bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of support provided by a semirigid orthosis and adhesive ankle taping before, during, and after exercise
Authors: Greene Tracy A. , Hillman Susan K.
Published: June 2007

The purpose of this study was to compare the relative effectiveness of athletic taping and a semirigid orthosis in providing inversion-eversion range restriction before, during, and after a 3 hour volleyball practice. The effect of each support method on the subjects' vertical jump ing ability was also assessed. Fourteen ankles were treated with both methods of support. Passive inver sion-eversion range of motion was measured on an ankle stability test instrument during five testing ses sions : 1) before support, 2) before exercise, 3) 20 minutes during exercise, 4) 60 minutes during exercise, and 5) after exercise. The two-way analysis of variance and posthoc comparisons revealed maximal losses in taping restriction for both inversion and eversion at 20 minutes into exercise. The orthosis demonstrated no mechanical restrictive failure until before and after ex ercise comparisons were made, and then only eversion range of motion was compromised. Neither support system affected subjects' vertical jumping ability. These results suggest that the semirigid orthosis may be more effective than taping in providing initial ankle protection and in guarding against ligamentous reinjury.
Incidence of cervical spinal stenosis in professional and rookie football players
Authors: Odor James M. , Watkins Robert G. , Dillin William H. , Dennis Steven , Saberi Mohammad
Published: June 2007

Sagittal canal/vertebral body ratios were measured on cervical spine lateral radiographs of 124 professional football players and 100 rookie football players. A total of 894 levels were measured in 224 players. Thirty-two percent (40) of the 124 professional football players, and 34% of the 100 rookies had a ratio of less than 0.80 at one or more levels from C3 to C6. The 0.80 ratio has been considered indicative of cervical spinal stenosis.

This is the first time that the incidence of spinal stenosis, as determined by Torg's ratio, has been dem onstrated in a population of professional and rookie football players. Because one-third of this population has cervical spinal stenosis as determined by the Torg ratio, other factors should be considered in the evalu ation of a player with a transient quadriplegic episode when making continued play decisions.
Arterial abnormalities of the shoulder in athletes
Authors: Nuber Gordon W. , McCarthy Walter J. , Yao James S.T. , Schafer Michael F. , Suker Jacob R.
Published: June 2007

Vascular lesions of the shoulder may be misinterpreted as one of the more familiar shoulder abnormalities by a treating physician. We are reporting on 13 athletes who were found to have symptoms related to compression of the subclavian or axillary artery or their tributaries. Nine were amateur or professional baseball pitchers. Severe arm fatigue or finger ischemia, secondary to embolization, were presenting symptoms. Arm fatigue was noted in all pitchers. After complete history and physical examination, including auscultation for bruits in functional positions, all athletes were evaluated by noninvasive tests (Doppler and Duplex scanning). Ar teriography was performed with positional testing, re creating overhead activity, and complete radiographic visualization of the dye to the digital arteries. Two patients were found to have subclavian artery aneu rysm. The remaining athletes were found to have compression of the subclavian artery beneath the an terior scalene muscle (five patients), the axillary artery beneath the pectoralis minor (two patients), both arterial segments (two patients), and one was found to have arterial compromise at the level of the humeral head. Branch artery compression was also noted. One pitcher occluded the posterior circumflex humeral artery with embolization to the digit.

The two patients with subclavian aneurysms under went saphenous vein bypass with cervical rib resection. All of the other athletes except one underwent resection of a 2 to 3 cm segment of the anterior scalene muscle or pectoralis minor muscles. All returned to their pre vious level of activity except one patient who developed impingement type symptoms and required acromio plasty. He is currently undergoing rehabilitation.

Proper recognition of vascular compromise in the upper extremity of athletes is essential to avoid the catastropic complications of arterial thrombosis.
Stress fractures of the femoral neck in athletes
Authors: Johansson Christer , Ekenman Ingrid , Tornkvist Hans , Eriksson Ejnar
Published: June 2007

Twenty-three patients with stress fractures of the fem oral neck were followed up at an average of 6.5 years after the injury. There were 16 recreational athletes and seven elite athletes. Most injuries (N = 15) occurred during running. The diagnosis was confirmed within 3 to 104 weeks (mean, 14 weeks) after the initial onset of symptoms. Sixteen of the patients were treated with internal fixation, the remaining seven were treated con servatively. Seven patients (30%) developed complica tions requiring major surgery. Five of these patients had Type 3 fractures (displaced) and four had been treated with internal fixation initially. The remaining two patients had Type 1 fractures (endosteal or periosteal callus without an overt fracture line); one was treated operatively and the other conservatively. Three patients developed avascular necrosis and two were treated by hip replacement. The third patient was treated with arthrodesis. Three refractures and one pseudarthrosis were treated by osteotomy.

