bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of acute and chronic luxations of the peroneal tendons
Authors: McLennan Jon G.
Published: June 2007

The study, diagnosis, and treatment of subluxations or dislo cations of the peroneal tendons has received little attention in the orthopaedic literature and has long been an enigma to the orthopaedic surgeon. This study reviews literature regarding this problem, and evaluates a group of patients treated by various modalities at Centinella Valley Hospital to provide, hopefully, a source of reference and suggestions as to treat ment.

Operative and nonoperative management of acute or chronic subluxating or dislocating peroneal tendons were evaluated over a 4-year period with a minimum follow-up of 2 years. Most injuries were athletically related. Sixteen patients had demon strable lesions in 19 ankles; all but two were a result of trauma documented at some time. All patients returned for follow-up physical examinations, x-ray films and to answer our question naires assessing their functional status, symptoms, limitations, and progress.

In 93% of the patients evaluated, conservative modes of treatment were initiated, although 44% ultimately required operative intervention. Three patients treated nonoperatively had evidence of resubluxation, although functionally there was little objective associated disability.

Because morbidity is minimal, conservative modes of treat ment are functionally satisfactory in most instances. However, in acute injuries in individuals involved heavily in athletics, operative reconstruction is desired. All patients required pro tective taping for a minimum of 6 months after injury regardless of mode of treatment.
Lateral instability of the ankle and results when treated by the Evans procedure
Authors: Vainionpää Seppo , Kirves Pekka , Läike Erkki
Published: June 2007

Between 1968 and 1976 81 ankles of 77 patients with lateral instability of the ankle joint were operated on in the Kotka Central Hospital. Sixty patients with 62 ankle surgeries had postoperative followup.

The average follow-up time was 5.2 years and the mean age of the patients was 28.3 years. In addition to the interview during the postoperative examination, all patients had antero posterior (AP) mortice, lateral AP stress, and sagittal stress x- ray films. In the clinical examination ankle joint mobility, stability, peroneal function, predisposition to swelling, and circumference of the calf were investigated.

Of the 62 ankles the result was excellent or good in 54 (87%), satisfactory in 5 (8%), and poor in 3 cases (5%).

Of the 16 athletes' 18 ankles treated the result was excellent or good in 16 and satisfactory in 2 cases.

The Evans procedure prevented talar tilting and gave good stability in anteroposterior direction.
Shoulder impingement syndromes in athletes and their surgical management*
Authors: Penny J.N. , Welsh R.P.
Published: June 2007

The painful arc syndrome may be produced by im pingement of the supraspinatus tendon, the biceps tendon, or the greater tuberosity of the humerus against the coracoacromial arch. Where conservative measures have failed, surgical intervention may pro vide considerable symptomatic relief by decompress ing the coracoacromial arch. In 20 cases surgically treated for biceps or supraspinatus impingements, 17 patients have returned to sporting activities without symptoms. The painful arc syndrome persists in three patients but they are symptomatically improved. Six patients with complete rotator cuff tears and subse quent impingement of the greater tuberosity of the humerus against the coracoacromial arch underwent widespread decompression. Five of the patients have returned to sporting activities much improved. Failure to recognize the associated acromioclavicular joint pathology is a frequent cause of failure of surgical treatment.
Surgical treatment of patellar instability: Indications and results
Authors: Henry Jack H. , Craven Phillip R.
Published: June 2007

The purpose of this study was to evaluate a consec utive series of 465 patients with patellar subluxation. Both knees were involved in some patients. Therefore, 557 knees were studied. The average age was 24 years. Specific symptoms and signs were reviewed. Instability, swelling, and patella alta were more com mon in the group requiring surgery.

All patients were treated conservatively with specific exercises initially. Failure of this conservative treat ment to significantly improve the symptoms, inability to do the activities of daily living, or expected associ ated pathology were indications for surgery. Surgery was required in 139 patients (27%). Some patients had surgery on both knees. Therefore 149 knees were repaired.

The surgical technique consisted of an extensor mechanism realignment. This consisted of release of the lateral patellofemoral ligaments, advancement of the vastus medialis obliquus muscle and, in some cases, transfer of the tibial tubercle. Arthrotomy was done in all cases.

Results were evaluated in terms of pain, function, and patellar instability. Signs evaluated preoperatively and postoperatively were tenderness of the retinacu lum or bone, patellar mobility, effusion, muscle atro phy, and tone. Range of motion was also evaluated. The average followup lasted three years.
Acute posterior cruciate ligament injuries
Authors: Loos William C. , Fox James M. , Blazina Martin E. , Del Pizzo Wilson , Friedman Marc J.
Published: June 2007

One hundred and two posterior cruciate ligament in juries were reviewed (43 chronic and 59 acute re pairs). The 59 acute repairs were profiled as to cause and site of injury, associated ligamentous damage, clinical examination, patient position at surgery, and reoperation rate. Twenty-two patients were followed up. Motor vehicle accidents and athletics were the usual causes of injury.

