Showing papers in "American Journal of Sports Medicine in 2006"
University of Minnesota1, Norwegian School of Sport Sciences2, University of Vermont3, Naval Medical Center Portsmouth4, Duke University5, Hospital for Special Surgery6, Cincinnati Children's Hospital Medical Center7, Vanderbilt University8, University of Pittsburgh9, American Orthopaedic Society for Sports Medicine10, University of Toronto11, University of North Carolina at Chapel Hill12, University of Southern California13, University of North Carolina at Greensboro14, University of Washington15, University of Michigan16
TL;DR: A group of physicians, physical therapists, athletic trainers, biomechanists, epidemiologists, and other scientists interested in this area of research met to review current knowledge on risk factors associated with noncontact anterior cruciate ligament injuries.
Abstract: The incidence of noncontact anterior cruciate ligament injuries in young to middle-aged athletes remains high. Despite early diagnosis and appropriate operative and nonoperative treatments, posttraumatic degenerative arthritis may develop. In a meeting in Atlanta, Georgia (January 2005), sponsored by the American Orthopaedic Society for Sports Medicine, a group of physicians, physical therapists, athletic trainers, biomechanists, epidemiologists, and other scientists interested in this area of research met to review current knowledge on risk factors associated with noncontact anterior cruciate ligament injuries, anterior cruciate ligament injury biomechanics, and existing anterior cruciate ligament prevention programs. This article reports on the presentations, discussions, and recommendations of this group.
945 citations
TL;DR: Treatment of patients with chronic elbow tendinosis with buffered platelet-rich plasma reduced pain significantly in this pilot investigation and should be considered before surgical intervention.
Abstract: BackgroundElbow epicondylar tendinosis is a common problem that usually resolves with nonoperative treatments. When these measures fail, however, patients are interested in an alternative to surgical intervention.HypothesisTreatment of chronic severe elbow tendinosis with buffered platelet-rich plasma will reduce pain and increase function in patients considering surgery for their problem.Study DesignCohort study; Level of evidence, 2.MethodsOne hundred forty patients with elbow epicondylar pain were evaluated in this study. All these patients were initially given a standardized physical therapy protocol and a variety of other nonoperative treatments. Twenty of these patients had significant persistent pain for a mean of 15 months (mean, 82 of 100; range, 60-100 of 100 on a visual analog pain scale), despite these interventions. All patients were considering surgery. This cohort of patients who had failed nonoperative treatment was then given either a single percutaneous injection of platelet-rich plasma ...
876 citations
TL;DR: Identification of both extrinsic and intrinsic risk factors associated with the anterior cruciate ligament injury mechanism may provide direction for targeted prophylactic treatment to high-risk individuals.
Abstract: The mechanism underlying gender disparity in anterior cruciate ligament injury risk is likely multifactorial in nature. Several theories have been proposed to explain the mechanisms underlying the gender difference in anterior cruciate ligament injury rates. These theories include the intrinsic variables of anatomical, hormonal, neuromuscular, and biomechanical differences between genders and extrinsic variables. Identification of both extrinsic and intrinsic risk factors associated with the anterior cruciate ligament injury mechanism may provide direction for targeted prophylactic treatment to high-risk individuals.
820 citations
TL;DR: This review summarizes conclusions based on evidence from the common components of the various interventions to discuss their potential to reduce anterior cruciate ligament injury risk and assess their potential for combined use in more effective and efficient intervention protocols.