At followup, all elite athletes stated that they had to end their career as a result of the injury. Results were rated by the ability of the athlete to return to sports. There were 9 bad or fair results, 13 good, and 1 excellent result. No difference in activity level or subjec tive rating was observed between the surgically and conservatively treated group either preinjury or postin jury. The most important factor influencing the compli cation rate seems to be the type of fracture. The high incidence of displaced fractures (Type 3) could specu latively be caused by undiagnosed tension side stress fractures. If so, the delay in correct diagnosis may be disastrous. However, we could only objectively observe this in one of our cases.
Injury patterns in Scottish heavy athletics
Authors: McLennan Jon G. , McLennan John E.
Published: June 2007

As interest and participation in the athletics of Scottish- American Highland games has increased throughout the United States, the aim of this study was to define injury patterns and risk factors. Field events of modern track and field evolved in part from the seven events of the "heavy athletics." A retrospective and prospective study of 170 athletes with at least 3 years of experience was carried out over 10 years. There were 729 injuries, 60% of which involved the upper extremities and back. The incidence of injury was 42.9%; there was an injury exposure rate of 0.3 per 40 hours of competition or training. With appropriate instruction, a consistent weight program, and exercise, few injuries were seri ous.
The contribution of the glenohumeral ligaments to anterior stability of the shoulder joint
Authors: O'Connell Patrick W. , Nuber Gordon W. , Mileski Robert A. , Lautenschlager Eugene
Published: June 2007

The purpose of this study was to investigate the liga mentous stabilizing mechanisms preventing anterior instability in the glenohumeral joint.

Six freshly thawed, unembalmed cadaveric shoulders were dissected, preserving the joint capsule and gle nohumeral ligaments, the coracohumeral ligament, and the subscapularis tendon. Hall-effect strain transducers were placed on the superior, middle, and inferior gle nohumeral ligaments. The humerus and scapula were fixed in a specifically designed mounting apparatus that allowed the glenohumeral joint to be placed in 0°, 45°, or 90° of abduction. The mounting apparatus was placed in a model TTC Instron Universal Testing Instru ment, which applied an external rotation torque to the humerus. Strain produced in the three glenohumeral ligaments was recorded on a three-channel X-Y chart recorder.

At 0° of abduction, the superior and middle gleno humeral ligaments developed the most strain. At 45° of abduction, the inferior and middle glenohumeral lig aments developed the most strain, with considerable strain also being developed in the superior glenohu meral ligament. At 90° of abduction, the inferior gleno humeral ligament developed the most strain, with strain also seen in the middle glenohumeral ligament.
A prospective, randomized study of three surgical techniques for treatment of acute ruptures of the anterior cruciate ligament
Authors: Engebretsen Lars , Benum Pal , Fasting Ove , Mølster Anders , Strand Torbjørn
Published: June 2007

Treatment of ACL tears is controversial. Recent reports on nonoperative treatment have shown poor results. Results after primary repair have deteriorated with time, leading to augmentation procedures that seem to have improved the results. However, there have been few prospective, randomized studies in this field. Our goal was to compare primary repair with a bone-patellar tendon-bone augmentation method and with a new method using the Kennedy Ligament Augmentation Device.

One hundred fifty patients aged 16 to 50, all of whom had acute ACL tears, were randomized with the closed envelope method to one of three groups treated with open surgical methods. Fifty patients were treated with primary repair, 50 patients with patellar tendon aug mentation, and 50 patients were augmented with the Kennedy Ligament Augmentation Device. All patients were operated on within 10 days of injury. The rehabil itation protocol was identical, consisting of a long leg cast for 2 weeks, followed by a brace with no weight bearing and limited motion for 6 weeks. The patients were followed prospectively by one surgeon (LE) using the Lysholm functional score, Tegner activity level score, clinical evaluation and KT-1000 arthrometer at 6 months, 1, and 2 years.

Three patients were lost to followup. There was no age or activity level difference between the groups. Sport activities led to 85% of the injuries, with skiing, soccer, and European handball representing 80% of injuries. All three groups reduced their activity level the 1 st year. The repair group remained at the same level after 2 years. The Ligament Augmentation Device group had a small increase, while the patellar tendon group had a significant increase to almost the preinjury level. The patellar tendon group was judged to have results superior to the other groups, according to Lach man, pivot shift, and KT-1000 test results. The Liga ment Augmentation Device group fared better than the primary repair group, according to the Lysholm score, Lachman test, and pivot shift. In general, the results were as follows: the repair group deteriorated from 1 to the 2 years control, the Ligament Augmentation Device group did not change, and the patellar tendon group improved.
The prolonged burner syndrome
Authors: Speer Kevin P. , Bassett Frank H.
Published: June 2007

Over the course of a single football season, six players evaluated by the medical staff had burners that dis played a prolonged neurologic recovery. These players were examined and subsequently evaluated with iso kinetic testing and electrodiagnostic studies to eluci date better the short-term natural history of the pro longed burner syndrome. Evidence of muscular weak ness at 72 hours postinjury best correlated with positive electrodiagnostic findings. No correlation was found between the initial physical examination findings and the results of electrodiagnostic testing. Isokinetic strength evaluation demonstrated many relative strength differences that were difficult to discern with manual muscle testing. The return of a player to athletic competition following this injury should largely be based on the clinical examination.
Physiologic loading of the anterior cruciate ligament does not activate quadriceps or hamstrings in the anesthetized cat
Authors: Pope David F. , Cole Kelly J. , Brand Richard A.
Published: June 2007