In the 59 acute repairs, the posterior cruciate avul sion site was femoral in 21, midsubstance in 13, and tibial in 25. The high incidence of associated injuries included medial collateral ligament tears, capsular damage, lateral knee component damage, and ante rior cruciate ligament ruptures. Thirteen of 59, be lieved to have isolated tears, had surgery in the prone position.

Twelve were subsequently reoperated. Eight of 12 reoperations were done prone initially for an "iso lated" tear. Our acute knees with poor results all had the most supposed "isolated" and midsubstance tears, and the most popliteal surgery.

The posterior cruciate ligament tear is due to major violence with associated ligament injuries and has no single universal physical sign. Arthroscopy and ex amination under anesthesia are recommended to pre vent the missed diagnosis (chronic case) or to clarify a suspected "isolated" tear prior to prone popliteal surgery.
Use of the air-inflated jacket in football*
Authors: Cain Thomas E. , Donzis Byron , Meins Jerry
Published: June 2007

Injuries to the rib cage are common in football, but little has been done to protect this area. This paper discusses the effectiveness and usefulness of a pro tective jacket in football. The jacket is highly durable, constructed of urethane-coated nylon, and heat- sealed to take on the shape of several cylinders inter connected by fabric valves which constrict in re sponse to a sudden blow.

Its exterior is covered by a 1/8-inch thick Lexan (General Electric, Toledo, OH) shield. The jacket weighs 6.5 oz. It showed impressive results when tested. Testing was done by forcefully swinging a baseball bat against the rib cage protected by the jacket. By digitization of high speed movie filming at 500 frames/second, we were able to determine the speed, velocity, and area of contact. The amount of force deflection was calculated to be 587.6 psi. To inflict this force, a player would have to be traveling 60 miles/hour and strike his opponent with the heel.

This lightweight, air-inflated, padded jacket has pro tected and prevented rib cage injuries in professional athletes. It is accepted well by players. This suggests that similar protective equipment for other areas would be useful and represents an advancement in prevent ing injury.
Functional versus organic knee pain in adolescents
Authors: Fritz Gregory K. , Bleck Eugene E. , Dahl Irene Susan
Published: June 2007

Psychologic factors, usually assessed with the Min nesota Multiphasic Personality Inventory, have been reported by various researchers as significant in cer tain groups of adult orthopaedic patients—most no tably those with low back pain. Much less is known about children and adolescents or other orthopaedic complaints. We did a pilot study to determine how significant nonorganic factors are in adolescents pre senting with knee pain and whether a brief screening protocol conducted in the waiting room can predict which adolescents do not have organic etiology for the knee pain. Twenty-eight consecutive adolescents were given the Junior-Senior High School Personality Questionnaire (HSPQ), and information on other vari ables was obtained prior to their first orthopaedic visit. Followup after six to eight months revealed that over a third of the patients had significant or predominant psychologic factors associated with the knee pain. The HSPQ and other individual variables were found, overall, to be of little help in differentiating between the functional and organic groups.
Clinical characteristics of patellar disorders in young athletes
Authors: Reider Bruce , Marshall John L. , Warren Russell F.
Published: June 2007

The clinical histories of 50 young athletes who com plained of patellar instability or pain were analyzed, and their physical findings were compared to those of 50 controls. The patients were divided into three groups, based on their symptoms. Analysis of their physical findings confirmed the validity of these divi sions. Those who complained of frank dislocation of the patella exhibited the most pronounced stigmata of quadriceps dysplasia, including vastus medialis defi ciency and infrapatellar fat pad enlargement, and had increased general ligamentous laxity, increased mean patellar mobility, and out-facing patellae with concom itantly decreased Q angles in chronic, recurrent cases.

Patients who complained of the classic patellar pain pattern, often called "chondromalacia patella," but who denied swelling were designated CMP. They had normal mean ligamentous laxity and mean patellar mobility, an increased incidence of in-facing patellae with concomitantly increased mean Q angle, and fre quently palpable lateral patellofemoral bands. Patients who complained of pain and swelling had physical findings intermediate to the other two groups, and generally correspond to what is usually termed sub luxation of the patella. They exhibited normal general laxity but increased mean patellar mobility, normal mean Q angle but an increased incidence of patellar infacing, and fat pad enlargement.
Hot-air ballooning injuries
Authors: Marcus Norman A. , Sweetser Edward R. , Benson Robert W.
Published: June 2007

The sport of hot-air ballooning is generally safe, but does place its participants in certain unique circumstances which may predispose them to injury. Fractures of the ankle and compression fractures of the lumbar spine are among the most common skeletal injuries that require ortho paedic care. Attention to basket design, proper education of the passenger, and careful consid eration of terrain and prevailing weather condi tions may help make ballooning a safer sport.
The injury rate in professional basketball
Authors: Henry Jack H. , Lareau Bernie , Neigut Deborah
Published: June 2007

The purpose of this study is to review seven years of medical experience with injuries to players of a profes sional basketball club. One of the authors was in volved with all injuries occurring during this period of time. All 71 athletes participating with this club were evaluated, and their specific injuries were studied with regard to incidence, time loss due to injury, and treat ment.

