bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of transcutaneous neural stimulation and isokinetic testing in arthroscopic knee surgery
Authors: Jensen Jack E. , Conn Richard R. , Hazelrigg Gary , Hewett John E.
Published: June 2007

A prospective study of the use of transcutaneous neural stimulation (TNS) in 90 arthroscopic knee surgery pa tients was performed to determine: (1) if TNS is as effective as traditional pain medication in treating post operative knee pain; and (2) if patients that had received TNS regain preoperative motion and strength quicker than the control population. The patients were divided into three equal groups. Group I consisted of patients with no TNS unit, Group II had a "placebo" unit, and Group III had a "live" unit. Preoperatively, each patient received an isokinetic muscle examination, orientation to the TNS unit, leg circumference measurements, and exercise instruction. An isokinetic muscle examination and leg circumference measurements were repeated at 1, 3, and 7 weeks postoperatively. Additionally, the amount of pain and medication required was analyzed. The results of the study indicated that the use of a TNS unit is an effective adjunct in decreasing postoperative pain in 93% of patients. The amount of pain and total pain medication required was greatest in the control group, less in the placebo, and markedly reduced in the TNS group. A comparison among the three groups revealed that the TNS group regained the following preoperative values 1 month sooner than the other two groups (3 as opposed to seven weeks postoperatively): isokinetic power in flexion and extension (P < 0.05), range of motion (P < 0.02), and leg volume (P < 0.05). There was no correlation between the pain and irregular wave forms on the isokinetic graph. The only compli cation noted was skin irritation at the electrode sites. TNS has been shown to be a significant benefit in the treatment of postoperative knee pain and in hastening recovery of muscular function through a full range of motion.
Frequency, associated factors, and treatment of breaststroker's knee in competitive swimmers
Authors: Rovere George D. , Nichols Andrew W.
Published: June 2007

Thirty-six competitive breaststroke swimmers were in terviewed and examined for knee pain specifically re lated to the breaststroke kick. Eighty-six percent of the subjects had a history of at least one episode of breast stroke knee pain, while 47.2% had breaststroke knee pain that occurred at least once a week. There was a significant relationship between more frequent knee pain and increasing swimmer's age, increasing years of competitive swimming, increasing breaststroke train ing distance, and decreasing warm-up distance. The subjects with frequent knee pain were found to have less internal rotation at the hip joint.

The most common site of breaststroke knee pain was the medial portion of the knee, with specific sites differing among the individuals. The medial synovial plica syndrome may be a cause of breaststroke knee pain, since 47% of subjects with weekly knee pain had tender, thickened medial plicae. Palpation of those pli cae produced pain similar to that experienced with the breaststroke kick.

The findings in this study suggest that reducing or eliminating breaststroke training distance should be an initial measure in treatment. Applications of ice, changes in kick technique, stretching exercises to in crease hip rotation, and administration of aspirin may also be effective. The breaststroke training distance should be increased very gradually in the early season, and warm-up distance should be adequate to help prevent the symptoms of breaststroker's knee.
True aneurysms of the hand resulting from athletic injury
Authors: Ho Paul K. , Dellon A. Lee , Wilgis E.F. Shaw
Published: June 2007

We report two cases of true aneurysms arising in the vasculature of the hand after blunt athletic trauma. This relatively rare tumor of the hand should be included as part of the differential diagnosis of masses arising in the hand after athletic injury.
A comparison of athletic mouthguard materials
Authors: Chaconas Spiro J. , Caputo Angelo A. , Bakke Niles K.
Published: June 2007

The development of protective mouthguards resulted from extensive injuries during participation in contact sports. This has produced a dramatic decrease in the incidence of injuries to the orofacial complex. Numerous materials and techniques have been used for mouth guard fabrication. The purpose of this investigation was to make an in vivo comparison of various thermoplastic mouthguard materials.

Mouthguards were fabricated upon maxillary models of 40 members of the UCLA football team. The mouth guards were made of the following materials: (1) poly (vinyl acetate-ethylene) copolymer clear thermoplastic; (2) polyurethane; and (3) laminated thermoplastic. Eleven measurements were taken for each mouthguard to demonstrate dimensional changes that occurred with wear. Statistical analyses determined differences be tween the types of mouthguards.

The clear thermoplastic revealed less dimensional change than the polyurethane material. The laminated thermoplastic showed significantly less dimensional change than the other materials tested.
"Effort" thrombosis of the subclavian vein in a competitive swimmer
Authors: Vogel Curt M. , Jensen Jack E.
Published: June 2007

"Effort" thrombosis is a unique form of subclavian and axillary vein thrombosis because it is the result of an unusual variant of the thoracic outlet syndrome. An other cause of subclavian vein thrombosis is local com pression from trauma, tumor, or development anoma lies ; a third is intimal damage from indwelling central venous catheters. This is a case report of "effort" thrombosis of the subclavian vein in a competitive swimmer. A recently developed technique of local in fusion of low-dose streptokinase therapy is used for clot lysis. Early diagnosis is essential for effective thrombus dissolution with streptokinase. The rationale, risk, and method of streptokinase administration are discussed. Since "effort" thrombosis is secondary to thoracic outlet syndrome (TOS), decompression of the thoracic outlet by removal of the first rib after clot lysis is recommended.
Ulnar artery thrombosis: A sports-related injury
Authors: Porubsky Gary L. , Brown Samuel I. , Urbaniak James R.
Published: June 2007

