bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathomechanics of posterior sag of the tibia in posterior cruciate deficient knees
Authors: Ogata Kosuke , McCarthy John A. , Dunlap Janet , Manske Paul R.
Published: June 2007

This study was an investigation of the pathomechanics of posterior sag of the tibia in knees with posterior knee instability caused by PCL deficiency. By using fresh cadaver knees, the authors hoped to define the rela tionship of the posterior joint capsule and the medial and lateral collateral ligaments (MCL, LCL) with poste rior knee instability in the PCL deficient knee. Thirty newtons of posterior stress were applied to the knees to simulate postoperative conditions. Roentgeno graphic methods were then used to evaluate posterior sag and change in the distance between the origin and insertion of the PCL. Strain gauges were used to meas ure the actual strain of the PCL and the collateral ligaments. The PCL, the posterior capsuie, and the medial and lateral collateral ligaments were sequentially divided and the above measurements were then re peated in the same way, using 30 N of applied posterior stress. When only the PCL was cut, posterior sag and medial rotation of the tibia occurred with increasing severity as flexion increased. No sagging or rotation of the tibia was observed at full extension in the knees that had isolated PCL "injury". When the posterior capsule was sectioned, no significant changes were noted in the severity of the sag or the rotation. When the MCL or LCL was divided in a PCL deficient knee, greater sag occurred with flexion and a significant sag was observed even at full extension. The MCL "injury" was associated with increased medial rotation, whereas LCL "injuries" were associated with lateral rotation of the tibia. Strain measurements on the mid- substance of the PCL were at a minimum at full exten sion and at a maximum at 90° of flexion with a passive range of motion from 0° to 90°. Both the MCL and LCL demonstrated an inverse relationship to the PCL in the intact knee: maximum strain on the MCL and LCL were at full extension.

This study suggested that in cases with a PCL injury, postoperative immobilization in full extension appears to be beneficial if MCL and LCL stability can be achieved, as these ligaments will prevent sagging in full extension, when the PCL is under the least strain. Our study also suggested that a significant posterior sag in full extension is indicative of an associated collateral ligament injury and can be partially assessed by rotation of the tibia.
Elevated plasma hydroxyproline
Authors: Murguia M.J. , Vailas A. , Mandelbaum B. , Norton J. , Hodgdon J. , Goforth H. , Riedy M.
Published: June 2007

Basal plasma hydroxyproline was measured in 104 male Navy Seal candidates 1 week into their intense physical training program, which lasted 7 weeks, and correlated to the incidence of connective tissue injuries incurred later in the training program. Eleven subjects (10.6%) were diagnosed as having connective tissue injuries. Those subjects with connective tissue injuries had a significantly higher (P < 0.05) mean plasma hydroxyproline value (4.02 μg/ml) than subjects without injury (3.10 μg/ml). The majority of graduates (75%) had plasma hydroxyproline values less than 3.3 μg/ml. These graduates represented the strongest and most enduring injury-free subjects. Of the subject pool who incurred connective tissue injuries, only 27% had plasma hydroxyproline values less than 3.3 μg/mi. The majority of the injured subjects (73%) had plasma hy droxyproline values greater than or equal to 3.3 μg/ml. In conclusion, there is a relationship between initial training basal plasma hydroxyproline levels and con nective tissue injuries later incurred in an intense phys ical training program. These data suggest that elevated plasma hydroxyproline levels may represent a risk fac tor associated with connective tissue injuries.
Comparative functional analysis of the Bristow, Magnuson-Stack, and Putti-Platt procedures for recurrent dislocation of the shoulder
Authors: Regan William D. , Webster-Bogaert Susan , Hawkins Richard J. , Fowler Peter J.
Published: June 2007

Literature on anterior shoulder instability deals most often with elimination of recurrence following recon struction. We analyzed the subjective function, loss of motion and shoulder strength of three operative pro cedures : Magnuson-Stack, Bristow, and Putti-Platt. A retrospective review of 27 patients, 9 in each surgical group, with no postoperative dislocations or on-going pain was performed. All patients were male, right hand dominant with the right shoulder affected. Average time of followup was 6.75 years (range, 4.2 to 10.3 years). All patients completed a questionnaire and had their range of motion measured by a hand-held goniometer and their shoulder strength tested on the Cybex II Dynomometer. Peak torque as a percent of body weight and side-to-side differences were calculated for six arm positions and compared to nine right hand dominant controls of similar age and recreational activ ity.

Sixty percent returned to throwing sport. One Mag nuson-Stack and Bristow patient felt full functional re turn to preinjury level. Three patients in each of these two groups returned to unmodified throwing sport whereas no Putti-Platt patient attained this level. Deficit of external rotation at shoulder neutral measured 4.7°, Magnuson-Stack; 12.2°, Bristow; and 21.8°, Putti- Platt. At 90° shoulder abduction, similar deficits in external rotation measured 6.4°, 11.6°, and 28.8° re spectively. These values were statistically significant employing analysis of variance.