We attempted to elicit quadriceps and hamstring elec tromyographic responses in seven chloralose-anesthe tized cats by loading the ACL with controlled anterior displacement of the tibia on the femur using rigid fixa tion and an MTS testing machine. We did not detect reflex activity in the quadriceps or hamstring muscles of any of the cats in response to anterior tibial displace ments of up to 4 mm, with rise times ranging from 1.0 to 0.1 seconds. In four of the cats we loaded the ACL using a wire loop. Loads of up to 125 N (4 to 5 times body weight) produced no reflex activity in any of the four animals, although we consistently observed mono synaptic reflex responses to tendon taps. Whole nerve recordings from the posterior articular nerve revealed substantial activity from afferents in response to tug ging on the ACL, although we could not differentiate receptors in the ACL from those in other periarticular tissues. Thus, while traction on the intact ACL causes signals in the afferent nerves, those signals are not translated into direct monosynaptic reflexes.
Meniscus repair in the anterior cruciate deficient knee
Authors: Hanks Gregory A. , Gause Trenton M. , Handal John A. , Kalenak Alexander
Published: June 2007

From 1979 to 1986, isolated repair of a peripheral vascular zone meniscal tear was performed in 22 pa tients (23 menisci) who had ACL insufficiency. For various reasons none of these patients underwent re pair or reconstruction of their ACL. The meniscus repair was done by open arthrotomy in 12 cases and by arthroscopic techniques in 11 cases. The purpose of this study was to evaluate the success rate of a men iscal repair in an anterior cruciate deficient knee. The average age of the patients at the time of surgery was 25 years and the average followup was 56 months. Six patients (26%) had mild occasional pain not requiring medication and one patient had moderate pain requiring nonnarcotic pain medication. Eight patients (26%) had occasional giving way episodes and one of them under went ACL reconstruction 5 years later because of frequent giving way. One patient required a postoper ative manipulation for inadequate range of motion, but there were no neurovascular injuries or infections. There were three patients (13%) who had failed repairs or a retear and required subsequent subtotal meniscec tomies. None of the other patients had any clinical symptoms or signs of a meniscal tear. There were no significant differences between the results of open or arthroscopic repair. Even though the failure rate of meniscus repair may be greater in an unstable knee, we conclude that meniscus repair is not contraindicated in an anterior cruciate deficient knee.
Injuries in the 1987 National Amateur Volleyball Tournament
Authors: Schafle Marie D. , Requa Ralph K. , Patton Wendy L. , Garrick James G.
Published: June 2007

In a prospective study of injuries in the 1987 United States Volleyball Association's national tournament, we found 154 injuries in 1520 participants during 7812 hours of play. The injury rate in this study was 1.97/ 100 hours of play.

Before the tournament, the participants' history was taken, and during the week of participation, records were kept of every player who presented with an injury.

Players ranged in age from 17 to 60 and competed in five age/gender groups. Females had an injury rate of 2.3 and males had an injury rate of 1.7. The highest injury rate was seen in the men's open division, ages 17 to 35 (2.7), and the lowest rate was seen in the men's Golden Masters, ages 46 and up (1.5). Seventy- nine percent of the injuries occurred during the tour nament and 21 % were considered to be chronic injuries with an acute exacerbation.

The upper extremities accounted for 20% of the injuries. The ankle (17.6%), low back (14.2%), and knee (11%) were the most common injury sites. Strains (36%) and sprains (28%) were the most frequent types of injury. Only eight (5.2%) injuries resulted in more than 5 days of time loss. Two of these injuries involved the knee and two others required surgery.

It is likely that in studies relying upon retrospective methods, fewer of the less severe injuries are found, thereby leading to an overestimation of the percentages of knee and ankle injuries and the proportion of severe injuries. The clinician contemplating providing care for a high-level tournament should expect a preponderance of minor injuries occurring in a variety of anatomical locations. Major injuries were seen but were rare in our study.
A three-phase analysis of the prevention of recreational softball injuries
Authors: Janda David H. , Wojtys Edward M. , Hankin Fred M. , Benedict Milbry E. , Hensinger Robert N.
Published: June 2007

Recreational sports injuries are expensive to society. Prevention of such injuries must be a major public health goal.

In a previous retrospective study, base sliding was found to be responsible for 71 % of recreational softball injuries. Because most injuries occurred during rapid deceleration against stationary bases, quick-release (break-away) bases were evaluated as a means to modify this mechanism of injury. In a prospective study, 633 softball games were played on break-away base fields and 627 games were played on stationary base fields. Forty-five sliding injuries occurred on the station ary base diamonds (1 injury for every 13.9 games) and only two sliding injuries occurred on the break-away fields (1 injury for every 316.5 games). The medical costs for injuries on the stationary base fields was 79 times greater than that on the break-away fields. In a 1035 game follow-up study performed on all fields equipped with break-away bases, two sliding injuries occurred (1 injury for every 517.5 games).

