bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional postoperative treatment of Achilles tendon repair
Authors: Carter Thomas R. , Fowler Peter J. , Blokker Cathy 
Published: June 2007

Twenty-one patients with surgically repaired Achilles tendon tears that were treated postoperatively with a functional orthosis rather than routine cast immobiliza tion were evaluated. The orthosis allowed unrestricted plantar flexion and limited dorsiflexion to neutral. Toe- touch weightbearing crutch ambulation was allowed immediately and was gradually increased over the 6 to 8 weeks of treatment. Of the 21 patients, 14 were men and 7 were women; the average age at injury was 35.6 years (range, 19 to 65). The minimum followup was 2 years, with an average of 31 months. The repairs were acute in 18 of the patients and chronic in 3. Subjectively, 16 patients felt they returned to their preinjury level of activity and only 1 was not satisfied with his result. Objectively, there were no significant alterations in ankle range of motion when compared to the contralateral limb, with plantar flexion unchanged and dorsiflexion increased an average of only 2°. The average plantar flexion and dorsiflexion strength, power, and endurance of the ankles as measured by isokinetic testing revealed no significant differences when comparing the operated leg to the nonoperated side: strength, 99% and 93%, respectively; power, 98% and 96%, respectively; and endurance, 93% and 91 %, respectively. The angles at which the peak torques occurred were similarly not statistically different. Two patients had superficial wound infections, and 1 had scar adherence of the skin to the tendon. No one had rerupture of the tendon. In conclusion, while the many benefits of postopera tive early motion are well proven, there has been hesi tation to implement this after Achilles tendon surgery due to the concern of compromising the repair. As shown by this study, early controlled motion can safely and effectively be used following Achilles tendon repair in the motivated, reliable patient.
Nontraumatic clavicular osteolysis in weight lifters
Authors: Scavenius Michael , Iversen Bjørn Franc 
Published: June 2007

In a previous study, we found an overrepresentation of weight lifters in patients who had a resection of the lateral end of the clavicle. To further investigate a possible association between competitive weight lifting and the development of nontraumatic osteolysis of the lateral end of the clavicle, we studied a group of 25 Danish weight lifters. This group was compared to an age-matched control group of 25 men who had never engaged in weight training procedures. None of the subjects had any history of trauma to the shoulder girdle. All 50 subjects underwent radiographic exami nation of both shoulder joints. In the weight lifter group, seven cases (28%) dem onstrated classical radiographic findings of clavicular osteolysis, with loss of subchondral bone detail, tran slucency, and cystic changes, while four subjects (16%) had subjective symptoms but no radiographic changes. None of the individuals from the control group revealed similar symptoms or radiographic signs. Thus, based on this limited material, the prevalence of the disorder is about 27%.
Anterior cruciate ligament reconstruction using a composite collagenous prosthesis
Authors: Dunn Michael G. , Tria Alfred J. , Kato Y. Pedro , Bechler Jeffrey R. , Ochner Robert S. , Zawadsky Joseph P. , Silver Frederick H. 
Published: June 2007

We evaluated a prototype composite collagenous an terior cruciate ligament replacement device designed to possess the advantages of biological grafts and syn thetic materials. Collagenous anterior cruciate ligament prostheses were made by embedding 225 reconsti tuted type I collagen fibers in a type I collagen matrix, and placing polymethylmethacrylate bone fixation plugs on the ends. The collagenous prosthesis was used to replace the anterior cruciate ligament of 31 mature rabbits. At 4 and 20 weeks postimplantation, histologic and mechanical studies were performed on the devel oping neoligament tissue, and compared to values for the contralateral sham-operated control. At 4 weeks, neoligament tissue infiltrated the collagen fibers of the prostheses. The tibial bone tunnel attach ment site contained new bone approaching the fibrous neoligament. The glutaraldehyde-treated prosthetic fi bers appeared intact, while the carbodiimide-treated prosthetic fibers began to resorb. The ultimate load and ultimate tensile strength of femur-neoligament-tibia complexes had decreased. At 20 weeks, glutaraldehyde-treated fibers appeared partially intact; in contrast, the carbodiimide-treated prostheses appeared to be completely degraded, and were replaced by organized, crimped neoligament tis sue. The ultimate tensile strength and ultimate load increased substantially due to deposition and remod eling of neoligament tissue. The neoligament ultimate load was 2 to 4 times the initial load value of the prosthesis. Implantation of a resorbable, composite collagenous anterior cruciate ligament prosthesis encourages the development of functional neoligament tissue. Studies are underway to optimize the mechanical and biological properties of the prostheses.
Incidence of injury in Texas high school football
Authors: DeLee Jesse C. , Farney William C. 
Published: June 2007

