bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Prognosis for Jumper's Knee in Male Athletes: Prospective Follow-up Study
Authors: Kettunen Jyrki A. , Kvist Martti , Alanen Erkki , Kujala Urho M. 
Published: July 2017

Background: Little information is available on the long-term outcome of jumper's knee, a common problem among athletes. Purpose: Our aim was to determine the 15-year prognosis of jumper's knee. Study Design: Prospective case control. Methods: The prognosis for jumper's knee was studied using two groups: athletes with jumper's knee and nonsymptomatic control athletes. At baseline, all subjects participated in standardized clinical examinations and measurements, and 15 years later they were asked to respond to a questionnaire. Results: Twenty athletes with jumper's knee and 16 athlete control subjects responded (response rate 74% and 84%, respectively). The jumper's knee group reported significantly more knee symptoms according to their Kujala score and more knee pain after repeated squatting. Fifty-three percent of the subjects in the jumper's knee group (9 of 17) reported that they had quit their sports career because of their knee problem, compared with 7% of the control athletes (1 of 14). Patellar height was associated with knee symptoms at follow-up. Conclusion: Jumper's knee causes mild but long-lasting symptoms after an athletic career.
Partial Tears of the Anterior Cruciate Ligament in Children and Adolescents
Authors: Kocher Mininder S. , Micheli Lyle J. , Zurakowski David , Luke Anthony 
Published: July 2017

Background: The functional outcome after partial anterior cruciate ligament tears in children and adolescents treated without reconstruction has not been established. Hypothesis: Nonreconstructive management of partial anterior cruciate ligament tears can be effective in certain pediatric patients. Study Design: Prospective cohort study. Methods: We studied 45 skeletally mature and immature patients 17 years of age or less who had an acute hemarthrosis, magnetic resonance imaging signal changes, grade A or B Lachman and pivot shift result, and an arthroscopically documented partial anterior cruciate ligament tears. All patients were treated without reconstruction, underwent a structured rehabilitation program, and were followed up for a minimum of 2 years. Results: Fourteen patients (31%) underwent subsequent reconstruction. Significant associations with subsequent reconstruction included tears that were greater than 50%, predominantly posterolateral tears, a grade B pivot shift test result, and older chronologic and skeletal age. Among patients who did not require reconstruction, those with tears that were greater than 50% or predominantly posterolateral had significantly lower Lysholm, satisfaction, and Cincinnati Knee Scale scores. Conclusions: Nonreconstructive management is recommended for partial anterior cruciate ligament tears in children and adolescents 14 years of skeletal age or younger with normal or near-normal Lachman and pivot shift results. Reconstruction is recommended in older athletes or in those with greater than 50% or predominantly posterolateral tears.
Effort Thrombosis in the Elite Throwing Athlete
Authors: DiFelice Gregory S. , Paletta George A. , Phillips Barry B. , Wright Rick W. 
Published: July 2017

Background: Upper extremity vascular injuries are uncommon in the elite throwing athlete. However, the extreme stresses that are placed on the upper extremity of elite baseball players, especially pitchers, puts them at risk for such injuries. One such injury is upper extremity venous thrombosis or “effort thrombosis.” Purpose: We wanted to review the common initial clinical symptoms and physical examination findings of effort thrombosis in elite baseball players and to review the associated clinical conditions such as hypercoagulable states and pulmonary embolism. Study Design: Retrospective review of a series of cases. Methods: A retrospective review of the medical records of a Major League Baseball organization and a Division I college was performed for the period 1987 to 1997. Results: We located four cases of effort thrombosis involving elite baseball players. Contrast venography was used to confirm the diagnosis in all cases. All patients were successfully treated with transluminal catheter-directed urokinase thrombolysis followed by first rib resection and systemic anticoagulant therapy for up to 3 months. All four players returned to play at or above their previous level of competition with no long-term chronic sequelae. Conclusions: Prompt clinical recognition, diagnosis, and treatment of effort thrombosis in the elite baseball player provides the player with an excellent prognosis for return to the previous level of play.
A Surgical Treatment for Unstable Osteochondritis Dissecans Lesions of the Humeral Capitellum in Adolescent Baseball Players
Authors: Takeda Hideaki , Watarai Koji , Matsushita Takashi , Saito Takao , Terashima Yuichiro 
Published: July 2017