Installing break-away bases in fields used by recrea tional leagues would achieve a significant reduction of serious softball injuries (98%) and, therefore, should be mandatory.

Based on our findings, the Centers for Disease Con trol has estimated 1.7 million injuries would be pre vented nationally per year, saving $2.0 billion per year nationally in acute medical care costs.
Axial loading injuries to the middle cervical spine segment
Authors: Torg Joseph S. , Sennett Brian , Vegso Joseph J. , Pavlov Helene
Published: June 2007

Injuries to the cervical spine at the C3-C4 level involving the bony elements, intervertebral disks, and ligamen tous structures are rare. We present 25 cases of trau matic C3-C4 injuries sustained by young athletes and documented by the National Football Head and Neck Injury Registry. Review of the cases reveals that the response of energy inputs at the C3-C4 level differ from those involving the upper (C1-C2) and lower (C4-C5- C6-C7) cervical segments. Specifically, the C3-C4 le sions appear to be unique with regard to the infre quency of bony fracture, difficulty in effecting and main taining reduction, and a more favorable recovery follow ing early, aggressive treatment. In the majority of instances, injury at this level results from axial loading of the cervical spine. Lesions were distributed into specific categories: 1) acute intervertebral disc hernia tion (N = 4), 2) anterior subluxation of C3 on C4 (N = 4), 3) unilateral facet dislocation ( N = 6), 4) bilateral facet dislocation ( N = 7), and 5) fracture of vertebral body C4 (N = 4).

Analysis of these 25 cases suggests that traumatic lesions of the cervical spine in general can be classified as involving the upper (C1-C2), middle (C3-C4), or lower (C4-C7) segments. This is based on our observations from this series that C3-C4 lesions 1) generally do not involve fracture of the bony elements; 2) acute inter vertebral disc herniations are frequently associated with transient quadriplegia; 3) reduction of anterior sublux ation of C3 on C4 is difficult to maintain; 4) reduction of unilateral facet dislocation is difficult to obtain by skeletal traction and is best managed by closed manip ulation and reduction under general anesthesia; and 5) reduction of bilateral facet dislocation is difficult to obtain by skeletal traction and is best managed by open methods.

The more favorable results observed in this series of immediate reduction of both unilateral and bilateral facet dislocations deserves emphasis. In two cases of unilat eral facet dislocation reduced within 3 hours of injury and subsequently fused anteriorly, significant neuro logic recovery occurred. The other four patients, two who underwent an open reduction and laminectomy and two treated closed with skeletal traction, remained quadriplegic.

In the four instances of bilateral facet dislocation where reduction was achieved by either closed or open methods, although there was no neurologic recovery, all four patients survived their injuries. However, the three patients who were not successfully reduced died.
Isokinetic torque imbalances in the rotator cuff of the elite water polo player
Authors: McMaster William C. , Long Susan C. , Caiozzo Vincent J.
Published: June 2007

The specific repetitive activity of water polo, like base ball pitching, emphasizes adduction and internal rota tion. This study used the Cybex II to evaluate the isokinetic strength of the rotator cuff in elite water polo players and in a group of control subjects. The water polo players were significantly stronger than the con trols. Of greater importance was the confirmation of imbalances in the rotator cuff force couples of adduc tion/abduction and external/internal rotation. These changes are similar to those reported for pitchers. The adductors in the water polo group had gained in relative strength resulting in an increase in the adduction/ab duction ratio to about 2:1. The internal rotators had gained in relative strength resulting in a decrease in the external/internal ratio to about 0.6:1. For both force couples the differences are more apparent at a slow speed. Side-to-side differences were not significant.
Analysis of athletic performance with prophylactic ankle devices
Authors: Burks Robert T. , Bean Bill G. , Marcus Robin , Barker Howard B.
Published: June 2007

We evaluated the effect of different ankle support de vices on athletic performance. Thirty varsity college athletes were tested with both ankles supported by taping, Swede-O brace, Kallassy brace or left unsup ported. The athletes performed four events: broad jump, vertical leap, 10 yard shuttle run, and 40 yard sprint. The events and appliances were randomized to prevent bias by fatigue.

Compared to the results when no support was used, ankle taping resulted in a significant decreased perform ance in the vertical jump (4%), shuttle run (1.6%), and sprint (3.5%) (P < 0.05). Use of the Swede-O brace decreased performance in the vertical jump (4.6%), broad jump (3.6%), and time of the sprint (3.2%). Re sults using the Kallassy brace showed a decrease in the vertical jump (3.4%) when compared to no support. The test results of the shuttle run with taping were slower than the Kallassy brace (P < 0.05). Wearing the Swede-O brace caused the athletes' broad jump dis tance to decrease more than the Kallassy brace (P < 0.05). Subjective questionnaires supported the Kallassy brace as the most comfortable support and the one that decreased performance the least.

