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Showing papers in "American Journal of Sports Medicine in 2002"


Journal ArticleDOI
TL;DR: Autologous chondrocyte transplantation for the treatment of articular cartilage injuries has a durable outcome for as long as 11 years, compared with 2 years after the transplantation.
Abstract: We evaluated the durability of autologous chondrocyte transplantation grafts in 61 patients treated for isolated cartilage defects on the femoral condyle or the patella and followed up for a mean of 7.4 years (range, 5 to 11). Durability was determined by comparing the clinical status at the long-term follow-up with that found 2 years after the transplantation. After 2 years, 50 of the 61 patients had good or excellent clinical results, and 51 of 61 had good or excellent results at 5 to 11 years later. Grafted areas from 11 of the patients were evaluated with an electromechanical indentation probe during a second-look arthroscopy procedure (mean follow-up, 54.3 months; range, 33 to 84); stiffness measurements were 90% or more of those of normal cartilage in eight patients. Eight of twelve 2-mm biopsy samples taken from these patients showed hyaline characteristics with safranin O staining and a homogeneous appearance in polarized light. Three fibrous and eight hyaline biopsy specimens stained positive to aggrecan and to cartilage oligomeric matrix protein. Hyaline-like specimens stained positive for type II collagen, and fibrous, for type I collagen. Autologous chondrocyte transplantation for the treatment of articular cartilage injuries has a durable outcome for as long as 11 years.

1,007 citations


Journal ArticleDOI
TL;DR: Anterior tibial translation for the anatomic reconstruction was significantly closer to that of the intact knee than was the single-bundle reconstruction, indicating that Anatomic reconstruction may produce a better biomechanical outcome, especially during rotatory loads.
Abstract: Background:The focus of most anterior cruciate ligament reconstructions has been on replacing the anteromedial bundle and not the posterolateral bundle.Hypothesis:Anatomic two-bundle reconstruction restores knee kinematics more closely to normal than does single-bundle reconstruction.Study Design:Controlled laboratory study.Methods:Ten cadaveric knees were subjected to external loading conditions: 1) a 134-N anterior tibial load and 2) a combined rotatory load of 5-N·m internal tibial torque and 10-N·m valgus torque. Resulting knee kinematics and in situ force in the anterior cruciate ligament or replacement graft were determined by using a robotic/universal force-moment sensor testing system for 1) intact, 2) anterior cruciate ligament deficient, 3) single-bundle reconstructed, and 4) anatomically reconstructed knees.Results:Anterior tibial translation for the anatomic reconstruction was significantly closer to that of the intact knee than was the single-bundle reconstruction. The in situ force normalize...

895 citations


Journal ArticleDOI
TL;DR: The typical musculoskeletal profile of the overhead thrower and various rehabilitation programs for specific injuries are discussed and structured, multiphase approach with emphasis on controlling inflammation, restoring muscle balance, improving soft tissue flexibility, enhancing proprioception and neuromuscular control is followed.
Abstract: The overhead throwing motion is an extremely skillful and intricate movement that is very stressful on the shoulder joint complex. The overhead throwing athlete places extraordinary demands on this complex. Excessively high stresses are applied to the shoulder joint because of the tremendous forces generated by the thrower. The thrower's shoulder must be lax enough to allow excessive external rotation, but stable enough to prevent symptomatic humeral head subluxations, thus requiring a delicate balance between mobility and functional stability. We refer to this as the "thrower's paradox." This balance is frequently compromised, which leads to injury. Numerous types of injuries may occur to the surrounding tissues during overhead throwing. Frequently, injuries can be successfully treated with a well-structured and carefully implemented nonoperative rehabilitation program. The key to successful nonoperative treatment is a thorough clinical examination and accurate diagnosis. Athletes often exhibit numerous adaptive changes that develop from the repetitive microtraumatic stresses observed during overhead throwing. Treatment should focus on the restoration of these adaptations during the rehabilitation program. In this article, the typical musculoskeletal profile of the overhead thrower and various rehabilitation programs for specific injuries are discussed. Rehabilitation follows a structured, multiphase approach with emphasis on controlling inflammation, restoring muscle balance, improving soft tissue flexibility, enhancing proprioception and neuromuscular control, and efficiently returning the athlete to competitive throwing.

