Showing papers in "American Journal of Sports Medicine in 2004"
TL;DR: The injury mechanism for anterior cruciate ligament injuries in female team handball appeared to be a forceful valgus collapse with the knee close to full extension combined with external or internal rotation of the tibia.
Abstract: ObjectiveTo describe the mechanisms for anterior cruciate ligament injuries in female team handball.Study DesignDescriptive video analysis.MethodsTwenty videotapes of anterior cruciate ligament injuries from Norwegian or international competition were collected from 12 seasons (1988-2000). Three medical doctors and 3 national team coaches systematically analyzed these videos to describe the injury mechanisms and playing situations. In addition, 32 anterior cruciate ligament-injured players in the 3 upper divisions in Norwegian team handball were interviewed during the 1998-1999 season to compare the injury characteristics between player recall and the video analysis.ResultsTwo main injury mechanisms for anterior cruciate ligament injuries in team handball were identified. The most common (12 of 20 injuries), a plant-and-cut movement, occurred in every case with a forceful valgus and external or internal rotation with the knee close to full extension. The other main injury mechanism (4 of 20 injuries), a 1...
1,245 citations
TL;DR: Patellar dislocators who present with a history of patellofemoral instability are more likely to be female, are older, and have greater risk of subsequent patellar instability episodes than first-time patellary dislocation patients.
Abstract: BackgroundThe goals of this study were to (1) define the epidemiology of acute patellar dislocation, (2) determine the risk of subsequent patellar instability episodes (subluxation and/or redislocation) during the study period, and (3) identify risk factors for subsequent instability episodes.Study DesignProspective cohort study.MethodsThe authors prospectively followed 189 patients for a period of 2 to 5 years. Historical data, injury mechanisms, and physical and radiographic measurements were recorded to identify potential risk factors for poor outcomes.ResultsRisk was highest among females 10 to 17 years old. Patients presenting with a prior history of instability were more likely to be female (P < .05) and were older than first-time dislocation patients (P < .05). Fewer first-time dislocators (17%) had episodes of instability during follow-up than patients with a previous history of instability (49%) (P < .01). After adjusting for demographics, patients with a prior history had 7 times higher odds of ...
895 citations
TL;DR: Age and previous injury were identified as the main risk factors for injury among elite football players from Iceland.
Abstract: BackgroundThe injury risk in football is high, but little is known about causes of injury.PurposeTo identify risk factors for football injuries using a multivariate model.Study DesignProspective cohort study.MethodsParticipants were 306 male football players from the two highest divisions in Iceland. Before the 1999 football season started, the following factors were examined: height, weight, body composition, flexibility, leg extension power, jump height, peak O2 uptake, joint stability, and history of previous injury. Injuries and player exposure were recorded throughout the competitive season.ResultsOlder players were at higher risk of injury in general (odds ratio [OR] = 1.1 per year, P = 0.05). For hamstring strains, the significant risk factors were age (OR = 1.4 [1 year], P < 0.001) and previous hamstring strains (OR = 11.6, P < 0.001). For groin strains, the predictor risk factors were previous groin strains (OR = 7.3, P = 0.001) and decreased range of motion in hip abduction (OR = 0.9 [1°], P = 0...
873 citations
TL;DR: Anterior cruciate ligament reconstruction failed to restore normal rotational knee kinematics during dynamic loading, and these abnormal motions may contribute to long-term joint degeneration associated with anterior cruciated ligament injury/reconstruction.
Abstract: Background: The effectiveness of anterior cruciate ligament reconstruction for restoring normal knee kinematics is largely unknown, particularly during sports movements generating large, rapidly applied forces.Hypothesis: Under dynamic in vivo loading, significant differences in 3-dimensional kinematics exist between anterior cruciate ligament-reconstructed knees and the contralateral, uninjured knees.Study Design: Prospective, in vivo laboratory study.Methods: Kinematics of anterior cruciate ligament-reconstructed and contralateral (uninjured) knees were evaluated for 6 subjects during downhill running 4 to 12 months after anterior cruciate ligament reconstruction, using a 250 frame/s stereoradiographic system. Anatomical reference axes were determined from computed tomography scans. Kinematic differences between the uninjured and reconstructed limbs were evaluated with a repeated-measures analysis of variance.Results: Anterior tibial translation was similar for the reconstructed and uninjured limbs. How...
