Showing papers in "American Journal of Sports Medicine in 1987"
TL;DR: Using bone scan- positive stress fractures for diagnosis indicates that tarsal stress fractures are much more common than previously realized and time to diagnosis and recovery is site-dependent.
Abstract: We analyzed cases of 320 athletes with bone scan-positive stress fractures (M = 145, F = 175) seen over 3.5 years and assessed the results of conservative management. The most common bone injured was the tibia (49.1%), followed by the tarsals (25.3%), metatarsals (8.8%), femur (7.2%), fibula (6.6%), pelvis (1.6%), sesamoids (0.9%), and spine (0.6%). Stress fractures were bilateral in 16.6% of cases. A significant age difference among the sites was found, with femoral and tarsal stress fractures occurring in the oldest, and fibular and tibial stress fractures in the youngest. Running was the most common sport at the time of injury but there was no significant difference in weekly running mileage and affected sites. A history of trauma was significantly more common in the tarsal bones. The average time to diagnosis was 13.4 weeks (range, 1 to 78) and the average time to recovery was 12.8 weeks (range, 2 to 96). Tarsal stress fractures took the longest time to diagnose and recover. Varus alignment was found frequently, but there was no significant difference among the fracture sites, and varus alignment did not affect time to diagnosis or recovery. Radiographs were taken in 43.4% of cases at the time of presentation but were abnormal in only 9.8%. A group of bone scan-positive stress fractures of the tibia, fibula, and metatarsals (N = 206) was compared to a group of clinically diagnosed stress fractures of the same bone groups (N = 180), and no significant differences were found. Patterns of stress fractures in athletes are different from those found in military recruits. Using bone scan for diagnosis indicates that tarsal stress fractures are much more common than previously realized. Time to diagnosis and recovery is site-dependent. Technetium99 bone scan is the single most useful diagnostic aid. Conservative treatment of stress fractures in athletes is satisfactory in the majority of cases.
869 citations
TL;DR: The antagonist muscles (hamstrings) were clearly demonstrated to assume the role of joint stabilizers in the patient who has a deficient ACL, and the importance of an appropriate muscle-conditioning rehabilitation program in such a patient is substantiated.
Abstract: The synergistic action of the ACL and the thigh muscles in maintaining joint stability was studied experimentally. The EMG from the quadriceps and hamstring muscle groups was recorded and analyzed in three separate experimental procedures in which the knee was stressed. The test revealed that direct stress of the ACL has a moderate inhibitory effect on the quadriceps, but simultaneously it directly excites the hamstrings. Similar responses were also obtained in patients with ACL damage during loaded knee extension with tibia subluxation, indicating that an alternative reflex arc unrelated to ACL receptors was available to maintain joint integrity.The antagonist muscles (hamstrings) were clearly demonstrated to assume the role of joint stabilizers in the patient who has a deficient ACL. The importance of an appropriate muscle-conditioning rehabilitation program in such a patient is substantiated.
812 citations
TL;DR: This study indicates that the method of surgical fixation is the major factor influencing the graft's mechanical properties in the im mediate postoperative period of ACL reconstruction.
Abstract: Different surgical methods of graft fixation in ACL reconstruction were examined to determine the effects on mechanical properties of the reconstructed ACL. Ten human cadavers were used in this study. Six different types of grafts were studied. The tendon grafts were removed from each cadaver and fixed to femurs and tibias as ACL substitutes with different surgical fixation methods, leaving femur-reconstructed graft-tibia preparations. The surgical techniques used were staple fixation, tying sutures over buttons, and screw fixation. In the latter, the screws were introduced through femoral and tibial drill holes from the outside in order to achieve interference fit as described by Lambert. Tensile testing demonstrated that the original ACL is significantly stronger than the graft used for reconstruction in linear load, stiffness, and maximum tensile strength. All of the failures of the reconstructed ACL grafts occurred at the fixation site, indicating that the mechanically weak link of the reconstructed graft is located at the fixation site. Among the different methods of fixation, one-third of the patellar tendon secured with a cancellous screw, especially with a custom designed large diameter screw, showed significantly higher values. Although many other factors affect the success of ACL reconstruction, our study indicates that the method of surgical fixation is the major factor influencing the graft's mechanical properties in the immediate postoperative period.
749 citations
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TL;DR: The injury pattern varied among the three groups of runners: hamstring strain and tendinitis were most common in sprinters, backache and hip problems were mostCommon in middle-distance runners, and foot problems wereMost common in marathon runners.
