bluuebunny/crossref_metadata_2025 huggingface dataset:
The Biomechanical Interdependence between the Anterior Cruciate Ligament Replacement Graft and the Medial Meniscus
Authors: Papageorgiou Christos D. , Gil Jorge E. , Kanamori Akihiro , Fenwick James A. , Woo Savio L-Y. , Fu Freddie H.
Published: July 2017

To establish a quantitative biomechanical relationship between the anterior cruciate ligament graft and the medial meniscus, 10 human cadaveric knees were examined using the robotic/universal force-moment sensor testing system. In response to a combined 134-N anterior and 200-N axial compressive tibial load, the resulting kinematics of the knee and the in situ forces in the anterior cruciate ligament, the anterior cruciate ligament graft, and the medial meniscus were measured. Anterior tibial translation significantly increased after anterior cruciate ligament transection, between 6.8±2.3 mm at full extension and 12.6±3.3 mm at 30° of flexion. Consequently, the resultant forces on the medial meniscus, ranging from 52±30 N to 63±51 N between full extension and 90° of knee flexion in the intact knee, were doubled as a result of anterior cruciate ligament deficiency. However, after anterior cruciate ligament reconstruction, anterior tibial translations were restored to the levels of the intact knee, and thus the forces on the medial meniscus were restored as well. Likewise, the in situ forces in the anterior cruciate ligament replacement graft increased between 33% and 50% after medial meniscectomy.
The Use of an Antifibrosis Agent to Improve Muscle Recovery after Laceration
Authors: Fukushima Kazumasa , Badlani Neil , Usas Arvydas , Riano Felix , Fu Freddie H. , Huard Johnny
Published: July 2017

Muscle injuries are challenging problems in traumatology and the most frequent injuries in sports medicine. Muscle injuries are capable of healing, although slowly and occasionally with incomplete functional recovery. We observed that lacerated muscle undergoes a rapid process of regeneration, which is hindered by the development of fibrosis. Biologic approaches to enhance muscle regeneration and prevent fibrosis are being investigated to improve muscle healing after injuries. We observed that growth factors can improve muscle regeneration but cannot prevent muscle fibrosis. We investigated the use of an antifibrosis substance, decorin, as an approach to prevent fibrosis and thereby improve muscle healing after injury in murine muscle. We observed that direct injection of human recombinant decorin can efficiently prevent fibrosis and enhance muscle regeneration in the lacerated muscle. More importantly, decorin can improve the recovery of strength in the injured muscle to a level similar to that observed in normal noninjured muscle. These results suggest that injection of decorin improves both the muscle structure and the function of the lacerated muscle to near complete recovery. This study will contribute significantly to the development of strategies to promote efficient muscle healing and complete functional recovery after muscle injuries.
Meniscal Allograft Transplantation
Authors: Rath Ehud , Richmond John C. , Yassir Walid , Albright Jeffreys D. , Gundogan Fusun
Published: July 2017

We evaluated 18 of 23 patients who had undergone cryopreserved meniscal allograft transplantation for compartmental pain after total meniscectomy 2 to 8 years (mean, 5.4) after the operation. The Short Form-36 scores revealed a decrease in pain with a significant improvement in function, although function remained limited. There was no significant decrease in joint space on 45° posteroanterior weightbearing radiographs through the duration of the study. Eight of 22 allograft menisci (36%) tore during the study period, necessitating 6 partial and 2 total meniscectomies. Two patients subsequently underwent reimplantation. Histologic examination of the removed tissue revealed reduced cellularity as compared with normal or torn native menisci. Four specimens also underwent detailed cytokine evaluation and demonstrated reduced cytokine expression compared with controls. While successful in alleviating compartmental pain that may be a late consequence of major meniscectomy, allograft menisci are repopulated with fewer cells than are present in normal or torn native menisci. These cells also demonstrate potentially reduced function, as measured by decreased growth factor production. This decreased biologic activity may be a factor that contributes to the high frequency of retears noted in this and prior studies.
Medial and Lateral Meniscal Tear Patterns in Anterior Cruciate Ligament-Deficient Knees
Authors: Smith Julious P. , Barrett Gene R.
Published: July 2017

We used our database to evaluate the locations of meniscal tears associated with anterior cruciate ligament injuries. Five hundred seventy-five meniscal tears were seen in 476 patients. Each tear was categorized prospectively according to the side (medial/ lateral), the radial zone of the tear, and the circumferential zone of the tear. The different tear locations were then compared for the medial and lateral menisci and evaluated for statistical significance. We found a nearly equal number of tears on the medial (305) and lateral (270) sides. A significantly greater number of tears on the medial side as compared with the lateral side were posterior (99.4% versus 87.8%) and peripheral (75.4% versus 44.1%). Peripheral posterior horn tears of the medial meniscus were the most common type of tear (230 of 575, 40%) by a statistically significant amount.
Initial Fixation Strength of Bioabsorbable and Titanium Interference Screws in Anterior Cruciate Ligament Reconstruction
Authors: Kousa Petteri , Järvinen Teppo L. N. , Kannus Pekka , Järvinen Markku
Published: July 2017

