bluuebunny/crossref_metadata_2025_split huggingface dataset:
The surgical treatment of osteochondritis of the capitellum
Authors: Mcmanama George B. , Micheli Lyle J. , Berry Michael V. , Sohn Roger S. 
Published: June 2007

This paper reviews 14 patients who underwent elbow arthrotomy for osteochondritis of the capitellum. The etiology in 7 of the 14 cases appears to be the result of repeated trauma from throwing sports. Five of the 14 described a singular significant traumatic episode, and in 2 of the 14, a clear etiology is uncertain. The diagnostic features including signs, symptoms, and el bow range of motion are examined. The operative findings are correlated with plain x-ray films of the elbow in all cases and with an elbow arthrogram in 11 out of 14 cases. The average length of followup was 24 months. The postoperative range of motion was in creased an average of 18°. Eighty-six percent (12 out of 14) patients returned to organized, competitive ath letic activity without restrictions. The Little League background of those patients with apparent repetitive microtrauma to the elbow is exam ined in terms of length of pitching experience and types of pitches thrown. In addition, the throwing mechanism of these patients is evaluated with respect to the type of delivery at possible risk for the development of osteochondritis. We conclude that after a failure of conservative ther apy, surgical treatment, including removal of the intraar ticular loose bodies, excision of capitellar lesions, and curettage to bleeding bone can be expected to produce pain relief and improvement in joint motion. A return to organized competitive sport activities can be expected.
An in vivo strain gage study of elongation of the anterior cruciate ligament
Authors: Henning Charles E. , Lynch Mary A. , Glick Karl R. 
Published: June 2007

The purpose of this paper is to study the load-elonga tion characteristics of a Grade II sprain of the anterior cruciate ligament (ACL) at the time of local anesthesia arthroscopy. The data may be used to increase diag nostic and prognostic accuracy when evaluating Grade II ACL sprains and to structure properly a rehabilitation program following ACL injury. This report is based on the data from two in vivo strain gage studies of Grade II ACL sprains. Following instrumentation of the ligament, several events com mon to physical examination and rehabilitation pro grams were tested. The Lachman test produced greater elongation of the anteromedial fibers than did the anterior drawer or pivot shift test. A fairly high force of 80 pounds may be required by the examiner's hands to test satisfactorily the anteromedial fibers in the acutely injured large athlete. The proper order for a rehabilitation program should be crutch walking, cycling, walking, slow running, and faster running. Patients should be cautioned to run on a perfectly level surface. Cycling produced 7% as much elongation as an 80 pound Lachman test, and the one leg half squat 21 % as much. Quadriceps rehabilitation can be done more safely using these exercises. Quadriceps exercises by knee extension against a 20 pound weight boot in the range of full extension to 22° flexion created peak elongation of the anteromedial fibers ranging from 87 to 121% of that produced by an 80 pound Lachman test. We recommend that quadri ceps exercises and testing by knee extension through a full range of motion not be done during the first year following ACL injury or reconstruction. Quadriceps contraction against a 20 pound weight boot at 45° flexion produced 50% as much elongation as an 80 pound Lachman test. Beginning at 9 months post-ACL reconstruction, we do measure quadriceps strength isometrically with the knee flexed 45°.
Prepatellar bursitis in wrestlers
Authors: Mysnyk M.C. , Wroble R.R. , Foster D.T. , Albright J.P. 
Published: June 2007

As part of a larger retrospective study examining all knee injuries sustained by the University of lowa wres tling team over 6 years, prepatellar bursitis was found to be the most frequent injury and, therefore, was examined in depth. Of the 136 wrestlers studied, 13 developed an initial case of prepatellar bursitis. This represented 21 % of all initial episodes of knee injuries. Five of these wrestlers had no recurrences, but the other eight together had 20 recurrences. Median time lost for the initial injury was only 4 days, but recurrences and surgeries added significantly to the total time lost. There were only two cases of septic prepatellar bursitis, but there have been six cases (in four wrestlers) in the three seasons since the end of the larger study period. The infecting orga nism in all but one case was Staphylococcus aureus and was penicillin-resistant in all but one. There was no clinical evidence of infection in 50% of the cases, em phasizing the need to do a Gram's stain and culture (and, therefore, an aspiration) on all cases of prepatellar bursitis. The prognosis appeared better if the wrestler had no previous history of bursitis, suggesting that pathologic changes in the bursal wall may impair its defense mechanisms. In sharp contrast to all other knee injuries, most prepatellar bursitis cases occurred in the off-season. Most developed insidiously, but direct impact during a takedown maneuver is suspected as being the most frequent cause. The highest frequency was in the lighter weights, there was a slight decrease with increasing years of experience, and no relationship was seen with the wrestlers' lead leg during takedowns or with the use of knee pads. Treatment included one or more of the following: rest, immobilization, padding, aspiration, compressive dress ing, steroid injection, and surgery. Steroid injections appeared ineffective. There was a clear distinction be tween knees with recurrences and those that healed after the initial episode. Once a single recurrence oc curred, others were likely. Six of eight wrestlers with recurrences eventually had surgery. No recurrences or complications occurred after surgery (followup of 2 to 8 years). Therefore, in a highly motivated athlete want ing to return to competition as soon as possible, sur gery is recommended as the definitive treatment after the second, or certainly the third, recurrence.
Functional cast immobilization of thumb metacarpophalangeal joint injuries
Authors: Primiano George A. 
Published: June 2007

