bluuebunny/crossref_metadata_2025 huggingface dataset:
Retroversion of the Humerus in the Throwing Shoulder of College Baseball Pitchers
Authors: Osbahr Daryl C. , Cannon David L. , Speer Kevin P.
Published: July 2017

Background

Increased external rotation and decreased internal rotation have been noted to occur progressively in the throwing shoulder of baseball pitchers.

Hypothesis

Proximal remodeling of the humerus contributes to the rotational asymmetry between shoulders in pitchers.

Study Design

Descriptive anatomic study.

Methods

Both shoulders of 19 male college baseball pitchers were evaluated and retroversion of the humerus calculated by using the technique of Söderlund et al. Measurements were taken of passive glenohumeral external rotation at 0° and 90° of abduction and internal rotation at 90° of abduction under a 3.5-kg load. Subjects completed a questionnaire on the amount and duration of overhead throwing performed during the ages 8 through 16 years.

Results

All of the subjects had greater external rotation at 0° and 90° of abduction, decreased internal rotation at 90° of abduction, and greater retroversion of the humerus in their dominant compared with nondominant shoulders. A significant difference was found between dominant and nondominant external rotation at 0° and 90° of abduction, internal rotation at 90° of abduction, and retroversion of the humerus. In the dominant arm, there was a significant correlation between retroversion of the humerus and external rotation at 0° and 90° of abduction. There was also a significant correlation between the side-to-side difference in retroversion of the humerus compared with the side-to-side difference in external rotation at 90° of abduction.

Conclusions

Rotational changes in the throwing shoulder are due to bony as well as soft tissue adaptations.
Is Impingement the Cause of Jumper's Knee?
Authors: Schmid Marius R. , Hodler Juerg , Cathrein Philipp , Duewell Stefan , Jacob Hilaire A. C. , Romero José
Published: July 2017

Background

Chronic overload is considered the main cause of patellar tendinitis, but it has been postulated that impingement of the inferior patellar pole against the patellar tendon during knee flexion could be responsible.

Hypothesis

The role of the patellar pole in patellar tendinitis can be determined by dynamic magnetic resonance imaging.

Study Design

Case-control study.

Methods

We compared 19 knees with patellar tendinitis and 32 asymptomatic knees of age-matched subjects using an open-configuration magnetic resonance imaging system. Dynamic sagittal images were obtained from full extension to 100° of flexion with and without activation of the quadriceps muscle. The following measurements were made from the images: tendon-patella angle, anteroposterior diameter of the tendon, signal difference-to-noise ratio, the shape of the inferior patellar pole, and the location of the patellar tendon insertion.

Results

The tendon-patella angle was not significantly different between groups at any flexion angle, with or without quadriceps muscle activation. The insertion site of the patellar tendon differed significantly but not the shape of the inferior pole of the patella. The volume and the signal difference-to-noise ratio of zones of increased intratendinous signal as well as the anteroposterior diameter of the proximal patellar tendon were increased in symptomatic knees.

Conclusions

The relationship between the patella and the patellar tendon was identical in both groups; therefore, chronic overload seems to be a major cause of patellar tendinitis.
Shock Wave Therapy for Patients with Lateral Epicondylitis of the Elbow
Authors: Wang Ching-Jen , Chen Han-Shiang
Published: July 2017

Background

The results of both nonoperative and surgical treatments for lateral epicondylitis of the elbow have been inconsistent. Shock wave therapy has been shown to have a favorable short-term effect in treating this condition.

Hypothesis

Shock wave therapy is an effective treatment for patients with lateral epicondylitis of the elbow and long-term results will be as favorable as short-term ones.

Study Design

Case series.

Methods

The effect of shock wave therapy was investigated in 57 patients with lateral epicondylitis of the elbow. Forty-three patients (24 men and 19 women with an average age of 46 years) with 1 to 2 years of follow-up were included in this study. In addition, six patients were treated with a sham procedure as a control group. Each patient was treated with 1000 impulses of shock wave therapy at 14 kV to the affected elbow. A 100-point scoring system was used for evaluating pain, function, strength, and elbow range of motion.

Results

Twenty-seven elbows (61.4%) were free of complaints, 13 (29.5%) were significantly better, 3 (6.8%) were slightly better, and 1 (2.3%) was unchanged. In the control group, the results were unchanged in all six patients. There were no device-related problems and no systemic or local complications.

Conclusions

Shock wave therapy is a safe and effective modality in the treatment of patients with lateral epicondylitis of the elbow.
Significance of Ultrasonographically Detected Asymptomatic Tendinosis in the Patellar and Achilles Tendons of Elite Soccer Players: A Longitudinal Study
Authors: Fredberg Ulrich , Bolvig Lars
Published: July 2017

Background

Chronic tendinosis of the Achilles or patellar tendons, or both, is one of the most frequent and severe conditions that affects athletes in sports such as soccer. It can often end an athlete's sports activity.

Hypothesis

Ultrasonography of asymptomatic tendons can be used to predict which athletes will develop tendon symptoms.

Study Design

Longitudinal study.

Methods

Using ultrasonography of the ankle and knee, we examined 54 elite soccer players in the top Danish soccer league before and after a single season (in January and December).