We evaluated the initial bone-patellar tendon-bone graft fixation strength of bioabsorbable as compared with titanium interference screws in anterior cruciate ligament reconstruction using matched pairs of porcine knees. Ten pairs underwent single-cycle failure loading at a rate of 50 mm/min, and 10 pairs underwent cyclic loading at half-hertz frequency. The cyclic loading started with 100 load cycles between 50 and 150 N. We then progressively increased loads in 50-N increments after each set of 100 cycles. After 100 cycles at 850 N, the specimens were loaded to failure at a rate of 50 mm/min. In the single-cycle failure loading test, the mean ultimate failure loads (SD) for the bioabsorbable (837 260 N) and titanium interference screws (863 192 N) were not significantly different, nor were the mean yield loads or the stiffness of the fixation. In the cyclic loading test, the yield loads were 605 142 N and 585 103 N for the bioabsorbable and titanium interference screws, respectively (no significant difference). Although there was no significant difference in the ultimate failure load, more bone block fractures were found in the grafts fixed with a titanium interference screw. Bioabsorbable interference screw fixation thus seems to provide a reasonable alternative to titanium screws.
Head Injuries in Snowboarders Compared with Head Injuries in Skiers
Authors: Fukuda Osamu , Takaba Michiyasu , Saito Takakage , Endo Shunro
Published: July 2017

We investigated snowboarding-related head injury cases and skiing-related head injury cases during five ski seasons at one resort area. There were 634 snowboarding-related head injuries and 442 skiing-related head injuries. The number of snowboarding head injuries increased rapidly over the study period. More male snowboarders than female snowboarders suffered head injuries. For both snowboarders and skiers, head injuries frequently occurred on the easy and middle slopes. Falls were the most frequent causes of injury in both groups. Jumping was a more frequent cause of injury in the snowboarders (30%) than in the skiers (2.5%). Injury to the occipital region predominated in the snowboarders as compared with the skiers. There were 49 organic lesions in 37 snowboarders and 46 organic lesions in 33 skiers. Subdural hematoma was frequent in the snowboarding head injury group, and fracture was frequent in the skiing head injury group compared with the snowboarding group (not significant). Subdural hematoma was likely to be caused by a fall rather than by a collision, and bone fracture was likely to be caused by a collision rather than by a fall. Four snowboarders and one skier died as a result of their head injuries. Our data suggest that snowboarding head injuries may be prevented by protection of the occipital region and refraining from jumping by beginners.
Neglected Ruptures of the Patellar Tendon
Authors: Casey Michael T. , Tietjens Barry R.
Published: July 2017

We describe a series of four patients treated for chronic ruptures of the patellar tendon (more than 6 months old). The proximally retracted patella was brought back to its anatomic position, and the tendon stumps were repaired and protected with multiple strands of strong circlage wire, in a figure-of-8 pattern, from the quadriceps tendon to the tibial tubercle. Postoperatively, immediate mobilization without the use of a brace was initiated. The patients averaged 29 months (range, 8 to 80) from the time of injury until definitive treatment and were observed for an average of 27 months (range, 11 to 40) after treatment. Before treatment, all patients had an extensor lag of at least 20°. At initial follow-up, all patients had full active extension with no extensor lag, and this did not deteriorate postoperatively or after wire removal. At the last follow-up, the average flexion was 0° to 112°. This technique avoids the use of autograft or allograft tissue and does not require lengthening of the quadriceps tendon.
Hip and Groin Injuries in Athletes
Authors: Anderson Kyle , Strickland Sabrina M. , Warren Russell
Published: July 2017

Although athletic injuries about the hip and groin occur less commonly than injuries in the extremities, they can result in extensive rehabilitation time. Thus, an accurate diagnosis and well-organized treatment plan are critical. Because loads of up to eight times body weight have been demonstrated in the hip joint during jogging, presumably even greater loads can occur during vigorous athletic competition. The available imaging modalities are effective diagnostic tools when selected on the basis of a thorough history and physical examination. Considerable controversy exists as to the cause and optimal treatment of groin pain in athletes, or the so-called “sports hernia.” There has also been significant recent attention focused on intraarticular lesions that may be amenable to hip arthroscopy. This article briefly reviews several common hip and groin conditions affecting athletic patients and highlights some newer topics.
Functional and Radiographic Outcome of Juvenile Osteochondritis Dissecans of the Knee Treated with Transarticular Arthroscopic Drilling
Authors: Kocher Mininder S. , Micheli Lyle J. , Yaniv Moshe , Zurakowski David , Ames Andrew , Adrignolo Anthony A.
Published: July 2017