A prospective study was performed on 40 patients who were treated with a modified thumb spica cast (MTSC) for injuries involving the region of the metacarpophalan geal joint of the thumb. Twenty-seven of these injuries occurred during sports participation. The immobilization consisted of a fiberglass cast which incorporated the thumb in a balanced position and allowed full flexion and extension of the wrist. Twenty patients had injuries involving the ulnar col lateral ligament (five surgical). Three patients had radial collateral ligament injuries (two surgical). Fourteen pa tients had fractures of the proximal phalanx, including five epiphyseal plate injuries. Two patients had dorsal dislocations and one patient had a metacarpal fracture. One patient with a nondisplaced distal metacarpal frac ture was treated with simple immobilization. All patients had successful completion of their treat ment within the usual time frame. There was no recur rence or increase in symptomatology during the treat ment. There was no residual discomfort, loss of position or malunion of the fractures treated. The advantages of the MTSC include improved func tional capabilities during immobilization, good patient acceptance, and no period of limited wrist motion or atrophy of forearm musculature. Our experience has been that the MTSC has been a reliable form of immobilization for treating injuries of the metacarpophalangeal joint of the thumb.
Meniscoid lesions of the ankle in soccer players
Authors: McCarroll John R. , Schrader John W. , Shelbourne K. Donald , Rettig Arthur C. , Bisesi Mark A. 
Published: June 2007

In 1950, Wolin and his colleagues described nine pa tients who exhibited a "meniscoid" lesion of the ankle. He used this term to describe a mass of hyalinized tissue that formed following an inversion sprain of the ankle. This band of tissue was predisposed to trapping between the fibula and the talus. His patients presented with persistent pain and swelling over the anterior aspect of the ankle. In the last 3 years, four patients have presented with this lesion at the Methodist Sports Medicine Center in Indianapolis. They were all soccer players who had experienced repeated ankle sprains accompanied by persistent pain, swelling and trapping. Initially, these patients were treated with physical therapy, taping, and antiinflammatory medication. After 6 months of treat ment, they continued to have symptoms and underwent arthroscopic examination. In each case a band of white, fibrous tissue was found during surgery and was re moved. After an appropriate period of rehabilitation, all four patients returned to competition with a cessation of symptoms. However, one patient reported recurrent pain on rare occasions.
Flexor digitorum profundus avulsions with associated distal phalanx fractures
Authors: Buscemi Michael J. , Page B.J. 
Published: June 2007

A review of the current literature reveals that avulsions of the flexor digitorum profundus tendon, with a sepa rate and concomitant intraarticular fracture of the distal phalanx, is an uncommon and easily misdiagnosed injury that has been infrequently described. This report encompasses a review of four patients with such an injury, and includes treatment recommendations for this complex injurious pattern. A classification system for flexor digitorum profundus avulsions is reviewed and it is proposed that the avul sion of the flexor digitorum profundus tendon with concomitant and separate intraarticular fracture of the distal phalanx, be added to the classification as a Type IV injury.
Magnetic resonance imaging of knee hyaline cartilage and intraarticular pathology
Authors: Wojtys Edward , Wilson Mark , Buckwalter Kenneth , Braunstein Ethan , Martel William 
Published: June 2007

Injuries to the hyaline cartilage of the knee joint are difficult to diagnose without invasive techniques. Even though these defects may be the most important prog nostic factors in assessing knee joint injury, they are usually not diagnosed until arthrotomy or arthroscopy. Once injuries to hyaline cartilage are found and/or treated, no technique exists to follow these over time. Plain radiographs, arthrograms, and even computed tomography fail to detail most hyaline cartilage defects. We used magnetic resonance imaging (MRI) to eval uate five fresh frozen cadaver limbs and 10 patients whose pathology was known from arthrotomy or ar throscopic examination. Using a 0.35 Tesla supercon ducting magnet and spin-echo imaging technique with a head coil, we found that intraarticular fluid or air helped to delineate hyaline cartilage pathology. The multiplane capability of MRI proved to be excellent in detailing small (3 mm or more) defects on the femoral condyles and patellar surface. Cruciate ligaments were best visualized on sagittal oblique projections while meniscal pathology was best seen on true sagittal and coronal projections. MRI shows great promise in providing a noninvasive technique of evaluating hyaline cartilage defects, their response to treatment, and detailed anatomical infor mation about cruciate ligaments and menisci.
The effect of muscle architecture on the biomechanical failure properties of skeletal muscle under passive extension
Authors: Garrett William E. , Nikolaou Pantelis K. , Ribbeck Beth M. , Glisson Richard R. , Seaber Anthony V. 
Published: June 2007

