bluuebunny/crossref_metadata_2025 huggingface dataset:
Three‐Dimensional Computer Reconstruction of a Temporal Bone
Authors: Lutz Charles , Takagi Akira , Janecka Ivo P. , Sando Isamu
Published: July 2017

The complexities of the temporal bone and the critical inter‐relationships among its key structures can be simplified with three‐dimensional computer‐assisted reconstruction. Knowledge of the topography of these structures and their mutual relationships in essential in any surgical approach to the temporal bone. Sixty sagittal histologic sections of a normal left temporal bone were examined. Each section, 30 μm in thickness, was optically enlarged. Segments representing the facial nerve, internal carotid artery, and inner ear structures from individual slides were traced and data were entered into a computer. A personal computer was used for data processing and analysis. Graphic software developed in our laboratory generated images with x‐y‐z coordinates that could be rotated In any plane. The high resolution of the computer graphics system, combined with the precision of histologic sections, permitted study of the critical three‐dimensional anatomic relationships among essential intratemporal bone structures. The capability of reproducing individual and joint images of the intratemporal bone structures and viewing them from all surgical angles gives skull base and otologic surgeons Important topographic guidance. Accurate spatial measurements of temporal bone anatomy are now possible with the application of computer graphic technology.
Deferoxamine Decreases Necrosis in Dorsally Based Pig Skin Flaps
Authors: Weinstein Gregory S. , Maves Michael D. , McCormack Michael L.
Published: July 2017

Deferoxamine, a free radical scavenger and iron chelator, has been shown to improve skin flap survival in ischemic flap surgery in rats. The present study investigates the value of deferoxamine in ischemic flap surgery in the porcine model. Four 4 × 12 cm flaps, 3 cm apart and 3 cm from the dorsal midline, were elevated on each of six female pigs, weighing 50 to 60 pounds each. The animals were divided into two test groups. Group 1 received six 1 gm doses of deferoxamine in 4 ml of sterile water intramuscularly every 6 hours preoperatively for five doses, followed by the administration of 1 g every 6 hours for the first 6 days postoperatively. Group 2 received 4 ml of normal saline administered intramuscularly as above. The percentage of flap necrosis was assessed on postoperative day 7 by the weighing paper technique. Group 1 had 17.1% necrosis and group 2 had 33% necrosis (p < 0.005). Deferoxamine has decreased flap necrosis in the porcine model and may be of use in augmenting the surviving length of flaps in human beings.
Attitudes of Marketing Students With Regard to Communications Skills
Authors: Hite Robert E. , Bellizzi Joseph A. , McKinley John W.
Published: July 2017

The purpose of this study was to determine marketing student attitudes toward communication skills, and how marketing classes (and assignments) are rated in terms of helping to improve communication skills. The results indicate that students attach a significant level of importance to communication skills and that marketing classes are rated high in terms of helping students improve such skills, but that more communication instruction is desired.
Focus Group Interviews: Exploratory Research in Introductory Marketing Classes
Authors: Iandoli Ce Ce , Cullinan Mary
Published: July 2017

Involving marketing students in a focus group interview is an exciting way to introduce them to exploratory market research. In this article, the authors provide step-by-step procedures and a “script” that helps instructors organize the focus group and use it as a basis for short- and long-term projects.
Lymphocytic Vacuolation and Membranous Cytoplasmic Bodies in Rats Dosed with an Acridan
Authors: Payne B. J. , Merrill T. G. , Tousimis A. J.
Published: July 2017

To facilitate study, a chemical of the acridan class was given to rats to increase the frequency of vacuolated lymphocytes. The chemical produced inanition and starvation, but this effect per se did not increase the vacuolation. In Wright-Giemsa-stained smears generally clear vacuoles up to 2 μm in diameter were the same as those that occur at a very low frequency in apparently normal animals and humans, in some chemical intoxications in animals, and in some natural diseases of humans. The use of several histochemical stains failed to further characterize the nature of the vacuoles. Samples were then processed for electron microscopic examination. By this procedure, the lymphocytes had membranous cytoplasmic bodies correlated with the presence of the vacuoles. The change appeared identical to light microscopic vacuoles and ultrastructural bodies described in chloroquine intoxication of rats and pigs and certain neurolipidoses of humans.
A Cerebral and Ocular Tumor of Reticular Tissue in a Horse
Authors: Finn J. P. , Tennant B. C.
Published: July 2017

An intracerebral and intraocular neoplasm occurred in a 15-year-old horse. The horse presented with signs of a cerebral space-occupying lesion, blindness, and opacity of the vitreous body. There were a number of cell types within the well-defined tumor, some of which were multinucleate, and some apparently exhibited phagocytosis. The tumor was productive of reticulin fibres. The tumor was diagnosed as a microglioma, an unusual human tumor and one not previously reported in the horse. The intraocular metastasis of the tumor is unique.
Mucinous Degeneration of the Epithelium of the Urinary Tract of Swine
Authors: Brobst D. F. , Cottrell R. , Delez A.
Published: July 2017

Mucinous degenerative change was observed in the epithelial cells lining the renal pelvis, ureter, and urinary bladder of pigs with exudative epidermitis, coliform enteritis, hog cholera, and suppurative arthritis. Mucins were observed within transitional cells either as granular or homogenous material within vacuoles. Lakes filled with mucins also were formed as a result of the coalescence of mucin from degenerating transitional cells. The cells and lakes of mucin were stained selectively by periodic acid-Schiff, alcian blue, and colloidal iron. On the basis of the reactivity patterns with these stains the transitional epithelial cells were considered capable of producing acidic and neutral mucins.
Neuromuscular Lesions in Restrained Rabbits
Authors: Mendlowski B.
Published: July 2017

