The anterior femoral osteotomy for patellofemoral instability.

This study reviews the results of anterior femoral osteotomies in five patients with symptomatic patellofemoral instability recalcitrant to surgical and nonsurgical treatment. Preoperatively, each patient was severely disabled in activities of daily living, but after an average of slightly more than 7 1/2 years of follow-up, four of the five patients remained significantly improved. Anterior femoral osteotomy has a high complication rate and should only be considered as a salvage procedure in individuals with a hypoplastic lateral femoral condyle and disabling patellofemoral instability in whom previous surgery yielded unsuccessful results.

Open-knee Magnuson debridement as conservative treatment for degenerative osteoarthritis of the knee.

The medical records of 11 patients (average age, 37 years) who underwent 12 open-knee Magnuson debridements for degenerative arthritis at the Cleveland Clinic Foundation between July 1982 and December 1991 were reviewed. The postoperative results were evaluated subjectively, using a modification of the National Survey of Total Knee Replacement questionnaire. These patients were followed with clinical and radiologic examinations for a mean of 73 months (range, 17-130 months).

Effect of an ankle orthosis and ankle ligament anesthesia on ankle joint proprioception.

The purposes of this study were to determine the effect of a rigid ankle orthosis (Aircast Air-Stirrup) and lateral ankle ligament anesthesia on ankle joint proprioception. Twelve noninjured subjects attempted to match nine reference ankle joint positions with their eyes closed before and after application of the ankle brace and before and after one or two of the lateral ankle ligaments (anterior talofibular and calcaneofibular) were anesthetized. Three-dimensional ankle joint orientations were recorded with a Motion Analysis system.

Selected Hip and Pelvis Injuries.

Hip pointers, illopsoas tendinitis, and other injuries of the hip and pelvis in active patients present a special diagnostic challenge. Sometimes the symptoms may be vague or misleading. For the most part, these Injuries do not cause permanent harm.

How I Manage Hip and Pelvis Injuries in Adolescents.

In brief Injuries to the adolescent hip and pelvis need not be disabling. A high index of suspicion when adolescents complain of pain, an accurate diagnosis, and appropriate treatment will lead to a fairly rapid return to full activity.

Anterior cruciate ligament injury and hamstrings coactivation.

Two experiments were conducted to determine whether injury to the anterior cruciate ligament influences coactivation patterns of the hamstrings during voluntary isometric knee extension. Normal patterns of hamstrings coactivation were established in a control group during submaximum and maximum effort isometric knee extension torque at two knee flexion angles. Subjects who had undergone anterior cruciate ligament reconstructive surgery and a group of conservatively managed patients were studied using a modified protocol.

Prospective study of osseous, articular, and meniscal lesions in recent anterior cruciate ligament tears by magnetic resonance imaging and arthroscopy.

Fifty-four patients with anterior cruciate ligament tears that were arthroscopically reconstructed within 3 months of initial injury were prospectively evaluated. Patients with grade 3 medial collateral ligament, lateral collateral ligament, or posterior cruciate ligament tears were excluded. Eighty percent of our patients had a bone bruise present on the magnetic resonance image, with 68% in the lateral femoral condyle.

The predictive value of radiographs in the evaluation of unilateral and bilateral anterior cruciate ligament injuries.

A review of 250 cases of surgical reconstruction of the anterior cruciate ligament identified 24 patients with bilateral complete tears of the anterior cruciate ligament. Twenty of these patients had previous reconstruction of one anterior cruciate ligament before rupture of the opposite ligament. Twelve injuries occurred during the same activity that was responsible for the initial opposite injury.

Posterior shoulder instability. Surgical versus conservative results with evaluation of glenoid version.

We conducted a retrospective study on 50 patients with recurrent posterior shoulder instability. Twenty-five patients were treated conservatively with a specific rehabilitation program strengthening the rotator cuff. The other 25 patients, who did not improve with rehabilitation, underwent surgical reconstruction, the majority of these being soft tissue repairs.

Technique and ground reaction forces in the back handspring.

The ground reaction forces at the hand that produced compression forces and varus/valgus moments at the elbow joint during the double-arm support phase of the back handspring were studied. The relationship of technique, namely elbow joint flexion, to these forces were also studied. Compression forces and forces producing valgus moments have been implicated in overuse injuries to the elbow joint.

Hand and wrist problems in the gymnast.