664 citations


Journal ArticleDOI
TL;DR: Pitchers in this age group should be cautioned about throwing breaking pitches (curveballs and sliders) because of the increased risk of elbow and shoulder pain and limitations on pitches thrown in a game and in a season can also reduce the risk of pain.
Abstract: BackgroundJoint pain is thought to be an early sign of injury to a pitcher.ObjectiveTo evaluate the association between pitch counts, pitch types, and pitching mechanics and shoulder and elbow pain in young pitchers.Study DesignProspective cohort study.MethodsFour hundred and seventy-six young (ages 9 to 14 years) baseball pitchers were followed for one season. Data were collected from pre- and postseason questionnaires, injury and performance interviews after each game, pitch count logs, and video analysis of pitching mechanics. Generalized estimating equations and logistic regression analysis were used.ResultsHalf of the subjects experienced elbow or shoulder pain during the season. The curveball was associated with a 52% increased risk of shoulder pain and the slider was associated with an 86% increased risk of elbow pain. There was a significant association between the number of pitches thrown in a game and during the season and the rate of elbow pain and shoulder pain.ConclusionsPitchers in this age ...

644 citations


Journal ArticleDOI
TL;DR: A comparison of the dominant shoulders of the two groups indicated that both external rotation at 90° and humeral head retroversion were significantly greater in the throwing group than in the nonthrowing group.
Abstract: The throwing shoulder in pitchers frequently exhibits a paradox of glenohumeral joint motion, in which excessive external rotation is present at the expense of decreased internal rotation. The object of this study was to determine the role of humeral head retroversion in relation to increased glenohumeral external rotation. Glenohumeral joint range of motion and laxity along with humeral head and glenoid version of the dominant versus nondominant shoulders were studied in 25 professional pitchers and 25 nonthrowing subjects. Each subject underwent a computed tomography scan to determine bilateral humeral head and glenoid version. The throwing group demonstrated a significant increase in the dominant shoulder versus the nondominant shoulder in humeral head retroversion, glenoid retroversion, external rotation at 90 degrees, and external rotation in the scapular plane. Internal rotation was decreased in the dominant shoulder. Total range of motion, anterior glenohumeral laxity, and posterior glenohumeral laxity were found to be equal bilaterally. The nonthrowing group demonstrated no significant difference in humeral head retroversion, glenoid retroversion, external rotation at 90 degrees or external rotation in the scapular plane between shoulders, and no difference in internal rotation at 90 degrees, total motion, or laxity. A comparison of the dominant shoulders of the two groups indicated that both external rotation at 90 degrees and humeral head retroversion were significantly greater in the throwing group.

590 citations


Journal ArticleDOI
TL;DR: The results demonstrate that persistent muscle strength abnormalities may give rise to recurrent hamstring injuries and discomfort, and an individualized rehabilitation program emphasizing eccentric training based on specific deficits contributes to a decrease in symptoms on return to sports.
Abstract: We determined the frequency of strength disorders in 26 athletes with a history of hamstring muscle injury and recurrent strains and discomfort. We also assessed the effectiveness of rehabilitation to correct muscle performance. After concentric and eccentric isokinetic assessment, 18 athletes were found to have strength deficits, as determined by statistically selected cutoffs of peak torque, bilateral differences, and the flexors/quadriceps ratio. The discriminating character of the eccentric trial was demonstrated, combining a preferential eccentric peak torque deficit and a significant reduction of the mixed eccentric flexors/concentric quadriceps ratio. The athletes with muscle imbalances followed a rehabilitation program individually adapted from their strength profile. Treatment length was from 10 to 30 sessions and resulted in isokinetic parameter normalization in 17 of 18 subjects. Isokinetically corrected subjects were observed for 12 months after return to athletics. None sustained a clinically diagnosed hamstring muscle reinjury. Subjective intensity of pain and discomfort were significantly reduced, and they all returned to their prior level of competition. These results demonstrate that persistent muscle strength abnormalities may give rise to recurrent hamstring injuries and discomfort. An individualized rehabilitation program emphasizing eccentric training based on specific deficits contributes to a decrease in symptoms on return to sports.

