Posterior cruciate ligament femoral insertion site characteristics. Importance for reconstructive procedures.

Background: Previous descriptions of the insertion site of the posterior cruciate ligament are inadequate.

Hypothesis: More than one reference system is required to adequately represent the anatomy of the femoral attachment.

Study Design: Descriptive anatomic study.

Arthroscopic repair of meniscal tears extending into the avascular zone in patients younger than twenty years of age.

Background: Limited data are available regarding repair results of meniscal tears extending into the central avascular region.

Hypothesis: Meniscal tears extending into the avascular region can be successfully repaired in patients less than 20 years old.

Study Design: Prospective cohort study.

Nontraumatic osteonecrosis of the humeral head.

The humeral head is the second most common site for nontraumatic osteonecrosis after the femoral head, yet it has attracted relatively little attention. Osteonecrosis is associated with many conditions, such as corticosteroid use, sickle-cell disease, alcoholism, dysbarism (or caisson disease), Gaucher's disease, and other systemic conditions. The diagnosis is a clinical and radiographic one, the latter forming the basis for its staging.

Thermal capsular shrinkage: Basic science and clinical applications.

Recently, the use of thermal energy to shrink the redundant glenohumeral joint capsule in patients with instability has generated a great deal of interest. Proponents assert that the procedure avoids the need for an open stabilization and it may be used as an adjunct to an open or arthroscopic capsulolabral repair. The use of nonablative thermal energy to shrink soft-tissue collagen appears to induce ultra-structural and mechanical changes at or above 60 degrees C.

Red plaque on a high school wrestler.

A 15-year-old freshman on a nationally ranked high school wrestling team had a 1-week history of a pruritic plaque on his left arm. He had no history of atopic dermatitis or a similar lesion. He had been treating the lesion with over-the-counter 1% hydrocortisone cream for 7 days without resolution.

Two-bundle posterior cruciate ligament reconstruction. An in vitro analysis of graft placement and tension.

This study had two purposes: first, to determine how femoral attachment location affects the load sharing between the two bundles of a Y-type posterior cruciate ligament reconstruction, and second, to determine how the bundles, separately and in combination, control posterior tibial translation throughout the full range of knee flexion. One and two-bundle reconstructions were performed in 12 cadaveric knees. The one-bundle reconstructions were attached within the femoral posterior cruciate ligament footprint at one of three locations, high and shallow (S1), mid and shallow (S2), or mid and deep (D).

Arthroscopic repair of meniscus tears extending into the avascular zone with or without anterior cruciate ligament reconstruction in patients 40 years of age and older.

Purpose: The purpose of this study was to prospectively determine the outcome of meniscal repairs for tears that extended into the central one-third zone of the meniscus, or had a rim width of 4 mm or greater, in a case series of patients 40 years of age and older.

Type Of Study: Prospective case series.

Materials And Methods: Thirty meniscal repairs in 29 patients were evaluated by a comprehensive examination (28 repairs) a mean of 34 months postoperatively, by follow-up arthroscopy (6 repairs) a mean of 24 months postoperatively, or both.

Avoidance of soccer injuries with preseason conditioning.

The effect of a preseason conditioning program was studied to evaluate its influence on the occurrence and severity of soccer injuries. Three hundred female soccer players (ages 14 to 18 years) were studied over a 1-year period. Forty-two of these players participated in a 7-week training program before the start of the season.

Prevention of permanent arthrofibrosis after anterior cruciate ligament reconstruction alone or combined with associated procedures: a prospective study in 443 knees.

We prospectively determined the effectiveness of an immediate knee motion and early intervention program to prevent permanent motion limitations in a consecutive series of patients who had anterior cruciate ligament autogenous patellar tendon reconstruction for isolated rupture (219 knees) or combined with other procedures (224 knees). The subjects were placed into either a progressive or delayed rehabilitation program and were followed for at least 12 months postoperatively. At follow-up a normal range of motion (0 degrees to at least 135 degrees) was found in 436 knees (98%), and mild losses of extension (-5 degrees) were found in 7 knees.

A prospective study of high school wrestling injuries.

We performed a prospective study to evaluate injury patterns in a large population of high school wrestlers during one season. Preseason screening was performed on 458 male wrestlers from 14 different high schools. Certified athletic trainers submitted detailed weekly team and individual injury reports.

High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees.

In a consecutive series, we treated 41 young patients who had anterior cruciate ligament deficiency, lower limb varus angulation, and varying amounts of posterolateral ligament deficiency. Seventy-three percent of the patients (N = 30) had lost the medial meniscus and 63% (N = 26) had marked articular cartilage damage in the medial compartment. All patients were treated with high tibial osteotomy and, in the majority (N = 34), anterior cruciate ligament reconstruction a mean of 8 months later.

Neuromuscular and hormonal factors associated with knee injuries in female athletes. Strategies for intervention.

Female athletes who participate in jumping and cutting sports are 4 to 6 times more likely to sustain a serious knee injury than male athletes participating in the same sports. More than 30,000 serious knee injuries are projected to occur in female intercollegiate and high school athletics in the US each year. The majority of these injuries occur by non-contact mechanisms, most often during landing from a jump or making a lateral pivot while running.

Running-related toenail abnormality.