680 citations
TL;DR: Results suggest that small increases in tibial slope do not affect A-P translations or in situ forces in the cruciate ligaments, however, increasing slope causes an anterior shift in the resting position of the tibia relative to the femur that is accentuated under axial loads.
Abstract: PurposeTo determine the effects of increasing anterior-posterior (A-P) tibial slope on knee kinematics and in situ forces in the cruciate ligaments.MethodsTen cadaveric knees were studied using a robotic testing system using three loading conditions: (1) 200 N axial compression; (2) 134 N A-P tibial load; and (3) combined 200 N axial and 134 N A-P loads. Resulting knee kinematics were determined before and after a 5-mm anterior opening wedge osteotomy. Resulting in situ forces in each cruciate ligament were determined.ResultsTibial slope was increased from 8.8 ± 1.8 ° to 13.2 ± 2.1 °, causing an anterior shift in the resting position of the tibia relative to the femur up to 3.6 ± 1.4 mm. Under axial compression, the osteotomy caused a significant anterior tibial translation up to 1.9 ± 2.5 mm (90 °). Under A-P and combined loads, no differences were detected in A-P translation or in situ forces in the cruciates (intact versus osteotomy).ConclusionsResults suggest that small increases in tibial slope do no...
651 citations
TL;DR: Suture anchor fixation offers an equal if not superior alternative to bone tunnel fixation for repair of the distal biceps tendon in the specimens tested, and superior yield strength was demonstrated.
Abstract: Background:Suture anchor and bone tunnel fixations are used for distal biceps tendon repairs and have not been compared.Hypothesis:Suture anchor fixation is equal or superior to bone tunnel fixation.Study Design:Randomized controlled in vitro study.Methods:A new fixation technique was compared to traditional bone tunnel fixation of distal biceps tendon ruptures between randomly selected sides of nine matched-pair, fresh-frozen elbow specimens from cadaveric donors (mean age = 74.7 years). Bone densities were determined. The distal biceps tendon was attached to the actuator of a servohydraulic load frame and loaded to tensile failure at a constant rate of 4 mm/sec. Bone density, sex, age, side, tuberosity area, repair, failure type, repair stiffness, and yield strength were compared.Results:Superior yield strength of suture anchor fixation (263 N) compared to bone tunnel fixation (203 N) (P= 0.0233) were demonstrated. When suture anchor fixation failure (1 of 9) occurred, the matched pair also failed.Concl...
622 citations
TL;DR: Significantly fewer ankle sprains in the intervention group were found compared to the control group, and a significant reduction in ankle sprain risk was found only for players with a history of ankle sprain.
Abstract: BackgroundAnkle sprains are the most common injuries in a variety of sports.HypothesisA proprioceptive balance board program is effective for prevention of ankle sprains in volleyball players.Study DesignProspective controlled study.MethodsThere were 116 male and female volleyball teams followed prospectively during the 2001-2002 season. Teams were randomized by 4 geographical regions to an intervention group (66 teams, 641 players) and control group (50 teams, 486 players). Intervention teams followed a prescribed balance board training program; control teams followed their normal training routine. The coaches recorded exposure on a weekly basis for each player. Injuries were registered by the players within 1 week after onset.ResultsSignificantly fewer ankle sprains in the intervention group were found compared to the control group (risk difference = 0.4/1000 playing hours; 95% confidence interval, 0.1-0.7). A significant reduction in ankle sprain risk was found only for players with a history of ankle ...
547 citations
TL;DR: Eleven percent of all knee arthroscopies show cartilage defects that may be suitable for cartilage Repair procedures, however, the natural history of these lesions and the number of patients that will benefit from a cartilage repair procedure are so far unknown.
