bluuebunny/crossref_metadata_2025 huggingface dataset:
The Use of Cold Therapy After Anterior Cruciate Ligament Reconstruction
Authors: Konrath Gregory A. , Lock Terrence , Goitz Henry T. , Scheidler Jeb
Published: June 2007

We performed a randomized, prospective study to as sess the effectiveness of postoperative cold therapy in patients who had anterior cruciate ligament reconstruc tions. Drain output, length of hospital stay, range of motion, and use of pain medication were all assessed. Patients were randomized into one of four groups after surgery. Group 1 patients had a cooling pad applied to the knee postoperatively and set at a temperature of 40° to 50°F, Group 2 had the cooling pad set at 70° to 80°F, Group 3 received ice packs, and Group 4 re ceived no cold therapy of any kind. The skin tempera tures in Groups 1 and 3 were significantly lower than the skin temperatures in Groups 2 and 4 ( P < 0.001). The length of hospital stay, range of motion at dis charge, use of oral and intramuscular pain medicine, and drain output were not significantly different be tween groups. No complications related to the type of cold therapy were seen in any group. Thus, both ice packs and cooling pads significantly decreased knee temperature, but we found no objective benefits in the early postoperative course due to this decrease in temperature.
Assessment of Thumb Positioning in the Treatment of Ulnar Collateral Ligament Injuries
Authors: Adams Brian D. , Muller David L.
Published: June 2007

In the treatment of ulnar collateral ligament injuries in the metacarpophalangeal joint of the thumb, a cast or splint is often molded with the thumb and hand posi tioned so the patient can return quickly to a particular sport or activity. However, it is unknown whether a given position of immobilization or whether an early rehabilitation program will compromise ligament heal ing by causing undue tension in the ligament. To better define acceptable positions for thumb immobilization and a safe range of motion, this laboratory study mea sured strain in the ulnar collateral ligament at different degrees of metacarpophalangeal joint flexion. Liga ment strain was found to increase with increasing joint flexion; the most significant increases in strain oc curred as the joint moved from 0° to 25° of flexion, with the dorsal portion of the ligament demonstrating greater strain than the palmar portion. Based on these results, immobilization of the metacarpophalangeal joint in excessive flexion and unrestricted early reha bilitation exercises should be done with caution and guided by the grade of injury or the quality of repair.
The Effect of Tourniquet Use in Anterior Cruciate Ligament Reconstruction
Authors: Arciero Robert A. , Scoville Charles R. , Hayda Roman A. , Snyder Robert J.
Published: June 2007

To evaluate the effect of tourniquet use during anterior cruciate ligament reconstruction, 40 consecutive pa tients were randomized into two groups: Group I (tour niquet) and Group II (no tourniquet). Preoperative eval uation included electromyography, measurement of thigh and calf girth, and determination of serum creat inine phosphokinase levels. Initial postoperative eval uations included serial creatinine phosphokinase de terminations. At 1 and 6 months postoperatively, the electromyographic examination was repeated and thigh and calf girth measurements were obtained. At 6 months and 1 year after surgery, the following evalu ations were made: thigh and calf girth, KT-1000 arthro metric testing, isokinetic testing of quadriceps and hamstring muscles, single-legged hop test for time, single-legged hop test for distance, and the Lysholm knee score. In Group I, the tourniquet was inflated for an average of 87 minutes, with an average pressure of 269 mm Hg. At 1 month postoperatively, 6 of 20 pa tients in Group I had positive electromyographic re cordings (compared with 2 of 20 in Group II, P = 0.08). At 1 month, thigh girths measured 10 cm proximal to the medial joint line suggested more atrophy in the tourniquet group ( P = 0.07). At 6 months, all electro myographic recordings had returned to normal. At 6 months and 1 year postoperatively, girth meas urements, isokinetic strength testing, functional testing, KT-1000 arthrometer evaluation, and the Lysholm knee scores were similar for both groups.
Proprioception in Anterior Cruciate Ligament-Deficient and Reconstructed Knees
Authors: MacDonald Peter B. , Hedden David , Pacin Ondrej , Sutherland Kelly
Published: June 2007

Proprioceptive function of the knee was quantified and compared in three groups of patients: those with ante rior cruciate ligament deficiency, with hamstring ten dons-ligament augmentation device anterior cruciate ligament reconstructions, and with bone-patellar ten don-bone anterior cruciate ligament reconstructions. A total of 32 subjects, including 6 uninjured control sub jects, were tested for threshold to perception of passive motion of the knee. All other sensory input was neu tralized and testing occurred in the 30° to 40° range of knee flexion. The noninvolved contralateral knee served as a control for each subject. Each leg was moved at 0.5 deg/sec into flexion or extension in a random sequence. The variables of age, KT-1000 ar thrometer scores, injury-to-surgery interval, injury-to- followup interval, and patient satisfaction were statisti cally analyzed for correlation with threshold to perception of passive motion of the knee. Control sub jects showed no statistically significant differences in threshold between their two knees. The three test groups all showed significantly higher values in the involved knee compared with the noninvolved knee ( P < 0.01). However, no statistically significant differ ences were found between the groups, including con trols, with respect to mean threshold to perception of passive motion. According to these results, anterior cruciate ligament reconstruction did not improve pro prioception in the patients in this study.
Comparison of Intersegmental Tibiofemoral Joint Forces and Muscle Activity During Various Closed Kinetic Chain Exercises
Authors: Stuart Michael J. , Meglan Dwight A. , Lutz Gregory E. , Growney Eric S. , An Kai-Nan
Published: June 2007