We compared the operative groups as a whole to the controls and compared the operative groups to each other. Statistically significant weakness was found in external rotation of all patients as opposed to control subjects at shoulder 90° abduction and neutral position (P < 0.05). No flexion weakness was found in the Bristow group. We have concluded that functional re turn to throwing sport favors the Magnuson-Stack and Bristow patients over the Putti-Platt. Statistically signif icant differences of external rotation loss exists at shoulder 90° abduction. The operative group was sta tistically significantly weaker than controls in external rotation at shoulder neutral and 90° abduction. Also, there was no relative weakness between groups.
An analysis of fitness and time-motion characteristics of handball
Authors: Alexander Marion J.L. , Boreskie Suzanne L.
Published: June 2007

This study was conducted to determine some fitness parameters of two elite handball players, including the current world champion, and also to determine some of the time-motion characteristics of the game of hand ball. The VO2 max values of the two players were found to be similar (53.1 and 55.2 ml/kg/min), while the world champion was substantially higher on the anaerobic power test and in peak ventilation scores. The results of heart rate monitoring of these players indicated that the mean game heart rate was dependent on several external factors, such as the skill level of each player, the fitness level of each player, the length of the rallies, and the player in control of the rally. The mean heart rate for the world champion was 149 beats per minute (bpm) during each game, while that for the other skilled player was 163.6 bpm, which represented 80% and 88% of maximum, respectively. The average length of each rally was 9 seconds, and the mean pause time (between rallies) was 10 seconds, producing a work- to-test ratio of approximately 1:1. The ball was found to be in play for an average of 47.3% of the total mean game time of 17 minutes. Each player was found to take approximately 350 strokes per match, with the world champion, and eventually the winner, taking a greater number of serves. Handball training should consist of interval training at an intensity of at least 80% of maximum heart rate, with a work-to-rest ratio of 1:1 and an emphasis on 10 second intervals.
Fat pad adhesion to partially torn anterior cruciate ligament: A cause of knee locking
Authors: Finsterbush A. , Frankl U. , Mann G.
Published: June 2007

Isolated damage to the ACL was found on arthroscopic examination of 51 patients who had symptomatic knees. There were 47 male and 4 female patients. The average age of the patients was 26.5 years, ranging from 13 to 43 years. Twenty-four of the patients had isolated partial tears of the ACL, and 27 had isolated complete tears. The purpose of this study was to examine the clinical patterns and arthroscopic findings in these two groups.

On examination, 12 patients were found to have locked knees. An additional six patients gave a history of knee locking. All 18 of these patients were clinically suspected of having meniscal damage; however, only partial and complete ACL tears were found at arthros copy. Of these 18 patients who had locking knees, 15 had a partial tear of the ACL and 3 had a complete tear. Locking was involved primarily in the group with partial ACL tears (15 of 24); only 3 of the 27 patients who had complete tears described locking. Of the 12 patients who had locked knees on examination, all were found to have fibrosis and adhesions of the fat pad and the synovium adjacent to the ACL stump. All 12 of these patients had a partial tear of the ACL. The fibrosis and adhesions were histologically documented in 10 of those 12 patients. The three patients who had partial ACL tears and histories of locking were not observed to have adhesions of synovium to the fat pad, but did have an entrapped remnant of ACL between the tibial plateau and femoral condyle. The remaining three pa tients, who had a history of locking and a complete ACL tear, also had a free part of the torn ACL inter posed between the femoral condyle and the tibial pla teau. These findings suggest that a mechanical factor is involved in the locking of knees of patients who have partial tears of the ACL.
High frequency electrical stimulation in muscle strengthening
Authors: Selkowitz David M.
Published: June 2007

This review of the published literature presents and discusses major findings and observations concerning the effects of high frequency electrical stimulation (ES) on strengthening the quadriceps femoris of healthy subjects. The paper does not focus on clinical studies, although clinical uses of ES, suggestions for further research, and measurement considerations are dis cussed.
The effect of tourniquet pressure on muscle function
Authors: Gersoff Wayne K. , Ruwe Patrick , Jokl Peter , Panjabi Manohar
Published: June 2007

The adverse effects of excessive tourniquet pressure on underlying muscle were studied using a cat model. A direct effect of the magnitude of tourniquet pressure on the degree of muscle disability was observed. The effect of direct pressure on the muscle may contribute to the postoperative weakness seen in the quadriceps muscle. Our data, in conjunction with the results of other studies that correlate certain tourniquet times and pressures with potential adverse effects, suggest that the selection of an appropriate tourniquet pressure and duration will minimize the development of clinically sig nificant complications.
Binding function in relation to injury risk in downhill skiing
Authors: Bouter Lex M. , Knipschild Paul G. , Volovics Alexander
Published: June 2007

