Showing papers in "American Journal of Sports Medicine in 2007"
TL;DR: The objectives of this study are to review the long-term consequences of injuries to the anterior cruciate ligament and menisci, the pathogenic mechanisms, and the causes of the considerable variability in outcome, and to strive toward a comparable level of quality of evidence in surgical treatment of knee injuries.
Abstract: The objectives of this study are to review the long-term consequences of injuries to the anterior cruciate ligament and menisci, the pathogenic mechanisms, and the causes of the considerable variability in outcome. Injuries of the anterior cruciate ligament and menisci are common in both athletes and the general population. At 10 to 20 years after the diagnosis, on average, 50% of those with a diagnosed anterior cruciate ligament or meniscus tear have osteoarthritis with associated pain and functional impairment: the young patient with an old knee. These individuals make up a substantial proportion of the overall osteoarthritis population. There is a lack of evidence to support a protective role of repair or reconstructive surgery of the anterior cruciate ligament or meniscus against osteoarthritis development. A consistent finding in a review of the literature is the often poor reporting of critical study variables, precluding data pooling or a meta-analysis. Osteoarthritis development in the injured joints is caused by intra-articular pathogenic processes initiated at the time of injury, combined with long-term changes in dynamic joint loading. Variation in outcome is reinforced by additional variables associated with the individual such as age, sex, genetics, obesity, muscle strength, activity, and reinjury. A better understanding of these variables may improve future prevention and treatment strategies. In evaluating medical treatment, we now expect large randomized clinical trials complemented by postmarketing monitoring. We should strive toward a comparable level of quality of evidence in surgical treatment of knee injuries. In instances in which a randomized clinical trial is not feasible, natural history and other observational cohort studies need to be as carefully designed and reported as the classic randomized clinical trial, to yield useful information.
2,014 citations
TL;DR: Female players landed with significantly more knee and hip flexion and had a 5.3 times higher relative risk of sustaining a valgus collapse than did male players, and movement patterns were frequently perturbed by opponents.
Abstract: Background: The mechanisms of anterior cruciate ligament injury in basketball are not well defined.Purpose: To describe the mechanisms of anterior cruciate ligament injury in basketball based on videos of injury situations.Study Design: Case series; Level of evidence, 4.Methods: Six international experts performed visual inspection analyses of 39 videos (17 male and 22 female players) of anterior cruciate ligament injury situations from high school, college, and professional basketball games. Two predefined time points were analyzed: initial ground contact and 50 milliseconds later. The analysts were asked to assess the playing situation, player behavior, and joint kinematics.Results: There was contact at the assumed time of injury in 11 of the 39 cases (5 male and 6 female players). Four of these cases were direct blows to the knee, all in men. Eleven of the 22 female cases were collisions, or the player was pushed by an opponent before the time of injury. The estimated time of injury, based on the group...
1,026 citations
TL;DR: Factors related to core stability predicted risk of athletic knee, ligament, and ACL injuries with high sensitivity and moderate specificity in female, but not male, athletes.
Abstract: Background: Female athletes are at significantly greater risk of anterior cruciate ligament (ACL) injury than male athletes in the same high-risk sports. Decreased trunk (core) neuromuscular control may compromise dynamic knee stability.Hypotheses: (1) Increased trunk displacement after sudden force release would be associated with increased knee injury risk; (2) coronal (lateral), not sagittal, plane displacement would be the strongest predictor of knee ligament injury; (3) logistic regression of factors related to core stability would accurately predict knee, ligament, and ACL injury risk; and (4) the predictive value of these models would differ between genders.Study Design: Cohort study (prognosis); Level of evidence, 2.Methods: In this study, 277 collegiate athletes (140 female and 137 male) were prospectively tested for trunk displacement after a sudden force release. Analysis of variance and multivariate logistic regression identified predictors of risk in athletes who sustained knee injury.Results...
826 citations
TL;DR: It is suggested that repairs should be performed, if possible, before more significant deterioration in the cuff musculature in order to optimize outcomes, and that understanding the degree of muscle atrophy and fatty infiltration before surgery can help guide patient expectations.