Abstract: BackgroundTraumatic articular cartilage injuries heal poorly and may lead to development of osteoarthritis at a young age. This study estimates the number of patients who may benefit from one of the surgical methods of cartilage repair.MethodsAll patients undergoing knee arthroscopy during a 6-month period at three collaborating hospitals were consecutively evaluated according to the International Cartilage Repair Society (ICRS) knee form. The material consists of 993 consecutive knee arthroscopies in patients with median age of 35 years.ResultsPreoperative radiographs demonstrated degenerative changes in 13% of the knees. Articular cartilage pathology was found in 66% and a localized cartilage defect was found in 20% of the knees. A localized full-thickness cartilage lesion (ICRS grade 3 and 4) was observed in 11% of the knees. Of the localized full-thickness lesions, 55% (6% of all knees) had a size above 2 cm2.ConclusionEleven percent of all knee arthroscopies show cartilage defects that may be suitabl...
536 citations
TL;DR: The pivot-shift examination may be a better measure of “functional instability” than instrumented knee laxity or Lachman examination after anterior cruciate ligament reconstruction.
Abstract: BackgroundRelationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction have not been established.HypothesisRelationships exist between objective and subjective assessments after anterior cruciate ligament reconstruction.Study DesignCase series.MethodsPatients (N = 202) undergoing anterior cruciate ligament reconstruction with 2-year minimum follow-up were studied. Objective variables of ligament stability at follow-up included instrumented laxity, Lachman examination, and pivot-shift examination. Subjective variables of symptoms at follow-up included pain, swelling, giving way, locking, crepitus, stiffness, and limping. Subjective function at follow-up included walking, squatting, stair climbing, running, cutting, jumping, twisting, activity limitation, sports level, activities of daily living level, work level, knee function, sports participation, Lysholm score, and satisfaction withoutcome.ResultsInstr...
456 citations
TL;DR: There was little evidence to suggest that the addition of ice to compression had any significant effect, but this was restricted to treatment of hospital inpatients and there was no evidence of an optimal mode or duration of treatment.
Abstract: Background: There are wide variations in the clinical use of cryotherapy, and guidelines continue to be made on an empirical basis.Study Design: Systematic review assessing the evidence base for cryotherapy in the treatment of acute soft-tissue injuries.Methods: A computerized literature search, citation tracking, and hand searching were carried out up to April 2002. Eligible studies were randomized-controlled trials describing human subjects recovering from acute soft-tissue injuries and employing a cryotherapy treatment in isolation or in combination with other therapies. Two reviewers independently assessed the validity of included trials using the Physiotherapy Evidence Database (PEDro) scale.Results: Twenty-two trials met the inclusion criteria. There was a mean PEDro score of 3.4 out of of 10. There was marginal evidence that ice plus exercise is most effective, after ankle sprain and postsurgery. There was little evidence to suggest that the addition of ice to compression had any significant effect...
442 citations
TL;DR: Aggressive quadriceps loading, with the knee in slight flexion, produces significant anterior tibial translation and ACL injury, suggesting that thequadriceps is the intrinsic force in noncontact ACL injuries, producing a model for further investigation.
Abstract: Background: The force responsible for noncontact anterior cruciate ligament (ACL) injuries remains controversial. The patella tendon to tibial shaft angle causes an anterior tibial shear force with quadriceps activation.Hypothesis: An aggressive quadriceps contraction can injure the ACL.Methods: The authors characterized noncontact ACL injury and kinematics with aggressive quadriceps loading. Thirteen freshfrozen knees were potted in a jig held in 20 ° of flexion while a 4500 N quadriceps contraction was simulated. Knee kinematics were recorded. A KT-1000 arthrometer and a simulated active quadriceps test assessed anterior displacement. Statistics were performed using paired t tests and 1-way analysis of variance.Results: Kinematics revealed the following mean values: anterior displacement, 19.5 mm; valgus, 2.3 °; and internal rotation, 5.5 °. Mean KT-1000 and active quadriceps test differences were 4.0 mm and 2.7 mm, respectively (statistically significant P = .002 and P = .002). Six knees showed gross A...
TL;DR: Clinical selection of exercises for improving scapular control should consider both maximum serratus activation and upper trapezius/serratus anterior ratios and the push-up plus is an optimal exercise.
