bluuebunny/crossref_metadata_2025 huggingface dataset:
Arthroscopic Surgery for Isolated Capitellar Osteochondritis Dissecans in Adolescent Baseball Players: Minimum Three-Year Follow-Up
Authors: Byrd J. W. Thomas , Jones Kay S.
Published: July 2017

Background

Osteochondritis dissecans of the capitellum of the humerus usually occurs in adolescence and is caused by the valgus forces associated with excessive throwing.

Hypothesis

Arthroscopic surgery is an appropriate procedure for this condition.

Study Design

Retrospective cohort study.

Methods

Arthroscopic surgery was performed on 10 baseball players (average age, 13.8 years) with osteochondritis dissecans whose symptoms had been apparent for an average of 9 months before the operation. Follow-up at an average of 3.9 years included use of a standard rating scale, radiographs, and a questionnaire regarding return to sport.

Results

There were two grade I, one grade II, two grade IV, and five grade V lesions. Symptoms and objective findings correlated poorly with the grade of the lesion. The postoperative score averaged 195, reflecting excellent results. Radiographically, the primary lesion was still apparent in one patient, secondary degenerative changes were evident in one patient, and, in one patient, the lesion was still evident and degenerative changes had occurred. Only four athletes returned to organized baseball.

Conclusions

Arthroscopic surgery for symptomatic osteochondritis dissecans of the capitellum in adolescent baseball players can provide excellent rating scores with intermediate follow-up but does not assure return to baseball.
How Four Weeks of Implantation Affect the Strength and Stiffness of a Tendon Graft in a Bone Tunnel
Authors: Singhatat Wamis , Lawhorn Keith W. , Howell Stephen M. , Hull Maury L.
Published: July 2017

Background

For a tendon graft to function as an anterior cruciate ligament, the tendon must heal to the bone tunnel. We studied the effect of 4 weeks of implantation on the strength and stiffness of a tendon in a bone tunnel using two different fixation devices in an ovine model.

Hypothesis

The type of fixation device in anterior cruciate ligament reconstruction may affect early healing, which can be measured as the strength and stiffness of a tendon in a bone tunnel.

Study Design

Controlled laboratory study.

Methods

An extraarticular tendon graft reconstruction was performed in ovine tibias. The graft was fixed with either a bioresorbable interference screw or a WasherLoc. After 4 weeks of implantation the strength and stiffness of the complex and the tendon graft-bone tunnel interface were determined by incrementally loading specimens to failure.

Results

For the interference screw, the strength deteriorated 63% and the stiffness deteriorated 40%. For the WasherLoc, the strength was similar and the stiffness improved 136%.

Conclusions

The type of fixation device determines whether the strength and stiffness of a tendon in a bone tunnel increases or decreases after implantation.

Clinical Relevance

The pace of rehabilitation may need to be adjusted based on the type of fixation device used to secure a soft tissue graft.
Relevance of Arm Position and Muscle Activity on Three-Dimensional Glenohumeral Translation in Patients with Traumatic and Atraumatic Shoulder Instability
Authors: von Eisenhart-Rothe Ruediger M. O. , Jäger Alwin , Englmeier Karl-Hans , Vogl Thomas J. , Graichen Heiko
Published: July 2017

Background

No quantitative data on glenohumeral translation exist allowing one to distinguish insufficiency of the active or passive stabilizers in different forms of shoulder instability.

Hypothesis

To determine whether 1) in traumatic or atraumatic shoulder instability an increase of glenohumeral translation can be observed in specific relevant arm positions, 2) muscle activity leads to recentering of the humeral head, and 3) there exist differences between traumatic and atraumatic instability.

Study Design

Prospective clinical trial.

Methods

In 12 patients with traumatic and 10 patients with atraumatic instability, both shoulders were examined in different arm positions—with and without muscle activity—by using open magnetic resonance imaging and a three-dimensional postprocessing technique.

Results

At 90° of abduction and external rotation, translation (anterior-inferior) was significantly higher in patients with traumatic unstable shoulders compared with their contralateral side (3.6 ± 1.5 versus 0.7 ± 1.6 mm). In patients with atraumatic instability, significantly increased translation (4.7 ± 2.0 mm) was observed, with the direction being nonuniform. Muscle activity led to significant recentering in traumatic but not in atraumatic instability.

Conclusions

In traumatic instability, increased translation was observed only in functionally important arm positions, whereas intact active stabilizers demonstrate sufficient recentering. In atraumatic instability, a decentralized head position was recorded also during muscle activity, suggesting alterations of the active stabilizers.

Clinical Relevance

Clinical Relevance: These data are relevant for optimizing diagnostics and therapeutic strategies.
Injury to the Anterior Cruciate Ligament during Alpine Skiing
Authors: Hame Sharon L. , Oakes Daniel A. , Markolf Keith L.
Published: July 2017

Background

The anterior cruciate ligament has been shown to be particularly susceptible to injury during alpine skiing. Tibial torque is an important injury mechanism, especially when applied to a fully extended or fully flexed knee.

Purpose

We wanted to record the forces generated in the anterior cruciate ligament with application of tibial torque to cadaveric knees in different positions.

Study Design

Controlled laboratory study.

