bluuebunny/crossref_metadata_2025 huggingface dataset:
Strain within the anterior cruciate ligament during hamstring and quadriceps activity*
Authors: Renström P. , Arms S.W. , Stanwyck T.S. , Johnson R.J. , Pope M.H.
Published: June 2007

The objectives of this study were to measure strain in the ACL during simulated: (1) hamstring activity alone, (2) quadriceps activity alone, and (3) simultaneous quadriceps and hamstring activity. Seven knee speci mens removed from cadavers were studied. Heavy sutures applied to load cells were attached to the hamstring and quadriceps tendons. Loads were then applied manually (hamstrings) and/or with an Instron testing machine (quadriceps) to simulate isometric con tractions of the various muscle groups. Strain was measured using a Hall effect transducer. Acting alone, the isometric hamstring activity decreased ACL strain relative to the passive normal strain at all positions tested. Thus, hamstring exercises are not detrimental to ACL repairs or reconstruction and can be included early in the rehabilitation program after ACL surgery. Acting alone, at flexion angles of 0° to 45°, the quad riceps significantly increased the strain within the ACL relative to the passive normal strain. Strain in the ACL during simultaneous hamstring and quadriceps activity was significantly higher than that during passive normal motion from full extension to 30° of flexion. The ham strings are not capable of masking the potentially harm ful effects of simultaneous quadriceps contraction on freshly repaired or reconstructed ACLs unless the knee flexion angle exceeds 30°.
Lateral retinacular release in patellofemoral subluxation
Authors: Henry J.H. , Goletz T.H. , Williamson B.
Published: June 2007

A consecutive series of patients who have undergone arthroscopy and lateral retinacular release for patello femoral subluxation was evaluated so that the results could be compared to an earlier series of open patel lofemoral reconstructions. Of 96 patients, 4 had bilat eral releases; therefore, 100 knees were evaluated. The average age was 28 years. Specific symptoms and signs were reviewed.

All patients were initially treated conservatively with specific exercises. Failure of the exercise program to improve symptoms significantly, the patient's inability to perform normal daily activities, or expected associ ated pathology were indications for surgery.

The surgical technique consisted of arthroscopy with treatment of associated pathology and lateral reti nacular release using the Smillie meniscotome through the inferior lateral portal. The patella could be tilted approximately 90° medially when the release was ac complished.

Pain, function, and patellar instability were evaluated preoperatively and postoperatively by signs of tender ness on the retinaculum or bone, patellar mobility, effusion, muscle atrophy, and tone. Range of motion was also evaluated. Average followup was 36 months.

When evaluated subjectively by the patients, pain improved from a mean preoperative grade of 3.4 to 1.7 postoperatively, function improved from 3.4 to 1.7, and instability from 3.4 to 1.6.

Objective evaluation found that tenderness on the patella improved from a mean preoperative grade of 3.3 to 1.7 postoperatively. Tenderness on the retinac ulum improved from 3.2 to 1.7. Patellar mobility im proved from 3.3 to 1.7. Effusion dropped from 3.2 preoperatively to 1.5 postoperatively; quadriceps atro phy from a mean preoperative grade of 3.2 to 1.5, and quadriceps tone from 3.2 to 1.6.

Lateral retinacular release compared favorably to a similar series of patellofemoral reconstructions. The average mean difference in preoperative and postop erative ratings improved 1.6 in lateral retinacular release compared to 1.9 in open patellofemoral reconstruc tions.

The authors believe that a lateral retinacular release involves less surgery than a formal patellofemoral re construction. The patients do improve significantly from lateral retinacular release, and the degree of improve ment parallels that of patellofemoral reconstruction. If the lateral retinacular release patient does not improve, then patellofemoral reconstruction should be consid ered.
Current trends in repair and rehabilitation of complete (acute) anterior cruciate ligament injuries
Authors: Bilko Thomas E. , Paulos Lonnie E. , Feagin John A. , Lambert Kenneth L. , Cunningham H. Ray
Published: June 2007

Results of a 21 question survey, taken at the ACL Study Group meeting in 1984, present a composite picture of current practices in ACL reconstruction and rehabilitation. Forty-four of the 50 questionnaires were returned. Responses represented views from knee sur geons in the United States, Canada, Australia, Sweden, and Switzerland. These results were compared with a report of a 1980 international survey in which views of 40 knee experts from the United States, Canada, Eng land, France, and Sweden were summarized. Ques tions on the two surveys were similar, particularly about rehabilitation. Although the time span between the two surveys was only 4 years, we can see both consisten cies and changes. Responses about length of time between ACL repair and full range of motion (by 6 months) were essentially the same (88% in 1980, and 86.4% in 1984). However, changes were evident in length of immobilization (longer in 1980) and prescribing isometric contractions of quadriceps 1 st week postop eratively (more frequently in 1980). Surgeons allowed patients to return to full activity sooner in 1980 than in 1984. Electrical stimulation was being used more fre quently in 1984, and apparently the practice of simul taneous hamstring and quadriceps contraction has come into prominence since 1980 as it was not men tioned in the first survey. In 1984, 50% of the respond ents indicated they prescribed it. Since standardized reporting systems are not established, we cannot do reliable statistical analyses on large samples. At the present time, making surveys with responses from similar groups every few years is the best available way to capture trends in treatment of ACL injuries.
Anterior cruciate ligament rupture in skiing
Authors: McConkey J.P.
Published: June 2007

