Showing papers in "American Journal of Sports Medicine in 2003"
TL;DR: Patellar tendon autografts had a significantly lower rate of graft failure and resulted in better static knee stability and increased patient satisfaction compared with hamstring tendon auto-grafts, however, patellar Achilles tendon Autograft reconstructions resulted in an increased rate of anterior knee pain.
Abstract: BackgroundThe best choice of graft tissue for use in anterior cruciate ligament reconstruction has been the subject of debate. Hypothesis: Anterior cruciate ligament reconstruction with patellar tendon autograft leads to greater knee stability than reconstruction with hamstring tendon autograft.Study DesignMetaanalysis.MethodsA Medline search identified articles published from January 1966 to May 2000 describing arthroscopic anterior cruciate ligament reconstruction with either patellar tendon or hamstring tendon autograft and with a minimum patient follow-up of 24 months.ResultsThere were 1348 patients in the patellar tendon group (21 studies) and 628 patients in the hamstring tendon group (13 studies). The rate of graft failure in the patellar tendon group was significantly lower (1.9% versus 4.9%) and a significantly higher proportion of patients in the patellar tendon group had a side-to-side difference of less than 3 mm on KT-1000 arthrometer testing than in the hamstring tendon group (79% versus 73....
721 citations
TL;DR: Results indicate that soccer players with an increased tightness of the hamstring or quadriceps muscles have a statistically higher risk for a subsequent musculoskeletal lesion.
Abstract: Background: Muscular tightness is frequently postulated as an intrinsic risk factor for the development of a muscle injury. However, very little prospective data exist to prove this.Hypothesis: Increased muscle tightness identifies a soccer player at risk for a subsequent musculoskeletal lesion.Study Design: Prospective cohort study.Methods: We examined 146 male professional soccer players before the 1999—2000 Belgian soccer competition. None of the players had a history of muscle injury in the lower extremities in the previous 2 years. The flexibility of the hamstring, quadriceps, adductor, and calf muscles of these players was measured goniometrically before the start of the season. All of the examined players were monitored throughout the season to register subsequent injuries.Results: Players with a hamstring (N = 31) or quadriceps (N = 13) muscle injury were found to have significantly lower flexibility in these muscles before their injury compared with the uninjured group. No significant differences...
677 citations
TL;DR: All female cadets who had some combination of risk factors sustained noncontact anterior cruciate ligament injuries, indicating that some combinations of factors are especially perilous to the female knee.
Abstract: Background: The causes of noncontact anterior cruciate ligament injury remain an enigma.Purpose: To prospectively evaluate risk factors for noncontact anterior cruciate ligament injuries in a large population of young athletic people.Study Design: Prospective cohort study.Methods: In 1995, 1198 new United States Military Academy cadets underwent detailed testing and many parameters were documented. During their 4-year tenure, all anterior cruciate ligament injuries that occurred were identified. Statistical analyses were used to identify the factors that may have predisposed the cadets to noncontact anterior cruciate ligament injuries.Results: Among the 895 cadets who completed the entire 4-year study, there were 24 noncontact anterior cruciate ligament tears (16 in men, 8 in women). Significant risk factors included small femoral notch width, generalized joint laxity, and, in women, higher than normal body mass index and KT-2000 arthrometer values that were 1 standard deviation or more above the mean. Th...
629 citations
TL;DR: Both grafts resulted in satisfactory functional outcomes but with increased morbidity in the patellar tendon group and increased knee laxity and radiographic femoral tunnel widening in the hamstring tendon group.