Methods

Thirty-seven fresh-frozen cadaveric knees were instrumented with a tibial load cell that measured resultant force in the anterior cruciate ligament while internal and external tibial torques were applied to the tibia at full extension, 90° of flexion, full flexion, and forced hyperflexion.

Results

At each knee flexion position, mean force generated by 10 N·m of internal tibial torque was significantly higher than the mean generated by 10 N·m of external tibial torque. Mean forces generated by tibial torque at 90° of flexion were relatively low. During flexion-extension without tibial torque applied mean forces were highest (193 N) when the knee was hyperflexed.

Conclusions

Application of internal tibial torque to a fully extended or fully flexed knee represents the most dangerous loading condition for injury from twisting falls during skiing.

Clinical Relevance

Understanding of the mechanisms of falls can be used to design better equipment and to better prevent or treat injury.
Quantitative Assessment of Classic Anteroinferior Bony Bankart Lesions by Radiography and Computed Tomography
Authors: Itoi Eiji , Lee Seok-Beom , Amrami Kimberly K. , Wenger Doris E. , An Kai-Nan
Published: July 2017

Background

An anteroinferior osseous defect of the glenoid rim is sometimes encountered in patients with recurrent anterior dislocations of the shoulder. A defect of more than 21% of the glenoid length is reported to cause instability after Bankart repair.

Hypothesis

We can estimate the critical size of glenoid defects by using radiography or computed tomography.

Study Design

A controlled laboratory study.

Methods

Osseous defects of 0%, 9%, 21%, 34%, and 46% of the glenoid length were created stepwise in 12 cadaveric scapulae, and plain radiographs simulating the axillary and West Point views and computed tomographic images were obtained. The maximum width of the remnant glenoid was measured under each condition and expressed as a percentage of the width of the intact glenoid.

Results

A 21% defect appeared to be 18.6% of the intact glenoid on the West Point view. With computed tomography, a 21% defect resulted in loss of 50% of the width on a single slice across the lower one-fourth of the glenoid.

Conclusions

We can estimate the size of a glenoid defect by using the West Point radiographic view or computed tomogram.

Clinical Relevance

These images gave decisive information as to whether an osseous glenoid defect required bone grafting to achieve stability after Bankart repair.
Injuries among World-Class Professional Beach Volleyball Players
Authors: Bahr Roald , Reeser Jonathan C.
Published: July 2017

Background

Very little is known about the injury characteristics of beach volleyball.

Purpose

To describe the incidence and pattern of injuries among professional male and female beach volleyball players.

Study Design

Cohort study–retrospective injury recall and prospective registration.

Methods

Injuries occurring over a 7.5-week interval of the summer season were retrospectively registered by interviewing 178 of the 188 participating players (95%) in the 2001 Beach Volleyball World Championships. Injuries were also cataloged prospectively during five of the tournaments held during this interval.

Results

Fifty-four acute injuries was recorded, of which 23 (43%) resulted in 1 or more days of missed practice or competition. The incidence of acute time-loss injuries was estimated to be 3.1 per 1000 competition hours and 0.8 per 1000 training hours. Knee (30%), ankle (17%), and finger injuries (17%) accounted for more than half of all acute time-loss injuries. In addition, 67 players reported 79 overuse injuries for which they received medical attention during the study period. The three most common overuse conditions were low back pain (19%), knee pain (12%), and shoulder problems (10%). Similar results were observed in the prospective portion of the study.

Conclusions

The rate of acute time-loss injuries in beach volleyball is considerably lower than that in most other team sports, but overuse injuries affecting the low back, knees, and shoulder represent a significant source of disability and impaired performance for professional beach volleyball players.
A Prospective Randomized Study of Patellar versus Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction
Authors: Jansson Kim A. , Linko Eric , Sandelin Jerker , Harilainen Arsi
Published: July 2017

Background

Bone-patellar tendon-bone graft has been the most commonly used graft material in anterior cruciate reconstructions, but there has been increasing use of hamstring tendon grafts. However, no existing clinical studies show adequate support for the choice of one graft over the other.

Hypothesis

Hamstring tendons are equally as good as patellar tendon in anterior cruciate ligament reconstructions.

Study Design

Prospective randomized clinical trial.

Methods

Ninety-nine patients with laxity caused by a torn anterior cruciate ligament underwent arthroscopically assisted reconstruction with graft randomization according to their birth year. Grafts were either bone-patellar tendon-bone with metal interference screw fixation or double-looped hamstring tendons with metal plate fixation. There were no significant differences between the two groups preoperatively or at operation. Standard rehabilitation included immediate postoperative mobilization without a knee brace, protected weightbearing for 2 weeks, and return to full activity at 6 to 12 months.

Results

Forty-three patients in the patellar tendon group and 46 patients in the hamstring tendon group were available for clinical evaluation at a minimum of 21 months after surgery. No statistically significant differences were seen with respect to clinical and instrumented laxity testing, International Knee Documentation Committee Score ratings, isokinetic muscle torque measurements, and Kujala patellofemoral, Lysholm, and Tegner scores.

Conclusion

Equal results were seen for patellar and hamstring tendon autograft anterior cruciate ligament reconstructions at 2 years after surgery. Both techniques seem to improve patients' performance.
Subscapularis Muscle Activity during Selected Rehabilitation Exercises
Authors: Decker Michael J. , Tokish John M. , Ellis Henry B. , Torry Michael R. , Hawkins Richard J.
Published: July 2017

Background

The upper and lower portions of the subscapularis muscle are independently innervated and activated.

