to 70 years. The dancers were compared with pair-matched controls. All 38 women underwent medical history taking, clinical ex amination, and roentgenography of the joints studied. The roentgenographs were independently judged by two investigators and grouped according to a modified classification of Hermodsson. We found a statistically significant increase in roentgenologic arthrosis of the ankle, subtalar, and first metatarsophalangeal joints in the ballet group compared with the control group. There was no significant difference regarding degenerative changes of the hip joint. However, subjects in the dance group who had evidence of degenerative changes on roentgenographs had no clinical complaints. There was a statistically significant increase in hallux valgus de formity in the ballet group ( P < 0.05). The dancers also showed a statistically significant increase in flexion, ex ternal rotation, and abduction of the hip joint, dorsal flex ion of the first metatarsophalangeal joint, and inversion and eversion of subtalar joint. But the control group had statistically significant increased plantar flexion of the first metatarsophalangeal joint. The most important cause of the statistically significant increase of arthrosis of the ankle and first metatarsophalangeal joints must be explained by repetitive microtrauma.
The Abductor and Adductor Strength Characteristics of Professional Baseball Pitchers
Authors: Wilk Kevin E. , Andrews James R. , Arrigo Christopher A.
Published: June 2007

The purpose of this investigation was to establish a data base regarding the isokinetic muscular performance characteristics of the abductor and adductor muscles of professional baseball pitchers. Eighty-three healthy professional baseball pitchers (mean age, 22.6 years; mean weight, 199 pounds) were evaluated by use of a Biodex isokinetic dynamometer. Isokinetic tests were performed concentrically at 180 and 300 deg/sec for both the throwing and nonthrowing shoulders. The test ing protocol and test repetitions were standardized for each subject. Statistical analysis was performed using a paired t-test. Determination of the correlation coeffi cient was made at the P< 0.05 level of significance. Test results for bilateral comparisons of mean peak torque for the throwing and nonthrowing shoulders demon strated a significant difference in adductor values be tween the dominant and nondominant shoulders at both test speeds. There were no significant differences be tween extremities for the shoulder abductor muscles. The abductor-to-adductor muscle ratios between the throwing and nonthrowing shoulders were also statis tically significant at both test speeds. Throwing arm val ues were 82.5% at 180 deg/sec and 93.8% at 300 deg/ sec compared with only 66.0% and 70.3%, respectively, for the nonthrowing shoulders.
Surgical Treatment of Complete Acromioclavicular Dislocations
Authors: Weinstein David M. , McCann Peter D. , Mcllveen Stephen J. , Flatow Evan L. , Bigliani Louis U.
Published: June 2007

Forty-four patients, ranging in age from 17 to 57 years (average, 32), were evaluated an average of 4 years (range, 2 to 9) after surgical reconstruction for Allman- Tossy Grade III acromioclavicular dislocations. Twenty- seven patients underwent repair for acute injuries (<3 weeks after injury) and 17 patients underwent recon structions for chronic injuries (>3 weeks). Coracocla vicular fixation with heavy nonabsorbable sutures was used to correct superior displacement in all cases. In addition, transfer of the coracoacromial ligament to the distal clavicle was performed in 15 of the 27 early re pairs and 17 of the 17 late reconstructions. Overall, 26 of 27 (96%) early repairs and 13 of 17 (77%) late re constructions achieved satisfactory results. There was a trend for better results and return to sports or heavy labor with early repairs; however, this was not statisti cally significant (P = 0.065). When the results of early repairs were compared with those of late reconstruc tions performed more than 3 months after injury, the results of the shoulders undergoing early repair were significantly better ( P < 0.01). Overall, 39 of 44 (89%) patients achieved a satisfactory result. Surgical recon struction for acromioclavicular dislocation provides re liable results including use of the arm for sports or repetitive work.
The Effect of Kurosaka Screw Divergence on the Holding Strength of Bone-Tendon-Bone Grafts
Authors: Pierz Kristan , Baltz Matthew , Fulkerson John
Published: June 2007

Fresh-frozen porcine knees were used to demonstrate the effects of diverging Kurosaka screw placement on linear load to failure in simulated anterior cruciate liga ment reconstructions. Screws, placed anteromedially (rear-entry or tibial type) or intraarticularly (endoscopic femoral type) into each tibia, were directed at 0°, 15°, or 30° divergence angles relative to a guide wire. Grafts were axially loaded to failure to determine holding strength. Hierarchical analysis of variance was used to analyze differences between tibial side and endoscopic femoral type screw placement and the angles of diver gence. Overall, the difference in pullout strength be tween rear-entry (or tibial side) and endoscopic femoral type fixation was shown to be statistically significant (P < 0.001). Anteromedially placed screws showed a sta tistically significant decrease in holding strength at 15° and 30° compared with 0° of divergence (P < 0.05). Intraarticular screw placement resulted in a statistically significant decrease in holding strength only at 30° of divergence (P < 0.05). This study supports the impor tance of accurate screw placement within the tibia to ensure optimal interference fixation and suggests that endoscopic screw placement may offer significant added security when there are minor degrees of divergence.
Fractures of the Sesamoid Bones of the Thumb
Authors: Dong Paul R. , Seeger Leanne L. , Shapiro Matthew S. , Levere Scott M.
Published: June 2007