Abstract: Sixty runners belonging to two clubs were followed for 1 year with regard to training and injury. There were 55 injuries in 39 athletes. The injury rate per 1,000 hours of training was 2.5 in long-distance/marathon runners and 5.6 to 5.8 in sprinters and middle-distance runners. There were significant differences in the injury rate in different periods of the 12 month study, the highest rates occurring in spring and summer. In marathon runners there was a significant correlation between the injury rate during any 1 month and the distance covered during the preceding month (r = 0.59). In a retrospective analysis of the cause of injury, a training error alone or in combination with other factors was the most common injury-provoking factor (72%). The injury pattern varied among the three groups of runners: hamstring strain and tendinitis were most common in sprinters, backache and hip problems were most common in middle-distance runners, and foot problems were most common in marathon runners.
598 citations
TL;DR: It is suggested that prevention or early detection and aggressive treatment are the only ways of avoiding complication in these problem cases of Infrapatellar Contracture Syndrome.
Abstract: Infrapatellar Contracture Syndrome (IPCS) is an infre quently recognized cause of posttraumatic knee mor bidity. Unique to this group of patients is the combina tion of restricted knee extension an...
397 citations
TL;DR: Non- operative treatment of the isolated posterior cruciate ligament midsubstance injury may be a viable alterna tive to the difficult repair/reconstruction procedure.
Abstract: The literature is divided as to the necessity of an intact posterior cruciate ligament for functional stability. Pre sented here is a prospective study of isolated posterior cruciate injuries seen in the acute stage in 13 patients, 6 males and 7 females. The diagnosis of posterior cruciate ligament tear was made clinically and con firmed by arthroscopy. The average age at injury was 22 years. The athletic activity at injury was varied. Hyperflexion was the most common mechanism of injury, followed by pretibial trauma in the hyperflexed knee or in the "dashboard" injury. There were seven complete midsubstance tears and five partial tears. Direct visualization of the posterior cruciate ligament was not attained in one patient. All patients were treated nonoperatively on a physiotherapy routine. Av erage followup was 2.6 years. Patients were clinically examined and subjected to KT-1000 and Cybex testing. All patients were able to return to their previous activity and experienced no limitations with their inj...
371 citations
TL;DR: It is concluded that traditional rehabilitation protocols are often ineffective in prevent ing the significant quadriceps muscle atrophy that may occur within the first few days of surgery.
Abstract: The hypothesis proposed in this study was that the initiation of active and passive knee motion within 48 hours of major intraarticular knee ligament surgery would not have the deleterious effects of increasing knee effusion, hemarthrosis, periarticular soft tissue edema, and swelling. We conducted a prospective study with randomized assignment of 18 patients into two groups: 9 patients in the "motion" group began 10 hours of daily continuous passive motion (CPM) on the 2nd postoperative day, while the remaining 9 in the "delayed motion" group used a soft hinged knee brace with knee hinges locked at 10 degrees of flexion and entered into the motion program on the 7th postoperative day. All knees were allowed full 0 degrees to 90 degrees of motion except for a total of seven knees with concomitant mensicus repairs and extraarticular reconstructions where 20 degrees to 90 degrees of motion was allowed, limiting the last 20 degrees of knee extension for the first 4 postoperative weeks to protect the repair. In all other respects, the rehabilitation program after surgery was the same for the two groups, including postoperative compression dressings, exercises, and weight-bearing status. Ten of the eighteen patients had acute ACL disruptions and 8 had chronic ACL insufficiencies. There was an even distribution of acute and chronic knee cases and of open and arthroscopic ligament procedures in the early and delayed motion groups. Associated surgery included four meniscus repairs, three medial collateral ligament repairs, and one lateral collateral ligament repair. Special suturing and fixation techniques were used at surgery to maintain the integrity of ligament and meniscus structures, allowing the surgeon to feel safe in subjecting the joint to early postoperative motion. The objective parameters measured were KT-1000 arthrometer measurements, Cybex isokinetic testing, girth measurements at four lower limb locations, range of motion goniometer measurements, postoperative pain medications, and days of hospitalization. Starting intermittent passive motion on the 2nd postoperative day did not increase joint effusion, hemarthrosis, or soft tissue swelling. In both motion groups, postoperative joint effusions were absent after the 14th postoperative day. There was no statistically significant difference in knee extension or flexion limits, pain medication used, or hospital stay in comparing the two knee motion programs. An important finding of this study was the significant decreases in thigh circumference that occurred within the first few weeks of surgery, which progressed despite a closely supervised inpatient and outpatient rehabilitation program.(ABSTRACT TRUNCATED AT 400 WORDS)
365 citations
TL;DR: Dynamic, fine-wire, intramuscular electromyography was performed on 12 different shoulder muscles in 13 normal male subjects as they pitched a baseball to provide a basis for understanding improved performance and an ad junct for sport-specific rehabilitation programs.
