bluuebunny/crossref_metadata_2025 huggingface dataset:
Shock Wave Therapy for Calcific Tendinitis of the Shoulder
Authors: Wang Ching-Jen , Yang Kuender D. , Wang Feng-Sheng , Chen Han-Hsiang , Wang Jun-Wen
Published: July 2017

Background

Shock wave therapy is a new modality that has shown efficacy in the treatment of various orthopaedic disorders.

Purpose

To determine the effectiveness, at 2- to 3-year follow-up, of shock wave therapy for calcific tendinitis of the shoulder.

Study Design

Prospective clinical study.

Methods

Thirty-seven patients (39 shoulders) with calcific shoulder tendinitis were treated with shock wave therapy (1000 impulses at 14 kV) and observed for 24 to 30 months. The control group, which underwent sham treatment with a dummy electrode, consisted of 6 patients (6 shoulders) with an average follow-up of 6 months. Evaluation included use of the 100-point Constant score system and shoulder radiographs.

Results

The overall results in the study group were 60.6% excellent (20 of 33 shoulders), 30.3% good (10), 3.0% fair (1), and 6.1% poor (2), and those of the control group were 16.7% fair (1 of 6 shoulders) and 83.3% poor (5). The symptom recurrence rate in the study group was 6.5%. Dissolution of calcium deposits was complete in 57.6% of the study group, partial in 15.1%, and unchanged in 27.3%. Fragmentation was seen in 16.7% of the control group patients; in 83.3% deposits were unchanged. No recurrence of calcium deposits was observed during the 2 years that the study group was followed.

Conclusions

Shock wave therapy is a safe and effective noninvasive treatment for patients with calcific tendinitis of the shoulder.
Assessment of Shoulder Proprioception in the Female Softball Athlete
Authors: Dover Geoffrey C. , Kaminski Thomas W. , Meister Keith , Powers Michael E. , Horodyski MaryBeth
Published: July 2017

Background

There have been reports of overhand throwing athletes having decreased joint position sense in their dominant shoulder as compared with the nondominant shoulder. Very little research, however, exists concerning joint position sense in the female athlete.

Hypothesis

Female softball athletes have decreased joint position sense in their dominant shoulder as compared with their nondominant shoulder.

Study Design

Factorial design with investigation of multiple independent variables.

Methods

Joint position sense was assessed in 50 female softball players and 50 nonthrowing female athletes by using an inclinometer during four glenohumeral joint motions. Both the dominant and nondominant shoulders were assessed and error scores were calculated to describe joint position sense. Data were collected during the course of a fall semester and analyzed by using a mixed model analysis of variance with repeated measures on the dependent variable (error scores).

Results

A significant group by movement interaction was observed, with the softball athletes demonstrating significantly greater external rotation error scores than the nonthrowing athletes.

Conclusion

We failed to reject the null hypothesis. Increased error scores (less joint position sense) were observed in both arms of subjects in the softball group.

Clinical Relevance

This study suggests that there is decreased shoulder proprioception in asymptomatic female athletes involved in overyhand throwing sports, which may predispose them to injury.
Injuries and Overuse Syndromes in Golf
Authors: Gosheger Georg , Liem Dennis , Ludwig Karl , Greshake Oliver , Winkelmann Winfried
Published: July 2017

Background

Although golf is becoming more popular, there is a lack of reliable epidemiologic data on golf injuries and overuse syndromes, especially regarding their severity.

Objective

To perform an epidemiologic study of the variety of different musculoskeletal problems in professional and amateur golfers and to find associations of age, sex, physical stature (body mass index), warm-up routine, and playing level with the occurrence of reported injuries.

Study Design

Retrospective cohort study.

Methods

We analyzed the injury data from a total of 703 golfers who were randomly selected over two golfing seasons and interviewed with the use of a six-page questionnaire.

Results

Overall, 82.6% (N = 526) of reported injuries involved overuse and 17.4% (N = 111) were single trauma events. Professional golfers were injured more often, typically in the back, wrist, and shoulder. Amateurs reported many elbow, back, and shoulder injuries. Severity of reported injuries was minor in 51.5%, moderate in 26.8%, and major in 21.7% of cases. Carrying one's bag proved to be hazardous to the lower back, shoulder, and ankle. Warm-up routines were found to have a positive effect if they were at least 10 minutes long.

Conclusions

Overall, golf may be considered a rather benign activity, if overuse can be avoided. If not, golf can result in serious, chronic musculoskeletal problems.
Fractures of Osteochondroma during Physical Exercise
Authors: Carpintero Pedro , León Francisco , Zafra Manuel , Montero Manuel , Berral Francisco-Jose
Published: July 2017

Background: The mechanism responsible and the best form of treatment for fractures of osteochondromas remain unclear.

Purpose: We studied the incidence, cause, treatment, and outcome of fractures of osteochondroma over a 17-year period.

Study Design: Retrospective cohort study.

Methods: We retrospectively reviewed all cases of osteochondroma at one institution over 17 years (1985 to 2002) to identify cases of fractures. These patients were then contacted for follow-up.

Results: Seven cases of fracture through the stalk of a pedunculated osteochondroma were identified. All fractures were sustained during physical exercise. One fracture was due to a direct blow, and the others to indirect muscle or tendon injury. Five patients were treated surgically with excision of the osteochondroma, and the other two received nonoperative treatment consisting of restriction of physical activity and observation. In all cases, patients were able to resume sporting activity within 4 to 8 weeks. The recovery period was shorter for patients who received surgical treatment.