Results

At the start of the season, ultrasonography had revealed abnormalities in 29% of those examined. Eighteen percent (18 of 98 tendons) were observed to have abnormal sonographic findings in the patellar tendon at the initial examination in January. These athletes were found to have a 17% risk of developing symptomatic jumper's knee during the 12-month season. Eleven percent (11 of 96 tendons) were observed to have abnormal sonographic findings in the Achilles tendon at the initial examination; it was calculated that they had a 45% risk of developing symptoms of Achilles tendinosis. Only one of the players with normal tendons in January actually developed symptoms by the end of the season.

Conclusions

For the first time it is now possible to identify risk factors for the development of serious tendon disorders in asymptomatic athletes. Future studies may be directed at developing preventive treatment to reduce the risk of chronic, therapy-resistant symptoms of tendinosis and ruptures.
The Effect of Graft-Tunnel Diameter Disparity on Intraosseous Healing of the Flexor Tendon Graft in Anterior Cruciate Ligament Reconstruction
Authors: Yamazaki Shuji , Yasuda Kazunori , Tomita Fumihisa , Minami Akio , Tohyama Harukazu
Published: July 2017

Background

Graft-to-tunnel healing is a significant factor in anterior cruciate ligament reconstruction, but there have been few studies on the effect of graft-tunnel diameter disparity on intraosseous healing of the flexor tendon graft.

Hypothesis

Graft-tunnel diameter disparity of 2 mm has no effect on the pull-out strength of the graft from the bone tunnel.

Study Design

Controlled laboratory study.

Methods

Forty-two beagle dogs were divided into three groups. In each animal, reconstruction was performed in the left knee by using a 4-mm diameter autogenous flexor tendon for groups 1 and 2 and by using a 4-mm wide bone-patellar tendon-bone graft in group 3. A 4-mm diameter tunnel was drilled in the tibia of groups 1 and 3 and a 6-mm diameter tunnel, in group 2. In each group, seven animals were sacrificed at 3 and 6 weeks.

Results

The perpendicular fibers connecting the graft to the bone were generated in groups 1 and 2, and the number appeared to be higher in group 2, where the space was greater. There was no significant difference in the ultimate failure load between groups 1 and 2 at each period.

Conclusion

Graft-tunnel diameter disparity of up to 2 mm may not adversely affect intraosseous healing of the flexor tendon graft.

Clinical Relevance

Surgeons need not be overly concerned about minor graft-tunnel diameter disparities.
Medial Collateral Ligament Reconstruction of the Elbow using the Docking Technique
Authors: Rohrbough Joel T. , Altchek David W. , Hyman Jon , Williams Riley J. , Botts Jonathan D.
Published: July 2017

Background

Medial collateral ligament insufficiency of the elbow with resultant valgus instability in throwing athletes is typically treated with free tendon graft reconstruction as described by Jobe.

Hypothesis

Improved results could be obtained with the use of the docking technique.

Study Design

Uncontrolled retrospective review.

Methods

The study group consisted of 36 athletes who had symptomatic insufficiency of the medial collateral ligament confirmed by magnetic resonance imaging and by surgical findings. Average follow-up was 3.3 years. Key elements of the docking technique included a muscle-splitting approach without routine transposition of the ulnar nerve, routine arthroscopic assessment, treatment of associated lesions, and docking the two ends of the tendon graft into a single humeral tunnel.

Results

Thirty-three of 36 patients (92%) returned to or exceeded their previous level of competition for at least 1 year, meeting the Conway-Jobe classification criteria of “excellent.” All 22 professional or collegiate athletes returned to or exceeded their previous competition level.

Conclusions

The docking technique allowed simplified graft tensioning and improved graft fixation.
Neurovascular Complications of Knee Arthroscopy
Authors: Kim Tae Kyun , Savino Richard M. , McFarland Edward G. , Cosgarea Andrew J.
Published: July 2017

During the last 3 decades, arthroscopy has revolutionized the way knee surgery is performed. The indications and the applications of arthroscopic procedures in the knee joint have enormously increased with the improvement in surgical technique and advent of new arthroscopic equipment. The use of arthroscopic techniques has led to a significant decrease in morbidity for the patient with intraarticular abnormalities, in terms of both diagnosis and surgical correction. Even though knee arthroscopy is a minimally invasive procedure with relatively low morbidity, it is not without risk of complications, of which neurovascular complications are among the most serious and devastating. The reported incidence of neurovascular complication is low, but it may be underestimated. Many neurovascular complications that occur are preventable with a thorough understanding of neurovascular anatomy, good preoperative and intraoperative planning, and attention to the details of basic techniques and the equipment used for the procedure. It is imperative that the surgeon who is performing arthroscopy be aware of these neurovascular complications, recognize them as early as possible, and initiate further evaluation and treatment as expeditiously as possible. In this article, the causes, management, prevention, and medicolegal implications of neurovascular complications of knee arthroscopy are reviewed.
Arthroscopic Anterior Cruciate Ligament Reconstruction: A Metaanalysis Comparing Patellar Tendon and Hamstring Tendon Autografts
Authors: Freedman Kevin B. , D'Amato Michael J. , Nedeff David D. , Kaz Ari , Bach Bernard R.
Published: July 2017

Background

The best choice of graft tissue for use in anterior cruciate ligament reconstruction has been the subject of debate. Hypothesis: Anterior cruciate ligament reconstruction with patellar tendon autograft leads to greater knee stability than reconstruction with hamstring tendon autograft.