Foot, ankle, knee, back, and hand injuries were found to occur most often. The most common as well as the most severe injuries were those of the ankle and knee. The average time loss from play due to injury was amazingly consistent for each specific in jury. Rehabilitation of injuries varied from no playing time loss to two years. Even though knee injuries carry a poor prognosis, the authors conclude that the inci dence of severe injury in professional basketball is low. This study will hopefully serve as useful informa tion for those involved with the care of basketball players.
Clinical diagnosis of ruptures of the anterior cruciate ligament
Authors: Jonsson Torsten , Althoff BO , Peterson Lars , Renström Per
Published: June 2007

The relative accuracy of the Lachman test and the anterior drawer sign was compared in 107 knee joints with ruptures of the anterior cruciate ligament. In examining an acutely injured knee in a patient without anesthesia, the Lachman test was superior to the anterior drawer sign, but, in chronic injuries, both the tests had high diagnostic accuracy.
Large calcified pelvic mass in a boxer
Authors: Doris Peter E. , Johnston Charles C.
Published: June 2007

Many conditions are associated with abdominal cal cifications, but few cause acute abdominal pain in a previously healthy person. This report describes a large calcified pelvic mass that required surgical in tervention.
Natural history of glenohumeral dislocation—revisited
Authors: Henry Jack H. , Genung John A.
Published: June 2007

The purpose of this study was to evaluate the natural history of glenohumeral dislocation in young athletes. A review of the literature revealed a consensus of opinion that the dislocated shoulder should be immo bilized from 3-6 weeks. However, a high recurrence rate could be expected.

One hundred twenty-one patients with acute trau matic anterior dislocations were evaluated (average age—19 years). Methods of immobilization were shoulder immobilizers and slings and swaths. Sixty- two patients were immobilized and 56 (90%) of these suffered recurrent dislocation. Fifty-nine patients were not immobilized and 50 (85%) re-dislocated their shoulders. The length of immobilization had no effect on the recurrence rate. All re-dislocations occurred within 18 months of the initial injury. Seventy-nine patients were operated on for recurrent dislocation.

With such a high recurrence rate in the athletic age group, the authors question if immobilization affects the prognosis.
Infectious mononucleosis in the athlete
Authors: Maki Dennis G. , Reich Richard M.
Published: June 2007

Although almost always a benign, self-limiting disease, infectious mononucleosis accounts for considerable symptomatic illness in the young athlete and can, on occasion, be truly life-threatening. Recognition of the syndrome "glandular fever," vis-a-vis infectious mononucleosis—fever, pharyngitis, lymphadenopa thy, and splenomegaly, with characteristic changes in the peripheral blood leukocytes—dates back over a half a century. However, seroepidemiologic studies have only recently established its viral causation and epidemiology. This acute infection by the Epstein-Barr virus is unique pathophysiologically—an acute, self- limiting, lymphoproliferative disorder with autoimmune features—and may well be the cause or one of the causes of several malignant neoplasms, Burkitt's lym phoma, and nasopharyngeal carcinoma.

This review (1) describes infectious mononucleosis, pathophysiologically, clinically, and epidemiologically; and outlines its most frequent and serious complica tions ; (2) discusses how to reliably diagnose infectious mononucleosis and evaluate the heterophile-negative case; and (3) addresses management, especially the thorny issues of the use of corticosteroids and restric tion from athletic training and participation.
The adolescent "swimmer's back"
Authors: Wilson Franklin D. , Lindseth Richard E.
Published: June 2007

Three patients with backache, aggravated by swim ming the butterfly stroke, were subsequently diag nosed as having Scheuermann's kyphosis. These pa tients were treated with conventional methods. How ever, they were allowed additional time out of the brace to participate in swimming and were encour aged to do so, but they withheld from the butterfly stroke.

An average of 27% correction of curvature was seen with an average follow-up of 1.6 years. Symp toms subsided in all cases. We feel that the psycho logical and emotional well-being of the athlete can likewise be enhanced by continual participation with out compromising the overall result.
A county sports medicine committee
Authors: Sweetser Edward R. , Nelson Michael A. , Miranda Gilbert E.
Published: June 2007

This paper describes the Albuquerque and Bernalillo County Medical Association Sports Medicine Commit tee, in existence since 1973. The Committee has had several non-physician members, including athletic trainers, physical therapists, dentists, and others. Among the many accomplishments of the Committee has been the development of a unique high school sports medicine program for the Albuquerque Public School System. The program combines certified ath letic trainers and volunteer team physicians in a close and formal working relationship. To support the high school program, the Committee has developed an injury reporting system, a computer program for re cording statistics, and a continuing education news- letter. The program has been well received by all concerned with it, especially the student-athletes.
Nonoperative treatment of double lateral ligament tears of the ankle*
Authors: Drez David , Young John C. , Waldman Douglas , Shackleton Robert , Parker William
Published: June 2007