This study was undertaken to determine the incidence of injury in high school football based on evaluation of 100 high schools in the State of Texas during a single football season (1989). Certified athletic trainers were the initial medical professionals providing on-site diag nosis and treatment of all injuries. An injury was defined as: 1) an incident causing an athlete to miss all or part of a single practice or game; 2) any incident treated by a physician; and 3) all head injuries reported to the athletic trainer. Data were collected that allowed cal culation of the time of exposure to injury per athlete in the sample. There was 75.5% participation in the study by the certified athletic trainers in the 100 schools. A total of 4399 athletes in varsity football programs participated in the study. There were 2228 injuries, as defined in the study, during the period of study, giving an inci dence of injury of 0.506 injury per athlete per year. Severe injuries—those requiring hospitalization—were found in 137 cases, for an incidence rate of 0.031 injury per athlete per year. The incidence of reportable defined injury was calculated to be 0.003 injury per hour of exposure per student athlete. The knee was found to be the most commonly injured anatomic site; the ankle ranked second.
Ruptures of the pectoralis major muscle
Authors: Wolfe Scott W. , Wickiewicz Thomas L. , Cavanaugh John T. 
Published: June 2007

We evaluated 12 patients with 14 ruptures of the pectoralis major muscle to compare surgical and con servative management of this injury. Because 9 of the injuries occurred while weight lifting, we performed an anatomic study on human hemithorax specimens dur ing a simulated bench press to determine the mecha nism of this rare occurrence. Excursion of individual pectoralis muscle fibers was measured at seven points along the broad muscle origin by the use of fine wires connected to the humeral insertion and to dial gauges on the study apparatus. Excursions in the concentric and eccentric phases of the lift were expressed as a percentage of resting fiber length. The short, inferior fibers of the muscle length ened disproportionately during the final 30° of humeral extension. We concluded that the inferior fibers have a mechanical disadvantage in the final portion of the eccentric phase of the lift, and application of high loads to these maximally stretched fibers produces rupture. We repaired five acute and two chronic ruptures, and measured peak torque and work production against the contralateral side using Cybex isokinetic testing. Surgically treated patients showed comparable torque and work measurements, while conservatively treated individuals demonstrated a marked deficit in both peak torque and work/repetition. We recommend repair of complete pectoralis muscle ruptures in active patients who require maximum strength in vocational or avoca tional activities.
Static capsuloligamentous restraints to superior-inferior translation of the glenohumeral joint
Authors: Warner Jon J.P. , Deng Xiang-Hua , Warren Russell F. , Torzilli Peter A. 
Published: June 2007

The purpose of this study was to determine the contri butions of specific capsuloligamentous structures to restraining superior-inferior translation of the glenohu meral joint. Eleven cadaveric shoulders were tested using a four degrees-of-freedom test apparatus. The humerus was free to translate in three planes and free to flex and extend when a superior and inferior force of 50 N was applied. Testing was performed in three positions of abduction (0°, 45°, and 90°) and three positions of rotation (neutral, maximum internal, and external). Shoulders were tested intact, vented, and after division of specific capsuloligamentous structures. The primary restraint to inferior translation of the ad ducted shoulder was the superior glenohumeral liga ment. The coracohumeral ligament appeared to have no significant suspensory role. With progressive abduc tion, the anterior and posterior portions of the gleno humeral ligament become the main static stabilizers resisting inferior translation: the anterior portion was the primary capsular restraint at 45° of abduction, while the posterior portion was the primary restraint at 90° of abduction, neutral rotation. Our results indicate that clinical assessment of glenohumeral translation in the superior-inferior plane should be performed in multiple positions of abduction and rotation.
The effect of harvesting the central one-third of the patellar tendon on patellofemoral contact pressure
Authors: Eilerman Michael , Thomas Joseph , Marsalka David 
Published: June 2007