Between January 1981 and March 1985, the author examined and treated 13 skiers who suffered ACL rupture of their knees in a characteristic but previously undescribed fashion. Injury is caused by a combination of passive and active loads applied to the ACL. Ultimate failure of the ACL is produced by violent quadriceps contraction to recover from an out of control sitting- back posture or to gain control after landing a jump. The injury is exclusive to expert skiers and there is no binding release. Combined loading of the ACL in skiing is exceedingly dangerous.
Topically applied dimethyl sulfoxide
Authors: Myrer J. William , Heckmann Richard , Francis Rulon S.
Published: June 2007

This study investigated the effects of topically applied dimethyl sulfoxide (DMSO) to traumatized muscle of adult male rats. Eighty rats were randomly assigned to one of two groups and subsequently traumatized, treated, and sacrificed. One group was used to examine inflammation; the other, healing. Each group was fur ther divided into an experimental group (70% DMSO and 30% distilled water) and a control group (100% distilled water); each group had five sacrifice times. Each treatment consisted of painting 1 ml of either the treatment or control solution on the contused tissue. The inflammation group received 15 additional treat ments, 3 per day for the next 5 days. A three-phased, single blind, histologic examination was performed. The principle findings were: (1) significantly fewer healing cells were present in the experimental group than in the control group during the period inflammation was examined, and (2) no significant difference existed be tween the experimental and control groups during the period healing was examined.
Horizontal fracture of the talar head
Authors: Mulligan Michael E.
Published: June 2007

An unusual talar fracture is presented along with a review of the literature concerning talar fractures. In evaluating certain ankle injuries, close scrutiny of the talar head, especially the mortise view, is emphasized.
A new operative approach to snapping hip and refractory trochanteric bursitis in athletes
Authors: Zoltan Donald J. , Clancy William G. , Keene James S.
Published: June 2007

This report concerns seven patients that had a painful hip due to snapping of the iliotibial band over the greater trochanter and resultant trochanteric bursitis, and whose symptoms were refractory to nonoperative treatment. An operative procedure that has not been previously described was performed. It involved the excision of an ellipsoid-shaped portion of the iliotibial band overlying the greater trochanter and removal of the trochanteric bursa.

Five of the seven patients were evaluated at the time this report was prepared; the average length of followup was 55 months. Four were significantly improved or relieved of their symptoms, and the fifth was an oper ative failure with complete recurrence. This final patient underwent a second, more extensive partial excision of the iliotibial band, and was asymptomatic 1 year later. A review of the clinic records of the remaining two patients that could not be contacted revealed that they both had been doing well at their 6 month evaluation.

For those patients with a symptomatic snapping hip and trochanteric bursitis unresponsive to conservative therapy, the procedure described is an effective method of treatment.
Followup of the acute nonoperated isolated anterior cruciate ligament tear
Authors: Hawkins Richard J. , Misamore Gary W. , Merritt Thomas R.
Published: June 2007

This report is an attempt to analyze what happens to an isolated ACL tear that is treated nonoperatively. The results of 40 patients treated initially by nonoperative means for this injury and followed an average of 4 years are reported. A very small percentage of these patients had associated meniscal pathology. Secondary recon structive surgery was necessary in 12 patients (30%). Primary meniscal tears were present in 4 of 25 knees (16%) and secondary meniscal tears occurred in an additional four of the patients. Giving way was a prob lem for 36 (86%) of the nonoperated patients, but pain and swelling were not significant problems for most. Full return to unlimited athletic activities was possible for only four (14%) of the patients. Objective signs of ACL insufficiency could be demonstrated on all patients upon clinical examination at followup. Overall grading of the knees revealed 87.5% fair or poor results.
Instrumented testing of functional knee braces
Authors: Beck Charles , Drez David , Young John , Cannon W. Dilworth , Stone Mary Lou
Published: June 2007

The ability of seven functional knee braces to control anterior tibial displacement in three severely lax ACL deficient knees using two instrumented testing devices was studied. Some braces were statistically shown to be much better in this regard than others, but not all data obtained was statistically significant. This material should aid one in determining which braces offer the greatest degree of control of anterior tibial displacement in patients with ACL insufficiency.
The Lenox Hill brace
Authors: Colville Mark R. , Lee Christopher L. , Ciullo Jerome V.
Published: June 2007

Forty-five patients with documented ACL injuries were examined objectively and subjectively to evaluate the effectiveness of the Lenox Hill brace in treating knee instability. The brace failed to significantly reduce max imal anterior subluxation of the tibia, but did increase resistance to displacement. Rotatory instability was improved an average of one grade by the brace, while varus/valgus laxity was unchanged.