Abstract: BackgroundSerratus anterior strengthening is used in prevention and treatment programs for poor scapular control. In certain clinical cases, exercises substantially activating the serratus with minimal upper trapezius activation are preferred.HypothesisThe standard push-up plus would show both the highest serratus anterior activation and lowest upper trapezius/ serratus ratios for both groups and all phases.Study DesignControlled laboratory study.MethodsThirty subjects, grouped as healthy or with mild shoulder dysfunction, were evaluated performing standard push-up plus exercises and modifications on elbows, knees, and against a wall. Surface electromyography of the serratus anterior and upper trapezius was compared between exercises.ResultsBoth groups responded similarly across exercises. The standard push-up plus demonstrated the highest activation of the serratus (to 123%) and lowest trapezius/serratus ratios (< 0.2) during plus phases. The wall push-up plus and phases of other exercises demonstrated h...
TL;DR: Clinical assessment accurately determined the existence of intra-articular abnormality but was poor at defining its nature, and magnetic resonance arthrography was much more sensitive than magnetic resonance imaging at detecting various lesions but had twice as many false-positive interpretations.
Abstract: BackgroundHip arthroscopy has defined elusive causes of hip pain.Hypothesis/PurposeIt is postulated that the reliability of various investigative methods is inconsistent. The purpose of this study is to evaluate the diagnostic accuracy of these methods.Study DesignRetrospective review of prospectively collected data.MethodsFive parameters were assessed in 40 patients: clinical assessment, high-resolution magnetic resonance imaging, magnetic resonance imaging with gadolinium arthrography, intra-articular bupivacaine injection, and arthroscopy. Using arthroscopy as the definitive diagnosis, the other parameters were evaluated for reliability.ResultsHip abnormality was clinically suspected in all cases with 98% accuracy (1 false positive). However, the nature of the abnormality was identified in only 13 cases with 92% accuracy. Magnetic resonance imaging variously demonstrated direct or indirect evidence of abnormality but overall demonstrated a 42% false-negative and a 10% false-positive interpretation. Mag...
TL;DR: It is suggested that graft type may not be the primary determinant for successful outcomes after anterior cruciate ligament surgery, and Objective differences were not detected between groups in the majority of studies, suggesting that their sensitivity to detect clinical outcomes may be limited.
Abstract: Anterior cruciate ligament graft choice is controversial, with no evidence-based consensus available to guide decision making. The study design was evidence-based medicine systematic review of randomized controlled trials evaluating patellar tendon versus hamstring tendon autografts. A literature review identified 9 randomized controlled trials comparing patellar tendon and hamstring tendon autografts. An evidence-based systematic review was performed. Objective and subjective outcomes of interest included surgical technique, rehabilitation, instrumented laxity, isokinetic strength, patellofemoral pain, return to preinjury activity, and Tegner, Lysholm, Cincinnati, and International Knee Documentation Committee-1991 scores. Additional surgery, graft failure, and complications were reviewed. Slight increased laxity on arthrometer testing was seen in the hamstring population in 3 of 7 studies. Pain with kneeling was greater for the patellar tendon population in 4 of 4 studies. Only 1 of 9 studies showed increased anterior knee pain in the patellar tendon group. Frequency of additional surgery seemed to be related to the fixation method and not graft type. No study reported a significant difference in graft failure between patellar tendon and hamstring tendon autografts. Objective differences (range of motion, isokinetic strength, arthrometer testing) were not detected between groups in the majority of studies, suggesting that their sensitivity to detect clinical outcomes may be limited. Increased kneeling pain in the patellar tendon group was seen consistently in the studies evaluated. Subjective differences in anterior knee pain or return-to-activity level were not consistently observed in these studies. With numbers available, failure rates were not significantly different between groups. These findings suggest that graft type may not be the primary determinant for successful outcomes after anterior cruciate ligament surgery.
TL;DR: Lateral tunnel placement can restore rotatory and anterior knee stability similarly to an anatomical reconstruction when the knee is near extension, however, the same is not true when the knees are at high flexion angles.
