bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical and physiological considerations in triathlons
Authors: Hiller W. Douglas B. , O'Toole Mary L. , Fortess Eric E. , Laird Robert H. , Imbert Peter C. , Sisk T. David 
Published: June 2007

Triathlons (races involving consecutive swimming, bi cycling, and running) have become commonplace in the United States. These races may involve from 30 min utes to 36 hours of continuous exercise, usually in warm or hot environments. Little has been published regarding the medical and physiological aspects of these events. This paper represents the first large study to date on the subject, including both an analysis of medical complications at six triathlons as well as a prospective electrolyte study conducted at two of these races. Medical records were kept and examined for all ath letes requiring treatment during a typical United States Triathlon Series (USTS) race in 1986 (1,000 starters; finish times, 2 to 4 hours), a typical Ironman Qualifier (IQ) race in 1986 (622 starters; finish times, 4 to 8 hours), and the 1982 through 1985 Hawaii lronman World Championships (4,583 starters; finish times, 9 to 17 hours). At the USTS race, fewer than 2% (17/1,000) of the starters required aid, at the IQ, approximately 10% (61 /622) of the starters were treated, and at the Ironman, an average of 17% (794/4,583) received med ical attention. The most common diagnoses at the USTS and IQ were dehydration and heat exhaustion. At the lronman, dehydration and heat problems were complicated by hyponatremia. Because hyponatremia has been reported as a com plication of ultraendurance events, a prospective study was performed on 36 athletes during a USTS race and 64 athletes at the 1984 lronman race. Prerace and postrace blood samples showed that no athletes were hyponatremic following the shorter USTS race, but 27% (17/64) of the athletes studied were hyponatremic fol lowing the lronman race. Medical personnel should be prepared to treat a minimum of 2% and up to 10% of the athletes in races lasting up to 4 hours, 10% to 20% of those in races lasting 4 to 8 hours, and at least 20% of starters in races lasting between 9 and 17 hours. For races less than 4 hours, the IV fluid of choice should be D5 1/2 NSS (normal saline solution). For races longer than 4 hours, D5NSS should be used for IV resuscitation.
Anatomical observations on the acromioclavicular joint and supporting ligaments
Authors: Salter E. George , Nasca Richard J. , Shelley Brian S. 
Published: June 2007

An anatomical study of the acromioclavicular (AC) joint and its supporting ligaments was performed using both macroscopic and microscopic methods. The project used 63 cadaver shoulders of unknown ages. Fifty- three joints were used for macroscopic and 10 for microscopic study. The data consisted of 1) micrometer measurements of the dimensions of the extrinsic and intrinsic ligaments of the AC joint; 2) measurement and description of the intraarticular meniscus and the su perior and inferior capsular ligaments of the AC joint; and 3) the anatomical course and relationship of the coracoacromial (CA) ligament to the supporting liga ments of the AC joint and a description of its insertion on the acromion process. The following observations were made: The cor acoclavicular ligament, especially the trapezoid liga ment, provides significant soft tissue restraints to up ward displacement of the clavicle. A complete AC joint disc was found in only one, meniscoid discs in 25, remnants of discs in 16, and no discs in 11 of the 53 joints studied macroscopically. (No age correlation was made since the ages of the cadavers were unknown.) The CA ligament interconnects with the inferior capsular ligament of the AC joint as well as with the coracoclavic ular and coracohumeral ligaments. It also has a broad area of insertion on the inferior acromial surface. The CA ligament appears to function as a buffer between the acromion and the rotator cuff, and to provide support for the AC joint. Transection of the CA ligament may result in loss of this buffering function.
A review of nonoperative treatment of Jones' fracture
Authors: Zogby Richard G. , Baker Bruce E. 
Published: June 2007