A case of ulnar artery thrombosis following a sports- related injury is reported. Treatment by resection of the thrombosed segment and replacement with a reversed vein graft resulted in complete relief of symptoms. An extensive review of the literature is presented.
Arthroscopic treatment of osteochondral lesions of the talus
Authors: Parisien J. Serge
Published: June 2007

A retrospective study of the arthroscopic treatment of transchondral fractures of the talar dome in 18 patients was conducted. Followup ranged from 3 months to 3 years; 10 patients had an average followup of 2 years (Group A) and 8 of 6.5 months (Group B). The 10 male and 8 female patients ranged in age from 14 to 40 years. Thirteen lesions were posteromedial while five were anterolateral. Fourteen of the 18 patients reported an inversion type injury to the ankle from playing various sports on weekends. One patient had a bimalleolar fracture of the ankle sustained in a car accident 18 months prior to referral, while the last patient in the series had a bilateral fracture of the os calcis from a work-related falling incident. All patients underwent conservative care for at least 4 months prior to referral. Arthroscopic treatment consisted of partial synovec tomy, debridement of osteochondral lesions with re moval of loose fragments, curettage, abrasion, and, in one case, drilling.

For analysis of postoperative management, patients were divided into two groups, 10 with the 2 year followup comprising Group A and the 8 with the 6.5 month followup in Group B. Group A was nonweight bearing for 6 weeks while Group B was ambulatory 2 weeks postoperatively. Group A was fully ambulatory when the 6 week nonweightbearing period expired. All patients had a full range of motion at the time of suture removal (1 week to 10 days). Both groups were evalu ated objectively and subjectively. Excellent or good results were obtained in 88% of the patients. One patient whose bimalleolar fracture of 18 months prior to referral was treated with plaster, but without achiev ing anatomical reduction, had a poor result. Complica tions were minimal: a broken ring curette was easily retrieved during one procedure, and a suture abscess cleared up with removal of the suture.

This study suggested that even in chronic lesions, arthroscopic surgery can yield a high percentage of excellent or good results with minimal morbidity, brief hospitalization, and a rapid recovery time for the patient by avoiding long skin incisions and deep soft tissue dissections, grooving of the distal tibia, or osteotomy of the medial malleolus.
Athletic injuries: Comparison by age, sport, and gender
Authors: DeHaven Kenneth E. , Lintner David M.
Published: June 2007

Injuries treated at the University of Rochester Section of Sports Medicine over a 7 year period were surveyed. Patients were drawn from professional, intercollegiate (Division 111), high school, intramural, and unorganized athletics at the University and the surrounding com munity. Data on injury diagnosis was available for 4,551 cases, with data on age, gender, and sport of injury available for 3,431 of the cases. The average patient age was 21.6 years, with a peak in the 16 to 19 age group. Patients with fractures had an average age below the overall mean, while those with internal derangement of the knee, patellofemoral pain syn drome, and inflammatory injuries were signifcantly older than average. Males accounted for 80.3% of all injuries. For both sexes the most common areas injured were the knee and ankle, with sprains/strains the most com mon injuries. Injuries involving the patellofemoral artic ulation were significantly more frequent among females. The most common sport of injury was football, with greater than 12 times the number of injuries seen in the next most common sport.
Dynamic joint control training for knee ligament injuries
Authors: Ihara Hidetoshi , Nakayama Akikazu
Published: June 2007

The purpose of this study was to introduce dynamic joint control training and to assess its effects in improv ing neuromuscular coordination of injured knees using the Kin-Com Isokinetic Dynamometer. Although four patients had a sensation of "giving way" on one knee, all eight knees were trained for 3 months using unstable boards with added sudden force given by a therapist. The training group (four patients) was examined during four sessions and the control group (five subjects) was examined during three sessions within a 3 month pe riod. All subjects were instructed to react to the sudden forward movement of the input arm of the Kin-Com Isokinetic Dynamometer with contraction of the ham string. Results of the first and final trials of peak torque time (PTT) and rising torque value (RTV) of the ham string between the training and control groups showed significant improvement. There was no correlation be tween isometric muscle strength (IMS) and PTT in the total 76 sessions. There is a strong implication that simple muscle training does not increase the speed of muscular reaction but dynamic joint control training has the potential to shorten the time lag of muscular reac tion.
Exercise-related stress reaction of the sacroiliac joint
Authors: Marymont John V. , Lynch Mary A. , Henning Charles E.
Published: June 2007

Low back pain, secondary to a variety of musculoskel etal injuries, is common in individuals engaged in ath letics. Sports-related stress reactions of the pars inter articularis are not uncommon. Stress reactions of the sacroiliac joint, on the other hand, are considered very rare. The limitations of plain radiographs and the ability of bone scintigraphy to detect stress lesions in athletes is well documented. In this paper we describe four young athletes with stress reactions of the sacroiliac region. We consider these to be uncommon but not rare, and probably self-limiting. Accurate diagnosis is important, however, to exclude more important causes of low back pain that require therapy. This type of injury also results in abnormal stresses to the lower extremi ties which can result in an independent and more serious injury. All sacroiliac stress reactions were un suspected and were diagnosed only by bone scin tigraphy after plain radiographs were noncontributory.
Acute periostitis in early acquired syphilis simulating shin splints in a jogger
Authors: Meier J.L. , Mollet E.
Published: June 2007