Time-trend studies suggest that in the recent past, the use of modern equipment and adequately functioning ski bindings have had a preventive effect on injuries. The question of whether a further decrease of injury figures can still be expected from better binding adjust ment is investigated in a case-control study (N = 1,148) conducted among Dutch skiers. Nonrelease of both bindings directly before injury was associated with a higher risk (odds ratio = 3.3) for lower extremity (LE) injury. Binding release before LE injury was highest (31 %) among those for whom adjustment was per formed and then confirmed with a test device. The proportion of nonrelease is highest for knee injuries. No effect on injury risk could be found for the time of adjustment, the method of adjustment, or the person performing the adjustment. Direct measurement of binding function seems indispensable. The use of rented or borrowed skis was associated with a higher risk (odds ratio = 1.9) for LE injury. The same holds for ignorance concerning the type of ski and the age of the skis and bindings. We concluded that binding adjust ment still seems to be a risk factor open to manipula tion. The efficacy of intervention aimed at better ad justment should be studied experimentally.
Personality, stress, and injuries in professional ballet dancers
Authors: Hamilton Linda H. , Hamilton William G. , Meltzer James D. , Marshall Peter , Molnar Marika
Published: June 2007

Twenty-nine soloist and principal dancers (mean age, 29.08 years) from America's two most celebrated ballet companies were administered questionnaires measur ing personality (API), occupational stress (OES), strain (PSQ), and coping mechanisms (PRQ), and injury pat terns. The results revealed that male dancers demon strated significantly more negative personality traits and psychological distress than female dancers or men in the general population. In addition, physical stress and personality traits, characteristic of the "overachiever," distinguished injured dancers. It is suggested that clas sical ballet's emphasis on the ballerina may be at odds with a masculine identity in male dancers. Furthermore, the qualities that lead to success in this profession may contribute to injuries if carried to an extreme.
Effect of standard and Aircast tennis elbow bands on integrated electromyography of forearm extensor musculature proximal to the bands
Authors: Snyder-Mackler Lynn , Epler Marcia
Published: June 2007

Classic tennis elbow, or lateral epicondylitis, has been described as an overuse or misuse injury resulting in a tendinitis. The extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) have been impli cated as primary culprits in this pathology. Tennis elbow has been treated using a constrictive band placed several centimeters distal to the origin of these two muscles. Aircast (Aircast Inc., Summit, NJ) has devel oped a new style of band that employs an air-filled bladder as the counterpressure element. This study tested the effect of both standard and Aircast bands on EMG activity of the EDC and ECRB proximal to the band compared to control values.

Ten normal subjects, ranging in age from 20 to 43 years, were tested. Right upper extremities were tested in all cases. The subjects' forearms were stabilized in the CYBEX II forearm stabilization V-pad. The ECRB and EDC were then impaled with monopolar EMG needle electrodes. The CYBEX data were recorded using the HUMAC system and the EMG data were recorded and analyzed using the Cadwell 7400. EMG data were recorded at 80% of maximum voluntary isometric contraction (MVIC) with no band, the standard band, and the Aircast band.

An analysis of variance (ANOVA) with repeated meas ures of integrated EMG (IEMG) and Duncan's multiple comparison tests revealed that the Aircast caused a significant reduction in IEMG of the ECRB and EDC when compared with control values and the standard band. The decrease in IEMG with the standard band was not statistically significant. This may begin to pro vide an explanation for the anecdotal reports of the clinical effectiveness of the air-bladder type of counter force bracing.
Peroneal nerve entrapment in runners
Authors: Leach Robert E. , Purnell Michael B. , Saito Akiyoshi
Published: June 2007

In a practice involving large groups of athletes, seven runners and one soccer player with peroneal nerve compression neuropathy secondary to exercise have been found. Running incited pain, numbness and tin gling to varying degrees in all patients, and examination after running revealed muscle weakness and a positive percussion test as the nerve winds around the fibular neck. Nerve conduction velocity studies confirmed the diagnosis in the five patients on whom the test was performed; other studies served primarily to exclude other causes of pain. All patients were treated surgically by neurolysis of the peroneal nerve as it travels under the sharp fibrous edge of the peroneus longus origin. Seven of eight had excellent results and returned to their previous level of physical exertion without further symptoms. We think entrapment of the peroneal nerve at the fibular neck is a more common entity than previously recognized, and it should be considered in the differential diagnosis of exertional lateral leg pain.
Anterior cruciate ligament insufficiency: A dynamic three-dimensional motion analysis
Authors: Marans Howard J. , Jackson Robert W. , Glossop Neil D. , Young M. Christine
Published: June 2007

An electrogoniometer, capable of measuring all six degrees of freedom of knee movement, was developed in our laboratory. This Instrumented Spatial Linkage system was then used to generate data for a three- dimensional assessment of 20 ACL deficient and 30 normal subjects during level walking. The system proved to be a viable method for describing total knee motion. We found the ACL deficient knees to have increased anterior/posterior translation and significant pattern differences compared to the controls. The re sults of this study may have implications in the treat ment of the ACL deficient patient.
The effects of cold therapy in the postoperative management of pain in patients undergoing anterior cruciate ligament reconstruction
Authors: Cohn B.T. , Draeger R.I. , Jackson D.W.
Published: June 2007

This prospective study assessed 54 consecutive ar throscopically assisted ACL reconstructions for the amount of postoperative pain relief provided by cold therapy, using the Hot/Ice Thermal Blanket. Twenty- six randomly selected patients undergoing this proce dure were compared to a control group consisting of 28 patients having the identical procedure in which the Hot/Ice unit was not used postoperatively. The initial ACL injury in both groups was sports related with the exception of three patients whose injury occurred while on the job.

