bluuebunny/crossref_metadata_2025 huggingface dataset:
Lower extremity equipment-related injuries in alpine recreational skiers
Authors: Ekeland Arne , Holtmoen Age , Lystad Harald
Published: June 2007

Lower extremity equipment-related injuries are the most significant injury group in alpine skiing. The lower extremity equipment-related injuries occurring at four Norwegian ski resorts were studied during the winter of 1985 to 1986. A total of 132 skiers with injuries were included (40% of all injured skiers) and compared with a randomly selected control population of 316 uninjured skiers. The most common lower extremity equipment- related injuries were knee sprains (56%) and lower leg fractures (14%), usually caused by no or late binding release.

Significantly more lower extremity equipment-related injuries (33%) than other skiing injuries (19%) needed hospital admittance. Children below 10 years had a risk of lower leg fractures nine times that of skiers beyond 20 years. Beginners were six times more at risk for a lower extremity equipment-related injury than skiers of higher skiing abilities. The following factors were also associated with a significantly increased risk for a lower extremity equipment-related injury: less than three skiing seasons, no skiing instruction, and no self-testing of the bindings.
Shoulder pain in wheelchair athletes
Authors: Burnham Robert S. , May Laura , Nelson Ewen , Steadward Robert , Reid David C.
Published: June 2007

Shoulder rotator cuff impingement syndrome is a com mon and disabling problem for the wheelchair athlete. In this study we investigated the role of shoulder strength imbalance as a factor for the development of this syndrome. Nineteen paraplegic male athletes underwent clinical and isokinetic examination of both shoulders with peak torque values measured in abduc tion, adduction, and internal and external rotation. Twenty athletic, able-bodied men without shoulder problems were tested as controls. Ten (26%) of the paraplegic athletes had rotator cuff impingement syn drome. The results of the isokinetic testing demon strated that 1) the paraplegics' shoulders were stronger than the controls in all directions ( P < 0.05); 2) the strength ratio of abduction:adduction was higher for paraplegic athletes ( P < 0.05); 3) paraplegics' shoulders with rotator cuff impingement syndrome were weaker in adduction and external and internal rotation than the paraplegic athletes without impingement syndrome ( P < 0.05); and 4) paraplegics' shoulders with rotator cuff impingement syndrome had higher abduc tion:adduction and abduction:internal rotation strength ratios than the shoulders of paraplegics without im pingement syndrome ( P < 0.05). We concluded that shoulder muscle imbalance, with comparative weak ness of the humeral head depressors (rotators and adductors), may be a factor in the development and perpetuation of rotator cuff impingement syndrome in wheelchair athletes.
Electromyographic and cinematographic analysis of elbow function in tennis players using single- and double-handed backhand strokes
Authors: Giangarra Charles E. , Conroy Betty , Jobe Frank W. , Pink Marilyn , Perry Jacquelin
Published: June 2007

It is generally believed that tennis players using a dou ble-handed backhand rarely develop lateral epicondyli tis since the helping arm appears to absorb more energy and changes the mechanics of the swing. The purpose of this paper was to compare muscle activity about the elbow in single- and double-handed backhand strokes in competitive tennis players. Muscle activity in 3 elbow extensors, a wrist flexor, and a forearm pron ator of the dominant arm was compared during the single-handed ( N = 14) and double-handed ( N = 13) backhand ground strokes using indwelling electro myography and high-speed cinematography. Signifi cantly higher activity was seen in the double-handed technique in the flexor carpi radialis muscle in the preparation phase and in the pronator teres muscle in the acceleration phase. Higher flexor carpi radialis mus cle activity in preparation of the double-handed stroke appeared to be a function of the double-handed grip used on the racquet, and the increased pronator teres muscle activity in acceleration indicated maintenance of greater pronation provided by the grip of the non- dominant hand. The decreased occurrence of lateral epicondylitis in players using a double-handed back hand may not be caused by decreased extensor activ ity, but rather by factors associated with flawed stroke mechanics more often seen in the single-handed tech nique.
Development of lower leg strength and flexibility with the strength shoe
Authors: Cook Stephen D. , Schultz Gretchen , Omey Monica L. , Wolfe Michael W. , Brunet Michael F.
Published: June 2007

The Strength Shoe is a modified athletic shoe with a 4- cm thick rubber platform attached to the front half of the sole. It is promoted as an effective method of increasing "speed, quickness, and explosive power," as well as ankle flexibility and calf circumference, when used in a plyometrics-based training regimen. This study evaluates, in a prospective, randomized trial, the efficacy and safety of the Strength Shoe training regi men for increasing lower leg flexibility and strength in intercollegiate track and field participants. No enhance ment of flexibility, strength, or performance was ob served for participants wearing the Strength Shoe at the end of an 8-week training program, following the suggested regimen of the manufacturer. The use of the Strength Shoe cannot be recommended as a safe, effective training method for development of lower leg strength and flexibility. However, the use of plyometrics in a properly supervised setting may improve athletic performance and merits further investigation.
An analysis of epidemiology and financial outcome
Authors: Garrick James G. , Requa Ralph K.
Published: June 2007