564 citations


Journal ArticleDOI
TL;DR: The results indicate that female recreational athletes may have altered motor control strategies that result in knee positions in which anterior cruciate ligament injuries may occur and technical training for female athletes may need to be focused on reducing the peak proximal tibia anterior shear force in stop-jump tasks.
Abstract: We compared the knee kinetics of 10 male and 10 female recreational athletes (aged 19 to 25 years) performing forward, vertical, and backward stop-jump tasks. Three-dimensional videography and force plate data were used to record the subjects' performance of the three stop-jump tasks, and an inverse dynamic procedure was used to estimate the knee joint resultant forces and moments. Women exhibited greater proximal anterior shear force than did men during the landing phase. All subjects exhibited greater proximal tibia anterior shear force during the landing phase of the backward stop-jump task than during the other two stop-jump tasks. Women also exhibited greater knee extension and valgus moments than did men during the landing phase of each stop-jump task. Men exhibited greater proximal tibia anterior shear force than did women during the takeoff phase of vertical and backward stop-jump tasks. These results indicate that female recreational athletes may have altered motor control strategies that result in knee positions in which anterior cruciate ligament injuries may occur. The landing phase was more stressful for the anterior cruciate ligament of both women and men than the takeoff phase in all stop-jump tasks. Technical training for female athletes may need to be focused on reducing the peak proximal tibia anterior shear force in stop-jump tasks. Further studies are needed to determine the factors associated with the increased peak proximal tibia anterior shear force in female recreational athletes.

561 citations


Journal ArticleDOI
TL;DR: Current thinking emphasizes precise diagnosis, rehabilitation involving the entire kinetic chain, restoration of patella homeostasis, minimal surgical intervention, and precise indications for more definitive corrective surgery.
Abstract: The patient-athlete with patellofemoral pain requires precise physical examination based on a thorough history. The nature of injury and specific physical findings, including detailed examination of the retinacular structure around the patella, will most accurately pinpoint the specific source of anterior knee pain or instability. Radiographs should include a standard 30° to 45° axial view of the patellae and a precise lateral radiograph. Nonoperative treatment is effective in most patients. Prone quadriceps muscle stretches, balanced strengthening, proprioceptive training, hip external rotator strengthening, patellar taping, orthotic devices, and effective bracing will help most patients avoid surgery. When surgery becomes necessary, indications must be specific. Lateral release is appropriate for patella tilt (abnormal rotation). Painful scar or retinaculum, neuromas, and pathologic plicae may require resection. Proximal patellar realignment may be accomplished using arthroscopic or a combined arthrosco...

557 citations


Journal ArticleDOI
TL;DR: The ligaments showed typical abnormalities corresponding to different entities of ankle instability and different intra-articular pathologic conditions, which revealed an essential amount of information that would otherwise have been undetected.
Abstract: BackgroundThere are little objective data on structural changes of the chronically unstable ankle. Such knowledge could help with preoperative planning.HypothesisPreoperative ankle arthroscopy provides important insights into the causes and mechanisms of ankle instability and the resulting disability.Study DesignCase series.MethodsFrom 1993 to 1999, arthroscopic examination was performed in the ankles of 148 patients with symptomatic chronic ankle instability that had lasted 6 months or more. All structural changes were recorded and compared with the clinical diagnosis.ResultsA rupture or elongation of the anterior talofibular ligament was noted in 86% of ankles, of the calcaneofibular ligament in 64%, and of the deltoid ligament in 40%. Cartilage damage was noted in 66% of ankles with lateral ligament injuries, whereas 98% of the ankles with deltoid ligament injuries had cartilage damage. Although lateral instability could be verified arthroscopically in 127 patients, medial instability was presumed clin...

488 citations


Journal ArticleDOI
TL;DR: A six-treatment, 6-week physical therapy regimen is efficacious for alleviation of patellofemoral pain.
Abstract: BackgroundAlthough physical therapy forms the mainstay of nonoperative management for patellofemoral pain, its efficacy has not been established.HypothesisSignificantly more pain relief will be achieved from a 6-week regimen of physical therapy than from placebo treatment.Study DesignMulticenter, randomized, double-blinded, placebo-controlled trial.MethodsSeventy-one subjects, 40 years of age or younger with patellofemoral pain of 1 month or longer, were randomly allocated to a physical therapy or placebo group. A standardized treatment program consisted of six treatment sessions, once weekly. Physical therapy included quadriceps muscle retraining, patellofemoral joint mobilization, and patellar taping, and daily home exercises. The placebo treatment consisted of sham ultrasound, light application of a nontherapeutic gel, and placebo taping.ResultsSixty-seven participants completed the trial. The physical therapy group (N = 33) demonstrated significantly greater reduction in the scores for average pain, w...

