bluuebunny/crossref_metadata_2025 huggingface dataset:
Biologic fixation of ligament prostheses and augmentations
Authors: Arnoczky Steven P. , Torzilli Peter A. , Warren Russell F. , Allen Answorth A.
Published: June 2007

The biologic fixation (bone ingrowth) of three prosthetic ligament devices (bovine xenograft Xenotech Labora tories, Inc., Irvine, CA; Gore-Tex, W. L. Gore and As sociates, Flagstaff, AZ; and knitted dacron, Stryker, Kalamazoo, MI) and one ligament augmentation device (LAD, braided polypropylene, 3M, St. Paul, MN) were evaluated in vivo. The devices were placed unstressed, in an extraarticular location in the cortical-cancellous bone of the proximal femur and humerus of dogs. Six months following implantation tissue ingrowth was eval uated using high resolution radiography, routine histol ogy, scanning electron microscopy, and biomechanical tensile tests to measure the ultimate (maximum) pull- out strength of the devices.

The knitted dacron and Gore-Tex prosthesis showed marked ingrowth of trabecular bone into the interstices of the device with evidence of bone growth around individual fibers of the prosthesis. The bovine xenograft demonstrated bone immediately adjacent to the mate rial with evidence of spicular ingrowth of bone into the natural clefts of the prosthesis. The LAD showed no evidence of bone ingrowth and demonstrated a fibrous tissue interface between the prosthesis and surround ing trabecular bone.

Six months following implantation the pull-out strengths of the devices were as follows: knitted dac ron, 445.7 ± 151.ON; Gore-Tex, 438.1 ± 131.94N; bovine xenograft, 332.8 ± 64.2N; and LAD, 78.4 ± 47.9N. Statistical analysis revealed no significant differ ence between the pull-out strengths of the knitted dacron, Gore-Tex, and bovine xenograft. While the pull- out strength of the LAD was significantly lower (P < 0.01) than the other devices it should be noted that this device was designed as a temporary augmentation for biological grafts and as such permanent biological fix ation through bone ingrowth is neither required nor desired. The Gore-Tex, LAD, and bovine xenograft devices all failed by pulling out of the bone tunnel, while all the dacron grafts failed by separation of the dacron outer sleeve of the prosthesis from its inner dacron reinforcement. This rupture occurred at the entrance of the graft into the bone tunnel.
Kinematic analysis of human upper extremity movements in boxing
Authors: Whiting William C. , Gregor Robert J. , Finerman Gerald A.
Published: June 2007

Using two synchronized cameras, four experienced boxers were filmed while they threw a series of punches at a practice bag. Three-dimensional (3D) coordinates of each boxer's shoulder, elbow, wrist, and glove were used to estimate linear and angular kinematics of the upper extremity. Average velocities at contact ranged from 5.9 to 8.2 m/s with peak velocities of 6.6 to 12.5 m/s reached 8 to 21 ms prior to hand/glove contact with the bag. Significant differences in shoulder and wrist velocities, elbow angle excursions, and elbow angular velocities were seen when comparing hooks and jabs. Few differences were evident when compar ing the kinematics of gloved versus bare-handed punches. Results are significant in providing kinematic data characteristic of experienced performers, which may be used in a kinetic model of punch impact and its relationship to potential injury mechanisms.
In vitro fibroblast seeding of prosthetic anterior cruciate ligaments
Authors: Brody Gordon A. , Eisinger Magdalena , Arnoczky Steven P. , Warren Russell F.
Published: June 2007

To evaluate the effect of in vitro seeding of fibroblasts on the connective tissue encapsulation of implanted ligament prostheses, canine skin fibroblasts were grown in tissue culture and seeded onto knitted Dacron prostheses. When the cells on the prostheses reached contact growth inhibition, as determined by growth curves, the prostheses were implanted into the dogs' knees as ACL replacements. Gross and histologic eval uation at 4 and 8 weeks revealed that the seeded prostheses consistently showed more uniform and abundant encapsulation with connective tissue than did the control (unseeded) prostheses. The giant cell re sponse observed in the tissue surrounding the un seeded prostheses was not noted in the seeded pros theses. This may be because seeding a prosthesis with fibroblasts prior to implantation "walls off" the prosthe sis from the environment of the joint, and therefore the prosthesis may not elicit as great a foreign body re sponse as does an unseeded prosthesis. The results of this preliminary study suggest that the in vitro seed ing of a ligament prosthesis with fibroblasts accelerates the connective tissue encapsulation of the implanted prosthesis.
Functional analysis of untreated and reconstucted posterior cruciate ligament injuries
Authors: Tibone James E. , Antich T.J. , Perry Jacquelin , Moynes Diane
Published: June 2007