Background: Various methods of surgical treatment for unstable osteochondritis dissecans lesions of the humeral capitellum have shown the potential to lead to osteoarthritis and poor functional results in throwing activities. Purpose: The purpose of this study was to evaluate the results of surgical treatment with pull-out wiring and bone grafting (as established by Kondo in 1989) in patients with unstable osteochondritis dissecans lesions of the humeral capitellum. Study Design: Retrospective review. Methods: Eleven male baseball players (average age, 14.7 years) with unstable osteochondritis dissecans lesions underwent internal fixation with pull-out wiring and bone grafting. Follow-up was an average 57 months. At an average 17 weeks after surgery, bony union of the osteochondritis dissecans lesion was radiographically confirmed and the wires were removed. Throwing was allowed beginning at 6 months after surgery. Results: At follow-up, all patients had obtained pain relief, and all except one had returned to previous throwing levels. Radiographs showed good healing, and minimal degenerative changes were found in only three joints. Conclusion: Healing of osteochondritis dissecans lesions of the elbow can be achieved after fragment fixation with pull-out wiring and a bone grafting technique.
Stress Injury of the Proximal Ulna in Professional Baseball Players
Authors: Schickendantz Mark S. , Ho Charles P. , Koh Jason 
Published: July 2017

Background: To date, stress injury of the proximal ulna has been infrequently reported as a cause of elbow pain in the throwing athlete. Purpose: We describe a syndrome of osseous stress injury of the proximal ulna in the professional throwing athlete. Study Design: Retrospective review. Methods: We evaluated the clinical, radiographic, and magnetic resonance imaging findings of seven professional baseball players with osseous stress injury of the proximal ulna. Results: Plain radiographs of the involved elbows failed to demonstrate any significant findings. All of the clinically significant lesions were detected with magnetic resonance imaging. In addition, magnetic resonance imaging was found to be of value in following the course of healing of the injuries. All of the lesions originated on the posteromedial aspect of the proximal ulna. The ulnar collateral ligament was intact in all seven athletes. One athlete had two occurrences of this injury. Six of the seven athletes returned to their previous level of play after a nonoperative course of treatment. Conclusions: We believe that this injury should be considered in the differential diagnosis of elbow pain in the throwing athlete. Magnetic resonance imaging is the diagnostic test of choice when this injury is suspected.
Operative versus Nonoperative Management of Acute Achilles Tendon Rupture
Authors: Kocher Mininder S. , Bishop Julius , Marshall Ryan , Briggs Karen K. , Hawkins Richard J. 
Published: July 2017

Background The optimal management strategy for acute Achilles tendon rupture is controversial. Purpose To determine the optimal management by using expected-value decision analysis. Study Design Cross-sectional study. Methods Outcome probabilities were determined from a systematic literature review, and patient-derived utility values were obtained from a visual analog scale questionnaire. A decision tree was constructed, and fold-back analysis was used to determine optimal treatment. Sensitivity analyses were used to determine the effect of varying outcome probabilities and utilities on decision-making. Results Outcome probabilities (expressed as operative; nonoperative) were as follows: well (0.762; 0.846), rerupture (0.022; 0.121), major complication (0.030; 0.025), moderate complication (0.075; 0.003), and mild complication (0.111; 0.005). Outcome utility values were well operative (7.9), well nonoperative (7.0), rerupture (2.6), major complication (1.0), moderate complication (3.5), and mild complication (4.7). Fold-back analysis revealed operative treatment as the optimal management strategy (6.89 versus 6.30). Threshold values were determined for the probability of a moderate complication from operative treatment (0.21) and the utility of rerupture (6.8). Conclusions Operative management was the optimal strategy, given the outcome probabilities and patient utilities we studied. Nonoperative management was favored by increasing rates of operative complications; operative, by decreasing utility of rerupture. We advocate a model of doctor-patient shared decision-making in which both outcome probabilities and patient preferences are considered.
Clinical Assessment of Three Common Tests for Superior Labral Anterior-Posterior Lesions
Authors: McFarland Edward G. , Kim Tae Kyun , Savino Richard M. 
Published: July 2017