Study Design

Metaanalysis.

Methods

A Medline search identified articles published from January 1966 to May 2000 describing arthroscopic anterior cruciate ligament reconstruction with either patellar tendon or hamstring tendon autograft and with a minimum patient follow-up of 24 months.

Results

There were 1348 patients in the patellar tendon group (21 studies) and 628 patients in the hamstring tendon group (13 studies). The rate of graft failure in the patellar tendon group was significantly lower (1.9% versus 4.9%) and a significantly higher proportion of patients in the patellar tendon group had a side-to-side difference of less than 3 mm on KT-1000 arthrometer testing than in the hamstring tendon group (79% versus 73.8%). There was a higher rate of manipulation under anesthesia or lysis of adhesions (6.3% versus 3.3%) and of anterior knee pain in the patellar tendon group (17.4% versus 11.5%) and a higher incidence of hardware removal in the hamstring tendon group (5.5% versus 3.1%).

Conclusions

Patellar tendon autografts had a significantly lower rate of graft failure and resulted in better static knee stability and increased patient satisfaction compared with hamstring tendon autografts. However, patellar tendon autograft reconstructions resulted in an increased rate of anterior knee pain.
Muscle Flexibility as a Risk Factor for Developing Muscle Injuries in Male Professional Soccer Players
Authors: Witvrouw Erik , Danneels Lieven , Asselman Peter , D'Have Thomas , Cambier Dirk
Published: July 2017

Background

Muscular tightness is frequently postulated as an intrinsic risk factor for the development of a muscle injury. However, very little prospective data exist to prove this.

Hypothesis

Increased muscle tightness identifies a soccer player at risk for a subsequent musculoskeletal lesion.

Study Design

Prospective cohort study.

Methods

We examined 146 male professional soccer players before the 1999–2000 Belgian soccer competition. None of the players had a history of muscle injury in the lower extremities in the previous 2 years. The flexibility of the hamstring, quadriceps, adductor, and calf muscles of these players was measured goniometrically before the start of the season. All of the examined players were monitored throughout the season to register subsequent injuries.

Results

Players with a hamstring (N = 31) or quadriceps (N = 13) muscle injury were found to have significantly lower flexibility in these muscles before their injury compared with the uninjured group. No significant differences in muscle flexibility were found between players who sustained an adductor muscle injury (N = 13) or a calf muscle injury (N = 10) and the uninjured group.

Conclusions

These results indicate that soccer players with an increased tightness of the hamstring or quadriceps muscles have a statistically higher risk for a subsequent musculoskeletal lesion.

Clinical Significance

Preseason hamstring and quadriceps muscle flexibility testing can identify male soccer players at risk of developing hamstring and quadriceps muscle injuries.
Glenohumeral Translations are Only Partially Restored after Repair of a Simulated Type II Superior Labral Lesion
Authors: Burkart Andreas , Debski Richard E. , Musahl Volker , McMahon Patrick J.
Published: July 2017

Background

The effect on joint stability of repair of type II superior labrum and biceps anchor lesions is unknown.

Hypothesis

Increased translations of the glenohumeral joint after a simulated type II lesion will be reduced after the lesion is repaired.

Study Design

Controlled laboratory study.

Methods

A robotic/universal force-moment testing system was used to simulate load-and-shift and apprehension tests on eight cadaveric shoulders to determine joint kinematics of the shoulder after venting, creation of a type II lesion, and repair of the lesion.

Results

At 30° of abduction, anterior translation of the vented joint in response to an anterior load was 18.7 ± 8.5 mm and was significantly increased to 26.2 ± 6.5 mm after simulation of a type II lesion. Repair did not restore anterior translation (23.9 ± 8.6 mm) to that of the vented joint. The inferior translation that also occurred during application of an anterior load was 3.8 ± 4.0 mm in the vented joint and increased significantly to 8.5 ± 5.4 mm with a simulated type II lesion. After repair, the inferior translation decreased significantly to 6.7 ± 5.3 mm.

Conclusions

Repair of a type II lesion only partially restored glenohumeral translations to that of the vented joint.

Clinical Relevance

Surgical techniques including improved repair of passive stabilizers injured in the type II lesion should be considered.
Comparison of Clinical and Dynamic Knee Function in Patients with Anterior Cruciate Ligament Deficiency
Authors: Patel Rohita R. , Hurwitz Debra E. , Bush-Joseph Charles A. , Bach Bernard R. , Andriacchi Thomas P.
Published: July 2017

Background

Whether passive measures of isokinetic muscle strength deficits and knee laxity are related to the dynamic function of the anterior cruciate ligament-deficient knee remains unclear.

Hypotheses

Arthrometer measurements are not predictive of peak external knee flexion moment (net quadriceps muscle moment), isokinetic quadriceps muscle strength correlates with peak external knee flexion moment (net quadriceps muscle moment), and isokinetic hamstring muscle strength correlates with peak external knee extension moment (net flexor muscle moment).

Study Design

Cross-sectional study.