Conclusions: Surgical excision of the fractured osteochondroma may be preferable for patients engaging in sport.
The Posterolateral Attachments of the Knee
Authors: LaPrade Robert F. , Ly Thuan V. , Wentorf Fred A. , Engebretsen Lars
Published: July 2017

Background: Quantitative descriptions of the attachment sites of the main posterolateral knee structures have not been performed.

Purpose: To qualitatively and quantitatively determine the anatomic attachment sites of these structures and their relationships to pertinent bony landmarks.

Study Type: Cadaveric study.

Methods: Dissections were performed and measurements taken on 10 nonpaired fresh-frozen cadaveric knees.

Results: The fibular collateral ligament had an average femoral attachment slightly proximal (1.4 mm) and posterior (3.1 mm) to the lateral epicondyle. Distally, it attached 8.2 mm posterior to the anterior aspect of the fibular head. The popliteus tendon had a constant broad-based femoral attachment at the most proximal and anterior fifth of the popliteal sulcus. The popliteus tendon attachment on the femur was always anterior to the fibular collateral ligament. The average distance between the femoral attachments of the popliteus tendon and fibular collateral ligament was 18.5 mm. The popliteofibular ligament had two divisions—anterior and posterior—in all cases. The average attachment of the posterior division was 1.6 mm distal to the posteromedial aspect of the tip of the fibular styloid process and the anterior division attached 2.8 mm distal to the anteromedial aspect of the tip of the fibular styloid process.

Conclusions: These structures had a consistent attachment pattern. This information will prove useful in the study of anatomic repair and reconstruction of the posterolateral structures of the knee.
Evaluation of Recurring Meniscal Tears with Gadolinium-Enhanced Magnetic Resonance Imaging
Authors: Vives Michael J. , Homesley David , Ciccotti Michael G. , Schweitzer Mark E.
Published: July 2017

Background: Magnetic resonance imaging has been shown to be of questionable accuracy in detecting recurrent meniscal tears after previous resection or repair.

Purpose: To compare the accuracy of nonenhanced magnetic resonance imaging with that of intraarticular contrast-enhanced direct magnetic resonance arthrography and intravenous contrast-enhanced indirect magnetic resonance arthrography for detection of recurrent meniscal tears.

Study Design: Prospective cohort study.

Methods: Forty-one patients who had previous meniscal tears treated by resection or repair but who were experiencing recurrent knee symptoms were prospectively randomized into one of three groups: conventional magnetic resonance imaging, indirect arthrography, and direct arthrography. The interpretations of two musculoskeletal radiologists were compared with the findings of an arthroscopic procedure performed 2 to 14 weeks later.

Results: Conventional imaging had a sensitivity of 57.9%, specificity of 80%, and overall accuracy of 62.5%. Intravenous contrast improved the sensitivity to 90.9%, specificity to 100%, and overall accuracy to 93.8%; intraarticular contrast had a sensitivity of 91.7%, specificity of 100%, and an overall accuracy of 92.9%.

Conclusions: We demonstrated an increased accuracy of intravenous or intraarticular contrast-enhanced magnetic resonance arthrography in detecting recurrent meniscal tears. Both contrast routes demonstrated similar accuracy, a finding not previously reported.
Factors Affecting Bone Loss in Female Endurance Athletes
Authors: Braam Lavienja A. J. L. M. , Knapen Marjo H. J. , Geusens Piet , Brouns Fred , Vermeer Cees
Published: July 2017

Background: Low bone mass leading to stress fractures is a well-known and yet unsolved problem among female athletes.

Purpose: To quantify the rate of bone loss in healthy female athletes and investigate the effects of estrogen and vitamin K supplementation on bone loss.

Study Design: Prospective cohort study.

Methods: We classified 115 female endurance athletes into amenorrheic, eumenorrheic, or estrogen-supplemented groups and randomized them to receive either placebo or vitamin K1. The bone mineral densities of the subjects' femoral neck and lumbar spine were measured at baseline and after 2 years.

Results: Bone mineral density in the lumbar spine remained constant, but bone density in the femoral neck had decreased significantly after 2 years in all three subgroups. The decrease was higher in amenorrheic (—6.5% ± 4.0%) than in eumenorrheic (—3.2% ± 4.1%) and estrogen-supplemented athletes (—3.9% ± 3.1%). Supplementation with vitamin K did not affect the rate of bone loss.

Conclusions: The rate of bone loss in all three subgroups of female athletes was unexpectedly high; neither estrogen nor vitamin K supplementation prevented bone loss.

Clinical Relevance: High-intensity training maintained over several years must be regarded in women as a risk factor for osteoporosis, and protocols for optimal treatment should be developed.
Clinical Outcomes after Combined Meniscal Allograft Transplantation and Anterior Cruciate Ligament Reconstruction
Authors: Sekiya Jon K. , Giffin J. Robert , Irrgang James J. , Fu Freddie H. , Harner Christopher D.
Published: July 2017

Background: Concomitant meniscal transplantation performed at the time of ligament surgery may help to protect the anterior cruciate ligament graft.