This study investigates the biomechanical failure prop erties of five architecturally different skeletal muscles and examines the role muscle structure plays in the passive extension characteristics of musculotendinous units. The muscles used in this study fall into four morphologic categories: fusiform, unipennate, bipen nate, and multipennate. Each muscle was pulled to failure at three different rates of strain (1, 10, and 100 cm/min). Specimens of fusiform, unipennate, and bipennate muscles were pulled from their proximal as well as distal attachments. The relationship of elongation to failure of the entire musculotendinous unit to resting muscle fiber length was examined to determine the effect of angle of pennation and fiber length on the failure properties. Our results demonstrate that all four muscle types tested show injury and rupture at the musculotendinous junction whether pulled from proximal or distal attach ment, regardless of muscle structure and rate of strain. There was a statistically significant difference (P < 0.005) in the degree of elongation to failure relative to resting muscle fiber length, with a tendency to greater elongation relative to fiber length for muscles with more pennate structure (tibialis anterior, 72.7% ± 1.0%; ex tensor digitorum longus, 113.1% ± 3.5%; rectus fem oris, 225.5% ± 3.7% elongation in percent resting fiber length).
The role of warmup in muscular injury prevention
Authors: Safran Marc R. , Garrett William E. , Seaber Anthony V. , Glisson Richard R. , Ribbeck Beth M. 
Published: June 2007

This study is an attempt to provide biomechanical sup port for the athletic practice of warming up prior to an exercise task to reduce the incidence of injury. Tears in isometrically preconditioned (stimulated before stretching) muscle were compared to tears in control (nonstimulated) muscle by examining four parameters: 1) force and 2) change of length required to tear the muscle, 3) site of failure, and 4) length-tension defor mation. The tibialis anterior (TA), the extensor digitorum longus (EDL), and flexor digitorum longus (EDL) mus cles from both hindlimbs of rabbits comprised our ex perimental model. Isometrically preconditioned TA (P < 0.001), EDL (P < 0.005), and FDL (P < 0.01) muscles required more force to fail than their contralateral controls. Precondi tioned TA (P < 0.05), EDL (P < 0.001), and FDL (P < 0.01) muscles also stretched to a greater length from rest before failing than their nonpreconditioned con trols. The site of failure in all of the muscles was the musculotendinous junction; thus, the site of failure was not altered by condition. The length-tension deforma tion curves for all three muscle types showed that in every case the preconditioned muscles attained a lesser force at each given increase in length before failure, showing a relative increase in elasticity, although only the EDL showed a statistically significant differ ence. From our data, it may be inferred that physiologic warming (isometric preconditioning) is of benefit in pre venting muscular injury by increasing the and length to failure and elasticity of the muscle-tendon unit.
The natural history and treatment of delayed union stress fractures of the anterior cortex of the tibia
Authors: Rettig Arthur C. , Shelbourne K. Donald , McCarroll John R. , Bisesi Mark , Watts Jennifer 
Published: June 2007

This study presents eight patients with stress fracture of the anterolateral cortex of the midshaft of the tibia. All of the patients, ranging in age from 14 to 23 years, were competitive basketball players who experienced pain while running or jumping for an average of 4.4 months before the diagnosis was made. Eight patients were treated with rest and/or pulsing electromagnetic field therapy. Although one of the pa tients required bone grafting procedure, all eight of these patients showed complete healing and were able to return to full activity after an average of 8.7 months of treatment. They have remained asymptomatic for an average of 14.7 months. The overall time from initial symptoms to return to competition averaged 12.5 months in this group of athletes. The results presented in this paper suggest that rest and pulsing electromagnetic field therapy may result in healing in some patients with delayed union stress fractures of the anterolateral cortex of the midshaft of the tibia. Although this injury is associated with a pro longed healing period, seven of eight patients with adequate followup in our study were able to return to competition without complications following treatment. One patient was asymptomatic for 33 months before experiencing a reinjury. In conclusion, we feel that diagnosis of stress fracture should be a primary consideration in basketball players presenting with a prolonged history of pain on the anterolateral aspect of the midthird of the tibia. Once the diagnosis is made we recommend initial treatment consist of rest and external electrical stimulation for a minimum time of 3 to 6 months prior to considering surgical intervention.
Gore-Tex prosthetic ligament in anterior cruciate deficient knees
Authors: Glousman Ronald , Shields Clarence , Kerlan Robert , Jobe Frank , Lombardo Stephen , Yocum Lewis , Tibone James , Gambardella Ralph 
Published: June 2007

