bluuebunny/crossref_metadata_2025 huggingface dataset:
Globalization, social exclusion and Labour's new work ethic
Authors: Holden Chris
Published: July 2017

This article argues that work is central to Labour's social policy, and that understanding the government's attitudes towards work is a prerequisite of understanding much else that it does. The centrality of work in Labour's social policy is itself explicable in terms of two ideas which have been embraced by New Labour—social exclusion and globalization. The article examines these two key ideas and their logic, and some of their policy implications in two main areas—tax and benefit reform and education. Finally, it argues that these two policy areas also need to be linked to a third in order to fully understand their aims and outcomes— that of the promotion of flexible labour markets. Together, these policies form a strategy aimed at increasing labour market efficiency within the context of international economic competition.
Religion, Hermeneutics and Violence: An Introduction
Authors: Rowley Matthew Patrick , Wild-Wood Emma
Published: July 2017

This introductory article orients the reader to the topic of this volume – the religious hermeneutics of violence – and situates the individual articles within the wider discussion of the role of religion in acts of violence. Summarising the state of modern scholarship on key debates concerning religion and violence, this article encourages the careful study of how individuals or groups in peculiar historical circumstances interact with their sacred texts and beliefs in a way that facilitates violence or oppression. Though the relationship between sacred texts and violence is complicated, few subjects so demand our attention and require our careful thought.
Early Modern Religious Violence and the Dark Side of Church History
Authors: Coffey John
Published: July 2017

How should Christians interact with historical violence in their own tradition? Faced with a barrage of arguments from the ‘New Atheists’ that this killing invalidates biblical truth claims, Christians might be tempted to ignore or excuse these darker episodes. This article argues that they should be willing to confess the failings of the past, place the violent acts in a careful reading of their historical context and re-examine these acts in light of scripture.
Einschlusskörperchen bei Hunden mit Staupe-Enzephalitis und anderen Erkrankungen des Zentralnervensystems
Authors: Fischer Karin
Published: July 2017

A histologic study was made of the central nervous system of 108 dogs with neurological illness. One group comprised 71 cases of distemper encephalitis. The second group of 37 cases encompassed toxoplasma encephalitis (14), symmetrical cerebral necrosis (10), reticulosis (6), lymphocytic meningoencephalitis (3), leukoencephalitis (2) and canine viral hepatitis (2).

Inclusion bodies can be found in all dogs with distemper encephalitis. In most cases this diagnosis is easy, even without the inclusion bodies. However, detection of inclusions becomes important in cases showing a form of distemper encephalitis atypical with respect to histologic type or localization. In one case each, focal symmetrical necroses and toxoplasmosis-induced lesions were observed in association with distemper infection of the CNS.

The regularity with which inclusion bodies can be found in all cases of distemper encephalitis means that in their absence, lesions induced by the distemper virus can be excluded with considerable assurance.

The dependence of the density of the inclusion bodies on the type of tissue changes, the histochemical and tinctorial features of the inclusion bodies, the occurrence of lesions in the cerebellar granule cells, and the formation of cell syncytia by glial cells with inclusion bodies are discussed with respect to their specificity for distemper viral infection of the CNS.
Recent Advances in Pain Research: Implications for Chronic Headache
Authors: Jensen TS
Published: July 2017

Within the last 2 decades there has been an explosion in new information on mechanisms underlying pain. Unfortunately this information has not resulted in a similar improvement of our handling of patients with chronic pain including chronic musculoskeletal pain. Neuronal hyperexcitability, which apparently is a key phenomenon in many (if not all) types of chronic pain results in changes in the nervous system from the level of the peripheral nociceptor to the highest cortical centers in the brain. The neuronal plastic changes in chronic pain conditions makes the nociceptive system amenable for treatment with several traditional as well as untraditional types of interventions. Two treatment areas that seem worth exploring within chronic pain including headache concerns preventive measures and endogenous pain modulation.
Epidemiology of Headache
Authors: Rasmussen BK
Published: July 2017

Headache disorders constitute a public-health problem of enormous proportions, with an impact on both the individual sufferer and society. Epidemiological knowledge is required to quantitate the significance of these disorders. The effects on individuals can be assessed by examining prevalence, distribution, attack frequency and duration, and headache-related disability. The socio-economic burden includes both direct costs associated with health care utilization and costs associated with missed work due to sickness absence or reduced efficiency. The individual and socio-economic burden of headaches is substantial. Headache disorders deserve more attention, especially concerning strategies leading to adequate primary prevention, diagnosis and treatment.
Rupture of the Pectoralis Major Muscle
Authors: Schepsis Anthony A. , Grafe Michael W. , Jones Hugh P. , Lemos Mark J.
Published: July 2017