Acute periostitis affecting the long bones is a charac teristic but uncommon manifestation of syphilis in the adult with an early acquired infection. This report de scribes the history of a jogger who developed acute localized periostitis of the shaft of both tibiae during the early stage of acquired syphilis. Symptomatology was initially attributed to the medial tibial stress syndrome.
Injuries in elite orienteers
Authors: Johansson Christer
Published: June 2007

A prospective study of injuries in 89 elite orienteers showed a total incidence of three injuries per 1,000 training hours, with no difference between the sexes. Mean absence from training per year due to injury was 20 days for men and 19 days for women. Most injuries (80.3%) occurred during training, while the remaining injuries occurred during competition. The lower extrem ities were affected in 93.6% of the male injuries and in all of the female injuries. The majority of injuries (60.6%) were moderate, while 19.7% were minor and 19.7% were major injuries. Overuse injuries accounted for 57%; 43% of the injuries were due to trauma. Overuse injuries predominated in the preseason period, while the incidence was equal between overuse and trau matic injuries over the rest of the year. Of a total number of 38 overuse injuries, 60.5% occurred during running on tracks or roads. Thirteen injuries (19.7%) were ma jor; the majority (84.6%) of these injuries were due to overuse, affecting the knee in eight cases (61.5%). Of the major injuries, 76.5% occurred during the period December to May. Of a total number of 28 traumatic injuries, 78.6% occurred while running on uneven ground, mainly in forests. Among the traumatic injuries, ankle sprains accounted for 57.1 %, equally distributed between the sexes. The majority of these sprains (81.2%) were moderate. This paper will discuss injury mechanisms and possibilities of prevention.
Surgical repair of Achilles tendon ruptures
Authors: Beskin James L. , Sanders Richard A. , Hunter Stephen C. , Hughston Jack C.
Published: June 2007

We evaluated the surgical results of 42 consecutive patients with spontaneous rupture of the Achilles ten don treated from 1973 to 1984 to determine the causes of rupture and to evaluate our treatment methods. Patients were divided into early and late repair groups and their charts reviewed to determine common clinical features. A new method of repair with early functional range of motion exercises before casting was used and compared to other techniques in common use. Thirty- one patients were contacted for long-term followup (average, 4.7 years). Twenty-three of these patients returned for intensive reevaluation and Cybex testing.

We found a high incidence of gout (14.3%) and previous steroid injections (7.1 %) in our patients. Good results were obtained from the four surgical methods used. There were no reruptures and only 7% of the patients experienced minor wound problems. Patients treated with early functional range of motion exercises averaged 12.5° more dorsiflexion at the time of cast removal and did not require adjunctive protective de vices. Long-term results, however, revealed equilibra tion of range of motion and near normal function in all repair techniques with 88% of all patients returning to preinjury activity levels.
Biomechanical evaluation of superficial transfer of the biceps femoris tendon
Authors: Brunet Michael E. , Kester Marcus A. , Cook Stephen D. , Leinhardt Ted M. , Haddad Ray J.
Published: June 2007

The biomechanics of the biceps femoris tendon transfer were determined from four fresh, frozen extremities. All transfers involved the proximal and anterior advance ment of a selected portion of the tendon to a position superficial to the lateral collateral ligament. The rota tional torque and flexion force were measured before and after the transfer with the knee positioned at 10°, 20°, 30°, and 45° of flexion, in neutral and 5° internal rotation. Although more specimens need to be tested for statistical confirmation, the transfer of the superficial portion of the biceps tendon resulted in average de creases of 2% and 15% in the rotational and flexion capacity of the biceps, respectively. Biomechanically, the functional lever arm of the transferred tendon about the longitudinal (internal-external rotation) axis was es sentially unchanged, while the functional lever arm about the sagittal (flexion-extension) axis was de creased slightly. The total transfer of the biceps tendon resulted in an increase of 28% in the rotational capacity, while the flexion capability was decreased an average of 75%. In addition, the total transfer resulted in the biceps becoming an extensor at 10° and 20° of flexion, which could actually worsen the instability. Thus, fol lowing the total transfer, the functional level arm about the sagittal axis was decreased, while the functional lever arm about the longitudinal axis was increased. In summary, neither the partial nor the total transfer of the biceps femoris tendon superficial and anterior to the fibular collateral ligament appeared to be a biome chanically effective ancillary for the treatment of anter olateral rotatory instability.
Prophylactic knee bracing in college football
Authors: Rovere George D. , Haupt Herbert A. , Yates C. Steven
Published: June 2007