Stability of the thumb metacarpophalangeal joint is pro vided by the collateral ligament proper, the accessory collateral ligament, the proximal and distal palmar liga ments, and the palmar plate. The adductor pollicis and flexor pollicis brevis muscles also provide soft tissue support and insert on the proximal phalanx of the thumb by way of the sesamoid bones. Fractures of the meta carpophalangeal joint sesamoid bones are uncom mon but are often associated with sporting injuries during which the joint is acutely hyperextended. Rou tine anteroposterior and lateral radiographs may be unremarkable, and oblique views are often necessary to document the fracture.

We report eight cases of fracture of the thumb meta carpophalangeal joint sesamoid. Seven were isolated sesamoid fractures, and one was associated with a metacarpophalangeal joint dislocation. None of the fractures were evident on anteroposterior radiographs, but all were seen in the oblique projection. Six fractures were treated with splint or cast immobilization for 2 to 3 weeks, and two were taped. Clinical followup of the seven patients with isolated sesamoid fracture at 6 to 8 weeks revealed pain-free normal function. One patient could not be reached for followup.
Anterior Shoulder Dislocation
Authors: Westin Craig D. , Gill Edward A. , Noyes Michael E. , Hubbard Margaret
Published: June 2007

Anterior shoulder dislocation is a common skiing injury. Several methods are available for reduction of shoulder dislocations. We evaluated a method for reduction of anterior shoulder dislocation that has not previously ap peared in the literature. This method is performed with the patient seated in a chair with the chair used as coun tertraction. The physician applies traction to the affected shoulder using downward pressure on a loop of stocki nette wrapped around the patient's forearm. Our method was successful in 97% of 118 anterior dislo cations with no complications. Ninety-three percent were performed without the use of narcotic analgesia.
Prolonged Reaction Time in Patients with Chronic Lateral Instability of the Ankle
Authors: Löfvenberg Richard , Kärrholm Johan , Sundelin Gunnevi , Ahlgren Olof
Published: June 2007

Impaired proprioception has been suggested as one cause of chronic lateral instability of the ankle. We sub jected 15 ankles in 13 patients with symptoms of chronic lateral instability to sudden angular displacement. The reaction times in the peroneus longus and the tibialis anterior muscles were recorded and compared with those from 15 control ankles. Significantly longer ipsi lateral reaction time was recorded in the patients (65 ms) compared with the controls (49 ms). We concluded that delayed proprioceptive response to sudden angular displacement of the ankle may predispose an individual to or be a cause of chronic lateral instability of the ankle.
Basketball Shoe Height and the Maximal Muscular Resistance to Applied Ankle Inversion and Eversion Moments
Authors: Ottaviani Robert A. , Ashton-Miller James A. , Kothari Sandip U. , Wojtys Edward M.
Published: June 2007

To determine if the height of a basketball shoe alters the maximal inversion and eversion moment that can be actively resisted by the ankle in the frontal plane, we tested 20 healthy, young adult men with no recent ankle injuries. Subjects underwent unipedal functional ankle strength testing under weightbearing conditions at 0°, 16°, and 32° of ankle plantar flexion using a specially designed testing apparatus. Testing was performed with the subject wearing either a low- or a three quarter- top basketball shoe. Shoe height did not significantly affect an individual's ability to actively resist an eversion moment at any angle of ankle plantar flexion. However, tests at 0° of ankle plantar flexion demonstrated that the three quarter-top basketball shoe we tested significantly increased the maximal resistance to an inversion mo ment by 29.4%. At 16° of ankle plantar flexion, inversion resistance was also significantly improved by 20.4%. These results show that athletic shoe height can signifi cantly increase the active resistance to an inversion mo ment in moderate ankle plantar flexion. The findings apply to a neutral foot position in the frontal plane, an orientation equivalent to the early phase of a potential ankle sprain.
Acromioclavicular Reconstruction Augmented with Polydioxanonsulphate Bands
Authors: Hessmann Martin , Gotzen Leo , Gehling Hermann
Published: June 2007

During a 5.5-year period, we treated 64 patients with acute acromioclavicular separations by surgical recon struction. According to the classification of Rockwood and Matsen, 54 patients had type III lesions, 1 patient had a type IV lesion, and 9 patients had type V lesions. Both the coracoclavicular ligaments and the ligaments of the acromioclavicular joint were reconstructed. An additional ligamentous augmentation was performed using completely resorbable 5- and 10-mm polydiox anonsulphate bands. Forty-five patients (70%) were re- examined at 2 to 7.5 years after surgery (mean, 32 months). The results were good or excellent in 40 cases (89%). Forty-one patients (92%) achieved a range of motion with an abduction deficit of less than 20°. Cal cifications in the area of the coracoclavicular or acro mioclavicular ligaments did not affect the final range of motion. Complications consisted of one subcutaneous infection, one deep infection, and one failure of the re construction. Augmenting the reconstruction with poly dioxanonsulphate bands allowed an early functional postoperative treatment. With this procedure, patients do not require removal of an implant, and complications from breakage or migration of metal implants are avoided.
Treatment of Osteitis Pubis in Athletes
Authors: Holt Mark A. , Keene James S. , Graf Ben K. , Helwig Dennis C.
Published: June 2007