420 citations


Journal ArticleDOI
TL;DR: There is a pattern of increased external rotation and decreased internal rotation in the dominant extremity that significantly correlates with an increase in humeral retroversion, which may be more strongly related to adaptive changes in proximal humeral anatomy than to changes in the soft tissues.
Abstract: BackgroundPrevious studies have documented changes in musculature, bony anatomy, and glenohumeral rotation in the dominant shoulder of baseball players.HypothesisIn a group of asymptomatic college baseball players the total range of motion in the dominant and nondominant shoulders will be similar. Any measured increase in external rotation and decrease in internal rotation occurring between the two sides will be consistent and directly correlate with an increased angle of humeral retroversion in the dominant extremity.Study DesignDescriptive anatomic study.MethodsFifty-four asymptomatic college baseball players were examined. Standard measurements of glenohumeral range of motion were made and humeral retroversion was determined radiologically.ResultsTotal rotational motion, measured at 90° of glenohumeral abduction, was 159.5° for the dominant shoulders and 157.8° for the nondominant shoulders. Mean differences in external and internal rotation in the dominant versus nondominant extremities were 9.7° and ...

Journal ArticleDOI
TL;DR: The incidence of soccer injuries can be reduced by preventive interventions, especially in low skill level youth teams, and coaches and players need better education regarding injury prevention strategies and should include such interventions as part of their regular training.
Abstract: Background:Risk factors for soccer injuries and possibilities for prevention have been discussed by several authors, but only a few have investigated the effectiveness of preventive interventions.Purpose:The aim of the present study was to evaluate the effects of a prevention program on the incidence of soccer injuries in male youth amateur players.Study Design:Prospective controlled intervention study.Methods:Seven soccer teams took part in a prevention program that focused on education and supervision of coaches and players, while seven other teams were instructed to train and play soccer as usual. Over 1 year all injuries were documented weekly by physicians. Complete weekly injury reports were available for 194 players.Results:The incidence of injury per 1000 hours of training and playing soccer was 6.7 in the intervention group and 8.5 in the control group, which equates to 21% fewer injuries in the intervention group. The greatest effects were observed for mild injuries, overuse injuries, and injuri...

Journal ArticleDOI
TL;DR: Posterior heel pain is multifactorial and includes paratenonitis, tendinosis, tend inosis with partial rupture, insertional tendinitis, retrocalcaneal bursitis, and subcutaneous tendo-Achillisbursitis.
Abstract: Achilles tendon disorders are among the more common maladies seen by sports medicine physicians. Understanding the anatomy and biomechanics of the Achilles tendon and contiguous structures is essential to the diagnosis and treatment of Achilles tendon overuse injuries. Posterior heel pain is multifactorial and includes paratenonitis, tendinosis, tendinosis with partial rupture, insertional tendinitis, retrocalcaneal bursitis, and subcutaneous tendo-Achilles bursitis. Each of these entities is distinct, but they often occur in combination. Although most cases of this disorder are successfully treated nonoperatively, a small subgroup of recalcitrant cases may benefit from surgical intervention. Complete ruptures in active, athletic persons should be treated operatively in most cases and result in predictably good outcomes. There may be some cases that escape early recognition and require a reconstructive procedure to salvage a potentially severe functional deficit.

Journal ArticleDOI
TL;DR: Arthroscopic stabilization of traumatic, first-time anterior shoulder dislocations is an effective and safe treatment that significantly reduces the recurrence rate of shoulder disLocations in young athletes when compared with conventional, nonoperative treatment.
Abstract: Background: Nonoperative treatment of traumatic shoulder dislocations leads to a high rate of recurrent dislocations.Hypothesis: Early arthroscopic treatment for shoulder dislocation will result in a lower recurrence rate than nonoperative treatment.Study Design: Prospective, randomized clinical trial.Methods: Two groups of patients were studied to compare nonoperative treatment with arthroscopic Bankart repair for acute, traumatic shoulder dislocations in young athletes. Fourteen nonoperatively treated patients underwent 4 weeks of immobilization followed by a supervised rehabilitation program. Ten operatively treated patients underwent arthroscopic Bankart repair with a bioabsorbable tack followed by the same rehabilitation protocol as the nonoperatively treated patients. The average follow-up was 36 months.Results: Three patients were lost to follow-up. Twelve nonoperatively treated patients remained for follow-up. Nine of these (75%) developed recurrent instability. Six of the nine have required subse...