We retrospectively studied 17 cases of distal pectoralis major muscle rupture to compare the results of repair in acute and chronic injuries and to compare operative and nonoperative treatment. Thirteen patients underwent surgery (six acute injuries [less than 2 weeks after injury] and seven chronic injuries) and four had nonoperative management. The mean age of the patients at injury was 29, and 10 of the 17 injuries were the result of weight lifting. Follow-up ranged from 18 months to 6 years (mean, 28 months). All patients subjectively rated strength, pain, motion, function with strenuous sporting activities, cosmesis, and overall satisfaction. Objectively, patients were examined for range of motion, deformity, atrophy, and strength. Isokinetic strength testing was performed in eight patients: six treated operatively (three acute and three chronic) and two treated nonoperatively. Overall subjective ratings were 96% in the acute group, 93% in the chronic group, and only 51% in the nonoperative group. Isokinetic testing showed that patients operated on for acute injuries had the highest adduction strength (102% of the opposite side) compared with patients with chronic injuries (94%) or nonoperative treatment (71%). There were no statistically significant subjective or objective differences in outcome between the patients treated operatively for acute or chronic injuries, but these patients fared significantly better than patients treated nonoperatively.
High Tibial Osteotomy and Ligament Reconstruction for Varus Angulated Anterior Cruciate Ligament-Deficient Knees
Authors: Noyes Frank R. , Barber-Westin Sue D. , Hewett Timothy E.
Published: July 2017

In a consecutive series, we treated 41 young patients who had anterior cruciate ligament deficiency, lower limb varus angulation, and varying amounts of posterolateral ligament deficiency. Seventy-three percent of the patients (N 30) had lost the medial meniscus and 63% (N 26) had marked articular cartilage damage in the medial compartment. All patients were treated with high tibial osteotomy and, in the majority (N 34), anterior cruciate ligament reconstruction a mean of 8 months later. Posterolateral reconstructions were also required in 18 knees. A 100% follow-up was obtained at a mean of 4.5 years after osteotomy. Gait analysis testing was done in 17 knees before and after osteotomy. At follow-up, a reduction in pain was found in 71% (29 knees); elimination of giving way, in 85% (35 knees); and resumption of light recreational activities without symptoms, in 66% (27 knees). The patient rating of the knee condition was normal or very good in 37% (15 knees) and good in 34% (14 knees). The mean Cincinnati Knee Rating Score significantly improved from 63 to 82 points. The mean adduction moment, 35% higher than controls preoperatively, significantly decreased to below normal values postoperatively. Correction of varus alignment was maintained in 33 knees (80%). We recommend osteotomy in addition to ligament reconstructive procedures in these knees with complex injury patterns.
Osteitis Pubis and Instability of the Pubic Symphysis
Authors: Williams Paul R. , Thomas Daniel P. , Downes Edward M.
Published: July 2017

Seven rugby players with osteitis pubis and vertical instability at the pubic symphysis were treated operatively after nonoperative treatment had failed to improve their symptoms. The vertical instability was diagnosed based on flamingo view radiographs showing greater than 2 mm of vertical displacement. The players had undergone at least 13 months of nonoperative therapy before surgery was considered. Operative treatment consisted of arthrodesis of the pubic symphysis by bone grafting supplemented by a compression plate. At a mean follow-up of 52.4 months, all patients were free of symptoms and flamingo views confirmed successful arthrodesis with no residual instability of the pubic symphysis. Based on our results with this procedure, we believe that arthrodesis of the pubic symphysis has a role in the treatment of osteitis pubis that is recalcitrant to nonoperative treatment. The combination of osteitis pubis and vertical pubis symphyseal instability may be the cause of failure of nonoperative treatment.
Baseball and Softball Sliding Injuries
Authors: Hosey Robert G. , Puffer James C.
Published: July 2017

We prospectively observed seven softball and three baseball Division I collegiate teams to study the incidence of sliding injuries, the types of injuries resulting from the sliding technique, and the amount of time lost from participation. Slides were categorized as either feet- or head-first on the basis of the leading part of the body during the slide. Slides were further stratified depending on whether a diveback technique was performed. We recorded 37 injuries in 3889 slides in 637 games and 7596 athlete game exposures. The overall incidence of sliding injuries was 9.51 per 1000 slides and 4.87 per 1000 game exposures. Softball players had a significantly higher incidence of sliding injuries (12.13 per 1000 slides) than did baseball players (6.01 per 1000 slides). In baseball, the injury rate was higher for feet-first slides (7.31 per 1000 slides) than for head-first slides (3.53 per 1000 slides) or divebacks (5.75 per 1000 divebacks). In softball, injury rates were higher for head-first slides (19.46 per 1000 slides) than for feet-first slides (10.04 per 1000 slides) or divebacks (7.49 per 1000 divebacks). The majority of injuries sustained were minor, with only four (11%) injuries causing the athlete to miss more than 7 days of participation.
Biomechanics of the Coracoclavicular Ligament Complex and Augmentations Used in Its Repair and Reconstruction
Authors: Motamedi Ali R. , Blevins Field T. , Willis Michael C. , McNally Thomas P. , Shahinpoor Mohsen
Published: July 2017