Abstract: Background: Patellar and hamstring tendon autografts are the most frequently used graft types for anterior cruciate ligament reconstruction, but few direct comparisons of outcomes have been published.Hypothesis: There is no difference in outcome between the two types of reconstruction.Study Design: Prospective randomized clinical trial.Methods: After isolated anterior cruciate ligament rupture, 65 patients were randomized to receive either a patellar tendon or a four-strand hamstring tendon graft reconstruction, and results were reviewed at 4, 8, 12, 24, and 36 months.Results: Pain on kneeling was more common and extension deficits were greater in the patellar tendon group. There were greater quadriceps peak torque deficits in the patellar tendon group at 4 and 8 months but not thereafter. In the hamstring tendon group, active flexion deficits were greater from 8 to 24 months, and KT-1000 arthrometer side-to-side differences in anterior knee laxity at 134 N were greater. Cincinnati knee scores, Internatio...
465 citations
TL;DR: Under a physiologic load in a position commonly assumed in sports, women tend to position their entire lower extremity and activate muscles in a manner that could increase strain on the anterior cruciate ligament.
Abstract: Background: Numerous factors have been identified as potentially increasing the risk of anterior cruciate ligament injury in the female athlete. However, differences between the sexes in lower extremity coordination, particularly hip control, are only minimally understood. Hypothesis: There is no difference in kinematic or electromyographic data during the single-legged squat between men and women. Study Design: Descriptive comparison study. Methods: We kinematically and electromyographically analyzed the single-legged squat in 18 intercollegiate athletes (9 male, 9 female). Subjects performed five single-legged squats on their dominant leg, lowering themselves as far as possible and then returning to a standing position without losing balance. Results: Women demonstrated significantly more ankle dorsiflexion, ankle pronation, hip adduction, hip flexion, hip external rotation, and less trunk lateral flexion than men. These factors were associated with a decreased ability of the women to maintain a varus knee position during the squat as compared with the men. Analysis of all eight tested muscles demonstrated that women had greater muscle activation compared with men. When each muscle was analyzed separately, the rectus femoris muscle activation was found to be statistically greater in women in both the area under the linear envelope and maximal activation data. Conclusions: Under a physiologic load in a position commonly assumed in sports, women tend to position their entire lower extremity and activate muscles in a manner that could increase strain on the anterior cruciate ligament. © 2003 American Orthopaedic Society for Sports Medicine
462 citations
TL;DR: These structures had a consistent attachment pattern and will prove useful in the study of anatomic repair and reconstruction of the posterolateral structures of the knee.
Abstract: Background: Quantitative descriptions of the attachment sites of the main posterolateral knee structures have not been performed.Purpose: To qualitatively and quantitatively determine the anatomic attachment sites of these structures and their relationships to pertinent bony landmarks.Study Type: Cadaveric study.Methods: Dissections were performed and measurements taken on 10 nonpaired fresh-frozen cadaveric knees.Results: The fibular collateral ligament had an average femoral attachment slightly proximal (1.4 mm) and posterior (3.1 mm) to the lateral epicondyle. Distally, it attached 8.2 mm posterior to the anterior aspect of the fibular head. The popliteus tendon had a constant broad-based femoral attachment at the most proximal and anterior fifth of the popliteal sulcus. The popliteus tendon attachment on the femur was always anterior to the fibular collateral ligament. The average distance between the femoral attachments of the popliteus tendon and fibular collateral ligament was 18.5 mm. The popliteo...
451 citations
TL;DR: Seven years after ACL reconstruction, the subjective and objective outcomes were similar after using the central-third BTB autograft and triple/quadruple semi-triple semitendinosus autografteds.
Abstract: Background: The aim of the study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third bone—patellar tendon—bone (BTB) autografts and triple/quadruple semitendinosus (ST) autografts.Hypothesis: In the long-term, ACL reconstruction using BTB autografts will render more donor-site problems than ST autografts.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: A randomized series of 71 patients (22 women and 49 men) with a unilateral ACL rupture who underwent reconstructive surgery were included in the study. The BTB graft was used in 34 patients (BTB group) and the ST-tendon graft was used in 37 patients (ST group). The patients were examined a median of 86 months (range, 68 to 114 months) after the reconstruction.Results: Sixty-eight of 71 patients (96%) were examined at follow-up. The clinical assessments at follow-up revealed no significant differences between the BTB group and the ST group in terms of the Lysholm score, Teg...