Ten of 16 rabbits restrained 6 h daily for 35 days developed focal to diffuse degeneration of the sciatic nerves. Very small necrotic areas also were found in the skeletal muscles of seven of 16 rabbits, but the muscle lesions did not correlate with the nerve changes.
Renal Disease in Prosimians
Authors: Boraski Edward A.
Published: July 2017

At the San Diego Zoo, renal lesions occurred spontaneously in 22 of 113 prosimian primates, 17 of them in the family Lorisidae (14 in galagos), three in Lemuridae, and one each in Indriidae and Tupaiidae. Of the Galago cases, six were in G. senegalensis and eight in G. crassicaudatus panganiensis. Lesions included focal and diffuse proliferative glomerulonephritis, membranoproliferative glomerulonephritis, interstitial nephritis, and pyelonephritis.
Primary Renal Tumors In Nonhuman Primates
Authors: Jones S. R. , Casey H. W.
Published: July 2017

In 17 nonhuman primates, nine females and eight males from 5 to 22 years old, there were 10 cases of renal carcinoma, four of renal adenoma, one nephroblastoma, one hamartoma and one transitional cell papillomatous hyperplasia. The most frequent clinical signs were anorexia, lethargy, weight loss, depression, and dehydration. Tumors were 0.1 to 10.0 cm in diameter. In neoplasms of tubular cell origin, papillary, tubular and solid histologic growth patterns occurred either separately or in combination. Thirty previously reported cases of primary renal tumors in nonhuman primates also were reviewed.
Biomechanical Analysis of a Double-Bundle Posterior Cruciate Ligament Reconstruction
Authors: Harner Christopher D. , Janaushek Marsie A. , Kanamori Akihiro , Yagi Masayoshi , Vogrin Tracy M. , Woo Savio L-Y.
Published: July 2017

The objective of this study was to experimentally evaluate a single-bundle versus a double-bundle posterior cruciate ligament reconstruction by comparing the resulting knee biomechanics with those of the intact knee. Ten human cadaveric knees were tested using a robotic/universal force-moment sensor testing system. The knees were subjected to a 134-N posterior tibial load at five flexion angles. Three knee conditions were tested: 1) intact knee, 2) single-bundle reconstruction, and 3) double-bundle reconstruction. Posterior tibial translation of the intact knee ranged from 4.9 2.7 mm at 90° to 7.2 1.5 mm at full extension. After the single-bundle reconstruction, posterior tibial translation increased to 7.3 3.9 mm and 9.2 2.8 mm at 90° and full extension, respectively, while the corresponding in situ forces in the graft were up to 44 19 N lower than those in the intact ligament. Conversely, with double-bundle reconstruction, the posterior tibial translation did not differ significantly from the intact knee at any flexion angle tested. This reconstruction also restored in situ forces more closely than did the single-bundle reconstruction. These data suggest that a double-bundle posterior cruciate ligament reconstruction can more closely restore the biomechanics of the intact knee than can the single-bundle reconstruction throughout the range of knee flexion.
Anterior Cruciate Ligament Reconstruction in Adolescents with Open Physes
Authors: Aronowitz Eric R. , Ganley Theodore J. , Goode Joel R. , Gregg John R. , Meyer James S.
Published: July 2017

The purpose of this study was to evaluate anterior cruciate ligament reconstructions performed in adolescents with open physes and a skeletal age of at least 14 years. At one center, from 1992 to 1996, 19 adolescents (ages, 11 to 15 years) with open physes and a skeletal age of at least 14 years underwent arthroscopic anterior cruciate ligament reconstruction using an Achilles tendon allograft placed through drill holes across the open physes in both the distal femur and proximal tibia. Fifteen patients returned for reevaluation at an average of 25 months postoperatively (range, 12 to 60 months); the remaining four patients were interviewed by telephone. There were no significant leg-length discrepancies or angular deformities as determined by scanograms and anteroposterior and lateral radiographs of the femur and tibia. The mean Lysholm knee score was 97 (range, 94 to 100) and the mean KT-1000 arthrometer side-to-side difference at 20 pounds of anterior force was 1.7 mm (range, 0.0 to 3.0). All patients were satisfied with the results of surgery, and 16 of 19 patients returned to the same sport they were participating in before the injury. This study demonstrates that anterior cruciate ligament reconstruction using an Achilles tendon allograft is a viable treatment option for skeletally immature patients with a skeletal age of 14 years who have sustained midsubstance tears of the anterior cruciate ligament.
Does Nitric Oxide Help Explain the Differential Healing Capacity of the Anterior Cruciate, Posterior Cruciate, and Medial Collateral Ligaments?
Authors: Min Cao , Stefanovic-Racic Maja , Georgescu Helga I. , Fu Freddie H. , Evans Christopher H.
Published: July 2017

