bluuebunny/crossref_metadata_2025 huggingface dataset:
Skier's Thumb
Authors: Gerber Christian , Senn Edgar , Matter Peter
Published: June 2007

Acute rupture of the ulnar collateral ligament of the metacarpophalangeal (MCP) joint of the thumb is often sustained in downhill skiing accidents and is hence called "skier's thumb." All complete ruptures seen at our hospital between 1975 and 1979 were operated using the "fishhook" pullout wire technique. Follow up results 29 months after early operation are pre sented for 47 cases. The overall results are excellent in 29, good in 14, and fair in 3 patients. One result had to be considered a failure. No patient had serious functional impairment or major constant pain. No pa tient took any pain medication. No reintervention was necessary. The distal bony avulsions showed the most favorable prognosis, and the ligamentous midsubst ance tears, the least favorable.

The fishhook pullout wire technique can be used in both ligamentous and bony avulsions of the ulnar collateral ligament and provides good or excellent results in 90% of the cases.
Isokinetic versus isotonic variable-resistance training
Authors: Smith Michael J. , Melton Paul
Published: June 2007

A study of isokinetic exercise and isotonic variable- resistance training divided 12 individuals into four groups: 1) control; 2) isotonic variable-resistance training; 3) low-speed isokinetic (5, 10, and 15 rpm); and 4) high-speed isokinetic training (30, 40, and 50 rpm). All exercised groups showed good gains in strength when tested isometrically, isotonically, and isokinetically. However, when the individuals were tested for motor performance, the high-speed isoki netic group dominated (5.38% gain in the vertical jump versus 3.87% for the slow isokinetic, and 1.57% for the isotonic variable resistance; 9.14% gain in the standing broadjump versus 0.42% and 0.28%; and 10.11% gain in the 40-yard dash versus 1.12% and 1.35%).

Training should be specific in all training and reha bilitation programs, with the athlete/patient training in the manner most similar to his athletic event or per formance.
The modified Bristow-Helfet procedure for recurrent anterior shoulder subluxations and dislocations
Authors: Hill James A. , Lombardo Stephen J. , Kerlan Robert K. , Jobe Frank W. , Carter Vincent S. , Shields Clarence L. , Collins H. Royer , Yocum Lewis A.
Published: June 2007

A review of 107 cases in which the Bristow-Helfet procedure was done for recurrent anterior shoulder subluxation and dislocation is presented. The redis location rate was 2% with very few complications. Eighty-nine percent of the patients were satisfied with the procedure. Mean loss of external rotation was 12.6°. Six of the 41 patients with dominant shoulder surgery were capable of throwing in the same manner as they did prior to injury. Five of 24 patients (21 %) with a diagnosis of recurrent anterior subluxation con tinued to have symptoms of instability following sur gery. Associated symptoms of posterior or voluntary subluxation may preclude a satisfactory result.
Stress reactions involving the pars interarticularis in young athletes
Authors: Jackson Douglas W. , Wiltse Leon L. , Dingeman Robert D. , Hayes Michael
Published: June 2007

A stress reaction involving the pars interarticularis of the lumbar spine was confirmed in seven young ath letes with a positive technetium pyrophosphate bone scan. No pars defects were detectable on their lum bosacral roentgenograms, which included oblique views. The return to normal levels of radioactive up take on repeat bone scans correlated closely with their clinical course. If the bony reaction is recognized early, it may heal at a subroentgenographic level and prevent the development of lumbar spondylolysis.

These early lesions usually show unilateral in creased uptake at one lumbar level on the bone scan and, initially, the athlete localizes the pain to the corresponding unilateral lumbar paraspinous area. The "one-legged hyperextension test" is positive on the ipsilateral side and aggravates the pain.

Treatment consists of avoiding the aggravating ac tivities and resting. The average time for return to pain-free competition was 7.3 months. These devel oping defects may be the source of considerable prolonged disability in the young athlete, particularly if undiagnosed and untreated.
The relationship of tarsal coalitions to ankle sprains in athletes
Authors: Snyder Robert B. , Lipscomb A. Brant , Johnston Robert K.
Published: June 2007

A review of charts and x-ray films of individuals who sustained ankle sprains was carried out to determine the presence of calcaneonavicular coalition. Coali tions were present in 63% of 215 patients with 223 ankle sprains. In 130 ankle sprains recorded as oc curring directly in athletics, 65% of the x-ray films showed some degree of calcaneal navicular abnor mality. This study found a much higher percentage of coalitions than anticipated in either the general pop ulation or the injured athletic population and rein forced the belief that there may be an underlying anatomic predisposition to ankle sprains.
Upper extremity injuries in skiing
Authors: Carr Daniel , Johnson Robert J. , Pope Malcolm H.
Published: June 2007