Abstract: BackgroundLocations of femoral tunnels for anterior cruciate ligament replacement grafts remain a subject of debate.HypothesisA lateral femoral tunnel placed at the insertion of the posterolateral bundle of the anterior cruciate ligament can restore knee function comparably to anatomical femoral tunnel placement.Study DesignControlled laboratory study.MethodsTen cadaveric knees were subjected to the following external loading conditions: (1) a 134-N anterior tibial load and (2) combined rotatory loads of 10-N.m valgus and 5-N.m internal tibial torques. Data on resulting knee kinematics and in situ force of the intact anterior cruciate ligament and anterior cruciate ligament graft were collected using a robotic/universal force-moment sensor testing system for (1) intact, (2) anterior cruciate ligament-deficient, (3) anatomical double-bundle reconstructed, and (4) laterally placed single-bundle reconstructed knees.ResultsIn response to anterior tibial load, anterior tibial translation and in situ force in t...
TL;DR: Clinical studies have discovered novel therapeutic uses for physiologic doses of AAS, without any significant adverse effects in the short term, and guidelines for the clinical evaluation of Aas users will be presented for sports medicine practitioners.
Abstract: Anabolic-androgenic steroids (AAS) are synthetic derivatives of testosterone. According to surveys and media reports, the legal and illegal use of these drugs is gaining popularity. Testosterone restores sex drive and boosts muscle mass, making it central to 2 of society's rising preoccupations: perfecting the male body and sustaining the male libido. The anabolic effects of AAS have been questioned for decades, but recent scientific investigation of supraphysiologic doses supports the efficacy of these regimens. Testosterone has potent anabolic effects on the musculoskeletal system, including an increase in lean body mass, a dose-related hypertrophy of muscle fibers, and an increase in muscle strength. For athletes requiring speed and strength and men desiring a cosmetic muscle makeover, illegal steroids are a powerful lure, despite the risk of subjective side effects. Recent clinical studies have discovered novel therapeutic uses for physiologic doses of AAS, without any significant adverse effects in the short term. In the wake of important scientific advances during the past decade, the positive and negative effects of AAS warrant reevaluation. Guidelines for the clinical evaluation of AAS users will be presented for sports medicine practitioners.
TL;DR: Identifying a pronated foot type prior to training may help reduce the incidence of medial tibial stress syndrome by early intervention to control abnormal pronation.
Abstract: PurposeTo identify the incidence of medial tibial stress syndrome (MTSS) in a group of naval recruits undergoing a 10-week basic training period and to determine potential risk factors.MethodOne hundred and twenty-four recruits (84 men and 40 women) were followed prospectively during basic training. Anthropometric and lower limb biomechanical data were recorded at the start of the program along with injury history and previous sporting activity for the 3 months prior to enlisting. Recruits were monitored during training for development of medial tibial strees syndrome and were asked to complete an exit interview at the end of the program.ResultsForty recruits (22 men and 18 women) developed medial tibial stress syndrome, giving an incidence of 35%. A significant relationship existed between gender and medial tibial stress syndrome (P= .012), with female recruits more likely to develop medial tibial stress syndrome than male recruits (53% vs 28%). A risk estimate revealed a relative risk of 2.03. The biome...
TL;DR: This 2-graft technique to reconstruct the primary static stabilizers of the posterolateral knee restored static stability, as measured by joint translation in response to varus loading and external rotation torque, to knees with grade III postersolateral injuries.
Abstract: Background: To date, no surgical technique to treat posterolateral knee instability anatomically reconstructs the 3 major static stabilizing structures of the posterolateral knee: the fibular collateral ligament, the popliteus tendon, and the popliteofibular ligament.Hypothesis: Static varus and external rotatory stability would be restored to the reconstructed knee with a posterolateral knee injury.Methods: The anatomical locations of the original fibular collateral ligament, popliteus tendon, and popliteofibular ligament were reconstructed using a 2-graft technique. Ten cadaveric specimens were tested in 3 states: intact knee, knee with the 3 structures cut to simulate a grade III injury, and the reconstructed knee.Results: For the varus loading tests, joint stability was significantly improved by the posterolateral reconstruction compared to the cut state at 0°, 30°, 60°, and 90° of flexion. There were no significant differences between the intact and reconstructed knees at 0°, 60°, and 90° for varus t...