The purpose of this study was to analyze intersegmen tal forces at the tibiofemoral joint and muscle activity during three commonly prescribed closed kinetic chain exercises: the power squat, the front squat, and the lunge. Subjects with anterior cruciate ligament-intact knees performed repetitions of each of the three exer cises using a 223-N (50-pound) barbell. The results showed that the mean tibiofemoral shear force was posterior (tibial force on femur) throughout the cycle of all three exercises. The magnitude of the posterior shear forces increased with knee flexion during the descent phase of each exercise. Joint compression forces remained constant throughout the descent and ascent phases of the power squat and the front squat. A net offset in extension for the moment about the knee was present for all three exercises. Increased quadri ceps muscle activity and decreased hamstring muscle activity are required to perform the lunge as compared with the power squat and the front squat. A posterior tibiofemoral shear force throughout the entire cycle of all three exercises in these subjects with anterior cru ciate ligament-intact knees indicates that the potential loading on the injured or reconstructed anterior cruci ate ligament is not significant. The magnitude of the posterior tibiofemoral shear force is not likely to be detrimental to the injured or reconstructed posterior cruciate ligament. These conclusions assume that the resultant anteroposterior shear force corresponds to the anterior and posterior cruciate ligament forces.
Chronic Achilles Tendinitis and Calf Muscle Strength
Authors: Alfredson Hakan , Pietilä Tom , Lorentzon Ronny
Published: June 2007

We evaluated 10 men and 3 women (mean age, 44 ± 8.5 years) with chronic Achilles tendinitis who under went surgical treatment. Surgery was followed by im mobilization in a weightbearing below-the-knee plaster cast for 6 weeks and a stepwise increasing strength training program. We prospectively studied calf muscle strength on the injured and noninjured sides preoper atively and at 16, 26, and 52 weeks postoperatively. Preoperatively, concentric peak torque in dorsiflexion at 90 deg/sec and plantar flexion at 225 deg/sec was significantly lower on the injured side. Postoperatively, concentric plantar flexion peak torque on the injured side increased significantly between Weeks 16 and 26 at 90 deg/sec but was significantly lower than the noninjured side from Weeks 16 to 52 at 90 and 225 deg/sec. Dorsiflexion peak torque at 90 and 225 deg/ sec increased between Weeks 0 and 26 and was significantly higher on the injured side at Week 26. Eccentric plantar flexion peak torque was significantly lower on the injured side at Week 26 but not at 1 year. This prospective study demonstrates that 6 months of postoperative rehabilitation for chronic Achilles tendi nitis is not enough to recover concentric and eccentric plantar flexion muscle strength compared with the non injured side.
Elongation of Arthroscopically Tied Knots
Authors: Mishra Dev K. , Cannon W. Dilworth , Lucas Duncan J. , Belzer John P.
Published: June 2007

It has been postulated that some arthroscopic shoulder stabilization failures may be due to knot slippage. In an effort to improve arthroscopic technique, we performed tensile testing on four arthroscopically tied knots with two commonly used suture materials. Handtied square knots served as controls. Sutures of No. 1 Maxon and No. 1 Ticron were used. Four types of sliding knot configurations were tested: the overhand loop, the Duncan loop, the Roeder knot, and the Snyder knot. Knots were tied via a knot pusher, and testing was performed in a normal saline-filled thermoplastic cham ber. Knots were tied around two rings connected to a Bionix 858 materials testing apparatus. The knots were tested under conditions of cyclic loading and loading to failure. Results of the testing revealed that the most important factor in knot security was the type of suture material, although there were differences with the type of knot. With the Maxon suture, there was significantly decreased ultimate failure load of all of the arthroscopi cally tied knots compared with handtied square knots. Knots tied with Ticron were similar in strength for both arthroscopically and handtied groups. The surgeon who chooses a monofilament absorbable suture should be aware that a high percentage of knots fail under low load cyclic testing, and that all of these knots were inferior to handtied square knot controls in testing to failure.
The Effect of Exercise, Prewrap, and Athletic Tape on the Maximal Active and Passive Ankle Resistance to Ankle Inversion
Authors: Manfroy Pierre P. , Ashton-Miller James A. , Wojtys Edward M.
Published: June 2007

This investigation explored alternatives to the null hy potheses that maximal active and passive resistance to inversion developed by a near-maximally inverted and weightbearing ankle is not altered by 1) the use of prophylactic adhesive athletic tape, 2) the use of non- adhesive prewrap (underwrap), or 3) 40 minutes of vigorous exercise. Ten healthy men and 10 healthy women (mean age, 25 ± 3 years) with no recent ankle injuries underwent testing to determine maximal ankle resistance to inversion under unipedal, weightbearing conditions. Tests were performed with and without the support of athletic tape, and before and after 40 min utes of exercise. Half the testing sessions were per formed with prewrap under the tape. At 15° of inver sion, without any external ankle support, healthy young men and women could maximally resist a mean (SD) inversion moment of 52.9 (6.4) N-m and 28.3 (5.8) N-m, respectively. Although use of ankle tape provided a 10% increase in maximal resistance to inversion moments, this increase diminished to insignificant lev els after 40 minutes of vigorous exercise. Use of pre wrap improved maximal resistance to inversion by more than 10%.
Magnetic Resonance Imaging During Healing of Surgically Repaired Achilles Tendon Ruptures
Authors: Karjalainen Pertti T. , Aronen Hannu J. , Pihlajamäki Harri K. , Soila Kalevi , Paavonen Timo , Bostman Ole M.
Published: June 2007