The financial outcome and epidemiology of ballet dan cers' injuries were studied by examining workers' com pensation insurance records covering 3 seasons (3 years) of activity for a large professional ballet com pany. One hundred four dancers sustained 309 injuries that resulted in insurance payouts for medical costs of $398,396. The average cost per injury was $1289. Although only 4.2% of the injuries resulted in medical costs exceeding $5000, these represented 60.0% of the total medical costs. Nine injuries resulted in medical costs in excess of $10,000 each. Overall, there were 2.97 injuries per injured dancer. Twenty-four dancers (23.0% of the injured) sustained 5 or more injuries each and thus were responsible for 51.9% (161) of all injuries. The foot (74 injuries, 23.9%), lumbar spine (71, 23.0%), and ankle (41, 13.3%) were the most frequently injured anatomic regions. The experience of this ballet com pany is similar to that of a college athletic department or a professional sports team. All could employ similar strategies to reduce injuries and associated costs.
Prospective evaluation of the McMurray test
Authors: Evans Peter J. , Bell G. Douglas , Frank CY
Published: June 2007

The accuracy and interexaminer reliability of the Mc Murray test for the diagnosis of meniscal tears were compared with arthroscopic findings in a prospective study of 104 consecutive patients awaiting elective arthroscopy. The only significant McMurray sign found to correlate with meniscal injury was a "thud" elicited on the medial joint line with a medial meniscal tear (P = 0.05) that had a fair interexaminer reliability (kappa = 0.35). The sensitivity of a medial thud was 16%, and the specificity was 98% with a positive predictive value of 83%. Examiner experience had little effect on the accuracy of diagnosis of medial meniscal tears. This study supports the continued but limited emphasis on the McMurray test in the clinical diagnosis of meniscal tears.
Quantitative evaluation after arthroscopic anterior cruciate ligament reconstruction
Authors: Shino Konsei , Nakata Ken , Horibe Shuji , Inoue Masahiro , Nakagawa Shigeto
Published: June 2007

We measured the anteroposterior ligamentous laxity and thigh muscle power in 92 subjects who were rated as successes after they had undergone arthroscopic anterior cruciate ligament reconstruction for unilateral anterior cruciate ligament insufficiency 18 to 36 months previously. The subjects were divided into 2 groups according to the type of graft: fresh-frozen allogenic tendon ( N = 47) or central one third of the ipsilateral patellar tendon (N = 45). Instrumented drawer tests in the Lachman position were performed to measure an terior tibial displacement at 200 N (anterior laxity). Thigh muscle power was isokinetically measured with a Cy bex II dynamometer. Significantly more anterior laxity was found in the reconstructed knees than in the contralateral normal knees regardless of graft material (paired t-test, P < 0.01), except for the male allograft patients. Although the mean anterior laxity difference between sides for the allograft patients was less than that for the autogenous ones, analysis of variance failed to demonstrate a statistically significant difference be tween the 2 groups if the comparison was strictly made within the same sex. Thigh muscle tests revealed that extension torque in the reconstructed knees was sig nificantly less than that in the contralateral knees and analysis of variance showed that knee extension torque at 60 deg/sec for the allograft patients was significantly better than that of the autograft ones (P < 0.05). We concluded that the allograft procedure is advantageous over the patellar tendon autograft in terms of better restoration of anterior stability.
Spear tackler's spine
Authors: Torg Joseph S. , Sennett Brian , Pavlov Helene , Leventhal Marvin R. , Glasgow Steven G.
Published: June 2007

We describe spear tackler's spine, a clinical entity that constitutes an absolute contraindication to participation in tackle football and other collision activities that ex pose the cervical spine to axial energy inputs. A subset of football players were identified who demonstrated: 1) developmental narrowing (stenosis) of the cervical canal; 2) persistent straightening or reversal of the normal cervical lordotic curve on erect lateral roentgen ograms obtained in the neutral position; 3) concomitant preexisting posttraumatic roentgenographic abnormal ities of the cervical spine; and 4) documentation of having employed spear tackling techniques. From data obtained by the National Football Head and Neck Injury Registry and the senior author's practice, 15 cases of spear tackler's spine were identified during 1987 to 1990.

All 15 cases were evaluated because of complaints referable to the cervical spine or brachial plexus result ing from football injuries. Of these, 11 had complete neurologic recovery without permanent sequelae. Four cases resulted in permanent neurologic deficits: quad riplegia, 2; incomplete hemiplegia, 1; and residual long track signs, 1. Permanent neurologic injury occurred as the result of axial loading of a persistently straightened cervical spine from use of head-impact playing tech niques. We suggest that individuals who possess the aforementioned characteristics of spear tackler's spine be precluded from participation in collision activities that expose the cervical spine to axial energy inputs.
Arthroscopic transglenoid suture capsulolabral repairs: Preliminary results
Authors: Goldberg Bruce J. , Nirschl Robert P. , McConnell John P. , Pettrone Frank A.
Published: June 2007

The arthroscopic transglenoid suture technique was performed on 38 shoulders for antenor capsulolabral repair or reconstruction. The primary complaint was instability in 34 shoulders (89%) and pain in 4 shoulders (11 %). In the instability subgroup, 3 (9%) experienced instability in their sleep, 17 (50%) with activities of daily living, and 14 (41 %) with athletic activities.