This study compared the ability of rabbit medial collateral ligament, posterior cruciate ligament, and anterior cruciate ligament tissue to synthesize nitric oxide, and determined its effects on matrix synthesis, an important component of ligament repair. It is not known whether ligament cells can produce nitric oxide and, if so, whether it influences healing of ligament injuries. The anterior cruciate and posterior cruciate ligament tissue produced large amounts of nitric oxide in response to the inflammatory cytokine interleukin-1. Medial collateral ligament, in contrast, produced only modest amounts of nitric oxide. Furthermore, anterior cruciate ligament and, to some degree, posterior cruciate ligament synthesized nitric oxide spontaneously in culture, whereas medial collateral ligament never did so. When nitric oxide was supplied to these tissues, it strongly inhibited collagen synthesis by the two cruciate ligaments, but had little effect on collagen synthesis by the medial collateral ligament. Endogenously synthesized nitric oxide was also able to inhibit collagen synthesis as well as proteoglycan synthesis by the two cruciate ligaments, but had little effect on matrix synthesis by the medial collateral ligament. We propose a novel hypothesis, based on nitric oxide production and matrix synthesis, that may help explain why the two cruciate ligaments have such limited healing capacity compared with the medial collateral ligament.
The Effects of Chlorhexidine Irrigation Solution on Contaminated Bone-Tendon Allografts
Authors: Burd Tim , Conroy Brian P. , Meyer S. Craig , Allen William C.
Published: July 2017

The purpose of this study was to determine an expedient and effective method for disinfecting contaminated human bone-tendon allografts. The first part of this study used beef muscle and cadaveric human tissues to determine the most effective solution and volume to decontaminate tissues inoculated with four different organisms: Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Of the solutions tested (benzalkonium chloride, castile soap, castile soap followed by benzalkonium chloride, triple antibiotic, chlorhexidine gluconate, and chlorhexidine gluconate/triple antibiotic), only the 4% chlorhexidine power irrigation solution and 4% chlorhexidine/triple antibiotic bath completely disinfected all tissues. Work in part 2 revealed that a 2% chlorhexidine irrigation solution was equally effective as the 4% solutions. Part 3 of the study involved human Achilles tendon-calcaneus allografts. We found similar results: 3 liters of 2% chlorhexidine power irrigation solution thoroughly removed all microorganisms from the contaminated tissues. All control allografts irrigated with normal saline solution alone revealed positive bacterial growth for all four organisms after 72 hours’ growth on sheep blood agar. Total decontamination time was 10 to 12 minutes. Two percent chlorhexidine irrigation solution may be an effective method for decontaminating human bone-tendon allografts challenged with a polymicrobial inoculum. This method of disinfecting bone-tendon allografts is at least five times more expeditious than methods in previously reported studies.
Injuries to the Shoulder in the Throwing Athlete
Authors: Meister Keith
Published: July 2017

Over the last decade, significant advances have been made in the study and understanding of shoulder mechanics. Much of this may be attributed to the use of more sophisticated technology to improve our ability to assess the shoulder in real-time athletics. As a consequence of these advances, our understanding of the pathophysiology of injury has also increased. Our manual examination skills have improved and our noninvasive diagnostic techniques have advanced greatly. New insight into forces at play during actions as complex as the throwing motion has allowed us to develop better protocols for the prevention and treatment of the most common injuries. Additionally, paralleling improvements in the understanding of shoulder kinematics and the pathophysiology of injury, advances in surgical techniques, particularly arthroscopy, have aided in the diagnosis of and the development of less invasive surgical treatments for injuries that do not respond to nonoperative measures. Undoubtedly, an up-to-date understanding of the developments in shoulder biomechanics, pathophysiology of injury, diagnostic techniques, and surgical management is necessary for the clinician who wishes to continue to apply proper skills in the sports medicine setting.
Intrinsic Risk Factors for the Development of Anterior Knee Pain in an Athletic Population: A Two-Year Prospective Study
Authors: Witvrouw Erik , Lysens Roeland , Bellemans Johan , Cambier Dirk , Vanderstraeten Guy
Published: July 2017

Many variables have retrospectively been associated with the presence of anterior knee pain. Very few prospective data exist, however, to determine which of these variables will lead to the development of anterior knee pain. It was our purpose in this study to determine the intrinsic risk factors for the development of anterior knee pain in an athletic population over a 2-year period. Before the start of training, 282 male and female students enrolled in physical education classes were evaluated for anthropometric variables, motor performance, general joint laxity, lower leg alignment characteristics, muscle length and strength, static and dynamic patellofemoral characteristics, and psychological parameters. During this 2-year follow-up study, 24 of the 282 students developed patellofemoral pain. Statistical analyses revealed a significant difference between those subjects who developed patellofemoral pain and those who did not concerning quadriceps and gastrocnemius muscle flexibility, explosive strength, thumb-forearm mobility, reflex response time of the vastus medialis obliquus and vastus lateralis muscles, and the psychological parameter of seeking social support. However, only a shortened quadriceps muscle, an altered vastus medialis obliquus muscle reflex response time, a decreased explosive strength, and a hypermobile patella had a significant correlation with the incidence of patellofemoral pain. We concluded that the latter four parameters play a dominant role in the genesis of anterior knee pain and we therefore deem them to be risk factors for this syndrome.
Tenocytes from Ruptured and Tendinopathic Achilles Tendons Produce Greater Quantities of Type III Collagen than Tenocytes from Normal Achilles Tendons: An in Vitro Model of Human Tendon Healing
Authors: Maffulli Nicola , Ewen Stanley W. B. , Waterston Stuart W. , Reaper Jacqueline , Barrass Victoria
Published: July 2017