Methods

Gait analysis was used to assess dynamic function during walking, jogging, and stair climbing in 44 subjects with unilateral anterior cruciate ligament deficiency and 44 control subjects. Passive knee laxity and isokinetic quadriceps and hamstring muscle strength were also measured.

Results

Arthrometer measurements did not correlate with peak external flexion or extension moments in any of the activities tested or with isokinetic quadriceps or hamstring muscle strength. Test subjects also had a significantly reduced peak external flexion moment during all three jogging activities and stair climbing compared with the control subjects and this was correlated with significantly reduced quadriceps muscle strength.

Conclusions

Absolute knee laxity difference did not correlate with dynamic knee function as assessed by gait analysis and should not be used as a sole predictor for the outcome of treatment. Patients with greater than normal strength in the anterior cruciate ligament-deficient limb performed low- and high-stress activities in a more normal fashion than those with normal or less-than-normal strength.
Computer Simulations of Patellofemoral Joint Surgery
Authors: Cohen Zohara A. , Henry Jack H. , McCarthy Denise M. , Van Mow C. , Ateshian Gerard A.
Published: July 2017

Background

Variable clinical outcomes of tibial tuberosity transfer surgery have been reported.

Hypotheses

The biomechanical outcome of surgery is patient-specific; no single procedure produces superior results for all patients. Use of patient-specific computer models can optimize choice of procedure.

Study Design

Computer simulation study using clinical data.

Methods

We used patient-specific multibody models of the patellofemoral joints of 20 patients with a diagnosis of patellar subluxation and osteoarthritis. Four tibial tuberosity transfer procedures (two anterior and two anteromedial) were simulated for each patient and compared with their preoperative model.

Results

When results for all patients were averaged, all simulated operations produced a statistically significant decrease in surface-wide mean contact stress, although no significant difference was found among them.

Conclusions

The simulated surgical outcomes were patient-specific: no single procedure was consistently superior at decreasing peak or mean stress and each procedure produced a potentially detrimental outcome, an increase in either mean stress or peak stress, in at least one patient.

Clinical Relevance

Computer simulation may serve as a valuable tool for tailoring procedures to specific patients.
Rotator Cuff Repair
Authors: Waltrip Robert L. , Zheng Nigel , Dugas Jeffrey R. , Andrews James R.
Published: July 2017

Background

The most common complication of rotator cuff repair is structural failure at the repair site. A single-layer repair does not adequately reproduce the anatomic insertion and may not optimize fixation strength.

Hypothesis

A double-layer rotator cuff repair will have greater initial fixation strength than a single-layer repair.

Study Design

Controlled laboratory study.

Methods

Twelve fresh-frozen matched pairs of cadaveric shoulders were repaired by using dual-site fixation with both suture anchors and transosseous tunnels on one side (technique 1). Fixation was achieved by using suture anchors with horizontal mattress sutures and bone tunnels with modified Mason-Allen sutures. Half of the contralateral matched shoulders underwent fixation with suture anchors and simple sutures to simulate commonly used arthroscopic methods (technique 2) and, in the rest, fixation was achieved by using transosseous tunnels and modified Mason-Allen sutures (technique 3). Repaired specimens then underwent cyclic loading at physiologic rates and loads. The number of cycles to failure, which was defined as a 1-cm gap at the repair site, was then recorded. An arbitrary cut-off point of 5000 cycles was chosen.

Results

The mean number of cycles to failure with technique 1 (3694 ± 1980 cycles) was significantly greater than that with either technique 2 (1414 ± 1888 cycles) or technique 3 (528 ± 683 cycles). Failure was predominantly through bone.

Conclusions

The initial fixation strength of our double-layer repair exceeds that of isolated single-layer repairs with either suture anchors or transosseous tunnels.
Clinical Outcome of Anterior Cruciate Ligament Reconstruction with Quadrupled Hamstring Tendon Graft and Bioabsorbable Interference Screw Fixation
Authors: Charlton William P. H. , Randolph Donald A. , Lemos Stephen , Shields Clarence L.
Published: July 2017

Background

To date, there has been no publication of clinical follow-up data on patients who have undergone quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable screw fixation.

Purpose

To report the results of quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable interference screw fixation.

Study Design

Retrospective review.

Methods

Sixty-five patients (66 knees) were retrospectively identified by chart review as having undergone quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable interference screw fixation with a minimum 2-year follow-up.

Results

Data were collected on 48 knees in 47 patients (73%) at an average 30.2 months (range, 24 to 43) after surgery. Thirty-six patients (37 knees) returned for clinical evaluation (56% return) and subjective follow-up only was obtained in 11 patients (17%). The mean Lysolm knee score was 91 (range, 45 to 98), with a mean of 97 for the uninvolved knee. The mean Tegner activity score was 5.7 (range, 3 to 7). The KT-1000 arthrometer mean side-to-side difference for manual maximum displacement was 2.03 mm (range, -1 to 8). The mean International Knee Documentation Committee knee score was 83 (range, 47 to 100). Patients who underwent associated partial meniscectomy or meniscal repair had significantly lower International Knee Documentation Committee scores than patients without associated procedures (P < 0.01).