The Hot/Ice Thermal Blanket consists of two rubber pads (blankets) connected by a hose to the main cooling unit. The pads were applied to either side of the oper ated knee in the operative suite. The pads received fluid which was circulated from the main unit. The temperature of the fluid was set at 50° in the recovery room and the unit was run continuously until the time of discharge, which was approximately 4 days. Hot/Ice patients required 53% less injectable Demerol and 67% less oral Vistaril than patients in the control group. Hot/ Ice patients had made the conversion from injectable to oral pain medication an average of 1.2 days sooner than did their non-Hot/Ice counterparts. There was no appreciable difference in length of hospital stay. Physi cal therapy and nursing records documented a greater percentage of compliant patients in the Hot/Ice group. According to these records the Hot/Ice patients were more helpful in self-assistance, were out of bed and ambulating in the halls more quickly, and did their range of motion exercises with greater ease. The results of this study support the potential benefit in pain reduction by use of a Hot/Ice Thermal Blanket in the postopera tive recovery of patients undergoing ACL reconstruc tion.
A kinematic comparison of ergometer and on-water rowing
Authors: Lamb Douglas H.
Published: June 2007

The purpose of this investigation was to compare on- water rowing with ergometer rowing by identifying the important kinematic variables, using vector loop analy sis. Two hypotheses were investigated that provided evidence that rowing ergometers are valid simulators of actual rowing and that the trunk segment is the major contributor to the total linear oar velocity. Thirty subjects were filmed rowing on-water and on an ergom eter. The film was digitized for X and Y coordinates of the body joint locations for a cycle of rowing from catch to finish. A model of rowing was designed such that the rowing movement could be defined as comprising two closed vector loops. The digitized data were fitted to the vector loop model to derive kinematic variables from the drive phase of rowing. Five kinematic variables that described the contributions of five body segments to the total linear oar velocity were analyzed statistically to find differences in the patterns of on-water and ergometer rowing. The results indicated that the kine matics of the upper arm and forearm segments were significantly different in the two types of rowing. These differences were of minor importance because of the small contributions made by the arms at the catch. The differences at the finish were a result of the lifting of the oar from the water not exhibited in ergometer rowing. The vector loop analysis provided the major finding that the trunk segment contributed significantly more to the drive phase portion of the rowing cycle for both on-water and ergometer rowing although the legs initiated the drive phase. Despite the differences that occurred in the arm motion at the beginning and end of the drive phase, most of the kinematic variables were similar throughout the drive phase, particularly for the legs and trunk. The objective of developing a biome chanical test that uses kinematic measures obtained on an ergometer is supported by the findings of this study, and such a study would supplement physiologic measures used in the selection of rowers.
A modified Bankart procedure for recurrent anterior/inferior shoulder instability
Authors: Loomer Richard , Fraser James
Published: June 2007

A modified Bankart procedure has been developed using a single interosseous extraarticular suture to correct the Bankart lesion and a longitudinal capsular incision to prevent capsular shortening and allow for performance of an anterior capsular shift. Its purpose is to allow full functional return in the active athletic population while controlling anterior/inferior instability. Followup of the first 30 patients on whom we used the procedure shows excellent postoperative range of mo tion (average loss: 2° of flexion, 1° of abduction, 4° of external rotation in adduction, and 7° of external rota tion in abduction) and return to sports (90%, of which 70% returned to their previous level). There is, however, an unacceptably high recurrence rate of 13%, all of which occurred early in the series. Technical refinement and experience have apparently reduced the recurrence rate without sacrifice of range of motion or functional ability.
Implications of muscular defense in testing for the anterior drawer sign in the knee
Authors: Iversen Bjørn Franc , Stürup Jens , Jacobsen Klaus , Andersen Jens
Published: June 2007

This study was performed with the aim of shedding some light on the effect of muscular guarding during clinical testing of the knee for anteroposterior laxity. Twenty physicians were tested on a knee phantom, for force used during testing for the anterior drawer sign. The force used averaged 109 N (range, 70 to 180 N).

Fifteen patients were examined by stress radiogra phy. Radiographs were taken with the knee flexed to 90° (the drawer test position) and with the knee flexed to 15° (the Lachman position). A comparison was made between the laxity measured on forward traction in the relaxed knee, and during traction while the patient was instructed to counteract the forward displacement of the tibia by tensing the hamstrings, thus simulating muscular defense. The test procedure was executed first with 80 N and then with 160 N applied.