Twenty patients with old ruptures of the PCL were analyzed. Ten patients were untreated, and ten patients had reconstruction of the PCL with the medial head of the gastrocnemius. The patients' gait was analyzed using high speed photography, footswitches, electro myography, and force plate. Patients were studied while walking, running, and stair-climbing. A Cybex muscle strength evaluation was also performed. Clini cally, all patients had moderate to severe posterior instability. Five of the 20 patients also had posterolat eral instability. Cybex testing showed quadriceps defi cits in both reconstructed and untreated groups when comparing involved and uninvolved limbs. The recon structed group also had deficits on hamstring Cybex testing. Footswitch data showed only minimal abnor malities. Gait velocity of walking was 91% of normal with a normal cadence. There was no significant differ ence in the single limb support times between the involved and uninvolved limbs in walking, fast walking, or running. The photometric data showed a tendency for increased knee flexion during the midstance phase of the gait cycle in comparing involved and uninvolved limbs. The knee flexion angles during midstance were similar in the patients with posterior instability when compared to the patients with the additional postero lateral instability. Force plate data showed decreased foot-floor reaction in the untreated group during termi nal stance while walking. Similar findings were found in the reconstructed group during running. Electromyo graphic analysis showed early activation of the gastroc nemius-soleus complex during the stance phase of the gait cycle. This was postulated as a compensation mechanism to stabilize the foot-ankle-tibia complex in the face of quadriceps weakness and posterior insta bility.
Treatment of acute patellar dislocation
Authors: Cash James D. , Hughston Jack C.
Published: June 2007

To determine the effectiveness of nonoperative and operative treatment of initial acute patellar dislocation, we reviewed the charts of 399 patients with the diag nosis of an acute dislocation, seen during a 30 year period. One hundred patients (103 knees) met the criteria for inclusion in the study.

The average age of the patient at injury was 21.7 years (range, 9 to 72 years). Length of followup aver aged 8 years (range, 2 to 26 years).

Retrospectively, we divided the patients into two groups, according to the examination of their unaf fected knee. Group I (69 knees) showed evidence on examination of congenital abnormality of the extensor mechanism in the unaffected knee, indicating a predis position to dislocate with less significant trauma. Group II (34 knees) showed no clinically perceptible congenital predisposition to dislocate based on examination of the unaffected knee.

In the nonoperatively treated knees in Group I, there was a 52% (28/54) incidence of good or excellent results. The nonoperatively treated knees in Group II had a 75% (15/20) incidence of good or excellent results.

Acute dislocation occurred more frequently in males than in females. Recurrence was rarer in patients whose initial dislocation had occurred when they were over 15 years old.

Contrary to recently published reports, primary acute traumatic patellar dislocations can be treated with non operative therapy with good or excellent results. Initial evaluation should include examination of the uninvolved knee which, if found to have signs of congenital abnor mality, would indicate a worse prognosis.
Isokinetic evaluation of shoulder rotational strength in high school baseball pitchers
Authors: Hinton Richard Y.
Published: June 2007

Isokinetic, shoulder rotational strength was evaluated in 26 high school baseball pitchers before the start of spring practice. Using the Cybex II (Cybex, Division of Lumex, Inc., Ronkonkoma, NY), test data were gath ered on the dominant and nondominant shoulders in the supine 90° abducted test position (90° AbTP) and the standing neutral test position (neutral TP). Tests were performed at 90 and 240 deg/sec. The HUMAC (Computer Sports Medicine, Inc., Flemington, NJ) com puter system was used to analyze data. Means and standard deviations for peak torque, total work, peak torque to body weight ratios, and agonist/antagonist ratios are presented. Comparison of dominant to non dominant sides and 90° AbTP to neutral TP values are reported. Peak torque and total work values for the throwing side internal rotators were significantly higher than the nonthrowing side in all tests. Pitching side externai rotators falled to show this dominance. Exter nal/internal rotation ratios for peak torque and total work were significantly lower on the pitching side, suggesting a relative imbalance of cuff musculature compared to the nonpitching shoulder. Significant dif ferences existed between data gathered in the two different test positions. In the 90° AbTP, external ro tation peak torque and total work values and external/ internal rotation peak torque and total work ratios were higher than the equivalent values gathered in the neutral TP. Internal rotation peak torque and total work values tended to be higher in the neutral TP than in the 90° AbTP. The rotator cuff imbalances exhibited in the pitching shoulder of participants in this study draw attention to the need for structured exercise to prevent and correct this deficit, which can act as a predisposing factor to injury in the throwing athlete. Significant dif ferences in torque data gathered in two commonly used shoulder rotational test positions suggest the need for multiple position testing for complete evaluation and the requirement of specifying test position when com paring shoulder rotational torque values clinically or experimentally.
Limited joint mobility in power lifters
Authors: Chang Dillon E. , Buschbacher Lois P. , Edlich Richard F.
Published: June 2007

In this study we compared the flexibility of 10 power lifters with 10 age-matched nonpower lifters as con trols. To do this, we used goniometric measurements, the behind the back reach test, and the sit and reach test. The sit and reach test was the only measurement that showed the flexibility of the power lifters to be greater than that of the nonpower lifters.
A biomechanical evaluation of tibiofemoral rotation in anterior cruciate deficient knees during walking and running
Authors: Czerniecki Joseph M. , Lippert Frederick , Olerud John E.
Published: June 2007

ACL injury has been associated with increased insta bility of the knee in both in vitro and in vivo studies using passively applied forces. This study assessed tibiofemoral rotation after ACL injury during the func tional activity of treadmill ambulation using a triaxial electrogoniometer. Isometric and isokinetic peak torques of the quadriceps and hamstrings were ob tained using the Cybex II isokinetic dynamometer.