TL;DR: The success rate of ulnar collateral ligament reconstruction in high school baseball players is nearly equal to that in more mature groups of throwers, and special attention should be paid to elite-level teenage pitchers who throw with high velocity.
Abstract: BackgroundThe incidence of ulnar collateral ligament injury has increased in baseball, especially at the high school level.HypothesisUlnar collateral ligament injury in high school baseball players is associated with overuse, high-velocity throwing, early throwing of breaking pitches, and improper warm-ups.Study DesignRetrospective cohort study.MethodsFollow-up physical examination and questionnaire data were collected at an average of 35 months after ulnar collateral ligament reconstruction from 27 former high school baseball players. Six potential risk factors were evaluated: year-round throwing, seasonal overuse, event overuse, throwing velocity more than 80 mph, throwing breaking pitches before age 14, and inadequate warm-ups.ResultsOverall, 74% returned to baseball at the same or higher level. Patients averaged 3 potential risk factors, and 85% demonstrated at least one overuse category. Of the pitchers, the average self-reported fastball velocity was 83 mph, and 67% threw breaking pitches before age...
TL;DR: The data suggest that current grade 1 return-to-play recommendations that allow for immediate return to play may be too liberal and a reconsideration of current concussion grading systems appears to be warranted.
Abstract: BackgroundRecent concussion management guidelines have suggested that athletes with mild (grade 1) concussions may be returned to play if asymptomatic for 15 minutes. The purpose of this study was to assess the utility of a current concussion management guideline in classifying and managing mild concussion.HypothesisHigh school athletes diagnosed with a grade 1 concussion will demonstrate measurable decline in neuropsychological functioning that persists during the 1st week of recovery.Study DesignProspective study designed to evaluate neuropsychological functioning both prior to and following concussion.MethodsForty-three high school athletes completed neuropsychological test performance and symptom ratings prior to the season and at two times during the 1st week following mild concussion.ResultsThirty-six hours after injury, mildly concussed high school athletes demonstrated a decline in memory (P < 0.003) and a dramatic increase in self-reported symptoms (P < 0.00001) compared to baseline performance.C...
TL;DR: The following is a comprehensive review on the evaluation and treatment of posterior cruciate ligament injuries with special focus on the current surgical techniques.
Abstract: Current knowledge and treatment of posterior cruciate ligament injuries continue to lag behind that of anterior cruciate ligament injuries. This is the result of the relative infrequency of posterior cruciate ligament injuries and the lack of consensus with respect to its natural history, surgical indications, technique, and postoperative rehabilitation. Recent anatomical and biomechanical studies have improved our understanding of the posterior cruciate ligament in an attempt to reproduce its anatomy and function during reconstruction. The following is a comprehensive review on the evaluation and treatment of posterior cruciate ligament injuries with special focus on the current surgical techniques.
TL;DR: The consistent findings in the present study demonstrate the high quality of the data obtained, and an injury-reporting system has been implemented as matter of routine in FIFA tournaments.
Abstract: BackgroundStandardized assessment of sports injuries provides not only important epidemiological information, but also directions for injury prevention, and the opportunity for monitoring long-term changes in the frequency and characteristics of injury.PurposeDevelopment and implementation of an easy to use injury-reporting system to analyze the incidence, circumstances and characteristics of injury during major international football tournaments.Study DesignProspective survey.MethodsA comprehensive injury report form was developed, and implemented during 12 international football tournaments. The physicians of all participating teams were asked to report all injuries after each match. The response rate was 84% on average.ResultsA total of 901 injuries were reported from 334 matches, which is equivalent to an incidence of 2.7 injuries per match. Approximately one injury per match resulted in a player's absence from training or matches. On average 86% of the injuries arose as a result of contact with anoth...
TL;DR: The multiple causes of bone tunnel enlargement after ACL surgery are described, and mechanical and biological causes have been reported, and both contribute to enlarged graft tunnels.