Conclusions

Quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable interference screw fixation is comparable with other methods of anterior cruciate ligament reconstruction in terms of patient satisfaction, knee stability, and function.
Ulnar and Median Nerve Palsy in Long-distance Cyclists
Authors: Patterson J. Megan M. , Jaggars Marissa M. , Boyer Martin I.
Published: July 2017

Background

Although case reports have identified the presence of distal ulnar nerve sensory and motor dysfunction in long-distance cyclists, the actual incidence of this condition, referred to as “cyclist's palsy,” is unknown.

Purpose

To determine the incidence of distal ulnar nerve compression in cyclists.

Study Design

Prospective study.

Methods

Twenty-five road or mountain bike riders responded to a questionnaire and were then physically examined and interviewed before and after a 600-km bicycle ride.

Results

Twenty-three of the 25 cyclists experienced either motor or sensory symptoms, or both. Motor symptoms alone occurred in 36% of the hands (11 cyclists) tested; no significant difference in the incidence of motor symptoms was found among cyclists of various experience levels or based on handlebar types (mountain bike versus road bike). Sensory symptoms alone occurred in 10% of hands (four cyclists) tested, with the majority of these being in the ulnar distribution. A significantly higher proportion of mountain bike riders had sensory deficits compared with road bike riders; however, there was no significant difference in the occurrence of sensory deficits based on level of experience. A total of 24% of the hands (eight cyclists) tested experienced a combination of motor and sensory symptoms. These motor and sensory symptoms were equally distributed between road bike riders and mountain bike riders and riders of various experience levels.

Conclusions

Cyclist's palsy occurs at high rates in both experienced and inexperienced cylists. Steps may be taken to decrease the incidence of cyclist's palsy; these include wearing cycling gloves, ensuring proper bicycle fit, and frequently changing hand position.
The Effect of Femoral Tunnel Position on Graft Forces during Inlay Posterior Cruciate Ligament Reconstruction
Authors: Oakes Daniel A. , Markolf Keith L. , McWilliams Justin , Young Charles R. , McAllister David R.
Published: July 2017

Background

The femoral tunnel may be positioned centrally or eccentrically within the posterior cruciate ligament footprint during a single-bundle posterior cruciate ligament reconstruction.

Hypothesis

After reconstruction, graft forces are significantly different from those of the native posterior cruciate ligament and are affected by the position of the femoral tunnel.

Study Design

Controlled laboratory study.

Methods

The resultant force in the native posterior cruciate ligament was measured in nine cadaveric knees as the knee was flexed from —5° to 120° of flexion. Posterior cruciate ligament reconstruction was performed with the femoral side of the graft positioned centrally and then offset 5 mm eccentric to the central position.

Results

Mean graft forces were not significantly different between eccentric and central tunnel positions during passive knee extension between 120° and 0° of flexion; at 5° of hyperextension, the eccentric position generated significantly lower graft forces. For both reconstruction techniques, mean graft forces were significantly higher than those for the native posterior cruciate ligament beyond approximately 90° of flexion, for 5 N·m internal and external tibial torque; 5 N·m varus and valgus moment.

Conclusions

Graft force reductions achieved with the eccentric femoral position appear to be relatively small compared with the forces expected during rehabilitation and activities of daily living.

Clinical Relevance

After posterior cruciate ligament graft reconstruction, rehabilitation activities that load the knee at high degrees of flexion should be avoided to limit excessive forces on the maturing graft.
Nonoperative Treatment of Acute Rupture of the Achilles Tendon: Results of a New Protocol and Comparison with Operative Treatment
Authors: Weber Martin , Niemann Marco , Lanz Renate , Müller Thorsten
Published: July 2017

Background

Excellent results are reported from both nonoperative and operative treatment of Achilles tendon rupture.

Purpose

To describe a new nonoperative treatment protocol for Achilles tendon ruptures and compare outcomes with operative treatment.

Study Design

Retrospective cohort study.

Methods

We treated 23 patients nonoperatively with an equinus ankle cast and boot and compared their outcome with that of a group of 24 patients previously treated operatively. Muscle strengthening and walking with full weightbearing were started as soon as tolerated in both groups. Follow-up examinations were performed for 18 nonoperatively treated patients after 23 months and for 15 operatively treated patients after 49 months.

Results

Subsidence of pain, return to unaided walking, and return to work was faster in the nonoperatively treated group. Patient satisfaction, return to sports, and ultimate strength was the same for both groups. The complication rate was similar, except for reruptures: four early in the nonoperative group and one late in the operative group. Two types of reruptures occurred in the nonoperative group: 1) normally healing tendon subjected to new trauma, rerupturing in the healing zone, and achieving a good result with continued nonoperative treatment; and 2) tendon failing proximal to the initial rupture at the muscle-tendon junction, without trauma, requiring operative repair and augmentation.

Conclusions

Results of operative and nonoperative treatment were equivalent.
Traumatic Anterior Shoulder Dislocation in Adolescents
Authors: Deitch John , Mehlman Charles T. , Foad Susan L. , Obbehat Amir , Mallory Mia
Published: July 2017

Background

Recurrent instability is the most common complication after traumatic anterior shoulder dislocation in young patients.

Hypothesis

The rate of recurrent instability in a homogeneous population of adolescents after initial traumatic anterior shoulder dislocation is significant and is associated with a guarded prognosis for full recovery.