Abstract: Dynamic, fine-wire, intramuscular electromyography (EMG) was performed on 12 different shoulder muscles in 13 normal male subjects as they pitched a baseball. Seven were major league baseball pitchers and six were amateur pitchers. The act of pitching a fast ball was filmed at 450 frames per second with the EMG signals recorded synchronously. The subscapularis, supraspinatus, and infraspinatus muscles were tested in 13 subjects, the biceps brachii muscle was tested in 12, and other shoulder muscles were tested variously among the subjects. Two groups of muscles were identified. Group I muscles, the supraspinatus, infraspinatus, teres minor, deltoid, trapezius, and biceps brachii, served primarily to position the shoulder and elbow for the delivery of the pitch. These muscles were found to have greater activity during the early and late cooking stages, with less activity during acceleration. Group II muscles accelerated the arm and baseball forward in space. These muscles, the pectoralis major, serratus anterior, subscapularis, and latissimus dorsi, had stronger activity during the propulsive phase of the pitch. The professional pitchers were able to use the muscles about the shoulder in an efficient manner to achieve greater pitching velocities. The subscapularis and latissimus dorsi muscles of Group II had stronger activity among the professionals, whereas the supraspinatus, teres minor, and biceps brachii muscles of Group I had only minimal activity. The amateurs, on the other hand, continued to use all of the rotator cuff muscles and the biceps brachii muscle of Group I through the acceleration stage of the pitch.(ABSTRACT TRUNCATED AT 250 WORDS)
350 citations
TL;DR: The biomechanical properties of passive and stimulated muscle rapidly lengthened to failure in an experimental animal model may lead to enhanced understanding of the mechanism and physiology of muscle strain injuries.
Abstract: We compared the biomechanical properties of passive and stimulated muscle rapidly lengthened to failure in an experimental animal model. The mechanical parameters compared were force to tear, change in length to tear, site of failure, and energy absorbed by the muscle-tendon unit before failure. Paired comparisons were made between 1) muscles stimulated at 64 Hz (tetanic stimulation) and passive (no stimulation) muscles, 2) muscles stimulated at 16 Hz (wave-summated stimulation) and passive muscles, and 3) muscles stimulated at 64 Hz and at 16 Hz. Both tetanically stimulated and wave-summation contracted muscles required a greater force to tear (at 64 Hz, 12.86 N more, P less than 0.0004; and at 16 Hz, 17.79 N more, P less than 0.003) than their nonstimulated controls, while there was no statistical difference in failure force between muscles stimulated at 16 Hz and 64 Hz. The energy absorbed was statistically greater for the stimulated muscles than for the passive muscles in Groups 1 and 2 (at 64 Hz, 100% more, P less than 0.0003; and 16 Hz, 88% more, P less than 0.0002). In Group 3, the tetanically contracted muscle-tendon units absorbed 18% more energy than the wave-summated stimulated muscles (P less than 0.01). All muscles tore at the distal musculotendinous junction, and there was no difference in the length increase at tear between muscles in each group. These findings may lead to enhanced understanding of the mechanism and physiology of muscle strain injuries.
288 citations
TL;DR: The results of this study indicated that early mobilization is the treatment of choice in cases of isolated MCL injury and the importance and effectiveness of using various biome chanical parameters in addition to the conventional ultimate values at failure to evaluate the progress of soft tissue repair.
Abstract: In order to assess the healing of the medial collateral ligament (MCL) and to detect the various effects of treatment regimens, in vivo animal experiments using a canine model were performed. Thirty-five canine MCLs were surgically transected and treated using three clinically popular regimens, e.g., no repair with cage and farm activities (Group 1), repair with 3 weeks immobilization (Group 2), and repair with 6 weeks im mobilization (Group 3). The varus-valgus laxity of the knee joint, structural properties of the femur-MCL-tibia (FMT) complex and the mechanical properties of the MCL substance (healing site) were quantitatively meas ured at 6, 12, and 48 weeks postoperatively. It was found that Group 1 animals had the best results. The varus-valgus laxity of the knee joint and the structural properties of the FMT complex returned to values comparable with the contralateral control by 12 weeks. The recovery of the mechanical properties of the MCL substance was slower and not complete, even at 48 weeks. I...
261 citations
TL;DR: The study suggests that minimal tension should be applied to the graft materials during surgical reconstruction of the ACL, and the knees in which both graft materials were fixed with 1 N tension showed the strongest and stiffest reconstruc tion at 3 months.
Abstract: 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 components 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/history and mechanical testing. 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 reconstruction at 3 months. The study suggests that minimal tension should be applied to the graft materials during surgical reconstruction of the ACL.
TL;DR: The results demon strate that the infraspinatus/teres minor muscle group was the most effective in controlling external rotation of the humerus and in reducing ligamentous strain.
