bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knee Stability and Graft Function after Anterior Cruciate Ligament Reconstruction
Authors: Yamamoto Yuji , Hsu Wei-Hsiu , Woo Savio L-Y. , Van Scyoc Andrew H. , Takakura Yoshiyuki , Debski Richard E. 
Published: December 2004

Background Locations of femoral tunnels for anterior cruciate ligament replacement grafts remain a subject of debate. Hypothesis A lateral femoral tunnel placed at the insertion of the posterolateral bundle of the anterior cruciate ligament can restore knee function comparably to anatomical femoral tunnel placement. Study Design Controlled laboratory study. Methods Ten cadaveric knees were subjected to the following external loading conditions: (1) a 134-N anterior tibial load and (2) combined rotatory loads of 10-N.m valgus and 5-N.m internal tibial torques. Data on resulting knee kinematics and in situ force of the intact anterior cruciate ligament and anterior cruciate ligament graft were collected using a robotic/universal force-moment sensor testing system for (1) intact, (2) anterior cruciate ligament-deficient, (3) anatomical double-bundle reconstructed, and (4) laterally placed single-bundle reconstructed knees. Results In response to anterior tibial load, anterior tibial translation and in situ force in the graft were not significantly different between the 2 reconstructions except at high knee flexion. For example, at 90° of knee flexion, anterior tibial translation was 6.1 ± 2.3 mm for anatomical double-bundle reconstruction and 7.6 ± 2.6 mm for laterally placed single-bundle reconstruction (P < .05). In response to rotatory loads, there were no significant differences between the 2 reconstruction procedures (4.8 ± 2.4 mm vs 4.8 ± 3.0 mm in anterior tibial translation at 15° of knee flexion, P > .05). Conclusion Lateral tunnel placement can restore rotatory and anterior knee stability similarly to an anatomical reconstruction when the knee is near extension. However, the same is not true when the knee is at high flexion angles. Clinical Relevance To reproduce the complex function of the anterior cruciate ligament, reproducing both bundles of the anterior cruciate ligament may be necessary.
Ankle Syndesmosis Sprains in National Hockey League Players
Authors: Wright Rick W. , Barile Raymond J. , Surprenant David A. , Matava Matthew J. 
Published: December 2004

Background Although syndesmosis sprains are less common in sports than lateral ankle sprains, they represent a significant source of morbidity. Several studies have described the increased recovery time for these injuries in a variety of sports. No previous study has described this injury in hockey players. Hypothesis Syndesmosis ankle sprains require a longer recovery time and are less common than lateral ankle sprains in elite hockey players. Study Design Uncontrolled retrospective review. Methods The medical records of the St Louis Blues (1994-2001) and Dallas Stars (1991-2001) National Hockey League teams were reviewed by the head athletic trainers. Ankle sprains were identified and divided into 2 groups: syndesmosis and lateral sprains. Player demographics, treatment, and time lost to play were recorded for each injury. Results Fourteen players were diagnosed with syndesmosis sprains, and 5 players sustained lateral sprains during this time period. Mean time to return to play in games was 45 days (range, 6-137 days) for syndesmosis sprains versus 1.4 days (range, 0-6 days) for lateral sprains. Conclusions Syndesmosis sprains represent a significant injury in hockey players with an extended time lost and, unlike in other sports, are a more common injury than lateral ankle sprains.
Multirater Agreement of Arthroscopic Meniscal Lesions
Authors: Dunn Warren R. , Wolf Brian R. , Amendola Annunziato , Andrish Jack T. , Kaeding Christopher , Marx Robert G. , McCarty Eric C. , Parker Richard D. , Wright Rick W. , Spindler Kurt P. 
Published: December 2004