Significant increases in tibiofemoral rotation were noted with increased running speed in the injured and normal knees. The degree of rotation in the injured limb did not significantly exceed that of the normal limb. Isokinetic strength of the quadriceps and hamstrings correlates significantly with the observed extent of ro tation.
Tibial collateral ligament bursitis
Authors: Kerlan Robert K. , Glousman Ronald E.
Published: June 2007

In 91 patients evaluated between 1982 and 1985, tibial collateral ligament bursitis was diagnosed. This entity has not been described since the work of Brantigan and Voshell in 1943. The diagnosis was based on the findings of tenderness over the tibial collateral ligament at the joint line, without a history of mechanical symp toms. With a nonsurgical program, 62% of the patients improved and subsequently required no further treat ment. Fifteen percent did not improve; of this group, one-third had a negative arthrogram or arthroscopy. Another 23% did not improve and ultimately underwent an arthroscopic partial medial meniscectomy. Tibial col lateral ligament bursitis is an entity that should be considered in any patient with medial joint pain in the knee. Treatment is simple, effective, and offers low morbidity.
Delayed unions and nonunions of stress fractures in athletes
Authors: Orava S. , Hulkko A.
Published: June 2007

From 1971 to 1985, 369 athletes presented to us with stress fractures. Of these patients, 10% (37) were treated for development of delayed unions or non unions. Twenty-seven of the patients were male and 10 were female. Their mean age was 23.1 years (range, 17 to 39). About half of the athletes were involved in endurance sports. The diagnostic criteria for a delayed union or nonunion were clinical and radiological evi dence. There was a diagnostic delay of about 3.5 months in the series. Plain radiographs, tomography, and isotope scans were used in the diagnosis. Special radiographic views were also used. In 15 cases (10 hallux sesamoid bone fractures, 1 midtibial shaft frac ture, 1 metatarsal V base fracture, 1 tarsal navicular fracture, 1 olecranon fracture, and 1 proximal tibial shaft fracture) nonoperative treatment was used. Operative treatment was used 22 times (5 sesamoid fractures, 5 midtibial fractures, 5 metatarsal V base fractures, 3 tarsal navicular fractures, 3 olecranon fractures, and 1 proximal tibial shaft fracture). Results were good or excellent in 32 cases (86.5%), moderate in 4 cases, and poor in 1 case.
Injuries in international ice hockey
Authors: Lorentzon Ronny , Wedren Hans , Pietilä Tom , Gustavsson Bengt
Published: June 2007

In this prospective study, we have investigated inci dence, nature, and mechanisms of injury in the Swedish national hockey team during 40 international games. There were 19 injuries associated with absence from practice or games, and 17 facial lacerations. The inci dence of injuries associated with absence was 79.2 per 1,000 player-game hours, compared to the correspond ing incidence of 78.4 found for Swedish national hockey. The incidence of facial wounds was 70.8 per 1,000 player-game hours, compared to the incidence of 21.8 for Swedish national hockey. The high incidence of facial injuries in international hockey is due to a high rate of stick contact injuries. Stricter enforcement of rules and more widespread use of visors would reduce the number of facial injuries.
Incidence, nature, and causes of ice hockey injuries
Authors: Lorentzon Ronny , Wedrèn Hans , Pietilä Tom
Published: June 2007

In this prospective study, we have investigated inci dence of injuries of different severity, types of injury, and mechanisms of injury during ice hockey practice and games. One Swedish elite hockey team was closely observed during three seasons (1982 to 1985). There was a total number of 95 injuries and 29 facial lacera tions. The majority of injuries were minor (73%) and only 8% were classified as major. Seventy-six percent of the injuries occurred during games and 24% during practice. The incidence of injury during practice was 1.4 per 1,000 player-practice hours and 78.4 per 1,000 player-game hours. In comparison with other sports, the incidence of injury during hockey practice is very low, while that during games is high. Eighty percent of the injuries were caused by trauma and 20% by over use. The most common types of injury were contusions, strains, and sprains. Complete tear of the medial col lateral ligament of the knee was the most common severe injury. Most injuries resulted from body contact, predominantly tackling (checking), and from puck or stick contact. A reduction of the number of minor and moderate injuries should be possible by stricter en forcement of the hockey rules, especially against stick violations, and more widespread use of visors.
Martial arts injuries
Authors: Birrer R.B. , Halbrook S.P.
Published: June 2007

A 5 year national survey of martial arts was done using the National Electronic Injury Surveillance System (NEISS). Seventy-four percent of the injuries involved the extremities and 95% were mild to moderate in nature. Even though most of the injury types were contusions/abrasions (36%), lacerations (14%), and sprains/strains (28%), 15% were dislocations and frac tures. Five percent of all injuries were severe, and there were 18 hospitalizations. There were no deaths. Weapon-related injuries were rare and never serious. Overall, the risk of serious injury in the sport was found to be low, especially when compared to other contact sports.
Reconstruction of the anterior cruciate ligament
Authors: Elmqvist Lars-Gunnar , Lorentzon Ronny , Langström Mats , Fugl-Meyer Axel R.
Published: June 2007

The clinical results in 29 patients who had undergone ACL reconstruction with quadriceps-patellar tendon graft over-the-top were studied at an average of 28 months postoperatively. Postoperative immobilization was at either 30° (N = 17) or 70° (N = 12) of knee flexion for 6 weeks. All patients then followed a com mon preparatory training program for 8 weeks. In the 14th postoperative week the patients were put on either progressive resistance training (N = 12) or isokinetic training (N = 17) for 6 weeks, after which all had identical training.