Journal ArticleDOI
TL;DR: Results from the hormone assays indicate that the women had a significantly greater than expected percentage of anterior cruciate ligament injuries during midcycle (ovulatory phase) and a less than expected proportion of those injuries during the luteal phase of the menstrual cycle.
Abstract: Anterior cruciate ligament injury rates are reported to be two to eight times higher in women than in men within the same sport. Because the menstrual cycle with its monthly hormonal fluctuations is one of the most basic differences between men and women, we investigated the association between the distribution of confirmed anterior cruciate ligament tears and menstrual cycle phase. Sixty-nine female athletes who sustained an acute anterior cruciate ligament injury were studied within 24 hours of injury at four centers. The mechanism of injury, menstrual cycle details, use of oral contraceptives, and history of previous injury were recorded. Urine samples were collected to validate menstrual cycle phase by measurement of estrogen, progesterone, and luteinizing hormone metabolites and creatinine levels at the time of the anterior cruciate ligament tear. Results from the hormone assays indicate that the women had a significantly greater than expected percentage of anterior cruciate ligament injuries during midcycle (ovulatory phase) and a less than expected percentage of those injuries during the luteal phase of the menstrual cycle. Oral contraceptive use diminished the significant association between anterior cruciate ligament tear distribution and the ovulatory phase.

Journal ArticleDOI
TL;DR: The docking technique allowed simplified graft tensioning and improved graft fixation and returned to or exceeded their previous level of competition for at least 1 year.
Abstract: BackgroundMedial collateral ligament insufficiency of the elbow with resultant valgus instability in throwing athletes is typically treated with free tendon graft reconstruction as described by Jobe.HypothesisImproved results could be obtained with the use of the docking technique.Study DesignUncontrolled retrospective review.MethodsThe study group consisted of 36 athletes who had symptomatic insufficiency of the medial collateral ligament confirmed by magnetic resonance imaging and by surgical findings. Average follow-up was 3.3 years. Key elements of the docking technique included a muscle-splitting approach without routine transposition of the ulnar nerve, routine arthroscopic assessment, treatment of associated lesions, and docking the two ends of the tendon graft into a single humeral tunnel.ResultsThirty-three of 36 patients (92%) returned to or exceeded their previous level of competition for at least 1 year, meeting the Conway-Jobe classification criteria of “excellent.” All 22 professional or col...

Journal ArticleDOI
TL;DR: Rotational changes in the throwing shoulder are due to bony as well as soft tissue adaptations, which contributes to the rotational asymmetry between shoulders in pitchers.
Abstract: BackgroundIncreased external rotation and decreased internal rotation have been noted to occur progressively in the throwing shoulder of baseball pitchers.HypothesisProximal remodeling of the humerus contributes to the rotational asymmetry between shoulders in pitchers.Study DesignDescriptive anatomic study.MethodsBoth shoulders of 19 male college baseball pitchers were evaluated and retroversion of the humerus calculated by using the technique of Soderlund et al. Measurements were taken of passive glenohumeral external rotation at 0° and 90° of abduction and internal rotation at 90° of abduction under a 3.5-kg load. Subjects completed a questionnaire on the amount and duration of overhead throwing performed during the ages 8 through 16 years.ResultsAll of the subjects had greater external rotation at 0° and 90° of abduction, decreased internal rotation at 90° of abduction, and greater retroversion of the humerus in their dominant compared with nondominant shoulders. A significant difference was found bet...

Journal ArticleDOI
TL;DR: Restoration and maintenance of the anatomic alignment of the Lisfranc joint is the key to appropriate treatment of injury to the midfoot.
Abstract: BackgroundMidfoot sprains in athletes represent a spectrum of injuries to the Lisfranc ligament complex, from partial sprains with no displacement to complete tears with frank diastasis. Treatment of these injuries varies from the treatment of high-velocity injuries seen in nonathletes.PurposeWe wanted to report the outcome of treatment in athletes with Lisfranc injuries classified according to our system.Study DesignRetrospective cohort study.MethodsWeightbearing radiographs and bone scintigrams were used to diagnose midfoot sprains in 15 athletes who were treated surgically or nonoperatively according to the following classification: nonoperative management for stage I injuries (undisplaced) and anatomic reduction with fixation for stage II (diastasis with no arch height loss) and stage III (diastasis with arch height loss) injuries.ResultsWe achieved an excellent outcome in 93% of 15 athletes with midfoot sprains at an average follow-up of 27 months (range, 9 to 72).ConclusionsWeightbearing radiographs...