This study presents the results of treatment of osteitis pubis in 12 intercollegiate athletes. Early in this series, athletes were treated with prolonged rest, oral antiin flammatory medications, and hip-stretching exercises. Of the nine athletes treated in this manner, only one resumed symptom-free activity after 16 weeks of therapy; eight remained symptomatic and subsequently received a corticosteroid injection (1 ml 1% lidocaine, 1 ml 0.25% bupivacaine, and 4 mg dexamethasone) into the pubic symphysis. Of these eight athletes, three returned to full participation within 3 weeks of injection, four required a second injection to alleviate their symp toms, and one was unable to resume athletic activities despite two injections and an inguinal herniorrhaphy. In recent years, we have recommended an injection if there is no reduction in symptoms after 7 to 10 days of treatment. Three athletes received a corticosteroid in jection when their symptoms did not resolve. All three returned to full athletic competition within 2 weeks of the injection. The results of our study suggest that a more rapid return to intercollegiate athletics can be achieved through the judicious use of corticosteroid injections.
Arthroscopic Findings Associated with Roof Impingement of an Anterior Cruciate Ligament Graft
Authors: Watanabe Bruce M. , Howell Stephen M.
Published: June 2007

Nineteen patients with roof impingement of an anterior cruciate ligament graft had their grafts inspected during second-look arthroscopy. The diagnosis of roof im pingement was suspected from the clinical findings of an effusion, extension deficit, recurrent instability, or an terior knee pain. The diagnosis was confirmed when a portion of the tibial tunnel was anterior to the tibial in tersection of the slope of the intercondylar roof on a lateral roentgenogram of the fully extended knee. Dur ing second-look arthroscopy the impinged anterior cru ciate ligament graft had one or more of the following features: fractured bundles, guillotined remnants at the tibial insertion, parallel fragmentation of an uninter rupted graft, fibrous nodule, or an extrusion of graft ma terial at the outlet of the notch. We hypothesize that these changes in the integrity of the anterior cruciate ligament graft are caused by mechanical injury from roof impingement.

Clinical Relevance. One should suspect that a patient with an effusion, extension deficit, recurrent instability, or anterior knee pain after an anterior cruciate ligament reconstruction may have roof impingement. A lateral roentgenogram in full extension is diagnostic if the tibial tunnel is anterior to the intercondylar roof. The surgeon should be aware that impinged grafts can have a variety of arthroscopic appearances in addition to the previ ously reported fibrous nodule or Cyclops lesion.
Acute Hemarthrosis of the Knee in Children
Authors: Matelic Thomas M. , Aronsson David D. , Boyd Dale W. , LaMont Richard L.
Published: June 2007

The purpose of this study was to determine the cause of acute hemarthrosis of the knee in a prospective pe diatric patient population. Between December 1988 and August 1991, 21 consecutive children who were seen with an acute traumatic hemarthrosis of the knee had an arthroscopic evaluation. The average age of the chil dren at the time of injury was 14 years, 3 months (range, 10 to 17 years). The mechanism of injury was a torsional strain to the knee in 12 (71%) of the 17 patients who could accurately remember the injury. The initial evalu ation included a history, physical examination, and an teroposterior, lateral, sunrise, and comparison radio graphs. The arthroscopic procedure was performed under general anesthesia, and the arthroscopic findings were compared with preoperative findings. During ar throscopic examination, an osteochondral fracture of the lateral femoral condyle or patella was identified in 14 (67%) of the 21 patients. Preoperative radiographs failed to identify the fracture in 5 (36%) of the 14 patients who had an osteochondral fracture. The anterior cru ciate ligament was visualized and probed; an injury was found in only two cases (10%). We concluded that in children an acute traumatic hemarthrosis reflects a ma jor injury to the knee. The children in this study had a high frequency of osteochondral fractures; ACL injuries were found in only two patients. Because of the unre liable nature of radiographic evaluation, arthroscopic evaluation is a valuable tool in differential diagnosis and treatment of acute hemarthrosis of the knee.
Early Versus Late Reconstruction for Anterior Cruciate Ligament Rupture
Authors: Marcacci Maurilio , Zaffagnini Stefano , Iacono Francesco , Pia Neri Maria , Petitto Aldo
Published: June 2007