Type I collagen is the main collagen in tendons; type III collagen is present in small amounts. Ruptured Achilles tendons contain a significantly greater proportion of type III collagen, which predisposes them to rupture. We used an in vitro model to determine whether tenocytes from Achilles tendons that were ruptured (N 22), nonruptured (N 7), tendinopathic (N 12), and fetal (N 8) show different behavior. Samples of Achilles tendon were digested with collagenase and the released tenocytes were collected. Primary tenocyte cultures were established and subsequently cultured onto glass coverslips. Once a confluent monolayer was obtained, the cell populations were “wounded” by scraping a pipette tip along the surface. The cultures were further incubated for either 1, 4, 8, 12, 16, or 24 hours, and production of types I and II collagen was assessed by immunostaining. In cultures from ruptured and tendinopathic tendons, there was increased production of type III collagen. Athletic participation places excess stress on the Achilles tendon, which could potentially lead to areas of microtrauma within the tendon. These areas may heal by the production of type III collagen, which is an abnormal healing response. Accumulation of such episodes of microtrauma could result in a critical point where the resistance of the tissue to tensile forces is compromised and tendon rupture occurs.
Risk of Injury during Alpine and Telemark Skiing and Snowboarding: the Equipment-Specific Distance-Correlated Injury Index
Authors: Rønning Roar , Gerner Tom , Engebretsen Lars
Published: July 2017

Estimation of injury risk in alpine sports is difficult. We present a new method of calculating an injury index related to the distance traveled on ski or snowboard. The distance-correlated injury index equals the number of injuries per 100,000 km traveled distance. This injury index can also be correlated to the type of equipment used. The equipment-specific distance-correlated injury index is the same as the distance-correlated injury index, but it is sport-specific. We found the distance-correlated injury index for alpine skiing to be 3.9 (95% CI 2.8 to 5.4); for snowboarding, 13.5 (95% CI 8.3 to 22.0); and for telemark skiing, 3.0 (95% CI 1.0 to 9.4), suggesting a three- to four-times higher incidence of injuries requiring hospital treatment among snowboarders than among alpine and telemark skiers.
A Prospective Study of High School Wrestling Injuries
Authors: Pasque Charles B. , Hewett Timothy E.
Published: July 2017

We performed a prospective study to evaluate injury patterns in a large population of high school wrestlers during one season. Preseason screening was performed on 458 male wrestlers from 14 different high schools. Certified athletic trainers submitted detailed weekly team and individual injury reports. There were 219 injuries in 418 wrestlers followed throughout the season for an overall injury incidence of 52 injuries per 100 wrestlers per season and an injury rate of 6.0 injuries per 1000 exposures. The most commonly injured areas were the shoulder (24%) and knee (17%). Injured wrestlers were an average of 5 months older and had a 32% higher experience level than noninjured wrestlers. Wrestlers with ligamentous laxity suffered fewer shoulder injuries than the other wrestlers. The majority of injuries occurred in practice (63%), although the injury rate was higher in match competitions. Sixty-eight percent of practice injuries occurred during hard wrestling, 23% during drills, and 9% during conditioning. The most common wrestling situation resulting in injury was the takedown position (68%). Our results show that the older and more experienced wrestler may be at greater risk of injury. Hard wrestling during practice and the takedown position resulted in the highest occurrence of injury.
Closed-Wedge Osteotomy for Osteochondritis Dissecans of the Capitellum: A 7- to 12-Year Follow-up
Authors: Kiyoshige Yoshiro , Takagi Michiaki , Yuasa Katsunori , Hamasaki Makoto
Published: July 2017

This article details a 7- to 12-year follow-up of seven young male baseball players with osteochondritis dissecans of the capitellum that we treated using closed-wedge osteotomy. This procedure was established by Yoshizu in 1986 for the treatment of “Little League elbow.” The bone of the capitellum was revascularized and remodeled within 6 months in all seven patients. Six of the patients were able to return to full athletic activity and continued to play baseball. Radiographic assessment during the follow-up study revealed minimal osteoarthritic change and suggests that the treatment is useful for such an injury.
Internal and External Tibial Rotation Strength after Anterior Cruciate Ligament Reconstruction Using Ipsilateral Semitendinosus and Gracilis Tendon Autografts
Authors: Viola Randall W. , Sterett William I. , Newfield Darren , Steadman J. Richard , Torry Michael R.
Published: July 2017

The internal and external tibial rotation torques of subjects who had undergone anterior cruciate ligament reconstruction using semitendinosus and gracilis tendon grafts were measured to determine whether harvest of the tendons results in weakness of tibial internal and external rotation. Cybex NORM dynamometer examinations were performed to measure internal and external tibial torque at angular velocities of 60, 120, and 180 deg/sec in 23 subjects. The sex-specific average torque data of the reconstructed limbs were compared with those of the contralateral limbs. Relative internal and external torque scores were calculated for each subject by subtracting the peak torque of the reconstructed knee from that of the contralateral knee. These relative scores were averaged and compared with the null hypothesis that each score should be statistically similar to zero. Subjects were evaluated at an average of 51 40 months postoperatively. The mean relative internal torque scores of the reconstructed limbs showed a statistically significant decrease from those of the contralateral limbs at all angular velocities. The mean relative external torque scores of the reconstructed limbs were statistically similar to those of the contralateral limbs at all angular velocities. Subjects who had undergone ligament reconstruction using semitendinosus and gracilis tendons demonstrated internal tibial rotation weakness in their reconstructed knees compared with their contralateral knees at all angular velocities tested. These results suggest that semitendinosus and gracilis tendon harvest causes weakness of internal tibial rotation.
Regeneration of the Semitendinosus Tendon Harvested for Anterior Cruciate Ligament Reconstruction: Evaluation Using Ultrasonography
Authors: Papandrea Paola , Vulpiani Maria Chiara , Ferretti Andrea , Conteduca Fabio
Published: July 2017