443 citations
TL;DR: Patients with anterior cruciate ligament-deficient knees experienced repeated episodes of rotational instability during walking, whereas patients with reconstruction experienced tibial rotation that is closer to normal.
Abstract: BackgroundIt is possible that gait abnormalities may play a role in the pathogenesis of meniscal or chondral injury as well as osteoarthritis of the knee in patients with anterior cruciate ligament deficiency.HypothesisThe three-dimensional kinematics of anterior cruciate ligament-deficient knees are changed even during low-stress activities, such as walking, but can be restored by reconstruction.Study DesignCase control study.MethodsUsing a three-dimensional optoelectronic gait analysis system, we examined 13 patients with anterior cruciate ligament-deficient knees, 21 patients with anterior cruciate ligament-reconstructed knees, and 10 control subjects with uninjured knees during walking.ResultsNormal patterns of knee flexion-extension, abduction-adduction, and internal-external rotation during the gait cycle were maintained by all subjects. A significant difference in tibial rotation angle during the initial swing phase was found in anterior cruciate ligament-deficient knees compared with reconstructed...
427 citations
TL;DR: The results of this study indicate that overhand athletes with impingement symptoms show abnormal muscle recruitment timing in the trapezius muscle, and support the theory that impingements of the shoulder may be related to delayed onset of contraction in the middle and lower parts of the trazzius muscle.
Abstract: Background: Altered muscle activity in the scapular muscles is commonly believed to be a factor contributing to shoulder impingement syndrome. However, one important measure of the muscular coordination in the scapular muscles, the timing of the temporal recruitment pattern, is undetermined.Purpose: To evaluate the timing of trapezius muscle activity in response to an unexpected arm movement in athletes with impingement and in normal control subjects.Study Design: Prospective cohort study.Methods: Muscle latency times were measured in all three parts of the trapezius muscle and in the middle deltoid muscle of 39 “overhand athletes” with shoulder impingement and compared with that of 30 overhand athletes with no impingement during a sudden downward falling movement of the arm.Results: There were significant differences in the relative muscle latency times between the impingement and the control group subjects. Those with impingement showed a delay in muscle activation of the middle and lower trapezius musc...
409 citations
TL;DR: The Bone Mulch Screw (1112 N) was the strongest in the single-cycle load-to-failure test, followed by EndoButton CL (1086 N), RigidFix (868 N), SmartScrew ACL (794 N), BioScrew (589 N), and RCI screw (546 N) as discussed by the authors.
Abstract: Background:Strength of graft fixation is the weakest link in anterior cruciate ligament reconstruction.Hypothesis:There is no difference in initial fixation strength between different hamstring tendon graft femoral fixation devices.Study Design:Randomized experimental study.Methods:Each of six devices was used in the fixation of 10 quadrupled human semitendinosus-gracilis tendon grafts in tunnels drilled in porcine femora and tested 10 times with a single-cycle load-to-failure test at a rate of 50 mm/min and 10 times with a 1500-cycle loading test between 50 and 200 N at one cycle every 2 seconds. The specimens that survived the cyclic loading were subjected to a single-cycle load-to-failure test.Results:The Bone Mulch Screw (1112 N) was strongest in the single-cycle load-to-failure test, followed by EndoButton CL (1086 N), RigidFix (868 N), SmartScrew ACL (794 N), BioScrew (589 N), and RCI screw (546 N). It also showed the lowest residual displacement (2.2 mm) and was strongest in the single-cycle load-t...
408 citations
TL;DR: Knowledge of the anatomy and function of the elbow complex, along with an understanding of throwing biomechanics, is imperative to properly diagnose and treat the throwing athlete.