Abstract: This study defines the interaction of the rotator cuff musculature and the glenohumeral ligaments in providing anterior stability to the glenohumeral joint. Eight cadaveric shoulders were studied using a testing frame that individually simulated the forces of the subscapularis, the supraspinatus, and the infraspinatus/teres minor musculature. The application of these forces abducted the humerus to approximately 90 degrees. The cocking phase of throwing was then simulated through the use of an Instron. With random variation of the rotator cuff forces, we investigated the effects that each force had on the rotation of the humerus and the strain of the inferior glenohumeral ligament. Our results demonstrate that the infraspinatus/teres minor muscle group was the most effective in controlling external rotation of the humerus and in reducing ligamentous strain. These observations are pertinent in the treatment of anterior instability syndromes of the shoulder.
TL;DR: In this article, the dimensions and configuration of the intercondylar notch in the normal knee were compared to those of knees with unilateral and bilateral ACL tears, and to determine if generalized ligamentous laxity is associated with intra-clavical notch stenosis and ACL tears.
Abstract: The purposes of this study were to document the dimensions and configuration of the intercondylar notch in the normal knee; to compare normal knee intercondylar notches to those of knees with unilateral and bilateral ACL tears to determine if there is a relationship between intercondylar notch stenosis and ACL tears; and to determine if generalized ligamentous laxity is associated with intercondylar notch stenosis and ACL tears. Three groups were compared: Group I, bilateral ACL tears; Group II, unilateral tears; and Group III, normal knees. Notch dimensions were computer-generated from CT scans. All patients were examined for ligamentous laxity. Statistically significant differences were found between normal and ACL-injured knees in regard to opening notch angle, ratio of notch width at two-thirds of the notch length to condylar width, and ratio of maximum notch width to condylar width, suggesting a significant association between anterior outlet stenosis and unilateral and bilateral ACL tears. The shapes of the notches were determined from tracings of the distal CT scan. Shapes ranged from inverted U to cresting wave. Narrow notches tended to be waveshaped, but more study is needed in this area. Notch-plasty is recommended for those with documented stenosis. The ratio of maximum notch width at two-thirds of the notch height to maximum condyle width should not be much less than 0.2, and the opening notch angle should be at least 50 degrees.
TL;DR: Findings suggest that decreasing muscle function seen clinically between 24 and 48 hours following strain injury may result from pain due to inflammation, andScarring and fibrosis seen at 7 days may explain the frequent recur rence of injury to strained muscles.
Abstract: This study correlates force generation and healing in muscle after controlled strain injury. Right tibialis anterior (TA) muscles from 30 rabbits were strained to approximately 80% of failure while the left TA muscles served as control. Both injured and control muscles were then tested for ability to generate force. Seven animals were sacrificed immediately after testing and the muscles were examined grossly and histologically. Remaining animals were retested at 24 hours (N = 7), 48 hours (N = 8), and 7 days (N = 8). Contractile ability following injury was 70.5% of control immediately, 51.1% at 24 hours, 74.5% at 48 hours, and 92.5% at 7 days. Immediate histology showed limited distal fiber rupture and hemorrhage. By 24 hours, histology showed fiber necrosis, infiltration of inflammatory cells, edema, and hemorrhage. At 48 hours there was complete fiber breakdown and intense inflammatory cell proliferation. At 7 days inflammation was reduced and collagen fibrosis more advanced. Our findings demonstrate that injured muscle begins functional recovery by 48 hours despite inflammation and active healing. This suggests that decreasing muscle function seen clinically between 24 and 48 hours following strain injury may result from pain due to inflammation. Scarring and fibrosis seen at 7 days may explain the frequent recurrence of injury to strained muscles.
TL;DR: The results of this study suggest that under normal knee joint motion, the functional deficit of the MCL in valgus rotation was compensated for by the remaining structures, especially by the ACL.
Abstract: The purpose of this study was to explain the functional roles of the medial collateral ligament (MCL) and the ACL and how they affect the kinematics of the knee joint after isolated MCL injury. Varus-valgus joint laxity was quantitatively measured using a device which allowed various degrees of freedom (DOF) of joint motion during application of a varus-valgus bending moment to the canine knee joint. When the knee motion was limited to 3 DOF (varus-valgus rotation, proximal-distal, and medial-lateral translation), valgus laxity increased significantly (171%) after sectioning the MCL. Thus, the MCL was the primary restraint to the valgus bending moment in the 3 DOF mode. However, the effect of sectioning the MCL on valgus laxity became minimal (21% increase) when the DOF of knee motion was increased to 5 (by adding axial tibial rotation and anterior-posterior translation). In this situation, external and internal tibial axial rotation were coupled with the varus and valgus rotation of the knee joint, respectively, and the ACL also functioned to restrain the varus-valgus rotation. The results of this study suggest that under normal knee joint motion, the functional deficit of the MCL in valgus rotation was compensated for by the remaining structures, especially by the ACL.