A 33-year-old man presented with a keratotic plaque on his distal second toe. The plaque had been present for several months, and he also reported nail discoloration. The patient had no other related complaints.

The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study.

To prospectively evaluate the effect of neuromuscular training on the incidence of knee injury in female athletes, we monitored two groups of female athletes, one trained before sports participation and the other not trained, and a group of untrained male athletes throughout the high school soccer, volleyball, and basketball seasons. Weekly reports included the number of practice and competition exposures and mechanism of injury. There were 14 serious knee injuries in the 1263 athletes tracked through the study.

Assessment of sports participation levels following knee injuries.

Although there are many published instruments designed to determine outcome following the treatment of knee injuries, only a few incorporate specific assessments of sports activity level and participation into the evaluation. This article reviews 3 of the most commonly used sports activity outcome instruments: the scales devised by Tegner and Lysholm, the Hospital for Special Surgery and the International Knee Documentation Committee. Problems and potential study biases that can arise with improper questionnaire design and data reduction techniques are reviewed, and recommendations are made to correct these problems.

Rigorous statistical reliability, validity, and responsiveness testing of the Cincinnati knee rating system in 350 subjects with uninjured, injured, or anterior cruciate ligament-reconstructed knees.

Although many instruments are used to assess outcome after knee ligament reconstruction, their reliability, validity, and responsiveness have not been adequately proven. Our purpose was to assess these statistical measures in a commonly used instrument, the Cincinnati Knee Rating System. Reliability was determined from the responses of 100 subjects who completed the instrument twice, a mean of 7 days apart.

Posttraumatic tibia valga in children. A long-term follow-up note.

Background: We reevaluated seven patients who initially had been managed nonoperatively because of a progressive valgus deformity that had occurred within approximately twelve months after satisfactory healing of a proximal tibial metaphyseal fracture sustained at an average age of four years (range, eleven months to six years and four months). All seven patients were described in a previous report from our institution, published in 1986. In that report, spontaneous improvement of the angulation was documented after an average duration of follow-up of thirty-nine months and nonoperative treatment of the deformity was recommended.

The effect of exercise and rehabilitation on anterior-posterior knee displacements after anterior cruciate ligament autograft reconstruction.

We studied the effect of rehabilitation strength training and return to activities on anterior-posterior knee displacements after patellar tendon autogenous anterior cruciate ligament reconstruction. A total of 938 measurements were sequentially collected for 142 patients with the KT-2000 arthrometer. Rehabilitation included immediate knee motion and early weightbearing, light sports at 6 months, and competitive sports at 8 months or later.

Automatic external defibrillators in the sports arena: the right place, the right time.

At first glance, the idea of having automatic external defibrillators (AEDs) at sports events may seem curious, since spectator sports are the domain of young, healthy athletes. Yet athletes are not entirely free of cardiac risk. More important, there are many other people at sports events (officials, coaches, fans) who are at risk for cardiac arrest.

Levels of carbon dioxide in helmet systems used during orthopaedic operations.

The use of isolation helmets has gained popularity as a method of possible protection of the operating-room personnel from diseases that can be transmitted during operative procedures. However, the use of these systems has been associated with a variety of symptoms, including fatigue, diaphoresis, nausea, headache, and irritability. These symptoms have often been attributed to the mental stress of the operative procedure or the physical discomfort of the helmet.

Arthroscopic-assisted outpatient anterior cruciate ligament reconstruction using the semitendinosus and gracilis tendons.

This study presents an average of 43-month results (range, 23 to 75 months) of 82 arthroscopically assisted, outpatient semitendinosus-gracilis anterior cruciate ligament reconstructions evaluated with the Cincinnati Knee Rating System. There were 44 acute and 38 chronic injuries. The results showed no significant effect of injury chronicity on all outcome variables except knee motion complications.

Decrease in knee joint pain and increase in function in patients with medial compartment arthrosis: a prospective analysis of valgus bracing.

We studied a brace designed to decrease loads on the medial tibiofemoral compartment in knees with chronic pain and arthrosis to determine if pain symptoms decreased, function improved, and dynamic gait characteristics altered during walking. Eighteen patients with symptomatic medial compartment arthrosis were fitted with a commercially available brace. All were evaluated after an average of 9 weeks of brace wear, and 13 patients were evaluated after 1 year of brace wear.

The effect of injury chronicity and progressive rehabilitation on single-incision arthroscopic anterior cruciate ligament reconstruction.

We conducted a prospective study on 50 consecutive patients who received a single-incision arthroscopic patellar tendon autograft reconstruction for anterior cruciate ligament (ACL) rupture. The purposes were to determine if differences existed in results between patients with acute and chronic ACL ruptures, and if a progressive rehabilitation program could safely return patients to sports activities early without compromising knee stability. Forty-two patients (84%) returned for follow-up a mean of 31 months postoperatively.

Osgood-schlatter disease: practical treatment for a self-limiting condition.

Osgood-Schlatter disease is one of the most common causes of knee pain in active adolescents. It is a generally benign disturbance at the junction of the patellar tendon and the tibial tubercle apophysis, and treatment during its 12- to 24-month course should be matched to severity. Mild symptoms require only patient education and moderation of activity, but severe symptoms call for a period of rest (or, rarely, immobilization) followed by aggressive quadriceps strengthening.