Subjectively, patients experienced a significant re duction in episodes of giving way, and athletic perform ance was improved by the brace in 69% of patients. Increased symptoms of instability correlated positively with greater measured laxity and low resistance to tibial displacement. The brace, while not effective in control ling absolute laxity, significantly reduced symptoms of instability in the nonelite athlete, possibly through in creasing relative resistance to subluxation. Overall, 91% of the patients examined were satisfied with the brace and felt it was beneficial for them.
Clinical diagnosis of meniscal tears
Authors: Anderson Allen F. , Lipscomb A. Brant
Published: June 2007

The accuracy in clinical diagnosis of meniscal tears was assessed in 100 knees. Arthroscopy was performed in each case to establish the diagnosis. The clinical diag nosis was correct in 87 cases, correct but incomplete in 4, and incorrect in 9. In those with mensical tears repeated popping occurred in 43%, swelling in 51%, and pain localized to the joint line in 63%. Tenderness over the joint line, the most accurate clinical sign, was positive in 77% and false positive in 11 % of meniscal tears. McMurray's test was positive in 58% and false positive in 5%, while the medial-lateral grind test was positive in 68% and false positive in 1 %. At least one of these manipulative tests was positive in 79% of meniscal tears. Repeated examination and addition of the medial-lateral grind test to the clinical evaluation of meniscal tears significantly improves diagnostic accu racy.
Ultrasound measurement of the anterior leg compartment
Authors: Brahim F. , Zaccardelli W.
Published: June 2007

Eight male subjects, weighing 65 to 83 kg and between 22 and 34 years of age, were measured for depth changes in the anterior leg compartment at rest and following treadmill running and weighted dorsiflexion exercises. Measurements were obtained from ultra sound scans at two points on the leg. The results showed no significant differences in the compartment's depth between rest and treadmill exercise, while signif icant changes were noted between rest and dorsiflexion exercises. These results suggest that the anterior leg muscles were maximally functioning during the dorsi flexion exercises, but not during the treadmill exercises. It is concluded that the ultrasound can be used to detect depth changes, and hence volume changes, in muscle compartments and may have potential use in combination with other techniques as a noninvasive diagnostic tool in assessing changes in a muscle com partment.
Magnetic resonance imaging as a tool for evaluation of traumatic knee injuries
Authors: Mandelbaum Bert R. , Finerman Gerald A.M. , Reicher Murray A. , Hartzman Steven , Bassett Larry W. , Gold Richard H. , Rauschning Wolfgang , Dorey Fred
Published: June 2007

Traumatic injury to the knee remains a diagnostic and therapeutic challenge. Magnetic resonance imaging (MRI) has been applied to musculoskeletal pathoa natomy and has been shown to be an effective tool for definition and characterization of knee pathology. A systematic approach is taken to establish anatomical and pathoanatomical correlations, as well as the role of MRI in the management of knee injuries.

Imaging was performed at the UCLA Medical Center using a permanent magnet system and a combination of solenoidal surface coils and thin-section, high-reso lution scanning techniques. Images depict structural anatomical and spatial details of the knee that correlate well with corresponding cadaveric cryosections. To determine pathoanatomical correlations and the effi cacy of MRI, 105 patients with preoperative diagnoses of meniscal tears, anterior and posterior cruciate liga ment tears, tibial plateau fracture, and patella and quad riceps injuries were imaged.

Results indicated that for the medial meniscus MRI demonstrated a 95.7% sensitivity, 81.8% specificity, 90% accuracy, 88.2% positive predictive value (PPV), and 93.1 % negative predictive value (NPV). Imaging of the lateral meniscus demonstrated a 75% sensitivity, 95% specificity, 91 % accuracy, 80% PPV, and 94% NPV. MRI of the ACL revealed 100% sensitivity, spec ificity, accuracy, positive and negative predictive values. MRI is a noninvasive tool which uses no ionizing radiation and can accurately define and characterize anatomy and pathoanatomy. This study indicates that MRI in conjunction with clinical evaluation can contrib ute to treatment decision-making processes and assist in preoperative planning. An algorithm demonstrating the potential clinical use of MRI is presented.
A study of the biological behavior of the meniscus as a transplant in the medial compartment of a dog's knee
Authors: Canham William , Stanish William
Published: June 2007

A surgical procedure was developed such that a menis cus could be reimplanted in the medial compartment of canine knees. The medial meniscus was removed and reimplanted in one group of seven animals, removed and reimplanted with a glutaraldehyde-preserved bio prosthesis in a second group of five animals, and re moved and replaced by an allograft meniscus preserved 2 to 3 weeks in tissue culture in a final group of ten animals.

All animals were autopsied at 2 months and the knees were examined by gross dissection and histologic study of the joint capsule meniscal interface.

