Abstracts: Ortopedia / traumatologia

Opar DA, Williams MD, Shield AJ.: Sports Medicine (Auckland, N.Z.) Mar 2012,42(3):209-26.

Hamstring strain injuries (HSIs) are common in a number of sports and incidence rates have not declined in recent times. Additionally, the high rate of recurrent injuries suggests that our current understanding of HSI and re-injury risk is incomplete. Whilst the multifactoral nature of HSIs is agreed upon by many, often individual risk factors and/or causes of injury are examined in isolation. This review aims to bring together the causes, risk factors and interventions associated with HSIs to better understand why HSIs are so prevalent. Running is often identified as the primary activity type for HSIs and given the high eccentric forces and moderate muscle strain placed on the hamstrings during running these factors are considered to be part of the aetiology of HSIs. However, the exact causes of HSIs remain unknown and whilst eccentric contraction and muscle strain purportedly play a role, accumulated muscle damage and/or a single injurious event may also contribute. Potentially, all of these factors interact to varying degrees depending on the injurious activity type (i.e. running, kicking). Furthermore, anatomical factors, such as the biarticular organization, the dual innervations of biceps femoris (BF), fibre type distribution, muscle architecture and the degree of anterior pelvic tilt, have all been implicated. Each of these variables impact upon HSI risk via a number of different mechanisms that include increasing hamstring muscle strain and altering the susceptibility of the hamstrings to muscle damage. Reported risk factors for HSIs include age, previous injury, ethnicity, strength imbalances, flexibility and fatigue. Of these, little is known, definitively, about why previous injury increases the risk of future HSIs. Nevertheless, interventions put in place to reduce the incidence of HSIs by addressing modifiable risk factors have focused primarily on increasing eccentric strength, correcting strength imbalances and improving flexibility. The response to these intervention programmes has been mixed with varied levels of success reported. A conceptual framework is presented suggesting that neuromuscular inhibition following HSIs may impede the rehabilitation process and subsequently lead to maladaptation of hamstring muscle structure and function, including preferentially eccentric weakness, atrophy of the previously injured muscles and alterations in the angle of peak knee flexor torque. This remains an area for future research and practitioners need to remain aware of the multifactoral nature of HSIs if injury rates are to decline.

Physical Examination of the Overhead Athlete's Shoulder.

Sewick A, Kelly JD, Rubin B.: Sports Medicine and Arthroscopy Review, Mar 2012, 20(1):11-5.

Overhead athletes seek the services of an orthopedic surgeon because of pain and/or dysfunction. It is important to address the cause of the symptoms more so than the source of the patient's pain, so that treatment will eliminate the problem rather than merely ameliorate symptoms temporarily. In order to accomplish a thorough assessment of shoulder function, the examiner must expand his/her view from isolated assessment of the glenohumeral joint range of motion, stability, assessment of rotator cuff strength, palpation and provocative maneuvers, and add assessment of the shoulder in the context of the kinetic chain. The examination of the thrower's shoulder, coupled with a thorough history, will usually provide a solid functional diagnosis and provide a good idea as to the presence of structural damage. As a result, the value of rehabilitation and the benefit of surgical intervention are made more predictable.

Leggin BG, Sheridan S, Eckenrode BJ.: Sports Medicine and Arthroscopy Review, Março 2012, 20(1):49-55.

The overhead throwing motion is a complex and coordinated movement pattern involving the lower extremities, the trunk, and the upper extremity. Because of these tremendous demands on the shoulder, various shoulder injuries may occur. Two of the more common injuries to throwers are shoulder instability and superior labrum anterior-posterior lesions. Although nonoperative treatment is frequently successful in treating these conditions, surgical management may be necessary for the athlete to return to their sport. The purpose of this article is to review the first 3 phases of rehabilitation after arthroscopic capsular stabilization and superior labrum anterior-posterior debridement or repair. The fourth phase, return to throwing, will be covered in the final section.

Radiographic findings in restrained hip joints associated with ACL rupture.

Ellera Gomes JL, Palma HM, Becker R. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2010, 18(11):1562-7. School of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, Porto Alegre, Brazil.