We investigated the clinical and laxity testing results at 5 years' followup in patients who had early or late anterior cruciate ligament reconstruction. Twenty-three patients (Group I) were treated within 15 days of injury. Fifty-nine patients (Group II) were treated more than 3 months after injury. Patellar tendon reconstruction and fascia lata graft augmented with a ligament augmentation device were the techniques used in both groups. According to the Inter national Knee Documentation Committee rating scale, 17 patients in Group I and 38 patients in Group II had satis factory results. The Lysholm score was good in all Group I patients and in 55 Group II patients. Flexion-extension deficits were comparable for both groups. Eighteen pa tients (78%) in Group I demonstrated satisfactory results according to the KT-2000 arthrometer testing, compared with 44 (75%) in Group II. No associated lesions were present in 12 (52%) cases in Group I, compared with 26 (44%) cases in Group II. Return to sports at the preop erative level was obtained by 21 (91 %) patients in Group I, compared with 42 (71 %) in Group II. The patients who had reconstruction during the early phase returned to sports activities sooner and had better clinical and laxity testing results.
Rupture of the Ischial Origin of the Hamstring Muscles
Authors: Orava Sakari , Kujala Urho M.
Published: June 2007

We treated eight patients who had complete rupture of the ischial origin of the hamstring muscles. This uncom mon injury results from a sudden forceful flexion of the hip joint when the knee is extended and the hamstring muscles powerfully contracted. The injuries occurred during athletic exercise in six men and two women who had a mean age of 40 years (range, 22 to 53). With prompt diagnosis and surgery the final functional results in these patients were good. If the diagnosis is delayed, it is not possible to accomplish a primary suture of the hamstring muscles to the ischial bone. Consequently, another surgical procedure will need to be performed to restore function. Unlike cases of bony avulsion of the ischial apophysis in growing children, acute complete rupture of the proximal hamstring muscles origin in adults should be treated with prompt surgery.
Traumatic Fibular Shaft Fractures in Athletes
Authors: Slauterbeck James R. , Shapiro Matthew S. , Liu Stephen , Finerman Gerald A. M.
Published: June 2007

A direct blow to the leg resulted in fibular shaft fractures in three elite college athletes participating in contact sports. None of the athletes had prior symptoms sug gestive of a stress fracture. All three athletes had benign-appearing fractures and were treated nonopera tively. Ultimate healing was delayed, occurring on av erage at 23 weeks, and each case was complicated by refracture. Fractures of the fibular shaft in athletes may require more aggressive treatment than other simple fractures to allow sufficient healing to withstand the rigors of athletics.
Grip Lock Injuries to the Forearm in Male Gymnasts
Authors: Samuelson Matthew , Reider Bruce , Weiss David
Published: June 2007

We performed an epidemiologic survey to estimate the number of grip lock injuries occurring among male high school and college gymnasts. These injuries occur when dowel grips used by the gymnast become locked on the bar as the gymnast's momentum carries him through the skill being performed. We also questioned injured gymnasts to obtain details of their injuries. Thir ty-eight high school coaches reported 17 injuries and 32 college coaches reported 21 injuries for a 10-year period; 36% of the coaches responding reported at least one such injury in their program. Of the 23 injured gymnasts who returned detailed questionnaires, 20 had sustained fractures and 9 required surgery. The distal forearm or wrist were the areas injured most often. Fourteen gymnasts had residual pain, seven had functional limitations, and eight had limited motion in the wrist. Fifteen of the 23 athletes were using a cubital (hyperpronated) grip at the time of injury and 19 were using dowel grips. Among the reasons cited for the injury, 18 gymnasts thought that their grips were either too large, worn, or stretched; 8 said the grips slid up their wrists, and 7 cited technical errors.
Relative and Absolute Reliability of the KT-2000 Arthrometer for Uninjured Knees
Authors: Myrer J. William , Schulthies Shane S. , Fellingham Gilbert W.
Published: June 2007

We assessed the reliability of the KT-2000 knee ar thrometer at 67, 89, 134, and 178 N and at manual maximum forces on 30 college students who were free from present or previous knee injuries. Two examiners tested all subjects on two occasions. Anterior laxity (P < 0.0001) and side-to-side difference ( P < 0.05) sig nificantly increased as force increased. There was a significant difference ( P < 0.0001) between testers for anterior laxity but not for side-to-side difference. We used intraclass correlation coefficients to estimate rel ative reliability. Anterior laxity intraclass correlation co efficients (2,1) between testers ranged from 0.81 to 0.86 and within tester correlations ranged from 0.92 to 0.95. Intraclass correlation coefficients for between testers for side-to-side differences ranged from 0.38 to 0.58 and within tester correlations ranged from 0.53 to 0.64. Subject-to-subject variability needs to be taken into account when interpreting intraclass correlation coefficient values. Our absolute reliability estimates (95% confidence intervals) were small, indicating little variability. Our data demonstrate the KT-2000 arthrom eter to be reliable. Researchers should present both relative and absolute reliability estimates, although we believe absolute estimates are of greater clinical value. Side-to-side differences are better discriminators than individual absolute values. We recommend that a <3 mm side-to-side difference be used to indicate stable knees.
The Role of Fatigue in Susceptibility to Acute Muscle Strain Injury
Authors: Mair Scott D. , Seaber Anthony V. , Glisson Richard R. , Garrett William E.
Published: June 2007