In a six-year study, 1,711 ski injuries and 998 controls at Sugarbush North Ski Area were studied. Upper extremity injuries, which constituted 25% of all ski injuries, did not increase in frequency. Men and women were at equal risk of injury. When edging conditions were poor, upper extremity injuries were more common than lower extremity injuries. Forty percent of all upper extremity injuries involved the thumb (85% included injuries to the ulnar collateral ligament of the metacarpophalangeal joint). Twenty- five percent of 405 skiers interviewed had, at one time, injured their thumbs while skiing but only one- quarter of these reported their injury. Our study sug gests that injury to the ulnar collateral ligament of the metacarpophalangeal joint may be the most frequent in skiing and that gripping the ski pole outside the strap may prevent these injuries.
A chronicle of injuries of an American intercollegiate football team
Authors: Canale S. Terry , Cantler Edwin D. , Sisk T. David , Freeman Barney L.
Published: June 2007

Many studies concerning the injuries occuring in high school and intercollegiate football have been re ported, including those emphasizing the number and type of injuries, geographic distribution of injuries, and the rate of injury compared to position, condition ing, officiating, equipment, and type of playing sur face. This report focuses on the individual player involved in a sports program for four or five years and emphasizes the statistical probability of that individual sustaining an injury during his playing career.

Conclusions, drawn from statistics compiled at Memphis State University from 1975 through 1979, involved 265 athletes. These 265 athletes sustained 283 injuries during this period. Of these 283 injuries, 69% were mild, 20% were moderate, and 11% were severe. The knee was most often involved and suf fered the most severe injuries. Ankle injuries ac counted for the second highest incidence of injury, but these were primarily mild or moderate injuries. The defensive line, especially the defensive ends, received the greatest percentage of injuries. The prob ability of injury for the individual player was found to be 106.7% for a five-year participant, 99.1% for a four-year participant, and 46.6% for a one-year par ticipant.
Pott's puffy tumor, frontal sinusitis, frontal bone osteomyelitis, and epidural abscess secondary to a wrestling injury
Authors: Tudor Robert B. , Carson John P. , Pulliam M.W. , Hill Allen
Published: June 2007

A blow sustained to the head while wrestling may produce frontal osteomyelitis and its complications, Pott's puffy tumor and epidural abscess. The symp toms may be minimal and may be manifested only by a mild headache and occasional stuffy nose. A 16- year-old boy was studied one month after a head injury sustained while wrestling, complaining only of recurrent headaches and fever. A fluctuant mass was found in the midfrontal area. Frontal sinusitis, subper iosteal abscess, epidural abscess, and frontal osteo myelitis were found at surgery. The frontal bone in volved by the osteomyelitis was debrided, and the epidural abscess was evacuated.
Weight training-related injuries in the high school athlete
Authors: Brady Thomas A. , Cahill Bernard R. , Bodnar Leslie M.
Published: June 2007

Eighty young athletes with weight training-related in juries were seen from August 1976 to August 1980. In 37 of the 80 athletes, it was difficult to pinpoint the cause of injury since the history revealed, in addition to weight training, either a program of running exces sive mileage or participation in repetitive lap running in the gymnasium.

The injuries of the remaining 43 athletes had a direct causal relationship to the weight training program. Twenty-nine developed lumbosacral pain. Seven of the 29 were hospitalized, and four required surgical treatment. Anterior iliac spine avulsion occurred in six cases, and laceration of the knee meniscus occurred as an initial injury in four athletes who required sur gery. Four athletes developed cervical sprain.

Universal Gym (Cedar Rapids, IA), Leaper (Strength/Fitness Systems, Independence MO) Or thotron (Lumex Inc., Bay Shore, NY), and free weights were used either singly or in combination by these young athletes in weight training.
Patellar pain and quadriceps rehabilitation
Authors: Wild John J. , Franklin Thomas D. , Woods G. William
Published: June 2007

Eighteen patients (26 knees) giving a history of patel lar dislocation and/or subluxation and continued pa tellar symptoms underwent evaluation to determine the efficacy of their rehabilitation programs. Four- channel cine-electromyography was utilized to assess the relative muscular effort of the vastus medialis, vastus lateralis, vastus medialis obliquus, and rectus femoris in a series of exercises. Ten degress of flexion of the knee reduced effective muscle effort in the vasti group to an average of ¼ of the muscle effort dem onstrated in full extension of the knee. No consistent pattern was noted by altering the rotation of the hip from neutral to external or internal rotation. The ad dition of weight (5 Ib) to the ankle did not enhance the muscle effort with the knee in full extension. Quad- sets and straight leg-raising exercises in full knee extension offer the best quadriceps rehabilitation pro gram in the patient with a patellar malalignment syn drome and persistent symptoms.
An analysis of roller skating injuries
Authors: Ferkel Richard D. , Mai Larry L. , Ullis Karlis C. , Finerman Gerald A.M.
Published: June 2007

This study retrospectively examines 186 patients treated for roller skating-related injuries.

The average patient age was 25.3 years, with males comprising 44% and females 56% of the patients. Of the 202 injuries, there were 130 fractures and 72 soft tissue injuries. The majority of the injuries involved the wrist (47%), while the elbow ranked second (14%) and the ankle third (10%). All fractures of the tibia- fibula and ankle involved a rotational mechanism, with 75% of ankle fractures involving the posterior malleo lus. Ankle fractures accounted for 46% of all surgical cases.

Although inexperienced skaters were involved in 77% of all accidents, experienced skaters' injuries required surgery twice as often. Female roller skaters were more frequently injured, but males had three times more operations. Over 90% of the skaters wore no protection. Skaters who seldom participated in other sports had a higher probability of being injured earlier, especially on their first try.

