Load-deformation characteristics of cadaver patellae: Relationship to intraosseous pressure.

Background: Anterior knee pain can arise from several sources. One of the main sources of pain in patients with anterior knee pain is the patella. Increased patellofemoral joint loading is the prime source of patellar pain.

Emerging evidence in NSAID pharmacology: important considerations for product selection.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in the treatment of pain and inflammation. Emerging pharmacokinetic and pharmacodynamic evidence in NSAID pharmacology provides important criteria for selecting an appropriate NSAID. The inhibition of COX enzymes by NSAIDs affects physiologic functions in the gastrointestinal, cardiovascular, and renal systems.

Assessment of musculoskeletal toxicity 5 years after therapy with levofloxacin.

Background: Safety concerns for fluoroquinolones exist from animal studies demonstrating cartilage injury in weight-bearing joints, dependent on dose and duration of therapy. For children treated with levofloxacin or comparator in randomized, prospective, comparative studies for acute otitis media and community-acquired pneumonia, this 5-year follow-up safety study was designed to assess the presence/absence of cartilage injury.

Methods: Children enrolled in treatment studies were also enrolled in a 1-year follow-up safety study, which; focused on musculoskeletal adverse events (MSAE).

Treatment of painful accessory navicular: a modification to simple excision.

An accessory tarsal navicular ossicle may produce pain and tenderness despite conservative treatment modalities. This condition causes pain along the medial arch and limitations of activities. This described modification of the Kidner procedure and simple excision technique keeps the tendon insertion intact while restoring some of the normal biomechanical relationships.

Long-term functional outcome after lateral patellar retinacular release in adolescents: an observational cohort study with minimum 5-year follow-up.

Background: Lateral patellar retinacular release has been recommended for patients with patellar tilt, tight lateral retinaculum, patellar subluxation, patellar dislocation, and patellofemoral pain. Studies of long-term outcomes after lateral release are limited, especially for differing indications.

Hypothesis: Adolescents do well after lateral retinacular release in the 5- to 22-year time frame.

Comparative safety profile of levofloxacin in 2523 children with a focus on four specific musculoskeletal disorders.

Background: Fluoroquinolones, including levofloxacin, have not been recommended for use in children largely because studies in juvenile laboratory animals suggest there may be an increased risk of fluoroquinolone-associated cartilage lesions. A large prospective trial is needed to assess the risks associated with using levofloxacin in children.

Objective: Assess the safety and tolerability of levofloxacin therapy in children based on observations for 1 year after therapy.

Adherence patterns among patients treated with fixed-dose combination versus separate antihypertensive agents.

Purpose: Adherence patterns of patients treated with a fixed-dose combination of amlodipine-benazepril versus an angiotensin-converting-enzyme (ACE) inhibitor plus a dihydropyridine calcium-channel blocker (CCB) prescribed as separate drugs were studied.

Methods: In this retrospective analysis of pharmacy claims from a managed care organization in the northeastern United States, patients who received at least two prescriptions for fixed-dose amlodipine-benazepril (n = 2839) or at least two prescriptions for an ACE inhibitor plus a dihydropyridine CCB (n = 3367) were followed over one year. Adherence, defined as the medication possession ratio (MPR), was calculated based on daily possession of the prescribed drug or drugs over the study period.

Comparison of standing balance between female collegiate dancers and soccer players.

Study Design: This study was designed as a comparison study of two cohorts.

Objectives: The hypothesis of this study was that soccer players and dancers have different balance abilities and that these differences could be objectively measured using center of pressure measurements.

Background: Center of pressure (COP) measurements are reproducible and have been validated in the literature for assessing standing balance.

Relationship of blood pressure control to adherence with antihypertensive monotherapy in 13 managed care organizations.

Objective: This study was conducted to evaluate the relationship between medication compliance and blood pressure (BP) control among members of 13 managed care organizations with essential hypertension (HTN) who received antihypertensive monotherapy for at least 3 pharmacy claims prior to the blood pressure measurement.

Methods: This was a retrospective review of medical and pharmacy claims over a 4-year period (1999-2002) from 13 U.S.

Patellofemoral pain syndrome: evaluation of location and intensity of pain.

Objectives: To identify the sites and intensity of pain in patients with patellofemoral pain syndrome.

Method: A prospective cohort study was conducted at an academic sports medicine practice in Boston, Massachusetts. All patients met inclusion criteria and were enrolled and evaluated during the study time frame.

Appropriate antibiotic therapy for community-acquired respiratory tract infections.