Background Three tests (active compression, anterior slide, and compression rotation) are commonly used to diagnose superior labral anterior-posterior lesions. Hypothesis We hypothesized that the accuracy, sensitivity, and specificity for these tests was less than that previously reported and that a click in the shoulder during manipulation was not specific for the study lesion. Study Design Case-control study. Methods The three tests were performed on 426 patients who subsequently underwent shoulder arthroscopy. The results of physical examination were compared with the arthroscopic findings and analyzed for sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. Results At arthroscopy, 39 patients had type II to IV lesions (study group); the remaining 387 patients had type I lesion or no lesion (control group). The incidences of positive results were not statistically different between the groups (P > 0.05). Our findings were as follows: most sensitive test, active compression (47%); most specific test, anterior slide (84%); highest positive predictive value, active compression (10%); highest overall accuracy, anterior slide test (77%); lowest overall accuracy, active compression test (54%). The presence of a click and the location of the pain were not reliable diagnostic indicators. Conclusions The results of such tests should be interpreted with caution when considering surgery for a possible superior labral anterior-posterior lesion.
Anterior Cruciate Ligament Reconstruction with and without a Ligament Augmentation Device
Authors: Drogset Jon Olav , Grøntvedt Torbjørn 
Published: July 2017

Background Ligament augmentation devices have been used in anterior cruciate ligament reconstruction since the suggestion of Kennedy et al. in 1980 that such devices would allow grafts to heal faster and more safely. Hypothesis Patients who had augmentation will have better outcomes after 8 years. Study Design Prospective randomized case control study. Methods Between 1991 and 1993, 100 patients were randomized to groups undergoing anterior cruciate ligament reconstruction with bone-patellar tendon-bone grafts with (49) or without (51) use of a Kennedy ligament augmentation device. Of these 100 patients, 94 were examined at an average of 8 years after surgery. Fifteen patients were excluded because of rupture in the other knee and 11 because of rerupture in the same knee. Results Of the remaining 68 patients, the mean Lysholm function score was 84 in the augmentation group and 87 in the control group. There was a statistically significant relationship between preoperatively detected cartilage injury and osteoarthritis. Almost half of the patients had developed osteoarthritis. We observed no significant difference between the two groups concerning rerupture rate, Lysholm or Lachman test scores, or KT-1000 arthrometer measurements. Conclusions We found no positive long-term effects supporting the use of augmentation in anterior cruciate ligament reconstruction.
The Role of Biomechanical Shoe Orthoses in Tibial Stress Fracture Prevention
Authors: Ekenman Ingrid , Milgrom Charles , Finestone Aharon , Begin Michal , Olin Carin , Arndt Toni , Burr David 
Published: July 2017

Background Biomechanical orthoses have been shown to lower stress fracture incidence in infantry recruits. However, these results may not be applicable to running athletes. Hypothesis Training in either running shoes or military boots with custom biomechanical shoe orthoses lessens tibial bone strains and strain rates during walking and running. Study Design Randomized controlled laboratory study. Methods In vivo strain measurements were made in nine subjects to determine whether the use of biomechanical orthoses lowers tibial strains during both walking and running and whether such lowering depends on the type of shoe worn. Measurements were made during treadmill walking at 5 km/hr and then during serial 2-km treadmill runs at 13 km/hr with running shoes, with and without the orthoses, and during serial 1-km runs with army boots, with and without the orthoses. Results When soft or semirigid biomechanical orthoses were worn with boots, the tibial peak-to-peak strains were significantly lowered. Soft orthoses also significantly lowered the tension and compression strain rates when worn with boots. During running, semirigid orthoses significantly increased the compression and tension strain rates when worn with boots. Conclusions The use of biomechanical orthoses may be warranted for tibial stress fracture prevention during training in which boots are worn and that mostly involves walking, but they are not warranted for activities that primarily involve running or are performed in running shoes.
The Fixation Strength of Six Hamstring Tendon Graft Fixation Devices in Anterior Cruciate Ligament Reconstruction: Part II: Tibial Site
Authors: Kousa Petteri , Järvinen Teppo L. N. , Vihavainen Mika , Kannus Pekka , Järvinen Markku 
Published: July 2017