Abstract: Female athletes have a 4 to 6 times higher incidence of anterior cruciate ligament injury than do male athletes participating in the same landing and pivoting sports. This greater risk of anterior cruciate ligament injury, coupled with a geometric increase in participation (doubling each decade), has led to a significant rise in anterior cruciate ligament injuries in female athletes. The gender gap in anterior cruciate ligament injury, combined with evidence that the underpinnings of this serious health problem are neuromuscular in nature, leads to the development of neuromuscular interventions designed to prevent injury. A systematic review of the published literature yielded 6 published interventions targeted toward anterior cruciate ligament injury prevention in female athletes. Four of 6 significantly reduced knee injury incidence, and 3 of 6 significantly reduced anterior cruciate ligament injury incidence in female athletes. A meta-analysis of these 6 studies demonstrates a significant effect of neuromuscular training programs on anterior cruciate ligament injury incidence in female athletes (test for overall effect, Z = 4.31, P < .0001). Examination of the similarities and differences between the training regimens gives insight into the development of more effective and efficient interventions. The purpose of this "Current Concepts" review is to highlight the relative effectiveness of these interventions in reducing anterior cruciate ligament injury rates and to evaluate the common training components between the training studies. In addition, the level of rigor of these interventions, the costs and the difficulty of implementation, the compliance with these interventions, and the performance benefits are discussed. This review summarizes conclusions based on evidence from the common components of the various interventions to discuss their potential to reduce anterior cruciate ligament injury risk and assess their potential for combined use in more effective and efficient intervention protocols.
630 citations
TL;DR: Players undertaking Nordic hamstring exercises in addition to conventional stretching and strengthening exercises had lower incidences and severities of injury during training and competition.
Abstract: BackgroundThe incidence of hamstring muscle injuries in professional rugby union is high, but evidence-based information on risk factors and injury-prevention strategies in this sport is limited.PurposeTo define the incidence, severity, and risk factors associated with hamstring muscle injuries in professional rugby union and to determine whether the use of hamstring strengthening and stretching exercises reduces the incidence and severity of these injuries.Study DesignCohort study (prevention); Level of evidence, 3.MethodsTeam clinicians reported all hamstring muscle injuries on a weekly basis and provided details of the location, diagnosis, severity, and mechanism of each injury; loss of time from training and match play was used as the definition of an injury. Players’ match and training exposures were recorded on a weekly basis.ResultsThe incidence of hamstring muscle injuries was 0.27 per 1000 player training hours and 5.6 per 1000 player match hours. Injuries, on average, resulted in 17 days of lost...
584 citations
TL;DR: The factors with the strongest associations with injury were overuse and fatigue, and high pitch velocity and participation in showcases were also associated with increased risk for injury.
Abstract: BackgroundThere is little evidence supporting current safety recommendations for adolescent pitchers.HypothesisPitching practices of adolescent pitchers without history of arm injury will be significantly different from those of adolescent pitchers who required shoulder or elbow surgery.Study DesignCase control study; Level of evidence, 3.MethodsNinety-five adolescent pitchers who had shoulder or elbow surgery and 45 adolescent pitchers who never had a significant pitching-related injury completed a survey. Responses were compared between the 2 groups using t tests and analyses. Multivariable logistic regression models were developed to identify the risk factors.ResultsThe injured group pitched significantly more months per year, games per year, innings per game, pitches per game, pitches per year, and warm-up pitches before a game. These pitchers were more frequently starting pitchers, pitched in more showcases, pitched with higher velocity, and pitched more often with arm pain and fatigue. They also use...
568 citations
TL;DR: Lateral ankle sprains in sports are the main cause of ligamentous posttraumatic ankle osteoarthritis and correlate with varus malalignment.
Abstract: BackgroundAnkle sprains are the most common injuries in sports and recreational activities.HypothesisAnkle osteoarthritis can be caused by ankle ligament lesions. Latency time between injury and osteoarthritis is influenced by the type and side of the injured ligaments. The side of the ligamentous lesion correlates with the hindfoot alignment.Study DesignCase series; Level of evidence, 4.MethodsOf a cohort of 247 patients with ankle arthritis, we reviewed data from 30 patients (33 ankles; mean age, 58.6 years) with ligamentous end-stage ankle osteoarthritis. The patients were evaluated etiologically, clinically, and radiologically.ResultsEtiologic analysis: 55% had a ligamentous lesion from sports injuries (soccer, 33%); 85% injured the lateral ankle ligaments, and 15% injured the medial and medial-lateral ligaments. The mean latency time between injury and osteoarthritis was 34.3 years. The survivorship rate for single severe ankle sprains was worse than that for chronic recurrent ligamentous lesions (me...
566 citations
TL;DR: Findings could indicate that a tightening of the posterior elements of the shoulder (capsule, rotator cuff) may contribute to impingement and suggest that management should include stretching to restore flexibility to the posterior shoulder.