Purpose: To determine the objective and subjective clinical outcomes after combined anterior cruciate ligament reconstruction and meniscal allograft transplantation.

Study Design: Uncontrolled retrospective review.

Methods: Twenty-eight patients who underwent anterior cruciate ligament reconstruction along with meniscal transplantation were retrospectively evaluated postoperatively at an average of 2.8 years (range, 1.8 to 5.6).

Results: On the International Knee Documentation Committee overall subjective assessment, 86% had normal or nearly normal scores. The SF-36 physical and mental component summary scores were at higher levels than those of the patients' age- and sex-matched populations. Objectively, nearly 90% had normal or nearly normal Lachman and pivot shift test scores. The KT-1000 arthrometer testing at 30 pounds and maximum manual both demonstrated an average increased anterior translation of 1.5 mm compared with the contralateral knee. Joint space narrowing of the transplanted compartments was not significantly different from that of the contralateral knee.

Conclusions: Meniscal transplantation with anterior cruciate ligament reconstruction can be a beneficial procedure in properly selected patients with either chronic anterior cruciate ligament insufficiency or failed anterior cruciate ligament surgery. Restoration of meniscal function may provide protection for the articular cartilage and improve joint stability.
Snowboarder's Talus Fractures Experimentally Produced by Eversion and Dorsiflexion
Authors: Funk James R. , Srinivasan Sreebala C. M. , Crandall Jeff R.
Published: July 2017

Background: Fracture of the lateral process of the talus is an unusual injury that has received heightened attention in recent years because of its association with snowboarding. The diagnosis is often confused with that of lateral ankle sprain. If left untreated, it can cause long-term impairment, including osteoarthritis and subtalar joint degeneration. It is generally thought to result from dorsiflexion and inversion. However, few experimental studies have been conducted to investigate the injury mechanism.

Hypothesis: Eversion of a dorsiflexed ankle is more likely to fracture the lateral process of the talus than inversion of a dorsiflexed ankle.

Study Design: Controlled laboratory study.

Methods: Ten cadaveric leg specimens were subjected to dynamic inversion or eversion of an axially loaded and dorsiflexed ankle.

Results: Inversion failed to produce any fractures in three injured specimens. However, all six specimens subjected to eversion sustained a fracture of the lateral process of the talus.

Conclusions: The incidence of fracture of the lateral process of the talus was significantly higher in the eversion group compared with the inversion group.

Clinical Relevance: Eversion of an axially loaded and dorsiflexed ankle may be an important injury mechanism for fracture of the lateral process of the talus among snowboarders.
Risk Factors for Injury in High School Football Players
Authors: Turbeville Sean D. , Cowan Linda D. , Owen Willis L. , Asal Nabih R. , Anderson Mark A.
Published: July 2017

Background

Many studies have reported the frequency and types of injuries in high school football players. However, few have assessed the relationship between player characteristics and risk of injury.

Purpose

To describe the epidemiologic characteristics of and risk factors for injury in high school football players and to determine whether players’ characteristics could be used to predict subsequent injury.

Study Design

Prospective cohort study.

Methods

This study was part of a 2-year prospective investigation (1998 to 1999) of risk factors for injury in 717 (343 in the 1998 season and 374 in the 1999 season) high school football players in the Oklahoma City, Oklahoma, School District. Player characteristics (playing experience, position, injury history) and physical parameters (body mass index, weight, height, grip strength) were measured at the beginning of each season. Logistic regression analysis was used to determine whether any of the baseline variables were associated with the odds of subsequent injury.

Results

The physical characteristics of players, such as body mass index and strength, were not associated with risk of injury. More playing experience and a history of injury in the previous season were significantly related to increased risk. Linemen were at the highest risk of injury, particularly knee injuries and season-ending injuries.

Conclusions

Future research should focus on decreasing the risk of injury to linemen.
Effects of Short-Term Cycling on Knee Joint Proprioception in Healthy Young Persons
Authors: Roberts David , Ageberg Eva , Andersson Gert , Fridén Thomas
Published: July 2017

Background

Criteria are needed for measuring the effects of exercise and fatigue on proprioception.

Purpose

To measure knee joint proprioception in healthy subjects before and after exercise and to establish a reference for further comparisons of patients with knee injuries.

Study Design

Controlled laboratory study.

Methods

We tested proprioception in the knees of 24 healthy subjects with a mean age of 24 years and median Tegner score of 5. Subjects were tested to estimate their thresholds for detecting slow passive motion, from starting positions of 20° and 40° before and after cycling on an ergometer bicycle until the pulse rate reached a steady state level and they reached a score of 14 to 17 on Borg's Ratio of Perceived Exertion scale.

Results

After cycling, significantly higher threshold values were found for perception of movement toward flexion from both 20° and 40°. No significant differences were seen in measurements of movement toward extension.

Conclusions

Knee joint proprioception seems to be impaired by exercise or training.

Clinical Relevance

This impairment may lead to defective dynamic stabilization of the joint, leading to an increased risk of injuries.
The Role of a Posteriorly Positioned Fibula in Ankle Sprain
Authors: Eren Osman Tugrul , Kucukkaya Metin , Kabukcuoglu Yavuz , Kuzgun Unal
Published: July 2017

Background

Specific anatomic variations of the ankle mortise may predispose people to ankle sprains.