Background: Tibial fixation is more problematic than femoral fixation in anterior cruciate ligament reconstruction. Hypothesis: There is no difference in initial fixation strength among hamstring tendon graft tibial fixation devices. Study Design: Randomized experimental study. Methods: Each of six devices used to fix 120 quadrupled human semitendinosus-gracilis tendon grafts into porcine tibiae was tested 10 times with a single-cycle load-to-failure test and 10 times with a 1500-cycle loading test. Specimens surviving cyclic loading were subjected to a single-cycle load-to-failure test. Results: Intrafix (1332 N) was the strongest in the single-cycle load-to-failure test, followed by WasherLoc (975 N), tandem spiked washer (769 N), SmartScrew ACL (665 N), BioScrew (612 N), and SoftSilk (471 N). After cyclic-loading tests, Intrafix showed the lowest residual displacement (1.5 mm) and was also strongest (1309 N) in the single-cycle load-to-failure test after the cyclic-loading test, followed by WasherLoc (3.2 mm; 917 N). Conclusion: The Intrafix provided clearly superior strength in the fixation of hamstring tendon grafts to the tibial drill hole. Clinical Relevance: Some caution may be warranted when using the implants that showed increased residual displacement, especially if aggressive rehabilitation is to be used. Preconditioning of the hamstring tendon graft-implant complex before tibial fixation is needed.
Iontophoretic Administration of Dexamethasone Sodium Phosphate for Acute Epicondylitis: A Randomized, Double-Blinded, Placebo-Controlled Study
Authors:   MPT, for the DEX–AHE–01–99 Study Group, Nirschl Robert P. , Rodin Dennis M. , Ochiai Derek H. , Maartmann-Moe Craig 
Published: July 2017

Background: A better treatment modality is needed to control the pain of medial or lateral epicondylitis (tennis elbow). Hypothesis: Dermal iontophoretic administration of dexamethasone sodium phosphate will be significantly more effective in controlling pain than a placebo in patients with medial or lateral elbow epicondylitis. Study Design: Randomized, double-blinded, placebo-controlled study. Methods: On six occasions, 1 to 3 days apart within 15 days, 199 patients with elbow epicondylitis received 40 mA-minutes of either active or placebo treatment. Results: Dexamethasone produced a significant 23-mm improvement on the 100-mm patient visual analog scale ratings, compared with 14 mm for placebo at 2 days and 24 mm compared with 19 mm at 1 month. More patients treated with dexamethasone than those treated with placebo scored moderate or better on the investigator's global improvement scale (52% versus 33%) at 2 days, but the difference was not significant at 1 month (54% versus 49%). Investigator-rated pain and tenderness scores favored dexamethasone over placebo at 2 days. Patients completing six treatments in 10 days or less had better results than those treated over a longer period. Conclusions: Iontophoresis treatment was well tolerated by most patients and was effective in reducing symptoms of epicondylitis at short-term follow-up.
Codominance of the Individual Posterior Cruciate Ligament Bundles: An Analysis of Bundle Lengths and Orientation
Authors: Ahmad Christopher S. , Cohen Zohara A. , Levine William N. , Gardner Thomas R. , Ateshian Gerard A. , Mow Van C. 
Published: July 2017