Independent of primary knee immobilization angle or training regimens, no differences could be demon strated with respect to stability, range of motion, func tion, or isokinetic mechanical output. For all patients, Lysholm knee function score improved from 60.5 to 93.6 (P < 0.001) and activity level from 3.9 to 6.3 (P < 0.001). Isokinetic peak torque, contractional work, and mean power of the quadriceps at 30, 90, and 180 deg/ sec were lower in the injured compared to the nonin jured leg (78% to 90%; P < 0.01) both preoperatively and at followup, and there were no significant differ ences between the preoperative and follow-up values. Clinical stability improved (P < 0.001) in 19 of the 29 patients (66%) and in 11 of those 17 patients with early isokinetic training (65%). Performance tests were nor mal in 23 of 29 patients (79%), with minor abnormalities in the rest.

We conclude that immobilization at a higher tension of the quadriceps or early isokinetic training did not results in any advantages in the long run, and that patients with early isokinetic training did not show any increased incidence of remaining instability.
Postsurgical knee rehabilitation
Authors: Timm Kent E.
Published: June 2007

This study was an investigation into the influences of rehabilitation procedures on the long-term success of postsurgical knee patients. In a blind retrospective par adigm, the cases of 5,381 patients (2,417 females, 2,964 males; mean age, 32.7 years; age range, 13 to 61 years) were reviewed to correlate rehabilitation methods with postsurgical success. Postsurgical suc cess was defined as patient resumption of required activities without symptom recurrence, over a period of 5 years after surgery. The four rehabilitation methods studied were programs of no exercise, home exercise, isotonic exercise, and isokinetic exercise. Statistical analysis revealed significant differences at the P = 0.05 level for comparison of the isokinetic exercise to the other methods on the basis of rehabilitation interval (isokinetic, 8.9 ± 3.7 weeks; isotonic, 12.3 ± 6.1 weeks; home, 10.0 ± 4.5 weeks) and correlation to success (isokinetic, r = 0.92, isotonic, r = 0.48, home, r = 0.09, no exercise, r = 0.00). It was concluded that rehabilitation methods that incorporate isokinetic exer cise are more efficient and effective than nonisokinetic programs in the long-term successful management of postsurgical knee patients.
An electromyographic analysis of shoulder function in tennis players
Authors: Ryu Richard K.N. , McCormick John , Jobe Frank W. , Moynes Diane R. , Antonelli Daniel J.
Published: June 2007

Shoulder injuries in tennis players are common because of the repetitive, high-magnitude forces generated around the shoulder during the various tennis strokes. An understanding of the complex sequences of muscle activity in this area may help reduce injury, enhance performance, and assist the rapid rehabilitation of the injured athlete.

The supraspinatus, infraspinatus, subscapularis, mid dle deltoid, pectoralis major, latissimus dorsi, biceps brachii, and serratus anterior muscles were studied in six uninjured male Division II collegiate tennis players using dynamic electromyography (EMG) and synchro nized high-speed photography. Each subject performed the tennis serve and the forehand and backhand groundstrokes, and each stroke was divided into stages.

The tennis serve contains four stages. Three stages characterize the forehand and backhand ground strokes. Our results indicate that the subscapularis, pectoralis major, and serratus anterior display the greatest activity during the serve and forehand. The middle deltoid, supraspinatus, and infraspinatus are most active in the acceleration and follow-through stages of the backhand. The biceps brachii increases its activity during cocking and follow-through in the serve with a similar pattern noted in the acceleration and follow-through stages of the forehand and back hand. The serratus anterior demonstrates intense activ ity in the serve and forehand, thus providing a stable platform for the humeral head and assisting in gleno humeral-scapulothoracic synchrony.

The tennis serve and forehand and backhand ground strokes are accomplished by complex sequences of muscle activity that incorporate contributions from the lower extremities and trunk into smooth, coordinated patterns. Although our study focused on shoulder function in the uninjured tennis player, it may provide a basis for understanding abnormal shoulder biomechanics that contribute to pain and dysfunction. The serratus anterior deserves special emphasis, for our study showed that its activity is essential to each of the three tennis strokes. Because of the similarities between the tennis serve and overhead throw, a conditioning program comparable to one pitchers use many be appropriate for tennis players.
Improved safety in ski jumping
Authors: Wester Knut
Published: June 2007

Among approximately 2,600 licensed Norwegian ski jumpers, only three injuries that caused a permanent medical disability of at least 10% were incurred during the 5 year period from 1982 through 1986. When compared to the previous 5 year period (1977 to 1981), a dramatic improvement in safety is seen, as both number and severity of such injuries were markedly reduced. There are several probable reasons for this improved safety record: better preparation of the jumps, the return to using only one standard heel block, and the fact that coaches are being more responsible, especially with younger jumpers.
Injury surveillance at the 1985 National Boy Scout Jamboree
Authors: Wetterhall Scott F. , Waxweiler Richard J.
Published: June 2007