Abstract: BackgroundThe role of degenerative changes in rotator cuff musculature with respect to the functional outcomes of rotator cuff repair have only recently been recognized and are still not well understood. In addition, the reversibility of these changes with repair of the tendons is questionable.HypothesisPoorer preoperative muscle quality negatively affects outcome, and a successful outcome (in terms of a healed repair) might demonstrate improvements in fatty infiltration and muscle atrophy.Study DesignCohort study; Level of evidence, 2.MethodsThirty-eight patients (mean age, 62 years) were prospectively evaluated with preoperative and 1-year postoperative clinical examination and appropriate magnetic resonance image sequencing to determine grades of muscle atrophy and fatty infiltration of the supraspinatus and infraspinatus muscles. American Shoulder and Elbow Society (ASES), Constant, and pain scores were determined as well as strength measurements. The retear rate and progression of muscle degeneration...
779 citations
TL;DR: The operative management of tendons combined with the application of autologous PRGF may present new possibilities for enhanced healing and functional recovery in patients affected by musculoskeletal traumatic injuries.
Abstract: BackgroundPlatelet-rich fibrin matrices release a natural mixture of growth factors that play central roles in the complex processes of tendon healing.HypothesisApplication of autologous platelet-rich matrices during Achilles tendon surgery may promote healing and functional recovery.Study DesignCase-control study and descriptive laboratory study; Level of evidence, 3.MethodsTwelve athletes underwent open suture repair after complete Achilles tendon tear. Open suture repair in conjunction with a preparation rich in growth factors (PRGF) was performed in 6 athletes and retrospectively compared with a matched group that followed conventional surgical procedure. The outcomes were evaluated on the basis of range of motion, functional recovery, and complications. Achilles tendons were examined by ultrasound at 50 ± 11 months in retrospective controls and 32 ± 10 months in the PRGF group. In the laboratory portion of the study, PRGF treatment was characterized by the number of platelets and concentration of ins...
618 citations
TL;DR: An “ideal” outcome was associated with <3 mm of instrumented laxity at 2 years, the absence of additional surgery in the knee, and HT grafts, and it is possible to obtain excellent results with both HT and PT autografts.
Abstract: BackgroundThere are no controlled, prospective studies comparing the 10-year outcomes of anterior cruciate ligament (ACL) reconstruction using patellar tendon (PT) and 4-strand hamstring tendon (HT) autografts.HypothesisComparable results are possible with HT and PT autografts.Study DesignCohort study; Level of evidence, 2.MethodsOne hundred eighty ACL-deficient knees that met inclusion criteria underwent ACL reconstruction (90 HT autograft, 90 PT autograft) by one surgeon and were treated with an accelerated rehabilitation program. All knees were observed in a prospective fashion with subjective, objective, and radiographic evaluation at 2, 5, 7, and 10-year intervals.ResultsAt 10 years, there were no differences in graft rupture rates (7/90 PT vs. 12/90 HT, P = .24). There were 20 contralateral ACL ruptures in the PT group, compared with 9 in the HT group (P = .02). In all patients, graft rupture was associated with instrumented laxity >2 mm at 2 years (P = .001). Normal or near-normal function of the k...
578 citations
TL;DR: A reproducible anatomical and radiographic point, 1 mm anterior to the anterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior point of the Blumensaat line on a lateral radiograph with both posterior condyles projected in the same plane, shows the mean femoral medial patellofemoral ligament center.
Abstract: BackgroundReconstruction of the medial patellofemoral ligament has recently become popular for restoring patellofemoral stability. Femoral insertion site anatomy of the medial patellofemoral ligament has been described. This anatomical insertion has been inferred to be the isometric point in medial patellofemoral ligament reconstruction, but data about radiographic landmarks for a postoperative or intraoperative control are missing.PurposeTo determine the radiographic landmarks for control of postoperative and intraoperative femoral medial patellofemoral ligament insertion.Study DesignDescriptive laboratory study.MethodsEight fresh-frozen human knees were dissected, and the medial patellofemoral ligament was exposed. After identification of the femoral medial patellofemoral ligament insertion site, the insertion center was marked with a lead ball of 2-mm diameter. Straight lateral radiographs were taken, and posterior-anterior as well as proximal-distal position were evaluated.ResultsSix of 8 insertion po...