In this article the objective evaluation of 39 cases of double lateral ligament tears of the ankle treated by cast immobilization is described. Such treatment re sulted in a 79.5% success rate as determined by repeat stress roentgenograms. In addition, a statistical method which may aid the orthopaedist in deciding whether to use nonoperative or operative treatment is presented.
Acute anterior cruciate ligament injury and repair reinforced with a biodegradable intraarticular ligament
Authors: Cabaud H. Edward , Feagin John A. , Rodkey William G.
Published: June 2007

The anterior cruciate ligament was transected at the femoral origin in the knee joint of 12 dogs. The liga ments were repaired in a conventional manner and reinforced with a polyglycolic acid (PGA) ligament of braided Dexon (Davis & Geck, Pearl River, NJ) suture. At two weeks the PGA ligament was still providing excellent support for the healing anterior cruciate ligament, and there was no synovitis within the knee joint. After five weeks, initial healing had firmly at tached the repaired anterior cruciate ligament to the femoral condyle, and the PGA ligament had resorbed without inflammatory or fibrotic response. All repaired and reinforced ligaments in this series healed and provided functional stability to the knee joints. Bio mechanical testing of the repaired anterior cruciate ligaments at four months produced a maximum strength of 54.2 ± 6.3 kgf. Sulfur-35 uptake showed viable active collagen-producing cells in the repaired ligaments four months postoperatively. Thus, the bio degradable PGA ligament reinforced and splinted suc cessfully the repaired anterior cruciate ligament.
Essential statistics review
Authors: Moynes Diane Radovich
Published: June 2007

As medicine and science have become more sophis ticated, so too have the research designs, data collec tion, and statistical analyses employed by medical investigators. This paper is a review of some of the basic terminology and procedures essential in evalu ating research results.
Evaluating parameters of a professional hockey team
Authors: Minkoff Jeffrey
Published: June 2007

A championship professional hockey team was eval uated with regard to three systems: cardiovascular, muscular, and visual. The cardiovascular system was tested three times during the season, revealing little significant variation in fitness parameters from the preseason to the late-season periods. The visual and muscular testings were performed only during the preseason. Visual functions, especially eye speed and span, were positively correlated to face-off ability, shot accuracy, and goal-tending capability. Muscular testing demonstrated the importance of hip strength in power skating; a rationale for the use of knee extension hip flexion and knee extension hip abduc tion ratios is clearly established.

The most striking correlations were found in relat ing skating skills to muscle testing performances of the left lower extremity as opposed to the right. Regression analysis of the data made it possible to predict super-star capability with 100% correlation to only three simple tests.
Furunculosis in a high school football team
Authors: Bartlett P.C. , Martin R.J. , Cahill B.R.
Published: June 2007

An outbreak of Staphylococcus aureus furuncles (boils) occurred among 26 members of a central Illi nois high school football team. A total of 55 boils were reported, with a diameter of induration ranging from 0.25 to 6 inches (mean = 1.25 inches). Eighty-nine percent of the boils were located on the extremities, and 70% were known to have developed following a bruise or break in the skin. The development of boils was associated with prior bruises and open wounds. Use of skin lubricant, elbow and forearm pads, whirl- pool bath, and athletic tape were also associated with the development of boils, but were not judged to be causal. Rather, these factors most likely reflected attempts to protect areas of compromised skin which were at high risk of developing boils. Lack of hot water and soap for showering may have facilitated the oc currence of the outbreak by discouraging players from showering. Other variables examined, but excluded as important factors, were the sharing of football pads, the sharing of towels, the laundering of athletic clothes, and the position played on the football team.
Kinematic and electromyographic patterns of Olympic race walkers
Authors: Murray M. Patricia , Guten Gary N. , Mollinger Louise A. , Gardner Gena M.
Published: June 2007

The performance of two Olympic race walkers was studied during free-speed, fast, and race walking. Measurements of the stride and temporal components of gait, as well as the simultaneous displacement patterns of the body segments, and the electromyo graphic activity of muscles of the trunk and upper and lower limbs were recorded during the three walking speeds. During the testing, the race walkers achieved an average speed of 12.5 km/hr as compared to the 8.7 km/hr average speed achieved by normal men of the same age during fast walking. Race walking was characterized by an increase in cadence and stride length beyond that of normal controls (in a prior study) during fast walking, with stride lengths averaging 125% of stature during race walking, and 115% dur ing normal fast walking. In the two race walkers the amplitudes of most of the movement patterns of the trunk and upper and lower limbs were exaggerated during race walking as compared to normal controls' fast walking. Several mechanisms were used by the race walkers to minimize the vertical excursion of the center of gravity of the body during race walking. All of the muscles monitored in the race walkers showed an increase in the amplitude of electromyographic activity during race walking as compared to fast walk ing ; duration of muscle activity was also usually in creased during race walking. Several suggestions for prevention of injuries associated with race walking are made.
Valgus extension overload in the pitching elbow
Authors: Wilson Franklin D. , Andrews James R. , Blackburn Turner A. , Mccluskey George
Published: June 2007

Five baseball pitchers, three college and two profes sional, with an average age of 24 years, exhibited pain between the acceleration phase and follow- through phase of the pitching motion. This caused the players to be unable to continue at the level of com petition necessary to play. A significant osteophyte on the posteromedial aspect of the olecranon process was identified in all pitchers. This caused impingement with the articular wall of the olecranon fossa and often created an area of chondromalacia. The more com monly identified posterior osteophyte was present in all cases. However, if just this posterior osteophyte is removed, the described lesion will be missed, with resultant persistent disability.