Background Establishing the validity of classification schemes is a crucial preparatory step that should precede multicenter studies. There are no studies investigating the reproducibility of arthroscopic classification of meniscal pathology among multiple surgeons at different institutions. Hypothesis Arthroscopic classification of meniscal pathology is reliable and reproducible and suitable for multicenter studies that involve multiple surgeons. Study Design Multirater agreement study. Methods Seven surgeons reviewed a video of 18 meniscal tears and completed a meniscal classification questionnaire. Multirater agreement was calculated based on the proportion of agreement, the kappa coefficient, and the intraclass correlation coefficient. Results There was a 46% agreement on the central/peripheral location of tears (κ = 0.30), an 80% agreement on the depth of tears (κ = 0.46), a 72% agreement on the presence of a degenerative component (κ = 0.44), a 71% agreement on whether lateral tears were central to the popliteal hiatus (κ = 0.42), a 73% agreement on the type of tear (κ = 0.63), an 87% agreement on the location of the tear (κ = 0.61), and an 84% agreement on the treatment of tears (κ = 0.66). There was considerable agreement among surgeons on length, with an intraclass correlation coefficient of 0.78, 95% confidence interval of 0.57 to 0.92, and P < .001. Conclusions Arthroscopic grading of meniscal pathology is reliable and reproducible. Clinical Relevance Surgeons can reliably classify meniscal pathology and agree on treatment, which is important for multi-center trials.
In Vivo Function of the Posterior Cruciate Ligament during Weightbearing Knee Flexion
Authors: DeFrate Louis E. , Gill Thomas J. , Li Guoan 
Published: December 2004

Background Current knowledge of posterior cruciate ligament function is mainly based on in vitro cadaveric studies. There are few studies on the in vivo function of the posterior cruciate ligament. The objective of the study was to quantify the multidimensional deformation of the posterior cruciate ligament. Hypothesis During in vivo weightbearing flexion, the posterior cruciate ligament undergoes complex 3-dimensional deformations, including elongation, twist, and changes in orientation. Study Design In vivo biomechanical study. Methods Magnetic resonance images of 5 human knees were used to create 3-dimensional computer models of each subject's knee, including the insertion areas of the posterior cruciate ligament. Orthogonal fluoroscopic images of each subject's knee were acquired as a quasi-static lunge was performed. The images and computer models were used to reproduce the in vivo motion of the knee. The relative motion of the femoral and tibial insertions was described in terms of elongation, twist, elevation (the angle between the tibial plateau and posterior cruciate ligament, measured in the sagittal plane), and deviation (mediolateral orientation, measured in plane of tibial plateau). Results The length of the posterior cruciate ligament increased significantly with increasing flexion. It twisted almost 80° as the knee flexed from 0° to 90°. The elevation angle remained relatively constant at 50°. The deviation angle was medially oriented by 20° at full extension, then decreased to approximately 10° at 30° through 90° of flexion. Conclusion The posterior cruciate ligament undergoes a complex twisting motion as it elongates with flexion. Clinical Relevance During reconstruction, the tunnels and graft may need to be placed such that the multidimensional deformation of the intact posterior cruciate ligament is reproduced.
The Effect of Anterior Cruciate Ligament Reconstruction on the Risk of Knee Reinjury
Authors: Dunn Warren R. , Lyman Stephen , Lincoln Andrew E. , Amoroso Paul J. , Wickiewicz Thomas , Marx Robert G. 
Published: December 2004

Background Although there is evidence that very active, young patients are better served with anterior cruciate ligament reconstruction, there is a lack of objective data demonstrating that future knee injury is prevented by these procedures. Hypothesis Anterior cruciate ligament reconstruction protects against reinjury of the knee that would require reoperation. Study Design Retrospective cohort study. Methods A cohort of 6576 active-duty army personnel who had been hospitalized for anterior cruciate ligament injury from 1990 to 1996 were identified. Using the Total Army Injury and Health Outcomes Database, the authors followed these individuals for up to 9 years and collected clinical, demographic, and occupational data. These data were evaluated with bivariate and multivariable analyses to determine the effect of anterior cruciate ligament reconstruction on the rate of knee reinjury that required operation. Results Of the 6576 study subjects, 3795 subjects (58%) underwent anterior cruciate ligament reconstruction and 2781 (42%) did not. The rate of reoperation was significantly lower among the anterior cruciate ligament reconstruction group (4.90/100 person-years) compared with those treated conservatively (13.86/100 person-years; P < .0001). Proportional hazard regression analyses adjusted for age, race, sex, marital status, education, and physical activity level confirmed that anterior cruciate ligament reconstruction was protective against meniscal and cartilage reinjury ( P < .0001). Secondary medial meniscal injury was more common than secondary lateral meniscal injury ( P < .003). Younger age was the strongest predictor of failure of conservative management leading to late anterior cruciate ligament reconstruction ( P < .0001). Conclusions Anterior cruciate ligament reconstruction protected against reoperation in this young, active population; younger subjects were more likely to require late anterior cruciate ligament reconstruction. Clinical Relevance Strong consideration should be given to anterior cruciate ligament reconstruction after anterior cruciate ligament injury in young, active individuals.
The Influence of Muscle Fatigue on Electromyogram and Plantar Pressure Patterns as an Explanation for the Incidence of Metatarsal Stress Fractures
Authors: Weist Roger , Eils Eric , Rosenbaum Dieter 
Published: December 2004