Study Design

Retrospective cohort study.

Methods

We identified 32 patients 11 to 18 years of age treated at our institution for a radiographically documented traumatic anterior shoulder dislocation; we performed a functional outcome assessment on 30 patients with use of two standard scoring systems.

Results

Overall, instability recurred in 24 of 32 patients, with 23 experiencing at least one recurrent dislocation. Persistent instability led 16 of 32 to undergo a shoulder stabilization procedure. There were no significant differences in the functional outcome of patients who had undergone surgical stabilization and those who were treated nonoperatively.

Conclusions

The recurrence rate of shoulder instability was 75%. Outcome scores were similar for patients treated with a surgical procedure and those treated nonoperatively.

Clinical Significance

Treatment efforts must be aimed at optimizing shoulder strength and stability. Prognosis for full recovery remains guarded. Available outcome instruments may not discriminate well between patients who do and do not choose surgery.
The Strain Behavior of the Anterior Cruciate Ligament During Bicycling
Authors: Fleming Braden C. , Beynnon Bruce D. , Renstrom Per A. , Peura Glenn D. , Nichols Claude E. , Johnson Robert J.
Published: July 2017

Stationary bicycling is commonly prescribed after anterior cruciate ligament injury or reconstruction; however, the strains on the ligament or ligament graft during stationary bicycling remain unknown. In this study we measured ligament strain on eight patients who were candidates for arthroscopic meniscectomy under local anesthesia. Six different riding conditions were evaluated: three power levels (75, 125, and 175 W), each of which was performed at two cadences (60 and 90 rpm). The peak ligament strain values ranged from 1.2% for the 175-W, 90-rpm, condition to 2.1% for the 125-W, 60-rpm, condition. No significant differences were found in peak strain values due to changes in power level or cadence. Thus, the strain values were pooled across the six riding conditions tested. The mean peak strain value was 1.7%, a value that is relatively low compared with other rehabilitation activities previously tested. These data suggest that knee rehabilitation programs can be designed to include this selection of power and cadence levels without significantly changing ligament strain values. Thus, stationary bicycling is a rehabilitation exercise that permits the patient to increase muscle activity by increasing the power level or decreasing the cadence without subjecting the ligament or ligament graft to higher strain values.
Glenoid Rim Lesions Associated with Recurrent Anterior Dislocation of the Shoulder
Authors: Bigliani Louis U. , Newton Peter M. , Steinmann Scott P. , Connor Patrick M. , McIlveen Stephen J.
Published: July 2017

Twenty-five shoulders with recurrent instability and associated anterior glenoid rim lesions were reviewed to 1) develop a classification system of the lesions, 2) evaluate radiographic techniques in detecting the lesions, and 3) analyze the outcome of surgery. Lesions were classified into three types: Type I, a displaced avulsion fracture with attached capsule; Type II, a medially displaced fragment malunited to the glenoid rim; and Type III, erosion of the glenoid rim with less than 25% (Type IIIA) or greater than 25% (Type IIIB) deficiency. Lesions were detected by plain radiographs (19 shoulders) or supplemental CT-arthrograms (12 shoulders) or both. In 16 Type I fractures, both the bony fragment and capsule were reattached to the glenoid rim. In five Type II and three Type IIIA lesions, only the capsule was repaired to the remaining glenoid rim. In the one Type IIIB lesion, a coracoid transfer was performed. At an average followup of 30 months, 22 shoulders (88%) had satisfactory results without recurrent instability, whereas three shoulders (12%) had postoperative redislocations. The majority of recurrent anterior dislocations with associated glenoid rim lesions can be treated by suturing the fracture fragment or capsule or both to the glenoid rim and addressing associated capsular laxity.
Articular Cartilage Injury with Acute Patellar Dislocation in Adolescents
Authors: Stanitski Carl L. , Paletta George A.
Published: July 2017

Acute patellar dislocation and relocation produces major forces at the articular surfaces. Articular injury was assessed in 48 patients, 24 boys and 24 girls (mean age, 14 years), with acute, initial, noncontact patellar dislocations. Correlation of the findings of radiographic and arthroscopic examinations was done. Eleven of the 48 patients (23%) had radiologic diagnoses of articular injuries. Thirty-four of the 48 patients (71%) had arthroscopic evidence of articular damage, 32 osteochondral and 2 chondral injuries. Eight of the 28 (29%) arthroscopically identified osteochondral loose bodies (4 to 20 mm) were identified radiologically. Overall, only 11 of the 34 (32%) arthroscopically documented articular injuries were defined by preoperative radiographs. These standard radiographs provided limited information for management decisions. Poor results after patellar dislocation treatment may involve nonrecognition of articular compromise.
Soft Tissue Restraints to Lateral Patellar Translation in the Human Knee
Authors: Desio Stephen M. , Burks Robert T. , Bachus Kent N.
Published: July 2017

