bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative pulmonary edema in young, athletic adults
Authors: Holmes James R. , Hensinger Robert N. , Wojtys Edward W. 
Published: June 2007

Pulmonary edema secondary to postextubation laryn gospasm is a potentially life-threatening problem, de manding early diagnosis and prompt treatment. We believe that this problem has been grossly underesti mated in its incidence, as only seven adults have been reported in the English literature, whereas seven adults have been observed at our institution in only a 24 month period. All were young, healthy, athletic adult males (average weight, 218 pounds) who underwent relatively minor, uncomplicated surgical procedures under gen eral anesthesia. Five of these patients were collegiate and/or profes sional athletes and had meticulous medical records detailing their clinical course. Clinical laryngospasm was noted immediately following extubation and anesthesia by mask with subsequent pulmonary edema. The di agnoses were confirmed by clinical examination, arterial blood gas determinations or pulse oximetry, and chest roentgenogram. Four adults required reintubation. Six of the seven adults demonstrated very rapid resolution of the pulmonary edema with prompt diagnosis and institution of a therapeutic regimen including oxygen, diuretics, reintubation, and/or positive pressure venti lation. In one patient, the problem was not immediately recognized, and progressed to florid pulmonary edema requiring emergent intubation 14 hours later in the emergency room, and 3 days of mechanical ventilation. The etiology of pulmonary edema following upper airway obstruction represents an interplay between several factors: cardiogenic and neurogenic mecha nisms, as well as hypoxia contribute. In this group, excessive negative intrathoracic pressure generated by forced inspiration against a closed glottis is the most likely, consistent, and logical explanation. This study suggests that young, healthy, athletic males may be at increased risk for this complication. We believe that their enhanced ability to generate ex cessive negative intrathoracic pressures is, at least in part, responsible. A heightened awareness of the prob lem in this at-risk group should invoke special consid erations, including choice of anesthesia, precautions on extubation, prolonged monitoring in the recovery phase if laryngospasm is observed or suspected, and rapid therapeutic intervention.
Soccer injuries among elite female players
Authors: Engström Bjorn , Johansson Christer , Tornkvist Hans 
Published: June 2007

Injuries occurring in two female elite soccer teams were recorded during 1 year. Of 41 players, 33 (80%) sus tained 78 injuries. The incidence of injury during games was 24/1000 hours, while the incidence during training was 7/1000 hours. The majority (88%) of injuries were localized to the lower extremities, with equal occur rence in the left and right legs. Forty-nine percent of the injuries occurred in the knee or ankle. Most of the injuries were minor (49%), while 36% were moderate and 15% were major. Of the major injuries (N = 12), 10 were due to trauma and 7 (58%) were knee ligament or meniscal tears. Overuse injuries constituted 28% of all injuries and occurred mainly during preseason train ing and at the beginning and end of the competitive season. Traumatic injuries (72%) occurred mainly dur ing games with a predominance at the beginning of the competitive season. Almost 80% of the traumatic inju ries occurred during physical contact with an opponent. Extrinsic factors such as weather, playing surface, tem perature, or the position of the player within the team did not influence the injury rate. We conclude that female elite soccer players sustain a high incidence of injury. Few injuries were major, but 17% of the players sustained a major knee injury during the year.
Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture
Authors: Noyes Frank R. , Barber Sue D. , Mangine Robert E. 
Published: June 2007

This study assessed the sensitivity of four different types of one-legged hop tests. The goal was to deter mine alterations in lower limb function in ACL deficient knees. Regression analyses were conducted between limb symmetry as measured by the hop tests and muscle strength, symptoms, and self-assessed func tion. In 67 patients, 50% had abnormal limb symmetry scores on a single hop test. When the results of two hop tests were calculated, the percent of abnormal scores increased to 62%. The percentage of normal scores indicated that these hop tests had a low sensi tivity rate. However, the high specificity and low false- positive rates allow the tests to be used to confirm suspected defects in lower limb function. Statistical trends were noted between abnormal limb symmetry on the hop tests and low velocity quadriceps isokinetic test results.
Retrospective direct comparison of three intraarticular anterior cruciate ligament reconstructions
Authors: Holmes Peter F. , James Stan L. , Larson Robert L. , Singer Kenneth M. , Jones Donald C. 
Published: June 2007