Management of juvenile osteochondritis dissecans is controversial. The purpose of this study was to evaluate the functional and radiographic outcomes of transarticular arthroscopic drilling for isolated stable, juvenile osteochondritis dissecans lesions of the medial femoral condyle with an intact articular surface after 6 months of nonoperative management had failed. We reviewed 30 affected knees in 23 skeletally immature patients (mean age, 12.3 years; range, 8.5 to 16.1) at an average follow-up of 3.9 years (range, 2.0 to 7.2). Functional outcome was determined using the Lysholm score and radiographic outcome was determined using lesion size, and the radiographic score of Rodegerdts and Gleissner. There was significant improvement in the mean Lysholm score (from 58 to 93). There was significant improvement in the mean lesion size on anteroposterior (4.5 ± 5.8 mm decrease) and lateral (8.4 ± 8.1 mm decrease) radiographs. There was also significant improvement in the mean radiographic score (from 3.0 to 1.9). Radiographic healing was achieved in all patients at an average of 4.4 months after drilling (range, 1 to 11 months). Linear regression analysis revealed that younger age was an independent, multivariate predictor of Lysholm score improvement. There were no apparent surgical complications. Given the low morbidity of drilling and the associated improvement in functional and radiographic outcomes, we advocate arthroscopic transarticular drilling for patients with juvenile osteochondritis dissecans of the medial femoral condyle with an intact articular surface who have had failure of initial nonoperative management.
Comparison of Torsional Strengths of Bioabsorbable Screws for Anterior Cruciate Ligament Reconstruction
Authors: Costi John J. , Kelly Andrew J. , Hearn Trevor C. , Martin David K.
Published: July 2017

The goals of this study were to evaluate torsional strength and modes of failure in commercially available bioabsorbable interference screws and to test the effect of screw diameter on torsional strength when screws become jammed during insertion. We tested the Arthrex, BioScrew, Endo-Fix, Phantom, and Sysorb screws, all 20 mm in length. Four major modes of failure were encountered. Analysis of variance revealed that both screw type and diameter had a significant effect on failure torque. The Endo-Fix 7-mm screw had the lowest failure torque (1.07 ± 0.18 N·m) and the Sysorb 8-mm screw had the highest (5.23 ± 0.24 N·m). The Sysorb was significantly stronger than all the other screws. The failure torques were within the range that has been reported for manual screw insertion. We concluded that technical factors, which can affect insertion torque, assume particular importance with the use of bioabsorbable interference screws.
A Knotless Suture Anchor
Authors: Thal Raymond
Published: July 2017

The development of a unique Knotless suture anchor for soft tissue repair to bone is described. This device allows for soft tissue repair to bone using a suture anchor without the need for knot tying. This provides a particular advantage for arthroscopic repairs, where knot tying can be difficult. The Knotless suture anchor has a short loop of suture secured to the tail end of the anchor. A channel located at the tip of the anchor functions to capture the loop of suture after it has been passed through the soft tissue. The soft tissue is tensioned as the anchor is inserted into bone to the appropriate depth. Biomechanical testing demonstrated increased suture strength in the Knotless suture anchor compared with standard suture anchors. This is because of the doubled-suture configuration that is created with the Knotless suture anchor loop. To the author's knowledge, this paper describes the first knotless suture anchor. A secure, low-profile repair can be created without knot tying.
Tennis after Total Knee Arthroplasty
Authors: Mont Michael A. , Rajadhyaksha Amar D. , Marxen Jeff L. , Silberstein Charles E. , Hungerford David S.
Published: July 2017

In this study, patients who played tennis after undergoing a total knee arthroplasty were analyzed in terms of their functional abilities and degree of satisfaction. The patients were recruited by means of a questionnaire that was sent to players from lists supplied by the United States Tennis Association. The study group consisted of 28 men and 5 women (46 total knee replacements) with a mean age of 64 years. Only 21% (7 of 33) of the patients’ surgeons approved of their patients undertaking tennis activity, with 45% (15 of 33) recommending only doubles tennis. At both 1 year and a mean of 7 years after arthroplasty, players were playing both singles and doubles tennis approximately three times per week (range, one to seven). All tennis players polled were satisfied with their knee arthroplasties and their ability to resume playing tennis. Because the study patients played at a high level, future studies are needed to determine the effect of tennis on the general population, which does not play at such a uniformly high level. The long-term (15 to 20 years) effect of tennis activity on the clinical and radiologic outcome of total knee arthroplasty also needs to be determined.
Regeneration of the Semitendinosus Tendon after Its Use in Anterior Cruciate Ligament Reconstruction
Authors: Ferretti Andrea , Conteduca Fabio , Morelli Federico , Masi Vincenzo
Published: July 2017

We describe the histologic course of regenerated tissue simulating the semitendinosus tendon in three patients after anterior cruciate ligament reconstruction with doubled semitendinosus and gracilis tendons. Specimens were retrieved during revision surgery for removal of tibial hardware at 6, 24, and 27 months, respectively. Resisted flexion during physical examination in all patients revealed a “string” on the posteromedial aspect of the knee that was quite evident, suggesting the presence of a regenerated semitendinosus tendon. At surgery, a well-defined fibrous band was identified about 3 cm proximal and medial to the pes anserinus, reproducing the pathway of the native semitendinosus tendon. In the specimen retrieved 6 months postoperatively, a prominent fibroblastic proliferation was observed together with a few vessels surrounded by fibrous tissue; only a few bundles of well-oriented collagen fibers were present, together with scattered rows of spindle-shaped cells. In both of the specimens retrieved 2 years postoperatively, all of the central, thicker portion of each specimen was occupied by well-oriented tendon-like fibers together with uniformly distributed spindle-shaped cells that had the appearance of mature tenocytes arranged in orderly rows. These findings help us to understand the progression of the healing process at the harvest site and the nature of the regenerated semitendinosus tendon, which has previously been investigated only by studies of clinical and functional outcomes and by imaging studies.
Anterior Cruciate Ligament Reconstruction with a Reharvested Bone-Patellar Tendon-Bone Graft
Authors: O'Shea John J. , Shelbourne K. Donald
Published: July 2017