Augmentation is a well-accepted and common component of coracoclavicular ligament repairs and reconstructions. The purpose of this study was to examine and compare the strength, stiffness, and mode of failure of the coracoclavicular ligament complex and four different augmentation techniques in cadaveric shoulders. There was no significant difference in the mean failure load between the intact ligament complex (724.9 230.9 N) and augmentations performed with braided polydioxanone (PDS) (676.7 115.4 N) or braided polyethylene placed through (986.1 391.1 N) or around (762.7 218.2 N) the clavicle. The mean failure load for augmentations using a 6.5-mm cancellous screw through the clavicle and into a single cortex of the coracoid (390.1 253.6 N) was significantly lower than that for the intact coracoclavicular ligaments. There was no difference in mean stiffness between the intact coracoclavicular ligament complex (115.9 36.2 N/mm) and the braided polyethylene augmentations placed through (99.8 22.2 N/mm) or around (90.0 25.5 N/mm) the clavicle. Polydioxanone augmentations were significantly less stiff (27.4 3.3 N/mm) than the intact complex, while screw augmentations were significantly stiffer (250.4 88.2 N/mm). There were no significant differences in strength or stiffness of braided polyethylene reconstructions placed around or through a drill hole in the clavicle.
Prospective Evaluation of Syndesmotic Ankle Sprains without Diastasis
Authors: Nussbaum Eric D. , Hosea Timothy M. , Sieler Shawn D. , Incremona Brian R. , Kessler Donald E.
Published: July 2017

Sixty consecutive collegiate athletes with “high” ankle symptoms were prospectively evaluated over a 3-year period in an effort to better define this debilitating ankle injury. All athletes included in this study had tenderness over the distal anterior tibiofibular ligament, tenderness proximally along the interosseous membrane, and functional disability. No study subject had a fracture or frank tibia-fibula diastasis. The severity of the sprain was quantified using the interosseous “tenderness length.” A standard rehabilitation protocol was followed by all patients. Athletes returned to competition when they could perform all functional testing without difficulty. Time to return to full competitive activity averaged 13.4 days. The number of days missed from competition was statistically related to the interosseous tenderness length (P 0.0001) and to positive results on the squeeze test (P 0.03). Fifty-three of the 60 injured athletes were evaluated at least 6 months after injury. Patients rated their outcomes as good or excellent. Six of the patients experienced occasional ankle pain and stiffness, four patients reported recurrent ankle sprains, and one patient had heterotopic ossification formation.
The Effects of Extended Play on Professional Baseball Pitchers
Authors: Murray Tricia A. , Cook Timothy D. , Werner Sherry L. , Schlegel Theodore F. , Hawkins Richard J.
Published: July 2017

The purpose of this study was to investigate kinematic and kinetic changes as a result of extended play in baseball pitching. Seven major league baseball pitchers were videotaped with high-speed (120 Hz) cameras during multiple innings of the same game. For each athlete, two fastballs (one thrown during the initial inning of play and one from the final inning) were chosen for analysis. Twenty-one physical landmarks were manually digitized from the video data. Kinematic and kinetic parameters were subsequently calculated relative to four phases of the pitching motion: windup, cocking, acceleration, and follow-through. Paired t-tests revealed that seven parameters changed significantly between early and late innings. These included decreases in maximum external rotation of the shoulder, knee angle at ball release, ball velocity, maximum distraction force at both the shoulder and elbow, and horizontal adduction torque at both release and its maximum value. Ultimately, a decline in performance was evident by a 2 m/s (5 mph) drop in ball speed. It is unclear whether the kinematic and kinetic changes occurred because of fatigue or if protective mechanisms were adopted.
Articular Cartilage Contact Pressure after Tibial Tuberosity Transfer
Authors: Kuroda Ryosuke , Kambic Helen , Valdevit Antonio , Andrish Jack T.
Published: July 2017

Medial transfer of the tibial tuberosity has been commonly used for treatment of recurrent dislocation of the patella and patellofemoral malalignment. In this study, six fresh human cadaveric knees were used. Static intrajoint loads were recorded using Fuji Prescale pressure-sensitive film for contact pressure and contact area determination in a closed kinetic chain knee testing protocol. Peak pressures, average contact pressures, and contact areas of the patellofemoral and tibiofemoral joints were calculated on native intact knee specimens and after tibial tuberosity transfer. All native intact knee specimens had a normal Q angle. Medialization of the tibial tuberosity significantly increased the patellofemoral contact pressure. Medial displacement of the tibial tuberosity also significantly increased the average contact pressure of the medial tibiofemoral compartment and changed the balance of tibiofemoral joint loading. The results of our study suggest that caution should be used when transferring a patellar tendon in the face of a preexisting normal Q angle as this will result in abnormally high peak pressure within the tibiofemoral joint. Overmedialization of the tibial tuberosity should be avoided in the varus knee, the knee after medial meniscectomy, and the knee with preexisting degenerative arthritis of the medial compartment.
An Examination of Injuries in Major League Soccer
Authors: Morgan Bruce E. , Oberlander Michael A.
Published: July 2017

We analyzed the injury data collected from the 10 teams (237 players) that constituted Major League Soccer during its inaugural season. The overall injury rate was 6.2 per 1000 hours of participation. An injury rate of 2.9 per 1000 hours was noted for practice and 35.3 per 1000 hours was found for games. The difference was statistically significant. With regard to severity, 36% of injuries (143 of 399) were categorized as an incident (no time lost from competition). Of the 256 injuries that caused the player to lose playing time, 59% were classified as minor (7 days lost), 28% as moderate (7 to 29 days lost), and 13% as major (30 days lost). Seventy-seven percent of the injuries (197 of 256) were to the lower extremity; most frequently affected were the knee (N 54) and ankle (N 46). Neither the player's age nor playing position was found to be associated with prevalence or severity of injury. We believe that this information serves to underscore the notion that soccer, as it is played at the professional level, is a sport with a relatively low incidence of injury.
Techniques for Reducing Anterior Knee Symptoms after Anterior Cruciate Ligament Reconstruction Using a Bone-Patellar Tendon-Bone Autograft
Authors: Tsuda Eiichi , Okamura Yoshihisa , Ishibashi Yasuyuki , Otsuka Hironori , Toh Satoshi
Published: July 2017