Arthroscopic examination revealed labral detachment in 35 shoulders (92%) with additional capsular abnor malities noted in 17 (45%). The remaining 3 shoulders (8%) demonstrated capsular laxity and thinning without labral detachment.

Twenty-nine shoulders had complete relief of insta bility. There were no redislocations. Four shoulders (10%) had recurrence of instability. Twenty shoulders (53%) obtained full range of motion, 15 (39%) had minor (<10°) loss of external rotation, 2 (5%) experienced greater (>10°) loss of external rotation, and 1 improved over a restricted preoperative range of motion.

Fifteen of the 20 competitive athletes and 11 of the 15 recreational athletes returned to the same level and same type of athletic activity. Five patients did not resume their preinjury athletics because of unrelated life-style changes; they reported no shoulder problems. Four patients significantly reduced their athletic partic ipation because of postoperative instability or residual pain.

In conclusion, relief of apprehension, reestablishment of shoulder stability and return to athletic activity, in cluding contact and throwing activities, can be achieved safely and effectively in appropriately selected patients.
Arthroscopic suture repair of superior labral detachment lesions of the shoulder
Authors: Field Larry D. , Savoie Felix H.
Published: June 2007

Twenty consecutive patients with superior labral ante rior and posterior lesions of the shoulder involving the biceps attachment to the labrum (Snyder types II and IV) were repaired arthroscopically and reviewed post operatively to evaluate the efficacy of the technique in the management of this recently described injury pat tern. Follow-up time averaged 21 months (range, 12 to 42). All patients were managed by an arthroscopic repair technique that included debridement of the frayed labrum and abrasion of the superior glenoid neck, fol lowed by the placement of multiple sutures into the torn labrum-biceps tendon complex using a Caspari suture punch. Patients were reexamined, and the results were quantitated with the shoulder evaluation form of the American Shoulder and Elbow Surgeons and with the Rowe rating scale. On evaluation, all patients obtained good or excellent results. This suture technique is recommended in the management of unstable superior labral detachment lesions of the shoulder.
Muscular control of the ankle in running
Authors: Reber Lyle , Perry Jacquelin , Pink Marilyn
Published: June 2007

The purpose of this study was to describe and compare the muscle firing patterns of the muscles controlling the ankle during running. Fine-wire electrodes monitored the activity of the gastrocnemius, soleus, peroneus brevis, tibialis posterior, and tibialis anterior muscles during 3 paces of running. High-speed film was used to synchronize the electromyographic data with the phases of running. The subjects were 15 recreational and competitive runners who were injury-free. There were 3 significant findings. First, the firing patterns of all of the posterior muscles demonstrated peak activity during midstance phase. Thus, these muscles were contracting in an eccentric fashion to control ankle dorsiflexion as the center of gravity passed over the ankle. Second, the tibialis anterior muscle fired above the fatigue threshold for 85% of the time. This may account for the high number of fatigue-related injuries to the tibialis anterior muscle seen in runners. Third, there was a significant increase of activity in the pero neus brevis muscle as the pace increased. This indi cates the importance of training this muscle when pace is increased. Using this information, a sport-specific effective and efficient exercise program for runners can be developed.
Echography of external iliac artery endofibrosis in cyclists
Authors: Abraham Pierre , Leftheriotis Georges , Bourre Yolande , Chevalier Jean-Michel , Saumet Jean-Louis
Published: June 2007

Forty-eight cyclists were studied for suspected external iliac artery endofibrosis with ultrasound B-mode imag ing. In highly trained competition cyclists, symptoms of external iliac artery endofibrosis were characterized by lower limb claudication during maximal effort that was caused by fibrosis thickening of the intima of the exter nal iliac arterial wall. Typical ultrasound imaging aspects consisted of parietal thickening, enhanced echogenicity of the arterial wall, straightness of the abnormal arterial segment, and mild narrowing of the arterial diameter of the proximal or medial segment of the diseased external iliac artery. Although ultrasound B-mode imaging study seems to be useful in the diagnosis of external iliac artery endofibrosis, results with this technique must be compared with results of clinical examination, physio logic tests, and arteriography.
The biomechanics of interference screw fixation of patellar tendon anterior cruciate ligament grafts
Authors: Brown Charles H. , Hecker Aaron T. , Hipp John A. , Myers Elizabeth R. , Hayes Wilson C.
Published: June 2007

Twenty-seven paired human cadaveric knee specimens were used to determine the effect of surgical technique and various interference screw parameters on the pullout strength of patellar tendon femoral bone blocks. The study compared the fixation strength of endoscop ically inserted and conventional "rear-entry" screws of different diameters and lengths. In all tests the most frequent mode of failure was bone block pullout from the interference screw. There was no significant differ ence in fixation strength between 9-mm diameter screws inserted through a conventional rear-entry tech nique and 7-mm diameter screws inserted through an endoscopic technique. There was no significant effect of screw length on fixation strength. The pullout force for 20-mm long screws increased on average 120% when 7-mm diameter screws were compared with 5.5- mm diameter screws. There was no significant effect of increased screw core diameter on fixation strength. There was a weak positive correlation ( r2 = 0.45) between screw insertion torque and pullout force. Our measured mean pullout force for the 7-mm endoscopi cally inserted screws of 362 ± 198 N represents 20.1 % of the failure load of the normal young adult anterior cruciate ligament. Our data indicate that properly in serted 7-mm diameter endoscopic interference screws can provide fixation strengths of patellar tendon ante rior cruciate ligament grafts equivalent to those of con ventional 9-mm diameter rear-entry, outside-in screws.
Medial Collateral Ligament Knee Sprains in College Football
Authors: Albright John P. , Powell John W. , Smith Walter , Martindale Al , Crowley Edward , Monroe Jeff , Miller Russ , Connolly John , Hill Billy A. , Miller Dennis , Helwig Dennis , Marshall Jim
Published: June 2007