530 citations
TL;DR: The intent is to provide a current, in-depth treatise on all aspects of acromioclavicular joint complex injuries to include anatomy, biomechanics, benchmark studies on instability and reconstruction, clinical and radiographic evaluation, and the most recent clinical research on surgical outcomes.
Abstract: Acromioclavicular joint injuries and, more specifically, separations are commonplace both in general practice and during athletic participation. This article reviews the traditional classification as well as the clinical evaluation of patients with acute and chronic acromioclavicular joint separations. It also highlights many recent advances, principally in the anatomy and biomechanics of the acromioclavicular joint ligamentous complex. The concept of increases in superior translation as well as disturbances in horizontal translation with injuries to this joint and ligaments are discussed. This information, coupled with the unpredictable long-term results with the Weaver-Dunn procedure and its modifications, have prompted many recent biomechanical studies evaluating potential improvements in the surgical management of acute and chronic injuries. The authors present these recent works investigating cyclic loading and ultimate failure of traditional reconstructions, augmentations, use of free graft, and the more recent anatomic reconstruction of the conoid and trapezoid ligaments. The clinical results (largely retrospective), including acromioclavicular joint repair, reconstruction and augmentation with the coracoclavicular ligament, supplemental sutures, and the use of free autogenous grafts, are summarized. Finally, complications and the concept of the failed distal clavicle resection and reconstruction are addressed. The intent is to provide a current, in-depth treatise on all aspects of acromioclavicular joint complex injuries to include anatomy, biomechanics, benchmark studies on instability and reconstruction, clinical and radiographic evaluation, and to present the most recent clinical research on surgical outcomes.
477 citations
TL;DR: The results of the current study suggest that, from a biomechanical point of view, it may be beneficial to reconstruct both bundles of the anterior cruciate ligament to better restore normal anterior tibial translation and combined rotation.
Abstract: BackgroundA rupture of the entire fibers of the anterior cruciate ligament leads to knee instability due to increased anterior tibial translation and increased internal tibial rotation. The influence of isolated deficiency of the anteromedial or posterolateral bundle of the anterior cruciate ligament on the resulting knee kinematics have not yet been reported.HypothesisTransection of the anteromedial bundle will lead to increased anterior tibial translation at 90°. Transection of the posterolateral bundle will show an increased anterior tibial translation as well as a combined rotatory instability at 30°.Study DesignControlled laboratory study.MethodsKinematics of the intact knee were determined in response to a 134-N anterior tibial load and a combined rotatory load of 10 N·m valgus and 4 N·m internal tibial rotation using a robotic/universal force moment sensor testing system. Subsequently, the fibers of the anteromedial and posterolateral bundle were resected in an alternating order and the new transla...
459 citations
TL;DR: The exercises side-lying external rotation, side- lying forward flexion, prone horizontal abduction withExternal rotation, and prone extension were found to be the most appropriate for intramuscular trapezius muscle balance rehabilitation.
Abstract: BackgroundStrengthening exercises for the scapular muscles are used in the treatment of scapulothoracic dysfunction related to shoulder injury. In view of the intermuscular and intramuscular imbalances often established in these patients, exercises promoting lower trapezius (LT), middle trapezius (MT), and serratus anterior (SA) activation with minimal activity in the upper trapezius (UT) are recommended.HypothesisOf 12 commonly used trapezius strengthening exercises, a selection can be performed for muscle balance rehabilitation, based on a low UT/LT, UT/MT, or UT/SA muscle ratio.Study DesignControlled laboratory study.MethodsElectromyographic activity of the 3 trapezius parts and the SA was measured in 45 healthy subjects performing 12 commonly described scapular exercises, using surface electromyography.ResultsFor each intramuscular trapezius ratio (UT/LT, UT/MT), 3 exercises were selected for restoration of muscle balance. The exercises side-lying external rotation, side-lying forward flexion, prone h...