This study indicates that roller skating injuries are influenced by skating experience, surface texture, skate type and quality, and protective equipment.
Microvasculature of the human meniscus
Authors: Arnoczky Steven P. , Warren Russell F.
Published: June 2007

The microvascular anatomy of the medial and lateral menisci of the human knee was investigated in 20 cadaver specimens by histology and tissue clearing (Spalteholz) techniques. It was found that the menisci are supplied by branches of the lateral, medial, and middle genicular arteries. A perimeniscal capillary plexus originating in the capsular and synovial tissues of the joint supplies the peripheral 10-25% of the menisci. A peripheral, vascular, synovial fringe ex tends a short distance over both the femoral and tibial surfaces of the menisci but does not contribute any vessels to the meniscal stroma. The posterolateral aspect of the lateral meniscus adjacent to the popliteal tendon is devoid of penetrating peripheral vessels as well as a synovial fringe. The anterior and posterior horn attachments of the menisci are covered with vascular synovial tissue and appear to have a good blood supply.
Stress fractures of the great toe sesamoids
Authors: Van Hal M.E. , Keene J.S. , Lange T.A. , Clancy W.G.
Published: June 2007

Stress fractures of the great toe sesamoids have not been previously confirmed as a clinical entity. In this report, we present four such cases, and document the diagnosis by histological sections. All of the patients had experienced the insidious onset of activity-related forefoot pain, and had radiographs that demonstrated a sesamoid fracture. None of the fractures healed with 6 weeks of immobilization and prolonged (4-6 months) inactivity. In all cases, the fractured sesamoid was excised, and the hematoxylin and eosin sections of the fracture segments documented the prefracture stress and incomplete repair characteristic of a stress fracture.
Injuries in Intercollegiate Wrestling
Authors: Snook George A.
Published: June 2007

A 5-year study of the injuries sustained by a single intercollegiate wrestling team is presented. The total number of injuries, a description of the injuries clas sified according to anatomical distribution, and mech anism of injury are given. A high incidence of upper body injuries is noted, and comments are made con cerning protective measures that can be taken.
Isokinetic rehabilitation after surgery
Authors: Sherman William M. , Pearson David R. , Plyley Michael J. , Costill David L. , Habansky Alan J. , Vogelgesang Donald A.
Published: June 2007

The postoperative rehabilitation of individuals who've had surgery has been a primary concern of all mem bers of the health care community. With the advent of new training devices for use during the rehabilitation period (i.e., isokinetic training devices) and new re search in sports medicine, there has been a renewed interest in how to best rehabilitate individuals following surgery (knee surgery, in particular). This paper briefly reviews basic muscle physiology as it relates to muscle fiber types and recruitment patterns. Sub sequently, it reviews studies that have investigated muscle atrophy and methods to reduce muscle dys function related to surgery, immobilization, and dis use. Finally, it reviews isokinetic training studies and examines the concept of "specificity of speed" train ing. These principles of muscle physiology and muscle plasticity are then applied to a proposed isokinetic rehabilitation program which might be adapted for use following joint surgery.
Physicians' legal responsibilities in managing ski trauma
Authors: Ferguson Cherry G.
Published: June 2007

Orthopaedic specialists and family physicians practic ing in skiing communities are faced with unavoidable, stringent, and expanding legal responsibilities to properly manage ski trauma. Their legal obligations apply to each component of clinical case manage ment : (1) diagnosis; (2) treatment; and (3) rehabilita tion. Neither medically nor legally is any one aspect less critical than another.

Concomitant with accelerating rates of participation in sports, it is clear that the law is demanding more from specialists and also primary care physicians whose practice is increasingly involving musculoskel etal athletic injuries.

The legal responsibilities and liabilities of both gen eralists and specialists are extensively reviewed in this report. The principles apply to the management of all athletic trauma by physicians.
Fatigue failure stress of the femoral neck
Authors: Skinner Harry B. , Cook Stephen D.
Published: June 2007

Fatigue fractures are frequent injuries in military pop ulations and occur more frequently in joggers in the civilian population. Repetitive stress below failure levels in a time period inadequate to permit remodeling is known to cause fatigue fractures. However, data on stress levels, the number of cycles to failure, and the time interval in in vivo human fatigue fractures is unknown. We recently treated a patient with a fatigue fracture of the femoral neck and were able to deter mine this data from patient records and finite element stress analysis. From this data we recommend a max imum total distance of 161 km (100 miles) over a three-month interval for runners who are beginning training. Shorter total distance would be advisable for obese patients.
An inexpensive intercondylar notch drill guide
Authors: Harris Scott M.
Published: June 2007

This report summarizes a method of constructing an intercondylar drill notch guide with used external fix ator materials.
Extraarticular fluid dissection in tissues during arthroscopy
Authors: Noyes Frank R. , Spievack Edward S.
Published: June 2007

Significant fluid extravasation occurred in four knees undergoing arthroscopic meniscectomy. In one knee, a partial compromise of peripheral blood flow was transiently detected.