The exact pathomechanics of problems in the wrists of gymnasts are yet to be defined. This article discusses injuries and overload phenomena in the wrist and skin problems, fractures, and sprains of the hand, including mallet finger.

Serum lidocaine and bupivacaine levels in local technique knee arthroscopy.

We investigated serum levels of lidocaine and bupivacaine following their intraarticular and subcutaneous injection for anesthetic effect in local technique knee arthroscopy. Fifteen patients scheduled for knee arthroscopy, but who were otherwise healthy, were studied. Following preparation of the knee, 25 cc of 1% lidocaine with epinephrine (1:100,000) and 25 cc of 0.

Efficacy of intermittent epidural morphine following posterior spinal fusion in children and adolescents.

Postoperative pain is a distressing and disabling feature of scoliosis surgery. Epidural morphine has recently been advocated to reduce the frequency and severity of postoperative pain in adults. A retrospective study of 35 patients was conducted to determine whether epidural administration of morphine is useful in the management of postoperative pain in children and adolescents following posterior spinal fusion.

Acute Knee Injury in Wrestling.

This case conference is one of a series presented at the annual meeting of the American College of Sports Medicine, Dallas, May 1988.

Evaluation and treatment of common spine and trunk problems.

This article was written not with the intent of establishing a comprehensive list of all problems seen in the trunk and spine of athletes nor as a cookbook for the treatment of these problems. In addition to the simple muscular strains and contusions of the back the physician must be aware of the possibility of underlying spondylolysis, spondylolisthesis, Scheuerman's kyphosis, and variants of Scheuerman's. In addition to these basic pain-related problems the team doctor should keep the possibility of spinal deformities such as scoliosis and silent kyphosis in mind and observe for those during team physicals.

A peer review process to assess the quality of graduate medical education.

Accreditation standards for graduate medical education require the internal evaluation of programs. In this paper, the authors describe a system of peer review instituted to meet these requirements and report on the supporting administrative structure and outcome of the peer review process. Although time-consuming and in some cases causing apprehension among staff members and residents, the experience of a peer review process was useful for staff members, residents, and administrators.

Isobutyl cyanoacrylate as a soft tissue adhesive. An in vitro study in the rabbit Achilles tendon.

Cyanoacrylates (CAs) are biodegradable, bacteriostatic, and hemostatic adhesives. CAs have been used in medical applications, but with adverse effects, including excessive inflammatory reaction and neural toxicity. Isobutyl CA (ICA) appears more biocompatible, with a long half-life that may be ideal for a soft tissue adhesive.

Anterior cruciate reconstruction using the Jones-Ellison procedure.

We performed a follow-up study of forty consecutive combined Jones-Ellison anterior-cruciate reconstructions in a young, athletic population. The mean interval from injury to operation was 2.7 years.

Injuries in Club Gymnastics.

In brief: There is relatively little information about injuries to club gymnasts. Therefore, the author conducted a statistical prospective study of the epidemiology of this group, following 873 club-level gymnasts for a nine-month season to establish injury incidence and related trends. Although the number of subjects was too small for statistical validity, many trends were identified.

Club gymnastics.

In summary, we came to the conclusion that gymnastics as performed at the club level has an injury rate that is compatible with other athletic endeavors and follows logical expectations. As these data are augmented in the future, and further refined and analyzed, we hope to be able to offer meaningful suggestions for avoiding injuries. Probably the most important single piece of information that we have gleaned so far is the major discrepancy between the injury rate in those students being spotted during a trick versus those not being spotted.

Introduction and history of gymnastics.

All ancient societies have been documented as having various aspects of gymnastics in their overall pattern of health and conditioning. In 700 BC the Athenians added gymnastics to Olympic competition; television coverage of gymnastics in the modern Olympics, combined with a heightened interest in physical fitness in general, has led to a resurgence of interest in this sport.

Ankle injuries in the athlete.

The ankle is one of the more vulnerable and commonly injured joints in athletic activities, with sprains accounting for between 30 and 50 per cent of all reported injuries among athletic teams. Despite this high volume and opportunity for experience, the ankle remains one of the most poorly understood and inadequately treated sites of injury.

lsokinetic Characteristics of Ballet Dancers and the Response to a Season of Ballet Training*.

Clinical isokinetic characteristics for professional ballet artists were determined preseason and at "peak" season. Twenty-eight dancers (equal N/sex) were studied at 45, 90, and 180 per second. The data indicated that, while male relative torques were similar to other athletes previously reported, the females were lower than most other female athletes.