426 citations
TL;DR: The Achilles tendon Total Rupture Score (ATRS) is a self-administered instrument with high clinical utility, and the score for measuring the outcome, related to symptoms and physical activity, after treatment in patients with a total Achilles tendon rupture is suggested.
Abstract: BackgroundThere is a need for a patient-relevant instrument to evaluate outcome after treatment in patients with a total Achilles tendon rupture.PurposeTo develop and validate a new patient-reported instrument for measuring outcome after treatment for total Achilles tendon rupture.Study DesignCohort study (diagnosis); Level of evidence, 1.MethodsDevelopment of this instrument consisted of item generation and test construction, item reduction, validation, evaluation of structure and internal consistency, test-retest, and test for responsiveness. The final version, the Achilles tendon Total Rupture Score (ATRS), was tested for validity, structure, and internal consistency (Cronbach's alpha) on 82 patients and 52 healthy persons. A correlation analysis was performed of the ATRS with the 2 validated foot/ankle/Achilles tendon scores, the Foot and Ankle Outcome Score (FAOS) and the Swedish version of the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A-S). Structure was evaluated with fa...
TL;DR: An arthroscopic approach to treat femoroacetabular impingement has particular relevance in high-demand patients, particularly in athletes seeking to return to high-level sport.
Abstract: Morphological and spatial abnormalities of the proximal femur and acetabulum have been recently recognized as causes of femoroacetabular impingement. During joint motion in hips with femoroacetabular impingement, abnormal bony contact occurs, and soft tissue structures (chondral and labral) often fail. Femoroacetabular impingement has been reported to be a contributor to early-onset joint degeneration. Ganz et al have described good midterm success with an open surgical dislocation approach to reconstruct normal joint clearance. The purpose of this report is to discuss relevant literature and describe an arthroscopic approach to treat femoroacetabular impingement. This approach has particular relevance in high-demand patients, particularly in athletes seeking to return to high-level sport.
TL;DR: A double-row technique produces a mechanically superior construct compared with the single-row method in restoring the anatomical footprint of the rotator cuff, but these mechanical advantages do not translate into superior clinical performance.
Abstract: BackgroundRestoring the anatomical footprint may improve the healing and mechanical strength of repaired tendons. A double row of suture anchors increases the tendon-bone contact area, reconstituting a more anatomical configuration of the rotator cuff footprint.HypothesisThere is no difference in clinical and imaging outcome between single-row and double-row suture anchor technique repairs of rotator cuff tears.Study DesignRandomized controlled trial; Level of evidence, 1.MethodsThe authors recruited 60 patients. In 30 patients, rotator cuff repair was performed with a single-row suture anchor technique (group 1). In the other 30 patients, rotator cuff repair was performed with a double-row suture anchor technique (group 2).ResultsEight patients (4 in the single-row anchor repair group and 4 in the double-row anchor repair group) did not return at the final follow-up. At the 2-year follow-up, no statistically significant differences were seen with respect to the University of California, Los Angeles score...
TL;DR: Female subjects prepared for landing with decreased hip and knee flexion at landing, increased quadriceps activation, and decreased hamstring activation, which may result in increased anterior cruciate ligament loading during the landing of the stop-jump task and the risk for noncontact ACL injury.
Abstract: Background: Biomechanical analysis of stop-jump tasks has demonstrated gender differences during landing and a potential increase in risk of noncontact anterior cruciate ligament injury for female athletes. Analysis of landing preparation could advance our understanding of neuromuscular control in movement patterns and be applied to the development of prevention strategies for noncontact anterior cruciate ligament injury.Hypothesis: There are differences in the lower extremity joint angles and electromyography of male and female recreational athletes during the landing preparation of a stop-jump task.Study Design: Controlled laboratory study.Methods: Three-dimensional videographic and electromyographic data were collected for 36 recreational athletes (17 men and 19 women) performing vertical stop-jump tasks. Knee and hip angular motion patterns were determined during the flight phase before landing.Results: Knee and hip motion patterns and quadriceps and hamstring activation patterns exhibited significant...