Journal ArticleDOI
TL;DR: It was found that hamstring tendon grafts performed similarly to patellar tendon grafting, although fewer patients in the hamstring tendon group had patellofemoral pain and loss of motion.
Abstract: Seventy patients with patellar tendon or hamstring tendon autografts for single-incision anterior cruciate ligament reconstruction were evaluated at least 2 years after surgery. All reconstructions were performed by the same surgeon, and metal interference screws were used for fixation of all grafts. No significant differences were noted between groups for Lysholm score, reduction in activity, KT-1000 arthrometer findings, quadriceps muscle size, return to sports, or ability to jump and do hard cuts and pivots. Significantly more patients in the patellar tendon group had patellofemoral pain at 6 months after surgery than did the hamstring tendon patients (48% versus 20%), and at last follow-up the incidence of patellofemoral pain was 42% and 20%, respectively. Fourteen patients in the patellar tendon group and seven in the hamstring tendon group had loss of motion (approximately 5 degrees ). Four patients (two in each group) had treatment failures and their results were not included in the clinical examination data. At 2 years' follow-up, 97% of patients with patellar tendon grafts and 100% of patients with hamstring tendon grafts rated their results as good or excellent. We found that hamstring tendon grafts performed similarly to patellar tendon grafts, although fewer patients in the hamstring tendon group had patellofemoral pain and loss of motion.

Journal ArticleDOI
TL;DR: Adjustable valgus bracing was effective in reducing medial compartment load and subsequent pain while also improving knee function in a group of patients with osteoarthritis.
Abstract: BackgroundPatients with medial compartment osteoarthritis of the knee may be treated nonoperatively with adjustable valgus bracing.HypothesisValgus bracing reduces load on the medial compartment through the application of an external valgus moment about the knee, resulting in pain relief.Study DesignProspective cohort study.MethodsEleven patients were tested using an instrumented brace and three-dimensional gait analysis. We measured the valgus moment applied by the adjustable valgus brace and determined the compressive load in the medial compartment. We also documented the effects of increased valgus alignment of the brace and increased strap tension on load sharing. Pain and activity levels were also recorded.ResultsPain and activity level improved in all subjects with valgus bracing. During gait, valgus bracing reduced the net varus moment about the knee by an average of 13% (7.1 N•m) and the medial compartment load at the knee by an average of 11% (114 N) in the calibrated 4° valgus brace setting. Inc...

Journal ArticleDOI
TL;DR: The number of publications reporting Achilles tendon ruptures is increasing, the quality of articles are increasing, and the trend for the number of reported complications is decreasing, and open repair and early mobilization give the best functional recovery and an acceptable complication rate.
Abstract: Background: There is no consensus on the best method for management of acute Achilles tendon ruptures. Individual preferences, drawn from experience and study, determine whether treatment is operative or nonoperative.Purpose: Our goal was to review the literature to try to determine what management method was the most popular and effective. We wanted to ascertain the best results in terms of complication rates and patient outcomes.Study Design: Retrospective review of retrospectively and prospectively collected data.Methods: We analyzed 125 articles in peer-reviewed journals for year of publication, patient numbers, sex, management method, follow-up complications, and patient satisfaction. Each article was graded using a validated methods score. Methods, patient satisfaction, and complication rates were correlated with the year each article was published.Results: Skin-healing complications were lowest in conservatively managed patients (3 of 578, 0.5%) and highest in open repair and immobilized patients (...

Journal ArticleDOI
TL;DR: Arthroscopic reconstruction with either graft results in a similar surgical outcome, reliably restoring knee stability over a 5-year period; however, patients with patellar tendon grafts are at greater risk of developing early signs of osteoarthritis.
Abstract: BackgroundThe choice of graft material for anterior cruciate ligament reconstruction is believed to play a major role in outcome, but most comparisons of graft choice have not been well controlled.HypothesisThe choice of graft material (patellar tendon or hamstring tendon) does affect clinical outcome after anterior cruciate ligament reconstruction.Study DesignProspective, nonrandomized clinical trial.MethodsTwo groups of 90 patients each were followed for a minimum of 5 years.ResultsInternational Knee Documentation Committee assessment revealed that more than 85% of each group had an overall score of A or B at all follow-up intervals. The median Lysholm knee score was greater than 90 for both groups at 2 and 5 years. Instrumented testing revealed no significant difference between the two groups beyond 3 years. Thirty-one percent of the patellar tendon group (25) had a fixed flexion deformity and 19% of the hamstring tendon group (14) had fixed flexion deformity at 5 years. Radiologic assessment revealed ...