Results showed that implantation by the surgical technique was effective and no loose bodies or partial detachments were found in the reimplantation or tissue culture-stored allogenic menisci. Allogenic menisci pre served in glutaraldehyde and termed a bioprosthesis attached to the joint capsule less satisfactorily. There was minimal inflammation of the synovium in any group at 2 months; however, the glutaraldehyde group showed repeated effusions at 1 and 2 weeks.
The use of the Putti-Platt procedure in the treatment of recurrent anterior dislocation
Authors: Collins Kenneth A. , Cross Mervyn
Published: June 2007

This study presents the results of 107 shoulder recon structions by one surgeon, of which 59 were Putti-Platt procedures, and 48 were combined Putti-Platt/Bank hart procedures. The patients were predominately young males engaged in contact sports, particularly the Rugby football codes. There were nine redislocations noted in clinical records for the 107 Putti-Platt or com bined Putti-Platt procedures, but 8 noted on the 71 replies to a questionnaire. There was only one redislo cation in the absence of significant trauma. The average loss of external rotation was 20° in the 41 patients that were able to present for reexamination. Sixty-two of the 71 patients who answered questionnaires were able to play any sport without functional impairment. The Putti-Platt procedure provides excellent shoulder sta bility for active sportsmen without significant loss of performance.
Soft tissue fixation to bone
Authors: Robertson Daniel B. , Daniel Dale M. , Biden Edmund
Published: June 2007

This experiment was designed to compare the imme diate fixation strengths of various methods of soft tissue fixation techniques. The fixation techniques tested were the barbed staple, stone staple, suture techniques, screw with spiked plastic washer, and the screw with spiked soft tissue plate.

Cadaveric soft tissue specimens were classified into three distinct morphologic types: capsular, tendinous, and extensor mechanism tissue. Each specimen was fixed to bone by one of the fixation techniques. The specimens were loaded in a cyclical fashion until fixation failure occurred.

One hundred thirty-seven trials were performed. The screws with the spiked plastic washer and soft tissue plate proved superior overall for all three tissue types. The stone staple was the poorest technique tested. Therefore, if cyclic loading or tension is anticipated at the fixation site, the fixation technique of choice would be the screw with spiked plastic washer or soft tissue fixation plate.
Bicycle accidents and injuries among adult cyclists
Authors: Kiburz Douglas , Jacobs Rae , Reckling Fred , Mason Judy
Published: June 2007

Bicycling accidents comprised the greatest recreational source of Emergency Room visits last year, numbering over 500,000. To evaluate cycling morbidity, 492 active adult bicyclists from a metropolitan area responded to a survey to determine cycle use and accident patterns. Nearly half (46%) have been involved in an accident with the cyclists being at fault 58.7% of the time. Soft tissue injuries to the extremities predominated with 9.3% of all injuries requiring hospitalization (average, 7 days) and 22.5% missing days from work or school. Significant factors contributing to bicycle accidents in cluded rider carelessness (58.7%), cycle malfunction (14.9%), environmental factors (36.9%), turns (22.9%) and hills (13.4%), and companion riders (15%). The use of riding helmets decreased the severity of injury and hospitalization time. The education of cyclists and driv ers with the integration of bicycles into normal traffic patterns should help decrease the morbidity and mor tality.
Symptomatic dorsal defect of the patella in a runner
Authors: Gamble James G.
Published: June 2007

The dorsal defect of the patella is a benign lesion characteristically located in the superolateral corner of the patella. The microscopic pathology shows fibrous tissue, reactive woven bone, and stringy, eosinophilic, extracellular debris. Although the lesion is usually asymptomatic, the juxtaarticular location in the patella can provoke symptoms in the athlete. Excision of the lesion and cancellous bone graft of the defect resolved the problem in a competitive adolescent runner.
Tarsal coalition in the young athlete
Authors: Elkus Richard A.
Published: June 2007

Twenty young athletes with tarsal coalition were stud ied. There was a total of 26 feet including 15 cases of calcaneonavicular bars, 9 cases of talocalcaneal bars, 1 talonavicular bar, and 1 mixed. Twenty-five feet had bar resection.

Calcaneonavicular bar resection is the recommended procedure for the adolescent who presents with a painful tarsal coalition. The talocalcaneal synostosis resection has been mentioned in the literature as yield ing poor results. This was not true in my series. The eight cases of talocalcaneal coalition presented all had improvement in motion and decreased pain after sur gical excision of the bar.
Conditions of the talus in the runner
Authors: Hontas Mark J. , Haddad Ray J. , Schlesinger Lee C.
Published: June 2007

The anatomy and biomechanics of the talus in its rela tionship with ankle and subtalar joints expose it to increased stresses and forces in the runner. Many injuries to the talus, such as stress fractures, antero lateral compression syndromes, osteochondral Stage I and II lesions, and posterior compartment fractures can be treated with consecutive methods initially. Surgical treatment is indicated if these problems become chronic or in the conditions of osteochondral Stage III and IV lesions, anterior impingement syndrome, or sympto matic or trigonum fractures.
Bunionectomies and related surgery in the elite female middle-distance and marathon runner
Authors: Lillich James Scott , Baxter Donald Ervin
Published: June 2007

When contemplating bunion surgery in the elite athlete, serious consideration should be given to its effects on the overall function and biomechanics of the forefoot. Many surgical treatment options are available, but their use in the high performance athlete has not previously been reported in the literature. In this paper we report on the successful use of the chevron bunionectomy procedure and related surgery in two world class female middle-distance and marathon runners.
Comparative electromyography of the lower extremity in jogging, running, and sprinting
Authors: Mann Roger A. , Moran Gary T. , Dougherty Sandra E.
Published: June 2007