Hypothesis

Upper and lower portions of the subscapularis muscle demonstrate different activation levels and require different exercises for rehabilitation.

Study Design

Controlled laboratory study.

Methods

Fifteen healthy subjects performed seven shoulder-strengthening exercises. Electromyographic data were collected from the latissimus dorsi, teres major, pectoralis major, infraspinatus, supraspinatus, and upper and lower subscapularis muscles.

Results

Upper subscapularis muscle activity was greater than lower subscapularis muscle activity for all exercises except for internal rotation with 0° of humeral abduction. The push-up plus and diagonal exercises consistently stressed the upper and lower subscapularis muscles to the greatest extent.

Conclusions

Humeral abduction was found to have a strong influence on the selective activation of the upper versus the lower subscapularis muscle and thus supported the design of different exercise continuums. In addition, the push-up plus and diagonal exercises were found to be superior to traditional internal rotation exercises for activating both functional portions of the subscapularis muscle.

Clinical Relevance

Our results showing that the upper and lower portions of the subscapularis muscle are functionally independent may affect training or rehabilitation protocols for the rotator cuff muscles.
Capsular Elongation in Shoulders with Recurrent Anterior Dislocation
Authors: Urayama Masakazu , Itoi Eiji , Sashi Ryuji , Minagawa Hiroshi , Sato Kozo
Published: July 2017

Background

Elongation of the shoulder capsule is often noticed on arthrograms or during surgery in shoulders of patients who have experienced recurrent anterior dislocations.

Hypothesis

We can quantify the elongation of the capsule in shoulders with recurrent anterior dislocations by using magnetic resonance arthrography.

Study Design

Retrospective review of prospectively collected data.

Methods

Twelve patients with unilateral recurrent anterior shoulder dislocations were enrolled in this study. Magnetic resonance images in the axial and coronal oblique planes were obtained from both shoulders (involved and uninvolved sides) after 10 ml of gadolinium/saline solution was injected into the glenohumeral joint. The length of the anteroinferior, inferior, and posteroinferior portions of the capsule was measured by using image analyzing software and normalized to the humeral head diameter.

Results

The anteroinferior capsule was significantly elongated in the involved shoulder at 4 mm (16% elongation) and 10 mm (19% elongation) superior to the inferior margin of the glenoid. The inferior capsule was also significantly elongated in the involved side both at the center (12% elongation) and at 4 mm anterior to the center of the glenoid (29% elongation). The posteroinferior capsule did not show any significant elongation.

Conclusions

The anteroinferior and inferior portions of the shoulder capsule are elongated an average of 19% in shoulders with recurrent anterior dislocation.
Effect of Preexisting Back Pain on the Incidence and Severity of Back Pain in Intercollegiate Rowers
Authors: O'Kane John W. , Teitz Carol C. , Lind Bonnie K.
Published: July 2017

Background

Back pain is a common problem among rowers.

Purpose

To determine whether preexisting back pain is a significant risk factor for back pain in intercollegiate rowers and how it relates to the ability of athletes to participate in college rowing.

Study Design

Survey.

Methods

Surveys from 1829 former intercollegiate rowing athletes were analyzed. The surveys included questions concerning back pain before the subjects' college career, back pain during intercollegiate rowing, missed practices, the duration of time lost from college rowing because of back pain, and career-ending back pain. Back pain was defined as pain lasting longer than 1 week.

Results

More subjects with preexisting back pain developed back pain during their college rowing career than subjects without preexisting back pain (57.1% versus 36.6%). Of those with preexisting pain, 55% missed practice because of back pain and 8% ended their college rowing careers; for those without preexisting pain, the percentages were 62% and 17%, respectively. For subjects with pain before their college rowing career, 78.8% missed less than 1 week and 5.9% missed more than 1 month. For subjects with no preexisting pain, 61.9% missed less than 1 week and 18.1% missed more than 1 month.

Conclusions

While rowers with preexisting back pain are more likely to have back pain in college, they are less likely to miss extended periods of practice time or end their college rowing careers because of back pain.
Reproducibility and Reliability of the Outerbridge Classification for Grading Chondral Lesions of the Knee Arthroscopically
Authors: Cameron Michelle L. , Briggs Karen K. , Steadman J. Richard
Published: July 2017

Background

Few studies have investigated the accuracy and reproducibility of the Outerbridge classification system for classification of chondral damage in the knee.

Hypothesis

Arthroscopically assigned Outerbridge grades are accurate, reliable, and reproducible.

Study Design

Cadaver study.

Methods

Six cadaveric knees underwent diagnostic arthroscopy, which was videotaped. An arthrotomy was then performed and the arthroscopically identified lesions were measured with calipers. Nine orthopaedic surgeons reviewed each video and graded each chondral lesion two separate times. Accuracy of observations was calculated based on the percentage of agreement between the grades determined during arthroscopy and arthrotomy.