Seventy-five patients underwent unilateral anterior cruciate ligament reconstruction with an ipsilateral bone-patellar tendon-bone autograft at our institution. The graft was harvested using a two-transverse-incision technique, and patellar and tibial bony defects were repaired with cored bone grafts collected by reaming the femoral socket and the tibial socket or tunnel. We evaluated the incidence of anterior knee pain, donor site tenderness, and sensory disturbance after use of these procedures. We also analyzed the correlation between anterior knee pain and age, sex, bone plug length, range of motion, postoperative stability, patellar tendon shortening, infrapatellar nerve injury, and the size of the patellar defect. Thirteen patients reported anterior knee pain. Donor site tenderness was detected in 10 patients and was located on the inferior pole of the patella, the tibial tubercle, or both. Sensory disturbance was found over the infrapatellar nerve area in 13 patients. Statistical analysis showed that anterior instability (side-to-side difference of 3 mm) and residual patellar bony defect (depth 2 mm) were risk factors for anterior knee pain. The results of our study suggest that cored cancellous bone grafting for complete restoration of the donor site bony defects and the two-transverse-incision technique to preserve the infrapatellar branch of the saphenous nerve contribute to prevention of anterior knee symptoms.
Dynamic Lateral Patellar Tilt in the Anterior Cruciate Ligament-Deficient Knee
Authors: Steiner Mark E. , Koskinen Seppo K. , Winalski Carl S. , Martin Scott D. , Haymen Michael
Published: July 2017

An open-configuration magnetic resonance imaging scanner was used to document patellar tracking abnormalities in 11 anterior cruciate ligament-injured knees. The contralateral normal knees were used as controls. Images were obtained with the quadriceps muscles at rest (knee flexion at 40°, 25°, and 10°) and with the quadriceps muscles contracted (knee flexion at 40° and 25°). When the quadriceps muscles were at rest there were no differences in patellar alignment between the anterior cruciate ligament-injured knees and the contralateral normal knees. When the quadriceps muscles were maximally contracted at 40° of flexion, the patellae of the anterior cruciate ligament-injured knees tilted laterally 3.6° relative to the resting state. When the quadriceps muscles were contracted at 25° of flexion, the patellae of the anterior cruciate ligament-injured knees tilted laterally approximately 4° relative to the resting state. Quadriceps-active lateral patellar tilt at 25° of flexion was greater in the anterior cruciate ligament-injured knees than in the contralateral normal knees, and it correlated with instrumented measurements of anterior tibial translation. Dynamic lateral patellar tilt during open kinetic chain exercises and during other activities that produce anterior tibial translation may contribute to extensor mechanism dysfunction in the anterior cruciate ligament-injured knee.
Effect of Screw Length on Bioabsorbable Interference Screw Fixation in a Tibial Bone Tunnel
Authors: Selby Jeffrey B. , Johnson Darren L. , Hester Peter , Caborn David N. M.
Published: July 2017

Initial tibial fixation strength is the weak link after anterior cruciate ligament reconstruction with a quadrupled hamstring tendon graft fixed with bioabsorbable interference screws. The purpose of this study was to determine the biomechanical differences between 28-mm and tapered 35-mm interference screws for tibial fixation of a soft tissue graft in 16 young cadaveric tibias. Failure mode, displacement before failure, and ultimate failure load were tested with a testing machine aligned with the tibial tunnel to simulate a worst-case scenario. The mode of failure was graft slippage past the screw in all but one of the specimens. The mean maximum load at failure of the 28-mm screw was 594.9 ± 141.0 N, with mean displacement at failure of 10.97 ± 2.20 mm. The mean maximum load at failure of the 35-mm screw was 824.9 ± 124.3 N, with a mean displacement to failure of 14.38 ± 2.15 mm. The 38% difference in mean maximal load at failure was significant. Important variables in hamstring tendon graft fixation within a bone tunnel include bone mineral density, dilatation, gap size, screw placement, and screw width and length. Attention to these variables will help to provide secure graft fixation during biologic incorporation throughout the rehabilitation period.
A Multidisciplinary Study of the Healing of an Intraarticular Anterior Cruciate Ligament Graft in a Goat Model
Authors: Papageorgiou Christos D. , Ma C. Benjamin , Abramowitch Steven D. , Clineff Theodore D. , Woo Savio L-Y
Published: July 2017