Background Stress fractures are common overuse injuries in runners and appear most frequently in the metatarsals. Purpose To investigate fatigue-related changes in surface electromyographic activity patterns and plantar pressure patterns during treadmill running as potential causative factors for metatarsal stress fractures. Study Design Prospective cohort study with repeated measurements. Methods Thirty experienced runners volunteered to participate in a maximally exhaustive run above the anaerobic threshold. Surface electromyographic activity was monitored for 14 muscles, and plantar pressures were measured using an in-shoe monitoring system. Fatigue was documented with blood lactate measurements. Results The results demonstrated an increased maximal force (5%, P < .01), peak pressure (12%, P < .001), and impulse (9%, P < .01) under the second and third metatarsal head and under the medial midfoot (force = 7%, P < .05; pressure = 6%, P < .05; impulse = 17%, P < .01) toward the end of the fatiguing run. Contact area and contact time were only slightly affected. The mean electromyographic activity was significantly reduced in the medial gastrocnemius (-9%, P < .01), lateral gastrocnemius (-12%, P < .01), and soleus (-9%, P < .001) muscles. Conclusion The demonstrated alteration of the rollover process with an increased forefoot loading may help to explain the incidence of stress fractures of the metatarsals under fatiguing loading conditions.
Painful Jerk Test
Authors: Kim Seung-Ho , Park Jae-Chul , Park Jun-Sic , Oh Irvin 
Published: December 2004

Background The jerk test has been used as a diagnostic test of the posteroinferior instability of the shoulder. Pain may or may not be associated with posterior clunking during the jerk test. Purpose To evaluate the presence or absence of pain with the jerk test as a predictor of the success of nonoperative treatment for posteroinferior instability of the shoulder and to identify the pathologic lesion responsible for the pain in the jerk test. Study Design Retrospective review of prospectively collected data. Methods Eighty-one patients (89 shoulders) who had posteroinferior instability with a positive posterior clunk in their shoulders during the jerk test were nonoperatively treated. The patients were divided into 2 groups with respect to the presence of pain in the jerk test: the painless jerk group (54 shoulders) and the painful jerk group (35 shoulders). Response to the nonoperative treatment was evaluated after at least a 6-month rehabilitation program. Patients who did not respond to the rehabilitation underwent arthroscopic examination to identify any pathologic lesions. Results The painful jerk group had a higher failure rate with nonoperative treatment (P< .001). In the painless jerk group, 50 shoulders (93%) responded to the rehabilitation program after a mean of 4 months. Four shoulders (7%) were unresponsive to the rehabilitation. In the painful jerk group, 5 shoulders (16%) were successful with the rehabilitation, whereas the other 30 shoulders (84%) failed. All 34 shoulders that were unresponsive to the rehabilitation had a variable degree of posteroinferior labral lesions. Conclusions The jerk test is a hallmark for predicting the prognosis of nonoperative treatment for posteroinferior instability. Shoulders with symptomatic posteroinferior instability and a painful jerk test have posteroinferior labral lesions.
A Prospectively Randomized Double-Blind Study on the Effect of Initial Graft Tension on Knee Stability after Anterior Cruciate Ligament Reconstruction
Authors: Nicholas Stephen J. , D'Amato Michael J. , Mullaney Michael J. , Tyler Timothy F. , Kolstad Kirsten , McHugh Malachy P. 
Published: December 2004