Twenty consecutive patients with 21 surgically re paired Achilles tendon ruptures were imaged with a 0.1-T magnet at 3 and 6 weeks, and at 3 and 6 months after surgery. Clinical follow-up examinations and func tional tests were performed at the time of scanning. An intratendinous area of high-intensity signal was ob served in 19 of the 21 surgically repaired Achilles tendons at 3 months after surgery on proton density- and T2-weighted images. The three patients with the largest lesions had clinically poor outcomes at 3 months, whereas those with smaller intratendinous le sions had normal recoveries. Furthermore, patients with an abnormal walk at 3 months (N = 5) had sta tistically larger intratendinous lesions than patients who could walk normally. In all patients the cross- sectional area of the rejoined Achilles tendon showed the largest increase after cast removal (between 6 weeks and 3 months after surgery). In all cases the largest tendon area was measured at 3 months after surgery. Magnetic resonance imaging provides a pre cise valuable tool to evaluate the postsurgical internal structure of the surgically repaired Achilles tendon.
Recalcitrant Patellar Tendinitis
Authors: Popp James E. , Yu Joseph S. , Kaeding Christopher C.
Published: June 2007

Magnetic resonance imaging findings and the results of surgical treatment and histologic evaluation of 11 knees in 9 athletes with recalcitrant patellar tendinitis are reported. All of the athletes had no improvement with traditional nonoperative treatment and all had ab normal magnetic resonance imaging findings consis tent with chronic patellar tendinitis. Surgical exploration and debridement were performed on the 11 knees by the same surgeon. With a minimum followup of 1 year, 7 of the 11 knees had excellent results, 3 had good results, and 1 had a poor result. Histologic evaluation of the debrided tissue was consistent with "angiofibro blastic tendinosis," which correlated with the abnormal preoperative magnetic resonance imaging findings in the proximal third of the infrapatellar tendon. This study correlated histologic findings with magnetic resonance imaging findings and shows that in selected patients excellent results can be achieved with surgical treat ment of recalcitrant patellar tendinitis or "jumper's knee."
Three-Dimensional Analysis of Normal Ankle and Foot Mobility
Authors: Kitaoka Harold B. , Ping Luo Zong , An Kai-Nan
Published: June 2007

We defined foot and ankle motion with respect to the neutral position. Thirteen normal fresh-frozen speci mens of the human foot were used. The foot was placed in the extreme positions of pronation, supina tion, dorsiflexion, and plantar flexion, and positions of multiple bones were monitored simultaneously with a magnetic tracking device to determine rotation of the talocrural, subtalar, metatarsal-navicular, and talo navicular joints under the various conditions. In prona tion, the most rotation occurred at the metatarsal-na vicular level, followed by the navicular-talar, talar-tibial, and calcaneal-talar levels. In supination, most rotation occurred at the navicular-talar level, followed by the calcaneal-talar, talar-tibial, and metatarsal-navicular levels. In dorsiflexion, most rotation occurred at the talar-tibial level, followed by the navicular-talar, calca neal-talar, and metatarsal-navicular levels. In plantar flexion, most rotation occurred at the talar-tibial level, but there was considerable motion at the navicular- talar, metatarsal-navicular, and calcaneal-talar levels. Understanding the specific joint motions that occur with various positions of the foot and ankle is important because measurements of joint mobility may assist in establishing diagnoses, monitoring clinical conditions, determining indications for operative treatment, as sessing results of treatment, and following the progress of rehabilitation.
The Effect of a Pneumatic Leg Brace on Return to Play in Athletes with Tibial Stress Fractures
Authors: Swenson E. James , DeHaven Kenneth E. , Sebastianelli Wayne J. , Hanks Gregory , Kalenak Alexander , Lynch James M.
Published: June 2007

A total of 18 competitive and recreational athletes were enrolled in a randomized, prospective study looking at the effect of pneumatic leg braces on the time to return to full activity after a tibial stress fracture. All patients had positive bone scans and 15 had positive radio graphic findings by Week 12. There were two treat ment groups. The traditional treatment group was treated with rest and, after 3 pain-free days, a gradual return to activity. The pneumatic leg brace (Aircast) group had the brace applied to the affected leg and then followed the same return to activity guidelines. The guidelines consisted of a detailed functional pro gression that allowed pain-free return to play. The brace group was able to resume light activity in 7 days (median) and the traditional group began light activity in 21 days (median). The brace group returned to full, unrestricted activity in 21 ± 2 days, and the traditional group required 77 ± 7 days to resume full activity. The Aircast pneumatic brace is effective in allowing ath letes with tibial stress fractures to return to full, unre stricted, pain-free activity significantly sooner than tra ditional treatment.
Fibular Grooving for Recurrent Peroneal Tendon Subluxation
Authors: Kollias Stephen L. , Ferkel Richard D.
Published: June 2007