Abstract: BackgroundAlterations in glenohumeral range of motion, including increased posterior shoulder tightness and glenohumeral internal rotation deficit that exceeds the accompanying external rotation gain, are suggested contributors to throwing-related shoulder injuries such as pathologic internal impingement. Yet these contributors have not been identified in throwers with internal impingement.HypothesisThrowers with pathologic internal impingement will exhibit significantly increased posterior shoulder tightness and glenohumeral internal rotation deficit without significantly increased external rotation gain.Study DesignCase control study; Level of evidence, 3.MethodsEleven throwing athletes with pathologic internal impingement diagnosed using both clinical examination and a magnetic resonance arthrogram were demographically matched with 11 control throwers who had no history of upper extremity injury. Passive glenohumeral internal and external rotation were measured bilaterally with standard goniometry at 9...
563 citations
TL;DR: A balance training program will significantly reduce the risk of ankle sprains in high school soccer and basketball players.
Abstract: BackgroundAnkle sprains are the most common musculoskeletal injuries that occur in athletes, and they have a profound impact on health care costs and resources.HypothesisA balance training program can reduce the risk of ankle sprains in high school athletes.Study DesignRandomized controlled clinical trial; Level of evidence, 1.MethodsSeven hundred and sixty-five high school soccer and basketball players (523 girls and 242 boys) were randomly assigned to either an intervention group (27 teams, 373 subjects) that participated in a balance training program or to a control group (28 teams, 392 subjects) that performed only standard conditioning exercises. On-site athletic trainers recorded athlete exposures and sprains.ResultsThe rate of ankle sprains was significantly lower for subjects in the intervention group (6.1%, 1.13 of 1000 exposures vs 9.9%, 1.87 of 1000 exposures; P = .04). Athletes with a history of an ankle sprain had a 2-fold increased risk of sustaining a sprain (risk ratio, 2.14), whereas athl...
481 citations
TL;DR: Both plyometric and balance training can reduce lower extremity valgus measures in female athletes and should be included in injury-prevention protocols.
Abstract: BackgroundNeuromuscular training that includes both plyometric and dynamic stabilization/balance exercises alters movement biomechanics and reduces ACL injury risk in female athletes The biomechanical effects of plyometric and balance training utilized separately are unknownHypothesisA protocol that includes balance training without plyometric training will decrease coronal plane hip, knee, and ankle motions during landing, and plyometric training will not affect coronal plane measures The corollary hypothesis was that plyometric and balance training effects on knee flexion are dependent on the movement task testedStudy DesignControlled laboratory studyMethodsEighteen high school female athletes participated in 18 training sessions during a 7-week period The plyometric group (n= 8) performed maximum-effort jumping and cutting exercises, and the balance group (n = 10) used dynamic stabilization/ balance exercises during training Lower extremity kinematics were measured during the drop vertical jump
462 citations
TL;DR: Footprint reconstruction of the rotator cuff using a double-row Repair improved initial strength and stiffness and decreased gap formation and strain over the footprint when compared with a single-row repair.
Abstract: BackgroundReestablishment of the native footprint during rotator cuff repair has been suggested as an important criterion for optimizing healing potential and fixation strength.HypothesisA double-row rotator cuff footprint repair will demonstrate superior biomechanical properties compared with a single-row repair.Study DesignControlled laboratory study.MethodsIn 9 matched pairs of fresh-frozen cadaveric shoulders, the supraspinatus tendon from 1 shoulder was repaired with a double-row suture anchor technique: 2 medial anchors with horizontal mattress sutures and 2 lateral anchors with simple sutures. The tendon from the contralateral shoulder was repaired using a single lateral row of 2 anchors with simple sutures. Each specimen underwent cyclic loading from 10 to 180 N for 200 cycles, followed by tensile testing to failure. Gap formation and strain over the footprint area were measured using a video digitizing system; stiffness and failure load were determined from testing machine data.ResultsGap formati...
TL;DR: A newly developed anatomical coracoclavicular ligament reconstruction with a modified Weaver-Dunn procedure and a recently described arthroscopic method using ultrastrong nonabsorbable suture material is compared to provide a stronger, permanent biologic solution for dislocation of the acromiOClavicular joint.