In cadaver studies, with the joint only moderately distended, a mean pressure of 158 mm of mercury was measured. With flexion of the knee to 90°, a mean pressure of 216 mm of mercury was recorded and rupture of the synovial pouch occurred in all knees. The fluid extravasated into the thigh due to rupture of the suprapatellar pouch. Fluoresceine labeled saline was utilized to follow the course of the extravasated fluid. The saline was found to loculate about the superficial femoral artery, easily dissecting up to the femoral triangle. Elevated femoral artery pressures and quadriceps muscle interstitial pres sures were documented at a relatively early point during the course of fluid extravasation. A second pathway of extravasation of intraarticular fluid was by rupture of the semimembranous bursa. The saline then dissected beneath the pes anserinus and into the calf muscles.

The study arrived at the following conclusions. First, fluid extravasation may initially occur in a subtle man ner. The surgeon should be aware of any lack of joint distension, increased fluid to distend the joint, or increased thigh tension during arthroscopy indicating extravasation. Second, joint distension should be avoided prior to knee flexion past 30 to 45° since the added compression on the fluid may easily rupture the synovial pouch. Third, caution is required in using inflow irrigation systems that exert pressure to distend the joint; an adequate outflow system is mandatory to avoid excessive joint distension during arthroscopic procedures.
Stress fractures of the ulna in athtetes
Authors: Mutoh Yoshiteru , Mori Takemi , Suzuki Yoshiro , Sugiura Yasuo
Published: June 2007

Two cases of stress fracture of the ulna in athletes are presented and the mechanism of injury discussed.
An EMG analysis of the shoulder in throwing and pitching
Authors: Jobe Frank W. , Tibone James E. , Perry Jacquelin , Moynes Diane
Published: June 2007

Five male subjects' throwing and pitching motions were analyzed by dynamic electromyography and high speed photography. Electrodes inserted into the deltoid and rotator cuff muscles attempted to define muscle activation patterns during the throwing and pitching cycle. The wind-up or preparation (Stage I) had no consistent pattern. Cocking (Stage II) had a sequential muscle activation pattern of first deltoid activity, followed by the S.I.T. muscles and finally by the subscapularis muscle. Acceleration (Stage III) had a lack of muscle activity, even though the arm was accelerating forward in space. Follow-through (Stage IV) was the most active stage with all the muscles firing intensely. The muscle patterns observed during the cycle were largely characteristic of attempts to decelerate the arm.
Reconstruction for chronic scapuloclavicular instability
Authors: Zaricznyj B.
Published: June 2007

Seventeen young patients with chronic scapuloclavi cular instability were treated with tendon graft recon struction. Sixteen patients had sustained a Type III and one sustained a Type II injury according to All man's classification (Allman, FL: Fractures and liga mentous injuries of the clavicle and its articulation. J Bone Joint Surg 49A: 774-784, 1967). Both the coracoclavicular ligaments and the ligaments of the acromioclavicular joint were reconstructed. The op eration was performed an average of 7.6 months after injury. The followup was from 8 months to 18 years, averaging 5.1 years. After surgery, 12 patients re turned to heavy or moderately heavy work and eight engaged in athletics. All patients regained normal motion and muscle strength, except for one patient with posttraumatic hemiplegia. None required further surgery. Followup x-ray films showed no instability or degenerative changes.
Spinal cord injury resulting from scuba diving
Authors: Dilibero Ralph J. , Pilmanis Andrew
Published: June 2007

With the recent increase in the number of scuba divers, there has come a concomitant increase in the cases of decompression sickness. About 24% of these cases have some neurological consequence involving the spinal cord and the potential to render a victim permanently paraplegic. The initial symptoms may be obvious or insidious and progressive. Victims have presented themselves to a physician days later complaining only of low back pain. If not suspected, the diagnosis may be overlooked and a victim may become permanently paraplegic. Twenty-five cases of spinal injuries resulting from decompression illness over a 5-year period treated at the University of South ern California Catalina Marine Science Center are reviewed. Emergency treatment was required and consisted of recompression and O2 therapy under pressure in a hyperbaric chamber to immediately pre vent the progression of the illness and lead to a reversal of pathology in the majority of cases. It is recommended that hyperbaric treatment be initiated early to best prevent progression of the disease, how ever, late treatment is helpful, even after 10 days. Adjunct therapy advised consists of 100% O 2 by mask, Ringer's solution, dextran 40, dexamethasone, and rapid sea-level transport of a victim to a de compression chamber. If air transport is used, the altitude should be maintained at 800 feet or less, or aircraft capable of sea-level pressurization should be used. It is also advised that one not drive or fly for a period of time after scuba diving. It is hoped that increased awareness of this problem on the part of physicians will accomplish prompt and thus more ef fective treatment.
Trauma on eight wheels
Authors: Kvidera Dennis J. , Frankel Victor H.
Published: June 2007