This is the second of 2 articles on a 3-year investigation of medial collateral ligament sprains of the knee to as sess the effectiveness of prophylactic knee braces in NCAA Division I college football players. Position, string, type of session, and daily brace wear were re corded. The injury rates for braced and unbraced knees were used to create an incidence density ratio. The data were stratified and simultaneously controlled for posi tion, string, and session and evaluated for their statis tical significance. The 987 Big Ten players generated 155,772 knee exposures over the study period (50% braced). Noticeable differences existed in the rates of injury for the braced and unbraced knees in almost ev ery position during practices, depending on player or nonplayer status. When the influential factors of posi tion, string, and session are considered, there is a con sistent but not statistically significant tendency for the players wearing preventive knee braces to experience a lower injury rate than for their unbraced counterparts. For starters and substitutes in the line positions, as well as the linebackers and tight ends, there was a consis tent trend toward a lower injury rate in both practices and games. The braced players in the skill positions (backs/kickers), at least during games, exhibited a higher injury rate.
Ankle Sprain Prophylaxis: An Analysis of the Stabilizing Effects of Braces and Tape
Authors: Shapiro Matthew S. , Kabo J. Michael , Mitchell Peter W. , Loren Gregory , Tsenter Michael
Published: June 2007

Five cadaveric ankles were used to determine the ef fects of prophylactic bracing and tape on resisting an inversion moment applied to the ankle. The ankles were tested in neutral flexion and 30° of plantar flexion and with both low- and high-top shoes. Eight different strap-on braces were studied. High-top sneakers sig nificantly increased the passive resistance to inversion afforded by all braces and tape. Many of the braces functioned to resist inversion at a level that was com parable with or exceeded the capability of freshly ap plied tape. This finding was independent of the type of footwear. Braces that were not as effective as freshly applied tape nevertheless retained the advantage over tape in that they could be easily readjusted and their effectiveness restored, whereas the quality of the sup port provided with tape deteriorated with usage.
Outpatient Surgical Management of Arthrofibrosis After Anterior Cruciate Ligament Surgery
Authors: Shelbourne K. Donald , Johnson Glen E.
Published: June 2007

We present a consecutive series of nine patients who were referred to us because of arthrofibrosis (loss of >15° of extension) after intraarticular anterior cruciate ligament reconstruction using autogenous patellar ten don (eight patients) or semitendinosus (one patient) graft. Eight patients had surgery within 2 weeks of injury. All patients had been immobilized in flexion after the anterior cruciate ligament reconstruction and they had failed to improve despite vigorous physical therapy and other closed methods of treatment. The mean time from anterior cruciate ligament reconstruction to the subse quent surgery was 10.2 months (range, 3 to 14). The patients underwent an outpatient arthroscopic anterior scar resection, notchplasty, a closed knee manipulation for flexion, and extension casting. Serial daily extension cast changes allowed the patients to obtain full exten sion, which was maintained by a bivalved extension splint for bedtime use. Flexion was actively sought by aggressive outpatient physical therapy. All patients ex cept one noted near-normal ultimate range of motion. One patient could only attain 10° short of flat extension at the end of his rehabilitation and was considered a failed result. At final followup (mean, 31 months), no patient complained of symptoms of instability, all had a normal gait, and all but one were able to return to athletic activities.
Isolated Autogenous Bone-Patellar Tendon-Bone Graft Site Morbidity
Authors: Rubinstein Richard A. , Shelbourne K. Donald , VanMeter Charles D. , McCarroll John C. , Rettig Arthur C.
Published: June 2007

To distinguish between morbidity caused by the isolated patellar tendon graft harvest and morbidity associated with anterior cruciate ligament reconstruction when the graft is harvested from the involved knee, we studied 20 patients who had an isolated contralateral graft harvest for anterior cruciate ligament reconstruction in the op posite knee. We defined and quantitated the morbidity by evaluating the uninjured knee from preoperative studies to current followup (range, 0.5 to 5 years; av erage, 2 years). All graft harvest surgeries were per formed in an identical fashion. Rehabilitation of the har vest knee included immediate range of motion, weightbearing, and closed chain kinetic exercises with a emphasis on early strengthening. All patients re gained full knee range of motion by 3 weeks. At final followup, there was no clinical or radiographic evidence of patella contracture or baja. Quadriceps strength av eraged 69% at 6 weeks and returned to 93% at 1 year and 95% at 2 years. Activity-related soreness at the donor site (patellar tendinitis) was rarely restricting and resolved after the 1 st year. No patient complained of patellofemoral joint pain in the donor knee. The modified Noyes subjective questionnaire score averaged 97 of 100 at last followup. The morbidity of an isolated au togenous patellar tendon graft harvest appears to be of short duration and largely reversible.
Bone Tunnel Enlargement After Anterior Cruciate Ligament Replacement
Authors: Fahey Mark , Indelicato Peter A.
Published: June 2007