The opposing effect of tensing the hamstrings on the anterior shift of the tibia was significantly less at 15° of knee flexion (with 80 N, P < 0.02; with 160 N, P < 0.05) than at 90°. With the hamstrings tensed and the knee flexed to 90°, no statistically significant gain in drawer sign was achieved by increasing the force from 80 to 160 N. With the knee in the Lachman position, increasing the force produced a significantly greater anterior drawer sign (P < 0.01).
Rupture of the pectoralis major muscle
Authors: Kretzler Harry H. , Richardson Allen B.
Published: June 2007

Nineteen cases of rupture of the pectoralis major mus cle are presented. ln 16 cases the rupture was repaired; in 3 cases repair was not performed. Physical findings and surgical technique are described and the anatomy of the insertion of the pectoralis major muscle is re viewed. Nine of the patients in this series sustained their injury while performing the bench press. The ma jority of the remaining patients were also involved in sports when injury occurred. Eleven of the ruptures were in the nondominant arm and eight in the dominant arm. All of the patients complained of weakness, pain, and deformity, with weakness being the major com plaint.

Following surgery and rehabilitation, all 16 patients who underwent repair were relieved of pain. The de formity was corrected in all 16 patients, although 2 patients who had a 5 year interval from repair to rupture did not achieve a completely normal contour. Thirteen of the 16 patients reported a full return to strength. The others had significant improvements.

Ruptures of the pectoralis major muscle are uncom mon, but not rare. Ruptures occurring under tension tear at or near the insertion onto the humerus, as in all 19 cases in this series. Distal ruptures are usually complete, despite physical signs that may be mislead ing. Distal tears are reparable, even after a delay to treatment. After surgical repair, the majority of patients may expect relief of pain, return of strength and normal contour, and maintenance of range of motion.
Enhancement of blood lactate clearance following maximal swimming
Authors: McMaster William C. , Stoddard Terry , Duncan William
Published: June 2007

Swimming is an endurance-intensive sport resulting in accumulation of lactate. Repeat performances are often necessary in championship events. Lactate produced during a maximal effort requires time to metabolize to a base level. If this dose not occur, performance in a repeat effort may be impaired. Thus, techniques to enhance lactate clearance are of potential benefit to the athlete. We have demonstrated previously that swimming at 65% of maximum velocity significantly improved lactate clearance over passive resting. This study tested the effect of various swimming velocities on lactate clearance. Following a maximal swim, blood lactate clearance was tracked during a 15 minute cool down swim. Velocities of 55%, 65%, and 75% of max imum were tested. The results confirmed that cool down swimming will return lactate values to near resting levels in the test interval. However, statistical superi ority of any of the test velocities was not demonstrated. The intensity of the swim should be below the lactate accumulation level. The 65% of maximum velocity was felt by all swimmers to be most comfortable and is a good target velocity for the athlete to reference.
Saphenous nerve entrapment at the adductor canal
Authors: Romanoff Mark E. , Cory Phillip C. , Kalenak Alexander , Keyser Glenn C. , Marshall Wayne K.
Published: June 2007

A retrospective study of 30 patients who met the clinical criteria for saphenous nerve entrapment at the adductor canal is described. Patients experienced symptoms, usually anterior knee pain, for an average of 36 ± 7 months. Each patient received an average of 1.9 ± 0.4 saphenous nerve blocks at the adductor canal during treatment. Baseline pain level (measured by the visual analog scale) was 6.4 ± 0.3. Final pain level at followup was significantly decreased (2.8 ± 0.5, P < 0.001). Eighty percent of patients had improved after a series of blocks. Age, medications taken, number of blocks performed, and length of followup were unrelated to outcome. Length of symptoms did significantly corre late with final pain level (r = 0.39, P < 0.05). The diagnosis of this syndrome, description of the saphen ous nerve block at the adductor canal, and the possible etiology are presented.
A dynamic analysis of a functional brace for anterior cruciate ligament insufficiency
Authors: Cook Frank F. , Tibone James E. , Redfern Fredrick C.
Published: June 2007

A dynamic, in vivo, functional analysis of braces de signed for ACL insufficiency has never been reported. In this study, 14 athletes who had arthroscopically proven absent ACLs were evaluated in the Biomechan ics Laboratory at the Centinela Hospital Medical Center. None of the ligaments were repaired or reconstructed. Footswitch, high speed photography, and force place data were recorded while the athletes performed run ning and cutting maneuvers with and without their custom fitted C.Ti. braces (Innovation Sports, Irvine, CA). Cybex testing, KT-1000 evaluation, and radio graphs were collected for each subject.

Statistical analysis showed that while performing cut ting maneuvers, braced limbs generated significantly increased shear forces compared to the same limb unbraced. During straight line running, braced limbs generated significantly less lateral and aft shear forces compared to the same limb unbraced. Running velocity increased while wearing a brace for most athletes, but this was not statistically significant. As expected, the sound limb generated significantly greater shear forces than the unbraced involved limb during most cutting maneuvers.

Athletes who did not achieve 80% of the Cybex (Cybex, Division of Lumex, Ronkonkoma, NY) quadri ceps torque of the sound limb generated significantly more forces during cutting maneuvers while wearing their braces.