Results

The overall accuracy was 68% but varied by location. The kappa coefficient between the two scores was 0.602; the arthroscopy grade was higher than the arthrotomy grade 63% of the time. The intraobserver and interobserver kappa coefficients were 0.80 and 0.52, respectively. The mean interobserver kappa between the two physicians in practice 5 years or more was 0.72, compared with 0.50 for physicians in practice less than 5 years.

Conclusions

The Outerbridge classification was moderately accurate when used to grade chondral lesions arthroscopically.

Clinical Relevance

Orthopaedic surgeons can accurately grade chondral lesions of the knee with the Outerbridge classification, regardless of their level of experience.
The Incidence of Injuries in Elite Junior Figure Skaters
Authors: Dubravcic-Simunjak Sanda , Pecina Marko , Kuipers Harm , Moran Jane , Haspl Miroslav
Published: July 2017

Background

There has been rapid growth in the technical and physiologic demands made on skaters who perform more and more difficult jumps, spins, lifts, throws, and free skating movements.

Purpose

To investigate the frequency of injuries and overuse syndromes in elite junior skaters.

Study Design

Questionnaire.

Methods

During four consecutive Junior World Figure Skating Championships and the Croatia Cup, we interviewed 236 female and 233 male skaters by questionnaire to determine the frequency of injuries and overuse syndromes.

Results

Fifty-nine of the female skaters (25%) and 65 of the male skaters (27.9%) reported sustaining acute injuries; 101 female (42.8%) and 106 male (45.5%) skaters reported overuse syndromes. Low back pain was reported by 19 female and 23 male skaters. The most frequent acute injury was ankle sprain. In singles female skaters, the most frequent overuse injury was stress fracture (19.8%), followed by jumper's knee (14.9%). In singles male skaters, jumper's knee (16.1%) was the most frequent injury, followed by Osgood-Schlatter disease (14.2%). More than 50% of injuries in young singles figure skaters involved overuse syndromes. Pairs skaters and ice dance skaters had a higher risk of acute injury than overuse syndrome because of falls from lifts and throw jumps.

Conclusions

Programs to improve postural alignment, flexibility, and strength, especially during the asynchronous period of bone and soft tissue development, should be instituted to prevent and reduce overuse syndromes.
Influence of Medial Hamstring Tendon Harvest on Knee Flexor Strength after Anterior Cruciate Ligament Reconstruction
Authors: Tashiro Toshiyuki , Kurosawa Hisashi , Kawakami Akira , Hikita Atsuhiko , Fukui Naoshi
Published: July 2017

Background

The advantages of hamstring tendon autografts for anterior cruciate ligament reconstruction are well known; however, concerns have arisen regarding the influence of hamstring tendon harvest on postoperative weakness in knee flexion.

Purpose

To evaluate the influence of hamstring tendon harvest on knee flexion strength in patients undergoing anterior cruciate ligament reconstruction.

Study Design

Prospective randomized study.

Methods

Ninety patients were randomly assigned at surgery to undergo anterior cruciate ligament reconstruction with either a semitendinosus tendon autograft or a semitendinosus and gracilis tendon autograft. Quadriceps and hamstring muscle strength was tested before surgery and at 6, 12, and 18 months after surgery.

Results

There was no significant difference in clinical results between the groups and neither group showed a significant decrease in isokinetic hamstring muscle strength. However, when the subjects’ knees were at positions of 70° or more of flexion, both isokinetic and isometric measurements revealed a significant decrease in hamstring muscle strength in both groups. The strength in the group with semitendinosus and gracilis tendons was considerably less than that in the group with semitendinosus tendon alone at 18 months.

Conclusions

Tendon harvest causes significant weakness of hamstring muscle strength at high knee flexion angles, but such weakness can be minimized if the gracilis tendon is preserved.
Elbow Injuries in Throwing Athletes: A Current Concepts Review
Authors: Cain E. Lyle , Dugas Jeffrey R. , Wolf Robert S. , Andrews James R.
Published: July 2017

Repetitive overhead throwing imparts high valgus and extension loads to the athlete's elbow, often leading to either acute or chronic injury or progressive structural change. Tensile force is applied to the medial stabilizing structures with compression on the lateral compartment and shear stress posteriorly. Common injuries encountered in the throwing elbow include ulnar collateral ligament tears, ulnar neuritis, flexor-pronator muscle strain or tendinitis, medial epicondyle apophysitis or avulsion, valgus extension overload syndrome with olecranon osteophytes, olecranon stress fractures, osteochondritis dissecans of the capitellum, and loose bodies. Knowledge of the anatomy and function of the elbow complex, along with an understanding of throwing biomechanics, is imperative to properly diagnose and treat the throwing athlete. Recent advantages in arthroscopic surgical techniques and ligament reconstruction in the elbow have improved the prognosis for return to competition for the highly motivated athlete. However, continued overhead throwing often results in subsequent injury and symptom recurrence in the competitive athlete.
Poly-L-lactic Acid Tack Synovitis after Arthroscopic Stabilization of the Shoulder
Authors: Freehill Michael Q. , Harms Dana J. , Huber Shane M. , Atlihan Dogan , Buss Daniel D.
Published: July 2017

Background

Progress has been made in the design of bioabsorbable implants, with reduced complication rates and slower degradation times.

Purpose

To report on complications related to use of poly-L-lactic acid implants after arthroscopic shoulder stabilization procedures.

Study Design

Retrospective cohort study.

