Midtarsal arthrodesis in the treatment of Charcot midfoot arthropathy. Surgical technique.

Background: Fracture-dislocation of the midfoot with collapse of the longitudinal arch is common in patients with neuropathic arthropathy of the foot. In this study, we describe a technique of midfoot arthrodesis with use of intramedullary axial screw fixation and review the results and complications following use of this technique.

Methods: A retrospective study of twenty-two patients who had undergone surgical reconstruction and arthrodesis to treat Charcot midfoot deformity was performed.

Reducing the risk of noncontact anterior cruciate ligament injuries in the female athlete.

High school and collegiate female athletes have a significantly increased risk of sustaining a noncontact anterior cruciate ligament injury compared with male athletes participating in the same sport. This review summarizes the current knowledge of the risk factors hypothesized to influence this problem, and the neuromuscular training programs designed to correct certain biomechanical problems noted in female athletes. The risk factors include a genetic predisposition for sustaining a knee ligament injury, environmental factors, anatomical indices, hormonal influences, and neuromuscular factors.

Lasso stitch with peroneal retinaculoplasty for repair of fractured os peroneum: a report of two cases.

Unlabelled: Fracture of the os peroneus with retraction of the peroneus longus tendon can lead to weakness, instability, and progressive foot deformity. Treatment recommendations vary and include simple immobilization, repair of the fractured ossicle, excision of part or all of the fractured ossicle with repair of the tendon and tenodesis with the peroneus brevis tendon. We present two patients treated with excision of the proximal fragment and repair of the tendon to the distal fragment with relief of pain and restoration of function.

Surgical repair of acute and chronic tibialis anterior tendon ruptures.

Background: Rupture of the tibialis anterior tendon is an uncommon disorder that can cause a substantial functional deficit as a result of loss of ankle dorsiflexion strength. We are not aware of any reports on a large clinical series of patients undergoing surgical repair of this injury.

Methods: Nineteen tibialis anterior tendon ruptures were surgically repaired in eighteen patients ranging in age from twenty-one to seventy-eight years.

Midtarsal arthrodesis in the treatment of Charcot midfoot arthropathy.

Background: Fracture-dislocation of the midfoot with collapse of the longitudinal arch is common in patients with neuropathic arthropathy of the foot. In this study, we describe a technique of midfoot arthrodesis with use of intramedullary axial screw fixation and review the results and complications following use of this technique.

Methods: A retrospective study of twenty-two patients who had undergone surgical reconstruction and arthrodesis to treat Charcot midfoot deformity was performed.

The function of the human anterior cruciate ligament and analysis of single- and double-bundle graft reconstructions.

Context: There exists controversy on the ability of a single or double anterior cruciate ligament graft technique to restore anterior cruciate ligament function. This article examines the published experimental and clinical data supporting these surgical procedures in the ability to restore knee stability.

Evidence Acquisition: An analysis of anterior cruciate ligament function and single- and double-graft reconstructions defined by selected biomechanical, robotic, kinematic, anatomical, and clinical studies.

Meniscal repair and transplantation: indications, techniques, rehabilitation, and clinical outcome.

The purpose of this paper is to provide current knowledge regarding the indications, operative techniques, rehabilitation programs, and clinical outcomes of meniscus repair and transplantation procedures. Meniscus tears that occur in the periphery may be repaired using a variety of operative procedures with high success rates. Complex multiplanar tears that extend into the central one-third avascular zone can also be successfully repaired using a meticulous vertically divergent suture technique.

Posterolateral knee reconstruction with an anatomical bone-patellar tendon-bone reconstruction of the fibular collateral ligament.

Background: The authors have long advocated a graft reconstruction of the fibular collateral ligament, believing that direct suture repair or augmentation procedures do not provide a stable construct.

Purpose: To describe an operative technique and determine the clinical outcome of a bone-patellar tendon-bone graft anatomical replacement of the fibular collateral ligament in a consecutive series of knees.

Study Design: Case series; Level of evidence, 4.

Reconstruction of the medial patellofemoral ligament with autologous quadriceps tendon.

In knees with insufficient or previously disrupted medial retinacular and patellofemoral ligaments caused by subluxation or dislocation, anatomic reconstruction of the medial patellofemoral ligament may be performed. This procedure involves harvesting of an 8 x 70-mm medial quadriceps tendon graft, which leaves the quadriceps tendon retinacular attachment intact and avoids patellar and femoral drill holes. This graft is passed beneath the retinaculum adjacent to the femoral epicondyle and is sutured to the medial intermuscular septum-a procedure that reproduces the medial patellofemoral ligament and is supported by imbrication of the remaining medial retinaculum.

An analysis of the causes of failure in 57 consecutive posterolateral operative procedures.

Purpose: To investigate 57 failed posterolateral procedures in 30 consecutive knees to determine factors that may have contributed to the failure.

Study Design: Case series; Level of evidence, 4.

Methods: Thirty patient records were reviewed by an independent surgeon.

Opening wedge high tibial osteotomy: an operative technique and rehabilitation program to decrease complications and promote early union and function.

Background: High tibial osteotomy has been associated with significant complications, including delayed union or nonunion, loss of correction, arthrofibrosis, and patella infera.

Hypotheses: A technique for opening wedge osteotomy that incorporates an autogenous iliac crest bone graft will prevent delayed union or nonunion, allow early rehabilitation and weightbearing, and prevent knee arthrofibrosis and patella infera. Secondly, the authors' methods for calculating the desired correction of valgus alignment prevent undesired alterations in tibial slope.