In a prospective study, 40 consecutive patients who underwent anterior cruciate ligament reconstruction with doubled semitendinosus and gracilis tendon autografts were examined pre- and postoperatively by ultrasound to investigate the anatomy of the donor site before and after the harvest of the tendons. The patients underwent ultrasonography at 2 weeks and 1, 2, 3, 6, 12, 18, and 24 months postoperatively. A total of 298 postoperative sonographic evaluations were performed. The semitendinosus tendon was imaged in the sagittal and axial planes: structure and margins were evaluated with the sagittal views; thickness and width were measured with the axial views. In all cases the following sequence of healing was documented: 2 weeks after surgery the semitendinosus tendon site was occupied by an area of increased thickness and decreased echogenicity, suggesting the presence of traumatic edema of the soft tissue surrounding the tenotomy. At 1 month, an irregular hypoechoic structure appeared in a near-anatomic position; at 2 months after surgery, thickness, width, and cross-sectional area of this structure were significantly greater than preoperatively. The amount of regenerated tissue increased up to that seen in the tissue of the 6-month examinations, which also showed a more uniform echostructure. The scans performed at 1 year showed distinct edges and reduction in thickness and width. At 18 and 24 months the echogenicity of the structure occupying the donor site was very similar to that of the normal semitendinosus tendon. However, this structure was clearly identified about 4 cm proximal to the pes anserinus, revealing a more proximal insertion of the regenerated semitendinosus tendon.
Arthroscopic Management of Glenohumeral Instability
Authors: Nelson Bradley J. , Arciero Robert A.
Published: July 2017

There has been substantial development of techniques for performing arthroscopic surgery of the shoulder over the past 20 years. A multitude of arthroscopic techniques have been developed in an attempt to manage the unstable glenohumeral joint while decreasing surgical morbidity. The results obtained with arthroscopic stabilization have been widely variable. This review will examine the current status of arthroscopic management of glenohumeral instability. The techniques and results of arthroscopic stabilization for primary anterior glenohumeral instability, recurrent anterior instability, and multidirectional instability will be discussed. A brief discussion on thermal capsulorrhaphy is included.
Upper Extremity Snowboarding Injuries
Authors: Idzikowski Jan R. , Janes Peter C. , Abbott Paul J.
Published: July 2017

A survey of snowboarding injuries was conducted over 10 seasons (1988 to 1998). A questionnaire evaluating 20 variables was used to collect data from 47 medical facilities near Colorado ski resorts. A total of 7430 snowboarding-related injuries were seen. A control group consisted of 3107 noninjured snowboarders. Most of those injured were 30 years of age or younger; 74% of injuries occurred in men and 26% in women; 39% of injured snowboarders were beginners and 61% were intermediate or experts. Men rode at more advanced levels than women. Injured snowboarders were more likely than noninjured snowboarders to be beginners. There were 3645 (49.06% of total) upper extremity injuries; 56.43% were fractures, 26.78% sprains, and 9.66% dislocations. The most common site of injury was the wrist (21.6% of all snowboarding injuries). Wrist fractures (except to the scaphoid) and sprains were more common in beginners, women, and younger age groups. Intermediate and expert men were more likely to sustain hand, elbow, and shoulder injuries, as well as more severe injuries. Falling was the predominant mechanism of upper extremity injuries. Snowboarders who wore protective wrist guards were half as likely to sustain wrist injuries as those who did not wear guards.
Light Microscopic Histology of Achilles Tendon Ruptures
Authors: Maffulli Nicola , Barrass Victoria , Ewen Stanley W. B.
Published: July 2017

We studied biopsies from the Achilles tendons of patients undergoing open repair for a subcutaneous rupture of their Achilles tendons (27 men, 11 women; mean age, 45.3 13.8 years) and specimens of Achilles tendons from persons with no known tendon ailments (43 men, 3 women; mean age, 64.2 9.7 years). Histologic examination was performed using stained slides that were interpreted using a semiquantitative grading scale assessing fiber structure and arrangement, rounding of the nuclei, regional variations in cellularity, increased vascularity, decreased collagen stainability, hyalinization, and glycosaminoglycan. We gave up to three marks for each of these variables, with 0 being normal and 3 being maximally abnormal. All the histology slides were assessed twice in a blinded manner; the agreement between two readings ranged from 0.56 to 0.87 (kappa statistics). The score of ruptured tendons was significantly greater than the average score of control tendons (20.5 3.6 versus 6.5 2.1), and there was significantly higher degeneration in the ruptured tendons. Nonruptured Achilles tendons, even at an advanced age, and ruptured Achilles tendons are clearly part of two distinct populations. Using these staining techniques, light microscopic degeneration is not a feature of tendons from healthy, older persons.
Does Intraarticular Morphine Improve Pain Control with Femoral Nerve Block after Anterior Cruciate Ligament Reconstruction?
Authors: McCarty Eric C. , Spindler Kurt P. , Tingstad Ed , Shyr Yu , Higgins Michael
Published: July 2017