Methods

Between 1997 and 1999, 52 patients underwent arthroscopic stabilization at one institution with an average of 2.2 poly-L-lactic acid tacks. Ten patients (19%), with an average age of 30 years, developed delayed onset of symptoms at an average of 8 months after surgery, including pain in all 10 and progressive stiffness in 6. The patients underwent magnetic resonance imaging and arthroscopic evaluation and debridement.

Results

Nine patients had gross implant debris. Evidence of glenohumeral synovitis was seen arthroscopically in all 10 patients. Three patients had significant full-thickness chondral damage on the humeral head. All preexisting labral lesions were healed. One year after arthroscopic debridement, loose body removal, and synovectomy, seven patients reported no or minimal pain and full return of motion. Two patients continued to have persistent pain and stiffness, and one patient reported discomfort with overhand throwing; all three had chondral lesions.

Conclusions

Patients with symptoms of delayed pain and progressive stiffness after arthroscopic stabilization with poly-L-lactic acid implants should be evaluated for synovitis and chondral injury. Arthroscopic treatment provides a significant decrease in symptoms and increased range of motion.
The Effects of Compressive Load and Knee Joint Torque on Peak Anterior Cruciate Ligament Strains
Authors: Fleming Braden C. , Ohlén Goran , Renström A. , Peura Glenn D. , Beynnon Bruce D. , Badger Gary J.
Published: July 2017

Background

High graft strains incurred during rehabilitation after anterior cruciate ligament reconstruction may be minimized if an external compressive load is simultaneously applied to the joint during closed kinetic chain exercises.

Hypotheses

Peak anterior cruciate ligament strains will 1) increase with an increase in resistance torque during an exercise that involves concentric contraction of the extensor mechanism, 2) decrease with an increase in resistance torque during an exercise that involves concentric contraction of the flexors, and 3) decrease when an external compressive load is applied to the knee during both exercises relative to the no external compressive load condition.

Study Design

Controlled laboratory study.

Methods

Strains in the anteromedial bundle were measured in 10 subjects with normal ligaments. Flexor and extensor exercises were performed against controlled resistance torques with and without a compressive load applied to the foot.

Results

An increase in resistance produced an increase in peak anterior cruciate ligament strain for the extensor exercise with no compressive load applied. During the flexor exercise without a compressive load, an increase in resistance produced a decrease in peak strains. During the extensor exercise, the peak anterior cruciate ligament strain was not reduced with the application of the external compressive force.

Conclusions

Extensor and flexor exercises that incorporate an external compressive load do not shield the anterior cruciate ligament from strain. However, no additional increase in strain occurs with an increase in resistance when the external compressive load is applied. Thus, it may be possible to increase the activity of the quadriceps muscles without increasing the strain by applying a compressive load (as with closed kinetic chain exercises).
Meniscal Repair Compared with Meniscectomy for Bucket-Handle Medial Meniscal Tears in Anterior Cruciate Ligament-Reconstructed Knees
Authors: Shelbourne K. Donald , Carr Donald R.
Published: July 2017

Background

Repair of meniscal tears is generally preferred over meniscectomy.

Hypothesis

Repair of unstable bucket-handle tears of the medial meniscus leads to better outcomes than partial meniscectomy.

Study Design

Retrospective review of prospectively collected data.

Methods

We reviewed the records of 155 patients who had isolated bucket-handle medial meniscal tears and anterior cruciate ligament tears. Fifty-six menisci were repaired; 99 that were degenerative and crushed beyond repair were removed. Patients were evaluated at a mean follow-up of 6 to 8 years after surgery with the International Knee Documentation Committee examination and a modified Noyes questionnaire.

Results

The mean subjective scores were similar for patients in both the repair (N = 51) and meniscectomy (N = 87) groups. However, in the repair group, the mean subjective score of 93.9 for nondegenerative menisci was significantly better than the 87.1 for degenerative menisci. Objective grades for 25 patients in the repair group were normal or nearly normal in 22 patients (88%) and for 51 of 56 patients (91%) in the removal group. Radiographic subscores for the repair group were normal or nearly normal in 23 patients in the repair group and 49 in the removal group.

Conclusion

Outcomes from meniscal repair were not superior to those from partial removal. Patients with repaired degenerative tears had significantly lower subjective scores than those with nondegenerative tears.
Thumb Amputations from Team Roping
Authors: Moneim Moheb S. , Firoozbakhsh Keikhosrow , Gross Dominic , Young Steven D. , Omer George
Published: July 2017

Background

Thumb injuries during team roping have elements of both avulsion and crush, resulting in a poor prognosis for replantation success.

Purpose

To review 19 cases of thumb amputation from team roping at our institution since 1983.

Study Design

Retrospective cohort study.

Methods

Cases were included in the study only if a microvascular repair of artery and vein was needed for the thumb to survive. Vein grafts were used to span the damaged vessel segment. Of the 19 thumb amputation cases, 15 attempts were made to replant the thumb. In the remaining four cases, patients had bone shortening and primary closure. The force of injury was calculated based on mechanism.