We report on the number of knee injuries sustained by a major college football team during 2 full years when all players were required to wear laterally placed pro phylactic knee braces during all practice sessions and all games. We found that the incidence rates of knee injuries were higher when the braces were worn com pared to a similar period when the braces were not worn. There was also an increased number of ACL injuries during the brace period. Several indices char acterizing the nature of the injuries were analyzed and were found not to be altered significantly when the prophylactic braces were used. These facts lead us to question the efficacy of prophylactic knee braces in preventing knee injuries in college football. The use of the braces was associated with increased episodes of muscle cramping in the triceps surae muscle group, required the constant attention of coaches and trainers to remind the players to wear the braces and to apply them correctly, and was costly. These findings indicate the need for other carefully controlled clinical and bio mechanical studies of these devices before their routine use can be advocated.
Skeletal muscle profiles in elite springboard and platform divers
Authors: Gerard Elizabeth S. , Caiozzo Vincent J. , Rubin Benjamin D. , Prietto Carlos A. , Davidson Dennis M.
Published: June 2007

This investigation determined the vastus lateralis mus cle fiber composition, as well as leg power and strength, in a group of 10 world class divers. Male divers had a low mean percentage of Type I fibers (36%), which was consistent with the functional demands of their sport, whereas females had a mean value of 61 %. The ratio of Type I/Type II cross-sectional fiber area was 0.95 in females and 0.82 in males. Angle-specific torque-veloc ity relationships, derived from Cybex testing of the knee extensors, revealed high torque values in males but not in females. The observed male-female differences have no clear explanation, unless muscle fiber composition has greater importance in the more difficult dives exe cuted by men.
Knee bracing and anterolateral rotatory instability
Authors: Coughlin L. , Oliver J. , Berretta G.
Published: June 2007

We reviewed the efficiency of bracing in 85 patients with anterolateral rotatory instability (ALRI). We were able to compare 18 patients using an antirotational brace with 67 using the AC brace (J. E. Hanger, Mon treal, Canada). We found the AC brace to offer better overall stability, 71 % compared to 50%.
Hinged cast after knee ligament surgery
Authors: Sandberg Rolf , Nilsson BO , Westlin Nils
Published: June 2007

One hundred thirteen patients scheduled for repair of knee ligament injuries were randomized to postopera tive immobilization in either a hinged or a long leg cast. The time of disability (i.e., sick leave) was significantly shorter (6 weeks) with a hinged cast, but only in ACL cases. All types of injuries regained their range of motion more rapidly after use of a hinged cast. There was no evidence that the motion permitted in a hinged cast hampers the result as regards to stability.
Freeze dried anterior cruciate ligament allografts
Authors: Jackson D.W. , Grood E.S. , Arnoczky S.P. , Butler D.L. , Simon T.M.
Published: June 2007

One ACL in each of 11 mature goats was replaced with a freeze dried bone-ACL-bone allograft. One year fol lowing implantation the goats had their knees evaluated biomechanically and for microvascularity and histologic changes. The reconstructed knees had a significantly greater total AP laxity (3.8 ± 0.6 mm) (mean and SEM) than the controls (1.0 ± 0.1 mm). Differences in primary AP laxity were responsible for 81 % of the difference in total laxity, with only a 0.4 mm difference in secondary laxity. Neutral stiffness in the reconstructive knee was 17% of control. while stiffness at 30 newtons (N) of anterior force was approximately 50% of controls. Lig ament stiffness in the linear region for the ACL allograft was 35% of the control value of 686 N/mm. The maxi mum load of the allografts was 571 ± 45 N, or 25% of the contralateral ACL control strength (2301 ± 155 N). Five of the seven allografts failed at the femoral inser tion. Both elongation (83%) and energy (21 %) to max imum load were less for allografts than controls. His tologic evaluation of the allografts revealed the pres ence of a regular oriented dense connective tissue which resembled a normal ligament. Microangiography revealed a periligamentous and endoligamentous vas cular pattern reminiscent of a normal ACL and complete revascularization of the bone plugs.
The physiologic effects of eight weeks of aerobic dance with and without hand-held weights
Authors: Blessing Daniel L. , Wilson G. Dennis , Puckett John R. , Ford H.T.
Published: June 2007

There are few reports concerning the physiologic alter ations that occur following a specified period of aerobic dance. Further, no data exist to describe the physio logic changes or potential risk associated with using hand-held weights during aerobic dance. The purpose of this study was to determine the changes in maximum oxygen uptake (VO2 max) and body composition follow ing 8 weeks of aerobic dance using hand-held weights (Heavyhands, AMF, Jefferson, lA). Twenty-eight college females volunteered for the study. All subjects were given a preoxygen and postoxygen uptake (VO2 max) treadmill test. Body composition was measured by taking the sum of five skinfold sites and determining the percent change following training. Subjects were randomly assigned to a hand-held weight or nonhand held weight group. No significant differences (P < 0.05) existed between groups for VO2 max and body com position after 8 weeks of traini ng. However, a significant improvement (P < 0.05) in VO2 max was found within the hand-held weight (37.7 to 42.6) and in the nonhand held weight group (36.5 to 41.9). Complaints from subjects included transient aches and pains in the shoulder area during the first 3 weeks as a result of hand-held weight use. These findings suggest that hand-held weights may be used safely but do not increase the work load sufficiently above that of aerobic dance alone to significantly modify VO2 max or body composition.
Evaluation of the polypropylene braid as a prosthetic anterior cruciate ligament replacement in the dog
Authors: Mendenhall H.V. , Roth J.H. , Kennedy J.C. , Winter G.D. , Lumb W.V.
Published: June 2007