Few studies have examined the rate of injuries for those attending summer camps and other recreational facili ties. We developed a surveillance system for the 1985 National Boy Scout Jamboree to determine the inci dence, nature, and cause of injuries among participants. To characterize the more severe injuries among scouts, we monitored referral visits to an onsite Army hospital. During the 9 day event there was a total of 179 injuries requiring referral visits among the 24,885 scouts, for an overall incidence of 8.5 injuries per 10,000 person- days. Twenty-eight injuries (16%) involved fractures. Ten injuries required hospitalization, for an overall rate of 0.5 per 10,000 person-days. Thirty-six (20%) of the injuries occurred during six organized athletic activities. Of these six, two new Jamboree activities, the bucking bronco and bicycle motocross racing, had the highest event-specific rates, 14.4 and 11.4 injuries per 10,000 participants, respectively. These two events also ac counted for one-third of all fractures. In contrast, there were no firearm-related injuries among the 32,616 par ticipants in riflery events. This simple and inexpensive surveillance system provided a mechanism for monitor ing activity modifications, as well as useful information for the selection and planning of organized activities at future Jamborees and similar recreational events.
Chronic Achilles paratenonitis
Authors: Kvist Martti H. , Lehto Matti U.K. , Jozsa Laszlo , Järvinen Markku , Kvist Helmer T.
Published: June 2007

Pathological alterations in chronic Achilles paratenonitis were studied histologically and using immunofluores cence techniques for fibronectin and fibrinogen in tissue samples obtained operatively from 11 athletes with this complaint and from 4 male cadavers serving as con trols. The average duration of the paratenonitis was 20.4 months. The paratendineal fatty areolar tissue was clearly thickened and edematous, showing widespread fat necrosis and considerable connective tissue prolif eration. The blood vessels were often obliterated and degenerated. Fibronectin and fibrinogen were com monly found in the proliferating connective tissue areas and in the vascular walls. Exudates rich in fibrinogen and fibronectin were seen in the inflamed paratendineal tissues, but not in the controls.

The results indicate that increased vascular permea bility and fibrin formation still persist in chronic Achilles paratenonitis and that marked obliterative and degen erative alterations of the blood vessels are frequent. The presence of fibronectin and fibrinogen points to an immature nature of scar tissue in chronic paratenonitis.
Calf muscle area and strength changes after five weeks of horizontal bed rest
Authors: LeBlanc Adrian , Gogia Prem , Schneider Victor , Krebs Jean , Schonfeld Ernesto , Evans Harlan
Published: June 2007

Nine male volunteers participated in a 10 week meta bolic study in which subjects underwent 5 weeks of ambulatory control and 5 weeks of complete horizontal bed rest. Bed rest is a model commonly used to simu late space flight. The changes in muscle area and strength of the calf dorsiflexors and plantar flexors were measured before and after bed rest using magnetic resonance imaging (MRI) and a Cybex II dynamometer. The muscle area of the plantar flexors (gastrocnemius and soleus) decreased 12%, whereas the muscle area of the dorsiflexors was not significantly decreased. The maximal muscle strength of the plantar flexors de creased 26%; the muscle strength of the dorsiflexors was not significantly decreased. These results, which demonstrate differential muscle atrophy and a larger loss in strength relative to muscle area, have important implications in the development of exercise counter measures to be impiemented during space fiight. The results also have implications for patients who have severe orthopaedic disorders and must be bed rested for long periods of time, and for persons who are voluntarily inactive (a large number of the elderly).
Jumper's knee and ultrasonography
Authors: Fritschy Daniel , de Gautard René
Published: June 2007

Twenty-five patients, aged between 15 and 45 years old, who were athletically active, presented with jump er's knee (patellar tendinitis). By use of ultrasono graphic examination, new and precise information was obtained that benefited the diagnosis, choice of treat ment, and monitoring of the evolution of jumper's knee in our patients. In 18 of the 25 patients, only 1 knee was affected; in 7 of the patients, both knees were affected, thus making a total of 32 painful tendons. These 25 patients were compared with a control group of 15 healthy, athletically active subjects between the ages of 25 and 35 years old.

In all of the 32 painful tendons, ultrasonographic anomalies were observed: thickening or swelling of the tendon (15 knees) appeared in acute cases; a hetero geneous structure of the tendon (24 knees); and thick ening and irregularities of the tendinous envelope (8 knees).