Journal ArticleDOI
TL;DR: A long-term prospective study of the results of medial meniscal transplantation combined with reconstruction of the anterior cruciate ligament found that patients with deep-frozen meniscal transplants generally had better results than patients with lyophilized meniscus transplants.
Abstract: Between May 1984 and December 1986, 23 patients with a history of medial meniscectomy and anterior knee instability were entered into a long-term prospective study of the results of medial meniscal transplantation combined with reconstruction of the anterior cruciate ligament. In 17 cases a lyophilized meniscal allograft was used and in 6 cases a deep-frozen meniscal allograft was used. The patients’ clinical outcomes were evaluated 3 and 14 years postoperatively by clinical assessment, Lysholm score, radiographs, magnetic resonance imaging, arthrography, and, in some cases, arthroscopy. Two anterior cruciate ligament reconstruction control groups were used for comparison, one group having previously undergone meniscectomy and one with intact menisci. The follow-up rate was 100% after 14 years. The Lysholm score was 84 ± 12 points at 3 years postoperatively and 75 ± 23 points at 14 years. Patients with deep-frozen meniscal transplants generally had better results than patients with lyophilized meniscal tr...

Journal ArticleDOI
TL;DR: Surgical repair or reconstruction of the cruciate ligaments was superior to nonsurgical treatment and functional rehabilitation was the most important positive prognostic factor.
Abstract: Background:Studies of traumatic knee dislocations have failed to provide a consensus regarding the best method of treatment.Purpose:Our purpose was to evaluate the results after surgical repair or reconstruction versus nonsurgical treatment and to compare the influence of prognostic factors.Study Design:Retrospective study.Methods:Eighty-nine patients were treated for traumatic knee dislocation. Surgical repair or reconstruction of the cruciate ligaments was performed in 63 patients (repair, 49; reconstruction, 14). In 26 patients, nonsurgical treatment was undertaken.Results:At an average follow-up of 8.2 years, the mean Lysholm and Tegner scores were 75 and 3.7, respectively. The outcome in the surgical group was better than in the nonsurgical group. The scores were higher in patients who were 40 years of age or younger, who had sports injuries rather than motor vehicle accident injuries, and who had undergone functional rehabilitation rather than immobilization.Conclusions:Surgical repair or reconstruc...

Journal ArticleDOI
TL;DR: Jumper's knee causes mild but long-lasting symptoms after an athletic career, and patellar height was associated with knee symptoms at follow-up.
Abstract: Background: Little information is available on the long-term outcome of jumper's knee, a common problem among athletes.Purpose: Our aim was to determine the 15-year prognosis of jumper's knee.Study Design: Prospective case control.Methods: The prognosis for jumper's knee was studied using two groups: athletes with jumper's knee and nonsymptomatic control athletes. At baseline, all subjects participated in standardized clinical examinations and measurements, and 15 years later they were asked to respond to a questionnaire.Results: Twenty athletes with jumper's knee and 16 athlete control subjects responded (response rate 74% and 84%, respectively). The jumper's knee group reported significantly more knee symptoms according to their Kujala score and more knee pain after repeated squatting. Fifty-three percent of the subjects in the jumper's knee group (9 of 17) reported that they had quit their sports career because of their knee problem, compared with 7% of the control athletes (1 of 14). Patellar height w...

Journal ArticleDOI
TL;DR: It is now possible to identify risk factors for the development of serious tendon disorders in asymptomatic athletes and to reduce the risk of chronic, therapy-resistant symptoms of tendinosis and ruptures.
Abstract: BackgroundChronic tendinosis of the Achilles or patellar tendons, or both, is one of the most frequent and severe conditions that affects athletes in sports such as soccer. It can often end an athlete's sports activity.HypothesisUltrasonography of asymptomatic tendons can be used to predict which athletes will develop tendon symptoms.Study DesignLongitudinal study.MethodsUsing ultrasonography of the ankle and knee, we examined 54 elite soccer players in the top Danish soccer league before and after a single season (in January and December).ResultsAt the start of the season, ultrasonography had revealed abnormalities in 29% of those examined. Eighteen percent (18 of 98 tendons) were observed to have abnormal sonographic findings in the patellar tendon at the initial examination in January. These athletes were found to have a 17% risk of developing symptomatic jumper's knee during the 12-month season. Eleven percent (11 of 96 tendons) were observed to have abnormal sonographic findings in the Achilles tendo...