We investigated the role of fatigue in muscle strain injuries using the extensor digitorum longus muscles of 48 rabbits. The muscles of the rabbits were fatigued by 25% or 50% then stretched to failure and compared with the contralateral controls. Three rates of stretch were used. The force to muscle failure was reduced in the fatigued leg in all groups (range, 93% to 97.4% compared with the controls). The change in muscle length in the fatigue groups was not different from the controls. The amount of energy absorbed in the fa tigued muscle was 69.7% to 92% that of the energy absorbed in the control muscle. The lowest energy absorption occurred in muscles that were more fa tigued. In eight additional rabbits, fatigued extensor digitorum longus muscles were compared with sub- maximally stimulated muscles with the equivalent con tractile properties, and no difference was seen. Mus cles subjected to strains are frequently injured under high-intensity eccentric loading conditions. Under these conditions, muscles absorb energy and provide control and regulation of limb movement. Our data showed that muscles are injured at the same length, regardless of the effects of fatigue. However, fatigued muscles are able to absorb less energy before reach ing the degree of stretch that causes injuries.
The Incidence and Distribution of Stress Fractures in Competitive Track and Field Athletes
Authors: Bennell Kim L. , Malcolm Susan A. , Thomas Shane A. , Wark John D. , Brukner Peter D.
Published: June 2007

The incidence and distribution of stress fractures were evaluated prospectively over 12 months in 53 female and 58 male competitive track and field athletes (age range, 17 to 26 years). Twenty athletes sustained 26 stress fractures for an overall incidence rate of 21.1%. The incidence was 0.70 for the number of stress frac tures per 1000 hours of training. No differences were observed between male and female rates ( P > 0.05). Twenty-six stress fractures composed 20% of the 130 musculoskeletal injuries sustained during the study. Although there was no difference in stress fracture incidence among athletes competing in different events ( P > 0.05), sprints, hurdles, and jumps were associated with a significantly greater number of foot fractures; middle- and long-distance running were as sociated with a greater number of long bone and pelvic fractures ( P < 0.05). Overall, the most common sites of bone injuries were the tibia with 12 injuries (46%), followed by the navicular with 4 injuries (15%), and the fibula with 3 injuries (12%). The high incidence of stress fractures in our study suggests that risk factors in track and field athletes should be identified.
Sports Injuries in the Game of Hurling
Authors: Watson Anthony W. S.
Published: June 2007

A prospective study of hurling injuries was conducted over the 8 months of one season on 74 players. These athletes averaged 4.30 ± 2.58 hours per week of training and 1.15 ± 0.21 hours per week of matches. Mean time of injury was 1.20 ± 2.53 days in the hospital, 20.34 ± 19.25 days off sport, and 13.34 ± 17.25 days of restricted activity. Together this injury time amounts to 14.3% of the season. There were 92 match- and 43 training-related injuries, giving 342.47 injuries per 10,000 hours of matches and 43.83 injuries per 10,000 hours of training. Overall, there were 369.9 days of injury per 1000 hours of participation. The most common type of injury was muscle strain (24.4% of the 135 total injuries). The hamstrings was the most com mon site of strain, accounting for 41 % of these injuries. Contusions comprised 16.3% of the injuries and sprains comprised 15.6%. The most frequently injured sites were the finger (13%), hamstrings (12%), back (11 %), head (9%), and knee and ankle (9%). Forty-one percent of the injuries were attributed to foul play. The results of the study suggest that the incidence of inju ries in hurling is high and may be attributed to poor conditioning, poor protection, and lack of enforcement of the rules.
Arthroscopic Shoulder Stabilization Using Transglenoid Sutures
Authors: Pagnani Michael J. , Warren Russell F. , Altchek David W. , Wickiewicz Thomas L. , Anderson Allen F.
Published: June 2007

Thirty-seven of 41 consecutive patients with recurrent anterior instability of the shoulder were retrospectively observed for a mean of 5.6 years (range, 4 to 10) after an arthroscopic stabilization procedure had been per formed. The operative technique involved the use of transglenoid sutures to repair the capsule and labrum. According to the criteria established by Rowe, 27 pa tients (74%) had good or excellent results, and 3 pa tients (7%) were graded as fair. Seven patients (19%) developed recurrent instability after the procedure and had failed results. Failure rates were equal in patients with a history of recurrent dislocation and those with recurrent subluxation. Absence of a Bankart lesion at operation was associated with postoperative instability ( P = 0.03). The presence or size of humeral head defects did not influence the result. Eight of 12 athletes who engaged in sports requiring repetitive overhead shoulder motion returned to full activity, and none of the 12 developed instability after operation. Four of the 13 patients who participated in contact sports or rec reational skiing developed postoperative instability ( P = 0.21). All failures occurred within 2 years of the procedure.
Posterior Shoulder Laxity in Asymptomatic Athletes
Authors: McFarland Edward G. , Campbell Gary , McDowell Jason
Published: June 2007