Abstract: BackgroundDespite numerous surgical techniques described, there have been few studies evaluating the biomechanical performance of acromioclavicular joint reconstructions.PurposeTo compare a newly developed anatomical coracoclavicular ligament reconstruction with a modified Weaver-Dunn procedure and a recently described arthroscopic method using ultrastrong nonabsorbable suture material.Study DesignControlled laboratory study.MethodsForty-two fresh-frozen cadaveric shoulders (72.8 ± 13.4 years) were randomly assigned to 3 groups: arthroscopic reconstruction, anatomical coracoclavicular reconstruction, and a modified Weaver-Dunn procedure. Bone mineral density was obtained on all specimens. Specimens were tested to 70 N in 3 directions, anterior, posterior, and superior, comparing the intact to the reconstructed states. Superior cyclic loading at 70 N for 3000 cycles was then performed at a rate of 1 Hz, followed by a load to failure test (120 mm/min) to simulate physiologic states at the acromioclavicular ...
TL;DR: Normative data collected in this article will allow clinicians to interpret how patients with knee injuries are functioning relative to their age-and gender-matched peers and will enable researchers to determine the clinical outcomes of treatment.
Abstract: BackgroundThe International Knee Documentation Committee Subjective Knee Evaluation Form may be used to measure symptoms, function, and sports activity for people with a variety of knee disorders, including ligamentous and meniscal injuries, osteoarthritis, and patellofemoral dysfunction. To date, normative data have not been established for this valid, reliable, and responsive outcomes instrument.PurposeTo provide clinicians and researchers with normative data to facilitate the interpretation of results on the International Knee Documentation Committee Subjective Knee Evaluation Form.Study DesignCross-sectional survey.MethodsThe Subjective Knee Evaluation Form was mailed to 600 people in each of 8 age/gender categories (18-24 years, 25-34 years, 35-50 years, and 51-65 years for both male subjects and female subjects). Participants were drawn from a panel of 550 000 households (1 300 000 subjects) representative of noninstitutionalized persons in the United States and were matched to data from the United ...
TL;DR: The International Knee Documentation Committee Subjective Knee Form is a responsive measure of symptoms, function, and sports activity for patients with a variety of knee conditions.
Abstract: Background and Purpose: The International Knee Documentation Committee Subjective Knee Form was developed to measure change in symptoms, function, and sports activity in patients treated for a variety of knee conditions. Although previous research has demonstrated reliability and validity of the form, its responsiveness has not been evaluated. The purpose of this study was to determine responsiveness of the International Knee Documentation Committee Subjective Knee Form.Study Design: Cohort study (diagnosis); Level of evidence, 1.Methods: Patients who participated in the original validation study for the International Knee Documentation Committee Subjective Knee Form completed the form and a 7-level global rating of change scale that ranged from greatly worse to greatly better after a mean of 1.6 years (range, 0.5-2.3 years). Analyses included calculation of the standardized response mean and mean change in International Knee Documentation Committee Subjective Knee Form score compared to the patient's per...
TL;DR: The peripheral portion of the medial meniscus provides a greater contribution to increasing contact areas and decreasing mean contact stresses than does the central portion, whereas peak contact stresses increase proportionally to the amount ofMeniscus removed.
Abstract: BackgroundThere is no consensus regarding the extent of meniscectomy leading to deleterious effects on tibiofemoral contact mechanics.HypothesisThe meniscus aids in optimizing tibiofemoral contact mechanics, increasing contact area, and decreasing contact stress.Study DesignControlled laboratory study.MethodsTwelve fresh-frozen human cadaveric knees each underwent 15 separate testing conditions—5 serial 20-mm posterior medial meniscectomy conditions (intact, 50% radial width, 75% radial width, segmental, and total meniscectomy) at 3 flexion angles (0°, 30°, and 60°)—under an 1800-N axial load. Tekscan sensors were used to measure total force and medial force, contact area, mean contact stress, and peak contact stress.ResultsAll posterior medial meniscectomy conditions resulted in significantly decreased contact areas and increased mean and peak contact stresses compared with the intact state (P < .05). The changes in contact mechanics after segmental and total posterior medial meniscectomies were not stat...