A long-term retrospective study (minimum 5 years) was done looking at three groups of anterior cruciate defi cient knee patients using both subjective and objective anterior cruciate tests. Twenty-seven chronic anterior cruciate ligament deficient knees reconstructed with the middle third of the patellar tendon and 28 chronic anterior cruciate ligament deficient knees reconstructed with the semitendinosus tendon were included in this consecutive group of patients and were felt to be directly comparable. It was found that the chronic an terior cruciate ligament deficient group reconstructed with the semitendinosus tendon had 4 excellent, 10 good, 7 poor, and 7 failures with an objective score averaging 4.5 of a possible 12, while the comparable group reconstructed with the middle third of the patellar tendon had 16 excellent, 7 good, 3 poor, and only 1 failure with a score of 10 of a possible 12 (P < 0.0032). For completeness sake, 20 anterior cruciate deficient knees from this group of consecutive patients that were reconstructed acutely with the semitendinosus tendon were also examined. This group had 8 excellent results, 9 good, 3 poor, and no failures with a score of 9.8 (P < 0.03 compared to the other group using the semiten dinosus tendon). This comparison between the two groups where the semitendinosus tendon was used in the anterior cruciate ligament reconstruction was made only to show the difference between studies dealing with knee reconstructions. There may be a significant difference between a study dealing with acutely recon structed knees versus one focusing on chronically re constructed knees, most likely because of both patient selection and time between injury and reconstruction. Subjectively, the activity forms gave postreconstruc tion activities of 112 of 200 for the chronically recon structed group using semitendinosus tendon, 115 for the chronically reconstructed group using the middle third of the patellar tendon, and 150 in the acutely reconstructed group using the semitendinosus tendon. The subjects rated their knee 6.2 (chronically recon structed with semitendinosus), 6.4 (chronically recon structed with middle third patellar tendon), and 7.9 (acutely reconstructed with semitendinosus) on a scale of 0 to 10. This paper will point out the superiority of using the middle third of the patellar tendon over the use of the semitendinosus tendon in chronically unstable knees. The semitendinosus tendon should not be used even with extraarticular augmentations. The data for the semitendinosus tendon in acute anterior cruciate liga ment reconstruction is included to show how different two groups of patients can be based on the time of reconstruction from the date of injury.
Traumatic pseudodislocation of the acromioclavicular joint in children
Authors: Black G. Brian , McPherson Jack A.M. , Reed Martin H. 
Published: June 2007

Traumatic acromioclavicular separation in the skeletally immature patient is frequently overdiagnosed and overtreated. Fifty-eight children, aged 5 to 16 years, who presented over a 15 year period with injuries to the distal clavicle, were reviewed retrospectively. The majority showed coracoclavicular widening radiograph ically, suggesting acromioclavicular separation. In 45 cases, a distal clavicular fracture was identified, while an acromioclavicular separation without fracture was initially diagnosed in 13. Long-term followups of these patients demonstrate excellent results with conservative management. "Pseudodislocation" involves a clavicular fracture of the lateral metaphysis or metaphyseal epiphyseal separa tion and not an acromioclavicular disruption. This pseu dodislocation of the acromioclavicular joint in the skel etally immature patient must be differentiated from the adult counterpart to avoid unnecessary operative inter vention.
Reconstruction of chronic insufficient anterior cruciate ligament in the knee using a synthetic Dacron prosthesis
Authors: Andersen Henrik Nørholm , Bruun Carsten , Sønergåro-Petersen Poul Erik 
Published: June 2007