Taping of the ankles is universally accepted for ankle prophylaxis. This study has shown a decrease in per formance when ankles are taped compared to ankles with no protection. Since the decreases in performance caused by ankle braces are minor, this should not be used as a criterion for selection of prophylactic support compared to taping.
Injuries in high-risk persons and high-risk sports
Authors: Backx Frank J.G. , Beijer Hein J.M. , Bol Eduard , Erich Wietze B.M.
Published: June 2007

In this Dutch population-based study we attempted to determine the incidence and severity of sports injuries occurring during different kind of sports in a longitudinal way. The study included 1818 school children aged 8 to 17 years. Over a period of 7 months, 399 sports injuries were reported in 324 youngsters. The most common types of injuries were contusions (43%) and sprains (21 %). Medical attention was needed in 25% of all cases. Young basketball, handball and korfball play ers had a nearly 100% chance of suffering one sports injury per year. Volleyball especially had a high inci dence rate in practice (6.7 in 1000 hours). Although physical education classes had a low incidence rate, there were significantly more fractures on the upper limb. Etiologically, sports-related factors were much more important than personal-bound factors. The in jured youths spent more time in practice than the noninjured ones, both in organized and nonorganized sports (P < 0.001). High-risk sports were characterized by contact, a high jump rate, and indoor activities. These three factors explained 78% of the total variance. The contact versus noncontact factor accounted for 48% of the medically treated injuries. An additional goal of this study was to explore the seasonal influence as an extrinsic environmental factor. We found that the duration of injury was increased in the spring (P < 0.05). Specific preventive measures were formulated in order to reduce the number of new and recurring inju ries and a proposal was made to implement injury prevention in school curriculums.
Assessing the limits of knee motion
Authors: Daniel Dale M.
Published: June 2007

Ten patients were examined clinically by 11 experi enced knee surgeons and with three measurement devices (Genucom, Knee Signature System, and KT- 1000). Nine of the 10 patients examined had sustained documented intraarticular ligament disruptions includ ing eight ACL disruptions and five posterior cruciate ligament disruptions. The eight patients with ACL inju ries had undergone reconstructive surgery. The clinical examination test sequence was performed as de scribed by the International Knee Documentation Com mittee. Testing results were reported as estimated degrees of angulation or millimeters of displacement. Testing results were divided into two groups based on the index minus nonindex knee difference. Eighteen displacement tests were performed on each knee by each examiner. The index minus nonindex knee differ ence was greater than 3 mm in 16% of the tests. Only 1 of the 198 displacement tests performed on the subject who did not have a ligament disruption was recorded as an index minus nonindex difference greater than 3 mm. There was appreciable difference between measurements recorded by different examiners, partic ularly anterior/posterior measurements in patients who had sustained combined anterior and posterior cruciate ligament injuries. There is a need to rigorously evaluate limits of motion tests that are used to develop treatment plans and report the results of ligament surgery.
The long-term course after treatment of acute anterior cruciate ligament ruptures
Authors: Sommerlath Karola , Lysholm Jack , Gillquist Jan
Published: June 2007

Acute total ACL (N = 60) and concomitant medial collateral ligament ( N = 46) ruptures were repaired in 60 patients (mean age, 28 years) without augmentation. Menisci were removed in 23 knees. Fifty-three (88%) of the patients were reexamined 9 to 16 years later with special emphasis on manual and instrumented stability testing (Stryker, Genucom), knee function score (Lysholm), and activity level (Tegner). Standing roentgenograms (30° of knee flexion) were taken in 69% of the patients. At followup, an ACL reconstruction had been performed in seven patients (12%) due to symptomatic instability. Sixty-four percent of the knees had a positive Lachman sign and 40% a positive pivot shift. Sagittal laxity difference was +3 mm or more in 57%. Knee function score was a mean of 86 ± 12 points. The mean activity level had changed from rec reational team sports (Level 7) to recreational individual sports (Level 5). Only patients with good knee stability were able to perform demanding sports and could continue at their desired activity level. Osteoarthritis of slight to moderate degree (Fairbank I/II) was found in 58% of the patients younger than 35 years of age at the time of trauma and in 87% of the older patients. Knees with intact menisci had less osteoarthritis than knees with removed menisci (P < 0.05).
The assessment of work-related activities and limitations in knee disorders
Authors: Noyes Frank R. , Mooar Lisa A. , Barber Sue D.
Published: June 2007

The success of knee treatment programs and surgery must be assessed, in part, by both the ability to return patients to work and the documentation of any work- related limitations. Existing occupational rating scales do not rate, in a valid manner, the effect of altered knee function on work activities. We performed a prospective randomized clinical trial in which two different occupa tional rating systems were tested on 50 patients. One system used job titles and an arbitrary numeric scale for rating occupations; the other used specific criteria for rating job functions according to the intensity, fre quency, and duration of certain tasks. The results showed that an effective and valid rating format should consist of five specific objectives: 1) evaluation of dif ferent knee functions that typically occur in the work environment; 2) evaluation of work activities separately from sports activities; 3) detection of patients who may have remained at an occupation but who have signifi cantly modified work activities because of knee symp toms ; 4) identification of patients who continue to work despite experiencing moderate to severe symptoms; and 5) identification of patients whose work activities decrease because of nonknee-related factors. Further more, the results showed that an effective rating sys tem should identify common data reduction errors that can bias the results in analyzing knee-related occupa tional limitations. The rating system developed circum vents the bias introduced by these anomalies. This system, if adopted by other researchers, would allow for the comparison of treatment results among studies.
The long-term followup of primary anterior cruciate ligament repair
Authors: Sherman Mark F. , Lieber Lawrence , Bonamo Joel R. , Podesta Luga , Reiter Ira
Published: June 2007