We sought to determine the results in patients who underwent revision anterior cruciate ligament reconstruction with a reharvested bone-patellar tendon-bone graft. Preoperative magnetic resonance imaging of the patellar tendon was used to determine the width of the tendon and the quality of the tissue. The section of the tendon harvested included 7 to 8 mm of the regenerated tendon and 2 to 3 mm of previously untouched tendon either medial or lateral to the healed tissue. The mean time from primary graft harvest to reharvest was 71.0 ± 44 months (range, 32 to 180). An accelerated rehabilitation program was used postoperatively. Objective follow-up of more than 2 years after surgery was available for 8 patients at a mean of 49.0 ± 15.4 months. The average range of motion in the anterior cruciate ligament-reconstructed knee was 6/0/133 at 1 month postoperatively and 6/0/145 at long-term followup. The mean manual maximum KT-1000 arthrometer difference between knees was 1.6 ± 1.2 mm. The mean isokinetic quadriceps muscle strength of the reharvested graft donor knee was 103% ± 7% of that of the opposite knee. Subjective scores were obtained from 11 patients (12 knees) at a mean of 51.5 ± 35.7 months (range, 24 to 150) after surgery; the mean score was 89.3 ± 6.9 points. We conclude that with appropriate preoperative planning, a reharvested patellar tendon can be used for revision anterior cruciate ligament reconstruction to obtain reliable stability and strength postoperatively.
Achilles Tendon Disorders in Athletes
Authors: Schepsis Anthony A. , Jones Hugh , Haas Andrew L.
Published: July 2017

Achilles tendon disorders are among the more common maladies seen by sports medicine physicians. Understanding the anatomy and biomechanics of the Achilles tendon and contiguous structures is essential to the diagnosis and treatment of Achilles tendon overuse injuries. Posterior heel pain is multifactorial and includes paratenonitis, tendinosis, tendinosis with partial rupture, insertional tendinitis, retrocalcaneal bursitis, and subcutaneous tendo-Achillis bursitis. Each of these entities is distinct, but they often occur in combination. Although most cases of this disorder are successfully treated nonoperatively, a small subgroup of recalcitrant cases may benefit from surgical intervention. Complete ruptures in active, athletic persons should be treated operatively in most cases and result in predictably good outcomes. There may be some cases that escape early recognition and require a reconstructive procedure to salvage a potentially severe functional deficit.
Posterior Cruciate Ligament Femoral Insertion Site Characteristics: Importance for Reconstructive Procedures
Authors: Mejia Etienne A. , Noyes Frank R. , Grood Edward S.
Published: July 2017

Background:

Previous descriptions of the insertion site of the posterior cruciate ligament are inadequate.

Hypothesis:

More than one reference system is required to adequately represent the anatomy of the femoral attachment. Study Design: Descriptive anatomic study.

Methods:

Twelve cadaveric specimens were evaluated by using two measurement methods relative to the femoral articular cartilage margin and two methods relative to the intercondylar femoral roof.

Results:

Reference lines perpendicular to the articular cartilage best defined the 12- and 1-o'clock positions, and those perpendicular to the articular cartilage or parallel to the femoral shaft best defined the 2-, 3-, and 4-o'clock positions. The angle of the proximal attachment to the roof was 88° ± 5.5°. The posterior cruciate ligament was a continuum of fibers rather than two distinct bundles, and its attachment showed variability in shape and thickness, extending past the midline in the notch (11:21 ± 15 minutes to 4:12 ± 20 minutes, right knee).

Conclusions:

More than one measurement system is required to accurately describe the femoral origin of the posterior cruciate ligament.

Clinical Relevance:

Accurate assessment of the anatomy is crucial for successful surgical reconstruction of the posterior cruciate ligament femoral attachment.
Prevention of Soccer Injuries: A Prospective Intervention Study in Youth Amateur Players
Authors: Junge Astrid , Rösch Dieter , Peterson Lars , Graf-Baumann Toni , Dvorak Jiri
Published: July 2017

Background:

Risk factors for soccer injuries and possibilities for prevention have been discussed by several authors, but only a few have investigated the effectiveness of preventive interventions.

Purpose:

The aim of the present study was to evaluate the effects of a prevention program on the incidence of soccer injuries in male youth amateur players.

Study Design:

Prospective controlled intervention study.

Methods:

Seven soccer teams took part in a prevention program that focused on education and supervision of coaches and players, while seven other teams were instructed to train and play soccer as usual. Over 1 year all injuries were documented weekly by physicians. Complete weekly injury reports were available for 194 players.

Results:

The incidence of injury per 1000 hours of training and playing soccer was 6.7 in the intervention group and 8.5 in the control group, which equates to 21% fewer injuries in the intervention group. The greatest effects were observed for mild injuries, overuse injuries, and injuries incurred during training. The prevention program had greater effects in low-skill than in high-skill teams.