Hypothesis

There is a correlation between a higher malleolar index (posteriorly positioned fibula) and incidence of ankle sprain.

Study Design

Prospective case control study.

Methods

We compared the malleolar index (transverse plane of the talus) on computerized axial tomographic images of 61 patients with ankle sprain with that of 101 normal controls. A positive number for the malleolar index meant that the lateral malleolus was posterior to the plane of the medial malleolus. A negative number meant that the lateral malleolus was actually anterior to the plane of the medial malleolus.

Results

The average malleolar index of the patients with ankle sprain was +11.5° with a standard deviation of 7°. Malleolar relationships varied from —6° to +39°, a range of 45°. The average malleolar index in the control group was +5.85° with a standard deviation of 4.9°, which varied from —8° to +16°. However, there was no correlation between recurrence of sprains and malleolar index values.

Conclusion

Patients with an ankle sprain were more likely to have a posteriorly positioned fibula, possibly predisposing them to ankle sprain.
Prospective Evaluation of the Ottawa Ankle Rules in a University Sports Medicine Center
Authors: Leddy John J. , Smolinski Robert J. , Lawrence James , Snyder Jody L. , Priore Roger L.
Published: July 2017

In a sports medicine center, we prospectively evaluated the Ottawa Ankle Rules over 1 year for their ability to identify clinically significant ankle and midfoot fractures and to reduce the need for radiography. We also developed a modification to improve specificity for malleolar fracture identification. Patients with acute ankle injuries ( 10 days old) had the rules applied and then had radiographs taken. Sensitivity, specificity, and the potential reduction in the use of radiography were calculated for the Ottawa Ankle Rules in 132 patients and for the new “Buffalo” rule in 78 of these patients. There were 11 clinically significant fractures (fracture rate, 8.3% per year). In these 132 patients, the Ottawa Ankle Rules would have reduced the need for radiography by 34%, without any fractures being missed (sensitivity 100%, specificity 37%). In 78 patients, the specificity for malleolar fracture for the new rule was significantly greater than that of the Ottawa Ankle Rules malleolar rule (59% versus 42%), sensitivity remained 100%, and the potential reduction in the need for radiography (54%) was significantly greater. The Ottawa Ankle Rules could significantly reduce the need for radiography in patients with acute ankle and midfoot injuries in this setting without missing clinically significant fractures. The Buffalo modification could improve specificity for malleolar fractures without sacrificing sensitivity and could significantly reduce the need for radiography.
Five-Year Results of Single-Incision Arthroscopic Anterior Cruciate Ligament Reconstruction with Patellar Tendon Autograft
Authors: Otto David , Pinczewski Leo A. , Clingeleffer Amanda , Odell Ross
Published: July 2017

We performed a retrospective study on 80 patients who underwent single-incision arthroscopic anterior cruciate ligament reconstruction with patellar tendon autograft and interference fit screw fixation in 1989. Twelve patients were lost to followup, allowing a clinical assessment of 68 patients to be conducted by independent examiners at 1 and 5 years after surgery, with radiographic assessment at 5 years. Thirty-three patients had chronic anterior cruciate ligament-deficient knees. Three patients reruptured their grafts during sports at 29, 48, and 56 months. At 5 years, 64 patients (98%) had grade 0 or 1 Lachman and pivot shift tests with manual stability testing. Fifty patients (77%) were participating in level I or II activities according to the International Knee Documentation Committee scale. Twenty-nine patients (45%) experienced low levels of pain when performing at their highest activity level. Five (8%) had thigh atrophy greater than 1 cm, and three (5%) had an extension loss of more than 3°. Eleven patients (17%) had tenderness over the graft site when kneeling. Fifteen of 62 patients (24%) had degenerative changes on radiographs, and this was more common in patients with chronic anterior cruciate ligament-deficient knees. Fifty-two patients (80%) had normal or nearly normal knees according to the overall International Knee Documentation Committee score.
The Effects of Aggressive Notchplasty on the Normal Knee in Dogs
Authors: LaPrade Robert F. , Terry Glenn C. , Montgomery Ronald D. , Curd David , Simmons David J.
Published: July 2017

We assessed the possible association between an aggressive intercondylar notchplasty and histopathologic, radiographic, and gait changes to the knee. Three groups of six adult greyhounds were observed for 6 months. Group I dogs had a sham operation. Group II dogs had a 4-mm notchplasty of the lateral femoral condyle where it articulates with the lateral tibial spine. Group III dogs had a 7- to 8-mm notchplasty of the lateral femoral condyle to simulate the long-term effects of an overly aggressive notchplasty. Force plate gait analyses were not significantly different for any dogs at 3 and 6 months. Histopathologic studies (hematoxylin and eosin and safranin O stains) revealed notchplasty area remodeling with a thin layer of lamellar bone covered by fibrous connective tissue. Both Group II and III dogs had significant loss of lateral femoral condyle and trochlear groove articular surface proteoglycans. The radiographic notch width index remained unchanged throughout the study for Group I; the indexes increased immediately after surgery in Groups II and III because of the notchplasty, but after 6 months these values returned to near-preoperative measurements. An aggressive intercondylar notchplasty caused articular cartilage histopathologic changes at 6 months consistent with those found in knees with early degenerative arthritis. Significant refilling of a non-impinged notchplasty occurred by 6 months after surgery. Our results raise concern about the effects of aggressive intercondylar notch widening in humans.
Early Phase Differential Effects of Slow and Fast Barbell Squat Training
Authors: Morrissey Matthew C. , Harman Everett A. , Frykman Peter N. , Ki Hoon Han
Published: July 2017