Fifty primary ACL repairs using the Marshall multiple suture technique were analyzed. The average age at surgery was 23 years (range, 15 to 56), with 76% under the age of 30. The average followup was 61.3 months (range, 48 to 86). The average time from injury to surgery was 7 days (range, 1 to 18). Eighty percent of the injuries were sports-related with football and skiing predominating. Thirty-eight percent were "isolated" ACL tears, and 62% had associated injuries. There was a 46% incidence of meniscal tear with 59% of the meniscal tears being repaired.

The postoperative evaluation included a multifactorial analysis correlating 43 variables including subjective, objective, radiographic, and KT-1000 data. The Hospi tal for Special Surgery Knee Diagnostic Score, a clinical objective score based on the postoperative Lachman and pivot shift examination, a KT-1000 arthrometer data score, and an overall combined assessment score were determined. The results showed 59% excellent, 18% good, 14% fair, and 8% poor.

The Lachman test was diagnostic in all cases. The quality of ACL tissue at repair was rated excellent or good in 62% of the cases. Four patterns of ACL tears were distinguished by the location of the tear. Football injury, younger age, increased preoperative pivot shift, midsubstance Type IV tear, and return of full motion correlated with poor postoperative results. Increasing age, tight jointedness, Type I tears, and a 5° flexion contracture correlated with good postoperative results.
Anterior cruciate ligament reconstruction using bone-patellar tendon-bone allografts
Authors: Drez David J. , DeLee Jesse , Holden John P. , Arnoczky Steven , Noyes Frank R. , Roberts Thomas S.
Published: June 2007

Twenty-eight goats underwent ACL reconstruction with freeze-dried bone-patellar tendon-bone allografts in one knee, the opposite knee serving as a control. One group of 16 knees was evaluated, in groups of four, at 6, 12, 26, and 52 weeks by histologic and vascular injection techniques. The other group of 12 knees was evaluated in two groups of six at 26 and 52 weeks by morpholog ical and biomechanical techniques of analysis.

Within the first 12 weeks these allografts were revas cularized ; in the first 26 weeks they had matured to resemble normal connective tissue. Graft stiffness was 29% of the control value and maximum force to failure was 43% of the control value.

The results of this study indicated that freeze-dried bone-patellar tendon-bone allografts are biomechani cally and biologically similar to patellar tendon auto- grafts.
Modification of the Bankart reconstruction with a suture anchor
Authors: Richmond John C. , Donaldson William R. , Fu Freddie , Harner Christopher D.
Published: June 2007

We assessed the effectiveness of a new suture anchor that has been designed to anchor sutures into a blind, straight hole drilled in bone. The strength of fixation in glenoid bone is 67 N for the No. 0 anchor and suture, and 82 N for the No. 2 device with suture. During 1988 and 1989, 32 patients underwent a modified Bankart reconstruction for recurrent anterior glenohumeral in stability at two centers as part of a prospective study of this modified technique. There were no complications as a result of the technique. The four surgeons involved agreed that the suture anchor simplified the procedure. Seventeen patients have been reviewed, with more than 1 year followup. Ninety-four percent had good to excellent results according to the Bankart rating scale. There was one recurrent dislocation in a football player.
Stress avulsion fracture of the tarsal navicular
Authors: Orava Sakari , Karpakka Jarmo , Hulkko Antero , Takala Timo
Published: June 2007

We report nine cases of stress-related avulsion fracture of the tarsal navicular in athletes. This uncommon over use injury is thought to occur following repetitive cyclic compressive loading secondary to an impingement of the tarsal navicular. The small dorsal triangular frag ment is best seen in weightbearing lateral view radio graphs and isotope scan and/or tomography help con firm the diagnosis. We feel that operative treatment is the method of choice in highly symptomatic cases and among top athletes because of the shorter recovery time.
Magnetic resonance imaging of traumatic knee articular cartilage injuries
Authors: Speer Kevin P. , Spritzer Charles E. , Goldner J. Leonard , Garrett William E.
Published: June 2007