In this study, a total of 57 patients with rupture of the anterior cruciate ligament and persistent functional in stability of the knee had their anterior cruciate ligament reconstructed with a Dacron prosthesis between No vember 1984 and February 1987. The patients, 43 males and 14 females with a mean age 26 years (range, 16 to 42), were followed for 2 to 4 years (mean, 34 months). In total, 30 patients had concomitant knee ligament or meniscal lesions. Postoperatively, the knee was not immobilized, but was actively trained in a cast brace. At followup, 54 of the patients were examined, and 71% had a good or excellent result according to the Lysholm score. The Tegner activity score improved in 33 patients and 15 achieved their preinjury sporting activity level. The instability, as measured by the ante rior drawer sign and the Lachman test, declined from 3.3 to 2.1. Ten prostheses had ruptured at a mean of 11 months (range, 3 to 21). One patient had a deep postoperative infection, another developed chronic syn ovitis, and one incurred reflex dystrophic changes.
Effect of shoe cushioning on the development of reticulocytosis in distance runners
Authors: Dressendorfer Rudolph H. , Wade Charles E. , Frederick Edward C. 
Published: June 2007

We studied erythropoietic activity in relation to the rearfoot cushioning of shoes worn by 14 male runners before, during, and the morning after a 17-day period of increased training mileage. The percentage of retic ulocytes in the red blood cell count (normal, <0.8%) served as the marker for erythropoietic activity. Each runner was assigned to either a firm-sole group (7) or a soft-sole group (7) according to the heel impact attenuation character (Peak g) of his shoes. Peak g was 18% greater in the firm-sole group (P < 0.001). Otherwise, the groups were similar in physical charac teristics, training mileage, and running ability. All sub jects ran a total of 430 km, a distance that averaged 79% higher than their regular training distance for a 17- day period. Resting blood samples were obtained at baseline and on three mornings (Days 11, 13, and Day 18, which followed the completion of the increased training period). No significant differences were found between the groups in red blood cell count, hematocrit, or total hemoglobin, haptoglobin, plasma-free hemoglobin, and serum ferritin levels. The groups did not differ in percent reticulocytes at baseline (0.2% firm-sole versus 0.2% soft-sole), on Day 11 after running 280 km (0.8% firm- sole versus 0.8% soft-sole), or on Day 13 after 48 hours of rest (1.3% firm-sole versus 1.0% soft-sole). However, on Day 18 after running 430 km, reticulocyte counts were 29% higher (P < 0.05) in firm-sole than soft-sole (2.2% versus 1.7%, respectively). The overall change in percent reticulocytes was linearly correlated with Peak g (r = 0.57, P < 0.05). Although marked reticulocytosis occurred in both groups, it was significantly more pronounced in the firm-sole group. The positive correlation between per cent reticulocytes and Peak g suggests that shoe rear foot cushioning is one determinant of the erythropoietic response to increased training mileage in distance run ners.
The effect of external ankle support in chronic lateral ankle joint instability
Authors: Karlsson Jon , Andreasson Gunnar O. 
Published: June 2007

We examined the effect of ankle taping on ankle joint stability by measuring mechanical stability using stand ardized stress radiographs. Anterior talar translation and talar tilt, both with and without ankle tape, were examined. The reduction of anterior talar translation and talar tilt with tape as compared to without tape was insignificant. The reaction time of the peroneus muscles was measured by electromyographic signal after a simulated ankle sprain on a tilting trapdoor. The reaction time was significantly slower in the unstable ankles of 20 athletes with unilateral ankle instability than in the stable contra lateral ankles. With tape, the reaction time was signifi cantly shortened, although not back to normal. The greatest improvement in reaction time was achieved in ankles with the highest degree of mechanical instability. Thus, the mechanism behind the function of ankle tape may be to restrict the extremes of ankle motion and to help shorten the reaction time of the peroneus muscles by affecting the proprioceptive function of the ankle.
Long-term functional results in patients with anterolateral rotatory instability treated by iliotibial band transfer
Authors: Vail T. Parker , Malone Terry R. , Bassett Frank H. 
Published: June 2007