We evaluated knee function, tensile properties, and histologic appearance of a healing intraarticular bone-patellar tendon-bone autograft after anterior cruciate ligament reconstruction in a goat model. The patellar tendon graft was fixed such that both bone-to-bone (femoral tunnel) and bone-to-tendon (tibial tunnel) healing could be studied. The total anteroposterior translation significantly increased from 3 to 6 weeks, ranging from increases of 28.8% to 46.7%. In situ forces in the replacement graft decreased as much as 22.2% at 6 weeks. Conversely, tensile properties of the femur-anterior cruciate ligament graft-tibia complex did not change significantly from 3 to 6 weeks. However, the mode of failure changed from the graft pulling out of the tibial tunnel at 3 weeks to a mix of midsubstance failures (N = 2) and pullouts (N = 5) at 6 weeks. Histologic evaluations revealed progressive and complete incorporation of the bone block in the femoral tunnel, but only partial incorporation of the tendinous part of the graft in the tibial tunnel. The differences demonstrated at 3 and 6 weeks may be a result of the remodeling process of the midsubstance of the graft as the interfaces within the osseous tunnels mature.
Effect of Superior Capsule and Coracohumeral Ligament Release on Strain in the Repaired Rotator Cuff Tendon
Authors: Hatakeyama Yuji , Itoi Eiji , Urayama Masakazu , Pradhan Rabindra L. , Sato Kozo
Published: July 2017

Twelve cadaveric shoulders were used to determine the effects of release of the superior capsule and the coracohumeral ligament on the strain in the repaired rotator cuff tendon. A rotator cuff tear (2 cm wide and 1.5 cm long) was created and repaired under a 3-kg tensile force. The strain in the repaired tendon was measured with use of linear transducers with the arm in 50 different positions. Release of either the superior capsule or the coracohumeral ligament diminished the tension of the repaired rotator cuff by an average of 25% with the arm in adduction. Release of both of these structures further reduced the tension by an average of 44% in adduction and 43% to 60% with the arm in 15° of elevation. The maximum reduction of tension in the repaired rotator cuff occurred when both the superior capsule and coracohumeral ligament were divided and when the arm was positioned in adduction and in 60° of external rotation. Release of the coracohumeral ligament is equally as efficient as releasing the superior capsule in reducing the strain of the repaired rotator cuff. Releasing both structures seems to be desirable when releasing one structure or the other is not sufficient.
The Effects of Removal and Reconstruction of the Anterior Cruciate Ligament on the Contact Characteristics of the Patellofemoral Joint
Authors: Hsieh Yeou-Fang , Draganich Louis F. , Ho Sherwin H. , Reider Bruce
Published: July 2017

Seven cadaveric knees were used to investigate the effects of removal and reconstruction of the anterior cruciate ligament with a bone-patellar tendon-bone graft on contact characteristics of the patellofemoral joint during physiologic levels of quadriceps muscle loads at 30°, 60°, and 90° of knee flexion. Loads were applied to the quadriceps tendon to equilibrate externally applied flexion moments equivalent to one-third of values for maximum isometric extension moments. Patellofemoral contact areas and pressures were measured using pressure-sensitive film. Excision of the anterior cruciate ligament resulted in significant decreases in the total patellofemoral contact area by as much as 94 mm2 (68%), the medial facet contact area by as much as 55 mm2 (93%), the combined average contact pressure by 0.7 MPa (21%), the medial facet average contact pressure by 2.3 MPa (70%), the combined peak contact pressure by 3.0 MPa (38%), and the medial facet peak contact pressure by 5.4 MPa (76%), all at 30° of knee flexion. Excision of the anterior cruciate ligament also resulted in significant decreases in total, medial facet, and lateral facet patellofemoral contact areas at 60° and 90° of knee flexion. Intraarticular reconstruction returned these to levels not significantly different from those of the intact knee.
Current Concepts in the Rehabilitation of the Overhead Throwing Athlete
Authors: Wilk Kevin E. , Meister Keith , Andrews James R.
Published: July 2017

The overhead throwing motion is an extremely skillful and intricate movement that is very stressful on the shoulder joint complex. The overhead throwing athlete places extraordinary demands on this complex. Excessively high stresses are applied to the shoulder joint because of the tremendous forces generated by the thrower. The thrower's shoulder must be lax enough to allow excessive external rotation, but stable enough to prevent symptomatic humeral head subluxations, thus requiring a delicate balance between mobility and functional stability. We refer to this as the “thrower's paradox.” This balance is frequently compromised, which leads to injury. Numerous types of injuries may occur to the surrounding tissues during overhead throwing. Frequently, injuries can be successfully treated with a well-structured and carefully implemented nonoperative rehabilitation program. The key to successful nonoperative treatment is a thorough clinical examination and accurate diagnosis. Athletes often exhibit numerous adaptive changes that develop from the repetitive microtraumatic stresses observed during overhead throwing. Treatment should focus on the restoration of these adaptations during the rehabilitation program. In this article, the typical musculoskeletal profile of the overhead thrower and various rehabilitation programs for specific injuries are discussed. Rehabilitation follows a structured, multiphase approach with emphasis on controlling inflammation, restoring muscle balance, improving soft tissue flexibility, enhancing proprioception and neuromuscular control, and efficiently returning the athlete to competitive throwing.
Autologous Chondrocyte Transplantation
Authors: Peterson Lars , Brittberg Mats , Kiviranta Illka , Åkerlund Evy Lundgren , Lindahl Anders
Published: July 2017