Radiographic increase in the size of tibial and femoral tunnels has been observed. This retrospective study compared tibial tunnel diameter in 56 autograft and 87 allograft patellar tendon bone-tendon-bone anterior cru ciate ligament replacements whose observed tunnel changes were correlated with clinical results at 1 year postoperatively. Tibial tunnel sclerotic margins were measured approximately 1 cm below the joint line. Ex act tunnel dimension was calculated by using a mag nification factor determined by the interference screw of known diameter within the same tunnel. Average al lograft tunnel enlargement was 1.2 mm (-2.5 to 6.0) compared with the autograft tunnel enlargement of 0.26 mm (-2.5 to 2.7); the difference was significant (P> 0.0002). No significant difference was seen in KT-1000 arthrometer measurements between autograft or allograft groups, and no correlation was seen be tween increased tunnel size and clinical outcome as determined by the modified Hughston knee evaluation system. Tunnel measurement reproducibility was con firmed by independent repeated measurements. The significance of this tunnel enlargement is unknown and does not appear to adversely affect clinical outcome of allograft utilization. Possible explanations include an immune response with resorption, stress shielding proximal to the interference screw resulting in resorp tion, or an inflammatory response by synovium in the tunnel.
The Efficacy of a Semirigid Ankle Stabilizer to Reduce Acute Ankle Injuries in Basketball
Authors: Sitler Michael , Ryan Jack , Wheeler Bruce , McBride Jack , Arciero Robert , Anderson James , Horodyski MaryBeth
Published: June 2007

This randomized clinical study was designed to pro spectively determine the efficacy of a semirigid ankle stabilizer in reducing the frequency and severity of acute ankle injuries in basketball. Athletic shoe, playing surface, athlete-exposure, ankle injury history, and brace assignment were either statistically or experimen tally controlled. Participants in the study were 1601 United States Military Academy cadets with no prepar ticipation, clinical, functional, or radiographic evidence of ankle instability. Subjects experienced a total of 13,430 athlete-exposures in the 1990 and 1991 intra mural basketball seasons. Ankle injury was defined as acute trauma to the ankle ligaments that resulted in an athlete's inability to participate in basketball 1 day after the injury. Use of ankle stabilizers significantly reduced the frequency of ankle injuries. Reduction in ankle in juries, however, depended on the nature of injury (fewer contact injuries occurred among those who wore braces). Injury severity was not statistically reduced, and wearing the ankle stabilizer did not affect the fre quency of knee injuries. Attitude toward ankle stabilizer use improved as use of the stabilizer increased.
Recurrent Anterior Shoulder Instability
Authors: Dowdy Paul A. , O'Driscoll Shawn W.
Published: June 2007

The purpose of this study was to compare 2 radio graphic methods for measuring anteversion and to de termine whether glenoid anteversion is a significant fac tor in recurrence of instability after anterior repair. West Point axillary roentgenograms were obtained in 128 pa tients (138 shoulders) at a mean of 9 years after sur gery. Two methods to measure glenoid anteversion were compared: The angle between the glenoid and the body of the scapula, and the angle between the glenoid and the posterior margin of the acromion. There was less variation in the measurements using the glenoid margin-posterior acromion angle. By this method, an teversion was 11 ° ± 4° for the 15 patients with multiple (2 or more) recurrences, 8° ± 3° for the 15 patients with 1 recurrence, and 6° ± 5° for the 109 patients with no recurrences. Although these differences are statistically significant (P = 0.003), they probably are not clinically important because they are small (mean of only 5°). The differences obtained by measuring the angle between the glenoid and the body of the scapula were not sta tistically significant.
Magnetic Resonance Imaging of the Glenoid Labrum in Anterior Shoulder Instability
Authors: Green Michael R. , Christensen Kevin P.
Published: June 2007

Detachment of the anterior inferior labrum and inferior glenohumeral ligament complex from the glenoid is a common lesion encountered in anterior shoulder insta bility while other types of labral lesions are associated with symptoms that mimic instability. Accurate delinea tion of labral lesion is, therefore, key in managing shoul der problems. In a prospective double-blinded fashion, we compared the magnetic resonance imaging findings with those noted at surgery in 33 patients with possible anterior shoulder instability. Of 28 surgically confirmed labral lesions, 21 were detected by imaging. Sensitivity was 75%, specificity 100%, while positive and negative predictive values were 100% and 41%, respectively. Overall accuracy was 79%. Based on a literature review and our clinical experience, we developed a classifica tion of glenoid labra according to the type and severity of the lesions. Method of treatment correlated with clini cal outcome, using this system, to a statistically signifi cant level. Unfortunately, this system enabled accurate classification with magnetic resonance imaging in only 7 of 33 (21 %) labra, with the precision necessary to affect surgical planning in our series. We conclude that magnetic resonance imaging is not useful in the surgical planning for most patients with obvious anterior shoul der instability.
Incidence and Mechanisms of Acute Ankle Inversion Injuries in Volleyball
Authors: Bahr Roald , Karlsen Ragnhild , Lian Øystein , Øvrebø Rune V.
Published: June 2007