The purpose of this scientific investigation, made prior to 1977, was to determine the suitability of a polypro pylene prosthetic ACL. The 3.6 mm diamond-braided prosthesis was implanted in 17 dogs. The device was passed through a trough on the anteromedial side of the tibial crest and over the top of the lateral femoral condyle. The device was internally fixed at both ends to bone using a bushing-lag screw technique which resulted in solid prosthesis immobilization at the time of surgery. Animals were necropsied at 3, 6, or 10 months after implantation. There was partial or total disruption of the prosthesis in all cases. Destruction of the prosthesis was attributed to excessive viscoelastic ity of the device and fatigue failure. Based on this study, prosthetic ACL replacement using this device is not recommended.
Injuries in women's gymnastics
Authors: McAuley Edward , Hudash Gail , Shields Kolleen , Albright John P. , Garrick James , Requa Ralph , Wallace Robert K.
Published: June 2007

This article takes a three-stage approach to the topic of injuries in women's gymnastics. In the first stage, we review the literature and summarize our current knowledge of injury rates, injuries in specific events, and anatomical location of injuries. In the second, we critically evaluate the relative contributions of these studies in terms of their generalizability, methods, and conceptual approaches. Finally, we present possible directions for future research in the area of women's gymnastic injuries.
Hematuria and microalbuminuria after a 100 kilometer race
Authors: Alvarez Concha , Mir Judit , Obaya Silvia , Fragoso Mirian
Published: June 2007

An investigation into hematuria and microalbuminuria induced by prolonged physical exercise was carried out by studying 26 runners who took part in a 100 km race by collecting urine samples before, after the race, and 24 hours later. Microscopic hematuria was present in two runners before the race. After this strenuous ex ercise there was macroscopic hematuria in five runners (19.2%) and microscopic hematuria in nine (34.6%). On examination by phase contrast microscopy there were neither dysmorphic erytrocytes nor red cell casts. Al buminuria was measured by radial immunodiffusion and was expressed as Ualb/U creat and Ualb/Uosm ratios. Clinical albuminuria was found in five runners with macroscopic hematuria, and microalbuminuria in 13 of the 21 re mainders ; in 6 of them it was associated with micro scopic hematuria. Twenty-four hours later all of the results were normal with the exception of the five runners who have had macroscopic hematuria and another one with microalbuminuria without hematuria.

We conclude that determination of albumin excretion in runners after exercise should be made as well as hematuria, and particular attention should be paid to cases of severe and/or prolonged microalbuminuria, since such individuals may be at risk of renal disease.
Anterior cruciate ligament injuries in the young athlete with open physes
Authors: McCarroll John R. , Rettig Arthur C. , Shelbourne K. Donald
Published: June 2007

From 1980 to 1985, 40 patients under the age of 14 with open physes were treated for midsubstance tears of the ACL at the Methodist Sports Medicine Center. In this series, 16 were treated conservatively with re habilitation, bracing, and counseling on activity modifi cation. The remaining 24 patients underwent arthros copic examination and either an extraarticular or intra articular reconstruction based on growth potential.

The average followup was 27 months for the con servative group and 26 months for the surgical group. In the conservative group, six patients underwent ar throscopy for meniscal tears, four medial and two lat eral. Only seven patients returned to sports, all experi encing recurrent episodes of giving way, effusions, and pain.

In the surgical group, 12 medial and 6 lateral meniscal tears were found at arthroscopy. There were 10 ex traarticular reconstructions and 14 intraarticular recon structions. All 24 returned to sports activity, and 22 of the 24 are still competing. The two remaining patients both suffered reinjury 3 years after their surgery.

We recommend arthroscopy and examination under anesthesia for the young patient with ACL tears. Based on the amount of instability, presence or absence of meniscal tears, and athletic desires of the patient and his or her family, a treatment plan can be undertaken.
Study of the infrapatellar nerve
Authors: Arthornthurasook Art , Gaew-Im Kasem
Published: June 2007

During operations on the knee, such as open menis cectomy and pes anserinus transplant for chronic an teromedial rotatory instability of the knee, the infrapa tellar nerve may easily be damaged or severed. Knowl edge of the normal anatomical variations of this nerve is thus of importance to the surgeon, so that he can avoid postoperative distress caused by unintentional injury to the infrapatellar nerve.