The cutting angle, approach time to the cut, and time on the force plate showed no significant differences during brace wear.

We conclude that the C.Ti brace allows significantly better running and cutting performances for athletes who have torn ACLs. Athletes who have not achieved 80% of quadricep strength as measured by Cybex testing showed even more improvement while wearing their braces. Brace prescribers are cautioned that braces do not prevent abnormal anterior tibial displace ment in anterior cruciate deficient knees and the long- term effects of brace wear are unknown.
Ibuprofen in the treatment of acute ankle joint injuries
Authors: Fredberg Ulrich , Hansen Poul Anders , Skinhøj Anette
Published: June 2007

Sixty-eight patients who presented to the casualty ward with acute ankle joint injuries were studied to examine the effect of ibuprofen on pain and ankle swelling. Thirty-two patients were treated with placebo tablets and 36 with 600 mg ibuprofen tablets taken four times a day for 4 to 6 days. All of the patients were immobi lized and requested to keep the foot elevated.

The results showed that ibuprofen had no effect on the ankle swelling. The need for additional analgesics was not influenced by treatment with ibuprofen, which means that ibuprofen has no effect on pain. The time elapsed from occurrence of the injury to arrival at the casualty ward was negatively correlated to the reduc tion of ankle joint swelling during the treatment period. Treatment with ice-sprays, icebags, or cold water dur ing the acute stage of injury did not influence the reduction of swelling during the treatment period.
The accident-prone and overuse-prone profiles of the young athlete
Authors: Lysens Roeland J. , Ostyn Michel S. , Auweele Yves Vanden , Lefevre Johan , Vuylsteke Magda , Renson Luc
Published: June 2007

A 1 year prospective study was done to develop an accident-prone and overuse-prone profile of young ath letes. A group of 185 freshman physical education students (118 males; 67 females) of the same age (18.3 ± 0.5 years) trained under the same conditions and were exposed to similar extrinsic risk factors.

Using a descriptive statistical technique, an analysis of correspondence, the complex interrelation between the criterium variables (acute injuries and overuse inju ries) and the predictor variables (intrinsic risk factors; physical characteristics—antropometric data, physical fitness parameters, flexibility aspects and malalignment of the lower extremities; and psychological factors— 16 personality traits) was estimated for males and females separately.

Although dynamic strength seems to be an important risk factor in acute injuries, sports accidents must be seen in relation to psychological factors. However, the overuse-prone profile is mainly based on physical traits: a combination of muscle weakness, ligamentous laxity, and muscle tightness predisposes to stress injuries. In addition, these overuse effects are intensified by large body weight and length, a high explosive strength, and malalignment of the lower limbs. Nevertheless, it has to be kept in mind that psychosomatic factors play a role in how one experiences these overuse phenomena.
Occult intraosseous fracture: Magnetic resonance appearance versus age of injury
Authors: Lee Joong K. , Yao Lawrence
Published: June 2007

Twenty-two cases of occult intraosseous fracture in the region of the knee are presented. Occult intraos seous fractures have been incidentally detected in the magnetic resonance (MR) evaluation of the knee in the setting of a recent physical injury and normal radio graphic studies. There is no unique mechanism of in jury, but occult intraosseous fracture presumably re sults from direct impaction or axial overloading. MR shows speckled or band-like areas of low signal in the intramedullary space of the epiphyses, and occasion ally, the adjacent metaphyses. In most cases, T2- weighted images show high signal in corresponding regions of variable size. The relative extent of high signal findings is shown to vary significantly with the age of injury. Individual variability within groups, how ever, precludes the actual prediction of lesion age on the basis of the MR appearance. Our observations provide indirect evidence that the findings on T2- weighted images resolve earlier than the corresponding findings on T1-weighted or proton density images. The primary differential diagnosis in cases of occult intraos seous fracture is stress fracture. The diagnosis of oc cult intraosseous fracture may be important in explain ing persistent pain after injury in otherwise normal knees.
The Stryker knee arthrometer in clinical practice
Authors: King J.B. , Kumar S.J.
Published: June 2007

The Stryker knee arthrometer was assessed in the environment of a nonspecialized National Health Serv ice clinic by junior doctors in training. Forty percent of proven anterior cruciate deficient knees had a meas ured anterior excursion of 2 mm or less compared with the normal side under the same circumstances. Twenty percent of normal knees tested showed more than this variation between knees when different observers were compared and also when the same observers were compared at three week intervals. There is thus a question about the use of this machine in a general orthopaedic clinic with different observers.
Upper extremity injuries in snow skiers
Authors: Van Dommelen Bruce A. , Zvirbulis Raimonds A.
Published: June 2007

All skiers with upper extremity injuries seen at the Henry Ford Hospital between 1983 and 1986 were evaluated in terms of age, sex, skill of the skier, type of snow conditions, pole type, grip type, direction of fall, and mechanism of injury. Our primary objective was to evaluate whether the type of pole used had an effect on the injury rate.