We evaluated the durability of autologous chondrocyte transplantation grafts in 61 patients treated for isolated cartilage defects on the femoral condyle or the patella and followed up for a mean of 7.4 years (range, 5 to 11). Durability was determined by comparing the clinical status at the long-term follow-up with that found 2 years after the transplantation. After 2 years, 50 of the 61 patients had good or excellent clinical results, and 51 of 61 had good or excellent results at 5 to 11 years later. Grafted areas from 11 of the patients were evaluated with an electromechanical indentation probe during a second-look arthroscopy procedure (mean follow-up, 54.3 months; range, 33 to 84); stiffness measurements were 90% or more of those of normal cartilage in eight patients. Eight of twelve 2-mm biopsy samples taken from these patients showed hyaline characteristics with safranin O staining and a homogeneous appearance in polarized light. Three fibrous and eight hyaline biopsy specimens stained positive to aggrecan and to cartilage oligomeric matrix protein. Hyaline-like specimens stained positive for type II collagen, and fibrous, for type I collagen. Autologous chondrocyte transplantation for the treatment of articular cartilage injuries has a durable outcome for as long as 11 years.
Osseous Adaptation and Range of Motion at the Glenohumeral Joint in Professional Baseball Pitchers
Authors: Crockett Heber C. , Gross Lyndon B. , Wilk Kevin E. , Schwartz Martin L. , Reed Jamie , OMara Jay , Reilly Michael T. , Dugas Jeffery R. , Meister Keith , Lyman Stephen , Andrews James R.
Published: July 2017

The throwing shoulder in pitchers frequently exhibits a paradox of glenohumeral joint motion, in which excessive external rotation is present at the expense of decreased internal rotation. The object of this study was to determine the role of humeral head retroversion in relation to increased glenohumeral external rotation. Glenohumeral joint range of motion and laxity along with humeral head and glenoid version of the dominant versus nondominant shoulders were studied in 25 professional pitchers and 25 nonthrowing subjects. Each subject underwent a computed tomography scan to determine bilateral humeral head and glenoid version. The throwing group demonstrated a significant increase in the dominant shoulder versus the nondominant shoulder in humeral head retroversion, glenoid retroversion, external rotation at 90°, and external rotation in the scapular plane. Internal rotation was decreased in the dominant shoulder. Total range of motion, anterior glenohumeral laxity, and posterior glenohumeral laxity were found to be equal bilaterally. The nonthrowing group demonstrated no significant difference in humeral head retroversion, glenoid retroversion, external rotation at 90° or external rotation in the scapular plane between shoulders, and no difference in internal rotation at 90°, total motion, or laxity. A comparison of the dominant shoulders of the two groups indicated that both external rotation at 90° and humeral head retroversion were significantly greater in the throwing group.
Single- versus Two-Incision Technique in Anterior Cruciate Ligament Replacement: Influence on Postoperative Muscle Function
Authors: Hess Thomas , Duchow Jochen , Roland Stephan , Kohn Dieter
Published: July 2017

The purpose of this study was to find out whether the single-incision technique for anterior cruciate ligament repair has advantages over the two-incision technique in terms of muscular function up to 1 year postoperatively. Twenty patients who underwent unilateral anterior cruciate ligament reconstruction with bone-patellar tendon-bone autografts were randomly assigned to one of the two procedures. Both groups (10 patients in each) were followed up at 1 year. Lysholm and International Knee Documentation scores and thigh circumferences were markedly reduced after surgery in both groups but improved up until the last follow-up examination at 12 months postoperatively. Clinical examination, functional scores, stabilometry measurements, and thigh circumferences did not differ between the two groups. Isokinetic evaluation revealed a significant reduction of extensor peak torques in both groups that was most pronounced at 3 months, then improved continuously but was still present 12 months postoperatively. A significant reduction of peak torques, up to 35%, was seen in the flexor muscles of the involved legs compared with the contralateral legs, but this deficit vanished completely after 12 months in both groups. At 3 and 6 months, for the flexor as well as the extensor muscles, the deficits in peak torque on the injured sides were found to have improved faster in the single-incision group. These results indicate improved dynamic muscle function with use of the single-incision technique because the dissection of the vastus lateralis muscle that occurs in the two-incision technique is avoided.
The Relationship of the Kicking Action in Soccer and Anterior Ankle Impingement Syndrome
Authors: Tol Johannes L. , Slim Erik , van Soest Arthur J. , van Dijk C. Niek
Published: July 2017

Two different hypotheses have been advanced to explain the formation of talotibial osteophytes in the anterior ankle impingement syndrome. We investigated how frequently hyperplantar flexion occurs during kicking and whether the site of impact of the ball coincides with the reported location of the osteophytes. We also measured the magnitude of the impact force. We studied 150 kicking actions performed by 15 elite soccer players by using mobile sensors and high-speed video. In 39% of the kicking actions, the plantar flexion angle exceeded the maximum static plantar flexion angle. Ball impact was predominantly made with the anteromedial aspect of the foot and ankle, with impact between the ball and the base of the first metatarsal bone in 89% of the kicking actions and between the ball and the anterior part of the medial malleolus in 76%. Postimpact ball velocity averaged 24.6 m/s, with a corresponding average contact force of 1025 N. Hyperplantar flexion was reached in only the minority of the kicking actions. The data on impact location and impact force support the hypothesis that spur formation in anterior ankle impingement syndrome is related to recurrent ball impact, which can be regarded as repetitive microtrauma to the anteromedial aspect of the ankle.
Knee Arthroscopy with the Use of Local Anesthesia—An Increased Risk for Repeat Arthroscopy?
Authors: Jacobson Eva , Forssblad Magnus , Weidenhielm Lars , Renström Per
Published: July 2017