Although decreased hip range of motion has been detected in many soccer players with noncontact anterior cruciate ligament (ACL), it is not clear whether it is associated with bone spurs, capsular soft tissue stiffness or both. Our aim was to investigate abnormal radiographic findings in soccer players with limited hip range of motion and noncontact ACL injury. Fifty consecutive male soccer players with restricted hip range of motion and noncontact ACL injury were subjected to radiographic examination to identify bone changes that could be associated with decreased hip range of motion. Of 50 patients, 56% revealed abnormal radiographic findings: pericapsular calcifications or acetabular rim osteophytes (24%), femoral neck deformity (10%), femoral neck and acetabular rim disorders (18%), neck groove caused by impingement (4%). Radiographic evaluation of those individuals showed a high number of bone abnormalities around the hip joint. This was considered to be an important finding to guide a decision-making process between three different approaches: changing the type of sports practiced, undergoing a more restrictive surgery (such as a double-bundle intra-articular reconstruction or an intra plus extra technique) or the onset of a hip-stretching program in addition to the conventional ACL rehabilitation protocol. In this last option, ACL-operated patients without radiographic hip abnormalities may have better outcomes for their decreased hip range of motion when submitted to a stretching program targeting the prevention of rotational overload on the reconstructed intra-articular grafts. The decision-making process concerning soccer players with ACL ruptures should take into consideration the amount of motion-limiting abnormalities around the hip joint.

Extensor hood syndrome--osteophytic irritation of digital extensor tendons in rock climbers.

SchÃ¶ffl V, Hochholzer T, SchÃ¶ffl I, Wilderness & environmental medicine, 2010 21(3):253-6, Department of Sportorthopedics, Klinikum Bamberg, Bamberg, Germany.

OBJECTIVE: Injuries to the flexor tendons and flexor tendon pulleys are frequently reported in rock climbers. Osteoarthritic changes with bone spurs are also well known. We report on the less commonly described extensor tendon irritation caused by such osteophytes. METHODS: Thirteen high-level rock climbers (12 men, 1 woman; average age 33.8 years [range 17-55]; average years of climbing experience 19 [range 5-30]; average climbing level 10.2) with extensor hood irritation caused by dorsally located osteophytes of proximal interphalangeal (n = 10) or distal interphalangeal joints (n = 3) were evaluated and managed. Twelve climbers received conservative therapy and 1 climber was treated surgically. RESULTS: Before treatment, the climbers were unable to achieve their normal climbing ability due to extensor tendon irritations with resultant effusion noted in the ultrasound examinations. After conservative treatment, and in 1 case surgery, all patients achieved their previous climbing ability. CONCLUSION: While all climbers were able to achieve their former climbing level after treatment, the condition is progressive and the osteoarthritic changes will likely cause further problems for these individuals in the future. Extensor hood irritation must be considered in the differential diagnosis of finger pain in rock climbers.

Effect of walking speed and severity of hip osteoarthritis on gait variability.

Kiss RM.: Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology. 2010, 20(6):1044-51. Budapest University of Technology and Economics, Dept. of Structures, 1111 Budapest, Bertalan Lajos 2, Hungary.

Gait analysis in orthopaedic and neurological examinations is important; however, few studies assess gait variability at different walking speeds in patients with varying degrees of hip osteoarthritis. We aimed to clarify (1) how different controlled speeds and (2) various severities of hip osteoarthritis influence gait variability. Gait variability was described by the standard deviation (SD) of the spatial-temporal and mean standard deviation (MeanSD) of angular parameters. The spatial positions of the anatomical points for calculating gait parameters were determined in 20 healthy elderly controls and 20 patients with moderate and 20 patients with severe hip osteoarthritis with a zebris CMS-HS ultrasound-based motion analysis system at three walking speeds. The SD of the spatial-temporal and MeanSD of angular parameters of gait, which together describe gait variability, significantly depended on speed and osteoarthritis severity. The lowest variability in the gait was found near the self-selected walking speeds. Hip joint degeneration significantly worsened variability on the affected side, with non-affected joints and the pelvis compensating by increasing flexibility and adapting to step-by-step motions. Particular attention must be paid to improving gait stability and the reliability of limb movements in the presence of and increasing severity of osteoarthritis.

Magnetic resonance imaging-documented chondral injuries about the knee in college football players: 3-year national football league combine data.

Hirshorn KC, Cates T, Gillogly S.: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the Internation. 2010, 26(9):1237.- Atlanta Medical Center, Georgia 30307, USA.