Thirty-five fractures secondary to roller skating acci dents from March 15 to October 1, 1979 were treated in the University of Washington-affiliated hospitals. Twenty-eight involved the wrist and elbow. Only three were in skeletally immature individuals. Sixty-three percent of the patients were female with the 20- to 34- year-old age group the most commonly involved. A fall, usually backwards, onto outstretched arms and hands was the most frequent mechanism of injury. A detailed study of the popular outdoor skating area in Seattle, Green Lake, indicated that more than 75% of the injuries occurred on sloped surfaces with other wise favorable environmental conditions. Most people were either first time skaters or had not skated since childhood. Based on our study, we recommend: (1) skating on level, familiar terrain; (2) learning to skate in a sparsely congested area; (3) skating with experi enced partners who can give instructions; and (4) using protective equipment, such as knee and elbow pads and rigid wrist splints.
Incidence of soccer injuries and their relation to training and team success
Authors: Ekstrand Jan , Gillquist Jan , Möller Margareta , Oberg Birgitta , Liljedahl Sten-Otto
Published: June 2007

One hundred-eighty players in a male soccer senior division of 12 teams were observed prospectively for 1 year to study the risk of soccer injuries in relation to exposure and to establish the connection between training, injuries, and team success. Totally, more than 100 hours of practice were analyzed. All injuries were examined by the same orthopaedic surgeon.

On the average, each team played 36 games and had 95 practice sessions with 66% attendance of selected players. A direct correlation was noted be tween team success and the amount of training. Teams with more than average training showed a diminishing number of injuries. A high practice-to- game ratio seems to be advantageous.

One injury every third game and every ninth practice session was documented. For the individual player the incidence of injury was 7.6/1000 practice hours and 16.9/1000 game hours.

The incidence of injury was higher at training camps. Correlation was noted between the design of the train ing and the incidence of injuries. The duration of warming up seemed adequate, but its content did not appear to be satisfactory from a clinical point of view. Redesign of the warm-up with more emphasis on flexibility and the addition of a cool-down is suggested to reduce injuries.
Preliminary report on the Jones, Ellison, Slocum (JES) repair for symptomatic anterior cruciate deficient knees
Authors: Ritter Merrill A. , Leaming Eric S. , McCarroll John R.
Published: June 2007

A modified Jones intraarticular anterior cruciate re construction was combined with a distal iliotibial band transfer (Ellison) and a pes anserinus transfer (Slo cum) for patients with symptomatic anterior cruciate deficient knees. The procedure was performed on 15 young (average age, 22.5 years) athletes, in a single operation through a long, straight, anterior, midline incision.

Preoperatively, all 15 patients (15 knees) had symp tomatic instability and all but one had a positive pivot shift. At follow up (averaging 39 month range 24-60 months) 13 (93%) had the pivot shift eliminated and only one, with 36 months followup, had instability on return to sports. Postoperatively, patients were im mobilized 3 weeks and then were started on a physical therapy program which ended in return to sports at 1 year.
Leg length discrepancy in marathon runners
Authors: Gross Richard H.
Published: June 2007

The incidence and degree of leg length discrepancy was studied in 35 male marathon runners. Seventy- seven percent were in their 30s or 40s. Eighteen run ners had a length difference of less than 5 mm, 10 had a difference of 5 to 9 mm, and 7 had differences of 1.0 cm or greater. Four of the five runners using a lift had less than a 5-mm discrepancy. It is concluded that discrepancies of 5 to 25 mm are not necessarily a functional detriment to marathon runners, and no con sistent benefits could be attributed to the use of a lift.
Some biomechanical aspects of the foot and ankle in athletes with and without shin splints
Authors: Vtasalo Jukka T. , Kvist Martti
Published: June 2007

Thirteen adult male athletes (long-distance runners and orienteerers without foot problems) and 35 male ath letes with shin splints were compared with respect to: 1) the position of the lower leg and the heel while standing, 2) the passive range of mobility in the subtalar joint, and 3) the angular displacement between the calcaneus and the midline of the lower leg (Achilles tendon angle) while running with bare feet on a tread mill. In standing, the two groups differed statistically significantly in the Achilles tendon angle, which values were greater in the shin splint group. With respect to passive mobility, the athletes with shin splints had significantly greater (P < 0.05-0.01) angular displace ment values in inversion, eversion, and in their sum than the control group. While running, the Achilles tendon angle of the shin splint group was significantly greater (P < 0.01) at the heel strike. Further, the shin splints group had a significantly greater (P < 0.01) angular displacement between the heel strike and the maximal everted position. The results suggest struc tural and functional differences in the feet and ankles between healthy athletes and those with shin splints.
Traumatic dislocations of the peroneal tendons
Authors: Arrowsmith Scott R. , Fleming Lamar L. , Allman Fred L.
Published: June 2007

Traumatic dislocation of the peroneal tendons is an often unrecognized injury which has been reported to occur most commonly during snow skiing. The strength of the peroneal retinaculum is exceeded during resist ance to violent passive dorsiflexion or to inversion stress. Pain, swelling, and ecchymosis may hinder early diagnosis; however, intense retromalleolar pain on ac tive eversion is a specific, highly suggestive finding. Fracture of a thin shell of the lateral malleolar cortex is diagnostic. In chronic cases, marked dislocation of the tendons is frequently demonstrable, with more than the usual degree of snapping. Surgical repair is advocated, using one of several procedures available. Most acute cases can be treated by simple repair of the torn or fractured structures. In chronic cases, or in acute cases with deficient structures predisposing to dislocation, it is necessary to reconstruct the peroneal retinaculum and/or deepen the peroneal groove. Longitudinal split ting of the peroneous brevis tendon was a new finding in this series.
Intermittent claudication in young athletes: Popliteal artery entrapment syndrome
Authors: Lysens Roeland J. , Renson Luc M. , Ostyn Michel S. , Stalpaert Georges
Published: June 2007

The intermittent compression of the popliteal artery by the medial of the gastrocnemius muscle is one of the causes of intermittent claudication in young athletes.