An electromyographic study of the lower extremity muscles was undertaken in order to compare jogging, running, and sprinting. The study demonstrated that as the speed of gait increased, the support phase de creased, from 620 msec for walking to 260 msec for jogging to 220 msec for running to 140 msec for sprinting. The electromyographic data demonstrated that all muscle groups except the hip flexor and adduc tor longus were active during foot descent, floor con tact, and midsupport. There was absence of muscle function during the late toe-off phase except that dem onstrated by the adductor longus and the abdominal muscles during sprinting. The main muscle group that appears to increase the speed of gait is that of the hip flexors, which is closely linked to the knee extensors in order to propel the body forward in the line of progres sion. There was little or no activity in the gastrocnemius or in the intrinsic muscles of the foot about the time of toe-off, leading the authors to conclude that push-off per se does not appear to occur.
Treatment of the medial collateral ligament injury
Authors: Inoue Masahiro , McGurk-Burleson Erin , Hollis J. Marcus , Woo Savio L.-Y.
Published: June 2007

The purpose of this study was to explain the functional roles of the medial collateral ligament (MCL) and the ACL and how they affect the kinematics of the knee joint after isolated MCL injury. Varus-valgus joint laxity was quantitatively measured using a device which al lowed various degrees of freedom (DOF) of joint motion during application of a varus-valgus bending moment to the canine knee joint. When the knee motion was limited to 3 DOF (varus-valgus rotation, proximal-distal, and medial-lateral translation), valgus laxity increased significantly (171%) after sectioning the MCL. Thus, the MCL was the primary restraint to the valgus bending moment in the 3 DOF mode. However, the effect of sectioning the MCL on valgus laxity became minimal (21% increase) when the DOF of knee motion was increased to 5 (by adding axial tibial rotation and ante rior-posterior translation). In this situation, external and internal tibial axial rotation were coupled with the varus and valgus rotation of the knee joint, respectively, and the ACL also functioned to restrain the varus-valgus rotation. The results of this study suggest that under normal knee joint motion, the functional deficit of the MCL in valgus rotation was compensated for by the remaining structures, especially by the ACL.
The efficacy of antiinflammatory medication in the treatment of the acutely sprained ankle
Authors: Dupont Michel , Béliveau Pierre , Theriault Germain
Published: June 2007

The value of nonsteroidal antiinflammatory drugs in the treatment of various sports-related injuries has been investigated by several groups. Despite these efforts, the experimental results are difficult to interpret, and very few investigations have focused on a single injury type in the acute phase. A double-blind study compared ibuprofen at a dose of 2,400 mg per day and a placebo in the 1 st week of treatment of 61 acute ankle sprains with varying degrees of severity. Medical evaluation by the same physician was performed on the 1 st, 4th, 8th, and 28th day following the injury. Subjective evaluation of pain, number of painful ligaments at palpation, pas sive mobilization induced pain, edema, and functional incapacity served as the clinical parameters. Although there were trends indicating a superiority of effective ness in the treatment group, the differences between groups were not statistically significant.
Recurrent herpes labialis in skiers
Authors: Mills John , Hauer Laurie , Gottlieb Alan , Dromgoole Sydney , Spruance Spotswood
Published: June 2007

Recurrent orofacial herpes infection may be triggered by high altitude skiing, presumably because of solar ultraviolet radiation exposure. Six (12%) of a group of 51 subjects with a history of skiing-triggered herpes observed during 1 week of high altitude skiing experi enced reactivations of orofacial herpes a median of 31/2 days after exposure. Within this group, application of a sunscreen with a sun protection factor (SPF) of 15 failed to influence the reactivation rate as compared with a placebo.

Reactivation of herpes triggered by skiing is common. As application of a sunscreen with an SPF of 15 did not appear to influence the reactivation rate, alternate approaches to the control of recurrent orofacial herpes are needed.
Evaluation of residual instability after arthroscopic meniscectomy in anterior cruciate deficient knees
Authors: Shields Clarence L. , Silva Ishmael , Yee Lincoln , Brewster Clive
Published: June 2007

Forty-five patients who underwent a partial meniscec tomy in an anterior cruciate deficient knee were fol lowed from 2 to 9 years. The average age at the time of the meniscectomy was 28.6 years. The majority of the patients were injured in recreational athletics. The subjects were evaluated preoperatively by a question naire and clinical examination, both of which were re peated at followup. The efficacy of the postsurgical rehabilitation was monitored with measurement of quadriceps and hamstring strength on the Cybex Dy namometer. All of the patients had a KT-1000 knee ligament arthrometer test at followup that was com pared with the clinical examination. Sixty-five percent of the subjects (13 of 20) with a Lachman and pivot shift of +1 returned to their previous activity level without limitation. Of the patients with a KT-1000 com pliance index of 1 mm, 70% (11 of 17) returned to the same athletic level. However, only 20% (2 of 11) of the patients with a clinical instability greater than +1 or a compliance index of 2 mm were able to perform without limitation. The location of the meniscal tear did not correlate with the functional outcome. Six patients re quired ACL reconstruction.
Injuries in runners
Authors: Lysholm Jack , Wiklander Jorgen
Published: June 2007