Abstract: Bone tunnel enlargement has been reported after anterior cruciate ligament (ACL) reconstruction surgery. Although the long-term outcome of this phenomenon is not yet known, tunnel lysis or expansion may be clinically significant in revision surgery because the enlarged tunnels may complicate graft placement and fixation. There any many proposed theories for tunnel lysis. The most accurate statement is that this condition has a multifactorial etiology. Mechanical and biological causes have been reported, and both contribute to enlarged graft tunnels. This article describes the multiple causes of bone tunnel enlargement after ACL surgery. Future techniques and advances in primary ACL surgery must seek to eliminate this phenomenon.
TL;DR: The authors did not find postoperative cuff integrity to have a significant effect on outcomes when compared with those with an intact cuff, but those with a retear still had a significant improvement in all clinical areas assessed, including strength.
Abstract: BackgroundOpen rotator cuff repairs have led to excellent clinical results; however, several studies have linked postoperative structural integrity to patient outcomes. The purpose of this study is to prospectively assess postoperative cuff integrity after open rotator cuff repair and assess its relationship to clinical outcome.HypothesisPreoperative rotator cuff tear size and postoperative rotator cuff integrity are important factors in overall clinical outcomes.Study DesignProspective nonrandomized clinical outcomes study.MethodsForty-seven consecutive patients undergoing repair of full-thickness rotator cuff tears by a single surgeon were enrolled in this prospective study. A standardized evaluation was performed preoperatively and postoperatively at annual intervals. All patients underwent postoperative magnetic resonance imaging at least 1 year after surgery. Statistical evaluation was performed using paired and unpaired 2-tailed t tests for comparison.ResultsThirty-two patients were available for ev...
TL;DR: The most isometric portion of the medial patellofemoral ligament is the inferior portions of its patellar attachment extending to the superior portion of its femoral attachment, with the superior femoral attachments having the most notable influences on isometry.
Abstract: BackgroundSeveral techniques have been described for reconstruction of the medial patellofemoral ligament. However, the isometry of the medial patellofemoral ligament has not been studied.PurposeTo define the anatomy and isometry of the medial patellofemoral ligament.Study TypeCadaveric study.MethodsThe authors dissected the medial patellofemoral ligament in 11 cadaveric knees and recorded its anatomic relationships. They evaluated the isometry of the medial patellofemoral ligament by obtaining measurements between various anatomic pairings at certain fixed angles of knee flexion.ResultsDuring knee flexion from 0° to 90°, the portion of the medial patellofemoral ligament from the inferior patellar attachment to the superior femoral attachment was nearly isometric, demonstrating an average change in length of only 1.1 mm. Statistical analysis showed the superior femoral attachment to be most significant in determining isometric behavior.ConclusionsThe most isometric portion of the medial patellofemoral lig...
TL;DR: The low level of permanent elongation after cyclic loading suggests that the anatomic reconstruction complex could withstand early rehabilitation; however, the decrease in the structural properties and stiffness of the clavicle should be considered in optimizing the anatomical reconstruction technique.
Abstract: BackgroundSurgical treatments of complete acromioclavicular joint dislocations replace or reconstruct the coracoclavicular ligaments with a single structure and do not account for the anatomical variance of each ligament in the design.PurposeTo evaluate the cyclic behavior and structural properties of an anatomic tendon reconstruction of the coracoclavicular ligament complex after a simulated acromioclavicular joint dislocation.Study DesignControlled laboratory study.MethodsCyclic loading followed by a load-to-failure protocol (simulated dislocation) of the normal coracoclavicular ligament complex was performed and repeated after an anatomic reconstruction on the same specimen (n = 9). The anatomical reconstruction consisted of a semitendinosus tendon that replicated the direction and orientation of both the trapezoid and conoid ligaments.ResultsThe coracoclavicular ligament and anatomical reconstruction complexes had clinically insignificant (<3 mm) permanent elongation after cyclic loading. The stiffnes...
TL;DR: The interference screw and the Rigidfix fixation demonstrated inferior fixation biomechanics compared to the Bio-Transfix and the Endobutton techniques.