Surgical excision of the posteromedial osteophyte through a relatively atraumatic posterolateral ap proach allowed early return of function without mor bidity. With an average follow up of 1 year, all of the pitchers returned for one full season at maximum effectiveness.
Rotational motion of the knee*
Authors: Zarins Bertram , Rowe Carter R. , Harris Bette Ann , Watkins Mary P.
Published: June 2007

This study deals with the quantitation of axial rotation at the knee. Passive rotation of the knee was measured at various degrees of flexion on 17 subjects with normal knees and 19 patients with unilateral anterolateral ro tatory instability.

Normal subjects were found to have bilateral sym metric rotational knee motion at each angle of flexion tested. When the knee is in a position of flexion be tween 30 and 90°, there are approximately 45° external and 25° internal rotation. Rotatory motion decreases with further extension and, at 5° of flexion, the knee has 23° external and 10° internal rotation.

The knee with a torn anterior cruciate ligament and anterolateral rotatory instability was found to have an arc of rotation similar to the contralateral knee and to the control knees between 30 and 90° flexion. At 15° of flexion, a slightly greater arc of rotation was meas ured compared to normal knees. At 5° of flexion, a significantly greater range of external (to 41 °) as well as internal (to 14°) rotation was measured.
Recurrent dislocation of the extensor carpi ulnaris in athletes
Authors: Rayan Ghazi M.
Published: June 2007

Traumatic recurrent dislocation of the extensor carpi ulnaris tendon may occur in athletes. Two such cases are discussed; the first is a bareback bronco rider and the second is a tennis player. It is suggested that acute wrist trauma followed by chronic repetitive forearm rotation, wrist palmar flexion, and ulnar deviation are common factors in producing this entity. Immobilization of the wrist and forearm following acute wrist trauma in a suspected case may prevent this condition.
Functional performance of the knee after intraarticular anesthesia
Authors: Barrack Robert L. , Skinner Harry B. , Brunet Michael E. , Haddad Ray J.
Published: June 2007

Ten healthy young volunteers underwent gait analysis and tests of knee joint position sense. Gait analysis included determination of stride characteristics (veloc ity, cadence, gait cycle, stride length, and single limb support time), force plate analysis, and motion analysis of the knee. The tests of joint position sense examined the ability of the subject to reproduce passive position ing of the knee and the ability to detect change in angle at the knee joint. In a double-blind manner, 10 cc of sterile fluid were injected into the left knee of each volunteer. Five received 2% lidocaine, the other five received sterile saline. All tests were then repeated. No statistically significant difference was observed in any measurement before and after injection in either test group. It is concluded that intraarticular anesthesia has no effect on gait pattern or joint proprioception as measured.

Intraarticular local anesthesia is used in sports medi cine to alleviate pain during arthroscopy of the knee under local anesthetic. The possibility of permitting damage in the early postoperative period due to loss of joint position sense is addressed in this paper. The results of this study suggest that injection of local anesthetic into a joint with an intact joint capsule does not compromise joint position sense as measured in this study. Furthermore, no change in gait parameters was observed in the functional task of ambulation. It must be noted that no conclusions regarding the loss of pain sensation can be made from the results of this study. Also, no conclusions regarding competitive ac tivity can be drawn from this study.
Optimization of knee ligament position for lateral extraarticular reconstruction
Authors: Krackow Kenneth A. , Brooks Robert L.
Published: June 2007

A kinematic study of five adult cadaver knees was performed to determine the behavior of the separation distances connecting all combinations of a network of points on the lateral side of the knee. Measurements were obtained between each pair of points at the level of the capsule for seven different angles of flexion ranging from 0 to 125°. The data obtained allow further analysis of tendinous reconstructions attached to each pair of points as regards stretching and laxity through out a normally occurring range of motion. The Rowe- Zarins combined intra- and extraarticular reconstruc tion, the Sling-and-Reef procedure, and other extraar ticular methods were analyzed in light of these data.

Attachment of a reconstruction at the proximal an terolateral tibia, in front of Gerdy's tubercle paired with femoral attachment high and proximal to the origin of the lateral collateral ligament on the femur, was ob served to demonstrate favorable behavior for several reasons. First, such a check reign represents an ob vious, major restraint to anterior translation as it is positioned well posteriorly on the femur and anteriorly on the tibia. Second, the attachment points were seen to demonstrate maximum separation between 15 and 45° of flexion, thereby not being forced into any unde sirable stretching if the knee were to move normally throughout the other portions of the motion cycle. Consequently, obligate stretch with full flexion or full extension would appear unlikely. Separation distances between attachment points were highly dependent upon changes in the femoral fixation point and much less variable as a result of tibial attachment position.