Twelve ankles in 11 consecutive patients with recur rent peroneal tendon dislocations were studied after undergoing a fibular grooving procedure. The mean age of the patients was 25 years (range, 13 to 45). The mean time from initial injury to surgery was 18 months, and the mean follow-up time was 6 years. All patients had preoperative peroneal tenderness; 9 of 12 ankles had active peroneal tendon subluxation on examina tion. All patients had failed results from nonoperative treatments of rehabilitation and bracing. Before the fibular grooving procedure, 10 ankles were shown to have intraarticular pathologic changes on arthroscopic evaluation. Postoperatively, there were no resubluxa tions. Eleven ankles were pain-free, 10 had full and symmetric range of motion, and 1 patient lost 3° of eversion. Ten patients were able to return to full unre stricted activities including all previous sports. Eleven ankles were rated as excellent results. Complications included suture abscesses in two patients and refrac tory pain in one patient who had multiple surgeries for subtalar pain but had no peroneal resubluxation. Re current peroneal tendon subluxation is an uncommon problem. An accurate diagnosis is essential. The fibu lar grooving procedure appears to reproducibly allevi ate resubluxation of the peroneal tendons and diminish pain. It also allows for retainment of motion and sub sequent return to work and sports with a high satisfac tion rate.
Knee Injuries in Women Collegiate Rugby Players
Authors: Levy Andrew S. , Wetzler Merrick J. , Lewars Marie , Laughlin William
Published: June 2007

We evaluated the prevalence and patterns of knee injuries in 810 women collegiate rugby players. Injuries that resulted in players missing at least one game were recorded and a questionnaire was used to delineate players' rugby and knee injury history. There were 76 total knee injuries in 58,296 exposures. This resulted in a 1.3 knee injury rate per 1000 exposures. Twenty-one anterior cruciate ligament tears were reported for a 0.36 incidence per 1000 exposures. Other injuries in cluded meniscal tears (25), medial collateral ligament sprains (23), patellar dislocations (5), and posterior cruciate ligament tears (2). Sixty-one percent of the medial collateral ligament sprains occurred in rugby forwards and 67% of anterior cruciate ligament tears occurred in rugby backs. All other injuries occurred with equal frequency in backs and forwards. This study demonstrates that knee injury rates in women's colle giate rugby are similar to those reported for other wom en's collegiate sports. The overall rate of anterior cru ciate ligament injury in women's rugby, however, is slightly higher than that reported for women soccer and basketball players.
Shoulder Muscle Firing Patterns During the Windmill Softball Pitch
Authors: Maffet Mark W. , Jobe Frank W. , Pink Marilyn M. , Brault John , Mathiyakom Witaya
Published: June 2007

The purpose of this study was to describe the activity of eight shoulder muscles during the windmill fast-pitch softball throw. Ten collegiate female pitchers were an alyzed with intramuscular electromyography, high speed cinematography, and motion analysis. The su praspinatus muscle fired maximally during arm elevation from the 6 to 3 o'clock position phase, cen tralizing the humeral head within the glenoid. The pos terior deltoid and teres minor muscles acted maximally from the 3 to 12 o'clock position phase to continue arm elevation and externally rotate the humerus. The pec toralis major muscle accelerated the arm from the 12 o'clock position to ball release phase. The serratus anterior muscle characteristically acted to position the scapula for optimal glenohumeral congruency, and the subscapularis muscle functioned as an internal rotator and to protect the anterior capsule. Although the wind mill softball pitch is overtly different from the baseball pitch, several surprising similarities were revealed. The serratus anterior and pectoralis major muscles work in synchrony and seem to have similar functions in both pitches. Although the infraspinatus and teres minor muscles are both posterior cuff muscles, they are char acteristically uncoupled during the 6 to 3 o'clock posi tion phase, with the infraspinatus muscle acting more independently below 90°. Subscapularis muscle activ ity seems important in dynamic anterior glenohumeral stabilization and as an internal rotator in both the base ball and softball throws.
Anteromedial Tibial Tubercle Transfer in Patients with Chronic Anterior Knee Pain and a Subluxation-Type Patellar Malalignment
Authors: Bellemans Johan , Cauwenberghs Frank , Witvrouw Eric , Brys Peter , Victor Jan
Published: June 2007

We performed a prospective analysis of 29 Fulkerson anteromedial tibial tubercle transfers in patients with chronic anterior knee pain. The average followup was 32 months (range, 25 to 44). Fourteen patients (Group 1) had subluxation-type malalignment (congruence an gle >20°, tilt angle >8°) and were treated with an isolated anteromedial tibial tubercle transfer. Fifteen patients (Group 2) had combined subluxation and tilt malalignment (congruence angle >20°, tilt angle <8°) and underwent anteromedial tibial tubercle transfer combined with a lateral release. Pre- and postopera tive evaluations included clinical and radiographic ex aminations, Lysholm and Kujala patellofemoral scores, and standing-alignment computed tomography scans in 15° of flexion taken transversely at the midpatellar. In all but one patient a dramatic improvement in Lysh olm and Kujala scores was noted. The congruence angle improved in all patients except one, with an average improvement of 16° in Group 1 and of 14° in Group 2. The tilt angle remained relatively unchanged (change, -0.5°) in Group 1, but it improved by 11 ° in Group 2. We conclude that an isolated anteromedial tibial tubercle transfer can consistently improve patellar subluxation and, when combined with a lateral release, can improve patellar subluxation and tilt, resulting in improved functional scores for patients with chronic anterior knee pain.
Diagnosis of Anterolateral Ankle Impingement
Authors: Liu Stephen H. , Nuccion Stephen L. , Finerman Gerald
Published: June 2007