TL;DR: Impaired core proprioception, measured by active proprioceptive repositioning of the trunk, predicted knee injury risk in female, but not male, athletes.
Abstract: BackgroundIn sports involving pivoting and landing, female athletes suffer knee injury at a greater rate than male athletes.HypothesesProprioceptive deficits in control of the body's core may affect dynamic stability of the knee. Female, but not male, athletes who suffered a knee injury during a 3-year follow-up period would demonstrate decreased core proprioception at baseline testing as compared with uninjured athletes.Study DesignCohort study (prognosis); Level of evidence, 2.MethodsStudy subjects were 277 collegiate athletes (140 female, 137 male) who were prospectively tested for core proprioception by active and passive proprioceptive repositioning. Athletes were monitored for injury for 3 years. An ANOVA and multivariate logistic regression were used to test whether core proprioception was related to knee injuries in athletes.ResultsTwenty-five athletes sustained knee injuries (11 women, 14 men). Deficits in active proprioceptive repositioning were observed in women with knee injuries (2.2°) and li...
TL;DR: Careful palpation during the first 3 weeks after injury and magnetic resonance imaging investigation performed during the following 6 weeks provide valuable information that can be used to predict the time to return to pre-injury level of performance in elite sprinting.
Abstract: BACKGROUND: Hamstring muscle strain is one of the most common injuries in sports. Still, knowledge is limited about the progression of clinical and magnetic resonance imaging characteristics and th ...
TL;DR: Outcomes showed patients regained some of their lost function within the first year after revision hip arthroscopy, and common findings among patients needing revision were hip pain, decreased range of motion, and functional disability.
Abstract: Each year, the indications for arthroscopic hip surgery expand, leading to increased volumes of arthroscopic hip surgery performed yearly, and this has created a need for treating physicians to understand and care for patients who have failed arthroscopic hip surgery.
TL;DR: Glenohumeral instability is a common injury in this population of young, healthy athletes, with subluxations comprising 85% of instability events.
Abstract: Background: The literature provides little information detailing the incidence of traumatic shoulder instability in young, healthy athletes.Hypothesis: Shoulder instability is common in young athletes.Study Design: Descriptive epidemiologic study.Methods: We prospectively captured all traumatic shoulder instability events at the United States Military Academy between September 1, 2004, and May 31, 2005. Throughout this period, all new traumatic shoulder instability events were evaluated with physical examination, plain radiographs, and magnetic resonance imaging. Instability events were classified according to direction, chronicity, and type (subluxation or dislocation). Subject demographics, mechanism of injury, and sport were evaluated.Results: Among 4141 students, 117 experienced new traumatic shoulder instability events during the study period; 11 experienced multiple events. The mean age of these 117 subjects was 20.0 years; 101 students were men (86.3%), and 16 were women (13.7%). The 1-year inciden...
TL;DR: The wait- and-see strategy was ineffective for the management of chronic recalcitrant tendinopathy of the main body of the Achilles tendon.
Abstract: BackgroundFew randomized controlled trials compare different methods of management in chronic tendinopathy of the main body of tendo Achillis.PurposeTo compare the effectiveness of 3 management strategies—group 1, eccentric loading; group 2, repetitive low-energy shock-wave therapy (SWT); and group 3, wait and see—in patients with chronic tendinopathy of the main body of tendo Achillis.Study DesignRandomized controlled trial; Level of evidence, 1.MethodsSeventy-five patients with a chronic recalcitrant (>6 months) noninsertional Achilles tendinopathy were enrolled in a randomized controlled study. All patients had received unsuccessful management for >3 months, including at least (1) peritendinous local injections, (2) nonsteroidal anti-inflammatory drugs, and (3) physiotherapy. A computerized random-number generator was used to draw up an allocation schedule. Analysis was on intention-to-treat basis.ResultsAt 4 months from baseline, the Victorian Institute of Sport Assessment (VISA)-A score increased in ...