Abstract: Repetitive overhead throwing imparts high valgus and extension loads to the athlete's elbow, often leading to either acute or chronic injury or progressive structural change. Tensile force is applied to the medial stabilizing structures with compression on the lateral compartment and shear stress posteriorly. Common injuries encountered in the throwing elbow include ulnar collateral ligament tears, ulnar neuritis, flexor-pronator muscle strain or tendinitis, medial epicondyle apophysitis or avulsion, valgus extension overload syndrome with olecranon osteophytes, olecranon stress fractures, osteochondritis dissecans of the capitellum, and loose bodies. Knowledge of the anatomy and function of the elbow complex, along with an understanding of throwing biomechanics, is imperative to properly diagnose and treat the throwing athlete. Recent advantages in arthroscopic surgical techniques and ligament reconstruction in the elbow have improved the prognosis for return to competition for the highly motivated athlete. However, continued overhead throwing often results in subsequent injury and symptom recurrence in the competitive athlete.
TL;DR: The current clinical and radiographic methods to detect early hip joint disease and the current indications and surgical techniques of hip arthroscopy are discussed.
Abstract: The management of hip injuries in athletes has evolved significantly in the past few years with the advancement of arthroscopic techniques. The application of minimally invasive surgical techniques has facilitated relatively rapid returns to sporting activity in both recreational and elite athletes. Recent advancements in both hip arthroscopy and magnetic resonance imaging have elucidated several sources of intraarticular abnormalities that result in chronic and disabling hip symptoms. Many of these conditions were previously unrecognized and, thus, left untreated. Current indications for hip arthroscopy include the presence of symptomatic acetabular labral tears, hip capsule laxity and instability, chondral lesions, osteochondritis dissecans, ligamentum teres injuries, snapping hip syndrome, iliopsoas bursitis, and loose bodies (for example, synovial chondromatosis). Less common indications include management of osteonecrosis of the femoral head, bony impingment, synovial abnormalities, crystalline hip arthropathy (gout and pseudogout), infection, and posttraumatic intraarticular debris. In rare cases, hip arthroscopy can be used to temporize the symptoms of mild-to-moderate hip osteoarthritis with associated mechanical symptoms. This article discusses the current clinical and radiographic methods to detect early hip joint disease and the current indications and surgical techniques of hip arthroscopy.
TL;DR: The Outerbridge classification was moderately accurate when used to grade chondral lesions arthroscopically and can be accurately graded by orthopaedic surgeons, regardless of their level of experience.
Abstract: BackgroundFew studies have investigated the accuracy and reproducibility of the Outerbridge classification system for classification of chondral damage in the knee.HypothesisArthroscopically assigned Outerbridge grades are accurate, reliable, and reproducible.Study DesignCadaver study.MethodsSix cadaveric knees underwent diagnostic arthroscopy, which was videotaped. An arthrotomy was then performed and the arthroscopically identified lesions were measured with calipers. Nine orthopaedic surgeons reviewed each video and graded each chondral lesion two separate times. Accuracy of observations was calculated based on the percentage of agreement between the grades determined during arthroscopy and arthrotomy.ResultsThe overall accuracy was 68% but varied by location. The kappa coefficient between the two scores was 0.602; the arthroscopy grade was higher than the arthrotomy grade 63% of the time. The intraobserver and interobserver kappa coefficients were 0.80 and 0.52, respectively. The mean interobserver ka...
TL;DR: Findings suggest that any degree of postconcussion headache in high school athletes 7 days after injury is likely associated with an incomplete recovery after concussion.
Abstract: Background:The relevance of headache to outcome after sports-related concussion is poorly understood.Hypotheses:High school athletes reporting headache approximately 1 week after injury will have s...
TL;DR: Early weightbearing with the ankle plantigrade is not detrimental to the outcome of repair after acute rupture of the Achilles tendon and shortens the time needed for rehabilitation, however, strength deficit and muscle atrophy are not prevented.