Anatomical variations of this nerve have been studied in 20 cadavers, with particular reference to its relation ship to the sartorius and the nerve's distance from the medial femoral epicondyle. In 52.9% of the cadavers studied, the anatomy of the infrapatellar nerve was identical on both sides. Four types of nerve were found and classified according to their relationship to the sartorius: posterior, penetrating, parallel, and anterior. The commonest type was the posterior (62.2%), where the nerve emerged at the posterior border of the sar torius before passing superficial to it to supply the skin and fascia over the front and medial aspect of the knee and the proximal part of the leg. Situated furthest from the medial femoral epicondyle was the parallel type (average, 105.7 mm), which runs parallel to the poste rior border of the sartorius before crossing it at infra patellar level.
The Mumford procedure in athletes
Authors: Cook Frank F. , Tibone James E.
Published: June 2007

No report in the English literature exists on objective muscle testing following the Mumford procedure (distal clavicular resection). Twenty-three athletes, including six at the professional level, were evaluated an average 3.7 years after the Mumford procedure was performed for degenerative changes after a Grade I or Grade II dislocation. All athletes were evaluated with an in depth questionnaire, physical examination, and radiographic study. Seventeen performed Cybex testing of both shoulders. All but one were satisfied with the surgery. Sixteen returned to their same level of sports activity, including five of the six professional athletes. The most common complaint of all those not achieving the pre vious level of sports was the inability to achieve their previous maximum bench press strength.

All athletes demonstrated full motion; five exhibited painless crepitation at the acromioclavicular joint. Ten of the twenty-three exhibited increased horizontal clavicular motion. Radiographs demonstrated an aver age of 1.9 cm of bone resection, with varying amounts of ossification present between the remaining clavicle and acromion in eight athletes.

The involved limb performed significantly more work than the sound limb in flexion (P = 0.0133) and internal rotation (P = 0.0575) at 300 deg/sec. The involved limb performed significantly more repetitions at 300 deg/sec than the sound limb in the extension plane (P = 0.0373).

The sound limb was significantly stronger during ex tension (P = 0.0759) and flexion (P = 0.0063) at 60 deg/sec compared to the involved limb. The sound limb performed significantly more total repetitions at 300 deg/sec in the abduction-adduction plane than the in volved limb (P = 0.0843).

The effect of limb dominance on upper extremity strength is reviewed. The authors conclude that the Mumford procedure produced excellent subjective re sults. The majority of the athletes achieved preinjury performance levels after initial clavicle resection for degenerative changes following Grade I or II sprains. While slow speed Cybex testing demonstrated some weakness, faster speed testing showed little or no weakness in fatigue of the involved shoulder.
An in vitro study of anterior cruciate ligament graft placement and isometry
Authors: Penner Darrell A. , Daniel Dale M. , Wood Peter , Mishra Dev
Published: June 2007

Isometric positioning of the ACL graft or prosthesis is an important consideration in successful reconstruction of the ACL-deficient knee. This study documented the relationship between graft placement and intraarticular graft length changes and graft tension changes during knee passive range of motion.

Fifteen fresh cadaveric knees were mounted in sta bilizing rigs. The ACL was identified and cut in each specimen. Intraarticular reconstruction was then per formed using a 6 mm polypropylene braid (3M LAD, St. Paul, MN). The following graft placements were evalu ated : 1) over-the-top, 2) modified over-the-top with a femoral bone trough, 3) femoral drill hole positions, and 4) tibial drill hole positions. The proximal end of the graft was fixed to the lateral aspect of the femur with a screw and spiked washer. The distal end of the graft was attached to a turnbuckle attached to a load cell on the anterior aspect of the tibia. The knee was then extended passively from 90° to 0°. Two experiments were performed. In Experiment A, the turnbuckle was adjusted to keep graft tension constant and the graft length changes were recorded. In Experiment B, the graft fixation sites were not altered and tension changes with range of motion were recorded.

A change in the graft distance between attachment sites with knee range of motion can be monitored either by ligament length or by tension change. With the over- the-top technique, in Experiment A, the graft distance between attachment sites increased as the knee was extended (x = 4.9 mm); in Experiment B, large tension increases were recorded with knee extension. With the modified over-the-top technique with femoral bone trough, isometry was approached as the average length increase with knee extension was reduced to 1.0 mm (Experiment A) and minimal tension increases occurred (Experiment B). Femoral drill holes positioned postero superiorly on the lateral femoral condyle produced vari able length or tension increases with knee extension. Anteriorly positioned femoral drill holes produced sig nificant length decreases with knee extension in Exper iment A (x = -5.5 mm) while tension measurements showed loss of graft tension with knee extension (Ex periment B). Finally, tibial drill hole position was also found to be vital for proper isometric tracking. Tibial drill holes situated immediately anterior to the antero medial portion of the ACL insertional site yielded the best isometric placement for the femoral orientations tested. Care must be taken, however, that this tibial position does not cause impingement in the intercon dylar notch.
The durability of anterior cruciate ligament reconstruction with the patellar tendon
Authors: Sandberg Rolf , Balkfors Bengt
Published: June 2007

Thirty patients operated on because of insufficiency of the ACL were objectively evaluated twice, 2 and 5 years after operation. The results were mostly good with regard to knee stability and function. No change in the outcome could be seen over the years.
Computed tomography (CT) arthrography of shoulder instabilities in athletes
Authors: Raf Mahvash , Minkoff Jeffrey , Bonamo John , Firooznia Hossein , Jaffe Leonard , Golimbu Cornelia , Sherman Orrin
Published: June 2007

Sixty professional and recreational athletes underwent CT arthrography of the shoulder for evaluation of sus pected shoulder joint derangement. These athletes, 46 males and 14 females ranging in age from 15 to 60 years (mean, 32 years), all had persistent pain that interfered with their sports activity and was resistant to conservative treatment.