Placing the knee through a flexion-extension range of motion with the tibia held unnaturally in external rotation, which is frequently done in the operating room, violates the normal kinematic pattern of knee motion. As a result, unsuitable attachment points may erro neously appear well behaved. This observation may offer one important explanation for long-term stretching of a ligament reconstruction which appeared satisfac torily tight and strong at the time of surgery. The data obtained allow proper positioning of anterolateral re constructions so that this mode of stretching will not be encountered as a result of normal knee motion.
The nonoperative treatment of Grade I and 11 medial collateral ligament injuries to the knee
Authors: Holden David L. , Eggert Allen W. , Butler James E.
Published: June 2007

A prospective investigation covering 8 years (1971 to 1978) at a major university was undertaken involving the nonoperative management of medial collateral lig ament injuries to the knee. Rigid diagnostic criteria were used for each injury prior to inclusion in a program of functional rehabilitation without cast immobilization.

Eighty-nine fresh ligamentous injuries were reviewed. Thirty-eight knees required surgery. The remaining 51 knees were classified as isolated Grade I or Grade II injuries. Forty-two (80%) successfully completed the program of rehabilitation. Nine (20%) were considered failures. These were attributed to inadequate diagnoses during the early period of the study. Average time required for the athletes to return to full competition was 21 days (range of 9 to 32 days.)
Medial collateral ligament healing
Authors: Frank C. , Woo S.L.-Y. , Amiel D. , Harwood F. , Gomez M. , Akeson W.
Published: June 2007

Medial collateral ligament healing without treatment has been studied in a rabbit model. Complete midsubstance gaps were found to heal by distinct scar formation over time. This healing process was fast since the gap was bridged quickly; however, more subtle changes in ap pearance of the healing tissue continued for many months. The ligament "scar" was found to be structur ally abnormal chemically and mechanically even at long- term followup. A plateau in its improvement suggests that the scar may never approach normal ligament characteristics (without treatment). A baseline of liga ment healing by scar formation has been established.
Body composition of elite American athletes
Authors: Fleck Steven J.
Published: June 2007

Five hundred twenty-eight male athletes participating in 26 Olympic events and 298 female athletes partici pating in 15 Olympic events underwent determination of body fat percentage (% fat) and lean body mass (LBM) via hydrostatic weighing and/or anthropometric methods. All groups of athletes were below the average values for % fat of college age men and women of 15% and 25%, respectively. In general, athletes involved in a sport where their body weight is supported, such as canoe and kayak (males, 13.0 ± 2.5%; females, 22.2 ± 4.6%) and swimming (males, 12.4 ± 3.7%; females 19.5 ± 2.8%), tended to have higher % fat values. Athletes involved in sports where a weight class has to be made to compete, such as boxing (males, 6.9 ± 1.6%) and wrestling (male, Junior World Freestyle 7.9 ± 2.7%), events such as the 100, 200, and 400 meters in athletes (male 100 and 200 meters, 6.5 ± 1.2%; female 100, 200 and 400 meters, 13.7 ± 3.6%) that are very anaerobic in nature and extremely aerobic events such as the marathon (males, 6.4 ± 1.3%) demonstrated lower % fat values. Athletes involved in sports where body size is a definite advantage, such as basketball (males, 84.1 ± 6.2 kg; females, 55.3 ± 4.9 kg) and volleyball (males, 75.0 ± 6.6 kg; females, 58.4 ± 4.5 kg) tended to have a larger LBM.
Arthroscopic meniscectomy in athletes
Authors: Lysholm Jack , Gillquist Jan
Published: June 2007

Twenty arthroscopic meniscectomies were done in 19 patients (mean age 24 years). Twelve medial and eight lateral meniscus lesions were treated. In one patient, both a medial and a lateral meniscus tear were treated at the same time. There were 9 total meniscectomies and 11 partial. All patients were international or national top athletes. Arthroscopy was performed using the anterior midline approach. Arthroscopic meniscectomy was done by means of triangulation technique.

Sixty-eight percent resumed their full athletic training and competition in 2 weeks or less. At followup 14.3 ± 9.4 months after surgery, 74% had an excellent result (full activity, no symptoms) and 21 % a good result (full activity, minimal symptoms). One international top weight lifter had to be reoperated on twice because of tearing of the meniscus remnant after partial meniscec tomy. Our conclusion is that the result after arthro scopic meniscectomy in athletes is good with a short rehabilitation period. Under extreme circumstances, early strenuous activities might lead to a retear in the meniscus remnant after partial meniscectomy.
Partial calcaneal ostectomy for retrocalcaneal bursitis
Authors: Jones Donald C. , James Stanley L.
Published: June 2007

Heel pain in runners is very common. Retrocalcaneal bursitis may be disabling to the competitive runner. When conservative treatment fails, surgery (partial cal caneal ostectomy) may be indicated. Ten patients un derwent partial calcaneal ostectomies at our clinic and returned to their desired level of activity within 6 months. When the surgeon adheres to the surgical principles outlined in this article, the results are uni formly good.
Saphenous nerve entrapment
Authors: Worth Robert M. , Kettelkamp Donald B. , Defalque Ray J. , Duane Karen Underwood
Published: June 2007

Saphenous nerve entrapment is a seldom recognized cause of pain along the medial side of the knee and proximal calf.