Abstract: PurposeTo evaluate femoral soft tissue fixation for anterior cruciate ligament reconstruction.HypothesisFemoral fixation devices have different ultimate strengths and slippage under cyclic loading.Study DesignControlled laboratory study.MethodsThirty-three porcine femora were used to study interference screw (9), Endobutton (8), Rigidfix cross-pin (8), and Bio-Transfix cross-pin (8) fixation methods. Fixation slippage was evaluated under cyclical load from 50 N to 250 N using a materials testing machine. Ultimate load was determined with a single load to failure.ResultsTotal graft slippage was greater (P< .001) for the Rigidfix (6.02 ± 2.12 mm) and the interference screw (5.44 ± 3.25 mm) compared to the Endobutton (1.75 ± 0.97 mm) and the Bio-Transfix (1.14 ± 0.53 mm). All techniques showed the greatest slippage during the first 100 cycles (Rigidfix 84%, Endobutton 70%, interference screw 56%, and Bio-Transfix 55%). The failure load for the interference screw technique (539 ± 114 N) was lower (P= .0008) t...
TL;DR: This review discusses common overuse injuries of the wrist including tendon injuries such as de Quervain's syndrome, subluxation of the extensor carpi ulnaris, and the common dorsal carpal impingement syndrome.
Abstract: Hand and wrist injuries in sports are some of the most common injuries reported. This review discusses common overuse injuries of the wrist including tendon injuries such as de Quervain's syndrome, subluxation of the extensor carpi ulnaris, and the common dorsal carpal impingement syndrome. The main focus of this section is the discussion of traumatic injuries to the hand in the athlete. Included is a discussion and review of fractures of the phalanges and metacarpals, common proximal interphalangeal joint injuries, and thumb carpal metacarpal and metacarpophalangeal joint injuries. Emphasis is placed on more common injuries seen regarding diagnosis, indications for non-operative versus operative treatment, and time to return to athletic competition.
TL;DR: Similar factors contribute to preoperative and postoperative arthritis in patients with anterior glenohumeral instability, suggesting that surgery does not influence the risk factors of arthritis.
Abstract: Background: Few large series of arthropathy related to anterior glenohumeral instability are available in the orthopaedic literature, preventing analysis of the incidence and the risk factors of preoperative and postoperative glenohumeral arthritis.Hypothesis: Anterior stabilization surgery influences the risk factors of glenohumeral arthritis.Study Design: Retrospective review.Methods: There were 570 patients who underwent an instability procedure. Clinical and radiographic preoperative data were collected for these patients. Arthritis was evaluated preoperatively and postoperatively with the Samilson classification. The mean age at surgery was 31.9 years. Follow-up averaged 6.5 years.Results: The preoperative incidence of arthritis was 9.2%. Arthritic risk factors were older age at the initial dislocation and at surgery, increased length of time from the initial dislocation until surgery, and the presence of osseous glenoid rim lesions. Postoperative arthritis in patients without any preoperative arthri...
TL;DR: The clinical characteristics of medial ankle instability are a feeling of giving way, pain on the medial gutter of the ankle, and a valgus and pronation deformity of the foot that can typically be actively corrected by the posterior tibial muscle.
Abstract: BackgroundVery little objective data are available regarding medial ankle instability.HypothesisSeveral structures contribute to the stabilization of the medial ankle, and, in the case of injury, they are not involved in a uniform way.Study DesignExplorative, prospective case series.MethodsFifty-one patients (52 ankles; males 27, females 25; age 36.4 [16 to 60] years) were surgically treated because of medial ankle instability. All clinical findings and structural changes, as found by arthroscopy and surgical exploration, were compared with the clinical diagnosis and then addressed for surgical reconstruction.ResultsPain in the medial gutter was noted in all ankles (100%). Arthroscopy verified a clinically expected additional lateral instability in 40 ankles (77%). At 4.43 years (2 to 6.5 years) after surgical reconstruction, the clinical result was considered to be good/excellent in 46 cases (90%), fair in 4 cases (8%), and poor in 1 case (2%).ConclusionThe clinical characteristics of medial ankle instab...