We found that the strap handled pole without any platform had the lowest injury rate. The saber type pole handle had the highest injury rate. Other observations showed ulnar collateral ligament injury of the thumb to be the most common upper extremity injury to skiers. A proportionally high number of skiers with upper ex tremity injuries were advanced skiers.
Surgical treatment of chronic Achilles tendinitis
Authors: Nelen G. , Martens M. , Burssens A.
Published: June 2007

Between 1977 and 1985, 170 patients suffering from chronic Achilles tendinitis were treated surgically. Ninety-one patients with 143 tendons returned for fol lowup. The duration of preoperative symptoms aver aged 18 months. In all cases, conservative treatment was first attempted but failed to alleviate symptoms. Only those patients whose lesions and symptoms were confined to the Achilles tendon segment 2 to 6 cm proximal of the insertion were included in this study. All athletes who had an insertion tendinopathy or a lesion at the musculotendinous junction were excluded from this study.

The surgical procedure depended on the lesion. For 93 tendons exhibiting pure peritendinitis, treatment consisted of a simple release of the fascia cruris and the peritenon. For the 50 tendons with tendinosis, a resection of diseased tendon tissue was performed. The defect could be sutured side to side in 26 cases but in the other 24 cases, reinforcement with a turned- down tendon flap was necessary because of the exten sive debridement.

Of the 93 cases in which only dorsal release was performed, results were considered excellent in 54 cases, good in 28, fair in 8, and poor in 3 cases. Of the 26 cases in which side-to-side suture was performed, 15 cases were rated as having excellent results, 4 as good, 4 as fair, and 3 as poor. For the 24 cases in which a turned down tendon flap procedure was per formed, the result was excellent in 12 cases, good in 9, fair in 2, and poor in 1 case.

The group of 170 patients treated surgically is part of a total number of 980 patients seen over this period in our hospital. The high percentage of operated cases for this group of 980 patients is explained by the fact that these 980 patients were a selected group of pa tients not including mild cases or patients with a tran sient Achilles tendinitis. Since the University Hospitals are mainly referral hospitals, many cases were referred because of complaints resistant to conservative treat ment.
Evaluation of claw toe deformity, weakness of the foot intrinsics, and posteromedial shin pain
Authors: Garth William P. , Miller Sylvia T.
Published: June 2007

Posteromedial middle one-third tibial pain and tender ness associated with stressful activities has been pre viously recognized as occurring at the origin of the flexor digitorum longus muscle. Seventeen running ath letes with this clinical syndrome were evaluated with regard to second toe range of motion and foot intrinsic muscle strength. The results were compared to results obtained from a comparable group of asymptomatic athletes.

Statistical analysis of the results of the evaluation indicated a significant displacement of the arc of motion of the second toe in the symptomatic athletes toward extension of the metatarsophalangeal joint and a de crease in flexion. Weakness or dysfunction of the intrin sic muscles in the symptomatic athletes was also found to be significant. This analysis supports the hypothesis that posteromedial middle one-third tibial stress symp toms may be related to overuse of the flexor digitorum longus muscle associated with mild claw toe deformity.
Intraarticular reaction associated with the use of freeze-dried, ethylene oxide-sterilized bone-patella tendon-bone allografts in the reconstruction of the anterior cruciate ligament
Authors: Jackson Douglas W. , Windler Gary E. , Simon Timothy M.
Published: June 2007

One hundred nine patients over a 3 year period under went reconstruction for chronic ACL ruptures using a freeze-dried, ethylene oxide-sterilized bone-patella ten don-bone allograft. Seven patients (6.4%) developed a characteristic persistent intraarticular reaction. This re action was characterized by persistent synovial effusion with collagenous particulates and cellular inflammatory response. Synovial biopsies in all cases showed a similar chronic inflammatory process, characterized by fibrin, collagen, and phagocytic cells. The intraarticular white cells were predominantly lymphocytes. Removal of the allograft resulted in resolution of the reaction in all of the patients. Three of the seven patients showed HLA conversion. Gas chromatography demonstrated detectable levels of ethylene chlorohydrin, a toxic re action product of ethylene oxide, within the allograft and synovium 14 months following implantation of one graft. These seven cases presented strongly suggest a nonspecific or immune mediated response that must be further delineated. The use of freeze-dried, ethylene oxide-sterilized allografts using standard techniques cannot be recommended for reconstruction of the ACL.
Arthroscopic evaluation of acute initial anterior shoulder dislocations
Authors: Baker Champ L. , Uribe John W. , Whitman Courtenay
Published: June 2007

Arthroscopic evaluation of patients with an acute an terior shoulder dislocation was done to identify and classify the intraarticular lesions that might predict re current dislocations. Forty-five shoulders fit the follow ing criteria for inclusion in our study: initial dislocation with no prior history of shoulder problems; confirmation of the dislocation radiographically or reduction by a physician; and arthroscopy within 10 days. The 42 men and 3 women had an average age of 21.2 years (range, 14 to 28 years). Mechanism of injury was a twisting of the arm into forced abduction and external rotation, a fall on the outstretched arm, or a direct blow to the shoulder.