Sir Robert Jones, in 1902, described a transverse fracture of the proximal diaphysis of the fifth metatarsal, which he treated conservatively with good results. Since that time, classification into acute and chronic categories by several authors has been proposed and most agree with the relatively high incidence of non- union. Controversy exists concerning operative versus nonoperative primary treatment especially in athletes. The purpose of this study was to determine if nonop erative treatment could be used effectively in treating these fractures. A retrospective study of nine patients with 10 Jones' fractures was completed. The cases were categorized as acute or chronic by clinical history and radiographic appearance. The average age was 23.6 years. There were eight males and one female. In this group, com petitive athletes sustained chronic fractures, while acute fractures occurred in nonathletes. Treatment consisted of a short leg nonweightbearing cast until radiographic and clinical healing occurred, followed by 6 weeks of limited activity. Mean clinical and radiographic union of chronic frac tures was 9.4 weeks; acute fractures, 22 weeks. All competitive athletes returned to their preinjury level of competition at an average of 12 weeks following initia tion of treatment. There was one refracture. Our data indicate that nonoperative treatment of early chronic or subacute fractures without intramedullary sclerosis can compare favorably with surgical treatment procedures reported in other studies in returning ath letes to play postinjury. We suggest serious consider ation be given to the method herein as a form of primary treatment of the early chronic Jones' fracture without intramedullary sclerosis.
Surgical management of Achilles tendinitis
Authors: Schepsis Anthony A. , Leach Robert E. 
Published: June 2007

Inflammation of the Achilles tendon and its contiguous structures is one of the most common overuse prob lems seen in runners. There are actually several etiol ogies. Involvement of the tendon itself is secondary to areas of mucinoid or fibrotic degeneration, or may be a result of a partial rupture. The sheath (or mesotenon) may also become chronically inflammed. Retrocalca neal bursitis seems to be a separate entity with hyper trophy and fibrosis of the bursa usually occurring in conjunction with a prominent posterior superior angle of the os calcis. The vast majority of patients can be successfully treated nonoperatively; however, there is a group of patients who are refractory to nonoperative management who would like to continue running, par ticularly if they are competitive. A retrospective review of 45 surgical cases in 37 patients was performed. All but two of these patients were competitive long-distance runners. There were 24 cases of Achilles tendinitis and/or tenosynovitis, 14 cases with retrocalcaneal bursitis, and 7 with a combi nation of both. Mean followup was 3 years (range, 1½ to 8 years). Overall there were 87% satisfactory results. Ninety-two percent of the patients with involvement with the tendon and/or sheath had a satisfactory out come as compared with 71 % of patients with retrocal caneal bursitis. Passive dorsiflexion in the 29 unilateral cases improved from a mean of 17° preoperatively to a mean of 25° postoperatively. We feel that surgery offers a solution for highly motivated runners with chronic posterior heel pain who would like to continue running when conservative measures have failed.
The patient with symptomatic chronic anterior cruciate ligament insufficiency
Authors: Fowler Peter J. , Regan William D. 
Published: June 2007

Forty-nine patients with 51 chronic symptomatic ante rior cruciate deficient knees were studied retrospec tively by chart review and follow-up examination an average of 5.8 years postinjury and 1.5 years from arthroscopic evaluation, with or without arthroscopic surgery, and the institution of a conservative rehabili tation program. Subjective evaluation of function was obtained by questionnaire. At arthroscopy, meniscal lesions were seen in 37 of 51 knees, and degenerative changes were noted in 24 knees. The ACL was absent in 43 knees. Partial men iscectomy or suturing was performed on 20 patients. All patients had an average of 3 weeks of supervised physical therapy stressing hamstring strengthening. At followup, thigh girth measurements of injured and normal legs found thigh wasting in 40 patients. Seven of 33 patients radiographed showed evidence of de generative changes. About two-thirds of the patients returned to some level of athletics and had no problems with activities of daily living. Twenty were able to return to pivoting sports, but only five could return to their preinjury levels of competition. Of the 18 patients who did not return to athletics, only 8 were considering or had had a ligament reconstruction. Those patients who chose to continue rehabilitation beyond the prescribed period and who modified their activities had a better functional outcome.
Anterior cruciate ligament repairs in world class skiers
Authors: Higgins R.W. , Steadman J.R. 
Published: June 2007