We are reporting our experience with 15 saphenous nerve entrapments in 14 patients between 1978 and 1981.
The Magnuson-Stack procedure for treatment of recurrent glenohumeral dislocations
Authors: Miller Lawrence S. , Donahue John R. , Good Robert P. , Staerk Arthur J.
Published: June 2007

The Magnuson-Stack procedure was developed in 1943 as a treatment for recurrent anterior dislocation of the glenohumeral joint. Since that time, very little literature has been published on this procedure.

The purpose of our study is to evaluate its efficacy in preventing further dislocations and, also, introduce the Cybex Isokinetic Dynamometer as a quantitative tool in scientifically evaluating total shoulder function.

At the Bryn Mawr (Pennsylvania) Hospital from 1971 to 1978, 43 patients underwent a Magnuson-Stack procedure. Twenty-nine returned detailed question naires ; 26 of these patients returned for clinical and roentgenographic examination by one of the authors, and 18 had their shoulder motion and power quantita tively compared to their contralateral normal arms with the Cybex Isokinetic Dynamometer.

Eighty-five percent of shoulders did not dislocate postoperatively; 90% considered their results satisfac tory. By gross physical examination, no shoulder atro phy was noted. Strength seemed to equal the uninjured shoulder. Range of motion showed a 10° loss of exter nal rotation as measured with a hand-held goniometer. However, by testing range of motion with the Cybex system, a 25° lack of external rotation was noted. Force values measured at 60° of arc/sec and 180° of arc/sec showed an 18 and 10% deficit, respectively, in external rotation.

The authors believe that the Magnuson-Stack pro cedure has a place in the treatment of recurrent anterior dislocations of the shoulder. Also, the Cybex II isolated joint testing system provides an accurate reproducible method of comparing the postoperative results of all patients treated for dislocation of the shoulder. Hope fully, from such data, information can be obtained which will be valuable in selecting the appropriate operative procedure for each individual's needs as well as assist ing in the development of postoperative rehabilitation programs designed to maximize shoulder function while minimizing disability time.
Coracoacromial ligament division
Authors: Johansson J.E. , Barrington T.W.
Published: June 2007

The object of this paper is to report on the findings of a retrospective study of 40 patients with 41 shoulders with persistent painful arc syndrome secondary to a chronic coracoacromial ligament inflammation who un derwent simple coracoacromial ligament division at the Toronto East General and Orthopaedic Hospital be tween January 1973 and June 1979. Initial therapy was always nonoperative. Surgical intervention was re served for patients who did not respond to conservative management and who had a painful arc with tenderness of the coracoacromial ligament. The aim of the cora coacromial ligament division was to relieve impinge ment by releasing the coracoacromial arch. Patients were carefully examined to rule out associated neck pathology, rotator cuff problems, and lesions of the acromioclavicular joint. Any patients with significantly large osteophytes under the anterior acromion were excluded. Forty patients (41 shoulders) were ques tioned and examined in followup. There were 29 males and 11 females. The ages ranged from 21 to 72 years (average 43.5 years). In 21 shoulders (51 %), there was a history of trauma as the initiating factor. The follow up ranged from 8 to 76 months (average 36.3 months). According to a described rating system, the results were satisfactory to excellent in 39 of 41 shoulders (95%) and unsatisfactory in two of 41 shoulders (5%). The back to work time ranged from 1 to 16 weeks (average 5.7 weeks). Age did not influence the results. There were no complications. The operation was judged to be simple and effective for treatment of persistent painful arc syndrome secondary to cora coacromial ligament inflammation.
Long-term followup of posterior cruciate ligament rupture: A study of 116 cases
Authors: Cross Mervyn J. , Powell J.F.
Published: June 2007

With adequate quadriceps exercises, the prognosis of a ruptured posterior cruciate ligament can be greatly improved. Of the 116 cases followed in this report, 55 were sports injuries while most of the remainder were traffic accidents. An excellent or good result was ob tained in 47 sports-injured patients, while only 5 in volved in road trauma obtained this result. Surgery was used to improve the eventual result and this was suc cessful in nine cases. Early repair is still the treatment of choice. Eighty percent of ruptures can have a good or excellent result with effective management.
The function of the anterior cruciate ligament during anterior drawer and Lachman's testing
Authors: Rosenberg T.D. , Rasmussen G.L.
Published: June 2007

In order to clarify the function of the anterior cruciate ligament (ACL) during clinical testing an in vivo arthro scopic method of assessing the tension of ACL was developed. Twenty young adult patients with normal knee ligaments and menisci were selected. A spring mechanism in the handle of the specially designed probe allowed the surgeon to apply a known perpen dicularly directed force to the ligament while the amount of displacement was observed and recorded. Tension was determined in the anteromedial central and pos terolateral portions of ACL before and during an anterior drawer test (knee flexed 90°) and before and during a Lachman's test (knee flexed 15°).