In a prospective, randomized, double-blinded manner, we compared the effects of a preoperative intraarticular injection of morphine (5 mg) or a placebo, combined with a postoperative femoral nerve block, on postoperative pain. Sixty-two patients underwent an arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft under general anesthesia. No statistical difference between the two groups was evident in terms of age, sex, weight, operative time, volume of bupivacaine received with the femoral nerve block, or tourniquet use or tourniquet time. Comparison of visual analog scale pain scores revealed no statistical difference between the groups at any point after the operation. Both groups had a significant decrease in visual analog scale scores after the femoral nerve block, with the lowest mean values 4 hours after the operation (morphine group, 1.7; placebo group, 1.4), and continuing to be significantly less through 24 hours (morphine, 2.6; placebo, 2.9). No significant difference in postoperative narcotic medication use was evident in the recovery room or at home. A post hoc power analysis revealed that the study power reached 87%, with a significance level of 5%. The postoperative femoral nerve block was effective, and intraarticular morphine provided no additional benefit.
Relationships between Throwing Mechanics and Shoulder Distraction in Professional Baseball Pitchers
Authors: Werner Sherry L. , Gill Thomas J. , Murray Tricia A. , Cook Timothy D. , Hawkins Richard J.
Published: July 2017

The extreme forces and torques and the high speeds and excessive ranges of motion of baseball pitching place tremendous stress on the soft tissues of the throwing shoulder. Little is known about the relationship between pitching mechanics and shoulder joint stress, especially in professional athletes. The purpose of this study was to quantify joint loads and kinematic parameters of pitching mechanics at the major league level and to study their relationships. Three-dimensional, high-speed video data were collected on 40 professional pitchers during the 1998 Cactus League spring training. A clinically significant distraction force was calculated at the shoulder joint, which reached an average peak value of 947±162 N (108%±16% body weight). Descriptive statistics and a multiple linear regression analysis were used to relate shoulder distraction to kinematic and kinetic parameters of pitching mechanics. This study was undertaken not only to investigate the peak forces and torques on the shoulder, but also to identify potential areas of intervention that might prevent throwing injuries. Knowledge of joint ranges of motion, angular velocities, and joint-reaction forces can provide a scientific basis for improved preventive and rehabilitative protocols for baseball pitchers.
Athletic Activity after Joint Replacement
Authors: Healy William L. , Iorio Richard , Lemos Mark J.
Published: July 2017

The first decade of the 21st century has been declared the “Bone and Joint Decade” by 35 nations and 44 states in the United States as of March 2001. It is not surprising that Americans are interested in musculoskeletal disease and the treatment of bone and joint disorders because our population is aging, the prevalence of arthritic joints is increasing, and senior Americans are demonstrating a strong desire to stay active in activities of daily living and athletics. One of the most successful treatments for painful arthritic joints, which limit activity, is total joint replacement, which predictably relieves pain and improves function. Much has been written about the technical aspects of total joint arthroplasty. Less has been written about safe and appropriate activities for patients who have had joint replacement operations. This article evaluates athletic activity after joint replacement by reviewing the orthopaedic literature and surveying members of The Hip Society, The Knee Society, and The American Shoulder and Elbow Surgeons Society. The authors have developed consensus recommendations for appropriate athletic activity for patients who have had joint replacement operations. This article is intended to serve as a guide for orthopaedic surgeons and primary care physicians who give patients recommendations for athletic activity after joint replacement. This article is also intended to stimulate further research in the area of athletic activity after total joint arthroplasty.
Four-Strand Hamstring Tendon Autograft Compared with Patellar Tendon-Bone Autograft for Anterior Cruciate Ligament Reconstruction
Authors: Aune Arne K. , Holm Inger , Risberg May Arna , Jensen Hanne Krogstad , Steen Harald
Published: July 2017

Seventy-two patients with subacute or chronic rupture of the anterior cruciate ligament were randomly assigned to autograft reconstruction with four-strand gracilis and semitendinosus tendon (N = 37) or with patellar tendon-bone (N = 35) from the ipsilateral side. The groups were similar in terms of age, sex, level of activity, degree of laxity, meniscal lesions found surgically, and rehabilitation program. The follow-up was performed at another hospital by independent observers after 6, 12, and 24 months. Sixty-one patients (32 with hamstring tendon grafts and 29 with patellar tendon grafts) complied with the follow-up routine for the full 24 months. No differences were found between the groups with respect to Cincinnati functional score, KT-1000 arthrometer measurements, or stairs hopple test results. The subjective result and the single-legged hop test result were better for the hamstring tendon group after 6 and 12 months, but no differences were found after 24 months. The hamstring tendon group showed better isokinetic knee extension strength than did the patellar tendon group after 6 months, but not after 12 and 24 months. There was a significant weakness in isokinetic knee flexion strength among the hamstring tendon group. Anterior knee pain was not significantly different between the groups, but kneeling pain was significantly less common in the hamstring tendon group after 24 months.
Revision Anterior Cruciate Ligament Reconstruction with a Reharvested Ipsilateral Patellar Tendon
Authors: Colosimo Angelo J. , Heidt Robert S. , Traub Jeff A. , Carlonas Richelle L.
Published: July 2017