From 1979 to 1984, 27 skiers who were either present or past members of the United States Ski Team or professional skiers had 30 ACL tears that were repaired primarily. Only two of the repairs were augmented with autogenous patellar tendon grafts. Five patients had complete knee dislocations, including tears of both cruciate ligaments. Nineteen patients had a concomi tant extraarticular iliotibial band tenodesis. Twenty- seven knees (24 patients) were followed an average of 57.6 months postoperatively. Recreational skiing was resumed at 5.4 months on average, and in ski racing and pivot-requiring sports all but three patients re sumed participation at an average of 9.1 months. In 78% of the knees there was pain-free function. Mild pain was reported in 19%, the majority of which (4/5) was related to vigorous activity. Of the total, only two knees were reported to have a sensation of giving way. On clinical examination 85% (23/27) had normal pivot shift examination with no evidence of abnormal motion. Four percent (1 /27) had a 1 + test and 11 % (3/27) had "glides." Arthrometer measurements revealed an aver age of 7.76 mm anterior displacement with 20 pounds of force on the knee with an ACL repair as compared to 5.56 mm on the uninjured knee. The laxity measure ments of knees with repaired ACLs fell within the range reported for uninjured knees in the normal population. Five patients had reinjuries to the ACL at an average time of 28 months postoperatively, with two of five undergoing rerepair. Only one patient had an iliotibial band tenodesis to supplement the original ACL repair. With proper surgical technique and rehabilitation, ACL repair can be statically and functionally successful in elite skiers. The use of the iliotibial band tenodesis is essential for successful ACL repair and the institution of immediate postoperative motion.
Biomechanical comparison of stimulated and nonstimulated skeletal muscle pulled to failure
Authors: Garrett William E. , Safran Marc R. , Seaber Anthony V. , Glisson Richard R. , Ribbeck Beth M. 
Published: June 2007

We compared the biomechanical properties of passive and stimulated muscle rapidly lengthened to failure in an experimental animal model. The mechanical param eters compared were force to tear, change in length to tear, site of failure, and energy absorbed by the muscle- tendon unit before failure. Paired comparisons were made between 1) muscles stimulated at 64 Hz (tetanic stimulation) and passive (no stimulation) muscles, 2) muscles stimulated at 16 Hz (wave-summated stimu lation) and passive muscles, and 3) muscles stimulated at 64 Hz and at 16 Hz. Both tetanically stimulated and wave-summation con tracted muscles required a greater force to tear (at 64 Hz, 12.86 N more, P < 0.0004; and at 16 Hz, 17.79 N more, P < 0.003) than their nonstimulated controls, while there was no statistical difference in failure force between muscles stimulated at 16 Hz and 64 Hz. The energy absorbed was statistically greater for the stim ulated muscles than for the passive muscles in Groups 1 and 2 (at 64 Hz, 100% more, P < 0.0003; and 16 Hz, 88% more, P < 0.0002). In Group 3, the tetanically contracted muscle-tendon units absorbed 18% more energy than the wave-summated stimulated muscles (P < 0.01). All muscles tore at the distal musculotendi nous junction, and there was no difference in the length increase at tear between muscles in each group. These findings may lead to enhanced understanding of the mechanism and physiology of muscle strain injuries.
Objective knee evaluation using the Genucom Knee Analysis System
Authors: Oliver John H. , Coughlin Larry P. 
Published: June 2007

The Genucom Knee Analysis System was used in a clinical setting to study the clinical practicality of the Genucom instrument, and the degree of correlation between Genucom and clinical knee examinations. The Genucom evaluation performed by an experienced ex aminer required 25 to 30 minutes for a 14 test bilateral examination. The instrument provided detailed graphi cal and tabular data of the test results. One hundred "normal knees" were examined in a series of seven Genucom tests. Normal "laxity bands" for both males and females were generated for a range of load applications for the seven tests. There was no significant difference observed between the male and female laxity distributions. However, a slightly lesser laxity was observed for the male population in general. A group of 38 subjects with 1 injured knee were assessed concurrently using clinical and instrument techniques. Comparisons were made for the 90° an terior-posterior (AP) drawer, the 30° AP drawer (Lach man), and the varus/valgus stress test. For the 90° AP drawer test, 16 subjects were found clinically to have less than or equal to 5 mm of excess laxity based on comparison with the opposite normal knee. The instru mented measurement concurred in 10 cases. In the other six cases it was noted that laxity on the uninjured knee reached the maximum of the "normal" instru mented population, that is with higher than normal laxities. Fifteen subjects were clinically tested with greater than 5 mm of excess laxity. The instrumented test concurred in all but one. For the Lachman test (30° AP drawer), 19 subjects were found with an excess laxity of less than or equal to 5 mm. The instrument concurred in all cases but one. Fifteen subjects had a clinical Lachman of greater than 5 mm of excess laxity. The instrumented meas urements concurred in all cases. For the varus/valgus stress test, five subjects were found with excess lateral joint opening of less than or equal to 5 mm. The instrumented test concurred in all but one case in which the varus laxity was clinically described as "subtle." Four clinical cases of medial joint opening of less than or equal to 5 mm were found in the group. The instru ment concurred in all cases. It was also found that 17 of 18 patients with a clinically positive pivot shift demonstrated a greater than 5 mm of excess laxity on the 30° AP drawer Genucom test. In this study, it was found that the results of the instrument evaluation correlated to a high degree with the clinical evaluations of the knees of the subjects. It appears that the computer-based instrument provides a significant contribution to objective measurement of knee joint stability (laxity).
A comparative electromyographic analysis of the shoulder during pitching
Authors: Gowan Ivan D. , Jobe Frank W. , Tibone James E. , Perry Jacquelin , Moynes Diane R. 
Published: June 2007