Results

Of the 15 attempts at replantation, only 5 (33%) were successful, despite meticulous technique. One patient subsequently had an emergency toe-to-thumb transfer after an unsuccessful replant, and the remaining nine underwent amputation. Nine of the 10 patients with failed replants had poor flow intraoperatively. In the group of patients younger than 15, the success was 3 of 5 (60%) and in the group 15 years or older the success was 2 of 10 attempts (20%.) Follow-up was available in 13 of the 15 cases of replanted thumbs.

Conclusions

All patients were subjectively satisfied with their results, and all patients with successful replants and seven patients with no thumb returned to rodeo. Biomechanical analysis showed a huge amount of force and pressure, several times larger than that of ring avulsion injury, results when a steer pulls on the thumb.
Partial Tears of the Subscapularis Tendon Found during Arthroscopic Procedures on the Shoulder
Authors: Kim Tae Kyun , Rauh Peter B. , McFarland Edward G.
Published: July 2017

Background

Prevalence and clinical significance of partial tears of the subscapularis tendon have not been widely studied.

Purpose

To determine prevalence of and clinical factors associated with partial tears of the subscapularis tendon at arthroscopy.

Study Design

Case control study.

Methods

During arthroscopic procedures on 314 consecutive shoulders, the arthroscopically visible portion of the subscapularis tendon was probed. Patients with and without partial tears were compared for prospectively identified variables.

Results

Partial tears were found in 60 of the 314 patients (19%). Increasing age and dominant arm involvement were significant variables for partial tears. Significantly associated factors included supraspinatus tendon tears (54 of 60; 90%), rotator cuff disease (44 of 60, 73%), and posterosuperior labral fraying (34 of 47, 72%). Increasing age, dominant arm involvement, and coexisting infraspinatus tendon tears were strong independent risk factors for partial tears.

Conclusion

Partial tears of the subscapularis tendon are not uncommon findings during shoulder arthroscopic procedures and are associated with extensive rotator cuff disease. They do not appear to be associated with glenohumeral instability, but a possible association with atypical forms of instability (subclinical or superior instability) cannot be excluded by this study. The absence of a significant association between the lesion and specific subjective symptoms or physical findings suggests that caution should be taken when attributing a specific symptom to this condition.
The Safe and Effective Use of Allograft Tissue—An Update
Authors: Barbour Scott A. , King Warren
Published: July 2017

The use of allograft tissue in orthopaedic surgery has increased tremendously over the last several years. Tissue availability, reduced surgical times, and lack of donor site morbidity are attractive characteristics to surgeons and patients alike. Although complications, such as disease transmission, are relatively uncommon when using allograft tissue, they do occur. This article will review the literature concerning the safe and effective use of allograft tissue, as well as present four case reports of Clostridium septicum infection caused by implantation of contaminated allograft tissue.
Alterations of Glycosaminoglycans During Patellar Tendon Autograft Healing After Posterior Cruciate Ligament Replacement
Authors: Bosch Ulrich , Gässler Norbert , Decker Brigitte
Published: July 2017

In each of 30 skeletally mature sheep, the posterior cruciate ligament was replaced in one knee by a free patellar tendon autograft using the central third of the ipsilateral patellar tendon. The healing autograft was compared with the contralateral posterior cruciate ligament and the patellar tendons and posterior cruciate ligaments of nonoperated animals. The content of glycosaminoglycans, chondroitin sulfate disaccharides, and dermatan sulfate disaccharides was assessed bio-chemically at six periods during the 2 years after surgery. The total glycosaminoglycans and chondroitin sulfate disaccharides in the native posterior cruciate ligament was threefold that in the native patellar tendon. In contrast, the amount of dermatan sulfate disaccharides was similar in both the native tendon and native ligament. In the autograft, glycosaminoglycans and chondroitin sulfate disaccharides increased significantly to about 144% and 172%, respectively, of the contralateral posterior cruciate ligament at Week 104. The dermatan sulfate disaccharides in the autograft also showed a significant increase up to Week 26, followed by a remarkable but not significant decrease until the end of the study. In the contralateral posterior cruciate ligament, the dermatan sulfate disaccharides increased significantly between Weeks 52 and 104. Thus, the amount of dermatan sulfate disaccharides was similar in both the autograft and the contralateral posterior cruciate ligament after 2 years. This study suggests that the patellar tendon autograft did not completely assume the biochemical properties of the posterior cruciate ligament.
Single-Incision Endoscopic Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Autograft
Authors: Bach Bernard R. , Levy Matthew E. , Bojchuk John , Tradonsky Steven , Bush-Joseph Charles A. , Khan Nazeer H.
Published: July 2017

We conducted a retrospective, minimum 2-year follow-up study to evaluate the effectiveness of a single-incision endoscopic anterior cruciate ligament reconstruction technique using patellar tendon autograft without extraarticular augmentation and followed by accelerated rehabilitation. One hundred three patients were evaluated (mean followup, 36 months; range, 24 to 55). There were significant improvements in physical examination test results (Lachman, anterior drawer, and pivot shift) postoperatively, and 94 patients (91%) had negative pivot shift results. KT-1000 arthrometric testing showed a significant reduction in manual maximum anterior translation and side-to-side differences at followup. Good range of motion was achieved. Patients with asymmetric prone heel heights usually had hyperextension in the contralateral knee. Functional tests showed 4% to 6% differences in side-to-side comparisons for a timed single-legged hop, single-legged hop for distance, and vertical jump. Postoperatively, the results of the Tegner scale were similar to preinjury scores. The mean results of the Hospital for Special Surgery scale (90), Lysholm score (89), and Noyes sport function score (90) were all excellent or good. Only 5 patients (5%) required reoperations for flexion contractures. Ninety-six patients (93%) reported they were “mostly” or “completely” satisfied, and 98 (95%) would recommend the procedure to others. These results demonstrated encouraging outcome using this single-incision technique.
Characteristic Ground-Reaction Forces in Baseball Pitching
Authors: MacWilliams Bruce A. , Choi Tony , Perezous Mark K. , Chao Edmund Y. S. , McFarland Edward G.
Published: July 2017