Anterior cruciate ligament revision reconstruction: results using a quadriceps tendon-patellar bone autograft.

Background: The quadriceps tendon is a viable graft source for revision anterior cruciate ligament reconstruction.

Purpose: To determine the functional results and graft failure rates in knees in which the patellar tendon had been previously harvested or was unavailable, expanded tunnels precluded the use of a semitendinosus-gracilis graft, or patients requested autogenous tissues instead of allografts for revision reconstruction.

Study Design: Case series; Level of evidence, 4.

Jump-land characteristics and muscle strength development in young athletes: a gender comparison of 1140 athletes 9 to 17 years of age.

Background: Many authors have speculated that altered neuromuscular control and strength of the lower extremity are responsible for the gender disparity in knee ligament injury rates.

Hypothesis: Significant increases in normalized quadriceps and hamstrings strength and limb symmetry on single-legged hop test occur with age. No gender differences in strength occur until age 14 years, after which boys generate greater peak torques than do girls.

Ominous Skin Lesion or Benign Sports-Related Imposter? The Most Common 'Don't Miss' Diagnoses.

Sports participants of all skill levels may develop sport-specific skin problems. Many skin disorders in athletes can mimic other potentially serious dermatologic entities that can be manifestations of musculoskeletal conditions, infections, inflammatory conditions, or carcinomas. Also, some skin conditions can alert the sports physician to look for possible anabolic steroid abuse.

Assessment of lower limb neuromuscular control in prepubescent athletes.

Background: Although neuromuscular indices have been extensively studied in adolescents and adults, limited data exist for prepubescent children.

Hypothesis: No differences exist between prepubescent boys and girls in lower limb strength, symmetry on single-legged hop testing, and limb alignment during drop-jump testing.

Study Design: Cross-sectional study (prevalence); Level of evidence, 1.

Meniscus transplantation: indications, techniques, clinical outcomes.

Although many meniscus tears can be successfully repaired, not all are salvageable, especially if considerable tissue damage has occurred. Meniscus transplantation has been shown to be an acceptable procedure for younger patients. The primary candidate is a patient younger than age 50 years who has had a total meniscectomy and who either has pain in the tibiofemoral compartment, arthroscopic evidence of articular cartilage deterioration, or both.

Patient adviser exercising for two: steps for a healthy, active pregnancy.

Staying healthy is important at any stage of life, but especially while you are pregnant. You want to give your baby the best possible start by eating right, not smoking, getting enough rest, and exercising.

Practical exercise advice during pregnancy: guidelines for active and inactive women.

Many women enjoy regular exercise as a part of a healthy lifestyle and may wish to continue exercising after they become pregnant. Some previously sedentary women may want to start an exercise program during pregnancy. Primary care and sports medicine physicians should understand the contraindications (eg, hypertension, diabetes, placenta previa, preeclampsia) and the concerns about exercise during pregnancy (eg, fetal nutrition, risk of preterm labor) and be able to offer reasonable guidelines to women who wish to start or continue exercise during pregnancy.

Posterior cruciate ligament revision reconstruction, part 2: results of revision using a 2-strand quadriceps tendon-patellar bone autograft.

Background: Posterior cruciate ligament reconstructions fail for similar reasons as to why anterior cruciate ligament reconstructions fail. Revision surgery is an option after failure.

Purpose: To prospectively study the results of 15 posterior cruciate ligament revision surgeries using a 2-strand quadriceps tendon-patellar bone autograft.

Posterior cruciate ligament revision reconstruction, part 1: causes of surgical failure in 52 consecutive operations.

Background: Posterior cruciate ligament reconstructions have not shown uniformly predictable results in restoration of normal posterior tibial translation. The authors are unaware of any study that has assessed the causes of failure of these operations, and they investigated 52 prior unsuccessful posterior cruciate ligament procedures to determine the factors that contributed to failure of the operations.

Study Design: Case series; Level of evidence, 4.

Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope.

Background: Although a change in tibial slope may occur during a medial opening wedge osteotomy, calculations have not been defined to address this problem. The authors investigated geometric factors important to correct axial alignment and tibial slope during osteotomy.

Purpose: To calculate, through 3-dimensional analysis of the proximal tibia, how the angle of the opening wedge along the anteromedial tibial cortex influences the tibial slope (sagittal plane) and valgus correction (coronal plane) during osteotomy, and to analyze the different radiographic methods reported in the literature to measure medial and lateral tibial slope.

The drop-jump screening test: difference in lower limb control by gender and effect of neuromuscular training in female athletes.

Background: A valgus lower limb alignment has been noted during noncontact anterior cruciate ligament injuries. A video drop-jump test can indicate an athlete's ability to control lower limb axial alignment in the coronal plane.

Hypotheses: Female athletes have decreased knee separation distances on landing and acceleration; male athletes have a neutrally aligned lower limb position.

Valgus bracing for degenerative knee osteoarthritis: relieving pain, improving gait, and increasing activity.

Pain from osteoarthritis, the leading cause of disability in older patients, affects gait mechanics. Wearing an unloading brace may improve gait symmetry, decrease symptomatic pain, and increase activity for patients who have osteoarthritis of the knee or other varus knee deformities. Brace use may contribute to improved knee proprioception, gait parameters, and pain scores.

The Ottawa knee rule: avoiding unnecessary radiographs in sports.

Physicians are often called upon to evaluate acute knee injuries. Radiographs are frequently ordered, but they may not be helpful for making the diagnosis and guiding treatment of soft-tissue injuries. A set of clinical criteria, called the Ottawa knee rule, has been established to predict when radiographs are truly necessary.