We evaluated the frequency of posterior subluxations on physical examination of athletes who had no symp toms of shoulder injuries and correlated the findings with other measures of joint laxity. During routine sports physical examinations, 356 shoulders in 178 athletes were examined for posterior subluxation and graded as either positive or negative for subluxation. Sulcus signs were performed and graded as I (<1.0 cm), II (1.0 to 1.5 cm), or III (>1.5 cm). Standard hyperlaxity tests of other joints were used to measure general ligamentous laxity. Statistical analysis included the Student's t-test and chi-square analysis ( P < 0.05). Overall, 55% of the shoulders could be subluxated posteriorly. More female shoulders (65%) than male shoulders (51%) could be subluxated posteriorly. Ten percent of the athletes had asymmetrical posterior shoulder laxity. Men had statistically significant less inferior translation (sulcus signs of grade I, 49%; grade II, 46%; grade III, 3%) than women (grade I, 36%; grade II, 54%; grade III, 9%). Five percent of the shoul ders had posterior subluxation and a grade III sulcus sign. Asymptomatic posterior subluxation present at physical examination may represent normal laxity and may not indicate pathologic instability.
Scoring Systems for Shoulder Conditions
Authors: Romeo Anthony A. , Bach Bernard R. , O'Halloran Kevin L.
Published: June 2007

We evaluated the comparability of four commonly used shoulder scoring systems in the United States. Fifty- two patients had 53 shoulder stabilization procedures. Surgical procedures included 34 open Bankart-type repairs, 15 capsular shifts, and 4 arthroscopic stabili zations. Results were assessed using the following scales: 1) Rowe, 2) modified-Rowe, 3) University of California at Los Angeles, and 4) the pre-1994 Ameri can Shoulder and Elbow Surgeons scale. No consen sus has been reached on the relative value of these systems. We observed significant variations using these systems. A majority of our patients (85%) had excellent results when the University of California at Los Angeles scoring system was used. However, only 38% of the patients had excellent results when the modified-Rowe scale was used. Overall, good or ex cellent results were observed in 89% to 95% of the patients using these four scoring systems. The Univer sity of California at Los Angeles score correlated poorly with the other systems. lnterrater reliability between the four systems was poor. Generalized results of an investigation can be biased based on the selection of a scoring system. The lack of a widely accepted scoring system for the shoulder limits comparison of manage ment for shoulder conditions. Thus, a widely accepted shoulder scoring system is needed.
A Comparison of Tibiofemoral Joint Forces and Electromyographic Activit During Open and Closed Kinetic Chain Exercises
Authors: Wilk Kevin E. , Escamilla Rafael F. , Fleisig Glenn S. , Barrentine Steve W. , Andrews James R. , Boyd Melissa L.
Published: June 2007

We chose to investigate tibiofemoral joint kinetics (compressive force, anteroposterior shear force, and extension torque) and electromyographic activity of the quadriceps, hamstring, and gastrocnemius muscles during open kinetic chain knee extension and closed kinetic chain leg press and squat. Ten uninjured male subjects performed 4 isotonic repetitions with a 12 repetition maximal weight for each exercise. Tib iofemoral forces were calculated using electromyo graphic, kinematic, and kinetic data. During the squat, the maximal compressive force was 6139 ± 1708 N, occurring at 91° of knee flexion; whereas the maximal compressive force for the knee extension exercise was 4598 ± 2546 N (at 90° knee flexion). During the closed kinetic chain exercises, a posterior shear force (poste rior cruciate ligament stress) occurred throughout the range of motion, with the peak occurring from 85° to 105° of knee flexion. An anterior shear force (anterior cruciate ligament stress) was noted during open kinetic chain knee extension from 40° to full extension; a peak force of 248 ± 259 N was noted at 14° of knee flexion. Electromyographic data indicated greater hamstring and quadriceps muscle co-contraction during the squat compared with the other two exercises. During the leg press, the quadriceps muscle electromyographic activ ity was approximately 39% to 52% of maximal velocity isometric contraction; whereas hamstring muscle ac tivity was minimal (12% maximal velocity isometric contraction). This study demonstrated significant differ ences in tibiofemoral forces and muscle activity be tween the two closed kinetic chain exercises, and be tween the open and closed kinetic chain exercises.
Anterior Cruciate Ligament Functional Brace Use in Sports
Authors: Wojtys Edward M. , Kothari Sandip U. , Huston Laura J.
Published: June 2007