PURPOSE: To evaluate the incidence and risk factors for knee cartilage injury in elite college football players invited to attend the US National Football League (NFL) Scouting Combine over a 3-year period. METHODS: All players entering the NFL Scouting Combine (National Invitational Camp) from 2005 through 2007 were evaluated. "At-risk" knees underwent magnetic resonance imaging (MRI), and the results were evaluated for chondral injuries. RESULTS: During the 3-year period reviewed, a total of 980 players were available for analysis, and a total of 516 players' knee MRI scans were obtained (53% of all players at the Combine). The total number of full-thickness chondral injuries evident on MRI was 197 (20.1%) among all players, or 38.2% of the players who had an MRI scan. Of the players, 30 (3.06% of all players at the Combine, or 5.8% of the players who had an MRI scan) had isolated medial compartment full-thickness chondral injuries, 41 (4.2%, or 7.9%) had isolated lateral compartment full-thickness chondral injuries, 48 (4.9%, or 9.3%) had patellofemoral compartment full-thickness chondral damage, and 78 (7.96%, or 15.1%) had full-thickness chondral injuries in more than 1 compartment. CONCLUSIONS: The epidemiologic and risk assessment data presented in this study offer a cross-section of a young and elite athletic population who were "prescreened" at the NFL Combine over a 3-year period and judged to have at-risk knees. The total number of full-thickness chondral injuries evident on MRI was 197 (20.1%) among all players, or 38.2% of the players who had an MRI scan: 30 players (3.06%, or 5.8%) had an isolated medial compartment full-thickness chondral injury, 41 players (4.2%, or 7.9%) had an isolated lateral compartment full-thickness chondral injury, 48 players (4.9%, or 9.3%) had isolated patellofemoral compartment full-thickness chondral damage, and 78 players (7.96%, or 15.1%) had full-thickness chondral injuries in more than 1 compartment. LEVEL OF EVIDENCE: Level IV, diagnostic study.

Osseous deficits after anterior cruciate ligament injury and reconstruction: a systematic literature review with suggestions to improve osseous homeostasis.

Nyland J, Fisher B, Brand E, Krupp R, Caborn DN.: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the Internation

201009 26(9):1248-57. Department of Orthopaedic Surgery, University of Louisville, Kentucky 40202, USA.

PURPOSE: This systematic review was performed to improve our understanding of the current evidence regarding the influence of anterior cruciate ligament (ACL) injury and reconstruction on involved lower extremity apparent bone mineral density, bone content, or bone area mass (bone integrity). METHODS: Two independent reviewers performed a Medline search from 1966 to January 2010 using the terms "anterior cruciate ligament" or "ACL" combined with "wound" or "injury" and "bone density" or "osteoporosis." Study inclusion criteria were English-language human studies. Reference sections of selected studies were also reviewed. RESULTS: Ten studies were identified that met our inclusion criteria. Eight studies performed ACL reconstruction with bone-patellar tendon-bone autografts and interference screw fixation. One study performed ACL reconstruction by use of Achilles tendon allografts with interference screw and staple fixation. Two ACL injury studies either did not involve ACL reconstruction or attempted primary repair with sutures. All studies reported varying levels of decreased bone mineral density, bone content, or bone area mass (bone integrity) at the involved lower extremity after ACL injury that did not return to premorbid levels even with ACL reconstruction and rehabilitation. Sites of reduced bone integrity included the proximal and distal femur, proximal tibia, patella, and calcaneus. Bone loss was increased with limited weight bearing and prolonged disuse or immobilization; however, significant improvements were not observed with accelerated rehabilitation. Some studies reported relations between Lysholm, Tegner, International Knee Documentation Committee survey, or function scores and bone integrity, whereas others reported no or poor relations. CONCLUSIONS: Involved lower extremity bone integrity is decreased after ACL injury. Current evidence suggests that premorbid bone integrity is not re-established after ACL reconstruction even when accelerated rehabilitation is performed. Recommendations to improve osseous homeostasis and bone health after ACL injury and reconstruction are provided.

Stress fractures: classification and management.

Kaeding CC, Najarian RG. The Physician and sportsmedicine, 2010 38(3):45-54. Sports Medicine Center, Department of Orthopaedics, The Ohio State University, Columbus, OH 43221, USA.

Stress fractures occur as a result of microdamage secondary to repetitive strains. A mechanism for the development of stress fractures involves the accumulation of microdamage, which occurs with multiple subultimate failure loads applied to the bone. Stress fractures may be classified as high or low risk, depending on the grade of the injury. The most common site of injury is the lower extremity. In this article, we review the pathophysiology, etiology, diagnosis, and management of stress fractures, and present treatment guidelines for return to play.

Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review

Objectives The authors examined the most current evidence for treatment options in athletes with osteitis pubis and osteomyelitis pubis, attempting to determine which options provide optimal pain relief with rapid return to sport and prevention of symptom reoccurrence. Methods Three databases—MEDLINE, Cochrane Database of Systematic Reviews and CINAHL—were searched using the OVID interface for all years between 1985 and May 2008. References were analysed from included studies, and additional relevant articles were obtained for inclusion. Inclusion criteria included (1) humans only, (2) subjects had no apparent risk factors for development of osteitis pubis or osteomyelitis of the pubic symphysis other than athletic involvement, (3) both physical exam findings and diagnostic imaging were used to confirm either diagnosis, and (4) a definitive treatment strategy was identifiable for management of osteitis pubis or osteomyelitis of the pubic symphysis. In total, 25 articles were included in the review. Results There were no randomised controlled trials identified with this study's search strategy. A total of 195 athletes were diagnosed as having osteitis pubis (186 males, nine females) and treated with either conservative measures/physical therapy, local injection with corticosteroids and/or local anaesthetic, dextrose prolotherapy, surgery or antibiotic therapy. Six case reports/series described conservative treatment measures (physical therapy, rest, non-steroid anti-inflammatory drugs). Four case series explored the use of corticosteroid injections in treatment. One case series described the use of dextrose prolotherapy as a treatment modality. Six case series described various surgical techniques (pubic symphysis curettage, polypropylene mesh placement and pubic bone stabilisation) in treatment. Ten case reports/series (10 subjects) outlined antibiotic treatment of osteomyelitis of the pubic symphysis. Conclusions The current medical literature shows only level 4 evidence of the treatment for osteitis pubis in 24 case reports/series in athletes. Without any direct comparison of treatment modalities, it is difficult to determine which individual treatment option is the most efficacious. Further study comparing the different treatment options is necessary to determine which modality provides the fastest return to sport.

Prevalence of radiological signs of femoroacetabular impingement in patients presenting with long-standing adductor-related groin pain .

A Weir, R J de Vos, M Moen, P Hölmich, J L Tol.: Br J Sports Med, 2011, 45:6-9.

Objective: A decreased range of motion (ROM) of the hip joint is known to predispose to athletic groin injury. Femoroacetabular impingement (FAI) of the hip leads to a reduced ROM. This study examined the prevalence of radiological signs of FAI in patients presenting with long-standing adductor-related groin pain (LSARGP). Design: Prospective case series. Setting: Outpatient Sports Medicine Department. Patients: 34 athletes with LSARGP defined as pain on palpation of the proximal insertion of adductor muscle and a painful, resisted adduction test. Assessment: A clinician blinded to the results of the radiological assessment performed a physical examination: iliopsoas length, hip ROM and anterior hip impingement test. Anteroposterior pelvic radiographs were examined by a second blinded clinician for the presence of: pistol grip deformity, centrum-collum-diaphyseal angle, femoral head neck ratio, coxa profunda, protrusio acetabuli, lateral centre edge angle, acetabular index and cross-over sign. Results: The prevalence of radiological signs of FAI was 94% (64/68). The mean number of radiological signs in hips with LSARGP was 1.84 (range 0–4, SD 1.05) and 1.96 (range 0–5, SD 1.12) in asymptomatic groins (p=0.95). The anterior hip impingement test was positive in nine cases. There was no relationship with the number of radiological signs (p=0.95). There was no correlation between hip ROM and the number of radiological signs (p=0.37). Conclusion: Radiological signs of FAI are frequently observed in patients presenting with LSARGP. Clinicians should be aware of this fact and the possible lack of correlation when assessing athletes with groin pain.

Adding a physical exercise programme to brief intervention for low back pain patients did not increase return to work.

Hagen EM, Odelien KH, Ã˜delien KH, Lie SA, Eriksen HR.: Scandinavian journal of public health, 201011 38(7):731-8. Spine Clinic, Sykehuset Innlandet HF, Ottestad, Norway.