The purpose of this investigation was to identify and quantify the soft tissue restraints, both medially and laterally, to lateral patellar translation. These restraints to lateral patellar translation at 20° of knee flexion were tested biomechanically on a universal testing instrument in nine fresh-frozen cadaveric knees. After preconditioning the tissues, the patella of each intact knee was translated laterally to a distance at which a force of 200 N was recorded. This distance was used to translate the patella for the remaining structures to be sectioned. The contribution of each structure to the total restraining force was determined as the percent of the force to restrain the intact specimen by sectioning the restraints in a predetermined order. The contribution of each structure to the restraining force was defined as the difference between the restraining force before and after its sectioning. The medial patellofemoral ligament was found to be the primary restraint to lateral patellar translation at 20° of flexion, contributing 60% of the total restraining force. The medial patellomeniscal ligament contributed 13% of the total force, and the lateral retinaculum contributed 10%. The medial patellotibial ligament and superficial fibers of the medial retinaculum were not functionally important in preventing lateral translation. The previously unrecognized contribution of the lateral retinaculum as a restraint to lateral patellar translation may shed new light on the failures of isolated lateral release for acute lateral dislocation of the patella.
Effects of Theraband and Lightweight Dumbbell Training on Shoulder Rotation Torque and Serve Performance in College Tennis Players
Authors: Treiber Frank A. , Lott Jason , Duncan Jewell , Slavens Greg , Davis Harry
Published: July 2017

The purpose of this study was to determine whether a 4-week isotonic resistance training program using Theraband elastic tubing and lightweight dumbbells would significantly increase concentric shoulder rotator strength or velocity of serve or both in a group of elite-level tennis players. Twenty-two male and female varsity college tennis players were randomly assigned to control or 4-week training groups. Subjects were pre- and posttested in concentric internal and external rotation torque using an isokinetic dynamometer. Functional performance was assessed before and after training by recording the peak and average velocities of eight maximal serves. The experimental group exhibited significant gains in internal rotation torque at both slow (120 deg/sec) and fast speeds (300 deg/sec) for total work and in peak torque to body weight ratio and torque acceleration energy at the fast speed. This group also exhibited significant gains in external rotation torque for the same parameters at fast speed. Regarding speed of serve, the experimental group exhibited significantly greater increase in peak speed ( 6.0% compared with 1.8%) and average speed ( 7.9% compared with 2.3%) compared with the control group. Men exhibited greater internal and external rotation torque on all parameters and in peak and mean speed of serve on both evaluations. Men also exhibited greater imbalance in external to internal rotation torque ratios. In conclusion, resistance training using Theraband tubing and lightweight dumbbells may have beneficial effects on strength and functional performance in college-level tennis players.
Rib Stress Fractures in Elite Rowers
Authors: Karlson Kristine A.
Published: July 2017

The potential cause of stress fracture of the rib in elite rowers was examined by a retrospective review of 14 fractures in 10 patients. Fractures occurred on the antero- to posterolateral aspects of ribs 5 through 9 and were most often associated with long-distance training and heavy load per stroke. A review of the literature yields striking similarities between these stress fractures and fractures caused by cough. It is suggested that actions of the serratus anterior and external oblique muscles on the rib cause stress fracture because of the repetitive bending forces in both rowing and coughing. A technique involving less use of both muscles through a truncated arm pull-through and a decreased layback position at the end of the stroke, and equipment changes to decrease length of the lever arm, should yield a decreased risk of rib stress fractures in rowing.
The Effects of Aging and Training on Skeletal Muscle
Authors: Kirkendall Donald T. , Garrett William E.
Published: July 2017

Aging results in a gradual loss of muscle function, and there are predictable age-related alterations in skeletal muscle function. The typical adult will lose muscle mass with age; the loss varies according to sex and the level of muscle activity. At the cellular level, muscles loose both cross-sectional area and fiber numbers, with type II muscle fibers being the most affected by aging. Some denervation of fibers may occur. The combination of these factors leads to an increased percentage of type I fibers in older adults. Metabolically, the glycolytic enzymes seem to be little affected by aging, but the aerobic enzymes appear to decline with age. Aged skeletal muscle produces less force and there is a general “slowing” of the mechanical characteristics of muscle. However, neither reduced muscle demand nor the subsequent loss of function is inevitable with aging. These losses can be minimized or even reversed with training. Endurance training can improve the aerobic capacity of muscle, and resistance training can improve central nervous system recruitment of muscle and increase muscle mass. Therefore, physical activity throughout life is encouraged to prevent much of the age-related impact on skeletal muscle.
Attempted Suicide: Factors Leading to Hospitalization
Authors: Hepp Urs , Moergeli Hanspeter , Trier Stefan N , Milos Gabriella , Schnyder Ulrich
Published: July 2017

Objective:

This study analyzes how sociodemographic and clinical characteristics influence the treatment decision for patients referred to a university hospital emergency room (ER) owing to attempted suicide.

Method:

Using a cross-sectional design, we monitored all patients admitted to a university hospital ER after attempting suicide, over a 3-year period ( n = 404). Treatment decisions were categorized into 3 groups: inpatient treatment, outpatient treatment, and no further treatment.

Results:

Older patients were more likely to be hospitalized, while women and patients with regular occupational activity were more likely to receive outpatient treatment. In logistic regression analysis, attempted suicide using aggressive methods, history of psychiatric inpatient treatment, and psychotic disorders were associated with inpatient treatment. Adjustment and neurotic disorders were related to outpatient treatment.