To examine the importance of resistance training movement speed, two groups of women (24 4 years, 162 5 cm, 59 7 kg) squatted repeatedly at 1) 2 seconds up, 2 seconds down (slow, N 11); or 2) 1 second up, 1 second down (fast, N 10), doing three warm-up sets and three eight-repetition maximum sets, three times per week for 7 weeks. Tests included force platform and video analysis of the vertical jump, long jump, and maximum squat, and isometric and isokinetic knee extensor testing at speeds from 25 to 125 deg/sec. The groups improved similarly in many variables with training but also showed some differences. In the long jump, the fast group was superior in numerous variables including knee peak velocity and total-body vertical and absolute power. In the vertical jump, fast training affected the ankle and hip more (e.g., average power), and slow training mostly affected the knee (average torque). In isokinetic testing, the fast group improved strength most at the faster velocities, while the slow group strength changes were consistent across the velocities tested. Although both slow and fast training improved performance, faster training showed some advantages in quantity and magnitude of training effects.
A New Concept For Isokinetic Hamstring: Quadriceps Muscle Strength Ratio
Authors: Aagaard Per , Simonsen Erik B. , Magnusson S. Peter , Larsson Benny , Dyhre-Poulsen Poul
Published: July 2017

Conventionally, the hamstring:quadriceps strength ratio is calculated by dividing the maximal knee flexor (hamstring) moment by the maximal knee extensor (quadriceps) moment measured at identical angular velocity and contraction mode. The agonist-antagonist strength relationship for knee extension and flexion may, however, be better described by the more functional ratios of eccentric hamstring to concentric quadriceps moments (extension), and concentric hamstring to eccentric quadriceps moments (flexion). We compared functional and conventional isokinetic hamstring: quadriceps strength ratios and examined their relation to knee joint angle and joint angular velocity. Peak and angle-specific (50°, 40°, and 30° of knee flexion) moments were determined during maximal concentric and eccentric muscle contractions (10° to 90° of motion; 30 and 240 deg/sec). Across movement speeds and contraction modes the functional ratios for different moments varied between 0.3 and 1.0 (peak and 50°), 0.4 and 1.1 (40°), and 0.4 and 1.4 (30°). In contrast, conventional hamstring:quadriceps ratios were 0.5 to 0.6 based on peak and 50° moments, 0.6 to 0.7 based on 40° moment, and 0.6 to 0.8 based on 30° moment. The functional hamstring:quadriceps ratio for fast knee extension yielded a 1:1 relationship, which increased with extended knee joint position, indicating a significant capacity of the hamstring muscles to provide dynamic knee joint stability in these conditions. The evaluation of knee joint function by use of isokinetic dynamometry should comprise data on functional and conventional hamstring:quadriceps ratios as well as data on absolute muscle strength.
Concussion Incidence in Elite College Soccer Players
Authors: Boden Barry P. , Kirkendall Donald T. , Garrett William E.
Published: July 2017

A unique aspect of soccer is the use of the head for directing the ball. The potential for resultant head injuries has been the focus of discussions worldwide. Prior work has attributed neuropsychologic deficits to the cumulative effects of heading, without evaluating concussion rates in soccer players. We prospectively studied the seven men's and eight women's varsity soccer teams in the Atlantic Coast Conference during two seasons to document concussion incidence. The 29 concussions diagnosed over the 2 years in 26 athletes, 17 (59%) concussions in men and 12 (41%) in women, resulted from contact with an opponent's head (8, 28%), elbow (4, 14%), knee (1, 3%), or foot (1, 3%); the ball (7, 24%); the ground (3, 10%); concrete sidelines (1, 3%); goalpost (1, 3%); or a combination of objects (3, 10%). Twenty concussions (69%) occurred in games; none resulted from intentional heading of the ball. The basic incidence was 0.96 concussions per team per season. The overall incidence was 0.6 per 1000 athlete-exposures for men, and 0.4 per 1000 athlete-exposures for women. By concussion grade, there were 21 (72%) grade 1, 8 (28%) grade 2, and no grade 3 concussions. These findings suggest that concussions are more common in soccer than anticipated and that acute head injuries may have potential for long-term neuropsychologic changes.
Development and Validation of the Quality Of Life Outcome Measure (Questionnaire) for Chronic Anterior Cruciate Ligament Deficiency
Authors: Mohtadi Nick
Published: July 2017