In a retrospective cohort study of ankle inversion injuries performed after the 1991-1992 season in the top two divisions of the Norwegian Volleyball Federation, 63 in juries were found among 318 players during 60,612 hours of training and 928 matches. The study was lim ited to acute ankle inversion injuries that caused an ab sence of 1 or more days from training or match play. The total injury rate was 0.9 ± 0.12 per 1000 player hours: 0.7 ± 0.11 during training and 2.6 ± 0.56 during match play. The relative risk of injury during match play versus training was 3.9 ( P < 0.001). Women had an injury rate of 1.1 ± 0.18, whereas that of men was 0.7 ± 0.15 (relative risk = 1.47; not significant). Most of the players (78%) had suffered at least one previous injury of the affected ankle. Most injuries were mild to moderate. The majority of the injuries (86%) occurred at the net, mainly when landing after blocking (63%) or attacking (29%). We suggest that simple measures such as rule changes, technical training, and prophylactic taping or bracing may lead to a significant reduction in the inci dence and severity of such injuries.
Anterior Cruciate Ligament Reconstruction Using the Semitendinosus and Gracilis Tendons Augmented by the Losee Iliotibial Band Tenodesis
Authors: Anderson Allen F. , Snyder Robert B. , Lipscomb A. Brant
Published: June 2007

Seventy patients were evaluated after combined intra- and extraarticular reconstruction of the anterior cruciate ligament. Semitendinosus and gracilis tendons were used for the intraarticular reconstruction and Losee iliotibial band tenodesis for the extraarticular procedure. Minimum followup was 5 years (average, 7). Clinical examination and instrumented ligament examination with the KT-1000 arthrometer and the Cybex II dyna mometer were used to evaluate results. Subjectively, patients had no complaints of instability with daily ac tivities ; 93% had no complaints of instability with athletic participation. Clinical examination demonstrated that 81 % had less than a 1 + Lachman test; 98% had a nega tive pivot shift. Instrumented examination of the antero posterior limits of motion revealed that only 57% had less than 3-mm side-to-side difference; 30% had 3- to 5-mm; and 13% had 6- to 9-mm. Mean hamstring muscle strength measured with the Cybex II dynamom eter was 94% at 60 and 96% at 100 deg/sec. When evaluated with the Zarins scale, 90% were rated good or excellent, 6% fair, and 4% poor. This reconstructive procedure restores functional, but not necessarily nor mal, stability in most anterior cruciate ligament-deficient knees. It allows patients to increase activity levels with out significant risk of additional injuries.
Fate of the ACL-injured Patient
Authors: Daniel Dale M. , Stone Mary Lou , Dobson Barbara E. , Fithian Donald C. , Rossman David J. , Kaufman Kenton R.
Published: June 2007

We followed 292 patients who had sustained an acute traumatic hemarthrosis for a mean of 64 months. The KT-1000 arthrometer measurements within 90 days of injury revealed the injured knee was stable in 56 pa tients and unstable in 236. Forty-five unstable patients had an ACL reconstruction within 90 days of injury. Sur gical procedures performed >90 days after injury in cluded ligament reconstruction in 46 patients. Factors that correlated with patients who had late surgery for a meniscal tear or an ACL reconstruction ( P < 0.05) were preinjury hours of sports participation, arthrometer mea surements, and patient age.

Follow-up data are presented for the patients divided into four groups: I, early stable, no reconstruction; II, early unstable, no reconstruction; III, early recon struction; and IV, late reconstruction. No patient changed occupation because of the knee injury. Hours per year of sports participation and levels of sports par ticipation decreased in all groups. Joint arthrosis was documented by radiograph and bone scan. Joint sur face injury abnormalities observed at surgery and me niscal surgery showed greater abnormalities by radio graph and bone scan scores ( P< 0.05). Reconstructed patients had a higher level of arthrosis by radiograph and bone scan.
An Electromyographic Analysis of the Knee During Functional Activities
Authors: Ciccotti Michael G. , Kerlan Robert K. , Perry Jacquelin , Pink Marilyn
Published: June 2007

This study compared the electromyographic activity of normal (N = 22), rehabilitated anterior cruciate ligament-deficient ( N = 8), and -reconstructed knees (N = 10) while subjects performed activities. Each sub ject had evaluation of 8 muscles during 7 functional ac tivities. Sixty-seven percent of the differences in the quadriceps muscle reflected increased activity in the vastus lateralis muscle of the rehabilitated group; 75% of the differences in the hamstrings muscles noted in creased biceps femoris muscle activity in the rehabili tated group; 56% of the differences in the lower leg mus culature showed increased tibialis anterior muscle activity in the rehabilitated group. Eighty-six percent of the statistically different intervals involved rehabilitated subjects demonstrating increased activity over recon structed or normal subjects or both. The presence of a quadriceps-hamstrings muscles coordinated response was identified consistently in all 3 groups in each ac tivity. This study supports surgical reconstruction for the anterior cruciate ligament-deficient knee. It also dem onstrates the importance of the vastus lateralis, biceps femoris, and tibialis anterior musculature in the reha bilitation of the anterior cruciate ligament-deficient patient. The presence of a quadriceps-hamstrings muscles coordinated response indicates that mechano receptors mediating this reflex arc exist in structures other than the cruciate ligament.
Medial Epicondylitis
Authors: Glazebrook Mark A. , Curwin Sandra , Islam Mohammad N. , Kozey John , Stanish William D.
Published: June 2007