The routine use of functional knee braces in the ante rior cruciate ligament-deficient, injured, or recon structed knee, lacks biomechanical support. Although subjective reports favoring bracing are plentiful, objec tive proof of significant control of tibial translation is not. This in vivo study was designed to assess the effect of six popular braces on anterior tibial translation, isoki netic performance, and neuromuscular function in five chronically unstable anterior cruciate ligament-defi cient knees. A knee stress test was performed on a specially designed device that allowed free tibial move ment while monitoring anterior tibial translation and muscle function in the quadriceps, hamstring, and gas trocnemius muscles. Results show that braces can decrease anterior tibial translation between 28.8% and 39.1% without the stabilizing contractions of the ham string, quadriceps, and gastrocnemius muscles. With lower extremity muscle activation and bracing, anterior tibial translation was decreased between 69.8% and 84.9%. Some improvement in spinal level muscle re action times was seen with brace use, especially in the quadriceps muscle. Unfortunately, most braces appear to consistently slow hamstring muscle reaction times at the voluntary level.
The Effects of Muscle Fatigue on Neuromuscular Function and Anterior Tibial Translation in Healthy Knees
Authors: Wojtys Edward M. , Wylie Bradford B. , Huston Laura J.
Published: June 2007

We investigated the effect of quadriceps and hamstring muscle fatigue on anterior tibial translation and muscle reaction time in 10 healthy subjects. The six men and four women had an average age of 21.3 years and had no known pathologic knee conditions. Each patient underwent a knee examination, arthrometer measure ments of tibial translation, subjective functional assess ment, and an anterior tibial translation stress test be fore and after quadriceps and hamstring muscle- fatiguing exercise. The recruitment order of the lower extremity muscles in response to anterior tibial trans lation did not change with muscle fatigue. However, the results showed an average increase of 32.5% in ante rior tibial translation (range, 11.4% to 85.2%) after fatigue. Muscle responses in the gastrocnemius, ham string, and quadriceps originating at the spinal cord and cortical level showed significant slowing and, in some cases, an absence of activity after the quadri ceps and hamstring muscles were fatigued. The in creases in displacement after fatigue strongly corre lated (0.62 to 0.96) with a delay in cortical-level activity (intermediate and voluntary). Muscle fatigue, which ap pears to affect the dynamic stability of the knee, alters the neuromuscular response to anterior tibial transla tion. Therefore, fatigue may play an important role in the pathomechanics of knee injuries in physically de manding sports.
Biomechanical Responses to Repeated Stretches in Human Hamstring Muscle In Vivo
Authors: Magnusson S. Peter , Simonsen Erik B. , Aagaard Per , Kjaer Michael
Published: June 2007

To examine stiffness, energy, and passive torque in the dynamic and static phases of a stretch maneuver in the human hamstring muscle in vivo we used a test- retest protocol and a repeated stretches protocol. Re sistance to stretch was defined as passive torque (in newton-meters) offered by the hamstring muscle group during passive knee extension as measured using an isokinetic dynamometer with a modified thigh pad. In 13 uninjured subjects, the knee was passively ex tended to a predetermined final position (0.0875 rad/ sec, dynamic phase) where it remained stationary for 90 seconds (static phase). The test-retest protocol in cluded two tests administered 1 hour apart. On a sep arate occasion, five consecutive static stretches were administered separated by 30 seconds and followed by a sixth stretch 1 hour later. For the test-retest phase, stiffness and energy in the dynamic phase and passive torque in the static phase did not differ and yielded correlations of r = 0.91 to 0.99. During the static phase, passive torque declined in both tests ( P < 0.0001). For the repeated stretches, decreases were observed for energy ( P < 0.01) and stiffness ( P < 0.05) in the dynamic phase and for passive torque ( P < 0.0001) in the static phase. However, the decline in the variables returned to baseline within 1 hour. The data show that the method employed is a useful tool for measuring biomechanical variables during a stretch maneuver. This may provide a more detailed method to examine skeletal muscle flexibility.
Chronic, Painful Ankle Instability in Skeletally Immature Athletes
Authors: Busconi Brian D. , Pappas Arthur M.
Published: June 2007

We report 10 cases of chronic, painful ankle instability in skeletally immature athletes associated with un united osteochondral fragments of the distal fibula. All the patients experienced multiple inversion injuries with recurrent pain and instability that failed to improve after a supervised exercise and rehabilitation program. Osteochondral fragments of the distal fibula were vis ible on all standard radiographs of the affected ankles. Treatment consisted of operative excision of the bony fragment and an anatomic nonaugmented repair of the lateral ligament complex and capsule. All 10 patients were available for long-term followup an average of 6.5 years (±2) after surgery; all ankles improved function ally, with no recurrences of instability.
Traumatic Peroneal Tendon Instability
Authors: Mason Rhett B. , Henderson Ian J. P.
Published: June 2007