Background No consensus exists on the amount of tension that should be applied to anterior cruciate ligament grafts to best facilitate graft incorporation and re-create normal knee mechanics. Hypothesis Differences in initial graft tension will affect postoperative knee stability. Study Design Prospective, randomized, double-blind clinical trial. Methods Forty-nine patients undergoing bone-patellar tendon-bone autograft anterior cruciate ligament reconstruction by a single surgeon were randomized into high-tension (n = 27) and low-tension (n = 22) groups. Grafts were set at 90 N or 45 N. Arthrometric measurements (KT-1000 arthrometer manual maximum) of anterior tibial displacement and knee range of motion were made before surgery and at 1 week and an average of 20 months after surgery. Knee outcome scores were collected before and after surgery, and a single-leg hop test was also performed at final follow-up. Results After anterior cruciate ligament reconstruction, anterior tibial displacement was significantly greater in the patients in the low-tension group (P < .05). The side-to-side difference in anterior tibial displacement in the high-tension and low-tension groups was 1.1 ± 1.7 mm versus 2.4 ± 2.4 mm 1 week after surgery and 2.2 ± 1.6 mm versus 3.0 ± 2.2 mm at follow-up. Five patients had abnormal anterior tibial displacement (>5 mm side-to-side difference), and all were in the low-tension group (P <.05). Knee outcome scores improved with surgery (P < .01), with similar results for low-tension and high-tension groups. Hop test deficits were not different between groups. Conclusions Initial graft tension affects the restoration of knee stability. A graft tension of 45 N was not sufficient for restoring knee stability.
Functional Bracing after Anterior Cruciate Ligament Reconstruction
Authors: McDevitt Edward R. , Taylor Dean C. , Miller Mark D. , Gerber John P. , Ziemke Gregg , Hinkin Daniel , Uhorchak John M. , Arciero Robert A. , St. Pierre Patrick 
Published: December 2004

Background Bracing after anterior cruciate ligament reconstruction is expensive and is not proven to prevent injuries or influence outcomes. Purpose To determine whether postoperative functional knee bracing influences outcomes. Study Design Prospective, randomized, multicenter clinical trial. Methods One hundred volunteers from the 3 US service academies with acute anterior cruciate ligament tears were randomized into braced or nonbraced groups. Only those subjects with anterior cruciate ligament tears treated surgically within the first 8 weeks of injury were included. Patients with chondral injuries, significant meniscal tears, or multiple knee ligament injuries were excluded. Surgical procedures and the postoperative physical therapy protocols were identical for both groups. The braced group was instructed to wear an off-the-shelf functional knee brace for all cutting, pivoting, or jumping activities for the first year after surgery. Results Ninety-five subjects were available with a minimum 2-year follow-up. There were no statistically significant differences between groups in knee stability, functional testing with the single-legged hop test, International Knee Documentation Committee scores, Lysholm scores, knee range of motion, or isokinetic strength testing. Two braced subjects had reinjuries, and 3 nonbraced subjects had reinjuries. Conclusions In this young, active population, postoperative bracing does not appear to change the clinical outcomes after anterior cruciate ligament reconstruction.
Nonsteroidal Anti-inflammatory Drugs and Acetaminophen in the Treatment of an Acute Muscle Injury
Authors: Rahusen Frank T. G. , Weinhold Paul S. , Almekinders Louis C. 
Published: December 2004