We reviewed 22 patients who had arthroscopic evalu ations and preoperative magnetic resonance imaging studies of their ankles because of chronic anterolateral ankle pain after sprains. The ability of surgeons to use the initial clinical examination to predict arthroscopi cally confirmed anterolateral ankle impingement was compared with the ability to predict this condition using preoperative magnetic resonance imaging. The patient population consisted of 15 men and 7 women who had an average age of 28 years. Five patients (23%) were intercollegiate athletes and 17 patients (77%) were recreational athletes. All patients reported previous traumas to the involved ankles, and all were seen with chronic ankle pain. Clinical examinations were used to assess ankle pain, swelling, range of motion, and sta bility. Anterolateral ankle impingement was confirmed in 18 patients (82%) with arthroscopic examination. Clinical examinations had a sensitivity of 94% and a specificity of 75% for predicting impingement, and magnetic resonance imaging had a sensitivity of 39% and a specificity of 50%. The results of this study suggest that preoperative magnetic resonance imag ing examination is not beneficial or cost-effective in the diagnosis of anterolateral ankle impingement; further more, its use may cause further delay in treatment.
Correlation of Patellar Articular Lesions with Results from Anteromedial Tibial Tubercle Transfer
Authors: Pidoriano Arthur J. , Weinstein Richard N. , Buuck David A. , Fulkerson John P.
Published: June 2007

This retrospective study determined that the outcome from anteromedialization of the tibial tubercle corre lates well with the location of patellar articular lesions. Detailed descriptions of patellar articular cartilage le sions were obtained from the operative reports of 36 patients who had anteromedialization performed be tween February 1984 and March 1994. The patterns fell into four distinct groups. Ten patients with type I (distal) patellar lesions and 13 patients with type II (lateral facet) patellar lesions had 87% good to excel lent subjective results, and 100% of these patients said they would have the procedure done again. Nine pa tients with type III (medial facet) lesions had 55% good to excellent results, and 5 patients with type IV (prox imal or diffuse) lesions had only 20% good to excellent results. Patients with type I or II lesions were signifi cantly more likely to have good or excellent results than those with type III or IV lesions. Central trochlear lesions were associated with medial patellar lesions and all patients with central trochlear lesions had poor results. There was no significant correlation between the Outerbridge grading of the patellar lesion and the overall results. Workers' compensation issues dimin ished the likelihood of a satisfactory outcome by 19%; however, this was not statistically significant. This is the first study to correlate the patellar articular cartilage lesion with outcome after tibial tubercle transfer.
Matrix Assessment of the Articular Cartilage Surface After Chondroplasty With the Holmium:YAG Laser
Authors: Lane John G. , Amiel Michael E. , Monosov Anna Z. , Amiel David
Published: June 2007

The goal of this study was to evaluate, histologically and biochemically, repair of the articular cartilage in a rabbit joint after the use of the holmium:yttrium-alumi num-garnet laser in a cartilage chondroplasty model. In 30 New Zealand White rabbits, chondroplasty was per formed with the laser at an intensity of 0.8 J at a rate of 10 Hz. The animals were sacrificed 12 weeks after surgery. Histologically, the safranin O staining index of proteoglycan correlated well with the biochemical re sults, illustrating a decrease of proteoglycan in the repaired articular cartilage after laser articular cartilage chondroplasty. The damaged articular cartilage sur face after the laser application was extensive. The damaged area observed was gradually distributed along the radius from the central point of the laser beam application. Biochemically, the amount of glycos aminoglycan in the repaired tissue (8 ± 2 mg of hex osamine per gram of dry cartilage) was statistically less when compared with that in the sham-treated tissue (40 ± 5 mg). The amount of sulfate incorporated into proteoglycans was 8 to 10 times less in the chondro plasty model compared with the control, suggesting that cell viability was greatly reduced in the treated tissues or expression of proteoglycans was greatly reduced. In the subchondral area, histologic evaluation showed the lack of osteocytes in lacunae of the bone tissue after use of laser energy. The architecture of the subchondral bone in the chondroplasty area was dam aged, with damage also seen in the membranes of the blood vessels.
Fracture of the Proximal Tibia With immediate Weightbearing after a Fulkerson Osteotomy
Authors: Stetson William B. , Friedman Marc J. , Fulkerson John P. , Cheng Margaret , Buuck David
Published: June 2007

The records of 234 people who had anteromedializa tion of the tibial tubercle with oblique osteotomy be tween 1983 and 1994 at two separate institutions were reviewed retrospectively. Six patients (2.6%) had frac tures of the proximal tibia postoperatively, within 13 weeks of the Fulkerson osteotomy. All fractures oc curred after a change in the postoperative physical therapy regimen from partial weightbearing to immedi ate full weightbearing. All fractures healed with accept able alignment of less than 5° of varus-valgus or an teroposterior angulation. Given this increase in fracture incidence, a more conservative postoperative physical therapy regimen is recommended. All patients should be nonweightbearing initially, advanced gradually to partial weightbearing, and allowed full weightbearing only after the osteotomy has radiographic evidence of complete healing.
The Biomechanics of the Human in Flight
Authors: Yeadon Maurice R.
Published: June 2007