Background: It is unclear how each bundle of the posterior cruciate ligament contributes to posterior knee stability. Hypothesis: Changes in bundle orientation and length occur such that neither bundle dominates in restraining posterior tibial motion throughout knee flexion and extension. Study Design: Controlled laboratory study. Methods: Six fresh-frozen cadaveric knees were studied in a joint-testing rig with individual quadriceps and hamstring muscle loading. Kinematic data for the tibia and femur were obtained at knee flexion angles from 0° to 120°. The joint was then disarticulated, and the insertions of the two bundles on the tibia and femur were digitized. Results: Length of the anterolateral bundle increased with increasing knee flexion angle from 10° to 120°. Length of the posteromedial bundle decreased with increasing knee flexion angle from 0° to 45° and increased slightly from 60° to 120°. Length of the anteromedial bundle was significantly less than that of the posteromedial at 0°, 10°, and 20° of knee flexion. The anterolateral bundle was significantly more horizontal at flexion angles of 0°, 10°, 20°, 30°, and 45° (P < 0.05). The posteromedial bundle was more horizontal at 120°. Conclusions: Changes in orientation take place such that neither bundle dominates in restraining posterior tibial motion throughout knee flexion and extension. Clinical Relevance: Double-bundle reconstructions achieve more physiologic knee function.
Anatomy of the Superior Glenoid Rim: Repair of Superior Labral Anterior to Posterior Tears
Authors: Lehtinen Janne T. , Tingart Markus J. , Apreleva Maria , Ticker Jonathan B. , Warner Jon J. P. 
Published: July 2017

Background: Successful placement of a fixation device on the superior glenoid rim during superior labrum repairs requires accurate knowledge of the glenoid rim anatomy. Purpose: To investigate the normal bony anatomy of the superior glenoid rim. Study Design: Descriptive anatomic study. Methods: Twenty cadaveric glenoid specimens were scanned to obtain cross-sectional images with peripheral quantitative computed tomography in three different positions, each perpendicular to the articular surface. Two straight lines were drawn along the interior bony margins of the articular surface and cortex, and image analysis software was used to calculate the angle between these lines. Three bony angles were measured. Results: The bony angles from the 10:30-, 12-, and 1:30-o'clock cross-sections were 55° ± 5°, 64° ± 5°, and 62° ± 8°, respectively. The posterosuperior angle (at the 10:30-o'clock position) was statistically significantly lower than the superior and anterosuperior angles. Intraobserver variation was less than 3%. Conclusions: The most superior point of the glenoid rim (12-o'clock position) seems to provide the most bone stock for anchor insertion. The available bone support was found to decrease posteriorly on the glenoid rim. Clinical Relevance: During superior labral repairs, the anchor or fixation device should be inserted at approximately a 30° angle in relation to the articular surface for maximal bone support.
Determination of Time of Biologic Fixation after Anterior Cruciate Ligament Reconstruction with Hamstring Tendons
Authors: Uchio Yuji , Ochi Mitsuo , Adachi Nobuo , Kawasaki Kenzo , Kuriwaka Masakazu 
Published: July 2017

Background It has been unclear when a hamstring tendon graft becomes biologically fixed in the bone tunnel after anterior cruciate ligament reconstruction. Hypothesis Postoperative biomechanical testing and magnetic resonance images can indicate biologic fixation of the graft in the femoral bone tunnel. Study Design Prospective cohort study. Methods Sixty-four patients were evaluated by serial biomechanical testing, magnetic resonance imaging, and second-look arthroscopy 2 years after surgery. Biologic fixation of the graft was confirmed radiographically by injecting a contrast medium into the femoral bone tunnel. Results Forty-two stable knees with graft fixation maintained a high stiffness (120% of normal) and showed low signal intensity in an early postoperative magnetic resonance image (12 ± 8 months). Fourteen stable knees without graft fixation had gradually increased anterior displacement with nearly normal stiffness and high signal intensity. Five unstable knees with graft fixation retained low stiffness (70%) and showed late low signal intensity at 20 ± 9 months. Three unstable knees without biologic fixation had rapidly increased anterior displacement, with half the stiffness of a normal knee. Conclusion Postoperative low stiffness and high signal intensity might indicate late biologic graft fixation, predicting a possibility of postoperative anterior knee instability.