The 15 acute patients all responded to classic con servative treatment including physical therapy and elec trotherapy. Four of the remaining 10 patients were treated successfully with various conservative treat ments, including deep transverse friction massage with ice. The other six patients were treated surgically, with tenolysis and "carding" of the patellar tendon. In one patient, this procedure failed, and 12 months later a second operation was performed, in which the distal pole of the patella was resected and the patellar tendon reinserted into bone. Recovery was uneventful. Now, at least 2 years after treatment, all of the patients consider themselves healed.
The effect of a nonsteroidal antiinflammatory drug on the healing of ligaments
Authors: Dahners Laurence E. , Gilbert Jerome A. , Lester Gayle E. , Taft Timothy N. , Payne Loel Z.
Published: June 2007

Because of the increasing number of ligament sprains being treated with nonsteroidal antiinflammatory drugs (NSAIDs), this study was undertaken to document the effects of one such drug on ligament healing in an experimental setting. Male Sprague-Dawley rats weigh ing between 400 and 500 g were used to evaluate the effect of the NSAID piroxicam on the healing of an experimental injury to the medial collateral ligament (MCL). The following factors were varied in the experi ments: dosage, days of treatment, and the day postin jury when treatment was begun. Piroxicam-treated rats were compared to placebo-treated rats in terms of the drug's effect on the mechanical strength of the healing ligament. The ligaments were mechanically tested in tension to failure at a constant deformation rate of 0.25 mm/sec on a materials testing machine. Administration of piroxicam on Days 1 to 6 postinjury resulted in a 42% increase in strength at Day 14 postinjury for the piroxicam-treated ligaments (P < 0.01) when compared with the placebo-treated controls. Neither doubling nor halving the standard piroxicam dose significantly al tered this increased healing strength. Biochemical analysis of collagen synthesis demonstrated a sugges tive, although not statistically significant, increase in collagen synthesis and collagen content in the piroxi cam-treated healing ligament. In separate experiments, piroxicam had no effect on the healed ligament at 21 days or on the strength of uninjured ligaments. In conclusion, piroxicam increased the early strength of healing ligaments in the rat when the drug was admin istered for short periods of time after injury. It did not affect the final strength when healing was complete, nor did it alter the strength of uninjured ligaments.
Illness and absence among wrestlers, swimmers, and gymnasts at a large university
Authors: Strauss Richard H. , Lanese Richard R. , Leizman Daniel J.
Published: June 2007

The object of this study was to document the preva lence of illness and absence in members of three men's intercollegiate athletic teams: varsity wrestling, swim ming, and gymnastics. Team members (N = 87) were interviewed weekly in January and February during 8 weeks of their competitive season. Symptoms, signs, and their duration were recorded on a standard form, as well as the number of days of absence from at least one class or team practice or competition. Mean prev alence of illness was 54 per 100 persons during the first 5 weeks of the study and 30 per 100 persons during the last 3 weeks. Eighty-six percent of the athletes had at least one respiratory illness during the 8 week period and 40% reported skin problems. There were no significant differences among teams for respi ratory or skin problems. Gastrointestinal symptoms were significantly more frequent among swimmers than among wrestlers or gymnasts (χ2 = 16.1, df = 2, P < 0.001). During an illness, an athlete was less likely to miss class than practice or competition (χ2 = 5.33, df = 1, P < 0.05). We conclude that there were no significant differences in the prevalence of illness among the three teams except that swimmers had more gastrointestinal problems as well as a transient syndrome associated with abnormal water quality (pH) in the swimming pool.
Sliding fibular graft repair for chronic dislocation of the peroneal tendons
Authors: Micheli Lyle J. , Waters Peter M. , Sanders Don P.
Published: June 2007

Chronic recurrent subluxation of the peroneal tendons can be a disabling condition in the young athlete. Con servative techniques of management, including taping, pads, or special shoes, are usually ineffective. Many authors have reported favorable results with surgical reconstruction. These repairs fall into four categories: periosteal reattachment, groove deepening, tenoplasty procedures, and bone block procedures. We are re porting the results of treatment of 12 patients with a sliding fibular graft procedure that has not previously been reported in the literature. Results were excellent in 11 of the 12 procedures. One patient with bilateral repairs reported recurrence of symptoms on one side and required reexploration.
Nonoperative treatment of Grade II and III sprains of the lateral ligament compartment of the knee
Authors: Kannus Pekka
Published: June 2007

The purpose of the study was to learn the long-term results of nonoperatively treated sprains of the lateral compartment of the knee joint, generally known to be relatively rare injuries. A multidimensional follow-up analysis was performed on an average 8 years after the injury in 11 patients with Grade II sprains and in 12 patients with Grade III sprains, including four standard ized knee scoring scales for subjective, objective, func tional, and radiographic evaluation, as well as isokinetic and isometric strength evaluations.

The result in Grade II sprains of the lateral ligament compartment (LAT) was generally good, although resid ual lateral laxity was common. In Grade III sprains, the results were much worse, with a high frequency of persisting severe or gross lateral laxity, insufficiency of the ACL, muscle weakness, and posttraumatic osteoar thritis of the injured knee.

Grade II sprains of the LAT respond successfully to nonoperative treatment; in Grade III sprains, however, such treatment cannot be recommended as a method of choice.
Cidex-induced synovitis
Authors: Harner C.D. , Fu F.H. , Mason G.C. , Wissinger H.A. , Rabin B.S.
Published: June 2007

Microscopic evidence of inflammation was observed in the synovium of rabbit knees that had been injected with 10 ppm of Cidex (2% glutaraldehyde). Initial changes were synovial hypertrophy, subsynovial edema, and vascular congestion. At concentrations of 100 ppm or greater, focal synovial necrosis, hemor rhage, and gross diffuse synovitis were observed. The degree of synovial inflammation was proportional to the concentration of Cidex. Observation of synovial re sponse versus time demonstrated this reaction to be a chemical synovitis without histologic evidence of a de layed hypersensitivity allergic component.