Conclusions:

The decision to hospitalize can be satisfactorily predicted by means of sociodemographic and clinical characteristics, while the number of patients assigned to outpatient treatment is underestimated. A triage that relies only on sociodemographic and clinical data as well as risk factors could result in too frequent admissions of patients after attempted suicide.
Serum Lipid Concentrations in Obsessive—Compulsive Disorder Patients with and without Panic Attacks
Authors: Agargun Mehmet Yucel , Dulger Haluk , Inci Rifat , Kara Hayrettin , Ozer Omer Akil , Sekeroglu Mehmet Ramazan , Besiroglu Lutfullah
Published: July 2017

Objective:

To examine serum lipid levels in patients with obsessive–compulsive disorder (OCD) and to test whether panic symptoms affect lipid concentrations in OCD patients.

Methods:

We assessed 33 OCD patients and 33 healthy control subjects matched for sex and age.

Results:

OCD patients had higher low-density lipoprotein, very-low-density lipoprotein, and tryglyceride levels, but lower high-density lipoprotein levels, than normal control subjects. We also found that only OCD patients with panic attacks had higher serum lipid concentrations, compared with normal control subjects. Serum lipid levels of pure OCD patients did not differ from control values.

Conclusion:

These findings suggest that high serum lipid concentrations are related to panic anxiety rather than other symptoms of the illness.
Structural and Functional Magnetic Resonance Imaging in Psychiatric Disorders
Authors: Pearlson Godfrey D , Calhoun Vince
Published: July 2017

Objective:

To report on recent advances in both structural and functional brain imaging studies in psychiatry and to highlight their importance for the field.

Method:

We reviewed recently published articles dealing with such advances and abstracted them into a selective review of the field.

Results:

Some of the more important trends include integration of genetic information into research studies, use of novel quantitative image measurement techniques, studies of new subject populations, the use of pharmacologic probes in functional magnetic resonance imaging (fMRI) studies, the incorporation of elements of virtual reality into fMRI task stimuli, and the methodological innovation of hyperscanning.

Conclusions:

A whole series of new approaches and techniques are resulting in rapid advances in neuroimaging in psychiatry. Several of these show the potential for clinical translation.
Socioeconomic Status and Self-Reported Barriers to Mental Health Service Use
Authors: Steele Leah , Dewa Carolyn , Lee Kenneth
Published: July 2017

Objective:

Socially disadvantaged individuals are at high risk for having their mental health service needs unmet. We explored the relations among education level, income level, and self-reported barriers to mental health service use for individuals with a mental illness, using data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2).

Methods:

Our sample group comprised the 8.3% of adult respondents who met the CCHS 1.2 criteria for an anxiety or affective disorder in the past 12 months ( n = 3101). We examined the association between education and income levels and self-reported accessibility, availability, or acceptability barriers to mental health care.

Results:

Accessibility, availability, and acceptability barriers were reported by 3%, 5%, and 16% of our sample, respectively. Individuals with a high school diploma were less likely than individuals without a high school diploma to report acceptability barriers to care (odds ratio 0.65; 95% confidence interval, 0.45 to 0.93). Higher-income individuals were less likely than lower-income individuals to report acceptability barriers to care (odds ratio 0.69; 95% confidence interval, 0.50 to 0.96). Employment, distress level, age, and family structure were also associated with acceptability barriers.

Conclusion:

Issues related to acceptability explain most of the unmet need for mental health services. Program planners should consider the development of targeted approaches to service delivery and outreach for low-income, working individuals who have not completed high school.
Use of Cytokines in Clozapine-Induced Agranulocytosis
Authors: Chin-Yee Ian , Bezchlibnyk-Butler Kalyna , Wong Lillian
Published: July 2017

Objective:

To report and review the use of cytokines for the treatment of clozapine-induced neutropenia.

Method:

Case report and review of literature.

Results:

Cytokines, granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF), appear to shorten the duration of clozapine-induced neutropenia.

Conclusions:

G-CSF or GM-CSF therapy should be considered in patients with profound neutropenia of prolonged duration (high-risk neutropenia).
Psychopathology in Offspring of Mothers with Borderline Personality Disorder: A Pilot Study
Authors: Weiss Margaret , Zelkowitz Phyllis , Feldman Ronald B , Vogel Judy , Heyman Marsha , Paris Joel
Published: July 2017

Objective:

Children of mothers with borderline personality disorder (BPD) were hypothesized to be at greater risk for psychopathology, particularly impulse spectrum disorders, than children of mothers with other personality disorders.

Method:

Twenty-one index children were compared with 23 children of mothers with a nonborderline personality disorder. Diagnoses were obtained using the Kiddie Schedule for Affective Disorders and Schizophrenia–Episodic Version (KSADS-E) and the Child Diagnostic Interview for BPD (CDIB), and functioning was rated with the Child Global Assessment Schedule (CGAS). Physical, sexual, and verbal abuse, as well as family violence and placements, were also assessed.

Results:

The children of the borderline mothers, as compared with controls, had more psychiatric diagnoses, more impulse control disorders, a higher frequency of child BPD, and lower CGAS scores. There were no differences between the groups for trauma.

Conclusion:

The offspring of borderline mothers are at high risk for psychopathology.