TL;DR: Surgery offers a solution for highly motivated runners with chronic posterior heel pain who would like to continue running when conservative measures have failed, and particularly if they are competitive.
Abstract: Inflammation of the Achilles tendon and its contiguous structures is one of the most common overuse problems seen in runners. There are actually several etiologies. Involvement of the tendon itself is secondary to areas of mucinoid or fibrotic degeneration, or may be a result of a partial rupture. The sheath (or mesotenon) may also become chronically inflammed. Retrocalcaneal bursitis seems to be a separate entity with hypertrophy and fibrosis of the bursa usually occurring in conjunction with a prominent posterior superior angle of the os calcis. The vast majority of patients can be successfully treated nonoperatively; however, there is a group of patients who are refractory to nonoperative management who would like to continue running, particularly if they are competitive. A retrospective review of 45 surgical cases in 37 patients was performed. All but two of these patients were competitive long-distance runners. There were 24 cases of Achilles tendinitis and/or tenosynovitis, 14 cases with retrocalcaneal bursitis, and 7 with a combination of both. Mean followup was 3 years (range, 1 1/2 to 8 years). Overall there were 87% satisfactory results. Ninety-two percent of the patients with involvement with the tendon and/or sheath had a satisfactory outcome as compared with 71% of patients with retrocalcaneal bursitis. Passive dorsiflexion in the 29 unilateral cases improved from a mean of 17 degrees preoperatively to a mean of 25 degrees postoperatively. We feel that surgery offers a solution for highly motivated runners with chronic posterior heel pain who would like to continue running when conservative measures have failed.
TL;DR: His tologic evaluation of the allografts revealed the pres ence of a regular oriented dense connective tissue which resembled a normal ligament, and Microangiography revealed a periligamentous and endoligamentic pattern reminiscent of a normal ACL and complete revascularization of the bone plugs.
Abstract: One ACL in each of 11 mature goats was replaced with a freeze dried bone-ACL-bone allograft. One year fol lowing implantation the goats had their knees evaluated biomechanically and for microvascularity and histologic changes. The reconstructed knees had a significantly greater total AP laxity (3.8 ± 0.6 mm) (mean and SEM) than the controls (1.0 ± 0.1 mm). Differences in primary AP laxity were responsible for 81 % of the difference in total laxity, with only a 0.4 mm difference in secondary laxity. Neutral stiffness in the reconstructive knee was 17% of control. while stiffness at 30 newtons (N) of anterior force was approximately 50% of controls. Lig ament stiffness in the linear region for the ACL allograft was 35% of the control value of 686 N/mm. The maxi mum load of the allografts was 571 ± 45 N, or 25% of the contralateral ACL control strength (2301 ± 155 N). Five of the seven allografts failed at the femoral inser tion. Both elongation (83%) and energy (21 %) to max imum load were less for allograf...
TL;DR: The cor acoclavicular ligament, especially the trapezoid liga ment, provides significant soft tissue restraints to up ward displacement of the clavicle and transection of the CA ligament may result in loss of this buffering function.
Abstract: An anatomical study of the acromioclavicular (AC) joint and its supporting ligaments was performed using both macroscopic and microscopic methods. The project used 63 cadaver shoulders of unknown ages. Fifty- three joints were used for macroscopic and 10 for microscopic study. The data consisted of 1) micrometer measurements of the dimensions of the extrinsic and intrinsic ligaments of the AC joint; 2) measurement and description of the intraarticular meniscus and the su perior and inferior capsular ligaments of the AC joint; and 3) the anatomical course and relationship of the coracoacromial (CA) ligament to the supporting liga ments of the AC joint and a description of its insertion on the acromion process.The following observations were made: The cor acoclavicular ligament, especially the trapezoid liga ment, provides significant soft tissue restraints to up ward displacement of the clavicle. A complete AC joint disc was found in only one, meniscoid discs in 25, remnants of discs in 16, and no discs in...
TL;DR: Surgical results of 42 consecutive patients with spontaneous rupture of the Achilles ten don treated from 1973 to 1984 revealed equilibra tion of range of motion and near normal function in all repair techniques with 88% of all patients returning to preinjury activity levels.