TL;DR: The majority of adult osteochondritis dissecans cases as well as those skeletally immature patients with unstable lesions and secondary loose bodies require fixation and possible bone grafting, and magnetic resonance imaging may allow early prediction of lesion healing potential.
Abstract: Osteochondritis dissecans of the knee is being seen with increased frequency in pediatric and young adult athletes and is thought to be, in part, owing to earlier and increasingly competitive sports participation. Despite much speculation, the cause of both juvenile and adult osteochondritis dissecans remains unclear. Early recognition is essential. Whereas adult osteochondritis dissecans lesions have a greater propensity to instability, juvenile osteochondritis dissecans lesions are typically stable, and those with an intact articular surface have a potential to heal with nonoperative treatment through cessation of repetitive impact loading. The value of adjunctive immobilization, protected weightbearing, and unloader bracing has not been established. Skeletally immature patients with stable lesions that have not healed with nonoperative treatment should have consideration given to arthroscopic drilling to promote healing before the lesion progresses and requires more involved treatment with a less optimistic prognosis. Magnetic resonance imaging may allow early prediction of lesion healing potential. The majority of adult osteochondritis dissecans cases as well as those skeletally immature patients with unstable lesions and secondary loose bodies require fixation and possible bone grafting. Many unstable lesions will heal after stabilization, but long-term prognosis is not clear. Chronic loose fragments can be difficult to fix and have poor healing potential. Results of excision of large lesions from weightbearing zones are poor. Chondral resurfacing techniques have limited long-term data for cases of osteochondritis dissecans in skeletally immature patients.
TL;DR: Small errors in graft length and position can dramatically increase the force and pressure applied to medial patellofemoral cartilage during reconstruction, which could lead to degradation, pain, and arthrosis.
Abstract: BackgroundThe influence of reconstruction of the medial patellofemoral ligament on the patellofemoral force and pressure distributions has not yet been investigated.HypothesisTechnical errors can cause tension to develop within a reconstructed medial patellofemoral ligament, which will adversely alter the normal patellofemoral force distribution by increasing the load applied to the medial cartilage.Study DesignControlled laboratory study.MethodsFour computational knee models were used to simulate knee function from 30° to 90° of flexion with (1) an intact medial patellofemoral ligament, (2) an anatomically correct reconstruction using a double hamstring tendon autograft, (3) a 5-mm proximally malpositioned femoral attachment site, (4) a graft that is 3 mm shorter than the intact medial patellofemoral ligament, and (5) combined proximal malpositioning and a short graft.ResultsThe results were similar for the intact and anatomically reconstructed medial patellofemoral ligament. Proximal malpositioning of t...
TL;DR: The altered kinematics observed in this study could explain the reason subjects with functional instability experience repeated episodes of ankle inversion injury in situations with only slight or no external provocation.
Abstract: BackgroundThe ankle joint requires very precise neuromuscular control during the transition from terminal swing to the early stance phase of the gait cycle. Altered ankle joint arthrokinematics and muscular activity have been cited as potential factors that may lead to an inversion sprain during the aforementioned time periods. However, to date, no study has investigated patterns of muscle activity and 3D joint kinematics simultaneously in a group of subjects with functional instability compared with a noninjured control group during these phases of the gait cycle.PurposeTo compare the patterns of lower limb 3D joint kinematics and electromyographic activity during treadmill walking in a group of subjects with functional instability with those observed in a control group.Study DesignControlled laboratory study.MethodsThree-dimensional angular velocities and displacements of the hip, knee, and ankle joints, as well as surface electromyography of the rectus femoris, peroneus longus, tibialis anterior, and s...
TL;DR: Reliance on patients’ self-reported symptoms after concussion is likely to result in underdiagnosis of concussion and may result in premature return to play.