To investigate the causes of, pathologic changes as sociated with, and treatment results after traumatic peroneal tendon subluxation or dislocation, we re viewed 11 cases in 10 patients at a mean followup of 29 months. We also describe a technique of superior peroneal retinacular repair combined with fibular rota tional osteotomy. Excellent clinical and functional re sults were achieved in 9 of the 11 cases, enabling the patients to return to previous competitive sports by 3 months. There was one persisting subluxation that required further surgery. Another ankle, with chronic sepsis from previous surgery and documented degen eration of the ankle joint, had a recurrence of the infection and sequestration of the osteotomized frag ment. The peroneal tendons, however, remained sta bilized by the resultant scar tissue. We conclude that superior peroneal retinacular repair, with or without fibular rotational osteotomy, is a successful technique in treating both acute and recurrent instability of the peroneal tendons. It can be combined with a Bröstrom repair when there is concurrent peroneal tendon and anterolateral ankle instability. Peroneal tenosynovitis and tendon splitting were commonly found at opera tion, especially in cases of recurrent instability. The degree of pathologic change in the tendon did not affect the clinical result.
Shoulder Injuries During Alpine Skiing
Authors: Kocher Mininder S. , Feagin John A.
Published: June 2007

We retrospectively reviewed alpine skiing injuries at a destination ski resort during three seasons to charac terize the incidence and types of shoulder injuries. A total of 3451 injuries in 3247 patients were reviewed. The overall injury rate was 4.44 injuries per 1000 skier- days. Injuries to the upper extremity represented 29.1% ( N = 1004) of all alpine ski injuries. Injuries involving the shoulder complex (393 injuries in 350 patients) accounted for 39.1% of upper extremity inju ries and 11.4% of all alpine skiing injuries. The rate of shoulder injury was 0.51 injuries per 1000 skier-days. Patients with shoulder injuries had a mean age of 35.4 years, and the male-to-female ratio of these patients was 3:1. Falls represented the most common mecha nism of shoulder injury (93.9%) in addition to collisions with skiers (2.8%), pole planting (2.3%), and collisions with trees (1%). The most common shoulder injuries were rotator cuff strains (24.2%), anterior glenohu meral dislocations or subluxations (21.6%), acromio clavicular separations (19.6%), and clavicle fractures (10.9%). Less common shoulder injuries included greater tuberosity fractures (6.9%), trapezius muscle strains (6.4%), proximal humeral fractures (3.3%), bi ceps tendon strains (2.3%), glenoid fractures (1.5%), scapular fractures (1%), humeral head fractures (1%), sternoclavicular separations (0.5%), an acromial frac ture (0.3%), a posterior glenohumeral dislocation (0.3%), and a biceps tendon dislocation (0.3%).
The Frequency of Baker's Cysts Associated with Meniscal Tears
Authors: Stone Kevin R. , Stoller David , De Carli Angelo , Day Robert , Richnak Joel
Published: June 2007

We reviewed the films of 1760 patients who had mag netic resonance image scanning of the knee joint to assess the most common pathologic changes associ ated with an incidental finding of a Baker's cyst. Of the 1760 knees scanned, Baker's cysts were noted in 238. The cysts were classified as small (55%), medium (30%), or large (15%) and were primarily found on the medial side of the knee (94%). The menisci were eval uated and changes were classified as complete tears, where signal contacts the surface, or degenerative intrasubstance tears. One hundred eleven (47%) com plete meniscal tears were found, and 88 (37%) degen erative tears. The majority of tears were found in the posterior horn of the medial meniscus (65 complete tears and 45 degenerative tears). Thus, 199 tears were found in 170 knees, and 106 of the 170 knees (62%) had tears of the posterior horn of the medial meniscus. Baker's cysts are frequent findings on physical exam inations and on magnetic resonance imaging scans of the knee. They are thought to be due to intraarticular pathologic changes, usually posterior meniscal tears. This study documents the association between Baker's cysts and meniscal tears and notes that a complete tear is not necessary for the cyst to be present.
Glenohumeral Translation in the Asymptomatic Athlete's Shoulder and Its Relationship to Other Clinically Measurable Anthropometric Variables
Authors: Lintner Scott A. , Levy Andrew , Kenter Keith , Speer Kevin P.
Published: June 2007

To determine the degree of shoulder translation in uninjured athletes, we examined 76 Division I colle giate athletes (44 women and 32 men) for passive range of motion in both shoulders and for knee and elbow hyperextension. Translation was based on a scale of 0 to 3+. Shoulders with symptoms of pain or a history of instability or dislocation were excluded from this study. Forty-six shoulders had 0 anterior transla tion, 75 had 1+, and 31 had 2+. Thirteen shoulders had 0 posterior translation, 56 had 1 +, and 83 had 2+. Thirty-eight shoulders had 0 inferior translation, 105 had 1 +, and 9 had 2+. No shoulder had translation of 3+ in any direction. Twenty-four athletes, 12 men and 12 women, had translational asymmetry of a minimum of one grade in at least one direction. No shoulder was asymmetric in all three directions. There was a signif icant correlation between dominant hand and in creased translation; 19 of 24 athletes with asymmetric shoulders had greater translation in the nondominant extremity. There was no relationship between transla tion and range of motion, knee or elbow hyperexten sion, thumb-to-forearm distance, or years spent in sports participation. Asymmetry of shoulder translation may exist in the normal shoulder. This review shows that up to 2+ translation in any direction cannot be considered abnormal.