Abstract: We evaluated the surgical results of 42 consecutive patients with spontaneous rupture of the Achilles ten don treated from 1973 to 1984 to determine the causes of rupture and to evaluate our treatment methods. Patients were divided into early and late repair groups and their charts reviewed to determine common clinical features. A new method of repair with early functional range of motion exercises before casting was used and compared to other techniques in common use. Thirty- one patients were contacted for long-term followup (average, 4.7 years). Twenty-three of these patients returned for intensive reevaluation and Cybex testing.We found a high incidence of gout (14.3%) and previous steroid injections (7.1 %) in our patients. Good results were obtained from the four surgical methods used. There were no reruptures and only 7% of the patients experienced minor wound problems. Patients treated with early functional range of motion exercises averaged 12.5° more dorsiflexion at the time of cast removal and ...
TL;DR: Bio mechanical, microvascular, and histological changes were evaluated 1 year following implantation of a freeze dried bone-ACL-bone allograft and a ligament augmentation device (LAD) and revealed soft tissue cellular ingrowth into the LAD in the extraarticular por tions.
Abstract: One ACL in each of 11 mature goats was replaced with a freeze dried bone-ACL-bone allograft and a ligament augmentation device (LAD). The LAD was released from its tibial fixation at 3 months postoperation. Bio mechanical, microvascular, and histological changes were evaluated 1 year following implantation. The re constructed knees had a significantly greater total AP translation (3.1 ± 0.5 mm) (mean and SEM) than the contralateral controls (1.0 ± 0.1 mm). Differences in primary AP translation were responsible for 59% of the difference in total translation, with only a 0.6 mm differ ence in secondary translation. Neutral stiffness in the reconstructive knee was 22% of control, while stiffness at 30 N of anterior force was approximately 35% of controls. Ligament stiffness in the linear region for the ACL allograft/LAD was 53% of the control value of 691 N/mm. The maximum load of the allograft/LADs was 1,052 ± 145 N, or 43% of the contralateral ACL control strength (2,448 ± 144 N). Five of the six allograft...
TL;DR: The case of a competitive weightlifter and wrestler who sustained a triceps rupture in the musculotendinous region, underwent surgery, and had an excellent result at 51/2 years postoperation is reported.
Abstract: Complete or partial rupture of the triceps tendon has been reported as a rare injury and also as the least commonly ruptured tendon.6, 24 The triceps most commonly ruptures from its tendoosseous insertion, but it may rupture in midsubstance or within its musculotendinous region. It may completely or partially rupture and also may be associated with radial head fractures. There are approximately 49 case reports of triceps ruptures in the English literature. We are reporting the case of a competitive weightlifter and wrestler who sustained a triceps rupture in the musculotendinous region, underwent surgery, and had an excellent result at 51/2 years postoperation. The history, clinical presentation, anatomy, and surgical repair of triceps rupture is discussed.
TL;DR: The continuous coding system of patient visits at an outpatient sports clinic showed great advantages as a basic data bank for scientific research, annual statistics, and patient identification and filing.
Abstract: At the Tampere Research Station of Sports Medicine (TRSSM) a continuous coding system of patient visits was started on March 1, 1985. The registration form contained 25 variables including all essential information about the patient's identification, sports, time of and reason for the visit, physician, examinations, diagnosis, treatment, and possible further measures. To classify and number the diagnosis, a specific classification of sports injuries and diseases was drawn up. The data were stored and analyzed using a DEC-2060 computer at the University of Tampere. During 6 months a total of 814 visits were recorded. The three most common sports were soccer, long-distance running, and orienteering. Competitive athletes totalled 337 (62%); 43 of these were top-ranking athletes. The most common reasons for visits were problems of the knee (266 visits, 33%), ankle (80, 10%), and low back (71, 9%). Knee sprains accounted for 10% of all visits. Problems related to the musculoskeletal system were the reason for 751 (92%) of all visits. Operative treatment was needed by 49 patients (6%). The continuous coding system of patient visits at an outpatient sports clinic showed great advantages as a basic data bank for scientific research, annual statistics, and patient identification and filing. The system described has been adopted as part of the daily routine at the TRSSM.
TL;DR: It is found that more attention should be given to a bal anced stretching regimen as part of the dancers' war mup in an effort to reduce the frequency of some of the chronic hip and knee complaints.
Abstract: Knee and hip problems account for up to 40% of injuries in classical ballet. Despite apparent flexibility, many dancers appeared to have tight iliotibial bands that contributed to lower limb problems. Thirty senior female ballet dancers were contrasted with thirty age-matched active volunteers for hip and knee range of motion, and the information derived was correlated with their orthopaedic medical histories. Dancers spent a reasonable period of time warming up, but it was usually with an unbalanced routine that emphasized hip abduction and external rotation to the exclusion of adduction work. This was reflected in the significantly lower range of passive hip adduction and internal rotation compared to the controls. Furthermore, the older and more experienced the dancer, the more this trend was exaggerated. This unbalanced flexibility may play a role in the production of lateral knee pain (30% of the dancers) and anterior hip pain (33% of the dancers). It is suggested that more attention should be given to a balanced stretching regimen as part of the dancers' warmup in an effort to reduce the frequency of some of the chronic hip and knee complaints.