Sixty runners belonging to two clubs were followed for 1 year with regard to training and injury. There were 55 injuries in 39 athletes. The injury rate per 1,000 hours of training was 2.5 in long-distance/marathon runners and 5.6 to 5.8 in sprinters and middle-distance runners. There were significant differences in the injury rate in different periods of the 12 month study, the highest rates occurring in spring and summer. In marathon runners there was a significant correlation between the injury rate during any 1 month and the distance covered during the preceding month (r = 0.59). In a retrospective analysis of the cause of injury, a training error alone or in combination with other factors was the most com mon injury-provoking factor (72%). The injury pattern varied among the three groups of runners: hamstring strain and tendinitis were most common in sprinters, backache and hip problems were most common in middle-distance runners, and foot problems were most common in marathon runners.
Electromyographic biofeedback in the treatment of voluntary posterior instability of the shoulder
Authors: Beall M. Scott , Diefenbach Ginger , Allen Arthur
Published: June 2007

Three cases of voluntary posterior instability of the shoulder are presented. They have all responded well to a program of electromyographic monitored biofeed back. This method offers a means of enhancing the results of nonoperative treatment.
Effect of electrical stimulation on quadriceps strength after reconstructive surgery of the anterior cruciate ligament
Authors: Sisk T. David , Stralka Susan W. , Deering Mary B. , Griffin Judy W.
Published: June 2007

The effect of prolonged daily electrical stimulation (ES) on quadriceps strength in 22 patients during the 6 weeks following anterior cruciate reconstruction was investigated. Patients were randomly assigned to re ceive either a combination of ES and exercise or exer cise alone. Isometric quadriceps strength was meas ured at the 7th, 8th, and 9th postoperative weeks. No significant difference in strength existed between the groups as a result of ES. A significant difference in strength did exist between competitive and recreational athletes regardless of treatment. Further research is needed to determine if the addition of ES to isometric exercise during immobilization can significantly retard strength loss after anterior cruciate reconstructive sur gery.
The medical aspects of soccer injury epidemiology
Authors: Keller Cary S. , Noyes Frank R. , Buncher C. Ralph
Published: June 2007

In this article, the six major studies of soccer injury epidemiology are reviewed. Strengths and weaknesses of each epidemiologic design are critiqued and the crucial importance of the definition of injury is empha sized. The effect of age, sex, and intensity of play on injury rates is discussed. Our present knowledge of injury rate by anatomical site, player position, and the type of playing surface are reviewed. We examined the importance of player factors such as flexibility, joint laxity, weakness, and incomplete rehabilitation from other injuries. In addition, we reviewed the role played by inadequate equipment, field conditions, and rule violations. A successful program for soccer injury pre vention is described, and guidelines for future soccer injury epidemiology research are proposed.
Circulatory disturbances in the throwing hand of baseball pitchers
Authors: Itoh Yoshiyasu , Wakano Koichi , Takeda Tsuyoshi , Murakami Tsuneji
Published: June 2007

Three cases of circulatory disturbance with ulcer for mation in the pitching hand of baseball pitchers are reported. The pathophysiology was of an entirely new entity. In one case, the neurovascular bundles of the middle finger were entrapped by the proximal edges of Cleland's ligaments. In the other two cases, the blood vessels to the index and middle fingers were com pressed within the lumbrical canal. Hypertrophy of the lumbrical muscles and/or thickening of the palmar apo neurosis were responsible for the compression of the vessels. Surgical release of Cleland's ligaments or pal mar aponeurosis, including superficial transverse fiber and vertical septa, resulted in good recovery of the circulation of the involved fingers. All of the pitchers returned to professional or college league baseball with out recurrence of the ulcer.
Adductor tendinitis and musculus rectus abdominis tendopathy
Authors: Martens Marc A. , Hansen Ludo , Mulier Jozet C.
Published: June 2007

Groin injuries are becoming more common today in soccer. Conservative treatment consisting of rest, physiotherapy, and medication yields favorable results in only 38% of the long-standing lesions. Operative treatment is indicated in selected cases. Better knowl edge of the underlying pathology and a more accurate initial conservative treatment directed to the ethiopath ogenesis could solve many of the problems. However, in our experience a simple subcutaneous adductor tenotomy and/or a rectus abdominis tenotomy in com bination with a fasciaplasty was done successfully in 75 of 81 patients. There was no loss of power in this group of patients as measured and compared with a control group.
Injury to the brachial plexus during Putti-Platt and Bristow procedures
Authors: Richards Robin R. , Hudson A.R. , Bertoia J.T. , Urbaniak J.R. , Waddell J.P.
Published: June 2007

Eight patients with documented recurrent anterior dis location of the shoulder sustained iatrogenic brachial plexus injuries during either Putti-Platt or Bristow pro cedures. Two patients also sustained axillary artery injuries. There were six males and two females. Post operatively, complete paralysis of the musculocuta neous nerve was noted in six cases and incomplete paralysis in one case. Two patients had complete axil lary nerve palsies. There were two cases of partial paralysis of the radial, median, and ulnar nerves, re spectively.

