bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
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.
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.
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.
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.
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.
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.
Biologic fixation of ligament prostheses and augmentations
Authors: Arnoczky Steven P. , Torzilli Peter A. , Warren Russell F. , Allen Answorth A. 
Published: June 2007

The biologic fixation (bone ingrowth) of three prosthetic ligament devices (bovine xenograft Xenotech Labora tories, Inc., Irvine, CA; Gore-Tex, W. L. Gore and As sociates, Flagstaff, AZ; and knitted dacron, Stryker, Kalamazoo, MI) and one ligament augmentation device (LAD, braided polypropylene, 3M, St. Paul, MN) were evaluated in vivo. The devices were placed unstressed, in an extraarticular location in the cortical-cancellous bone of the proximal femur and humerus of dogs. Six months following implantation tissue ingrowth was eval uated using high resolution radiography, routine histol ogy, scanning electron microscopy, and biomechanical tensile tests to measure the ultimate (maximum) pull- out strength of the devices. The knitted dacron and Gore-Tex prosthesis showed marked ingrowth of trabecular bone into the interstices of the device with evidence of bone growth around individual fibers of the prosthesis. The bovine xenograft demonstrated bone immediately adjacent to the mate rial with evidence of spicular ingrowth of bone into the natural clefts of the prosthesis. The LAD showed no evidence of bone ingrowth and demonstrated a fibrous tissue interface between the prosthesis and surround ing trabecular bone. Six months following implantation the pull-out strengths of the devices were as follows: knitted dac ron, 445.7 ± 151.ON; Gore-Tex, 438.1 ± 131.94N; bovine xenograft, 332.8 ± 64.2N; and LAD, 78.4 ± 47.9N. Statistical analysis revealed no significant differ ence between the pull-out strengths of the knitted dacron, Gore-Tex, and bovine xenograft. While the pull- out strength of the LAD was significantly lower (P < 0.01) than the other devices it should be noted that this device was designed as a temporary augmentation for biological grafts and as such permanent biological fix ation through bone ingrowth is neither required nor desired. The Gore-Tex, LAD, and bovine xenograft devices all failed by pulling out of the bone tunnel, while all the dacron grafts failed by separation of the dacron outer sleeve of the prosthesis from its inner dacron reinforcement. This rupture occurred at the entrance of the graft into the bone tunnel.
Treatment of acute patellar dislocation
Authors: Cash James D. , Hughston Jack C. 
Published: June 2007

To determine the effectiveness of nonoperative and operative treatment of initial acute patellar dislocation, we reviewed the charts of 399 patients with the diag nosis of an acute dislocation, seen during a 30 year period. One hundred patients (103 knees) met the criteria for inclusion in the study. The average age of the patient at injury was 21.7 years (range, 9 to 72 years). Length of followup aver aged 8 years (range, 2 to 26 years). Retrospectively, we divided the patients into two groups, according to the examination of their unaf fected knee. Group I (69 knees) showed evidence on examination of congenital abnormality of the extensor mechanism in the unaffected knee, indicating a predis position to dislocate with less significant trauma. Group II (34 knees) showed no clinically perceptible congenital predisposition to dislocate based on examination of the unaffected knee. In the nonoperatively treated knees in Group I, there was a 52% (28/54) incidence of good or excellent results. The nonoperatively treated knees in Group II had a 75% (15/20) incidence of good or excellent results. Acute dislocation occurred more frequently in males than in females. Recurrence was rarer in patients whose initial dislocation had occurred when they were over 15 years old. Contrary to recently published reports, primary acute traumatic patellar dislocations can be treated with non operative therapy with good or excellent results. Initial evaluation should include examination of the uninvolved knee which, if found to have signs of congenital abnor mality, would indicate a worse prognosis.
A biomechanical evaluation of tibiofemoral rotation in anterior cruciate deficient knees during walking and running
Authors: Czerniecki Joseph M. , Lippert Frederick , Olerud John E. 
Published: June 2007

ACL injury has been associated with increased insta bility of the knee in both in vitro and in vivo studies using passively applied forces. This study assessed tibiofemoral rotation after ACL injury during the func tional activity of treadmill ambulation using a triaxial electrogoniometer. Isometric and isokinetic peak torques of the quadriceps and hamstrings were ob tained using the Cybex II isokinetic dynamometer. Significant increases in tibiofemoral rotation were noted with increased running speed in the injured and normal knees. The degree of rotation in the injured limb did not significantly exceed that of the normal limb. Isokinetic strength of the quadriceps and hamstrings correlates significantly with the observed extent of ro tation.