Abstract: PurposeTo study the effects of early weightbearing and ankle mobilization after acute repair of ruptured Achilles tendon.Study DesignComparative longitudinal study.MethodsPatients in group 1 were postoperatively immobilized with their ankle in gravity equinus, they were encouraged to bear weight on the operated limb as soon as possible to full weightbearing, and they received a single cast change at 2 weeks, with the ankle accommodated in an anterior splint in a plantigrade position, allowing the ankle to be plantar flexed fully but not dorsiflexed above neutral. Patients in group 2 were immobilized with their ankle in full equinus with a cast change at 2 weeks, when the ankle was immobilized in mid equinus, and at 4 weeks, when the ankle was immobilized in a plantigrade position, and they were advised to bear weight.ResultsPatients in group 1 attended fewer outpatient visits, completely discarded their crutches at an average of 2.5 weeks, and more were satisfied with the results of surgery. At ultrasonog...
TL;DR: Equal results were seen for patellar and hamstring tendon autograft anterior cruciate ligament reconstructions at 2 years after surgery, and both techniques seem to improve patients' performance.
Abstract: BackgroundBone-patellar tendon-bone graft has been the most commonly used graft material in anterior cruciate reconstructions, but there has been increasing use of hamstring tendon grafts. However,...
TL;DR: A more restrictive attitude regarding return to competitive pivoting sports after anterior cruciate ligament injury may be warranted.
Abstract: Background: Long-term outcome after anterior cruciate ligament injury among top-level pivoting athletes is unknown.Purpose: To evaluate outcome among competitive team handball players after anterior cruciate ligament injury.Study Design: Prospective cohort study.Methods: A previously studied group of 86 elite players who had an anterior cruciate ligament rupture were invited to participate in follow-up evaluations a mean of 7.8 years later.Results: Among the 57 operatively treated patients who returned for follow-up, 33 (58%) returned to team handball at their preinjury level, compared with 18 of 22 (82%) in the nonoperative group. Eleven of the 50 players (22%) who continued playing reinjured their anterior cruciate ligament when playing team handball. The overall Lysholm score was 85 ± 13 in both groups, but the five players classified as poor were all operatively treated. Nearly half of the players had an International Knee Documentation Committee classification of abnormal or severely abnormal. There ...
TL;DR: Female college basketball players did not exhibit altered knee muscle coordination characteristics that would predispose them to anterior cruciate ligament injury when landing from jumps, based on the observation that hamstring muscle activation was similar for both groups.
Abstract: Background: Female athletes are more likely than male athletes to injure the anterior cruciate ligament. Causes of this increased injury incidence in female athletes remain unclear, despite numerous investigations.Hypothesis: Female athletes will exhibit lower hamstring muscle activation and smaller knee flexion angles than male athletes during jump landings, especially when the knee muscles are fatigued.Study Design: Controlled laboratory study.Methods: Eight female and six male varsity college basketball athletes with no history of knee ligament injury performed jump landings on the dominant leg from a maximum height jump and from 25.4 cm and 50.8 cm high platforms under nonfatigued and fatigued conditions. Knee joint angle and surface electromyographic signals from the quadriceps, hamstring, and gastrocnemius muscles were recorded.Results: Women landed with greater knee flexion angles and greater knee flexion accelerations than men. Knee muscle activation patterns were generally similar in men and wome...
TL;DR: Tendon graft reconstruction may be an alternative to coracoacromial ligament transfer and may provide a permanent biologic reconstruction with superior initial biomechanical properties, including that of tensile strength.
Abstract: BackgroundNumerous surgical techniques have been described to address injuries to the coracoclavicular ligaments.PurposeTo compare the biomechanical properties of tendon graft reconstructions with those of the native coracoclavicular ligaments and various other repair methods.Study DesignControlled laboratory study.MethodsEleven fresh-frozen human cadaveric shoulders were tensile tested to failure to compare the biomechanical properties of the native coracoclavicular ligaments, coracoacromial ligament transfer, No. 5 Mersilene suture repair, 5-mm Mersilene tape repair, and tendon graft reconstructions with gracilis, semitendinosus, and long toe extensor tendons.ResultsReconstructions with semitendinosus, gracilis, or long toe extensor tendon grafts were found to have superior initial biomechanical properties compared with coracoacromial ligament transfer; failure strengths were as strong as those of the native coracoclavicular ligaments. Failure of the tendon grafts occurred through the midsubstance of th...