In this report we present two such cases which emphasize the importance of the clinical aspects of this pathologic entity. Early diagnosis of the entrapped ar teries eventually leads to diagnosis of thrombosis and peripheral ischemia. The popliteal entrapment syn drome should not be confused with chronic posterior compartment syndrome during exercise.
Closed versus open partial meniscectomy: Postoperative changes in the force-velocity relationship of muscle
Authors: Prietto Carlos A. , Caiozzo Vincent J. , Prietto Pablo P. , Mcmaster William C.
Published: June 2007

This study compares the effects of closed and open partial meniscectomies on the in vivo force-velocity relationship of the knee extensors. One group of normal subjects (controls, N = 7) and two groups of patients (closed partial meniscectomy, N = 9; open partial men iscectomy, N = 6) participated in this study. Each volunteer was tested on three occasions (presurgery, 20 days postsurgery, and 42 days postsurgery) for maximal knee extension torque at 0, 48, 96, 144, and 192°/sec using an isokinetic dynamometer. Maximal knee extension torques were recorded at a specific joint angle (30° below the horizontal plane) for all test speeds. Presurgically, the injured leg exhibited a uni form impairment of approximately -20%. At 20 days postsurgery, a substantial difference was evident be tween the two groups of patients. For the closed group, the mean (±SE) impairment was -19.5 ± 2.2, -23.9 ± 2.8, -31.5 ± 4.0, -37.5 ± 5.3, and - 34.5 ± 6.1% at 0, 48, 96, 144, and 192°/sec, respectively. In contrast, the corresponding impairment for the open group was -34.9 ± 7.2, -47.7 ± 4.8, -57.5 ± 5.3, -57.0 ± 3.5, and -59.1 ± 3.2%. The impairment of both groups was speed-specific with the greatest deficits occurring at 192°/sec. At 42 days postsurgery, there were no sig nificant differences between the two groups of patients although the open group still demonstrated speed- specific impairment. These results demonstrate that the closed approach has less effect on functional pa rameters which are important to athletic competition.
The medial patellar plica syndrome
Authors: Nottage Wesley M. , Sprague Norman F. , Auerbach Burt J. , Shahriaree Hesmet
Published: June 2007

A retrospective review of all patients diagnosed at arthroscopy as having a medial patellar plica with no other intraarticular pathology was conducted. Charac teristic clinical findings, including pseudolocking, were identified. The clinical response of 68 patients (78 knees) to shelf resection was noted at 3 and 6 months. The 6-month review demonstrated 60% to be totally relieved of their preoperative pain and 31 % with occa sional discomfort, but capable of full activities. Three patients were graded with poor results (4%) due to limitations in their work and sports, and four patients were lost to followup. The overall good and excellent results totalled 91 %. No surgical complications, infec tions, or wound dehiscences were noted.
Impacted third molars: A contributing factor in mandibular fractures in contact sports
Authors: Schwimmer Alan , Stern Robert , Kritchman David
Published: June 2007

Studies have shown that the presence of impacted third molars places the mandible at increased risk for fracture. Individuals participating in high contact sports are subject to maxillofacial trauma; therefore, partici pants with impacted third molars are at increased risk for fractured mandibles. Three cases are reviewed to illustrate this problem.
The athletic polydrug abuse phenomenon
Authors: Hill James A. , Suker Jacob R. , Sachs Kalman , Brigham Craig
Published: June 2007

A case of a power weight lifter who is ingesting large doses of anabolic steroids plus other drugs to counter act their short-term side effects is presented.

This type of polydrug abuse phenomenon which is unique to the competitive athlete is widespread despite the lack of convincing evidence that anabolic steroids increase muscular strength. The vast extent of this drug abuse problem is poorly appreciated by the gen eral medical community.

The potential complications of the long-term usage of these drugs such as liver failure, hepatocellular car cinoma, and peliosis hepatitis make these drugs ex tremely dangerous.
Symptomatic shoulder instability due to lesions of the glenoid labrum
Authors: Pappas Arthur M. , Goss Thomas P. , Kleinman Paul K.
Published: June 2007

Lesions of the glenoid labrum can be associated with and cause shoulder instability and symptomatology by (1) allowing the shoulder to dislocate recurrently (ana tomical instability); (2) allowing the shoulder to sublux ate (anatomical instability); and (3) allowing the shoulder to click, catch, and lock secondary to partially attached fragments becoming interposed between the articular surfaces (functional instability). The latter two clinical entities are usually associated with "lesser" labral dam age and diagnosis can be difficult. Six illustrative cases are presented and salient diagnostic and therapeutic points are discussed. The glenohumeral axillary arthro tomogram is presented as a sensitive diagnostic test for detecting labral lesions.
Acute tears of the posterior cruciate ligament: Clinical study and results of operative treatment in 27 cases
Authors: Bianchi Mario
Published: June 2007

Twenty-seven knees (in 27 patients) operated on for acute posterior cruciate ligament tears at the Istituto Ortopedico "G. Pini" of Milan from 1974 to 1979 are documented according to injury, type and degree of instability, surgical technique, and treatment.