A patient-based, subjective outcome measure for chronic anterior cruciate ligament deficiency was developed, pretested, and validated. The development of the outcome measure was completed in four stages: 1) item generation (167 items), 2) item reduction (by surveying 79 patients), 3) questionnaire formation and pretesting (20 patients), and 4) reliability, responsiveness, and validity assessment (100 patients). This disease-specific quality of life measure is a 32-item questionnaire using a 100-mm visual analog scale response format. Face validity was derived from extensive direct patient input. Content validity was determined by consensus among 20 knee surgeons. There was no significant difference on test-retest reliability, with an overall average error of 6%. The outcome measure demonstrated responsiveness to clinical change correctly in 21 of 25 patients (84%). Construct validity was shown by the ability of the questionnaire to measure the full spectrum of disease; scores ranged from 8 to 99 out of a maximum score of 100. The questionnaire was able to distinguish patients who went on to have surgery (average score, 31) from those who would be treated nonoperatively (average score, 79). The quality of life outcome measure for chronic anterior cruciate ligament deficiency is the first subjective knee scale of its kind to be validated to measure quality of life in patients with chronic anterior cruciate ligament deficiency.
Determination of the In Situ Forces in the Human Posterior Cruciate Ligament Using Robotic Technology
Authors: Fox Ross J. , Harner Christopher D. , Sakane Masataka , Carlin Gregory J. , Woo Savio L-Y.
Published: July 2017

We examined the in situ forces in the posterior cruciate ligament as well as the force distribution between its anterolateral and posteromedial bundles. Using a robotic manipulator in conjunction with a universal force-moment sensor system, we applied posterior tibial loads from 22 to 110 N to the joint at 0° to 90° of knee flexion. The magnitude of the in situ force in the posterior cruciate ligament and its bundles was significantly affected by knee flexion angle and posterior tibial loading. In situ forces in the posterior cruciate ligament ranged from 6.1 6.0 N under a 22-N posterior tibial load at 0° of knee flexion to 112.3 28.5 N under a 110-N load at 90°. The force in the posteromedial bundle reached a maximum of 67.9 31.5 N at 90° of knee flexion, and the force in the anterolateral bundle reached a maximum of 47.8 23.0 N at 60° of knee flexion under a 110-N load. No significant differences existed between the in situ forces in the two bundles at any knee flexion angle. This study provides insight into the knee flexion angle at which each bundle of the posterior cruciate ligament experiences the highest in situ forces under posterior tibial loading. This information can help guide us in more accurate graft placement, fixation, and tensioning, and serve as an assessment of graft performance.
Open Capsulorrhaphy with Suture Anchors for Recurrent Anterior Dislocation of the Shoulder
Authors: Ferretti Andrea , De Carli Angelo , Calderaro Michele , Conteduca Fabio
Published: July 2017

Forty of 42 consecutive open capsulorrhaphies with suture anchors for treatment of traumatic recurrent anterior dislocation of the shoulder were reviewed after a minimum follow-up of 2 years. Two patients were lost to follow-up. Follow-up was conducted according to the rating systems of Rowe and the Society of American Shoulder and Elbow Surgeons. The surgical outcome was satisfactory in 38 patients (95%). Eighteen of the 22 patients who were involved in competitive overhead or collision sports before surgery returned to their preoperative sports levels. One patient, whose operation was unsuccessful, experienced recurrent dislocation. In one patient, a deep infection that occurred as a complication of the surgical technique healed after suture anchor removal. Although a longer follow-up is necessary, this technique appears to have encouraging results as it avoids the risks related to the use of screws and staples.
The Effects of a Popliteus Muscle Load on In Situ Forces in the Posterior Cruciate Ligament and on Knee Kinematics
Authors: Harner Christopher D. , Höher Jürgen , Vogrin Tracy M. , Carlin Gregory J. , Woo Savio L-Y.
Published: July 2017

To investigate the effect of simulated contraction of the popliteus muscle on the in situ forces in the posterior cruciate ligament and on changes in knee kinematics, we studied 10 human cadaveric knees (donor age, 58 to 89 years) using a robotic manipulator/universal force moment sensor system. Under a 110-N posterior tibial load (simulated posterior drawer test), the kinematics of the intact knee and the in situ forces in the ligament were determined. The test was repeated with the addition of a 44-N load to the popliteus muscle. The posterior cruciate ligament was then sectioned and the knee was subjected to the same tests. The additional popliteus muscle load significantly reduced the in situ forces in the ligament by 9% to 36% at 90° and 30° of flexion, respectively. No significant effects on posterior tibial translation of the intact knee were found. However, in the ligament-deficient knee, posterior tibial translation was reduced by up to 36% of the translation caused by ligament transection. A coupled internal tibial rotation of 2° to 4° at 60° to 90° of knee flexion was observed in both the intact and ligament-deficient knees when the popliteus muscle load was added. Our results indicate that the popliteus muscle shares the function of the posterior cruciate ligament in resisting posterior tibial loads and can contribute to knee stability when the ligament is absent.
Compensatory Muscle Activity in the Posterior Cruciate Ligament-Deficient Knee During Isokinetic Knee Motion
Authors: Inoue Masayuki , Yasuda Kazunori , Yamanaka Masatomo , Wada Tatsuhiko , Kaneda Kiyoshi
Published: July 2017

We performed electromyographic analyses in 12 patients with posterior cruciate ligament-deficient knees to compare electrical activity in the quadriceps, hamstring, and gastrocnemius muscles between the uninjured and involved limbs. Each patient performed concentric isokinetic knee motion at 30 and 60 deg/sec in both limbs separately. Torques in knee extension and flexion and surface electromyograms from the quadriceps, medial hamstring, and medial gastrocnemius muscles were simultaneously recorded. The uninjured limb served as a control for each patient. Before generation of flexion torque, the gastrocnemius muscle was electrically activated significantly earlier in posterior cruciate ligament-deficient knees than in uninjured knees at each velocity. However, we could not find any significant differences between the posterior cruciate ligament-deficient and uninjured knees in torque curves and electromyelograms of the quadriceps and hamstring muscles. This study suggests that early contraction of the gastrocnemius muscle may be a part of a compensatory mechanism in posterior cruciate ligament-deficient knees.
The Development and Evaluation of a Disease-Specific Quality of Life Measurement Tool for Shoulder Instability
Authors: Kirkley Alexandra , Griffin Sharon , McLintock Heidi , Ng Linda
Published: July 2017