Although there have been many reports of good results when local anesthesia is used with knee arthroscopy, it is not used as a standard anesthetic. Concerns about local anesthesia include the fear of prolonged surgery, which could result in inadequate anesthesia, thus causing the patient unnecessary discomfort. The purpose of this study was to evaluate the risk of repeat arthroscopy and the patient satisfaction rate up to 6 months after knee arthroscopy under local anesthesia. In this prospective, randomized study, 400 patients scheduled for elective knee arthroscopy were allocated to one of three groups: local anesthesia (200 patients), spinal anesthesia (100 patients), or general anesthesia (100 patients). All enrolled patients were asked to complete a questionnaire 6 months after surgery and all of their medical records were reviewed. No repeat arthroscopies occurred in the spinal and general anesthesia groups and only three occurred in the local anesthesia group, a nonsignificant difference. In only one of these three cases was the clinical course altered by the repeat arthroscopy. There was no difference in the satisfaction rate between the three anesthesia groups. We conclude that the choice of anesthesia does not influence the frequency of repeat arthroscopy, satisfaction with the procedure, or recovery at 6 months after knee arthroscopy.
Biomechanical Effects of Femoral Notchplasty in Anterior Cruciate Ligament Reconstruction
Authors: Markolf Keith L. , Hame Sharon L. , Hunter D. Monte , Oakes Daniel , Gause Paul
Published: July 2017

Notchplasty is frequently performed in conjunction with anterior cruciate ligament reconstruction. Bench loading tests were performed on 26 fresh-frozen knee specimens to measure excursion of a bone-patellar tendon-bone graft, anterior-posterior laxity of the knee, and graft forces before and after performing a 2-mm and a 4-mm notchplasty. The mean intraarticular pretension required to restore normal anterior-posterior laxity at 30° of flexion (laxity-matched pretension level) was 27 N before notchplasty, 48 N after 2-mm notchplasty, and 65 N after 4-mm notchplasty. The mean graft pretension decreased 53% and 58%, respectively, on completion of a loading test series involving anterior-posterior and constant tibial loading forces. Mean laxity increased 1.4 mm at full extension and decreased 1.8 mm at 90° of flexion after a 2-mm notchplasty. Mean graft forces increased markedly between 30° and 90° of passive flexion after notchplasty. Our results show that after a notchplasty, a higher level of graft pretension will be necessary to restore normal laxity at 30° of flexion. This increased level of pretension, combined with changes in graft excursion, produced dramatic increases in graft force when the knee was flexed to 90°. These relatively high forces would be detrimental to a remodeling graft and could lead to subsequent failure of the reconstruction.
The Effect of the Menstrual Cycle on Anterior Cruciate Ligament Injuries in Women as Determined by Hormone Levels
Authors: Wojtys Edward M. , Huston Laura J. , Boynton Melbourne D. , Spindler Kurt P. , Lindenfeld Thomas N.
Published: July 2017

Anterior cruciate ligament injury rates are reported to be two to eight times higher in women than in men within the same sport. Because the menstrual cycle with its monthly hormonal fluctuations is one of the most basic differences between men and women, we investigated the association between the distribution of confirmed anterior cruciate ligament tears and menstrual cycle phase. Sixty-nine female athletes who sustained an acute anterior cruciate ligament injury were studied within 24 hours of injury at four centers. The mechanism of injury, menstrual cycle details, use of oral contraceptives, and history of previous injury were recorded. Urine samples were collected to validate menstrual cycle phase by measurement of estrogen, progesterone, and luteinizing hormone metabolites and creatinine levels at the time of the anterior cruciate ligament tear. Results from the hormone assays indicate that the women had a significantly greater than expected percentage of anterior cruciate ligament injuries during midcycle (ovulatory phase) and a less than expected percentage of those injuries during the luteal phase of the menstrual cycle. Oral contraceptive use diminished the significant association between anterior cruciate ligament tear distribution and the ovulatory phase.
Radiofrequency Electrothermal Shrinkage of the Anterior Cruciate Ligament
Authors: Carter Thomas R. , Bailie David S. , Edinger Samantha
Published: July 2017