TL;DR: In this article, the authors used the multicenter Orthopaedic Outcome Network (MOON) database of a prospective longitudinal cohort of anterior cruciate ligament reconstructions to determine the number of ACL ligament graft ruptures and tears of the intact ACL in the contralateral knee.
Abstract: Background: The risk of tear of the intact anterior cruciate ligament in the contralateral knee after anterior cruciate ligament reconstruction of the opposite knee and the incidence of rupturing the anterior cruciate ligament graft during the first 2 years after surgery have not been extensively studied in a prospective manner. Clinicians have hypothesized that the opposite normal knee is at equal or increased risk compared with the risk of anterior cruciate ligament graft rupture in the operated knee.Hypothesis: The risk of anterior cruciate ligament graft rupture and contralateral normal knee anterior cruciate ligament rupture at 2-year follow-up is equal.Study Design: Cohort study; Level of evidence, 2.Methods: The Multicenter Orthopaedic Outcome Network (MOON) database of a prospective longitudinal cohort of anterior cruciate ligament reconstructions was used to determine the number of anterior cruciate ligament graft ruptures and tears of the intact anterior cruciate ligament in the contralateral kn...
TL;DR: The anatomy of the human clavicle and coracoid process of the scapula is defined to guide surgeons in reconstructing the CC ligaments and allows the surgeon to predict the origin of the conoid and trapezoid ligaments accurately and to correctly create bone tunnels to reconstruct the anatomy ofThe CC complex.
Abstract: BackgroundRecently acromioclavicular joint reconstruction techniques have focused on anatomic restoration of the coracoclavicular (CC) ligaments. Such techniques involve creating bone tunnels in the distal clavicle and coracoid.PurposeTo define the anatomy of the human clavicle and coracoid process of the scapula, in order to guide surgeons in reconstructing the CC ligaments.Study DesignDescriptive laboratory study.MethodsOne hundred twenty (60 paired) cadaveric clavicles and corresponding scapulae (mean age ± and standard deviation, 48.3 ± 16.6 years) devoid of soft tissue were analyzed (dry osteology). Differences related to race and sex were recorded. Nineteen fresh-frozen cadaveric clavicles with intact CC ligaments were measured as well (fresh anatomic).ResultsThe mean clavicle length was 149 ± 9.1 mm. In the dry osteology group, the distance from the lateral edge of the clavicle to the medial edge of the conoid tuberosity in male and female specimens was 47.2 ± 4.6 mm and 42.8 ± 5.6 mm, respectively...
TL;DR: Patterns of football injuries vary, especially by type of exposure and level of play, with particular emphasis placed on high-risk plays (running plays) and positions (running backs and linebackers).
Abstract: BackgroundFootball, one of the most popular sports among male high school students in the United States, is a leading cause of sports-related injuries, with an injury rate almost twice that of basketball, the second most popular sport.HypothesisInjury patterns will vary between competition and practice exposures and between levels of play (ie, high school vs. National Collegiate Athletic Association [NCAA]).Study DesignDescriptive epidemiology study.MethodsFootball-related injury data were collected over the 2005-2006 school year from 100 nationally representative high schools via High School RIO™ (Reporting Information Online) and from 55 Division I, II, and III colleges via the NCAA Injury Surveillance System.ResultsNationally, an estimated 517 726 high school football-related injuries (1881 unweighted injuries) occurred during the 2005-2006 season. The rate of injury per 1000 athlete-exposures was greater during high school competitions (12.04) than during practices (2.56). The rate of injury per 1000 ...
TL;DR: Talar bone grafting required a longer time to return to activity than microfracture in high-demand patients, but both groups had similar postoperative AOFAS scores.