Conclusions:

The incidence of soccer injuries can be reduced by preventive interventions, especially in low skill level youth teams. Coaches and players need better education regarding injury prevention strategies and should include such interventions as part of their regular training.
The 7-o'clock Posteroinferior Portal for Shoulder Arthroscopy
Authors: Davidson Philip A. , Rivenburgh Dennis W.
Published: July 2017

Background:

Access to the inferior glenohumeral joint of the shoulder is very limited through the traditional 2- or 3-o'clock anterior portals.

Hypothesis:

The 7-o'clock posteroinferior portal offers an excellent alternative approach.

Study Design:

Descriptive anatomic study.

Methods:

Six paired cadaveric shoulders were used to arthroscopically develop and test a 7-o'clock posteroinferior portal. The distances between the portal and the subscapular and axillary nerves were measured with the arm in six different positions, combining flexion, extension, abduction, and adduction.

Results:

The distance from the 7-o'clock posteroinferior portal to the axillary nerve was 39 ± 4 mm and to the suprascapular nerve was 28 ± 2 mm. There was no statistically significant nerve-to-portal differential distance when the arm was placed in flexion, extension, abduction, or adduction. The inside-to-outside technique produced a 7-o'clock posteroinferior portal approximately 5 mm further from both the axillary and suprascapular nerves than did the outside-to-inside method. The angle of divergence from the 7-o'clock posterior portal skin incision to the axillary nerve was 47° and to the suprascapular nerve was 33°.

Conclusions:

The 7-o'clock portal affords safe, direct working access to the inferior capsular recess of the glenohumeral joint.

Clinical Relevance:

The 7-o'clock portal is a safe and effective technique for use by shoulder surgeons.
Classification, Investigation, and Management of Midfoot Sprains
Authors: Nunley James A. , Vertullo Christopher J.
Published: July 2017

Background

Midfoot sprains in athletes represent a spectrum of injuries to the Lisfranc ligament complex, from partial sprains with no displacement to complete tears with frank diastasis. Treatment of these injuries varies from the treatment of high-velocity injuries seen in nonathletes.

Purpose

We wanted to report the outcome of treatment in athletes with Lisfranc injuries classified according to our system.

Study Design

Retrospective cohort study.

Methods

Weightbearing radiographs and bone scintigrams were used to diagnose midfoot sprains in 15 athletes who were treated surgically or nonoperatively according to the following classification: nonoperative management for stage I injuries (undisplaced) and anatomic reduction with fixation for stage II (diastasis with no arch height loss) and stage III (diastasis with arch height loss) injuries.

Results

We achieved an excellent outcome in 93% of 15 athletes with midfoot sprains at an average follow-up of 27 months (range, 9 to 72).

Conclusions

Weightbearing radiographs and bone scintigrams are sensitive, reproducible, and relatively inexpensive methods of investigation of these injuries. Restoration and maintenance of the anatomic alignment of the Lisfranc joint is the key to appropriate treatment of injury to the midfoot.
Biomechanical Comparison of the FasT-Fix Meniscal Repair Suture System with Vertical Mattress Sutures and Meniscus Arrows
Authors: Borden Peter , Nyland John , Caborn David N. M. , Pienkowski David
Published: July 2017

Background

A meniscal repair technique that combines the strength of vertical mattress sutures and the decreased tissue morbidity of an all-inside technique would be advantageous.

Hypothesis

The FasT-Fix Meniscal Repair Suture System will provide load at failure, stiffness, and displacement equivalent to that of vertical mattress sutures and superior to that of Meniscus Arrows.

Study Design

In vitro biomechanical study.

Methods

After repair of a 2-cm vertical longitudinal medial meniscal lesion, three groups of six human cadaveric knees were biomechanically tested in a random order on a servohydraulic device, and three groups of five specimens underwent cyclic loading.

Results

Specimens repaired with Meniscus Arrows had reduced load at failure, stiffness, and displacement, but there were no differences between the FasT-Fix and vertical mattress suture methods. During cyclic loading, specimens repaired with two Meniscus Arrows failed before test completion, whereas specimens repaired with two vertical mattress sutures (6.0 ± 3.7 mm) or with two FasT-Fix implants (5.1 ± 1.4 mm) maintained fixation with comparable displacements.

Conclusions

The FasT-Fix provided load at failure, stiffness, and displacement comparable with that of vertical mattress sutures.

Clinical Relevance

The results suggest that the FasT-Fix may be preferable to Meniscus Arrows for meniscal repair with minimal associated tissue morbidity.
Treatment of Postoperative Anterior Cruciate Ligament Infections with Graft Removal and Early Reimplantation
Authors: Burks Robert T. , Friederichs Matthew G. , Fink Barbara , Luker Mark G. , West Hugh S. , Greis Patrick E.
Published: July 2017

Background

Septic arthritis after arthroscopic anterior cruciate ligament reconstruction is rare, and the most appropriate treatment is unclear. Current recommendations are that, if the graft is removed, reimplantation should be delayed for 6 to 9 months.

Hypothesis

Early removal of the graft with appropriate infection management followed by early reimplantation can lead to good results.

Study Design

Uncontrolled retrospective review.

Methods

Records of all patients who developed postoperative infection after anterior cruciate ligament reconstruction were reviewed. Four patients had early graft removal and appropriate infection management including 6 weeks of intravenous antibiotics followed by anterior cruciate ligament graft reimplantation within 6 weeks of completion of antibiotic therapy.