TL;DR: The rate of acute time-loss injuries in beach volleyball is considerably lower than that in most other team sports, but overuse injuries affecting the low back, knees, and shoulder represent a significant source of disability and impaired performance for professional beach volleyball players.
Abstract: BackgroundVery little is known about the injury characteristics of beach volleyball.PurposeTo describe the incidence and pattern of injuries among professional male and female beach volleyball players.Study DesignCohort study–retrospective injury recall and prospective registration.MethodsInjuries occurring over a 7.5-week interval of the summer season were retrospectively registered by interviewing 178 of the 188 participating players (95%) in the 2001 Beach Volleyball World Championships. Injuries were also cataloged prospectively during five of the tournaments held during this interval.ResultsFifty-four acute injuries was recorded, of which 23 (43%) resulted in 1 or more days of missed practice or competition. The incidence of acute time-loss injuries was estimated to be 3.1 per 1000 competition hours and 0.8 per 1000 training hours. Knee (30%), ankle (17%), and finger injuries (17%) accounted for more than half of all acute time-loss injuries. In addition, 67 players reported 79 overuse injuries for w...
TL;DR: This technique returns elbow kinematics to near normal, with less soft tissue dissection and risk of ulnar nerve injury and ease of graft insertion, tensioning, and fixation.
Abstract: BackgroundTechniques for ulnar collateral ligament reconstruction have evolved.HypothesisUlnar collateral ligament reconstruction with interference screw fixation restores elbow kinematics and failure strength to that of the native ligament.Study DesignControlled laboratory study.MethodsOf 10 matched pairs of cadaveric elbows, one underwent kinematic testing under conditions of an intact, released, and reconstructed ligament. Single 5-mm diameter bone tunnels were created at the isometric anatomic insertion sites on the medial epicondyle and sublime tubercle. Graft fixation was achieved with 5 × 15 mm soft tissue interference screws. The reconstructed and contralateral intact elbows were then tested to failure.ResultsAverage stiffness for intact elbows (42.81 ± 11.6 N/mm) was significantly greater than for reconstructed elbows (20.28 ± 12.5 N/mm). Ultimate moment for intact elbows (34.0 ± 6.9 N·m) was not significantly different from reconstructed elbows (30.6 ± 19.2 N·m). Release of the ulnar collateral ...
TL;DR: Tendon harvest causes significant weakness of hamstring muscle strength at high knee flexion angles, but such weakness can be minimized if the gracilis tendon is preserved.
Abstract: BackgroundThe advantages of hamstring tendon autografts for anterior cruciate ligament reconstruction are well known; however, concerns have arisen regarding the influence of hamstring tendon harve...
TL;DR: The purpose of this review is to present issues surrounding the allograft industry, including regulation of tissues and tissue banks and procurement, processing, sterilization, and storage of allografted tissue.
Abstract: Use of musculoskeletal allografts has become increasingly popular, with widespread use among knee surgeons. The advantages and disadvantages of their use have been documented. In the knee, allografts are used for ligament reconstruction, meniscal transplantation, and articular surface reconstruction. The purpose of this review is to present issues surrounding the allograft industry, including regulation of tissues and tissue banks and procurement, processing, sterilization, and storage of allograft tissue. Tissue bank regulation is ultimately under the jurisdiction and authority of the Food and Drug Administration; some individual states regulate tissue banks. The American Association of Tissue Banks is a scientific organization that encourages education, research, and voluntary accreditation of tissue banks. It promotes safety and standards for retrieval, processing, storage, and distribution of transplantable human tissue. Allograft tissues are generally harvested and processed aseptically, which may not prevent contamination. Tissue sterilization is difficult and controversial. Tissue banks historically have used one of two methods of sterilization, ethylene oxide or gamma radiation. Both methods have risks and benefits. Newer methods of sterilization are being developed. Allograft tissue that is not transplanted fresh can be freeze-dried or deep frozen for storage. Ultimately, allograft transplantation in the knee facilitates knee form and function and enhances the patient's quality of life. Orthopaedic surgeons who use allograft tissue must understand the tissue banking process to provide safe and effective tissues to their patients.