Abstract: BackgroundThe treatment options of talar osteochondral lesions are numerous. Although studies show these treatments have been used with varying success, the ability to return to activity (RTA), including sports after treatment of talar dome injuries, have not been well documented.HypothesisA treatment plan that uses microfracture for Hepple stage 2 through 4 lesions and autogenous bone grafting for Hepple stage 5 lesions for athletes with articular lesions of the talus will produce a high rate of return to athletic activity.Study DesignCase series; Level of evidence, 4.MethodsPreoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and RTA were assessed prospectively 2 to 8 years after surgery in high-demand (athletic) patients with articular injuries to the talar dome treated according to the above protocol over a 6-year period.ResultsThere were 26 microfracture procedures and 20 bone grafts to the talus. The AOFAS scores for both microfracture (preoperative, 54.6; postop...
TL;DR: These data demonstrate the EndoButton to be the strongest repair technique, with no failures during cycling at physiologic loads and with the largest load to failure.
Abstract: BackgroundRecent technical improvements have led the way to a resurgence of the single-incision approach for repair of distal biceps tendon injuries. There has been no biomechanical evaluation of all these techniques with comparison to the standard 2-incision bone tunnel technique.HypothesisThere will be no difference under cyclic loading and ultimate failure between the 2-incision bone tunnel technique, suture anchor repair, interference screw, and EndoButton techniques for the repair of distal biceps tendon ruptures.Study DesignControlled laboratory study.MethodsSixty-three fresh-frozen cadaveric elbows were randomly assigned to 4 treatment groups (bone tunnel, EndoButton, suture anchor, interference screw). Cyclic loading was then performed from 0° to 90° at 0.5 Hz for 3600 cycles with a 50-N load. A differential variable reductance transducer was placed between the radius and distal tendon to determine displacement. The construct was then pulled to failure at 120 mm/min.ResultsA multiple analysis of v...
TL;DR: With greater than 70% good or excellent results, fresh osteochondral allograft transplantation is a successful surgical treatment for osteochondritis dissecans of the femoral condyle.
Abstract: Background: The treatment of osteochondritis dissecans in the adult knee can be challenging. As part of our comprehensive treatment program, fresh osteochondral allografts have been used in the surgical management of osteochondritis dissecans of the femoral condyle.Hypothesis: Fresh osteochondral allograft transplantation will provide a successful surgical treatment for osteochondritis dissecans of the femoral condyle.Study Design: Case series; Level of evidence, 4.Methods: Sixty-six knees in 64 patients underwent fresh osteochondral allografting for the treatment of osteochondritis dissecans. Each patient was evaluated both preoperatively and postoperatively using an 18-point modified D'Aubigne and Postel scale. Subjective assessment was performed using a patient questionnaire. Radiographs were evaluated preoperatively and postoperatively.Results: Mean follow-up was 7.7 years (range, 2-22 years). There were 45 men and 19 women with a mean age of 28.6 years (range, 15-54 years). All patients had undergone...
TL;DR: No negative effects could be demonstrated from continuing Achilles tendon-loading activity, such as running and jumping, with the use of a pain-monitoring model, during treatment and the treatment protocol, which gradually increases the load on the Achilles tendon and calf muscle, demonstrated significant improvements.
Abstract: BackgroundAchilles tendinopathy is a common overuse injury, especially among athletes involved in activities that include running and jumping. Often an initial period of rest from the pain-provoking activity is recommended.PurposeTo prospectively evaluate if continued running and jumping during treatment with an Achilles tendon-loading strengthening program has an effect on the outcome.Study DesignRandomized clinical control trial; Level of evidence, 1.MethodsThirty-eight patients with Achilles tendinopathy were randomly allocated to 2 different treatment groups. The exercise training group (n = 19) was allowed, with the use of a pain-monitoring model, to continue Achilles tendon-loading activity, such as running and jumping, whereas the active rest group (n = 19) had to stop such activities during the first 6 weeks. All patients were rehabilitated according to an identical rehabilitation program. The primary outcome measures were the Swedish version of the Victorian Institute of Sports Assessment—Achille...
TL;DR: Neurocognitive differences may be associated with the loss of neuromuscular control and coordination errors, predisposing certain intercollegiate athletes to noncontact anterior cruciate ligament injuries.