The results were consistent in all 20 knees. Baseline tension was greater at 15° of flexion than at 90°. A Lachman's test produced maximal tension in the ma jority of the ligaments. The anterior drawer did not produce maximal tension in any portion of the ligament. Tension within the anteromedial and central portion of the ligament predominated during both uses.

This analysis confirms the specificity of Lachman's test as an indicator of ACL integrity. The concept of two reciprocally functioning ACL "bands" by either an terior drawer or Lachman's test is not supported by our data.
Elbow flexion analysis in Bristow patients
Authors: Chen Shen-Kai , Perry Jacquelin , Jobe Frank W. , Healy Bitte S. , Moynes Diane Radovich
Published: June 2007

Seven male nonathletes who had Bristow procedures for shoulder dislocation were analyzed by dynamic electromyography (EMG) and Cybex strength measure ment to evaluate the function of elbow flexion. Bilateral strength of elbow flexion also was measured in the 10 controlled subjects to compare the dominant and non- dominant arms. The EMG data showed the operated short head of biceps function at low constant intensity, compared with the nonoperated side, while the long head of biceps and brachialis increased their activity. The strength measured by the Cybex demonstrated the elbow flexion on the operated side was not signifi cantly different from the normal group. These data demonstrated that the Bristow procedure reduced the dynamic response of the short biceps which was com pensated for by the increase in level of activity of the long heads and brachialis muscle. As a result, normal range of elbow function was restored. Our patients had had intense rehabilitation programs. This appears to be an essential part of the postoperative management to develop the needed compensatory muscle action.
The snapping hip syndrome
Authors: Schaberg James E. , Harper Marion C. , Allen William C.
Published: June 2007

The snapping hip syndrome is a symptom complex characterized by hip pain and an audible snapping of the hip with exercise typically seen in young individuals. "External" and "internal" etiologies have been de scribed, although the "internal" etiology is poorly un derstood.

A clinical, radiographic, and anatomical study of eight patients with this disorder, secondary to an internal etiology, was undertaken to aid in the diagnosis and surgical treatment.

Iliopsoas bursography with cineradiography revealed subluxation of the iliopsoas tendon to be an apparent cause of the snapping hip. The anatomy of the hip in relationship to the iliopsoas tendon is defined with the anterior inferior iliac spine, iliopectineal eminence, and lesser trochanter assuming a significant role in the syndrome.

An operative approach involving a partial release and lengthening of the iliopsoas tendon, with minimal resec tion of a lesser trochanteric bony ridge, if involved, is described.
Ski fractures of the femur
Authors: Yvars Manuel F. , Kanner Howard R.
Published: June 2007

There have been few reports of femoral ski injuries. Twenty-four cases of femoral ski fractures (as well as one dislocation), collected over 8 years, are presented. Two-thirds of the patients were under 30 years of age. The largest single cause of injury (one-third of the cases) involved collision. High speed skiing with loss of control and falling on icy surfaces were other frequent causes of injury. Internal fixation methods were usually chosen for skeletally mature patients, with traction and casting used in children.

Femoral injuries have occurred in recent years de spite improvements in ski equipment, snowmaking, and trail-grooming. It is felt that these improvements have led to faster skiing with increased kinetic forces of injury, and more severe consequences of a fall or collision.
Exercise performance of professional football players
Authors: Shields Clarence L. , Whitney Frank E. , Zomar Vickie D.
Published: June 2007

With the likely hypothesis that the degree to which a football player is physically suited to his position will determine his value as a player, we attempted to de scribe the characteristics of a given player and position and, from that, to determine the characteristics that make up a first class player in that position.

Over a 4-year period 167 football players were ex amined at the National Athletic Health Institute, Ingle wood, California, and grouped according to playing position and class. Position groups were: 1, linemen; 2, linebackers and tight ends; 3, running backs, quar terbacks and kickers; and 4, wide receivers and defen sive backs. Classes were: I, rookies (nonstarters); II, veterans (nonstarters); and III, starters (veterans and an occasional rookie).

Testing was in two phases, body characteristics and direct measurement of body function. All testing was done in connection with the preseason physical exam.

Significant differences were found when data were analyzed by position. Position 1 players were taller, heavier, and had a higher percentage of body fat than players at other positions. These values decreased from Position 1 to Position 4. In terms of cardiovascular fitness the opposite trend was seen. Strength meas ures were also specific to given position groups.

While few differences were seen when data were analyzed by class, one interesting finding was that Class III players (starters) were not only the oldest, but also had the highest level of cardiovascular fitness.

Our conclusion is that while size, strength, and en durance are obvious advantages for the successful regular player, there is an unmeasurable quality re flected in the playing ability of the veteran player that is not easily identified in the beginning player.