The purpose of this paper is to define the use of the extraarticular, lateral reconstruction in the spectrum of patients with cruciate deficiency. A review was con ducted of 112 consecutive patients with a Maclntosh type iliotibial band transfer done between 1972 and 1986. Fifty-six of the patients had a partial or complete meniscectomy, and 24% had failed a previous extraar ticular procedure. Eighty-one percent were men, with a mean age of 23. Twenty-five percent of the patients had radiographic degenerative changes at the knee at the outset. Ninety-eight percent had an anterior drawer of 1 + or greater; 97% had a pivot shift greater than trace. All patients had symptomatic knee instability. Seventy-seven of the 112 patients (69%) were available for followup (range, 24 months to 15.5 years; median, 7.6). Twenty-three patients (21 %) returned for exami nation, KT-1000 and Cybex testing, and radiographs. An additional 54 patients (48%) were seen by their local physicians or returned a detailed questionnaire that included the Cincinnati knee rating scale. At final followup, 38% complained of some knee instability, 36% had recurrent effusions, 61 % had inter mittent pain, 79% had radiographic gonarthrosis, and 25% had undergone additional surgery. Forty-two per cent had a positive Lachman after surgery, and only 15% had a pivot shift. The mean knee score was 81.1. Previous extraarticular anterior cruciate ligament recon struction, meniscectomy, and generalized ligamentous laxity were associated with a significant decrement in the knee rating (P = 0.05). Ligamentous laxity strongly correlated with symptoms of giving way. Also, the incidence of pain, swelling, giving way, and activity modification correlated with meniscectomy and in creased as the length of followup increased for all patients. In conclusion, this study suggests that extraarticular lateral reconstruction does not restore normal knee function, but does eliminate the pivot shift and may decrease the incidence of repeat knee injury in selected patients with symptomatic cruciate deficiency. Lateral reconstruction alone should be limited to low-demand patients without previous meniscectomy, or general ized ligamentous laxity in whom more anatomic recon struction is not possible.
Anterior cruciate ligament-medial collateral ligament injury: Nonoperative management of medial collateral ligament tears with anterior cruciate ligament reconstruction
Authors: Shelbourne K. Donald , Porter David A. 
Published: June 2007

We present the results of a series of patients who had nonoperative management of the medial collateral lig ament with anterior cruciate ligament reconstruction. From February 1983 through December 1989, 84 of 90 consecutive patients were available for followup (mini mum, 1 year; mean, 3.1 years) with a combined anterior cruciate ligament-medial collateral ligament injury (an terior cruciate ligament rupture and medial collateral ligament tear) received surgical management by the same physician. The last 68 of these 84 patients who met the inclusion criteria underwent patellar tendon graft for anterior cruciate ligament reconstruction, with concomitant nonoperative management of medial col lateral ligament tears. Follow-up evaluation consisted of physical examina tion for medial laxity, range of motion, and isokinetic and KT-1000 testing. Brace use and postoperative level of competition were also recorded. In addition, the patients completed a subjective assessment question naire rating pain, swelling, and stability. They also rated overall activity level, and any changes in their ability to do the activities tested: walk, climb stairs, run, jump, or twist. Our results indicate that proper reconstruction of the anterior cruciate ligament, in conjunction with nonoperative management of tears of the medial collat eral ligament in combined anterior cruciate ligament- medial collateral ligament injuries, can give excellent stability and good to excellent functional outcome in patients with combined anterior cruciate ligament-me dial collateral ligament injuries.
The subscapularis muscle and its glenohumeral ligament-like bands
Authors: Klapper Robert C. , Jobe Frank W. , Matsuura Peter 
Published: June 2007