This study assessed whether removing the central one- third of the patellar tendon, with or without side-to-side repair of the patellar tendon defect, would alter patel lofemoral pressure. Patellofemoral pressure was as sessed by testing five stable knees from five different cadaveric donors on a specially designed hydraulic knee machine. Patellofemoral joint pressures were measured by placing pressure-sensitive film into the patellofemoral articulation. The joint was loaded in a static fashion, with quadriceps forces consistent with walking (647 N) and stair climbing (1923 N), at 30°, 60°, and 90° of knee flexion. Using the same knees, the central one-third of the patellar tendon was then sectioned, and patellofemoral joint pressure measure ments were repeated at identical knee flexion angles and quadriceps forces. Side-to-side repair of the patel lar tendon defect was performed and patellofemoral joint pressure measurements were repeated. There were no statistically significant differences be tween the control and sectioned values or between the control and repaired defect values. These results sug gest that harvesting the central one-third of the patellar tendon—with or without side-to-side repair of the pa tellar tendon defect—does not alter patellofemoral pressures.
The predictive value of radiographs in the evaluation of unilateral and bilateral anterior cruciate ligament injuries
Authors: Schickendantz Mark S. , Weiker Garron G. 
Published: June 2007

A review of 250 cases of surgical reconstruction of the anterior cruciate ligament identified 24 patients with bilateral complete tears of the anterior cruciate liga ment. Twenty of these patients had previous recon struction of one anterior cruciate ligament before rup ture of the opposite ligament. Twelve injuries occurred during the same activity that was responsible for the initial opposite injury. The average time between sur gical reconstruction and rupture of the opposite liga ment was 29.3 months (range, 3 to 103). No significant demographic differences existed between patients with unilateral or bilateral ruptures of the anterior cruciate ligament. Standardized measurements of intercondylar notch height and width and medial and lateral femoral condyle height and width were performed on routine notchview radiographs of 31 knees of patients with bilateral inju ries, 30 with unilateral injury, and 30 with no anterior cruciate ligament injury. Statistical analysis revealed no significant differences between the three groups when comparing absolute measures or any of eight mathe matical ratios calculated from these measurements. We concluded that measurements of the intercondylar notch made from radiographs may not be reliable pre dictors of injury to the anterior cruciate ligament. We found no significant clinical or demographic differences between patients with unilateral or bilateral complete ruptures of the anterior cruciate ligament.
Reconstruction of old anterior cruciate ligament tears with a Dacron prosthesis
Authors: Gillquist Jan , Odensten Magnus 
Published: June 2007

Seventy patients with chronic anterior instability under went anterior cruciate ligament reconstruction with a Dacron prosthesis pretensioned to 60 N. Of these patients, 49% (34) had combined medial instability, 32% (22) had failed previous anterior cruciate ligament sur gery, and 37% (26) had previous meniscectomy. At reconstruction, 12 patients had their medial instability treated; 22 did not. Follow-up intervals were 3, 6, and 12 months and then each year to 5 years. The 5-year followup included 69 patients; the other 1 had the ligament removed because of a synovial fistula at 8 months. Results were 23% prosthesis ruptures, 3% poor, 17% fair, 16% good, and 39% excellent. The 2-year results showed the same distribution, but a lower rupture rate, which was affected by placement of the tibial tunnel within the anterior one-third of the tibia (9 times increase) and coexisting nonrepaired me dial instability (5 times increase). Those patients with perfect placement of the ligament who also had good medial stability and no previous ligament surgery had no rupture at 5 years. The stability that was gained at surgery was gradually lost (-11.2% per year). At 5 years, the uninjured knee also had lost 41% of the preoperative stability; the mean laxity difference was within ±2 mm. The mean improvement in subjective knee function (Lysholm score 74.5 to 91.9) was main tained during the followup. The mean preoperative ac tivity level improved significantly, but did not reach the preinjury level. These results show that the Dacron prosthesis will not give acceptable results in salvage cases where other instabilities are left untreated.
The Dacron ligament prosthesis in anterior cruciate ligament reconstruction
Authors: Barrett Gene R. , Line Lawrence L. , Shelton Walter R. , Manning James O. , Phelps Ray 
Published: June 2007