Materials for this study came from clinical evaluations, roentgenograms, and operative observations. Inability to obtain follow-up data eliminated two cases from the results. Followup on the other patients ranged from 2 to 5 years and consisted in part of individual interviews conducted after reintroduction into working and sport ing activity. Three separate gradings of the results were assessed: objective, subjective, and functional. The overall results in the objective category were 48% good, 44% fair, and 8% poor. Functional gradings were 55% good and 45% fair, while subjectively patients reported 70% good and 30% fair results.
Articular and ligamentous contributions to the stability of the elbow joint
Authors: Morrey Bernard F. , An Kai-Nan
Published: June 2007

This preliminary study of four elbow specimens inves tigates the relationship of articular geometry and liga mentous structures in providing stability to the elbow joint. A technique is presented that describes the con straining features of varus-valgus and distraction in extension and at 90° of elbow flexion. Valgus stability is equally divided among the medial collateral ligament, anterior capsule, and bony articulation in full extension; whereas, at 90° of flexion the contribution of the ante rior capsule is assumed by the medial collateral ligament which provides approximately 55% of the stabilizing contribution to valgus stress. Varus stress is noted to be resisted primarily by the anterior capsule (32%) and the joint articulation (55%) with only a small (14%) contribution from the radial collateral ligament. At 90° of flexion, little change is noted in the contribution to the radial collateral ligament (9%), but the anterior capsule offers only 13%, with the remaining stability (75%) arising from the joint articulation. In extension, the soft tissue resistance to distraction is provided minimally by either the radial (5%) or the medial (5%) collateral ligaments, and thus primarily originates from the anterior capsule (85%). At 90° of flexion, however, the capsule offers virtually no resistance to distraction (8%). The radial collateral ligament contributes 10% of the stability, while the medial collateral ligament ac counts for 78% of the resistance to distraction in this position.

Too few specimens have been studied to form any conclusions for direct clinical applications at this time. However, the technique provides a reliable tool with additional studies for different positions and loading conditions underway. These efforts should disclose useful information that might be applied to the manage ment of chronic elbow instability, radial head or olecra non fracture, the design and implantation of elbow prostheses, or provide a rationale for other reconstruc tive procedures.
Stress fracture of the fifth metatarsal
Authors: Delee Jesse C. , Evans J. Pat , Julian Jerry
Published: June 2007

Stress fractures of the fifth metatarsal have been re ported with increasing frequency, especially in athletes. Prolonged healing time and the risk of refracture follow ing conservative treatment have led to recommenda tions for operative treatment including bone grafting of these fractures. An axial intramedullary screw, inserted without opening the fracture site, was used in 10 ath letes with stress fractures of the fifth metatarsal. Union was obtained in all patients in an average of 7.5 weeks. All patients returned to their sports in an average of 8.5 weeks postoperatively. There were no operative com plications or refractures after screw insertion. Com plaints of local pain over the screw head and/or the fifth metatarsal head, seen in 7 of the 10 patients, were relieved by local shoe modifications.
Traumatic osteitis pubis: The gracilis syndrome
Authors: Wiley James J.
Published: June 2007

The "gracilis syndrome," a fatigue fracture of traumatic etiology involving the bony origin of the gracilis muscle at the pubic symphysis, is akin to traumatic osteitis pubis and injuries of the adductor longus muscle origin. It is a well-recognized and reported injury in European athletes, but has received less attention in North Amer ica.

This paper describes a case of this syndrome in a 23-year-old male athlete with a 2-year history of groin, perineal and medial thigh pain, of gradual onset, asso ciated with his participation in rather violent contact sports. The only positive finding on examination was the belated appearance of local tenderness over the symphysis pubis. Radiographically, a bony fragment, including the inferior corner of his left pubis at the symphysis, could be identified. This lesion was surgi cally excised, and the patient was relieved of his symp toms. The histopathological features of the fragment revealed both viable and nonviable bony trabeculae embedded in fibrous tissue, suggesting that the lesion is an avulsion type of fatigue fracture with the avulsion related to the directional pull of the gracilis muscle.
Performance measurement and percent body fat in the high school athlete
Authors: Mcleod William D. , Hunter Stephen C. , Etchison Bill
Published: June 2007

Standards for performance have been derived from the preseason assessment of the high school athlete. The performance of 3,174 athletes during five performance tests was measured. The tests included dips, sit-ups, and pull-ups, in addition to grip strength measurement and vertical jump capability. Measurements were con verted to the amount of work done or force developed. Nondimensional ratios were determined using the ta bles and empirical equations presented in this paper. These quantities were then compared to the percent body fat. The average performance of the athletes as determined by the testing procedures described herein decreases dramatically as the body fat increases above 10% in males and 19% in females.
Anterior cruciate-deficient knees: A review of the literature
Authors: Rovere George D. , Adair Daniel M.
Published: June 2007