The purpose of this study was to assess the sensitivity of magnetic resonance imaging in determining the pres ence of articular cartilage injuries of the knee with arthroscopy as the standard for comparison. Forty-nine articular cartilage lesions were documented in 28 knees (27 patients) by arthroscopy. There were 22 men and 5 women with an average age of 29 years. Multiplanar magnetic resonance imaging was performed with spin echo and gradient-refocused acquisition in a steady state pulse technique. All of the knees had magnetic resonance imaging done within 4 weeks prior to ar throscopy. The magnetic resonance images were inter preted before arthroscopy and interpreted again after the results of arthroscopy were known to better define the potential learning curve for evaluating chondral lesions and to identify the technical limits of the existing imaging protocol/software. For full-thickness articular cartilage lesions, the prearthroscopy sensitivity of mag netic resonance imaging was 41% (12/29) and the postarthroscopy sensitivity was 83% (24/29). For par tial-thickness chondral injury, the prearthroscopy sen sitivity of magnetic resonance imaging was 15% (3/20) and the postarthroscopy sensitivity was 55% (11/20). The presence of an intraarticular effusion assisted the detection of chondral lesions because of an "arthro gram" effect. As a noninvasive method of evaluating articular cartilage and despite experienced interpreta tion and the benefit of retrospective analysis, both the prearthroscopy and the postarthroscopy sensitivity of magnetic resonance imaging was low using the imaging parameters described. Injury to articular cartilage is a frequent cause of knee pain and knee surgery; it is important to note at this time that magnetic resonance imaging cannot reliably exclude the presence of an articular cartilage injury.
Effectiveness of orthotic shoe inserts in the long-distance runner
Authors: Gross Michael L. , Davlin Lance B. , Evanski Philip M.
Published: June 2007

Five hundred questionnaires were distributed to long- distance runners who had used, or who were using orthotic shoe inserts for symptomatic relief of lower extremity complaints. Three hundred forty-seven (69.4%) responded (males, 71%; females, 29%). The mean age of the respondents was 36 years (range, 15 to 61). The average distance run per week was 39.6 miles (range, 5 to 98). The mean duration for use of the orthotic inserts was 23 months (range, 1 to 96). The predominant (63%) type of orthotic device used was flexible. The presumed diagnoses in the population studied were excessive pronation (31.1 %), leg length discrepancy (13.5%), patellofemoral disorders (12.6%), plantar fasciitis (20.7%), Achilles tendinitis (18.5%), shin splints (7.2%), and miscellaneous (4.9%).

Of the runners responding, 262 (75.5%) reported complete resolution or great improvement of their symptoms. Results of treatment with orthotic shoe inserts were independent of the diagnosis or the run ner's level of participation. A high degree of overall satisfaction was demonstrated by the finding that 90% of the runners continued to use the orthotic devices even after resolution of their symptoms. Orthotic shoe inserts were most effective in the treatment of symp toms arising from biomechanical abnormalities, such as excessive pronation or leg length discrepancy. Along with other conservative measures, orthotic shoe inserts may allow the athlete to continue participation in run ning and avoid other treatment modalities that are more costly and time consuming, and therefore less accept able to them.
Serum lidocaine and bupivacaine levels in local technique knee arthroscopy
Authors: Weiker Garron G. , Kuivila Thomas E. , Pippinger Charles E.
Published: June 2007

We investigated serum levels of lidocaine and bupiva caine following their intraarticular and subcutaneous injection for anesthetic effect in local technique knee arthroscopy. Fifteen patients scheduled for knee ar throscopy, but who were otherwise healthy, were stud ied. Following preparation of the knee, 25 cc of 1% lidocaine with epinephrine (1:100,000) and 25 cc of 0.25% bupivacaine were instilled into the knee joint. An additional 40 cc of the combined solution was used to anesthetize four arthroscopic portal sites from the skin into the joint capsule. The arthroscopic procedure was then performed. We took blood samples 5, 15, 30, 60, and 120 minutes after intraarticular injection. High- performance liquid chromatography was used to deter mine serum values of the agents. Levels of the anes thetic agents in all of the patients at all time intervals were well within the ranges considered safe. Patient surveys of these and 49 other patients indicated a high degree of satisfaction with the technique. No compli cations from the anesthetic agents were noted at our hospital in over 500 similar cases. We conclude that local anesthesia as described here is a safe and effec tive alternative to conventional anesthetic techniques. Additionally, it can save time in the operating room and reduce patient costs.
Arthroscopic treatment of symptomatic synovial plica of the knee
Authors: Dorchak John D. , Barrack Robert L. , Kneisl Jeffrey S. , Alexander A. Herbert
Published: June 2007

We studied all patients undergoing arthroscopic resec tion of symptomatic plica without other intraarticular abnormality at our institution from October 1981 to March 1987. To be considered abnormal, plicae had to be thickened and/or fibrotic when viewed arthroscopi cally. Seventy-six of nearly 2000 patients (4%) who underwent diagnostic arthroscopies met our inclusion criteria. Clinical response after arthroscopic resection was evaluated in 51 patients at an average of 47 months (range, 15 to 77).
The painful shoulder during freestyle swimming
Authors: Scovazzo Mary Lynn , Browne Anthony , Pink Marilyn , Jobe Frank W. , Kerrigan John
Published: June 2007