Results

Follow-up at an average of 21 months (range, 14 to 31) showed that the patients treated with early reimplantation had full symmetric knee range of motion and no effusion. The average modified Lysholm score was 92.5. Radiographs demonstrated no joint-space narrowing or osteophyte formation. The 30-pound KT-1000 arthrometer side-to-side difference averaged 3 mm.

Conclusion

Graft removal after confirmed anterior cruciate ligament graft infection and intravenous antibiotic administration followed by early graft reimplantation can give excellent results.
Effect of Drain Use in the Early Postoperative Period after Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Graft
Authors: Dhawan Aman , Doukas William C. , Papazis Janet A. , Scoville Charles R.
Published: July 2017

Background

Little data exist on the effect of routine use of postoperative drainage after arthroscopic anterior cruciate ligament reconstruction, although clinical studies of other procedures have not shown benefit to this practice.

Hypothesis

Use of a postoperative drain will not result in decreased suprapatellar girth, increased range of motion, and decreased pain compared with nonuse.

Study Design

Prospective randomized clinical trial.

Methods

Twenty-one patients undergoing arthroscopically assisted bone-patellar tendon-bone anterior cruciate ligament reconstruction were randomly assigned to receive a drain for 24 hours (12 patients) or no drain (9 patients). Data for comparison of groups were collected daily through postoperative day 7.

Results

Pain scores on a visual analog scale demonstrated the same improving trend over time for both treatment and control groups; however, the treatment group had significantly higher average pain scores, except on day 7. Differences in suprapatellar girth, flexion, and extension were not found to be statistically significant between groups.

Conclusion

Use of a drain after arthroscopically assisted anterior cruciate ligament reconstruction provided no benefit in terms of range of motion, effusion, or pain in the early postoperative period.
Hip Arthroscopy: Current Indications, Treatment Options, and Management Issues
Authors: Kelly Bryan T. , Williams Riley J. , Philippon Marc J.
Published: July 2017

The management of hip injuries in athletes has evolved significantly in the past few years with the advancement of arthroscopic techniques. The application of minimally invasive surgical techniques has facilitated relatively rapid returns to sporting activity in both recreational and elite athletes. Recent advancements in both hip arthroscopy and magnetic resonance imaging have elucidated several sources of intraarticular abnormalities that result in chronic and disabling hip symptoms. Many of these conditions were previously unrecognized and, thus, left untreated. Current indications for hip arthroscopy include the presence of symptomatic acetabular labral tears, hip capsule laxity and instability, chondral lesions, osteochondritis dissecans, ligamentum teres injuries, snapping hip syndrome, iliopsoas bursitis, and loose bodies (for example, synovial chondromatosis). Less common indications include management of osteonecrosis of the femoral head, bony impingment, synovial abnormalities, crystalline hip arthropathy (gout and pseudogout), infection, and posttraumatic intraarticular debris. In rare cases, hip arthroscopy can be used to temporize the symptoms of mild-to-moderate hip osteoarthritis with associated mechanical symptoms. This article discusses the current clinical and radiographic methods to detect early hip joint disease and the current indications and surgical techniques of hip arthroscopy.
The Effect of Wedged Insoles on the Lateral Thrust of Anterior Cruciate Ligament-Insufficient Knees
Authors: Yoshimura Ichiro , Naito Masatoshi , Hara Michiya , Zhang Jingfan
Published: July 2017

Background

Patients with untreated anterior cruciate ligament insufficiency often develop osteoarthritis. In Japan, laterally or medially elevated insoles have been widely used for the relief of symptoms associated with unicompartmental osteoarthritis of the knee.

Hypothesis

The use of a valgus wedge in the shoe of a patient with anterior cruciate ligament insufficiency will decrease lateral thrust.

Study Design

Controlled laboratory study.

Methods

An accelerometer was used to measure thrust force in 60 control knees and 35 knees with anterior cruciate ligament insufficiency. The sensor was attached to the affected and the control anterior tibial tubercles to record motion in the medial-lateral and perpendicular directions. The lateral thrust immediately after heel strike was measured continuously by a telemeter under stabilized walking conditions. Measurements were made both with and without wedged insoles.

Results

When compared with the control knee, the peak value of lateral acceleration immediately after heel strike was significantly greater in the anterior cruciate ligament-insufficient knees. However, lateral thrust decreased significantly in the anterior cruciate ligament-insufficient knees when a wedged insole was used.

Conclusions

Use of an insole resulted in a significant decrease in lateral thrust, even in anterior cruciate ligament-insufficient knees.