Abstract: BackgroundBiomechanical analyses suggest that the loss of neuromuscular control is associated with noncontact anterior cruciate ligament sprains; however, previous research has not explored the link between neurocognitive function and unintentional knee injuries.PurposeTo determine if athletes who suffer a noncontact anterior cruciate ligament injury demonstrate decreased baseline neurocognitive performance when compared with matched controls.Study DesignCase control study; Level of evidence, 3.MethodsThe baseline scores from a computerized neurocognitive test battery (ImPACT) were analyzed to compare verbal memory, visual memory, processing speed, and reaction time. Eighty intercollegiate athletes who, subsequent to testing, experienced noncontact anterior cruciate ligament injuries, were matched with 80 controls based on height, weight, age, gender, sport, position, and years of experience at the collegiate level.ResultsStatistical differences were found between the noncontact anterior cruciate ligament...
TL;DR: The incidence of knee injuries sustained during matches was higher than that reported in all other football codes, surpassed only by rugby union at the international level.
Abstract: BackgroundShoulder injuries constitute a considerable risk to professional rugby union players; however, there is a shortage of detailed epidemiologic information about injuries in this population.PurposeTo describe the incidence, severity, and risk factors associated with shoulder injuries in professional rugby union.Study DesignDescriptive epidemiology study.MethodMedical personnel prospectively reported time-loss injuries in professional rugby union in England, and the shoulder injuries were evaluated.ResultsThe incidence of shoulder injuries was significantly lower during training (0.10/1000 player—training hours) compared with matches (8.9/1000 player—match hours). The most common match injury was acromioclavicular joint injury (32%); the most severe was shoulder dislocation and instability (mean severity, 81 days absent), which also caused the greatest proportion of absence (42%) and had the highest rate of recurrence (62%). The majority of match shoulder injuries were sustained in the tackle (65%),...
TL;DR: It is demonstrated that donor-site morbidity after osteochondral harvest can be significant and when performing these procedures, surgeons should consider these risks and discuss them with their patients.
Abstract: BackgroundMosaic autogenous osteochondral transplantation has been used to treat large osteochondral defects.HypothesisThere is potential, previously unrecognized donor-site morbidity associated with osteochondral harvest from asymptomatic knees for the treatment of talar osteochondral defect lesions.Study DesignCase series; Level of evidence, 4.MethodsFifteen patients underwent mosaic osteochondral transplantation to treat a talar osteochondral defect lesion, with 11 patients available for follow-up. A Lysholm knee score was used to assess donor-site morbidity at a mean follow-up of 47 months (range, 7-77 months). Mean age was 29 years (range, 21-44 years). A single surgical team performed the mosaicplasties. Significance was determined using the Student t test.ResultsAll patients had asymptomatic knees preoperatively. Mean postoperative Lysholm score was 81 (range, 49-100). By Lysholm criteria, 5 rated as excellent, 2 as good, and 4 as poor. No significant difference was detected in terms of the harvest...
TL;DR: The transtibial technique can produce tunnels centered in the anterior cruciate ligament footprints, but a starting point close to the tibial joint line is required, which will result in a relatively short tibIAL tunnel.
Abstract: BackgroundRecommended techniques for transtibial drilling in anterior cruciate ligament reconstruction are based on strategies to prevent graft impingement and preserve tibial tunnel length. The limitations of this drilling technique may restrict the ability to centralize tunnels in the anterior cruciate ligament footprints.HypothesisA transtibial drilling starting point to centralize the tibial and femoral tunnels in their respective footprints can be identified, but it will result in a short tibial tunnel.Study DesignDescriptive laboratory study.MethodsThe femoral and tibial attachments of the anterior cruciate ligament were characterized in 12 fresh-frozen cadaveric knees. Knees were secured in 70° and 90° of flexion. A guide pin was drilled antegrade through the central femoral and proximal anterior cruciate ligament attachment sites through the central tibial anterior cruciate ligament attachment site to exit on the anterior tibia.ResultsIn 90° of flexion using the central femoral and tibial attachme...