The purpose of this study was to develop a valid, reliable, and responsive disease-specific quality of life measurement tool for patients with shoulder instability. Development included 1) identification of a specific patient population; 2) generation of issues specific to the “disease” (“items”) from reviewing the literature, interviewing health caregivers, and interviewing patients representing all demographics, disease type and severity, and treatments; 3) item reduction using patient-generated frequency-importance products and correlation matrices; and 4) pretesting the prototype instrument on 2 groups of 10 patients. The final instrument, the Western Ontario Shoulder Instability Index, has 21 items representing 4 domains. The instrument attributes (validity, reliability, and responsiveness) were evaluated. Construct validation demonstrated that this index correlated predictably with other measures. Reliability was very high at 2 weeks and 3 months, and the index was more responsive (sensitive to change) than five other shoulder measurement tools (the Disabilities of the Arm, Shoulder and Hand scale; The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form; the UCLA Shoulder Rating Scale; the Constant Score; and the Rowe Rating Scale), a global health instrument (the SF12), and range of motion. Since the patient's perception of changes in health status is the most important indicator of the success of a treatment, we suggest that this measurement tool be used as the primary outcome measure to evaluate treatments in this patient population, although it can also be used for monitoring patients' progress in clinical practice.
Surgical Repair of Chronic Complete Hamstring Tendon Rupture in the Adult Patient
Authors: Cross Mervyn J. , Vandersluis Ronald , Wood David , Banff Margaret
Published: July 2017

Complete rupture of the hamstring tendons in the adult is a rare injury. This report discusses complete rupture of the hamstring tendons in nine patients treated by late operative repair. All patients were referred from outside centers for a second opinion after failed non-operative treatment. The diagnosis was made quite easily on clinical grounds and was confirmed at surgery. Surgical treatment in all cases consisted of reattachment of the hamstring tendons to the origin on the ischium, and in all cases it was necessary to perform neurolysis of the sciatic nerve. Good results were achieved in all cases, at follow-up all patients were satisfied with the surgery.
The Thermal Effect of Monopolar Radiofrequency Energy on the Properties of Joint Capsule
Authors: Hecht Paul , Hayashi Kei , Cooley A. James , Yan Lu  , Fanton Gary S. , Thabit George , Markel Mark D.
Published: July 2017

The purpose of this in vivo study was to analyze the short-term tissue response of joint capsule to monopolar radiofrequency energy and to compare the effects of five power settings at 65°C on heat distribution in joint capsule. In 12 mature Hampshire sheep, the medial and lateral aspects of both stifles were treated with monopolar radiofrequency energy under arthroscopic control in a single uniform pass to the synovial surface. The radiofrequency generator power settings were 0, 10, 15, 20, 25, and 30 watts (N 8/group). The electrode tip temperature was 65°C. Histologic analysis at 7 days after surgery revealed thermal damage of capsule at all radiofrequency power settings. The lesion's cross-sectional area, depth, vascularity, and inflammation were commensurate with radiofrequency power. Tissue damage was indicated by variable inflammatory cell infiltration, fusion of collagen, pyknosis of fibroblasts, myonecrosis, and vascular thrombosis, whereas synovial hyperplasia, fibroblast proliferation, and rowing of sarcolemmal nuclei demonstrated regenerative processes. This study revealed that radiofrequency power settings and heat loss through lavage solution play a significant role in heat distribution and morphologic alterations in joint capsule after arthroscopic application of monopolar radiofrequency energy.
Comparison of Initial Fixation Strength Between Biodegradable and Metallic Interference Screws and a Press-Fit Fixation Technique in a Porcine Model
Authors: Seil Romain , Rupp Stefan , Krauss Paul W. , Benz Anette , Kohn Dieter M.
Published: July 2017

The objective of this study was to evaluate the initial fixation strength of a biodegradable interference screw compared with press-fit fixation and a titanium interference screw in anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft. Porcine lower limbs were used. The specimens underwent 500 loading cycles between 60 and 250 N. This corresponds to loads in the graft during aggressive rehabilitation. Thereafter, intact specimens were loaded to failure. Failure mode was defined by visual analysis. Under cyclic loads none of the interference screw fixations failed. In the press-fit group (angle between load axis and tunnel axis 80°), five specimens failed. The mean maximal load to failure was 945 N ( 87) for the titanium screw, 797 N ( 60) for the biodegradable screw, and 708 N ( 211) for the five press-fit specimens that did not fail during cyclic loading. With respect to primary fixation strength, biodegradable screws are a reasonable alternative to titanium interference screws. The press-fit fixation did not provide a secure fixation in all cases. Five press-fit specimens failed under cyclic loads comparable with those seen under conditions of accelerated rehabilitation.
Postexercise Increase in Nitric Oxide in Football Players with Muscle Cramps
Authors: Maddali Sirish , Rodeo Scott A. , Barnes Ronnie , Warren Russell F. , Murrell George A. C.
Published: July 2017