Clinical Relevance

Use of an insole is one possible prophylaxis for osteoarthritis for an anterior cruciate ligament-insufficient knee.
The Effects of Removal and Reconstruction of the Anterior Cruciate Ligament on Patellofemoral Kinematics
Authors: Hsieh Yeou-Fang , Draganich Louis F. , Ho Sherwin H. , Reider Bruce
Published: July 2017

Patellofemoral pain may be associated with anterior cruciate ligament deficiency or may occur after anterior cruciate ligament reconstruction. We investigated the effects of the removal and reconstruction of the anterior cruciate ligament on the kinematics of the tibiofemoral and patellofemoral joints during physiologic levels of quadriceps muscle loads in seven cadaveric knees. A bone-patellar tendon-bone graft was used for intraarticular reconstruction of the anterior cruciate ligament. The spatial positions of the tibiofemoral and patellofemoral joints were measured between 0° and 90° of knee flexion in 15° increments with a six degree-of-freedom digitizing system. Excision of the anterior cruciate ligament resulted in statistically significant increases in anterior tibial translation between 0° and 90° and valgus tibial rotation between 30° and 90°; intraarticular reconstruction returned these to levels not significantly different from those of the intact knee. Excision of the anterior cruciate ligament resulted in significant increases in lateral patellar tilt, ranging from 6.3° to 9.0° between full extension and 90° of knee flexion, and in lateral patellar shift, ranging from 2.9 mm at 15° of knee flexion to 5.9 mm at 90°; intraarticular reconstruction returned these to levels not significantly different from those of the intact knee. Neither removal nor reconstruction of the anterior cruciate ligament significantly affected tibial internal-external rotation, patellar flexion, patellar mediolateral rotation, patellar anteroposterior translation, or patellar proximodistal translation.
The Role of the Scapula in Athletic Shoulder Function
Authors: Ben Kibler W.
Published: July 2017

The exact role and the function of the scapula are misunderstood in many clinical situations. This lack of awareness often translates into incomplete evaluation and diagnosis of shoulder problems. In addition, scapular rehabilitation is often ignored. Recent research, however, has demonstrated a pivotal role for the scapula in shoulder function, shoulder injury, and shoulder rehabilitation. This knowledge will help the physician to provide more comprehensive care for the athlete. This “Current Concepts” review will address the anatomy of the scapula, the roles that the scapula plays in overhead throwing and serving activities, the normal biomechanics of the scapula, abnormal biomechanics and physiology of the scapula, how the scapula may function in injuries that occur around the shoulder, and treatment and rehabilitation of scapular problems.
Heavy-Load Eccentric Calf Muscle Training For the Treatment of Chronic Achilles Tendinosis
Authors: Alfredson Håkan , Pietilä Tom , Jonsson Per , Lorentzon Ronny
Published: July 2017

We prospectively studied the effect of heavy-load eccentric calf muscle training in 15 recreational athletes (12 men and 3 women; mean age, 44.3 7.0 years) who had the diagnosis of chronic Achilles tendinosis (degenerative changes) with a long duration of symptoms despite conventional nonsurgical treatment. Calf muscle strength and the amount of pain during activity (recorded on a visual analog scale) were measured before onset of training and after 12 weeks of eccentric training. At week 0, all patients had Achilles tendon pain not allowing running activity, and there was significantly lower eccentric and concentric calf muscle strength on the injured compared with the noninjured side. After the 12-week training period, all 15 patients were back at their preinjury levels with full running activity. There was a significant decrease in pain during activity, and the calf muscle strength on the injured side had increased significantly and did not differ significantly from that of the noninjured side. A comparison group of 15 recreational athletes with the same diagnosis and a long duration of symptoms had been treated conventionally, i.e., rest, nonsteroidal antiinflammatory drugs, changes of shoes or orthoses, physical therapy, and in all cases also with ordinary training programs. In no case was the conventional treatment successful, and all patients were ultimately treated surgically. Our treatment model with heavy-load eccentric calf muscle training has a very good short-term effect on athletes in their early forties.
Arthroscopic Transglenoid Stabilization Versus Open Anchor Suturing in Traumatic Anterior Instability of the Shoulder
Authors: Steinbeck Jörn , Jerosch Jörg
Published: July 2017

Sixty-two consecutive patients with recurrent traumatic anterior instability of the shoulder were prospectively observed. Thirty patients were observed after arthroscopic stabilization, and 32 were observed after open Bankart repair during a mean follow-up of 36 and 40 months, respectively (range, 24 to 60 months for both groups). To reattach the labrum, the arthroscopic technique used transglenoid sutures and the open technique used bone anchors. Redislocation occurred in two patients (6%) in the open repair group and in five patients (17%) in the arthroscopic repair group. Three of the five patients with redislocations in the arthroscopic repair group underwent reoperation. According to the criteria of Rowe et al., 29 patients (90.6%) who had open repair and 24 patients (80%) who had arthroscopic repair had good-to-excellent results. The patients averaged 90.6 points in the open repair group and 83.1 points in the arthroscopic repair group postoperatively. Little or no limitations in their postoperative sports activities were reported by 30 patients (94%) who underwent open repair and by 25 patients (83%) who had arthroscopic repair. Despite similar patient populations and using arthroscopic examination to select the type of repair in both groups, the results of arthroscopic shoulder stabilization are inferior to those of the classic open Bankart procedure.
Articular Cartilage Changes Seen With Magnetic Resonance Imaging-Detected Bone Bruises Associated With Acute Anterior Cruciate Ligament Rupture
Authors: Johnson Darren L. , Urban William P. , Caborn David N. M. , Vanarthos William J. , Carlson Cathy S.
Published: July 2017