We studied 40 patients who underwent reconstruction for chronic anterior cruciate ligament deficiency with a Dacron ligament prosthesis using a modified MacIntosh over-the-top technique, augmented with iliotibial band. Thirty patients had undergone at least 1 prior surgical procedure on the affected knee, but only 7 patients had previous anterior cruciate ligament reconstruction. All patients were followed for a mean of 47.5 months. The results at final followup demonstrated an average side-to-side arthrometer difference of 1.0 mm. The Lysholm score improved from 65 preoperatively to 89 at the end of the review; the Tegner activity level score improved from 3 to 5. Objectively, 75% of the patients had a negative Lachman test result and 95.1% of the subjects had negative or trace pivot shift results at review. Mild knee pain was still present with day-to-day activity in 87.7% of the patients. Complications occurred in 27.5% of patients, includ ing five who had implant ruptures and two who had their grafts removed. Synovitis was a significant prob lem. Based on our failure criteria, 47.5% (19) of the sub jects had failed results. In this study, radiologic evidence of tracer separation greater than 1 cm was a criterion of failure. With inclusion of tracer separation, the failure rate increased to 60.0% (24). Multiple previous surgeries of any type had an ad verse effect on results. Damage to secondary stabiliz ers in these cases increased failure rate. Based on the high complication and failure rates, and relatively poor end result in this retrospective review, we cannot rec ommend this procedure.
An evaluation of pre- and postoperative nonsteroidal antiinflammatory drugs in patients undergoing knee arthroscopy
Authors: Nelson William E. , Henderson Richard C. , Almekinders Louis C. , DeMasi Ralph A. , Taft Timothy N. 
Published: June 2007

The potential benefits of a nonsteroidal antiinflamma tory drug to 67 patients undergoing knee arthroscopy were evaluated in a prospective, randomized, placebo- controlled, double-blinded study. Group A received the drug (diclofenac, 75 mg twice daily) for 3 to 5 days before and for 7 days after surgery. Group B received a placebo preoperatively and the drug postoperatively. Group C received a placebo at both times. Codeine was available postoperatively for all patients if needed. Outcomes reported by the subjects included pain, crutch use, and return to activities. Outcomes assessed by physicians included knee effusion, range of motion, and gait. Knee flexion and extension strengths were measured isokinetically pre- and postoperatively. Pain scores on the 1 st postoperative day were higher in Group C than in Group A. Pain scores at all other time points were not significantly different in the three treatment groups. Groups A and B required less co deine during the first 72 hours after surgery than Group C (mean, 2.9 ± 1.0 versus 6.8 ± 1.0 pills). Recovery of function, recovery of strength, and physical examina tion parameters were not significantly different in the three treatment groups. Diclofenac was an effective analgesic in the immedi ate postoperative period. Recovery from arthroscopy, however, was not enhanced by taking the drug.
The quantitative measurement of normal passive medial and lateral patellar motion limits
Authors: Skalley Thomas C. , Terry Glenn C. , Teitge Robert A. 
Published: June 2007

To quantify normal motion, medial and lateral passive patellar motion limits were measured in 67 high school athletes randomly selected from a group of 1340 ath letes undergoing preseason physical examinations. Pa tellar displacement was measured at knee flexion an gles of 0° and 35°, using both a Patella Pusher (a hand held force gauge) and a manual technique, and the results were compared. Demographic data and physical examination of the deceleration mechanism (Q angle, vastus medialis obliquus dysplasia, patella alta and baja, and valgus and varus alignment) were correlated with patellar motion limits. With the knee in extension, passive displacement of the patella averaged 9.6 mm medially and 5.4 mm laterally. In flexion, medial displacement averaged 9.4 mm and lateral displacement averaged 10.0 mm. No positive correlations were found between demographic data or deceleration mechanism examination parame ters and patellar motion limits, suggesting that motion produced by the displacement force was limited by ligamentous restraints only. The clinical assessment of the passive limits of pa tellar motion should include examination at knee flexion angles of 0° and 35°. The manually produced displace ment was found to be more reproducible than displace ment by the Patella Pusher (P < 0.05).
The accuracy of the clinical knee examination documented by arthroscopy
Authors: Oberlander Michael A. , Shalvoy Robert M. , Hughston Jack C. 
Published: June 2007