TL;DR: It is suggested that a narrowed posterior arch of the inter condylar notch may predispose a knee to ACL tear.
Abstract: Although the intercondylar notch becomes narrowed with a failed repair of the ACL or with chronic instability of the knee, narrowed intercondylar notches have frequently been observed during arthrotomy for an acute ACL tear in previously uninjured knees. In order to determine whether the structure of the intercondylar notch predisposes a knee to anterior cruciate tears, a computer graphics study was designed. Notch view roentgenograms of 50 patients with an acute ACL injury and 50 "normal" patients without history of significant knee injury were compared. An interactive graphics design station was used to obtain the area of the anterior opening (ANT) and posterior arch (POST) of the intercondylar notch. A "total" (TOTAL) area was obtained by tracing the distal 7.5 cm of the femur. Only the ratios of areas obtained from each roentgenogram were used for comparison because of varying femur sizes among patients and possible slightly varying techniques of taking the notch view roentgenogram itself. The following ratios were developed: ANT/POST, POST/TOTAL, and (POST-ANT)/TOTAL. The difference between the means of the ratio POST/TOTAL for knees with acute ACL tears and those for normal knees was statistically significant (P less than 0.005). This study suggests that a narrowed posterior arch of the intercondylar notch may predispose a knee to ACL tear.
TL;DR: The purpose of this paper is to identify forearm muscle firing patterns during the pitching cycle in an effort to under stand this etiology of elbow injuries, and cannot substantiate that medial elbow problems are a result of an increase in the use of flexor muscles during the curve ball pitch.
Abstract: Elbow injuries are common in baseball pitchers. Curve balls are thought to increase this risk, particularly if the athlete begins throwing this pitch at an early age. The purpose of this paper is to identify forearm muscle firing patterns during the pitching cycle in an effort to understand this etiology. Dynamic EMG was performed on eight collegiate pitchers to evaluate extensor digitorum communis, brachioradialis, flexor carpi radialis, flexor digitorum superficialis, extensor carpi radialis longus, extensor carpi radialis brevis, pronator teres, and supinator. Each subject threw a fast ball and curve ball, which were filmed at 450 frames per second and synchronized with the EMG. These signals were converted from analog to digital records. Results showed low to moderate activity in all muscles during all phases of the pitch. The function is probably positioning to accept the transfer of energy from the larger trunk and girdle structures. The most notable difference between the fast ball and curve ball is a slight increase in the extensor carpi radialis longus and extensor carpi radialis brevis activity during late cocking, acceleration, and follow-through of the curve ball as compared to the fast ball. This difference, however, is not significant. In addition, there was no significant difference between the fast ball and the curve ball in the flexor-pronator group in any phase. We cannot substantiate that medial elbow problems are a result of an increase in the use of flexor muscles during the curve ball pitch.
TL;DR: This paper represents the first large study to date on the subject, including both an analysis of medical complications at six triathlons as well as a prospective electrolyte study conducted at two of these races.
Abstract: Triathlons (races involving consecutive swimming, bicycling, and running) have become commonplace in the United States. These races may involve from 30 minutes to 36 hours of continuous exercise, usually in warm or hot environments. Little has been published regarding the medical and physiological aspects of these events. This paper represents the first large study to date on the subject, including both an analysis of medical complications at six triathlons as well as a prospective electrolyte study conducted at two of these races. Medical records were kept and examined for all athletes requiring treatment during a typical United States Triathlon Series (USTS) race in 1986 (1,000 starters; finish times, 2 to 4 hours), a typical Ironman Qualifier (IQ) race in 1986 (622 starters; finish times, 4 to 8 hours), and the 1982 through 1985 Hawaii Ironman World Championships (4,583 starters; finish times, 9 to 17 hours). At the USTS race, fewer than 2% (17/1,000) of the starters required aid, at the IQ, approximately 10% (61/622) of the starters were treated, and at the Ironman, an average of 17% (794/4,583) received medical attention. The most common diagnoses at the USTS and IQ were dehydration and heat exhaustion. At the Ironman, dehydration and heat problems were complicated by hyponatremia. Because hyponatremia has been reported as a complication of ultraendurance events, a prospective study was performed on 36 athletes during a USTS race and 64 athletes at the 1984 Ironman race. Prerace and postrace blood samples showed that no athletes were hyponatremic following the shorter USTS race, but 27% (17/64) of the athletes studied were hyponatremic following the Ironman race.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: A high risk gymnast is defined as one who is performing at an advanced competitive level, performing floor or beam exercises, and practicing more than 20 hours per week, and there was a positive correlation between duration of frequency of practice (fatigue) and injury rate.