Abstract: BackgroundNeurocognitive testing has been endorsed as a “cornerstone’ of concussion management by recent Vienna and Prague meetings of the Concussion in Sport Group. Neurocognitive testing is important given the potential unreliability of athlete self-report after injury. Relying only on athletes'ormalities after injury.Study DesignCase control study; Level of evidence, 3.MethodsHigh school and college athletes with a diagnosed concussion were tested 2 days after injury. Postinjury neurocognitive performance (Immediate Postconcussion Assessment and Cognitive Testing) and symptom (postconcussion symptom) scores were compared with preinjury (baseline) scores and with those of an agex and education-matched noninjured athlete control group. “Abnormal” test performance was determined statistically with Reliable Change Index scores.ResultsSixty-four percent of concussed athletes reported a significant increase in symptoms, as judged by postconcussion symptom scores, compared with preinjury baseline at 2 days af...
TL;DR: The risk of injury in different team sports can be compared using standardized methodology and even if the incidence and characteristics of injuries are not identical in all sports, prevention of injury and promotion of fair play are relevant topics for almost all team sports.
Abstract: BackgroundSeveral authors have analyzed the incidence of injuries in a given sport, but only a few have examined the exposure-related incidence of injuries in different types of sports using the same methodology.PurposeAnalysis of the incidence, circumstances, and characteristics of injuries in different team sports during the 2004 Olympic Games.Study DesignCohort study; Level of evidence, 2.MethodsDuring the 2004 Olympic Games, injuries in 14 team sport tournaments (men's and women's soccer, men's and women's handball, men's and women's basketball, men's and women's field hockey, baseball, softball, men's and women's water polo, and men's and women's volleyball) were analyzed. After each match, the physician of the participating teams or the official medical representative of the sport completed a standardized injury report form. The mean response rate was 93%.ResultsA total of 377 injuries were reported from 456 matches, an incidence of 0.8 injuries per match (95% confidence interval, 0.75-0.91) or 54 i...
TL;DR: Anomical reconstruction of the glenoid with autogenous iliac crest bone graft for recurrent glenohumeral instability in the setting of bone deficiency is an effective form of treatment for this problem.
Abstract: BackgroundAnterior shoulder instability associated with severe glenoid bone loss is rare, and little has been reported on this problem. Recent biomechanical and anatomical studies have suggested guidelines for bony reconstruction of the glenoid.HypothesisAnatomical glenoid reconstruction will restore stability in shoulders with recurrent anterior instability owing to glenoid bone loss.Study DesignCase series; Level of evidence, 4.MethodsEleven cases of traumatic recurrent anterior instability that required bony reconstruction for severe anterior glenoid bone loss were reviewed. In all cases, the length of the anterior glenoid defect exceeded the maximum anteroposterior radius of the glenoid based on preoperative assessment by 3-dimensional CT scan. Surgical reconstruction was performed using an intra-articular tricortical iliac crest bone graft contoured to reestablish the concavity and width of the glenoid. The graft was fixed with cannulated screws in combination with an anterior-inferior capsular repai...
TL;DR: Male athletes demonstrated a neuromuscular spurt as evidenced by increased vertical jump height and increased ability to attenuate landing force, which may be related to the increased risk of anterior cruciate ligament injury.
Abstract: BackgroundFemale athletes have increased risk of anterior cruciate ligament rupture after the onset of puberty.HypothesesMale athletes would demonstrate a longitudinal increase in vertical jump height compared with female athletes. There would be longitudinal gender differences in ground-reaction forces and loading rates.Study DesignCohort study; Level of evidence, 2.MethodsSixteen female and 17 male adolescent athletes were evaluated for 2 consecutive years. Subjects were included if they were classified as pubertal during the first year of testing and postpubertal during the second year. As subjects performed a drop vertical jump, ground-reaction force, and vertical jump height were measured. Data analysis consisted of a mixed design analysis of variance with post hoc analysis (paired t tests).ResultsThe male athletes demonstrated increased vertical jump height with maturation (P < .001); female athletes did not. Boys significantly reduced their landing ground-reaction force (P = .005), whereas girls di...
TL;DR: Medial patellofemoral ligament reconstruction provides excellent long-term pain relief and functional return in patients with patellar instability and femoral trochlear dysplasia and prevents recurrent dislocation, despite the diminished bony constraint of a dysplastic trochlea.