The diagnostic accuracy of the clinical examination for intraarticular injuries of the knee was documented by arthroscopy over a 6-month period. Two-hundred ninety patients (296 knees) were evaluated by history, physical examination, and standard radiographs. Supplemental diagnostic studies included 41 magnetic resonance images, 2 arthrograms, and 1 previous ar throscopy that had been recently performed. Overall, the correct diagnosis was made in 165 knees (56%), an incomplete diagnosis in 92 (31%), and an incorrect diagnosis in 39 (13%). There were only 2 knees (0.07%) with no discernable lesions. When a single lesion was present in the knee, the diagnosis was made correctly in 72% of cases. When more than 2 were discovered, the diagnosis was correct in only 30%. However, all individual lesions were diagnosed with an accuracy of greater than 90%. The lesions most difficult to diagnose were chondral fractures, fibrotic fat pads, tears in the anterior cruciate ligament, and loose bodies. Knees with acute lesions and those with a single diagnosis proved to be signifi cantly easier to diagnose (P < 0.01). The variables that proved to be insignificant were age, sex, magnetic resonance imaging, surgeon, workers' compensation, or pending litigation.
Anterior subcutaneous transfer of the ulnar nerve in the athlete
Authors: Rettig Arthur C. , Ebben James R. 
Published: June 2007

To evaluate the effectiveness of subcutaneous subfas cial anterior transfer of the ulnar nerve in the surgical treatment of cubital tunnel syndrome in athletes, we retrospectively reviewed athletes undergoing subcuta neous anterior transfer of the ulnar nerve at the elbow. Criteria for inclusion in the study included active partic ipation in athletic activity, confirmed cubital tunnel syn drome, failure to respond to conservative treatment, and having an anterior subcutaneous subfascial trans fer as the only procedure performed. Twenty athletes underwent a total of 21 procedures. Results were evaluated by time to return to sport and a questionnaire developed to evaluate elbow function in the athlete. The athletes returned to full activity at an average of 12.6 weeks. Average subjective postoperative scores were 84. Elbow rating scores averaged 9 (range, 0 to 10). Anterior subcutaneous subfascial transfer of the ulnar nerve is a safe, effective means for treating cubital tunnel syndrome in athletes. The findings in this study are significant in that they confirm the effectiveness of the subcutaneous subfascial transfer procedure in re turning the athlete to competition. Of secondary impor tance is the development of an elbow rating question naire appropriate to the athlete.
Arthroscopic Treatment of Posttraumatic Elbow Pain and Stiffness
Authors: Timmerman Laura A. , Andrews James R. 
Published: June 2007

Nineteen consecutive cases of posttraumatic arthrofi brosis of the elbow secondary to a fracture or fracture- dislocation and treated with arthroscopic debridement and manipulation were retrospectively reviewed. All of the patients had pain and stiffness in their elbows, and all had failed a conservative therapy program. All 19 patients were followed postoperatively for an average of 29 months (range, 12 to 51). One hundred-point scoring systems were used to evaluate subjective (pain, swell ing, locking, and activities) and objective (range of mo tion) results. The average preoperative subjective score of 39 im proved to 91 postoperatively (P= 0.0001); the objective score improved from 46 preoperatively to 81 postop eratively (P = 0.0001). Extension improved from a mean of 29° to 11 °; flexion improved from an average of 123° to 134°. Fourteen patients had limitations in their sports activity preoperatively; 11 were able to return to their preinjury levels of activity after surgery. This study demonstrated good-to-excellent overall re sults in 79% of the patients treated with arthroscopic debridement for posttraumatic elbow arthrofibrosis. Al though complete return of preinjury motion was not ob tained, each patient showed a significant improvement in motion and subjective symptoms.