Injury to the anterior cruciate ligament may lead to functional instability, meniscal injury, and premature degenerative changes of the knee or, if treatment and rehabilitation are carried out carefully, to a functionally stable knee with no premature degenerative changes. Unfortunately, the complex anatomy of the three fiber bundles, consisting of multiple collagenous strands, which constitutes the anterior cruciate ligament com bined with variation of injuries to the ligament, with or without injury to other structures of the knee, makes any standardization of surgical treatment difficult. In this paper, we review the biomechanics of the knee, the anatomy and vascularization of the anterior cruciate ligament, the healing characteristics of ligamentous ma terial, and the types of surgical repair that have ap peared in recent articles. Those repairs can be divided into direct repair, extraarticular substitution and intraar ticular augmentation, freeze-dried fascia lata allografts, and temporary supportive prosthesis such as carbon fiber. Essential to the success of any surgical repair of the anterior cruciate-deficient knee is a prolonged, care fully organized rehabilitation program that allows ade quate healing and strengthening of the ligament before it is used normally again. The patient's clear under standing of the importance of a prolonged rehabilitation is best established before the surgical procedure is done.
Disruption of the vastus medialis obliquus with medial knee ligament injuries
Authors: Hunter Stephen C. , Marascalco Robert , Hughston Jack C.
Published: June 2007

We reviewed the clinical records of 189 consecutive surgically treated acute ligamentous injuries of the me dial compartment of the knee to determine the preva lence of disruptions of the vastus medialis obliquus muscle and to document the results of simultaneous repair of the disruption. Forty knees (40 patients) dem onstrated a vastus medialis muscle disruption at the time of surgical repair for the medial ligamentous dis ruption. All were surgically corrected and the sites of tearing were documented. The vastus medialis obliquus muscle was ruptured from the adductor tubercle in 31 (78%) knees. Of these, the tibial collateral ligament was torn from its femoral attachment in 19 (61 %) knees and the meniscofemoral portion of the capsular ligament ligament was torn from its femoral attachment in 23 (74%) knees. The vastus medialis obliquus muscle was ruptured from the patella in seven (18%) knees and was ruptured interstitially in nine (23%) knees. Each of the 40 patients returned for objective, subjective, and functional follow-up evaluation (average, 39 months). At follow-up examination, 88% of the 40 knees were rated as good subjectively, 90% objectively, and 93% functionally. A high correlation exists between tears of the vastus medialis obliquus muscle from its femoral attachment and tears of the medial compartment liga ments from their respective femoral attachments. Sur gical repair of disruptions of the vastus medialis obli quus muscle at the time of primary repair of injury to the ligaments of the medial compartment of the knee can prevent subsequent disorder of the extensor mech anism and can produce an objectively, subjectively, and functionally stable knee.
Subclavian thrombosis following hockey injuries
Authors: Butsch John L.
Published: June 2007

Subclavian thrombosis is not an uncommon disease following an injury. It has been reported following se vere trauma to mere hyperabduction of the arm. Hereto fore it has not been reported following a hockey injury. I wish to report two cases where subclavian thrombosis occurred following a hockey injury. The records of the National Hockey League for a 3-year period along with the world literature have been reviewed. The mecha nisms producing the thrombosis and pathogenesis are described along with the modes of diagnosis and treat ment.
The biomechanics of anterior cruciate ligament rehabilitation and reconstruction
Authors: Arms Steven W. , Pope Malcolm H. , Johnson Robert J. , Fischer Richard A. , Arvidsson Inga , Eriksson Ejnar
Published: June 2007

The rehabilitation of knee injuries involving the anterior cruciate ligament (ACL) is controversial. This paper describes strain in the normal and reconstructed ACL during a series of passive and active tests of knee flexion with and without varus, valgus, and axial rotation torques on the tibia. Strain in the human knee ACL was significantly different depending on whether the knee flexion angle was changed passively or via simulated quadriceps contraction. The knee joint capsule was found to be important for strain protection of the ACL. Quadriceps activity did not strain the normal or recon structed ACL when the knee was flexed beyond 60°, but significantly strained the tissue from 0 to 45° of knee flexion. Immobilization may not protect the ACL if isometric quadriceps contractions are allowed to occur. Properly placed reconstructions exhibited strain behav ior which closely followed the anteromedial band of the ACL.
Histochemical correlates of hamstring injuries
Authors: Garrett W.E. , Califf J.C. , Bassett F.H.
Published: June 2007

This study reports the histochemical fiber type com position of the human hamstring muscles. Muscle spec imens from necropsy specimens were obtained from seven locations in the hamstring, four locations in the quadriceps, and one location in the adductor magnus. The hamstring muscles are shown to have a relatively high proportion of Type II fibers. Type II fibers are more involved with exercise of higher intensity and force production and it is postulated that the hamstrings are capable of high intrinsic force production. The ham strings are two-joint muscles and are, therefore, subject to increased stretch and force production extrinsically by motion at the hip and knee. It is proposed that high levels of tension in the hamstrings produced by intrinsic force production and extrinsic stretch may make them prone to injury in periods of intense muscular activity. This proposal is also relevant to other frequent athletic muscle injuries.