Significant intraoperative levels of Cidex were noted in the rinse solutions at several hospitals. When a single rinse is used, the concentration of Cidex present in the rinse basin is 100 to 300 ppm. If the same rinse is used for subsequent cases, the Cidex concentration is on the order of 1,000 ppm by the fifth arthroscopic pro cedure. If a double rinse is used and the rinse changed with each operative case, the Cidex concentration in the second rinse is less than 10 ppm. After irrigation of the knee joint with 1 liter of saline, the intraarticular concentration of Cidex is less than 10 ppm regardless of the rinse technique.
A stabilometric technique for evaluation of lower limb instabilities
Authors: Friden Thomas , Zätterström Rose , Lindstrand Anders , Moritz Ulrich
Published: June 2007

Stabilometry is a technique designed to register pos tural equilibrium control. This investigation used a com puterized strain gauge force plate to measure sway movements in the frontal plane with the patient standing on one leg. Fifty-five young healthy individuals were studied as a reference group and to determine the reproducibility of the method. The clinical population consisted of 14 patients with unilateral injuries to the lateral ligaments of the ankle. These were measured, both with and without an ankle brace. The different parameters used to describe the body sway could well discriminate between the injured and the uninjured leg. When the brace was used the effect was obvious and none of the parameters showed any significant differ ence compared to the uninjured leg.
Comparison of rehabilitative knee braces
Authors: Cawley Patrick W. , France E. Paul , Paulos Lonnie E.
Published: June 2007

A biomechanical comparison of eight popular commer cially available rehabilitative knee braces was under taken using a specially designed mechanical surrogate and computerized data acquisition system. Tests con ducted included passive extension, valgus rotation, and anterior-posterior tibial translation. Most of the braces tested significantly reduced both translations and rota tions compared to the unbraced limb under static test conditions. Braced versus braced performance varied and was found to depend upon a number of mechanical and design factors.
Factors affecting the region of most isometric femoral attachments
Authors: Grood Edward S. , Hefzy Mohamed S. , Lindenfield Thomas N.
Published: June 2007

We measured how the distance between selected tibial and femoral attachments of the PCL changes with knee flexion in six intact cadaver knees. The femoral location was the primary determinant of whether the distance increased, decreased, or remained nearly constant. The proximal-distal location of a fiber's femoral attachment had a stronger effect than had the anterior-posterior location. The tibial location had only a small statistically significant effect. These results suggest that the func tion of fibers within the PCL is determined primarily by their femoral attachment location.

We determined all femoral attachments whose tibio femoral distance changed 0, 2, 4, 6, 8, and 10 mm during flexion from 0° to 90°. No absolutely isometric point existed. Attachments whose separation distance changed less than 2 mm formed a bullet-shaped region whose base was against the roof of the intercondylar notch and whose nose pointed posteriorly and slightly distally. The axis of the "bullet" was near the proximal edge of the femoral insertion of the PCL. Along the axis, anterior attachments, located near the roof of the intercondylar notch, were more isometric than were posterior attachments, located near the cartilage. At tachments located distal to the axis moved away from the tibial insertion of the PCL when the knee was flexed. The more distal the femoral attachment, the larger the increase in tibiofemoral distance that occurred with flexion. The opposite was true of attachments proximal to the 2 mm region.
Surgical treatment of chronic lateral instability of the ankle joint
Authors: Karlsson Jón , Bergsten Tommy , Lansinger Olle , Peterson Lars
Published: June 2007

Sixty patients with chronic lateral functional and me chanical instability of the ankle joint were treated with shortening and reinsertion of the lateral ankle ligaments. All patients were followed prospectively for 2 to 5 years (mean, 3 years 6 months). We found the functional results to be excellent or good in 53 patients (88%). Patients with unsatisfactory results had either general ized joint hypermobility or long-standing ligament insuf ficiency.

Anterior talar translation (ATT) and talar tilt (TT) were measured radiologically on standardized radiographs. Patients with excellent and good functional results had better mechanical stability, both ATT and TT, than those with fair and poor functional results. A good correlation was found between clinical, functional, and radiological results.

In conclusion we found that reconstruction of the ankle stability by shortening and reinsertion of the lateral ankle ligaments is a safe and simple method and is a good alternative to other more complex methods of ligament reconstruction. The method should, how ever, be used with great care in patients with general ized joint hypermobility or in patients with long-standing ligament insufficiency.
An unusual ankle injury in top skiers
Authors: Fritschy Daniel
Published: June 2007

Although skiers' feet are immobilized in extremely rigid boots, ligamentous lesions of the ankle may occur, especially in world class slalom skiers. The lesion arises when a sudden external rotation of the ankle causes the talus to press against the fibula and thus open the distal tibiofibular articulation.