Based on this preliminary study of 45 shoulders, we present a classification of the lesions found in the acute shoulder dislocation. Group 1 (six shoulders) had cap sular tears with no labral lesions: these shoulders were stable under anesthesia and had no or minimal hemar throsis. Group 2 (11 shoulders) had capsular tears and partial labral detachments: these shoulders were mildly unstable and had mild to moderate hemarthrosis. Group 3 (28 shoulders) had capsular tears with labral detach ments : these shoulders were grossly unstable and had large hemarthrosis. They had complete capsular/labral detachments.

In the past, redislocation rates have been primarily related to age at the time of initial dislocation and, to a lesser degree, the period of immobilization. We have identified the intraarticular lesions in 45 patients with an initial anterior glenohumeral dislocation and classi fied these shoulders into three groups based on the lesions found. By doing so, we can develop a more accurate method of determining which shoulders are prone to recurrent dislocation. We can then adjust the patient's treatment to prevent recurrent dislocation.
The influence of external compression on muscle blood flow during exercise
Authors: Styf Jorma
Published: June 2007

Intramuscular pressures and muscle blood flow were measured in the anterior tibial muscle during dynamic concentric exercise in 14 subjects. Pressures were recorded by the microcapillary infusion method and muscle blood flow by the 133-Xenon clearance tech nique. Muscle blood flow during constant exercise de creased from 34.5 (SD = 10.3) to 10.6 (SD = 4.9) ml/ 100 g/min (P < 0.001 ) when muscle relaxation pressure was increased from 13.5 (SD = 2.7) to 39.9 (SD = 9.0) mm Hg by external compression. Muscle relaxation pressure during exercise is the intramuscular pressure between contractions. External compression of the lower limb during exercise impedes muscle blood flow by increasing muscle relaxation pressure. The experi mental model seems suitable to study the influence of external compression by knee braces on intramuscular pressure during exercise.
Helmet protection from head injuries among recreational bicyclists
Authors: Wasserman Richard C. , Buccini Robert V.
Published: June 2007

Head injuries account for the great majority of bicycling deaths and hospital admissions. Helmet use has been suggested as an effective means of preventing injury, but few studies have addressed this issue. We collected questionnaire data by mail from 191 recreational bi cyclists who reported having fallen and struck their heads in a cycling mishap. Information was collected on the nature of the mishap, the extent of injury, and the helmet status of the rider at the time of the fall. Fifty-seven percent of riders were wearing helmets during the mishap. Helmet wearers were significantly older than those not wearing helmets. Helmet wearers experienced significantly fewer skull fractures (1 % ver sus 11%) and facial soft tissue injuries (5% versus 18%) than those not wearing helmets (χ2 = 6.7, 6.5; P = 0.01, 0.01). No other variables accounted for differ ences in injuries. These data support the contention that bicycle helmets are effective in preventing head injuries.
Does a major knee injury definitely sideline an elite soccer player?
Authors: Engström Björn , Forssblad Magnus , Johansson Christer , Tornkvist Hans
Published: June 2007

Injuries occurring in three Swedish elite soccer teams were analyzed during 1 year. A total of 49 of 64 players (75%) sustained 85 injuries. The incidence of injury during games was 13 injuries per 1000 hours, while the incidence during training was 3 injuries per 1000 hours. Twenty percent of the injuries required hospital facili ties. The majority of the traumatic injuries (93%) were to the lower extremities, with one third of the total injuries occurring in the knee. Overuse injuries ac counted for 35% of all injuries and occurred mainly during preseason training and at the end of each sea son. Conversely, the majority of traumatic injuries oc curred during games, equally distributed between the first and second halves with a predominance toward the end of each half. The position of the player within the team did not influence injury rate. The referee considered 28% of the traumatic injuries to be caused by violation of existing rules. Thirty-four percent of the injuries were major, causing more than 1 month of absence from training and/or games. Eleven knee in juries required surgical intervention revealing seven rup tured ACLs, of which three were chronic. At followup, 9 to 18.5 months after injury, 4 of 12 players with major knee injuries had returned to play at the elite level. The others had either been transferred to lower divisions or were still in rehabilitation.
Torque production in the shoulder of the normal young adult male
Authors: Otis James C. , Warren Russell F. , Backus Sherry I. , Santner Thomas J. , Mabrey Jay D.
Published: June 2007

Shoulder torque measurements were obtained from 36 normal young adult males during flexion, abduction, internal rotation, and external rotation. Normative, an gle-specific torque measurements were determined un der isometric conditions and isokinetically at 48 deg/ sec. The effects of dominance, angular velocity, and joint position were determined and a method provided for determining the expected maximal torque at a spe cific speed and position based upon torque measure ments from the contralateral shoulder. This method can be used in cases of unilateral shoulder abnormalities to predict normative torque values for the affected side based on torque measurements from the unaffected shoulder.