The subscapularis muscle and the distribution of its tendinous bands is of significance in the surgical man agement of the shoulder joint. This distribution pattern has not been previously described in detail. We feel that, in any anterior approach to the glenohumeral joint for fracture fixation, joint replacement, and soft tissue reconstruction, a thorough understanding of the distri bution pattern of the subscapularis bands is essential. We examined the subscapularis muscles from five cadavers. Four sections from the lateral one-half of each muscle were custom-mounted and stained with Masson's trichrome. We found a consistent pattern in which the tendinous bands were evenly interspersed in the midportion of the muscle and condensed laterally into a single large, flat tendon in the superior two-thirds of the muscle. The inferior one-third remained muscular. Understanding this pattern should help the surgeon have confidence that he/she has obtained a more se cure repair in procedures involving the subscapularis muscle.
Measurements of length and tension patterns during reconstruction of the posterior cruciate ligament
Authors: Ogata Kosuke , Mccarthy John A. 
Published: June 2007

The twofold purpose of this study was to develop an intraoperative technique to assess isometric positioning of posterior cruciate ligament grafts and to demonstrate the rationale for postoperative immobilization of the knee in full extension after a posterior cruciate ligament reconstruction. Multiple femoral fixation sites were se lected on the medial intercondylar notch and the pos terior cruciate ligament substitute was assessed for changes in length and tension at each of these sites during knee flexion from 0° to 120°. The most isometric and isotonic femoral fixation site was localized over a small area slightly distal to the center of the medial intercondylar notch surface. This isometric point can be identified intraoperatively using recognizable surface markers within the knee. When a posterior stress was applied to the proximal tibia, the posterior cruciate ligament substitute showed the least increase in tension and length when the knee was locked in full extension for all of the potential femoral attachment sites assessed. This suggests that postoperative immobilization should be maintained in full extension to limit the stress placed on the posterior cruciate ligament reconstruction.
Osseous injury associated with acute tears of the anterior cruciate ligament
Authors: Speer Kevin P. , Spritzer Charles E. , Bassett Frank H. , Feagin John A. , Garrett William E. 
Published: June 2007

Multiplanar spin-echo magnetic resonance imaging was performed on 54 patients with acute complete anterior cruciate ligament tears. Imaging was done within 45 days of index anterior cruciate ligament injury. Spin- echo T1- and T2-weighted images were used to deter mine the lesion morphology and location. Only the T2- weighted sagittal images were used for the incidence assessment; T2-weighted spin-echo imaging reflects free water shifts and best indicates the acute edema and inflammatory changes from injury. Eighty-three percent (45 of 54) of the knees had an osseous contusion directly over the lateral femoral con dyle terminal sulcus. The lesion was highly variable in size and imaging intensity; however, the most intense signal was always contiguous with the subchondral plate. Posterolateral joint injury was seen in 96% (43 of 45) of the knees that had a terminal sulcus osseous lesion determined by magnetic resonance imaging. This posterolateral lesion involves a spectrum of injury, in cluding both soft tissue (popliteus-arcuate capsuloliga mentous complex) and hard tissue (posterolateral tibial plateau) injuries. The consistent location of the osseous and soft tissue injuries underscores a necessary similar mechanism of injury associated with these acute anterior cruciate ligament tears. Based on these characteristic findings, several proposed mechanisms of injury are discussed.
An injection technique to create a bloodless field in arthroscopically assisted anterior cruciate ligament reconstruction
Authors: Furia John P. , Zambetti George J. 
Published: June 2007

We did a retrospective study of 67 patients who had arthroscopically assisted anterior cruciate ligament re construction using the middle one-third of the patellar tendon to evaluate a technique for creating a bloodless field using a local anesthetic with epinephrine injection (the injection technique). For 37 patients, the bloodless field was created using the injection technique. In 30 others, hemostasis was achieved in the usual fashion with the pneumatic tourniquet. All patients underwent general anesthesia. Mean op erative time and length of hospital stay was similar for each group. Mean postoperative pain medication con sumption was significantly decreased for patients treated with the injection technique. No clinically rec ognizable complications could be attributed to either technique. We conclude that subcutaneous and intra articular injection of local anesthesia with epinephrine is a satisfactory method of establishing a bloodless field in arthroscopically assisted anterior cruciate ligament reconstruction operations.