Abstract: BackgroundReconstruction of the medial patellofemoral ligament has been proven to restore stability in patients with lateral patellar instability. No study to date has examined the results in a patient population with the predisposing factor of femoral trochlear dysplasia.HypothesisReconstruction of the medial patellofemoral ligament restores stability and provides pain relief in patients who have lateral patellar instability in association with trochlear dysplasia.Study DesignCase series; Level of evidence, 4.MethodsThirty-four patients with chronic patellar instability and trochlear dysplasia were treated with medial patellofemoral ligament reconstruction using an adductor tendon autograft, bone–quadriceps tendon autograft, or bone–patellar tendon allograft. All patients were evaluated preoperatively and postoperatively with Kujala, Lysholm, and Tegner scores at a minimum of 24 months.ResultsThirty-four patients were followed for a mean of 66.5 months (range, 24-130 months) after surgery. Kujala scores ...
TL;DR: Traditional and cyclooxygenase-2–specific nonsteroidal anti-inflammatory drugs significantly inhibited tendon-tobone healing in rats, and this inhibition appears linked to cyclo oxygengen enzyme-2.
Abstract: Background:Nonsteroidal anti-inflammatory drugs are commonly prescribed after rotator cuff repair. These agents can impair bone formation, but no studies have evaluated their impact on tendon-to-bone healing.Hypothesis:Traditional nonselective nonsteroidal anti-inflammatory drugs and cyclooxygenase-2–specific nonsteroidal antiinflammatory drugs interfere with tendon-to-bone healing.Study Design:Controlled laboratory study.Methods:One hundred eighty Sprague-Dawley rats underwent acute rotator cuff repairs. Postoperatively, 60 rats received 14 days of celecoxib, a cyclooxygenase-2–specific nonsteroidal anti-inflammatory drug; 60 received indomethacin, a traditional nonselective nonsteroidal anti-inflammatory drug; and 60 received standard rat chow. Animals were sacrificed at 2, 4, and 8 weeks and evaluated by gross inspection, biomechanical testing, histologic analysis, and polarized light microscopy to quantify collagen formation and maturation.Results:Five tendons completely failed to heal (4 celecoxib, 1...
TL;DR: The preoperative evaluation, surgical techniques, and clinical outcomes of revision ACL reconstruction are reviewed.
Abstract: Failed anterior cruciate ligament (ACL) reconstruction presents a difficult clinical challenge. Successful revision ACL reconstruction depends on identifying the causes of failure and correcting technical or diagnostic errors. Failed ACL reconstruction may be either traumatic or atraumatic. Atraumatic failures may be attributable to technical errors, diagnostic errors, or failure of graft incorporation. Published outcomes of revision ACL reconstruction have been worse than for primary ACL reconstruction. The preoperative evaluation, surgical techniques, and clinical outcomes of revision ACL reconstruction are reviewed.
TL;DR: Microfracture is an effective first-line treatment to return young athletes with short symptomatic intervals and small articular cartilage lesions of the knee back to high-impact athletics.
Abstract: BackgroundKnee articular cartilage injuries in athletes present a therapeutic challenge and have been identified as an important cause of permanent disability because of the high mechanical joint stresses in athletes.PurposeTo determine whether microfracture treatment of knee articular cartilage injuries can return athletes to high-impact sports and to identify the factors that affect the ability to return to athletic activity.Study DesignCase series; Level of evidence, 4.MethodsThirty-two athletes who regularly participated in high-impact, pivoting sports before articular cartilage injury were treated with microfracture for single articular cartilage lesions of the knee. Functional outcome was prospectively evaluated with a minimum 2-year follow-up by subjective rating, activity-based outcome scores, and the ability for postoperative participation in high-impact, pivoting sports.ResultsAt last follow-up, 66% of athletes reported good or excellent results. Activity of daily living, Marx activity rating sc...
TL;DR: There were significant kinematic differences between the fastball and curveball but few kinetic differences, and the change-up had lower joint kinetics, lower angular velocities, and different body positions than the other 3 pitch types had.