The efficacy of electrothermal collagen shrinkage in the treatment of patients with anterior cruciate ligament laxity was evaluated. Eighteen patients who had continuity of the anterior cruciate ligament but had symptomatic laxity were treated with arthroscopic electrothermal shrinkage of the anterior cruciate ligament using a monopolar radiofrequency probe. The mean length of follow-up in patients whose stability was maintained was 20.5 months. Seven of the patients had undergone previous reconstruction, four with patellar tendon graft and three with quadrupled hamstring tendon graft. Laxity was chronic in nine patients and acute in nine. The KT-1000 arthrometer results at 1 month postoperatively revealed decreased anterior excursion, with an average side-to-side difference of 1.9 mm. However, 11 patients had a failed result at an average 4.0 months. Of the seven patients with successful results, six had native ligaments and had been treated for acute laxity and one had a patellar tendon graft and had been treated for chronic laxity. Even with the short-term follow-up in our study, it is evident that thermal shrinkage using radiofrequency technology has limited application for patients with anterior cruciate ligament laxity. Although it may be useful in treating patients with an acutely injured native anterior cruciate ligament, further study is needed to see if the ligament stretches out over time or is at increased risk of reinjury.
Braided Hamstring Tendons for Reconstruction of the Anterior Cruciate Ligament: A Biomechanical Analysis
Authors: Tis John E. , Klemme William R. , Kirk Kevin L. , Murphy Kevin P. , Cunningham Bryan
Published: July 2017

Background:

In an effort to improve the strength and stiffness of anterior cruciate ligament grafts, several authors have advocated alterations of graft structure and orientation, including braiding the tendons in hamstring tendon grafts. Hypothesis: Braiding hamstring tendons does not increase graft strength and stiffness.

Study Design:

Controlled laboratory study.

Methods:

Sixteen hamstring tendon and 21 bone-patellar tendon-bone grafts were harvested from 12 cadavers and divided into three groups: 1) braided four-strand hamstring tendon, 2) unbraided four-strand hamstring tendon, and 3) bone-patellar tendon-bone. All grafts were placed under a 50-N preload on a servohydraulic testing device and were tensioned to failure.

Results:

The strength and stiffness of the tested specimens averaged 427 ± 36 N and 76 ± 10 N/mm, respectively, for braided specimens, 532 ± 44 N and 139 ± 18 N/mm for unbraided specimens, and 574 ± 46 N and 158 ± 15 N/mm for patellar tendon specimens. There was a 20% decrement in hamstring tendon graft tensile strength and a 45% decrease in stiffness after braiding because of the suboptimal multidirectional orientation of individual tendons within the braided grafts.

Conclusions:

In vitro braided hamstring tendon grafts demonstrated mechanically inferior strength and stiffness characteristics compared with unbraided hamstring tendon grafts and patellar tendon grafts.

Clinical Relevance:

Braiding of hamstring tendon grafts provides no mechanical advantage in anterior cruciate ligament reconstruction.
Catastrophic Injuries in Wrestlers
Authors: Boden Barry P. , Lin Willie , Young Megan , Mueller Frederick O.
Published: July 2017

Background

There is a paucity of comprehensive information on catastrophic wrestling injuries.

Objective

Our objective was to develop a profile of catastrophic injuries in wrestling and a list of relevant risk factors.

Study Design

Retrospective review.

Methods

We retrospectively reviewed 35 incidents that were reported to the National Center for Catastrophic Sports Injury Research over an 18-year period from 1981 until 1999.

Results

Except in the case of one male college athlete, all injuries occurred in male high school wrestlers. There were 2.11 direct catastrophic injuries per year or 1 per 100,000 participants. The majority of injuries occurred in match competitions (80%), with a trend toward more injuries in the low- and middle-weight classes. The position most frequently associated with injury was the defensive position during the takedown maneuver (74%), followed by the down position (23%), and the lying position (3%). Catastrophic injuries included 27 cervical fractures or major cervical ligament injuries, 4 spinal cord contusions with transient quadriparesis, 3 severe head injuries, and an acutely herniated lumbar disc. The injuries resulted in quadriplegia in 11, residual neurologic deficits in 6, paraplegia in 1, and death in 1 head-injured athlete.

Conclusions

Although catastrophic injuries in wrestling are rare, they do occur. Referees can help prevent such injuries by strictly enforcing penalties for slams and by gaining more awareness of dangerous holds. Coaches may also prevent serious injuries by emphasizing proper wrestling techniques.
The Influence of the Integrity of Posterolateral Structures on Tibiofemoral Orientation When an Anterior Cruciate Ligament Graft is Tensioned
Authors: Wentorf Fred A. , LaPrade Robert F. , Lewis Jack L. , Resig Scott
Published: July 2017

Background

The effect of injury to the posterolateral structures of the knee on the success of an anterior cruciate ligament reconstruction is not well known.

Hypothesis

Increasing graft tension increases the amount of external rotation of the tibia if the posterolateral structures are deficient.

Study Design

Laboratory study.

Methods

Eight cadaveric knees underwent techniques similar to a clinical reconstruction except that the distal fixation on the tibia was an external tensioning device used to apply a traction force on the graft. The knee was secured in a joint-testing machine and an instrumented spatial linkage was used to measure the motion of the tibia with respect to the femur. Measurements were taken with forces increasing from 0 to 100 N. The fibular collateral ligament, popliteofibular ligament, and the popliteus tendon were individually cut sequentially, and differences in the relative position of the tibia with respect to the femur were compared with the intact baseline.

Results

External rotation increased significantly when all of the posterolateral structures were cut and 60, 80, or 100 N of distal traction was applied.

Conclusions

Deficiency of posterolateral structures of the knee significantly affected the relative external rotation of the tibia.

Clinical Relevance

Injured posterolateral structures should be repaired before fixation of anterior cruciate ligament grafts.