The patellar tendon remains the most popular graft choice for anterior cruciate ligament reconstruction and has been proven to be the strongest substitute. Between 1991 and 1998, we performed revision anterior cruciate ligament reconstruction using the reharvested central third of the ipsilateral patellar tendon in 15 patients. Adequate follow-up was obtained in 13 of these 15 patients. The results in these 13 patients (mean age, 27.2 years) were reviewed. At an average postoperative follow-up of 39.4 months (range, 24 to 65), 11 patients had good or excellent results and 2 patients had fair results. Clinical examination revealed an average Tegner knee score of 5.8 (range, 3 to 9) and an average Lysholm knee score of 77.6 (range, 61 to 98). Postoperative KT-1000 arthrometer results showed an average side-to-side difference of 1.92 mm (range, -2.0 to 4.0). No patient demonstrated any loss of range of motion and only one reported patellofemoral problems, which were moderate. These favorable results demonstrate that, with appropriate patient selection, the use of a reharvested central third patellar tendon is a viable option for revision of a failed anterior cruciate ligament reconstruction.
The Position of the Tibia during Graft Fixation Affects Knee Kinematics and Graft Forces for Anterior Cruciate Ligament Reconstruction
Authors: Höher Jürgen , Kanamori Akihiro , Zeminski Jennifer , Fu Freddie H. , Woo Savio L-Y.
Published: July 2017

Ten cadaveric knees (donor ages, 36 to 66 years) were tested at full extension, 15°, 30°, and 90° of flexion under a 134-N anterior tibial load. In each knee, the kinematics as well as in situ force in the graft were compared when the graft was fixed with the tibia in four different positions: full knee extension while the surgeon applied a posterior tibial load (Position 1), 30° of flexion with the tibia at the neutral position of the intact knee (Position 2), 30° of flexion with a 67-N posterior tibial load (Position 3), and 30° of flexion with a 134-N posterior tibial load (Position 4). For Positions 1 and 2, the anterior tibial translation and the in situ forces were up to 60% greater and 36% smaller, respectively, than that of the intact knee. For Position 3, knee kinematics and in situ forces were closest to those observed in the intact knee. For Position 4, anterior tibial translation was significantly decreased by up to 2 mm and the in situ force increased up to 31 N. These results suggest that the position of the tibia during graft fixation is an important consideration for the biomechanical performance of an anterior cruciate ligament-reconstructed knee.
Effect of Arm Elevation and Rotation on the Strain in the Repaired Rotator Cuff Tendon
Authors: Hatakeyama Yuji , Itoi Eiji , Pradhan Rabindra L. , Urayama Masakazu , Sato Kozo
Published: July 2017

In 14 cadaveric shoulders, a rotator cuff tear (2 cm wide and 1.5 cm long) was created and repaired under a 3-kg tensile force with the arm in adduction. Strain on the repaired tendon was measured at 0°, 15°, 30°, and 45° of elevation in the sagittal, scapular, and coronal planes and from 60° of internal rotation to 60° of external rotation. The strain in all of the planes decreased significantly with the arm elevated more than 30°. With 30° of elevation in the scapular and coronal planes, the strain increased in internal rotation and decreased in external rotation. In all of the positions measured, the strain in the sagittal plane was significantly greater than in the other planes. We concluded that more than 30° of elevation in the coronal or scapular plane and rotation ranging from 0° to 60° of external rotation compose the safe range of motion after repair of the rotator cuff.
A Cyclooxygenase-2 Inhibitor Impairs Ligament Healing in the Rat
Authors: Elder Christopher L. , Dahners Laurence E. , Weinhold Paul S.
Published: July 2017

Celecoxib was the first of a new class of nonsteroidal antiinflammatory drugs, the cyclooxygenase-2 (COX-2) specific inhibitors, marketed as having the same antiinflammatory efficacy as other nonsteroidal antiinflammatory drugs without their increased risk of gastrointestinal ulceration. Among the widest uses of nonsteroidal antiinflammatory drugs is in the treatment of acute soft tissue injuries. Although the benefits of celecoxib have been shown when used for rheumatoid arthritis and osteoarthritis, we are unaware of any studies concerning its effect on soft tissues. We used the surgically incised medial collateral ligament of male Sprague-Dawley rats as an experimental model for acute ligament injuries to investigate the effects of celecoxib on ligament healing. Fifty rats underwent surgical transection of the right medial collateral ligament. Postoperatively, half were given celecoxib for the first 6 days of recovery, the other half were not. The animals were sacrificed 14 days after the operation, and both the injured and uninjured medial collateral ligaments were mechanically tested to failure in tension. Celecoxib-treated/injured ligaments were found to have a 32% lower load to failure than untreated/ injured ligaments. The results of this study do not support use of cyclooxygenase-2 specific inhibitors in the treatment of ligament injuries.
Quality of Life Assessment in Elite Collegiate Athletes
Authors: McAllister David R. , Motamedi Ali R. , Hame Sharon L. , Shapiro Matthew S. , Dorey Frederick J.
Published: July 2017