TL;DR: Overall, golf may be considered a rather benign activity, if overuse can be avoided, but if not, golf can result in serious, chronic musculoskeletal problems.
Abstract: Background: Although golf is becoming more popular, there is a lack of reliable epidemiologic data on golf injuries and overuse syndromes, especially regarding their severity.Objective: To perform an epidemiologic study of the variety of different musculoskeletal problems in professional and amateur golfers and to find associations of age, sex, physical stature (body mass index), warm-up routine, and playing level with the occurrence of reported injuries.Study Design: Retrospective cohort study.Methods: We analyzed the injury data from a total of 703 golfers who were randomly selected over two golfing seasons and interviewed with the use of a six-page questionnaire.Results: Overall, 82.6% (N = 526) of reported injuries involved overuse and 17.4% ( N = 111) were single trauma events. Professional golfers were injured more often, typically in the back, wrist, and shoulder. Amateurs reported many elbow, back, and shoulder injuries. Severity of reported injuries was minor in 51.5%, moderate in 26.8%, and majo...
TL;DR: Injuries occurred 3.7 times more often in games than during practice, and the relative risk of reinjury was significantly increased by previous injuries to the elbow, shoulder, knee, hand, lower spine or pelvis, and by concussions.
Abstract: BackgroundPrevious studies of basketball injury have not been able to assess injury incidence and risk.PurposeTo determine rates and risks of injury in Canadian intercollegiate basketball.Study DesignProspective cohort study.MethodsStandardized data were collected with a validated instrument from 98.1% of the 318 athletes on the eight men's basketball teams in the Canada West Division of the Canadian Intercollegiate Athletic Union.ResultsA total of 142 athletes sustained 215 injuries (44.7% of players injured) over the 2-year study period. The greatest number of injuries resulting in more than seven sessions of time loss involved the knee, whereas the most common injuries causing fewer than seven sessions of time loss involved the ankle. The most common mechanism of injury was contact with another player, especially in the “key.” Injuries occurred 3.7 times more often in games than during practice. Centers had the highest rate of injury, followed by guards, and then forwards. The relative risk of reinjury...
TL;DR: Magnetic resonance imaging alone should not be used as a basis for operative intervention in this patient population and should be replaced by other methods, including surgery, if necessary.
Abstract: BackgroundAlthough several studies have described magnetic resonance imaging findings in shoulders of asymptomatic volunteers, no such investigation has been performed on asymptomatic dominant and nondominant shoulders of elite overhead athletes.HypothesisAsymptomatic dominant shoulders of elite overhead athletes may have a higher incidence of magnetic resonance imaging abnormalities than either their nondominant shoulder or shoulders of asymptomatic volunteers.Study DesignProspective cohort study.MethodsDetailed magnetic resonance imaging scans of asymptomatic dominant and nondominant shoulders of elite overhead athletes were obtained. Three experienced musculoskeletal radiologists interpreted each scan for multiple variables, including rotator cuff appearance. Images from a surgical control group were intermixed to assess accuracy and control for observer bias. A 5-year follow-up interview was performed to determine whether magnetic resonance imaging abnormalities found in the initial stage of the study...
TL;DR: The initial fixation strength of the double-layer rotator cuff repair exceeds that of isolated single-layer repairs with either suture anchors or transosseous tunnels.