Nitric oxide, a free radical inter- and intracellular messenger molecule, is important in exercise physiology. This study tested the hypothesis that serum nitric oxide concentrations change after strenuous exercise with severe generalized muscle cramps. The study group consisted of 77 professional football players in preseason training. All players' concentrations of serum nitrite and of other serum chemicals were determined during their preseason evaluations and compared with the concentrations in 40 serum samples taken from 25 of those same players who required intravenous rehydration for severe generalized muscle cramps after a training session. Player weight and percentage of body fat were significantly higher in players who received intravenous fluids than in players who did not. The serum of players requiring intravenous hydration showed evidence of skeletal muscle breakdown (increases in lactate dehydrogenase, creatinine phosphokinase, aspartate aminotransferase, and alanine aminotransferase) and of dehydration (elevations in protein, blood urea nitrogen, and cholesterol). The major finding, however, was a nearly 300% increase in serum nitrite concentrations in players requiring rehydration. There were no correlations between concentrations of nitrate and of any of the other serum chemicals. These data support the hypothesis that large amounts of nitric oxide are synthesized in professional football players after strenuous exercise with severe muscle cramps. The study design did not allow us to determine whether this increase in nitric oxide was due to exercise or muscle cramps or both, but it does provide a basis for evaluating these relationships.
Biomechanical Performance of Bankart Repairs in a Human Cadaveric Shoulder Model
Authors: Mohammed Khalid D. , Sonnabend David H. , Goldberg Jerome A. , Hutabarat Simon , Walker Peter , Walsh William R.
Published: July 2017

The objective of this study was to develop a method to evaluate the biomechanical performance of Bankart repairs in a human cadaveric shoulder in a clinically relevant orientation. Twenty fresh-frozen human cadaveric shoulder girdles were used to compare the biomechanical performance of intact anteroinferior capsulolabral complexes with the biomechanical performance of three Bankart lesion reconstruction techniques. Repairs were performed on surgically created Bankart lesions. Evaluations were performed with the shoulders in glenohumeral abduction and external rotation. The repair techniques employed interosseous sutures, Mitek GII suture anchors, or Acufex T-Fix devices. The suture material used in all repairs was No. 2 Ti-Cron. The biomechanical performance of the three reconstruction techniques did not differ, but each was significantly inferior compared with that of the intact shoulder samples. The interosseous repairs failed by suture pullout through soft tissue. Repairs in the Mitek GII group failed by pullout of the suture anchors, suture breakage, or pullout of the suture through soft tissue. Repairs in the T-Fix group failed by pullout of the suture through soft tissue or failure of the polymer portion of the T-Fix suture.
Cardiovascular Disease in Athletes
Authors: Basilico Frederick C.
Published: July 2017

As a physician, coach, or trainer, we see athletes as healthy, physically fit, and able to tolerate extremes of physical endurance. It seems improbable that such athletes may have, on occasion, underlying life-threatening cardiovascular abnormalities. Regular physical activity promulgates cardiovascular fitness and lowers the risk of cardiac disease. However, under intense physical exertion and with a substrate of significant cardiac disease—whether congenital or acquired— athletes may succumb to sudden cardiac death. The deaths of high-profile athletes receive much attention through the national news media, but there are also deaths of other athletes. With repetitive, intense physical exercise, the heart undergoes functional and morphologic changes. Knowledge of those changes may help one identify cardiovascular abnormalities that can cause sudden death from the heart known as an “athlete's heart.” This article will review cardiovascular diseases that may limit an athlete's participation in sports and that may put an athlete at risk for sudden cardiac death. It also reviews the extent and limitations of the cardiovascular preparticipation screening examination. Team physicians, coaches, and trainers must understand the process of evaluation of a symptomatic athlete that may indicate significant cardiac abnormalities. Finally, guidelines to determine eligibility of athletes with cardiovascular disease to return to sports will be reviewed.
Subtalar Subluxation in Ballet Dancers
Authors: Ménétrey Jacques , Fritschy Daniel
Published: July 2017

Ankle injuries frequently occur in dancers. Among these injuries, only a few cases of talar subluxation have been reported in the literature. In our series, we diagnosed and treated 25 subtalar subluxations over a 1-year period in the Ballet Béjart Lausanne company. The subluxations occurred after a grand plie on pointes or at the landing of a jump on demi-pointes, without any mechanism of ankle sprain. The dancer usually noted a sudden and sharp pain in the talonavicular joint and hindfoot with a feeling of “forward displacement” of the foot. At palpation, the talonavicular ligament, the anterior talofibular ligament, and the posteromedial part of the subtalar joint were painful. A limitation of the ankle extension and a clear hypomobility of the subtalar joint were noted. Under the effect of shearing forces on the midtarsal joint, a posteromedial subtalar subluxation occurred. Treatment consisted of a manipulation that reduced the subluxation. Continuous taping, which locks the talonavicular joint in the anterior direction, was recommended for 6 weeks. Dancing could be resumed in a swimming pool after 2 weeks, and on the ground after 3 to 4 weeks. We found that subluxation could recur, and that it could eventually become chronic.