Journal ArticleDOI
TL;DR: Age-adjusted logistic regression analysis revealed that the correlation between sports and recurrence rate was false, and it clearly showed that physical therapy and immobilization do not reduce the risk of recurrence.
Abstract: We evaluated the factors influencing the recurrence rate after primary anterior traumatic shoulder dislocation, especially sports activity. A significant number of patients changed to athletic activities that produce less shoulder strain. The natural assumption would be that sports activity directly influences recurrence. However, age-adjusted logistic regression analysis revealed that the correlation between sports and recurrence rate was false. Our statistical findings also clearly showed that physical therapy and immobilization do not reduce the risk of recurrence. The only factor associated with recurrence was age between 21 and 30 years. Patients in this age group who participate in high-risk sports activities should undergo primary surgical stabilization because of the increased risk of recurrence.

Journal ArticleDOI
TL;DR: It is recommended that in knees with grade 3 posterolateral injuries and evidence of varus or coupled posterior-external rotation instability the postersolateral structures be repaired or reconstructed at the time of posterior cruciate ligament reconstruction to decrease the chance of later graft failure.
Abstract: To determine whether untreated grade 3 posterolateral knee injuries contribute to a significant increase in force on a posterior cruciate ligament reconstruction graft, we measured the force on the graft during joint loading of a posterior cruciate ligament-reconstructed knee with otherwise intact structures and then selectively cut the popliteofibular ligament, popliteus tendon, and the fibular collateral ligament. A posterior cruciate ligament reconstruction was performed in eight fresh-frozen cadaveric knees. One end of the graft was fixed to a tensioning jig with a load cell used to measure force in the graft as loads were applied to the knee. The force on the graft was significantly higher with the posterolateral structures cut during varus loading at 30°, 60°, and 90° of flexion than it was in the same joint under the same loading conditions but with the posterolateral structures intact. Additionally, coupled loading of posterior drawer force and external tibial torque at 30°, 60°, and 90° significa...

Journal ArticleDOI
TL;DR: A therapeutic intervention of strengthening the adductor muscle group appears to be an effective method for preventingAdductor strains in professional ice hockey players.
Abstract: Background: Adductor strains are among the most common injuries in ice hockey. Hip adductor weakness has been identified as a strong risk factor.Hypothesis: An intervention program including muscle strengthening can reduce the incidence of adductor strains in professional ice hockey players.Study Design: Prospective risk factor prevention study.Methods: Thirty-three of 58 players from the same National Hockey League team were identified as “at risk” on the basis of preseason hip adductor strength and participated in an intervention program. The program consisted of 6 weeks of exercises aimed at functional strengthening of the adductor muscles. Injury and individual exposure data were recorded for all players.Results: There were 3 adductor strains in the 2 seasons subsequent to the intervention, compared with 11 in the previous 2 seasons (0.71 versus 3.2 per 1000 player-game exposures). All adductor strains were first-degree strains and occurred during games.Conclusions: A therapeutic intervention of stren...

Journal ArticleDOI
TL;DR: Although there was no evidence that clinically relevant or symptomatic intrinsic rotator cuff pathologic conditions progress in those patients with partial-thickness tears treated with arthroscopic anterior acromioplasty, the subgroup of patients with grade 2B partial tears had a statistically significantly higher failure rate and may have been better served with primary repair.
Abstract: We evaluated the clinical outcome of arthroscopic acromioplasty and debridement in 162 patients who had either normal rotator cuffs, grade 1 (frayed tendon) partial-thickness tears, or grade 2 (less than 50% of the tendon) partial-thickness tears. The mean time from surgery to the response to the L'Insalata outcome questionnaire was 52.7 months (4.5 years) among the 105 respondents (107 shoulders). The mean score was 90 points; eight patients (8%) scored less than 70 points (range, 30 to 65.5), and their treatment failed early on. The patients with grade 2B (bursal) partial-thickness rotator cuff tears had a significantly higher failure rate (38%). Although the clinical outcome of patients with partial-thickness tears of the rotator cuff comprising less than 50% of the tendon (grade 1 and 2) was not significantly different from that of patients without partial rotator cuff tears, the subgroup of patients with grade 2B partial tears had a statistically significantly higher failure rate and may have been better served with primary repair. With follow-up to 10 years, there was no evidence that clinically relevant or symptomatic intrinsic rotator cuff pathologic conditions progress in those patients with partial-thickness tears treated with arthroscopic anterior acromioplasty.