Reconstruction for symptomatic anterior cruciate defi cient knees has yielded varying success rates. Pros thetic cruciate replacement has recently become a po tentially attractive alternative. The results of the Gore- Tex polytetrafluoroethylene ligament, which is intended as a permanent replacement, are reported. Eighty-two patients were followed prospectively, mean age was 28 years (range, 16 to 51 years) and mean followup was 18 months (range, 12 to 30 months). Subjective scores improved in all categories, including pain, swelling, giving way, locking, and stair climbing. All patients without complications had no episodes of actual giving way, considered themselves improved, and returned to activities of daily living at 3 weeks and athletics at 8 months. Range of motion lacking at 3 months was 2° of extension and 10° of flexion, and at 12 months was 0° of extension and 4° of flexion. All mean objective data, including the anterior drawer, Lachman, and pivot shift, demonstrated im provement at final followup. Cybex testing revealed improvement in relative quadriceps strength from 88% to 99%. The KT-1000 Arthrometer showed improve ment in the injured-normal knee difference score throughout the follow-up period. Of importance is that while final objective data was improved over initial data, an early nonprogressive shift toward loosening was indicated by worsening of the drawer, Lachman, pivot shift, and KT-1000 scores. This shift may be attributed to resorption of interposed soft tissue, creep, or loosening of the graft. Subjective scores remained stable after improving. Complications included four ruptures, four chronic sterile effusions with partial attenuation, one infection, and one symptomatic loose body. There were 14 re- operations (17%), a total of 15 complications (18%), and 7 permanent complications (8%). There were no deaths, pulmonary emboli, or medical complications. We feel that the Gore-Tex ligament may become a rational alternative for anterior cruciate reconstruction in selected cases of prior reconstructive failure or older, less active individuals with symptomatic instability. Sur gical dissection is minimal, with maintenance of autog enous tissues yielding rapid recovery and low morbidity. The results presented are based upon preliminary data, and indications for expanded use of the ligament and definitive conclusions regarding the natural history of the graft will have to await further long-term followup.
A comparison of body and organ weights, physiologic parameters, and pathologic changes in target organs of rats given combinations of exercise, anabolic hormone, and protein supplementation
Authors: Bauman David H. , Richerson Joan Taylor , Britt A.L. 
Published: June 2007

This study was engineered to closely mimic the training protocol of a competitive athlete using repetitive exer cise sessions, dietary protein supplementation, and anabolic steroids. The length of the study was 37 days. Thirty-four Sprague Dawley male rats Crl:CD(SD)BR in the weight range of 150 to 175 grams were used. These were randomly divided into four exercise groups, varying protein consumption and anabolic hormone administration. Eight nonexercised control rats were kept separate from the study to act as a comparison for organ weight, hematology, and serology. Exercise consisted of a 30 minute swim three times a week. Parameters recorded were total body weight and per cent gain, wet and dry muscle weight of the isolated anterior tibialis, weights of designated organs, hema tologic profiles, and serum chemistries including triglyc erides, high density and low density lipids. Histopathol ogy of known "target organs" was performed and bone marrow aspirates were taken. Body weights of rats given anabolic steroid, protein supplement, and exercise were the lowest of all groups. Testicular weight was significantly decreased in the anabolic groups. Anabolic groups had the lowest hem atocrits of the exercised groups. All serology values were within normal ranges and no pathologic changes were seen in any of the tissues taken from specific "target organs."
Arthroscopic "second look" at the GORE-TEX ligament
Authors: Ferkel Richard D. , Fox James M. , Wood David , Del Pizzo Wilson , Friedman Marc J. , Snyder Stephen J. 
Published: June 2007

We performed an arthroscopic "second look" in 21 knees (20 patients) that had arthroscopic implantation of the GORE-TEX prosthesis for chronic ACL insuffi ciency. Arthroscopy was done on eight knees at the time of screw removal, eight for knee pain, two for giving way, and three for recurrent effusions. The de gree of synovial joint reaction, graft synovial ingrowth, and graft rupture was graded. Microscopic examination was carried out on all biopsies of the GORE-TEX liga ment. The average patient age was 30 years and the aver age time interval from original implantation to second look was 11 months. The GORE-TEX was intact in 11 knees, 10% ruptured in 6, and completely ruptured in 4. There was no correlation between number of GORE- TEX strands ruptured and synovial reaction. No parti cles of the graft were noted in the synovium if the implant was intact, but particles were noted with graft rupture. We conclude that the intact GORE-TEX ligament is an inert substance and does not cause significant joint reaction. Impingement in the intercondylar notch ap peared to be the most common cause of graft failure. Further study is critical to determine the natural history of the GORE-TEX ligament and the knees' response to this prosthetic device.