The purpose of this paper is to describe the patterns of activity of 12 shoulder muscles in painful shoulders, and compare those patterns of activity with normal shoulders. The results show significant differences in 7 of the 12 muscles. Those muscles included the anterior deltoid, middle deltoid, infraspinatus, subscapularis, up per trapezius, rhomboids, and the serratus anterior. There were no significant differences between muscle activity patterns of normal versus painful shoulders in the latissimus dorsi, pectoralis major, teres minor, su praspinatus, or the posterior deltoid. This information will contribute to the development of muscle condition ing programs to optimize performance and prevent injury, as well as develop programs for scientific reha bilitation strengthening.
Physiologic responses to maximal treadmill and deep water running in men and women
Authors: Butts Nancy Kay , Tucker Mary , Greening Christine
Published: June 2007

Maximal physiologic responses to treadmill running and deep water running using a flotation device were com pared in 12 trained men and 12 trained women. Al though the men had significantly higher ventilation vol umes, VO2max (liters of oxygen per minute and milli liters of oxygen per kilogram per minute), there were no significant differences in maximal heart rates or respiratory exchange ratios between the sexes. Signif icantly lower ventilation volumes, VO2max (LO2:min-1 and mlO2·kg -1·min-1), and heart rates were obtained in response to maximal water running compared to treadmill running, regardless of gender. Neither the men's nor the women's maximal respiratory exchange ratios were significantly different between modes. The analysis of variance indicated that there were no signif icant interactions for any of the maximal responses to the tests between the sexes. The magnitude of these differences is similar to that found between treadmill running and cycling ergometry and should not preclude deep water running as a training technique. Caution, however, is advised if the training intensity is to be prescribed on the basis of land-determined heart rates.
Quantitative assessment and training of isometric cervical extension strength
Authors: Leggett Scott H. , Graves James E. , Pollock Michael L. , Shank Michael , Carpenter David M. , Holmes Bryon , Fulton Michael
Published: June 2007

The purpose of this study was to evaluate the reliability and variability of repeated measurements of isometric cervical extension strength and determine the effect of 10 weeks of dynamic variable resistance cervical ex tension training on isometric cervical extension strength. Seventy-three subjects (age, 29 ± 12 years [mean ± SD]) completed isometric cervical extension strength tests on 4 separate days (D1, D2, D3, and D4). For each test, isometric cervical strength was measured at 126°, 108°, 90°, 72°, 54°, 36°, 18°, and 0° of cervical flexion. Between-day correlation coeffi cients over the eight angles of cervical flexion were high for D2 versus D3 (r = 0.90 to 0.96). Test variability (standard error of estimate) between D2 versus D3 was low (7.4% to 10.2% of mean) through the entire range of motion. Regression analysis showed that the iso metric cervical extension strength curve is linear and descending from flexion to extension. In a second study, 14 subjects (age, 25 ± 3 years) trained the cervical extensor muscles for 10 weeks while 10 sub jects (age, 23 ± 3 years) served as controls. Training included 8 to 12 cervical extensions to volitional fatigue, 1 day per week. The training group improved isometric cervical extension strength at six of eight angles before to after training ( P ≤ 0.05). During the same time period the control group did not change. These data indicate that repeated measures of isometric cervical extension strength are highly reliable and can be used for the quantification of isometric cervical extension strength through a 126° range of motion. Also, training the cervical extensors 1 day per week can significantly increase isometric cervical extension strength through most of the range of motion.
Role of the coracoid bone block in the modified Bristow procedure
Authors: Schauder Keith S. , Tullos Hugh S.
Published: June 2007

In 20 shoulders (19 patients) with a Bankart lesion, the isolated coracoid process was transferred as a bone graft to the anterior rim of the glenoid. The graft was positioned directly at the site of the Bankart lesion without displacing the insertion of the conjoined tendon or subscapularis. The average age of the patients was 22.5 years (range, 15 to 42). Follow-up examination at a minimum of 3 years (average, 55 months) showed 17 of 20 shoulders (85%) presented with good or excellent results. One recurrent dislocation was noted. There were no complications related to screw fixation of the coracoid process. External rotation loss of the operated arm in 90° of abduction averaged only 5°. Ten of 12 patients (83%) with an operation on the dominant shoul der returned to throwing sports and overhead motion activities. However, a 15% fair or poor rate suggests that this procedure may control dislocation, but that subluxation is not as well controlled.
Injuries to pitchers in women's collegiate fast-pitch softball
Authors: Loosli Alvin R. , Requa Ralph K. , Garrick James G. , Hanley Ellen
Published: June 2007

An injury survey of eight college softball teams ranked among the top 15 during the 1989 women's NCAA tournament championship by their athletic trainers found 26 injuries and complaints in 20 of 24 players. There were 15 grade I (nontime-loss) injuries, all mus culotendinous except for a leg contusion and an ankle sprain. The 6 grade II injuries (altered play) were also musculotendinous except for 2 sprains to the hand and wrist. The 5 grade III (stopped play) injuries were some what more varied in type and resulted in an average of almost 7 weeks of time lost per injured player. Eighty- two percent of the time-loss injuries (grades II and III) involved the upper extremity. This survey suggests that there are likely to be a significant number of injuries involving loss of time from practice or games among elite women's fast-pitch softball pitchers.