Seven of the patients underwent brachial plexus ex ploration an average of 16 weeks following their initial operation (range, 4 to 40). Suture material was removed from around or within two musculocutaneous nerves and one ulnar, one median, and one axillary nerve. Two lacerated musculocutaneous nerves were amenable to delayed primary repair. Two musculocutaneous, one median and one axillary nerve required grafting. Injury to the brachial plexus was associated with inadequate knowledge of regional anatomy, blind clamping of axil lary artery lacerations, use of axillary incisions which limited exposure, and failure to identify the musculo cutaneous nerve during Bristow procedures. If a brach ial plexus injury occurs during a Putti-Platt or a Bristow procedure and the lesion does not rapidly, progres sively, and completely recover, the brachial plexus should be explored since there is a high likelihood of structural neurologic injury.
Graft tension in anterior cruciate ligament reconstruction
Authors: Yoshiya Shinichi , Andrish Jack T. , Manley Michael T. , Bauer Thomas W.
Published: June 2007

The purpose of this study was to examine the effect of initial tensioning on the outcome of reconstruction of the ACL.

The ACLs of 15 adult mongrel dogs were excised and reconstructed. In the first five dogs, the ACLs of both knees were reconstructed using the medial one- third of the patellar tendon. The graft was fixed under a tension of 1 N (0.22 pounds) in one knee and 39 N (8.8 pounds) in the opposite knee. In the remainder of the dogs, the reconstructions were augmented with Dacron prostheses. Tensioning of both graft compo nents in the augmented reconstructions was either with 1 N in one knee and 39 N in the contralateral knee or disproportionate tensions of 1 N and 39 N applied to the autogenous material and to the prosthesis. Sacrifice was 3 months postsurgery and results were examined with microangiography/histology and mechanical test ing.

In the reconstructions with the patellar tendon alone, the biologic study showed poor vascularity and focal myxoid degeneration within the graft pretensioned with a load of 39 N. In the augmented reconstructions, the knees in which both graft materials were fixed with 1 N tension showed the strongest and stiffest reconstruc tion at 3 months. The study suggests that minimal tension should be applied to the graft materials during surgical reconstruction of the ACL.
Analysis of the intercondylar notch by computed tomography
Authors: Anderson Allen F. , Lipscomb A. Brant , Liudahl Kevin J. , Addlestone Ronald B.
Published: June 2007

The purposes of this study were to document the dimensions and configuration of the intercondylar notch in the normal knee; to compare normal knee intercon dylar notches to those of knees with unilateral and bilateral ACL tears to determine if there is a relationship between intercondylar notch stenosis and ACL tears; and to determine if generalized ligamentous laxity is associated with intercondylar notch stenosis and ACL tears. Three groups were compared: Group I, bilateral ACL tears; Group II, unilateral tears; and Group III, normal knees. Notch dimensions were computer-gen erated from CT scans. All patients were examined for ligamentous laxity. Statistically significant differences were found between normal and ACL-injured knees in regard to opening notch angle, ratio of notch width at two-thirds of the notch length to condylar width, and ratio of maximum notch width to condylar width, sug gesting a significant association between anterior outlet stenosis and unilateral and bilateral ACL tears. The shapes of the notches were determined from tracings of the distal CT scan. Shapes ranged from inverted U to cresting wave. Narrow notches tended to be wave- shaped, but more study is needed in this area. Notch- plasty is recommended for those with documented stenosis. The ratio of maximum notch width at two- thirds of the notch height to maximum condyle width should not be much less than 0.2, and the opening notch angle should be at least 50°.
Isolated posterior cruciate ligament injuries in athletes
Authors: Fowler P.J. , Messieh S.S.
Published: June 2007

The literature is divided as to the necessity of an intact posterior cruciate ligament for functional stability. Pre sented here is a prospective study of isolated posterior cruciate injuries seen in the acute stage in 13 patients, 6 males and 7 females. The diagnosis of posterior cruciate ligament tear was made clinically and con firmed by arthroscopy. The average age at injury was 22 years. The athletic activity at injury was varied. Hyperflexion was the most common mechanism of injury, followed by pretibial trauma in the hyperflexed knee or in the "dashboard" injury. There were seven complete midsubstance tears and five partial tears. Direct visualization of the posterior cruciate ligament was not attained in one patient. All patients were treated nonoperatively on a physiotherapy routine. Av erage followup was 2.6 years. Patients were clinically examined and subjected to KT-1000 and Cybex testing. All patients were able to return to their previous activity and experienced no limitations with their injured knees. Using Hughston's criteria, subjective and functional ratings were all good. However, only 3 rated good and 10 fair when assessed objectively. We conclude that acceptable functional stability in these patients does not necessarily require absolute static stability. Non- operative treatment of the isolated posterior cruciate ligament midsubstance injury may be a viable alterna tive to the difficult repair/reconstruction procedure.
Cement coating of osteoarticular allografts in rats to prevent the immune response
Authors: Rodrigo J. , Reynolds H. , Thorson E. , Gray J. , Thompson E. , Heitter D.
Published: June 2007

Recently, more attention is being paid to the treatment of the articular surface defect in the young, active individual. Resurfacing or "shell" allografts are being considered as one of the alternatives for treatment. The immune response by the host may be the chief obstacle to the successful use of fresh osteoarticular allografts. Since proteins on the surfaces of allograft bone cells are considered to be the principal antigens eliciting the immune response, we hypothesized that mechanical masking of these cells by a biodegradeable blocking agent might prevent the immune response. Osteoarti cular allografts of the distal femur were performed in rats and the cut surfaces of the graft were coated with cement before implantation. In a preliminary experi ment, six biodegradeable cement materials were tried (bone wax, zinc polycarboxylate, collodion, fibrin ad hesive, zinc oxide, and isobutyl-cyanoacrylate). Of these, the zinc oxide cement and isobutyl-cyanoacry late were effective in inhibiting the immune response observed in control rat distal femur allografts.