Background Nonsteroidal anti-inflammatory drugs are frequently used to treat muscle injuries in athletes. It is not known whether the anti-inflammatory effects of these drugs are important or whether their effectiveness is a result of their central anal-gesic effect. Hypothesis The effects of nonsteroidal anti-inflammatory drugs are no different than the effects of an analgesic (acetaminophen) without anti-inflammatory action in an experimental, acute muscle contusion model. Study Design Controlled animal study. Methods A standardized, unilateral, nonpenetrating injury was created to the tibialis anterior muscle of 96 adult male mice. Four treatment groups were used: group 1, placebo treatment; group 2, treatment with rofecoxib, a nonsteroidal anti-inflammatory drug with cyclooxygenase-2 selectivity, and treatment after the injury; group 3, rofecoxib treatment starting 24 hours before the injury; and group 4, acetaminophen treatment after the injury. The muscle and the contralateral normal muscle were evaluated at 2, 5, and 7 days after injury by grading of gait, wet weight as a measure of edema, and histologic evaluation. Results Group 1 had significantly more gait disturbances at day 2 than all other groups (P < .05). No differences were found at days 5 and 7. Wet weights showed an increase at day 2 in group 1 (P < .01). Again, no differences were found at days 5 and 7. Histology revealed similar inflammatory changes at day 2 in all groups, with regeneration of muscle fibers at days 5 and 7. Conclusions The results indicate that rofecoxib as a nonsteroidal anti-inflammatory drug and acetaminophen as a non-nonsteroidal anti-inflammatory drug analgesic have similar effects. The lack of differences in wet weights and histology suggests that the anti-inflammatory effects of rofecoxib are not an important feature of its action. Clinical Relevance The routine use of nonsteroidal anti-inflammatory drugs in muscle injuries may need to be critically evaluated because low-cost and low-risk analgesics may be just as effective.
The Effects of Varied Joint Motion and Loading Conditions on Posterior Cruciate Ligament Fiber Length Behavior
Authors: Covey Dana C. , Sapega Alexander A. , Marshall Robert C. 
Published: December 2004

Background The posterior cruciate ligament has been described as being composed of 2 bands that reciprocally tighten and loosen with knee flexion, but the fiber anatomy and behavior may be more complex. Hypothesis The mechanical effects of defined loading conditions at discrete knee joint angles can vary significantly within the substance of the posterior cruciate ligament depending on the fiber region tested. Study Design Controlled laboratory study. Methods Nine intact, fresh-frozen cadaveric knees were instrumented with excursion filaments implanted within 4 fiber regions of the posterior cruciate ligament. Patterns of fiber behavior were analyzed as a function of the variable linear separation distance between tibial and femoral fiber attachment sites during joint motion under a simulated quadriceps contraction, tibial internal rotation, and tibial external rotation. Analysis of variance, the Newman-Keuls multiple comparisons procedure, and paired t tests were used to evaluate statistical significance. Results Compared with the control pattern of fiber behavior during unloaded passive knee motion from 0° to 120°, the quadriceps force caused loosening of most ligament fibers at knee flexion of less than 75°. Tibial internal rotation significantly slackened the anterior and central fiber regions near extension and significantly tightened the central and posterior fiber regions with progressive flexion. External rotation had an effect similar to internal rotation on the anterior and central fiber regions but caused significant slackening of the posterior fiber regions from 0° to 45°. Conclusions Distinct geographic regions within the posterior cruciate ligament have different functional roles depending on the joint angle and the type of load to which the knee is subjected. Clinical Relevance The specific graft placement parameters in a given surgical procedure relate to end-to-end length changes of the graft and may have important implications for postoperative rehabilitation and return to specific functional activities.
Single infusion of myeloid progenitors reduces death from Aspergillus fumigatus following chemotherapy-induced neutropenia
Authors: BitMansour Andrew , Cao Thai M. , Chao Stephanie , Shashidhar Sumana , Brown Janice M. Y. 
Published: December 2004

AbstractHematopoietic progenitors committed to the myeloid lineage, the common myeloid and granulocyte-monocyte progenitors (CMP/GMP), have been shown to protect against opportunistic pathogens following myeloablative radiation; however, the efficacy of this approach has not been studied in the setting of chemotherapy-induced neutropenia. In this mouse model, the infusion of CMP/GMP on the day after 5-fluorouracil (5-FU) administration (D+1) resulted in a significant increase in the number of splenic neutrophils by D+8 when compared with 5-FU–only controls (P = .02), the majority of which were CMP/GMP-derived (54%). Moreover, 19% and 28% of neutrophils in the blood and bone marrow, respectively, were CMP/GMP-derived. Survival following intranasal challenge with the fungus Aspergillus fumigatus was significantly higher in CMP/GMP-infused mice than the controls (56% and 33% respectively; P = .019). Thus, a single infusion of CMP/GMP enhances tissue neutrophil content and increases survival against a lethal challenge with A fumigatus in the setting of chemotherapy-induced neutropenia.