Seventeen patients had shoulder instability based on clinical manifestations and CT arthrographic findings. An additional five patients, also based on clinical mani festations and CT arthrographic findings, were consid ered to have an unobtrusive degree of anterior joint laxity. Patients with anterior instability (20 cases) all had an anteroinferior tear or detachment of the glenoid labrum, as well as some violation of the insertion of the joint capsule onto the scapula. Those with posterior instability (two cases) had a combination of labral and capsular tears.

Two other major patterns of labral tears, both unaf filiated with shoulder instability, were identified. These included total or partial detachment of superior seg ments of the labrum, and anterior labral tears at the midglenoid level. Moreover, various degrees of labral attenuation (or, less often, enlargement), osteophyte formation, and alterations in articular cartilage were observed. Surgical correlation was obtained in 25 pa tients, with 95% accuracy of CT arthrographic findings.

CT arthrography is a minimally invasive and highly accurate technique for investigation of glenohumeral derangement. Specifically, the extent of pathologic changes associated with instability can be determined and differentiated from other intraarticular causes of incapacity, such as labral tears caused by throwing, or degenerative changes.
Medial subluxation of the patella as a complication of lateral retinacular release
Authors: Hughston Jack C. , Deese Melvin
Published: June 2007

We examined 54 patients (60 knees) referred to us because of their failure to improve, or because of a worsening of their preoperative symptoms, following an arthroscopic lateral retinacular release. Thirty knees developed medial subluxation of the patella postoper atively. This disabling condition is new to us. It is previously unreported as a complication of arthroscopic lateral retinacular release. Anterior knee pain was the only reported preoperative symptom in 14 knees. Six teen knees had a preoperative diagnosis of lateral patellar subluxation on the basis of a positive appre hension sign only. Eighteen of 30 knees had no surgery of the extensor mechanism other than the arthroscopic lateral release. The remainder additionally underwent varying types and numbers of operations in an attempt to resolve their disability.

CAT scan evaluation of three patients who volun teered for the procedure demonstrated severe atrophy and retraction of the vastus lateralis. Loss of this dy namic lateral stabilizer contributed to the medial sub luxation of the patella.
Prevalence and types of injuries in aerobic dancers
Authors: Rothenberger Lee A. , Chang June I. , Cable Thomas A.
Published: June 2007

A sample of 726 aerobic dancers was surveyed by questionnaire to document the prevalence, types, and severity of injuries experienced. Data were gathered on demographics, exercise behavior, and environmental conditions during a 1 week period. Most of the subjects (66%) engaged in aerobic dance classes at least every other day, with a mean exercise time of 195 minutes per week. Twenty-eight percent of the subjects had been exercising 1 to 2 years, and 26% had been exercising 2 years or longer.

Forty-nine percent of the subjects reported a history of at least one injury related to aerobic dancing. Most of the injuries were to the shin (24.5%), lower back (12.9%), and ankle (12.2%). Among those subjects injured, 23% reportedly saw a physician because of their injury. The frequency with which subjects exer cised was associated with a history of injury. Subjects who exercised fewer than four times per week reported fewer injuries (43%) than those who exercised four times per week (60%) or more (66%).

This study is a first step toward providing data to help physicians counsel aerobic dancers regarding in jury prevention.
The stabilizing effect of the ligamentous structures in the sinus and canalis tarsi on movements in the hindfoot
Authors: Kjærsgaard-Andersen Per , Wethelund Jon-Oddvar , Helmig Peter , Søballé Kjeld
Published: June 2007

Three-plane kinesiology of hindfoot instability was stud ied after lesions to the ligamentous structures in the sinus and canalis tarsi in 20 amputation specimens. Neither a lesion of the cervical ligament nor of the interosseous talocalcaneal ligament resulted in an in crease in the total range of movements above 2.6° in any of the three planes. However, the percentage in crease in the total range of movements after cutting of the ligaments was generally largest in the talocalcaneal joint compared to the increase in the total hindfoot joint complex. The largest percentage increase (43%) in the talocalcaneal joint occurred at dorsiflexion after cutting the interosseous talocalcaneal ligament.

The demonstrated minor instability after experimental lesions of the ligamentous structures in the sinus and canalis tarsi may have a clinical identity in the sinus tarsi syndrome. Patients with that syndrome rarely present an objective hindfoot instability, although a major complaint is a feeling of hindfoot instability.
The results of operative treatment of osteochondritis dissecans of the patella
Authors: Schwarz Charles , Blazina Martin E. , Sisto Domenick J. , Hirsh Linda C.
Published: June 2007

The course of osteochondritis dissecans (OCD) of the patella and the results of operative treatment are ana lyzed retrospectively in a review of 31 operatively treated cases in 25 patients. Followup was obtained for 21 cases, with an average of 73 months (range, 15 months to 20 years). These 25 patients were predom inantly males, and averaged 18 years of age at the time of surgery. A history of trauma was associated with the lesion in 38% of the cases, and the lesion was bilateral in one out of four patients. The most common present ing complaints were subpatellar pain and swelling. The most common initial physical findings were patellofem oral crepitus and joint effusion.