Abstract: Gymnastics has undergone a tremendous increase in popularity largely due to exposure during the Olympics. The injury rate in gymnastics is exceeded only by football, wrestling, and softball. A prospective analysis of club level gymnastic injuries over one season (1982-83) was conducted. Complete responses from 15 clubs (2,558 participants) were obtained. Parameters of clubs followed were: skill level, student, instructor ratio, safety equipment, and conditioning and warm-up exercises. Data obtained from each participant were: injuries sustained, event in which injury occurred, setting of injury, type of injury, and duration of disability. Results were 62 injuries among 542 competitive and 2,016 noncompetitive level athletes (5.3 per 100 competitors and 0.7 per 100 beginners). Of the 62 injuries, 51 were acute and 11 chronic. Twenty-one injuries occurred during floor exercises, 13 on beam, 9 on vault, 6 on uneven parallel bars, and 2 on springboard. Acute injuries included 21 sprains, 16 fractures, 6 contusions, 4 dislocations, and 4 muscle strains. A significant finding was the increased frequency of acute injury seen at dismount. Also there was a positive correlation between duration of frequency of practice (fatigue) and injury rate. We would define a high risk gymnast as one who is performing at an advanced competitive level, performing floor or beam exercises, and practicing more than 20 hours per week.
TL;DR: Athletes participating in noncontact sports involving abduction and external rotation of the shoulder (e.g., throwing) may develop occult recurrent subluxation manifested only as pain and the lack of contact trauma preceding symptoms can lead to incorrect diagnosis by the physician.
Abstract: Athletes participating in noncontact sports involving abduction and external rotation of the shoulder (e.g., throwing) may develop occult recurrent subluxation manifested only as pain. The lack of contact trauma preceding symptoms, the failure of the athlete to ap preciate the instability, the relative rarity that the lesion has been previously recognized and reported, and the lack of objective evidence of instability often lead to incorrect diagnosis by the physician.We report 30 shoulders in 28 patients with this lesion. Nineteen of these patients had been originally seen by other physicians prior to presenting to us and mis diagnosed. The newly described apical oblique roent genographic projection revealed Hill-Sach's lesions in 23 of 28 patients in this series. In addition, two of the five patients without Hill-Sach's lesions had bony changes pathognomonic for the Bankart lesion on the apical oblique projection. A total of 25 of the 28 patients had objective roentgenographic evidence of previous anter...
TL;DR: A direct correlation was noted between performance level of the athlete and incidence of injuries and within all events, although some variation was noted within these separate groups.
Abstract: Two hundred fifty-seven high school track athletes from 17 teams were observed prospectively for one complete season (77 days) to study the incidence and types of injuries and to establish the relationship among injuries, duration of training, and individual performance ability. One hundred seventy-four (68%) of the athletes were male and 83 (33%) were female. A total of 41 injuries was observed over this period of time. One injury occurred for every 5.8 males and every 7.5 females. On the average, an injury resulted in 8.1 days of missed practice, 8.7 days for males and 6.6 days for females. Sprinting events were responsible for 46% of all injuries. The majority (83%) of injuries involved the lower extremities. Management of these injuries varied greatly. A direct correlation was noted between performance level of the athlete and incidence of injuries. The average noninjured athlete ranked at the 57.4 percentile based on best seasonal performance while the average injured athlete ranked at the 75.4 percentile. This direct relationship was present for both sexes and within all events, although some variation was noted within these separate groups.
TL;DR: The use of the prophylactic knee braces was associated with increased episodes of muscle cramping in the triceps surae muscle group, required the constant attention of coaches and trainers to remind the players to wear the braces and to apply them correctly, and was costly.
Abstract: We report on the number of knee injuries sustained by a major college football team during 2 full years when all players were required to wear laterally placed prophylactic knee braces during all practice sessions and all games. We found that the incidence rates of knee injuries were higher when the braces were worn compared to a similar period when the braces were not worn. There was also an increased number of ACL injuries during the brace period. Several indices characterizing the nature of the injuries were analyzed and were found not to be altered significantly when the prophylactic braces were used. These facts lead us to question the efficacy of prophylactic knee braces in preventing knee injuries in college football. The use of the braces was associated with increased episodes of muscle cramping in the triceps surae muscle group, required the constant attention of coaches and trainers to remind the players to wear the braces and to apply them correctly, and was costly. These findings indicate the need for other carefully controlled clinical and biomechanical studies of these devices before their routine use can be advocated.