I used a computer simulation model of aerial move ment to investigate the techniques for producing and controlling rotations of the human body during free flight. I found that the rotational motion can change from a twisting somersault to a nontwisting somersault by flexing at the hips at a suitable time. Twist may be produced in the aerial phase by means of asymmetri cal movements of arms or hips, which result in a tilting of the longitudinal axis away from the plane perpendic ular to the angular momentum vector. Asymmetrical movements may also remove the tilt and stop the twist. Elite performances of twisting somersaults are charac terized by a large contribution from aerial twisting tech niques. A progression of movements is presented for learning a double somersault with one and a half twists in the second somersault.
Hyperbaric Oxygen Therapy For Acute Ankle Sprains
Authors: Borromeo Charles N. , Ryan Jeffrey L. , Marchetto Paul A. , Peterson Russell , Bove Alfred A.
Published: June 2007

We conducted a randomized double-blind study of 32 subjects with acute ankle sprains to compare treatment with hyperbaric oxygen at 2 atmospheres absolute pressure (N = 16) (treatment group) with treatment with air at 1.1 atmosphere absolute pressure (N = 16) (control group) in a hyperbaric chamber. Each group received three treatments at their respective pres sures : one for 90 minutes and two for 60 minutes each. Mean age, severity grade, and time to treatment (treat ment group, 34.3 ± 6.3 hours; control group, 32.6 ± 4.6 hours) were similar in both groups. Joint function measured by a functional index improved from 0.40 ± 0.2 to 6.3 ± 0.4 with hyperbaric oxygen and from 0.8 ± 0.3 to 5.3 ± 0.6 with air. The change from initial to final evaluation was significantly greater in the treatment group. Foot and ankle volume by water displacement decreased from 1451 ± 57 ml to 1425 ± 63 ml with hyperbaric oxygen and from 1403 ± 50 ml to 1371 ± 45 ml with air (no difference was noted between hy perbaric oxygen treatment and air treatment using a two-way analysis of variance). Subjective pain index fell from 3.3 ± 0.5 to 0.8 ± 0.3 with hyperbaric oxygen and from 2.6 ± 0.3 to 0.3 ± 0.2 with air. No differences were noted in passive or active range of motion when comparing hyperbaric oxygen treatment with air treat ment. Time to recovery was the same in both groups (treatment, 16.0 ± 6.3 days; control, 15.4 ± 2.8 days). Regression analysis to determine the influence of time to treatment, initial severity of injury, hyperbaric oxy gen, and age showed no effect of hyperbaric oxygen treatment on time to recovery.
Split Lesions of the Peroneus Brevis Tendon in Chronic Ankle Laxity
Authors: Bonnin Michel , Tavernier Thierry , Bouysset Maurice
Published: June 2007

Between 1993 and 1995, we operated on 18 patients for split lesions of the peroneal brevis tendon associ ated with chronic ankle instability. Five patients were competitive athletes, seven were recreational athletes, and six were active persons. Symptoms developed in three phases: ankle sprain, chronic instability, and pos terolateral pain. The mean delay between sprain and posterolateral pain was 6 years. At the time of surgery the main complaint was retromalleolar pain in nine patients, pain and instability in eight patients, and in stability only in one patient. Diagnosis of tendinous lesions was based on clinical examination in three cases, preoperative magnetic resonance imaging in eight cases, preoperative tenography in one case, and surgical exploration in six cases. The lesion was local ized at the tip of the lateral malleolus and was visible only after opening the peroneal retinaculum. In three cases an accessory peroneal muscle was present. A Chrisman-Snook procedure was performed in 13 cases and a simple tendinous repair in 5 cases. The split lesion of the peroneus brevis tendon may be the result of chronic ankle laxity. This lesion needs a spe cific surgical treatment and the peroneal tendon must be checked in case of surgical procedure for ankle laxity. After ligamentous repair, residual pain can be due to a neglected peroneus brevis tear.
Salvage Surgery for Lateral Tennis Elbow
Authors: Organ Scott W. , Nirschl Robert P. , Kraushaar Barry S. , Guidi Eric J.
Published: June 2007

We undertook a retrospective analysis of 34 patients (35 elbows) who had prior failed surgical intervention for lateral tennis elbow. Revision surgeries were per formed between 1979 and 1994. Each patient's non operative and operative history was recorded before our salvage revision surgery. At revision surgery, find ings included residual tendinosis of the extensor carpi radialis brevis tendon in 34 of 35 elbows. In 27 elbows, the pathologic changes in the extensor carpi radialis brevis tendon had not been previously addressed at all, and in 7 elbows the damaged tissue had not been completely excised. Salvage surgery included excision of pathologic tissue in the extensor carpi radialis brevis tendon origin combined with excision of excessive scar tissue and repair of the extensor aponeurosis when necessary. Based on a 40-point functional rating scale proposed here, 83% of the elbows (29 of 35) had good or excellent results at an average followup of 64 months (range, 17 months to 17 years). To prevent failure of surgical treatment for tennis elbow, the patho logic tissue usually present in the extensor carpi radi alis brevis tendon should be resected. Release oper ations, which weaken the extensor aponeurosis but fail to address the pathoanatomic changes, are not recommended.
Experimental Study on External Tibial Rotation of the Knee
Authors: Kaneda Yoichi , Moriya Hideshige , Takahashi Kazuhisa , Shimada Yutaka , Tamaki Tamotsu
Published: June 2007