Forty-four operations were performed on 31 knees. The most commonly performed procedures were cu rettage of the patella and removal of loose bodies, in combination or as part of another procedure. A new patellofemoral rating scale was used to evaluate re sults. Thirty-eight percent of the knees had a good or excellent result, while 62% had a fair or poor result. Persistent pain with restricted function and residual patellofemoral crepitus were common findings.

In general, the patients who come to surgery for OCD of the patella have a guarded prognosis for full recovery of knee function.
Low back pain among retired wrestlers and heavyweight lifters
Authors: Granhed Hans , Morelli Bengt
Published: June 2007

The lifetime incidence and prevalence of low back pain among 32 retired wrestlers (ages 39 to 62 years) and 13 retired heavyweight lifters (ages 40 to 61 years) were evaluated and compared to the corresponding results in a cross-sectional study of 716 men (ages 40 to 47 years). The radiologic findings and the findings upon physical examination in the athletes were com pared to the findings in another study of normal, active, similarly aged men who were sampled at random. The lifetime incidence and prevalence of low back pain was higher among the wrestlers (59%) compared with both the lifters (23%) and the control group (31%). The tolerance for backache seemed to be higher among the athletes than the controls. A higher frequency of old fractures was found among the wrestlers. The athletes with fractures had a higher frequency of low back pain. A significant decrease in disk height was found among the lifters.
Sport and medicine in ancient Greece
Authors: Appelboom Thierry , Rouffin Christine , Fierens Eric
Published: June 2007

Sport and medicine in ancient Greece were the result of a widespread tradition of liberty, which was at the heart of one of the most brilliant civilizations in history. Whereas war encouraged the development of surgical knowledge springing out of medical experience on the battlefield, peace promoted the burgeoning of sport as an integral part of Greek upbringing, allowing the chan neling of young people's aggressiveness into physical competition. Medicine was magical and mythological, especially in the time of Homer (9th century BC); Aes culapius, the mythical god of healing, was its reference point. With Hippocrates (5th century BC), the body of medical experience was to be codified and built up, and was to undergo a novel evolution based on the theory of the balance of the four humors. The athlete's men tality, faced with trauma in the sports ground, under went a change; injury was no longer considered a punishment by the gods. At the same time, temple offerings tendered in the hope of victory gave way to the athlete's personal preparation based on a specifi cally modified lifestyle, diet, and training. The resulting progress in medicine and public health, especially from the 5th century BC onward, was not only to favor athletic performances of high quality but also surgical techniques that were very advanced for their time. Thus it can be seen that the medical knowledge associated with the practice of sport progressed during antiquity because of its obligation to follow the warrior and then the athlete.
Patterns of meniscal injury with acute anterior cruciate ligament tears
Authors: Cerabona Frank , Sherman Mark F. , Bonamo Joel R. , Sklar John
Published: June 2007

One hundred two patients underwent an arthrotomy for the primary repair of an acute ACL tear with or without an associated collateral ligament injury. The mean age was 23 years. Forty-seven patients (46%) had meniscal injuries. Meniscal injuries were found in 41 % of Group I patients (isolated ACL injuries) and in 54% of Group II patients (injured ACL/collateral liga ments). Twenty-eight medial and 22 lateral meniscal tears were noted. Twenty-six of the 50 meniscal tears (52%) were sutured in an attempt to repair the menisci. Of these, 20 of the medial (71 %), and 6 of the lateral (27%) meniscal injuries were sutured. No patients in this series required a total meniscectomy. A thorough evaluation of the menisci is mandatory in knees with an acutely injured ACL.
Operative ankle arthroscopy
Authors: Martin David F. , Baker Champ L. , Curl Walton W. , Andrews James R. , Robie David B. , Haas Albert F.
Published: June 2007

Ankle arthroscopy has become an accepted procedure for the treatment of various intraarticular disorders. More than 100 ankle arthroscopies have been per formed at our institution since 1983. To better define the role of arthroscopic surgery in the treatment of ankle disorders, we evaluated the preoperative exami nation and indications, operative data, and radiographs of those patients with a minimum of 1 year of followup. Fifty-eight ankles in 57 patients were identified; their average follow-up period was 25 months (range, 12 to 49 months).

Preoperative diagnoses were synovitis (26), trans chondral defects of the talus (17), degenerative joint disease (8), and osteophytes or loose bodies (7). Sub jective results were good or excellent in 64% of cases. The best overall results were achieved in patients with synovitis (77%) and transchondral defects of the talus (71 %). Degenerative joint disease patients did not do well. They had only 12% good or excellent results and a 43% rate of subsequent fusion. Complications in cluded superficial and deep infections, temporary and permanent paresthesias, and hemarthroses; the overall complication rate was 15%.

In conclusion, operative ankle arthroscopy can be useful in selected patients. It is an effective surgical procedure in patients with synovitis and transchondral defects of the talus. The benefits and long-term results are less predictable with loose bodies and impinging osteophytes; the results are poor with degenerative joint disease. There appears to be a significant risk of complication with ankle arthroscopy; however, with proper indications, a thorough knowledge of anatomical landmarks, and meticulous technique, good results can be obtained.