Abstract: Background:Controversy exists about whether breaking pitches are more stressful than are fastballs. Previous biomechanical studies compared kinematics but not kinetics.Hypothesis:Elbow and shoulder forces and torques are statistically different among the fastball, curveball, change-up, and slider.Study Design:Descriptive laboratory study.Methods:Twenty-one healthy collegiate pitchers were studied with a high-speed automated digitizing system. All subjects threw fastballs (n = 21), most threw curveballs (n = 20) and change-ups (n = 19), and a few threw sliders (n = 6). Wrist, elbow, and shoulder kinetics were calculated using inverse dynamics. Nine kinetic and 26 kinematic parameters were compared among the different pitch types using repeated-measures analysis of variance.Results:At the shoulder, internal rotation torque, horizontal adduction torque, abduction torque, and proximal force were significantly less in the change-up than in the other 3 pitches. Shoulder horizontal adduction torque was greater i...
TL;DR: The data from this study suggest that future anterior cruciate ligament reconstruction techniques should reproduce not only anterior stability but also medial-lateral stability, as these findings correlate with the observation that osteoarthritis in patients with anterior crucial ligament injuries is likely to occur in this region.
Abstract: BackgroundPrevious studies of knee joint function after anterior cruciate ligament deficiency have focused on measuring anterior-posterior translation and internal-external rotation. Few studies have measured the effects of anterior cruciate ligament deficiency on 6 degrees of freedom knee kinematics in vivo.ObjectiveTo measure the 6 degrees of freedom knee kinematics of patients with anterior cruciate ligament deficiency.Study DesignControlled laboratory study.MethodsThe knee joint kinematics of 8 patients with unilateral anterior cruciate ligament rupture was measured during a quasi-static lunge. Kinematics was measured from full extension to 90° of flexion using imaging and 3-dimensional modeling techniques. The healthy, contralateral knee of each patient served as a control.ResultsAnterior cruciate ligament deficiency caused a statistically significant anterior shift (approximately 3 mm) and internal rotation of the tibia (approximately 2°) at low flexion angles. However, ligament deficiency also caus...
TL;DR: The lower extremity is the most frequently injured body area in both leagues, and Women's Nationalasketball Association athletes are more susceptible than are National Basketball Association athletes.
Abstract: Background Gender-based differences in injury rates have been reported in scholastic and collegiate basketball. The purpose of this study was to retrospectively compare injury rates in women's and men's professional basketball. Hypothesis Female professional basketball players are injured at a higher rate than are men. Study design Cohort study (prevalence); Level of evidence, 2. Methods Women's National Basketball Association and National Basketball Association injury data were retrospectively reviewed for 6 full seasons. The frequency of all injuries and the rate of game-related injuries were calculated. Results Complete player profiles were obtained on 702 National Basketball Association athletes and 443 Women's National Basketball Association athletes who competed in their respective leagues during the data collection period. Total game exposures totaled 70,420 (National Basketball Association) and 22,980 (Women's National Basketball Association). Women's National Basketball Association athletes had a higher overall game-related injury rate (24.9 per 1000 athlete exposures; 95% confidence interval, 22.9-26.9; P Conclusion The lower extremity is the most frequently injured body area in both leagues, and Women's National Basketball Association athletes are more susceptible than are National Basketball Association athletes. There were, however, few statistical differences in the actual injuries occurring between the 2 leagues.
TL;DR: Significant differences in injury rates were found by age and division of play, and the public health significance of body checking injury in minor hockey is great.
Abstract: BackgroundHockey is one of the top sports for participation in youth in Canada. There are limited data on the epidemiology of injury in youth hockey.PurposeThrough implementation and validation of an injury surveillance system, youth ice hockey injury rates, risk factors, and mechanisms of injury will be examined.Study DesignDescriptive epidemiology study.MethodsDuring the 2004-2005 season in minor hockey in Calgary, Alberta, Canada, 71 hockey teams (N = 986) were studied, including teams from each age group (Atom, 9/10 years; Pee Wee, 11/12 years; Bantam, 13/14 years; Midget, 15/16 years) and division of play (7-10 divisions per age group). A certified athletic therapist or candidate did weekly assessments of any identified hockey injury. Injury definition included any injury occurring during the regular hockey season that required medical attention, removal from a session, or missing a subsequent session.ResultsOf the 986 participating players, 216 players sustained a total of 296 injuries in the 2004-2...