Dynamic, fine-wire, intramuscular electromyography (EMG) was performed on 12 different shoulder muscles in 13 normal male subjects as they pitched a baseball. Seven were major league baseball pitchers and six were amateur pitchers. The act of pitching a fast ball was filmed at 450 frames per second with the EMG signals recorded synchronously. The subscapularis, su praspinatus, and infraspinatus muscles were tested in 13 subjects, the biceps brachii muscle was tested in 12, and other shoulder muscles were tested variously among the subjects. Two groups of muscles were identified. Group I mus cles, the supraspinatus, infraspinatus, teres minor, del toid, trapezius, and biceps brachii, served primarily to position the shoulder and elbow for the delivery of the pitch. These muscles were found to have greater activ ity during the early and late cocking stages, with less activity during acceleration. Group II muscles acceler ated the arm and baseball forward in space. These muscles, the pectoralis major, serratus anterior, sub scapularis, and latissimus dorsi, had stronger activity during the propulsive phase of the pitch. The professional pitchers were able to use the mus cles about the shoulder in an efficient manner to achieve greater pitching velocities. The subscapularis and latis simus dorsi muscles of Group II had stronger activity among the professionals, whereas the supraspinatus, teres minor, and biceps brachii muscles of Group I had only minimal activity. The amateurs, on the other hand, continued to use all of the rotator cuff muscles and the biceps brachii muscle of Group I through the accelera tion stage of the pitch. These data may provide a basis for understanding improved performance and an ad junct for sport-specific rehabilitation programs.
The arthroscopic meniscal repair
Authors: Jakob R.P. , Stäubli H.U. , Zuber K. , Esser M. 
Published: June 2007

Conservative meniscal repair should limit resection to only pathologic portions of the meniscus. The periphery of the meniscus is well vascularized, enabling healing of longitudinal tears. Sutures that perforate the menis cus vertically usually lead to stable healing. In arthros copic meniscal surgery, isolated tears are sutured from within the joint, usually using techniques related to specially developed instrumentation. Our system uses three curved cannulas of various radii and a specific needle of 1.2 mm thickness, and can be operated by one hand while the joint is distracted with an AO/ASIF femoral distractor. In our series of 54 arthroscopic meniscal repairs, 42 (78%) healed without reinjury. Retears occurred in 12 patients, and were refixed again using the same techniques. Our experience has led us to conclude that the type of meniscal tear most suitable for arthroscopic repair is a vertical longitudinal lesion that involves the vascular ized zone; abrading the synovial surfaces is helpful, as is positioning the sutures tightly together; the repair should be checked at 4 months by arthroscopy or by arthrogram; and a combination of nonabsorbable and resorbable sutures is most satisfactory. We believe that with experience arthroscopic meniscal repair becomes a less involved procedure than open repair, and that in the future such repair will be successfully extended to the more centrally located lesions.
Plasma bupivacaine levels following single dose intraarticular instillation for arthroscopy
Authors: Meinig Richard P. , Holtgrewe Jeffrey L. , Wiedel Jerome D. , Christie D. Beau , Kestin Kathryn J. 
Published: June 2007