Flexor and extensor muscle-tendon unit activity at the elbow during the golf swing was recorded from subjects with and without medial epicondylitis. There was no sig nificant difference in total swing time between symp tomatic (1.23 ± 0.15 sec) and asymptomatic (1.15 ± 0.13 sec) subjects nor between golfers with low (1 to 6 handicap, N = 8) and high (11 to 19 handicap, N = 8) scoring abilities. Symptomatic and asymptomatic sub jects displayed similar electromyographic profiles for flexor and extensor muscles of the forearm. Electro myographic activity of the common extensor muscles was persistent throughout the four swing phases, rang ing from 33.59% of maximum voluntary contraction at address to 58.77% at contact. Common flexor muscles produced a consistent burst of electromyographic ac tivity during contact phase (flexor burst, 90.77% of maxi mum voluntary contraction). Symptomatic subjects' mean flexor muscle electromyographic activity was sig nificantly greater than that of asymptomatic subjects in both address and swing phases. When forearm brace and oversized grips were imposed on symptomatic sub jects, there was no significant difference in mean elec tromyographic magnitude or muscle activation pattern during the golf swing. Thus, the method of sympto matic relief of the intervention strategies tested is still in question.
The Diagnosis and Treatment of Medial Subluxation of the Patella After Lateral Retinacular Release
Authors: Nonweiler David E. , DeLee Jesse C.
Published: June 2007

Five patients with medial subluxation of the patella oc curring after isolated lateral retinacular release were treated between July 1985 and July 1989. The diag nosis was made by clinical examination. The patients complained of pain, swelling, and giving way after the lateral release. All five patients had increased medial passive patellar mobility, a positive gravity subluxation test, and a positive medial apprehension test. All pa tients failed conservative treatment. The patients were treated by reconstruction of the lateral retinaculum using sensory epidural anesthesia. At an average fol lowup of 3.3 years, four of the five patients had no symp toms of instability and the medial patellar mobility and gravity subluxation tests were negative. There were three excellent and two good results using the grading system of Merchant and Mercer.
Arthroscopic Evaluation of Meniscal Repairs
Authors: Tenuta Joachim J. , Arciero Robert A.
Published: June 2007

Fifty-one patients with 54 meniscal repairs were evalu ated with second-look arthroscopy and physical exami nation at an average of 11 months (range, 4 to 30) after repair. Thirty-five of 54 repairs (65%) were completely healed and 9 repairs were incompletely healed, for an overall satisfactory healing rate of 81% (44 of 54 re pairs). Ten repairs did not heal (19%). An anterior cru ciate ligament reconstruction combined with meniscal repair increased meniscal healing—36 of 40 (90%) healed versus 8 of 14 (57%) in cruciate stable knees. Rim width was a significant factor; no meniscal repair with a rim width greater than 4 mm healed. Meniscal repair with anterior cruciate ligament reconstruction in patients less than 30 years old and performed within 19 weeks of injury resulted in improved healing rates. In patients with simultaneous meniscal repair and anterior cruciate ligament reconstruction, a higher rate of com plete healing (16 of 19 repairs, 84%) was observed after the conservative rehabilitation program. Those who fol lowed the aggressive program had a complete healing rate of 63% (12 of 19 repairs). Satisfactory healing (complete plus incomplete arthroscopic healing) was similar for both groups, 89% and 90%, respectively.
An In Vitro Investigation Into the Effects of Repetitive Motion and Nonsteroidal Antiinflammatory Medication on Human Tendon Fibroblasts
Authors: Almekinders Louis C. , Baynes Albert J. , Bracey Lynette W.
Published: June 2007

Soft tissue injuries due to repetitive motion are common sports injuries and are often treated with antiinflamma tory therapies. We investigated the in vitro effects of repetitive motion and nonsteroidal antiinflammatory medication on human tendon fibroblasts. In addition, we studied the effects related to the presence of inflam matory cells. Repetitive motion was associated with an increased release of prostaglandin E2 and increased deoxyribonucleic acid (DNA) and protein synthesis. The presence of nonsteroidal antiinflammatory medication decreased prostaglandin E2 release and DNA synthe sis but increased protein synthesis. Contact with mac rophages caused a marked additional increase in pros taglandin E2 and a concomitant increase in DNA synthesis. Release of interleukin-6 by the macrophages also suggested that this cytokine plays a role in the re sponse to repetitive motion. Our results can aid in the search for a more scientific approach to the treatment of soft tissue injuries associated with repetitive motion. They suggest that nonsteroidal antiinflammatory medi cation may have potentially negative effects during the proliferative phase of a healing since it was associated with decreased DNA synthesis. However, it may be beneficial in the maturation and remodeling phase since it stimulated protein synthesis.
Articular Hypermobility and Chondral Injury in Patients With Acute Patellar Dislocation
Authors: Stanitski Carl L.
Published: June 2007