Abstract: BackgroundThe most common complication of rotator cuff repair is structural failure at the repair site. A single-layer repair does not adequately reproduce the anatomic insertion and may not optimize fixation strength.HypothesisA double-layer rotator cuff repair will have greater initial fixation strength than a single-layer repair.Study DesignControlled laboratory study.MethodsTwelve fresh-frozen matched pairs of cadaveric shoulders were repaired by using dual-site fixation with both suture anchors and transosseous tunnels on one side (technique 1). Fixation was achieved by using suture anchors with horizontal mattress sutures and bone tunnels with modified Mason-Allen sutures. Half of the contralateral matched shoulders underwent fixation with suture anchors and simple sutures to simulate commonly used arthroscopic methods (technique 2) and, in the rest, fixation was achieved by using transosseous tunnels and modified Mason-Allen sutures (technique 3). Repaired specimens then underwent cyclic loading at...
TL;DR: Hamstring muscle injury confirmed by magnetic resonance imaging was associated with a longer absence from competition than injuries where no hamstring injury was detected, and Muscle fatigue may be important in the pathogenesis of hamstring injury.
Abstract: BackgroundLittle is known about the clinical features of posterior thigh injuries and their contribution to accurate diagnosis and prognostic assessment of hamstring muscle strain injury.HypothesesThe clinical features of posterior thigh injury can be used to diagnose hamstring muscle strain and to predict duration of absence from competition.Study DesignProspective clinical study.MethodsFor two playing seasons, the clinical features of posterior thigh injury, timing of injury, and playing days lost were recorded for Australian Rules football players. Magnetic resonance imaging was used to confirm hamstring muscle injury.ResultsPosterior thigh injuries associated with pain and tenderness were recorded for 83 players, with magnetic resonance imaging confirming hamstring injury in 68 (82%). Most of the hamstring injuries were sudden onset (62; 91%) and occurred after a significant warm-up period (57; 84%). Of the patients whose injuries were sudden onset and occurred after the warm-up period (N = 59), 57 (9...
TL;DR: At the high school level, male and female athletes shared a common mechanism of injury, and yet the female athletes had fewer intraarticular injuries in basketball and soccer, and women may enjoy a better prognosis after reconstruction.
Abstract: BackgroundDespite research on the increased risk of anterior cruciate ligament tears in female athletes, few studies have addressed sex differences in the incidence of associated intraarticular injuries.HypothesisWhen patients are stratified by sport and competition level, no sex differences exist in either the mechanism of injury or pattern of intraarticular injuries observed at anterior cruciate ligament reconstruction.Study DesignProspective cohort study.MethodsTwo hundred twenty-one athletes undergoing anterior cruciate ligament reconstruction met our inclusion criteria of anterior cruciate ligament tear as a singular event without reinjury or history of prior injury or surgery in either knee. Data were collected on competition level (high school, amateur), sport (basketball, soccer, skiing), mechanism of injury, articular cartilage injuries, and meniscal tears. Data were statistically analyzed by sex with the chi-square test and Student's t-test.ResultsHigh school athletes had no significant sex diff...
TL;DR: Three treatments with 2100 impulses of low-energy shock waves were a safe and effective method for treatment of chronic plantar fasciitis in long-distance runners.
Abstract: Background:Recent articles have reported success with repeated low-energy shock wave application for treatment of chronic plantar fasciitis in runners.Hypothesis:Shock wave treatment for chronic plantar fasciitis is safe and effective.Study Design:Prospective, randomized, placebo-controlled trial.Methods:Forty-five running athletes with intractable plantar heel pain for more than 12 months were enrolled; half were assigned to a treatment group that received three applications of 2100 impulses of low-energy shock waves, and half received sham treatment. Follow-up examinations were performed at 6 months and at 1 year by a blinded observer.Results:After 6 months, self-assessment of pain on first walking in the morning was significantly reduced from an average of 6.9 to 2.1 points on a visual analog scale in the treatment group and from an average of 7.0 to 4.7 points in the sham group. The mean difference between groups was 2.6 points. After 12 months, there was a further reduction of pain in both groups, to...