Overhand throwing requires contributions from and interaction between all limb segments. Most previous investigations have concentrated on the throwing arm itself, yet poor mechanics at the arm may originate in the lower extremities. Multicomponent ground-reaction forces of both the push-off and landing limbs were measured in six collegiate and one high school level baseball pitchers. Full body kinematics were simultaneously recorded to correlate phases in the pitching cycle with the force data. Pitchers were found to generate shear forces of 0.35 body weight in the direction of the pitch with the push-off leg and to resist forces of 0.72 body weight with the landing leg. Wrist velocity was found to correlate highly with increased leg drive. This study validates the clinical impression that the lower extremity is an important contributor to the throwing motion. Based on this study, strengthening of the lower extremities could be inferred to be important both to enhance performance and to avoid injury.
Arthrometric Evaluation of Posterior Cruciate Ligament Injuries
Authors: Eakin Colin L. , Cannon W. Dilworth
Published: July 2017

We reviewed the clinical examinations and knee arthrometry evaluations of 40 patients: 10 with posterior cruciate ligament injuries, 10 with combination anterior and posterior cruciate ligament injuries, 10 with anterior cruciate ligament injuries alone, and 10 with no history of knee injury. Using a 3-mm side-to-side difference as the minimal limit for detection of posterior cruciate ligament injury, the sensitivity of the arthrometer at 40 pounds of posterior force was 90%, the specificity was 100%, the predictive value of a positive test was 100%, and the predictive value of a negative test was 91%. When total anterior-posterior translation was assessed, the sensitivity was 100%, the specificity was 85%, the predictive value of a positive test was 87%, and the predictive value of a negative test was 100%. The overall accuracy of arthrometry for detection of posterior cruciate ligament injury was 96% for 40 pounds of posterior force and 94% for total anterior-posterior translation at 40 pounds. Grade 1 posterior cruciate ligament injuries had significantly greater arthrometric posterior translation compared with grade 0 (normal) knees. Regression analysis showed arthrometric laxity measurements correlated well with the clinical grade of the posterior drawer test. Finally, the accuracy of the arthrometer was not affected by concomitant anterior cruciate ligament injury.
Preemptive Analgesia: Its Role and Efficacy in Anterior Cruciate Ligament Reconstruction
Authors: Gatt Charles J. , Parker Richard D. , Tetzlaff John E. , Szabo Martha Zorko , Dickerson Audrey B.
Published: July 2017

As more outpatient orthopaedic surgical procedures are performed, postoperative pain control has gained importance. The benefits of preemptive analgesia, the use of analgesics or anesthetics or both before painful stimuli to prevent or reduce pain, have been widely published in the anesthesia and general surgery literature, but not in the orthopaedic literature. We prospectively compared the effects, on postoperative pain and narcotic use, of intraarticlar preoperative injections of 1) placebo with epinephrine, 2) bupivacaine with epinephrine, and 3) bupivacaine and morphine with epinephrine. Thirty patients (10 in each group) underwent arthroscopic anterior crucate ligament reconstruction using patellar tendon autograft under general anesthesia. Pain was assessed with a 10-point visual analog scale pre- and postoperatively, and postoperative narcotic pain medication use was recorded. Postoperative pain was significantly greater in group 1 (placebo) than in the preemptive-treatment groups (groups 2 and 3), and in group 2 than in group 3. The differences became less apparent with time, and after 1 hour, no significant differences in pain scores existed between the groups. However, intravenous narcotic pain medication was administered in the recovery room to patients with pain scores greater than 5, equalizing pain scores. Group 3 used significantly less postoperative narcotic medication than group 1. Preemptive analgesia using intraarticular bupivacaine and morphine with epinephrine resulted in lower pain scores during the 1st hour after an arthroscopic anterior cruciate ligament reconstruction than did preemptive treatment with bupivacaine and epinephrine or placebo and epinephrine.
The Effect of Screw Insertion Torque on Tendons Fixed with Spiked Washers
Authors: Beynnon Bruce D. , Meriam Christopher M. , Ryder Steven H. , Fleming Braden C. , Johnson Robert J.
Published: July 2017