The objectives of this study were to establish baseline Medical Outcomes Study Short Form Health Survey (SF-36) data for Division I collegiate athletes and to determine the effects of injury severity and training time. All participating athletes (N = 562) at a major university were evaluated with the SF-36. Regression analysis was performed to identify predictive factors. When the men without injury were compared with a previously established norm group, there was a significant increase in the role emotional score. In the women without injury there were significant increases in mental component summary, physical function, role emotional, mental health, and vitality scores when compared with the norm group. Serious injury was a predictor of lower scores in all domains, whereas minimal injury was predictive of lower physical component summary, role physical, bodily pain, social function, and general health scores. Increased training time was predictive of higher mental component summary, role physical, vitality, and general health scores. Elite collegiate athletes scored differently from previously established age-matched norms, and injury was a strong predictor of lower scores.
Reconstruction of the Lateral Ankle Ligaments with Bone-Patellar Tendon Graft in Patients with Chronic Ankle Instability
Authors: Sugimoto Kazuya , Takakura Yoshinori , Kumai Tsukasa , Iwai Makoto , Tanaka Yasuhito
Published: July 2017

Background

Unsatisfactory long-term results have been reported after use of a Broström repair for patients with chronic ankle ligament insufficiency.

Hypothesis

Repair or reconstruction of both the anterior talofibular and calcaneofibular ligaments is essential for normal kinematics of the ankle-hindfoot.

Study Design

Case series.

Methods

Thirteen patients with chronic instability of the ankle were found at operation to have injuries of both the anterior talofibular and calcaneofibular ligaments, with a lack of healthy ligament margins suitable for suturing. Reconstruction of the ligaments was performed with bone-patellar tendon graft. The score devised by Good et al. was used to assess the patients’ clinical condition before the operation and at final follow-up.

Results

Before the operation, six patients had a grade 3 clinical condition and seven had a grade 4 condition. At a mean follow-up of 26.5 months, all patients had a grade 1 condition. The average talar tilt of the patients was improved from 18.4° ± 5.5° to 4.9° ± 2.6°, and the average anterior drawer sign was improved from 9.1 ± 2.6 mm to 5.8 ± 1.6 mm.

Conclusion

In cases of combined injuries, short-term results of reconstruction of the anterior talofibular and calcaneofibular ligaments using bone-split patellar tendon graft were good, with a low frequency of complications.
Humeral Retroversion and Its Relationship to Glenohumeral Rotation in the Shoulder of College Baseball Players
Authors: Reagan K.M. , Meister Keith , Horodyski Mary Beth , Werner Dave W. , Carruthers Cathy , Wilk Kevin
Published: July 2017

Background

Previous studies have documented changes in musculature, bony anatomy, and glenohumeral rotation in the dominant shoulder of baseball players.

Hypothesis

In a group of asymptomatic college baseball players the total range of motion in the dominant and nondominant shoulders will be similar. Any measured increase in external rotation and decrease in internal rotation occurring between the two sides will be consistent and directly correlate with an increased angle of humeral retroversion in the dominant extremity.

Study Design

Descriptive anatomic study.

Methods

Fifty-four asymptomatic college baseball players were examined. Standard measurements of glenohumeral range of motion were made and humeral retroversion was determined radiologically.

Results

Total rotational motion, measured at 90° of glenohumeral abduction, was 159.5° for the dominant shoulders and 157.8° for the nondominant shoulders. Mean differences in external and internal rotation in the dominant versus nondominant extremities were 9.7° and 8.2°, respectively. Humeral retroversion measured 36.6° ± 9.8° in the dominant and 26° ± 9.4° in the nondominant extremity. The mean difference in retroversion correlated significantly by Pearson's product moment with the difference in external (P = 0.001) and internal (P = 0.003) rotation measurements.

Conclusions

There is a pattern of increased external rotation and decreased internal rotation in the dominant extremity that significantly correlates with an increase in humeral retroversion. The loss of internal rotation and gains in external rotation may be more strongly related to adaptive changes in proximal humeral anatomy than to changes in the soft tissues.
Radiographic and Histologic Analysis of the Tibial Tunnel after Allograft Anterior Cruciate Ligament Reconstruction in Goats
Authors: Harris N. Lindsay , Indelicato Peter A. , Bloomberg Mark S. , Meister Keith , Wheeler Donna L.
Published: July 2017

Background

Several problems have been reported with use of allogenic grafts in anterior cruciate ligament reconstruction, including local immune response to allograft tendon within the synovial fluid, delayed maturation and ligamentization, and progressive tibial tunnel enlargement.

Hypothesis

There is a correlation between the use of allograft and tibial tunnel enlargement.

Study Design

Controlled laboratory study.

Methods

Twenty healthy adult female goats underwent allograft anterior cruciate ligament reconstruction and were followed with serial radiographs at 6-week intervals. Animals were randomly chosen for sacrifice between 18 and 36 weeks for histologic assessment.

Results

Significant radiographic increases in tunnel size were noted within the first 6 weeks of healing and remained up to 36 weeks with no further remodeling noted. Histologic analysis showed progressive ligamentization of the allografts with tendon-to-tunnel wall biologic fixation with dense connective tissue. Remodeling and incorporation of the bone plug was seen in all cases. The allograft tendon underwent early fibrous attachment within the tunnel and remodeled toward ligament histologic structure. Remodeling and incorporation of the bone plug was seen by 18 weeks.

Conclusion

Tibial tunnel enlargement, consistent with that seen in humans after allograft anterior cruciate ligament reconstruction, did not appear to affect the ultimate incorporation of the allograft on a histologic level.