Respiratory tract infections (RTIs) are expensive for MCOs and cause significant morbidity among their members. Although awareness of resistance to antibiotics is increasing, antibiotic selection for community-acquired RTIs remains largely empiric. When making formulary decisions, Pharmacy and Therapeutics Committees may want to consider the spectrum of coverage that an antibiotic provides and its vulnerability to resistance development.

Waterproof casts for immobilization of children's fractures and sprains.

This study was designed to determine the efficacy of waterproof cast-lining materials in children with short-arm, long-arm, and short-leg casts. Eligible patients had healing fractures 2 weeks after reduction, stable fractures requiring no reduction, or sprains. A total of 165 waterproof-lined casts were applied and 124 children and parents completed a survey (76.

Discoid lateral meniscus: prevalence of peripheral rim instability.

The purpose of this study was to determine the prevalence of peripheral rim instability in discoid lateral meniscus. A consecutive series of 112 patients (128 knees) (mean age 10.0 years [range 1 month to 22 years]) who underwent arthroscopic evaluation and treatment of a discoid lateral meniscus between 1993 and 2001 was reviewed.

Elbow disorders in throwing athletes.

Skeletally immature throwing athletes are injured when they throw too frequently or use throwing styles and pitches that overstress their elbows. Despite safety guidelines for throwing that recommend throwing more than 300, but less than 600, pitches per season, compliance is almost impossible to monitor, given multiple opportunities for throwing abuse away from organized, supervised league play. All throwers should avoid the side-arm throwing style.

Does football cause an increase in degenerative disease of the lumbar spine?

Degenerative disease of the lumbar spine is exceedingly common. Whether any specific activity increases the likelihood of developing degenerative disc disease (DDD) or facet degeneration (FD) has enormous implications. Within the field of occupational medicine there are specific activities, occupations, and morphologic characteristics that have been related to low back pain.

Tibial eminence fractures in children: prevalence of meniscal entrapment.

Background: Meniscal entrapment under a displaced tibial eminence fragment may be a rationale for arthroscopic or open reduction in type 2 and 3 tibial eminence fractures.

Purpose: To determine the prevalence of meniscal entrapment in children with type 2 and 3 tibial eminence fractures.

Study Design: Case series.

Tendon or joint disorders in children after treatment with fluoroquinolones or azithromycin.

Background: Fluoroquinolones (FQs) have been infrequently used in children, largely because of concern that these agents can cause lesions of the cartilage in juvenile animals. However, the relevance of this laboratory observation to children treated with FQs is unknown. A retrospective, observational study was conducted to assess the incidence and relative risk of tendon or joint disorders (TJDs) that occur after use of selected FQs compared with azithromycin (AZ), a drug with no known effect on cartilage or tendons in humans or animals.

The young dancer.

The injuries that are prevalent in and unique to dancers have their origins inextricably linked to faulty technique or poor biomechanics, combined with other risk factors. It is this combination of factors that must be addressed when considering diagnosis, treatment, and rehabilitation. For the dancer to return to full activity with minimal risk of recurrent injury, neuromuscular re-education is mandatory.

Back injuries in the young athlete.

The diagnosis of back pain in the young athlete should be specific and not attributed to nonspecific, mechanical causes. Risk factor identification and intervention are required. Treatment is then initiated in a specific pattern, addressing flexibility and muscular imbalances.

Idiopathic scoliosis and spondylolysis in the female athlete. Tips for treatment.

Idiopathic scoliosis and spondylolysis can be common back problems in female athletes. Diagnosis and treatment can be difficult. With the notable trend toward increasing participation of women and girls in organized sports, it is necessary to know which sports carry additional risks for participants to have these two conditions develop and to determine treatment modalities.

Role remodeling and teamwork: priorities for managed care realignment.

The realignment of work and processes in MCOs is underway. Senior executives are now looking to senior health care managers for skills, behaviors, attitudes, thinking, and leadership that are very different from traditional expectations. To help define these revised expectations, a national survey was conducted of managed care executives who were asked to assess current versus future roles, values, and characteristics they see as essential to senior health care managers in managed care pharmacy.

Bucket-handle tear of the medial plica.

Purpose: The etiology of pathological media plica of the knee is unknown. We describe two cases of large, torn medial plicae. The cases help understand the etiology and avoid diagnostic pitfalls.

Antiemetic therapy in managed care oncology: roundtable discussion.

Few diagnoses are feared more by patients than cancer. In addition to the life-threatening nature of many cancers, the spectre of very difficult the treatment provides patients with little or no level of comfort. However, recent advances in the treatment of the side effects of cancer chemotherapy are helping to change these attitudes.