Using biplanar roentgenographic photogrammetry, we investigated posterolateral rotatory instability of the knee joint both before and after sectioning of postero lateral structures, the posterior cruciate ligament, and the lateral collateral ligament. Fifteen fresh-frozen ca daveric knees were used. Compared with the intact state, sectioning of the posterior cruciate ligament alone did not increase the amount of external tibial rotation, but the axis of external tibial rotation shifted when the anterolateral bundle of the posterior cruciate ligament was cut. When the posterior cruciate ligament was cut after sectioning of the posterolateral structures and the lateral collateral ligament, external tibial rota tion increased and the axis of external rotation shifted. The results demonstrated that sectioning of the antero lateral bundle of the posterior cruciate ligament is as sociated with a change in the location of the axis of tibial rotation. Therefore an isolated posterior cruciate ligament injury can alter the kinematics of the knee joint by changing the axis of external tibial rotation. The present results also demonstrate that the posterior cruciate ligament serves as a kind of secondary re straint to posterolateral rotatory instability in knees with injured posterolateral structures. Helical motion analy sis using biplanar roentgenographic photogrammetry is a useful method for evaluating knee kinematics.
Posterior Tibial Tunnel Placement to Avoid Anterior Cruciate Ligament Graft Impingement by the Intercondylar Roof
Authors: Miller Mark D. , Olszewski Albert D.
Published: June 2007

Recent recommendations to "customize" tibial tunnel placement based on the slope of the intercondylar roof and the amount knee hyperextension were derived from a series of cases with graft impingement by the intercondylar roof. We believe that this impingement is caused by anterior placement of the graft and not by variations of notch anatomy among individual patients. In Phase 1 of this study, we drilled tibial tunnels in the posteromedial aspect of the anterior cruciate ligament "footprint" after the ligament was excised in cadaveric knees. We then passed an impingement rod into the back of the knee joint. Lateral radiographs with the knee in hyperextension were taken of each specimen, and the distance between the superior border of the rod and intercondylar roof was measured. In Phase 2, we prospectively obtained lateral hyperextension ra diographs of 75 consecutive knees with anterior cruci ate ligament reconstructions and evaluated them for graft impingement based on recently published guide lines. In Phase 1, we found no cases of impingement and an average roof clearance of 8.3 mm. In Phase 2, we noted no cases of severe impingement, 3 cases of moderate impingement (4%), and 72 cases (96%) with no impingement. We conclude that posteromedial tibial tunnel placement alone is adequate to avoid graft im pingement in almost all patients. Individualized tibial tunnel placement with specialized tibial guidance sys tems is not necessary.
Osteochondritis Dissecans of the Femoral Condyles
Authors: Anderson Allen F. , Pagnani Michael J.
Published: June 2007

Nineteen patients with 20 osteochondritis dissecans lesions were evaluated between 2 and 20 years after excision of a partially detached (grade III) or loose (grade IV) fragment from the femoral condyles. Evalu ation with the Hughston rating scale for osteochondritis dissecans revealed one excellent result, four good, four fair, six poor, and five failure results. Eleven pa tients had developed osteochondritis dissecans before skeletal maturity. In contrast to what has been stated in the literature, the results in these patients were no better than in those who developed osteochondritis dissecans as adults. The short-term results of excision are good, but the long-term results are extremely poor. Consequently, we recommend bone grafting and re placement of the fragment when it is technically pos sible because the long-term results are better than those after excision.
Results of Percutaneous Longitudinal Tenotomy for Achilles Tendinopathy in Middle- and Long-Distance Runners
Authors: Maffulli Nicola , Testa Vittorino , Capasso Giovanni , Bifulco Giovanni , Binfield Peter M.
Published: June 2007

From August 1989 to January 1995 we performed multiple percutaneous longitudinal tenotomies under local anesthetic on 52 middle- and long-distance run ners with unilateral Achilles tendinitis or peritendinitis that had failed conservative treatment. Forty-eight pa tients were reviewed at an average of 22.1 months (SD, 6.5) after surgery. Results were rated as excellent in 25 patients, good in 12, fair in 7, and poor in 4. Four patients developed subcutaneous hematomas. One patient developed a superficial infection at one of the incision sites, which was managed by oral antibiotics with full recovery. Three patients complained of over- sensitivity to the incisions; this was resolved by rubbing hand cream over the incisions several times a day. One patient developed hypertrophic painful scars on three of the five incisions, but corticosteroid injections yielded good functional and cosmetic results. Isometric strength and endurance of the gastrocsoleus complex was measured just before the procedure, and at 6 weeks and 6 months later. Both were within 10% of the normal contralateral limb by the 6th postoperative month. Percutaneous longitudinal tenotomy is simple, can be performed on an outpatient basis, requires minimal follow-up care, and, in our experience, has produced no significant complications. We use this procedure as the operative treatment of choice for cases of chronic tendinitis that have failed conservative treatment.
Recent Developments in the Labor Theory of Value
Authors: Foley Duncan K.
Published: June 2007