Thirty adolescents with acute, primary patellar disloca tion were assessed for a relationship between articular hypermobility and chondral injury. The 15 patients with out articular hypermobility had a 2.5 times increased frequency of articular lesions when compared with 15 patients with hypermobility. Assessment of articular hy permobility should be part of the examination in patients with patellar dislocation.
"Aggressive" Nontreatment of Lateral Meniscal Tears Seen During Anterior Cruciate Ligament Reconstruction
Authors: Fitzgibbons Robert E. , Shelbourne K. Donald
Published: June 2007

Based on our experience, we hypothesized that certain lateral meniscal tears identified at the time of anterior cruciate ligament reconstruction can be left without re moval or repair and that they will remain asymptomatic. We looked at 189 lateral meniscal tears that were left in situ at the time of anterior cruciate ligament reconstruc tion. At an average clinical followup of 2.6 years (range, 1 to 9 years) we found that 1) posterior horn avulsion tears, if left alone, do not cause clinical symptoms after anterior cruciate ligament reconstruction; 2) vertical tears totally posterior to the popliteus tendon are asymptomatic before and after reconstruction; and 3) other complete and incomplete lateral meniscal tears (vertical longitudinal, radial, or anterior vertical), if stable at the time of anterior cruciate ligament reconstruction, can be left in situ without becoming clinically symptom atic. All patients in the study population returned to their desired level of sporting activities by the time of follow-up evaluation. Our high clinical success rate in leaving selected lateral meniscal tears in situ is an "ag gressive" attempt at meniscal salvage without in creased morbidity from repair or resection. During the time we observed the patients (1 to 9 years), the lateral menisci remained asymptomatic.
Collagen Fibril Organization in the Patellar Tendon Autograft After Posterior Cruciate Ligament Reconstruction
Authors: Bosch Ulrich , Decker Brigitte , Möller Hans D. , Kasperczyk Werner J. , Oestern Hans J.
Published: June 2007

We replaced the posterior cruciate ligament in 30 skel etally mature sheep with a patellar tendon autograft using the central third of the ipsilateral patellar tendon. The healing autograft was compared with the contralat eral posterior cruciate ligament and the patellar tendons and posterior cruciate ligaments of nonoperated ani mals. The collagen fibril diameters were analyzed using transmission electron photomicrographs of fibril cross sections taken at six periods during the 2 years after surgery. The patellar tendon and posterior cruciate liga ment were characterized by a broad, nongaussian dis tribution of collagen fibril diameters. The autografts shifted to a unimodal distribution by an increase of small-diameter collagen fibrils. The frequency of small- diameter fibrils measuring up to 100 nm was 99% after 2 years. At that time, these small-diameter fibrils rep resented 91.6% of the area covered by collagen fibrils. The mean diameter of the collagen fibrils in the au tografts significantly decreased to 45% of the controls at Week 26 and remained at this level until the end of this study. The percentage of area covered by collagen fibrils per 1 μm2 was 78% of the controls 2 years post operatively. This study suggests that the patellar tendon autograft could not reproduce the collagen fibril orga nization of the posterior cruciate ligament. This may be a biologic factor responsible for inconsistent results in posterior cruciate ligament replacement.
Collagen Fibril Populations in Human Anterior Cruciate Ligament Allografts
Authors: Shino Konsei , Oakes Barry W. , Horibe Shuji , Nakata Ken , Nakamura Norimasa
Published: June 2007

We studied human anterior cruciate ligament allograft specimens by quantitative electron microscopy to ana lyze their collagen fibril populations. The specimens were procured at the time of second-look arthroscopy from the superficial region of the midzone of the anterior cruciate ligament grafts after synovial clearage. The grafts used for the anterior cruciate ligament recon structions were from fresh-frozen allogenic Achilles, tibialis anterior or posterior, or peroneus longus or bre vis tendons and had been implanted 3 to 96 months previously. By 12 months after surgery, the anterior cru ciate ligament allografts consisted predominantly of small-diameter collagen fibrils (30 to 80 nm), which re sulted in a unimodal pattern in the collagen fibril profile. The number of large-diameter fibrils (90 to 140 nm) within the allogenic tendon grafts had decreased. This predominance of small-diameter collagen fibrils per sisted in almost all specimens older than 12 months. The anterior cruciate ligament allografts had collagen fibril profiles that did not resemble normal tendon grafts or normal anterior cruciate ligaments, even several years after surgery.
Anatomic Reconstruction of the Lateral Ankle Ligaments Using a Split Peroneus Brevis Tendon Graft
Authors: Colville Mark R. , Grondel R. Jeffrey
Published: June 2007

Fifteen patients with recurrent inversion ankle sprains and documented lateral ankle instability were treated with an anatomically oriented ligament reconstruction using a split peroneus brevis tendon graft. This recon struction is designed to augment repair of the anterior talofibular and calcaneofibular ligaments without re stricting subtalar motion. Of the 12 patients available for long-term followup, all were functionally improved, with no recurrences of instability. Stress radiographic exami nation at followup confirmed that mechanical stability had been restored in all ankles. Eversion strength and subtalar joint motion were maintained after surgery. We recommend this procedure in patients who require aug mented reconstruction of the lateral ankle ligaments.