This study reports on a group of 10 skiers recruited between 1975 and 1986. These are professional skiers participating in World Cup races. Three patients under went an operation for lesion of the tibiofibular syndes mosis, while the other seven were treated conserva tively. All were able to resume their previous level of competition and only one skier later complained of painful instability in distal tibiofibular joint.
The role of recreational sport activity in Achilles tendon rupture
Authors: Jozsa L. , Kvist M. , Balint B.J. , Reffy A. , Jarvinen M. , Lehto M. , Barzo M.
Published: June 2007

During the last few decades, the incidence of tendon ruptures has increased in civilized countries. Our ma terial comprises 749 patients who had 832 tendon ruptures treated surgically between 1972 and 1985. There were no competitive athletes among the patients studied. There were 292 single ruptures of the Achilles tendon, 274 of the proximal biceps brachii, 113 of the extensor pollicis longus, and 70 of other tendons. Forty- eight patients had multiple ruptures and 35 patients had reruptures. Achilles tendon ruptures often occurred in recreational sports activities (59%), in contrast to other tendon ruptures (2%; P < 0.001). The mean age for patients who had Achilles tendon rupture was 35.2 years and for patients with other ruptures, 50.7 years (P < 0.001). There was a connection between the high incidence of blood group O and tendon ruptures (P< 0.001). In cases of multiple ruptures and reruptures, the frequency of blood group O was 71%. Sixty-two point three percent of the patients with Achilles tendon rupture were professionals or white collar workers, which is markedly more than in the Hungarian popula tion (12.7%; P < 0.001). Two hundred and six Achilles tendon ruptures were studied histologically, and all cases displayed pathological alterations. The results indicate that complete rupture of the Achilles tendon is usually a sequel to a sedentary life-style and participa tion in sports activities.
An in vitro study of the Müller anterolateral femorotibial ligament tenodesis in the anterior cruciate ligament deficient knee
Authors: Draganich Louis F. , Reider Bruce , Miller Paul R.
Published: June 2007

The biomechanical effectiveness of the Müller antero lateral femorotibial ligament (ALFTL) iliotibial band ten odesis on anterior stability and internal rotational sta bility of the ACL deficient knee was investigated in six cadaver knees. Anterior drawer and internal rotation of the tibia were measured at 15° increments from 0° to 90° in response to 50 N of anteriorly applied tibial force and 3 Nm of internally applied internal torque, respec tively, in the intact knee, the ACL excised knee, and following the ALFTL reconstruction. A strain gage was used to measure the resting graft tension and to meas ure strain in the graft during the load-displacement tests.

The Müller ALFTL tenodesis failed to return normal anterior stability to the ACL deficient knee (P < 0.05). The tenodesis did, however, reduce the anterior laxity of the ACL deficient knee from 30° to 90° of knee flexion (P < 0.05). The tenodesis overconstrained inter nal tibial rotation of the ACL excised knee from 30° to 90° (P < 0.05). Measurements of strain in the tenodesis supported the load-displacement findings that the ten odesis was most effective in constraining anterior drawer and internal tibial rotation from 30° to 90° of knee flexion.
An analysis of the sidestep cutting manoeuvre
Authors: Cross Mervyn J. , Gibbs Nathan J. , Bryant Grace J.
Published: June 2007

The sidestep cutting manoeuvre is a common mecha nism of noncontact or isolated ACL ruptures in athletes. We analyzed the amount and direction of tibial rotation that occurred at the knee joint with a triaxial electro goniometer on 11 male subjects who performed the sidestep cutting manoeuvre. The mean total tibial ro tation was 19.84 ± 5.63° and the mean maximum point of internal tibial rotation occurred at 34.77 ± 5.30% of the stance phase. However, greater values for internal tibial rotation occurred in the swing phase in association with a greater angle of knee flexion. Therefore, in our subjects, during the sidestep cutting manoeuvre, inter nal tibial rotation did occur at the knee but was not maximal.

Under normal circumstances when performing the sidestep cutting manoeuvre, maximum internal tibial rotation does not occur and so the ACL is not placed under excessive strain in such a manoeuvre. If the ACL ruptures during a sidestep cutting manoeuvre then a possible cause may be the athlete's loss of the ability to control internal tibial rotation of the knee.
A multicenter study on the results of anterior cruciate ligament reconstruction using a Dacron ligament prosthesis in "salvage" cases
Authors: Lukianov Alexis V. , Richmond John C. , Barrett Gene R. , Gillquist Jan
Published: June 2007

A multicenter study is presented on 80 patients who underwent ACL reconstruction using a Dacron (E.I. Du Pont de Nemours and Co., Wilmington, DE) ligament prosthesis. Patient selection was based on a history of a failed autologous reconstruction and/or primary repair of the ACL. These selection criteria are unique and have not been previously reported in the literature. The frequency of prior intraarticular ACL surgery was 1.24 procedures per patient and 1.68 when combined with prior extraarticular reconstructions.

Forty-one patients had a mean followup of 28 months (24 to 42 months). The mean followup for all of the patients was 21 months. The graft was augmented with autologous tissue in 59 cases and used as a pure prosthesis in the rest. Functionally, the mean Lysholm score improved from 40 to 81 points. The percentage of a combined excellent/good Lysholm rating increased from 6% to 60%. The Tegner activity rating level im proved from 2 to 4. The percentage of a negative Lachman sign, anterior drawer, and pivot shift was approximately 75% at followup.

There was no significant difference between the re sults of augmentation and nonaugmentation cases, indicating that the graft acts as a permanent prosthesis rather than as a scaffold or stint. The patients showed a significant improvement considering their preopera tive global instability.