The long-term success of a hamstring tendon graft depends not only on the type of device that is used for fixation but also on the mechanical interlocking of the soft tissue between the fixation device and bone. The purpose of this study was to evaluate the effect of screw insertion torque on the structural properties of soft tissue fixed to bone with a spiked metal washer. Two bovine tendons, one similar in size to a human semitendinosus tendon and the other similar in size to a human gracilis tendon, were secured to a bovine femur using a figure-of-8 technique with screws and metal spiked washers. A single load to failure was applied at 25 mm/sec. A significant positive linear correlation was observed between fixation screw insertion torque magnitude and the ultimate failure load value. An increase in the fixation screw insertion torque produced an increase in the ultimate failure load value. Similarly, there was a significant positive linear correlation between fixation screw insertion torque magnitude and the average maximum linear load value. No relationship was detected between screw insertion torque magnitude and the linear stiffness values of the tendon-fixation construct, indicating that a reproducible model was used. This study demonstrates that screw insertion torque is an important variable that controls the initial strength of soft tissue fixation to bone.
The Anterior Horn of the Medial Meniscus
Authors: Berlet Gregory C. , Fowler Peter J.
Published: July 2017

A morphologic study of 48 cadaveric knees was performed to more accurately define the osseous and soft tissue anatomy of the insertion of the anterior horn of the medial meniscus. Soft tissue relationships of the anterior horn of the medial meniscus to the anterior cruciate ligament and the lateral meniscus were examined. Four tibial insertion locations of the medial meniscus were identifiable by bony landmarks. Type I insertions were located in the flat intercondylar region of the tibial plateau; type II occurred on the downward slope from the medial articular plateau to the intercondylar region; type III occurred on the anterior slope of the tibial plateau; there was no firm bony insertion of the anterior horn in type IV. The occurrence for type I was 59% (20 of 34); type II, 24% (8 of 34); type III, 15% (5 of 34); and type IV, 3% (1 of 34). The variance in insertion patterns may have clinical applications for patients with atypical anterior knee pain and for performing meniscal allograft. Type III and type IV insertions may be unable to resist peripheral extrusion of the loaded meniscus, placing it at risk for anterior subluxation and causing anterior knee pain in specific cases. Awareness of these patterns may be valuable in medial meniscus harvest and transplantation.
Rectus Femoris Muscle Tear Appearing as a Pseudotumor
Authors: Temple H. Thomas , Kuklo Timothy R. , Sweet Donald E. , Gibbons C. L. Max H. , Murphey Mark D.
Published: July 2017

Quadriceps muscle strains are common sporting injuries, but occasionally a tear of the rectus femoris muscle can appear as a soft tissue mass of the anterior thigh with or without a significant history of trauma. Between 1992 and 1996, seven patients were referred to the Orthopaedic Oncology Unit at Walter Reed Army Medical Center with an unexplained soft tissue mass of the thigh. Three were active duty soldiers, three were military dependents, and one was a retired serviceman. All patients were men, and the mean age was 32 years (range, 15 to 73). A palpable, mildly tender mass was confirmed on clinical examination. Laboratory studies and plain radiographs were normal. Magnetic resonance imaging showed an obvious, but often ill-defined, lesion at the musculotendinous junction of the rectus femoris muscle. Four patients subsequently underwent a tissue biopsy to rule out a soft tissue sarcoma. Histologic studies showed fibrosis, degeneration of muscle fibers, and chronic inflammatory cells with no evidence of malignancy. A chronic rectus femoris muscle tear can mimic a soft tissue tumor or sarcoma and needs to be excluded in the differential diagnosis. These tears may occur acutely or may represent an overuse injury caused by repeated micro-trauma. Careful history taking, physical examination, and selective radiographic studies, specifically magnetic resonance imaging, can confirm the diagnosis of muscle tear and full functional recovery can be anticipated.
Is Psychosis a Neurobiological Syndrome?
Authors: Fujii Daryl E , Ahmed Iqbal
Published: July 2017

Objective:

To describe theoretical weaknesses in the DSM-IV criteria for psychotic disorders and to argue that schizophrenia-like psychosis is a neurobiological syndrome similar to aphasia or apraxia.

Method:

We outline the criteria for the concept of neurobiological syndrome and present supporting evidence for schizophrenia-like psychosis as a neurobiological syndrome.

Results:

There is evidence in the literature to support the hypothesis that schizophrenia-like psychosis is a neurobiological syndrome.

Conclusion:

Conceptualizing schizophrenia-like psychosis as a neurobiological syndrome has important implications for both clinicians and researchers.
PET and SPECT Imaging in Psychiatric Disorders
Authors: Zipursky Robert B , Meyer Jeffrey H , Verhoeff N Paul
Published: July 2017

Objectives:

To review recent findings from positron emission tomography (PET) and single photon emission computed tomography (SPECT) studies that investigate the pathophysiology and treatment of schizophrenia, depression, and dementia.

Methods:

We carried out a review of the literature.

Results:

PET and SPECT studies have provided evidence of dopamine system dysregulation in patients with schizophrenia and variable loss of monoamines in patients with depression. Antipsychotic response has been demonstrated to be associated with blockade of dopamine D2 receptors, and antidepressant response has now been linked to blockade of serotonin transporter receptors. PET and SPECT have been extensively evaluated as diagnostic procedures for dementia. Substantial progress has been made in developing radioligands that bind to amyloid deposits in the brain, which should provide new opportunities for early diagnosis and treatment monitoring in Alzheimer's disease.

Conclusion:

Advances in PET and SPECT imaging have provided new insights into the biology of major psychiatric disorders and their treatment. In the future, we can expect that these imaging techniques will become more central to the management of psychiatric disorders.