A second experiment was performed using nine rats with zinc oxide and nine rats with isobutyl-cyanoacry late cements. These were compared with 20 control rats that had allografts without cement coating. Eight een of the control rats (90%) developed an immune response, while only 22% (2/9) of the rats with zinc oxide coating and 33% (3/9) of the rats with isobutyl- cyanoacrylate developed an immune response.

In a third experiment distal femur allografts were performed in 13 rats using only the liquid component of the zinc oxide cement. Forty percent (5/13) of the rats developed an immune response, suggesting that the effect of the zinc oxide preparation (and perhaps also of the isobutyl-cyanoacrylate) might better be ex plained by a chemical alteration of the antigens of the allograft bone cells rather than by a mechanical blocking effect. It might also be explained by a systemic inhibition of the immune response by chemicals in the cement.

These observations in a rat model demonstrate that the immune response can be inhibited by local treat ment of the allograft. The theory needs now to be tested in a larger animal model with an articular surface defect where adequate surgery can be done. Then conclusions can be drawn for the possible practical application to the young, active individual with an artic ular surface defect.
Transverse tibial stress fractures
Authors: Blank Samuel
Published: June 2007

Five transverse tibial stress fractures have been re viewed. Two of three cases in the anterior midtibia and one in the proximal posteromedial tibia had radionuclide scans. These cases demonstrated minimal scan activity at the stress fracture site. This minimal scan activity in patients with a clinical history of pain and a tender mass suggests poor bone reparation and nonunion. One anterior midtibial stress fracture developed a complete fracture. A proximal anterior tibial ridge stress fracture revealed radiological and clinical evidence of healing.
Concussions in college football
Authors: Buckley W.E.
Published: June 2007

The purpose of this investigation was to examine risk patterns of concussion in college football. Multivariate models were used to interpret the data. Specifically, log-linear modeling and analysis techniques were incor porated into the investigation. An average of 49 college teams were studied over the 8 year period 1975 to 1982. This represented over 36,000 athlete-seasons and 395 team-seasons. The data selected were limited to 1,005 game-related concussions. The general hy potheses tested were the null hypothesis that the vari ables of team (offense and defense), player position, situation (rushing and passing), and activity (block and tackle) had no effect on the occurrence of these game- related concussions.

It was found that concussions were a persistent and regular but relatively infrequent type of injury in college football. Concussions accounted for 75% of the total number of injuries on or about the head. The injuries were examined relative to player position, situation, and activity using a log-linear modeling technique, with in teractions among the variables also established.

The contribution of each variable was not always equal or completely interactive. Generally, the highest risk of concussion was associated with offensive and defensive players involved in a block on a rushing play. Specifically, running backs demonstrated the highest risk of concussion, regardless of activity. The lowest risk was for offensive linemen and quarterbacks while blocking on any type of play.

On defense, the secondary exhibited the highest risk of concussion while being blocked on a running play. Similarly, linemen experienced their greatest risk while being blocked on plays run inside the tackle. The small est risk of concussion was demonstrated by lineback ers on passing plays.

This investigation demonstrated the viability of mul tivariate analysis of sport injury data and confirmed the utility of the log-linear analysis of nominal data.
Stress fractures of the medial malleolus
Authors: Shelbourne K. Donald , Fisher David A. , Rettig Arthur C. , McCarroll John R.
Published: June 2007

Six athletes, all engaged in running activities at the time of injury, presented with tenderness over the medial malleolus and ankle effusion. Three patients had a fracture line which could be seen on radiographs. These patients were treated by open reduction and internal fixation using two 4.0 cancellous screws. The other three patients had normal radiographs but bone scans showed increased uptake over the medial malleolus. These patients were treated with cast and immobiliza tion.

We believe that each of these patients suffered a stress fracture of the medial malleolus. We suggest that the possibility of a stress fracture be considered in the differential diagnosis of patients who present with 1) chronic or subacute pain over the medial malleolus and ankle effusion, and 2) a history of running activity at the time of injury or running activities aggravating the pain. Bone scans appear to be more sensitive than radiographs in detecting a stress fracture of the medial malleolus. We propose that athletes with radiographic signs of a medial malleolar fracture who desire early return to full participation should be treated by open reduction and internal fixation. For these patients, early motion can be initiated. Other athletes whose fracture cannot be detected on radiographs but whose malleo lus shows increased uptake in the area on bone scans can be treated nonsurgically with immobilization and then progressive increase in activity. All of our patients returned to full activity between 6 and 8 weeks after treatment was initiated.