Occult osteochondral lesions (bone bruises) have been documented on magnetic resonance images in more than 80% of patients sustaining acute anterior cruciate ligament ruptures. Despite the high prevalence of these lesions, little is known about the histologic changes in the adjacent articular cartilage. Ten patients with acute anterior cruciate ligament ruptures who had a preoperatively documented (by magnetic resonance imaging) geographic bone bruise at the sulcus terminalis on the lateral femoral condyle underwent a 3-mm diameter trephine biopsy of the articular cartilage and subchondral bone overlying the bone bruise at the time of anterior cruciate ligament reconstruction. Biopsy samples of the articular cartilage and subchondral bone were stained with hematoxylin and eosin and toluidine blue. All patients had significant arthroscopic and histologic articular cartilage irregularity in the area overlying the bone bruise. Arthroscopic findings of the articular cartilage included softening (dimpling), fissuring, or overt chondral fracture. Histologic examination revealed degeneration of the chondrocytes and loss of toluidine blue staining in the articular cartilage (loss of proteoglycan). There was necrosis of osteocytes in the subchondral bone, and empty lacuna were visible. This study defines the exact histologic changes of the articular cartilage overlying a geographic bone bruise secondary to an acute anterior cruciate ligament tear. Our findings suggest that a geographic bone bruise found on magnetic resonance imaging indicates substantial damage to normal articular cartilage homeostasis.
Medial Elbow Joint Laxity in Professional Baseball Pitchers
Authors: Ellenbecker Todd S. , Mattalino Angelo J. , Elam Erik A. , Caplinger Roger A.
Published: July 2017

Injuries to the ulnar collateral ligament frequently occur in throwing athletes because of large, repetitive valgus stresses to the elbow during the cocking and acceleration phases of throwing. Identification of injury to this ligament is important in evaluating the throwing elbow. The purpose of this study was to determine whether differences in medial elbow laxity exist between the dominant and nondominant extremities in uninjured baseball pitchers. Forty uninjured professional baseball pitchers were tested bilaterally with a Telos GA-IIE stress radiography device. Joint space width between the trochlea of the humerus and the coronoid process of the ulna was measured on anteroposterior radiographs obtained with no stress applied and with a 15-daN valgus stress. Results showed significant differences between the medial joint space opening of the dominant and nondominant elbows with no stress applied. With stress, the dominant elbow opened 1.20 0.97 mm, while the nondominant elbow opened 0.88 0.55 mm. A significantly greater difference in medial joint space opening between the stressed and unstressed elbows was measured in the dominant elbow compared with the nondominant elbow (0.32 0.42 mm). This study identifies increased medial elbow laxity in the dominant arm in uninjured pitchers.
Graft Fixation Strength with Arthroscopic Anterior Cruciate Ligament Reconstruction
Authors: Stapleton Timothy R. , Waldrop John I. , Ruder Craig R. , Parrish Todd A. , Kuivila Thomas E.
Published: July 2017

To compare the fixation strengths of two arthroscopic anterior cruciate ligament reconstruction techniques, we harvested 10-mm bone-patellar tendon-bone grafts with 25-mm bone plugs from 12 fresh-frozen cadaveric knees. One knee of each pair was fixed using Acufex instruments and the two-incision technique; one knee was fixed using Arthrotek instruments and the one-incision technique. We used cannulated 9 25 mm Kurosaka screws for femoral and tibial tunnel fixation. All knees were mounted on the Instron Test System and were stressed to failure by recreating a pivot shift maneuver. The one-incision technique graft fixation was significantly stronger (mean failure, 695 N) than that with the two-incision technique (mean failure, 593 N). In all one-incision technique knees, either the patellar tendon graft avulsed off a bone plug or the plug broke. In five of six two-incision technique knees, the tibial bone plug pulled out around the interference screw. Patellar tendon graft length ranges from 90 to 105 mm, and the average two-incision technique tunnel length is 120 mm. The interference screw compressed the femoral bone plug into cortical bone but compressed the tibial bone plug into cancellous bone in the two-incision technique, while in the one-incision technique the bone plug was compressed into cortical bone on both sides.
The Active Compression Test: A New and Effective Test for Diagnosing Labral Tears and Acromioclavicular Joint Abnormality
Authors: O'Brien Stephen J. , Pagnani Michael J. , Fealy Stephen , McGlynn Scott R. , Wilson Joseph B.
Published: July 2017

Labral tears and acromioclavicular joint abnormalities were differentiated on physical examination using a new diagnostic test. The standing patient forward flexed the arm to 90° with the elbow in full extension and then adducted the arm 10° to 15° medial to the sagittal plane of the body and internally rotated it so that the thumb pointed downward. The examiner, standing behind the patient, applied a uniform downward force to the arm. With the arm in the same position, the palm was then fully supinated and the maneuver was repeated. The test was considered positive if pain was elicited during the first maneuver, and was reduced or eliminated with the second. Pain localized to the acromioclavicular joint or “on top” was diagnostic of acromioclavicular joint abnormality, whereas pain or painful clicking described as “inside” the shoulder was considered indicative of labral abnormality. A prospective study was performed on 318 patients to determine the sensitivity, specificity, and positive and negative predictive values of the test. Fifty-three of 56 patients whose preoperative examinations indicated a labral tear had confirmed labral tears that were repaired at surgery. Fifty-five of 62 patients who had pain in the acromioclavicular joint and whose preoperative examinations indicated abnormalilties in the joint had positive clinical, operative, or radiographic evidence of acromioclavicular injury. There were no false-negative results in either group.