Arthroscopy of the knee was performed using 30 ml single dose intraarticular instillations of 0.5% or 0.25% solutions of bupivacaine (Marcaine). A total of 18 pa tients (mean age, 34 years), divided into two groups, participated in this study. Venous plasma levels were measured at 0, 10, 20, 30, 45, 60, 90, 120, and 240 minute intervals following a single instillation into the knee joint. All patients had suspected traumatic internal derangement of the knee. Electrocardiogram tracings, blood pressure, and neu rologic assessment were monitored at each venous sampling interval or more often if clinically indicated. The type and amount of supplemental anesthesia were also recorded. None of our 18 patients required a general anesthetic because of pain although the follow ing procedures were performed: meniscectomy, plica release, abrasion chondroplasty, loose body retrieval, and limited meniscal repair. A new methodology for the measurement of plasma bupivacaine using the gas chromatograph mass spectrometer is described. Mon itoring specific molecular mass fragments allows the measurement of picogram per milliliter levels of bupi vacaine. The highest peak plasma concentration occurred 20 minutes after instillation of 30 ml of 0.5% bupivacaine. The 625 ± 225 ng/ml level was well below the 2,500 to 4,000 ng/ml reported to elicit early subjective CNS symptoms of bupivacaine toxicity. Thus, a single dose intraarticular instillation of 30 ml 0.5% or 0.25% bupi vacaine is convenient, efficacious, and pharmacologi cally safe for routine clinical arthroscopy.
A biomechanical analysis of anterior cruciate ligament reconstruction with the patellar tendon
Authors: Tibone James E. , Antich T.J. 
Published: June 2007

Eleven patients, 2 years after ACL reconstruction with a patellar tendon graft, returned for follow-up testing consisting of: 1) subjective assessment and functional analysis, 2) objective examination for residual ligamen tous instability, 3) isokinetic quadriceps and hamstrings strength assessment, 4) radiographic assessment, 5) instrumented measurement of anterior shear displace ment via a knee arthrometer, and 6) force plate and film analysis while performing cutting maneuvers in a laboratory setting. All 11 patients had been tested preoperatively through all steps except the fifth. The group subjectively rated the postoperative knee as 83% of the preinjury status, an increase from a 53% mean prior to reconstruction. Six of 11 patients were able to return to their full preinjury level of competition, with or without a brace. Four patients had positive drawer tests, five had positive Lachman examinations, and all subjects had negative pivot shifts. Significant quadri ceps torque deficits remained ( P < 0.0005), with the postoperative knee extensors approximately 85% of the contralateral limb. The involved limb hamstrings were equal in strength to the nonoperated limb. Radio graphic evaluation revealed four, five, and four patients with positive findings of the patellofemoral joint, medial joint space, and lateral joint space, respectively. Only one patient had normal radiographs. Instrumented knee laxity testing revealed the operated knee to be signifi cantly looser only during maximum passive displace ment (7.2 mm versus 5.3 mm, P < 0.01) and not during the other measurements. Biomechanical analysis of the straight cut maneuver revealed no significant differ ences between the nonoperated and operated limbs at the 2 year postoperative mark. Values for the cross cut were now similar between limbs, abolishing the deficit that had existed preoperatively. This study confirms, in a laboratory setting, that a patellar tendon reconstruction of the ACL can improve the functional status of the knee and enhance athletic performance.
Cineradiographic studies with shoulder instabilities
Authors: Maki Neil J. 
Published: June 2007

Thirty patients with shoulder disorders were examined with fluoroscopy under general anesthesia. Prior to this cineradiography, 20 shoulders had diagnoses of insta bility and 10 had diagnoses of other stable-shoulder disorders. Three patients (10%) had changes in their shoulder diagnoses after imaging: 1) One patient with an im pingement syndrome also had an unstable shoulder; 2) One patient suspected of having anterior subluxations prior to imaging, demonstrated posterior subluxations instead with imaging; and 3) One patient with recurrent posterior dislocations demonstrated a multidirectional instability pattern with imaging. Fluoroscopic examination or the shoulder under anesthesia provides useful diagnostic information. Its use is recommended for documentation, especially when there is uncertainty about a diagnosis, or to confirm the proper placement of metal after reconstruc tive surgery.