This paper reviews the historical roots of Marx's labor theory of value and some contemporary contributions to the critique of this theory. Modern commentary on Marx's labor theory of value based on dual system of parallel prices and embodied labor coefficients loses sight of the theory's roots in the philosophy of historical materialism and its function as a theory of money. Recently developed empirical single system approaches, including the New Interpretation that identifies the monetary expression of labor time with the ratio of money value added to living productive labor expended in its production, address these problems, and open the possibility of a progressive research program based on Marx's theory.
Technical Change and Profits: The Prisoner's Dilemma
Authors: Baldani Jeffrey , Michl Thomas R.
Published: June 2007

We examine the implications of biased-lower marginal, but higher fixed, cost-technical change in a model of oligopoly. Such changes create an incentive for firms to adopt new technologies in a quest for increased output, market share, and profits. These individual incentives lead to a prisoner's dilemma: the increase in firms' outputs causes market price to fall. The analysis specifies conditions under which the decrease in price will result in lower profits for both the individual firms and the industry as a whole.
Wages, Employment, and Militancy: A Simple Model and Some Empirical Tests
Authors: Screpanti Ernesto
Published: June 2007

This paper presents a model and some empirical findings on the wage-conflict curve. The theory is based on the view that two kinds of information asymmetries affect the process of wage fixing: firms have to cope with a moral hazard behavior in the supply of work effort, whilst workers have to face the firms' interest in supplying deformed information on outside job opportunities. Wage fixing is then explained by combining an efficiency wage theory with a bargaining strength theory. The outcome is an equation which makes wage changes in industry depend on the rate of inflation, the rate of change in industrial employment, and the workers' degree of militancy. The equation has been estimated on time series data of five countries (France, Germany, Italy, the United Kingdom, and the United States) in the postwar period. The econometric findings show that the rate of inflation and the rate of change in employment exert a decisive influence on wage dynamics in all five countries, whilst the autonomous degree of militancy exerts it in all of them except Germany.
Making Sense of the Current Expansion of the U.S. Economy: A Long Wave Approach and a Critique
Authors: Hossein-zadeh Ismael , Gabb Anthony
Published: June 2007

Despite the impressive rebounding of the U.S. economy from the long contraction of the 1970s, a number of radical political economists seem to be dismissive, oblivious, or in denial of this significant turnaround. To the extent that they reluctantly acknowledge the recovery, they immediately add that the recovery represents no long-wave expansion, and that it merely represents a transitory" upswing along the long downswing of the 1970s (Brenner 1998, Moseley 1999, O'Hara 2000, as well as most of the proponents of the SSA thesis). What do we make of the glaring gap between the reality of the current expansion of the U.S. economy and the perceptions of these economists of that expansion? Our search for answer(s) to this question leads us to the conclusion that these radical economists are gravely misreading the expansion; that such misreading stems, among other reasons, from serious theoretical and methodological weaknesses; and that significant policy and/or political implications can follow from such dubious assessments and judgments.
The Fair Labor Standards Act of 1938 and Competing Visions of the Living Wage
Authors: Mutari Ellen
Published: June 2007

This article explores the relationship between legislated wage floors and the more elusive concept of a living wage. Wages are one way that society has signaled gender and racial identity and constitute an important social practice for shaping gender relations. In the debates over passage of the Fair Labor Standards Act, advocates simultaneously utilized alternative definitions of the term living wage. In part, these alternative views of the living wage reflected attempts to distinguish different forms of masculinity.
Relocation Subsidies: Regional Growth Policy or Corporate Welfare?
Authors: Vogel Richard M.
Published: June 2007

Relocation subsidies in the form of property tax abatements, subsidized construction bonds, or the outright provision of land, buildings, and other services, are being offered in increasing frequency as a lure to keep old firms from moving out of a city or region as well as to attract new firms and industry into the region. For a community, these incentives are typically a strategic response to the issue of retaining and creating jobs against the threat of firms locating or relocating to competing communities.
Markets Against Economic Democracy
Authors: Gunn Christopher
Published: June 2007

Renewed reliance on markets has made it more difficult for democratic institutions of production to survive. The impact of diminished market mediation is illustrated by the cases of the plywood cooperatives in the United States and the Mondragon cooperatives in Spain. New property relations and institutions that are more supportive of economic democracy are essential if market transmission of the norms of capitalism are to be overcome.
Are Markets Like Mushrooms? and Other Neoliberal Quandries
Authors: Meurs Mieke
Published: June 2007

The neoliberal Washington Consensus dominated global policy making over the 1980s. Fundamental to this consensus were three theoretical and ideological tenets: that privatization and markets are a natural order and that this order is best achieved if the state economic role is limited. I argue that private property and markets simply cannot be established as neoliberals propose, nor can the state be so easily curtailed. To support this argument, I will draw briefly on examples from the "transition economies." I argue that a more historical understanding of the nature of markets, property, and diverse forms of social organization will allow policy makers to more accurately use these institutions to achieve desired ends. This does not resolve the question of how to define those ends.