AIMS: To investigate if a standardised physical exercise programme given in addition to a brief intervention at a spine clinic had an effect on return to work. METHODS: A total of 246 patients sick-listed 8-12 weeks for non-specific low back pain were offered a brief intervention programme at the spine clinic with examination, information, reassurance, and encouragement to engage in physical activity as normal as possible, before they were randomised into an intervention group (n = 124) and a control group (n = 122). Patients in the intervention group participated in a physical exercise programme at the spine clinic. RESULTS: During the 2-year follow-up, there were no significant differences between the groups on sick leave, pain, use of analgesics, psychological distress, coping strategies, fear-avoidance beliefs, self-reported disability, or walking distances. However, both groups increased return to work, reported less pain and better function, and reduced fear-avoidance beliefs for physical activity during the follow-up period. Fear-avoidance beliefs for work were not changed. CONCLUSIONS: A physical exercise programme for low back pain patients given after a brief intervention at a spine clinic did not have any additional effect on sick leave or fear-avoidance beliefs. Both groups reported less pain, better physical function, and increased return to work during follow-up. The treatment at the spine clinic did not contain a vocational rehabilitation programme directed towards individual work-related problems, which might explain no change in fear-avoidance beliefs for work.

Hamstring strain injuries: are we heading in the right direction? Mendiguchia J, Alentorn-Geli E, Brughelli M

British journal of sports medicine46(2):81-5, 2012 Acute hamstring injuries are the most prevalent muscle injuries reported in sport. Despite a thorough and concentrated effort to prevent and rehabilitate hamstring injuries, injury occurrence and re-injury rates have not improved over the last three decades. This failure is most likely due to the following: (1) a lack of studies with high level of evidence into the identification and prevention of hamstring injuries and (2) a reductionist approach of the current literature. The objectives of this article are to review and critique the current literature regarding isolated risk factors, and introduce a new concept for a more comprehensive scientific understanding of how multiple risk factors contribute to hamstring strain injury. The authors hope that this new conceptual model can serve as a foundation for future evidence-based research and aid in the development of new prevention methods to decrease the high incidence of this type of injury.

Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play. Ekstrand J, Healy JC, WaldÃ©n M, Lee JC, English B, HÃ¤gglund M

British journal of sports medicine46(2):112-7, 2012 Background Hamstring injury is the single most common injury in professional football. MRI is commonly used to confirm the diagnosis and provide a prognosis of lay-off time. Objective To evaluate the use of MRI as a prognostic tool for lay-off after hamstring injuries in professional football players and to study the association between MRI findings and injury circumstances. Methods Prospective cohort study where 23 European professional teams, were followed between 2007 and 2011. Team medical staffs recorded individual player exposure and time-loss injuries. Radiological grading was performed using a modified Peetrons classification into four grades where grades 2 and 3 represent fibre disruption. Results In total, 516 hamstring injuries occurred and 58% of these were examined by MRI. Thirteen per cent were grade 0 injuries, 57% grade 1, 27% of grade 2 and 3% of grade 3. Grade 0 and 1 injuries accounted for 56% (2141/3830 days) of the total lay-off. The lay-off time differed between all four radiological grades of injury (8±3, 17±10, 22±11 and 73±60 days, p<0.0001). Eighty-three per cent of injuries affected the biceps femoris while 11% and 5% occurred to the semimembranosus and semitendinosus, respectively. Re-injuries (N=34/207) constituted 16% of injuries. All re-injuries occurred to the biceps femoris. Conclusion MRI can be helpful in verifying the diagnosis of a hamstring injury and to prognosticate lay-off time. Radiological grading is associated with lay-off times after injury. Seventy per cent of hamstring injuries seen in professional football are of radiological grade 0 or 1, meaning no signs of fibre disruption on MRI, but still cause the majority of absence days.

Distal patellar tendon avulsion fracture in a football player with osteogenesis imperfecta. Jansen JA, Haddad FS

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA20(2):327-30, 2012 Proximal patellar tendon ruptures have been described in adults with osteogenesis imperfecta, but distal avulsions from the tibial tubercle have not. This is the first case reporting a distal patellar tendon avulsion fracture in a football player with osteogenesis imperfecta and the technique of surgical repair.

Bilateral triradiate cartilage injury: an overuse syndrome in an adolescent football player. Ergen FB, Yildiz AE, Ayvaz M, Aydingoz U

41(3):353-5, 2012 The triradiate cartilage is not a recognized site for an overuse injury. We present here X-ray and MRI findings of a young athlete with chronic right-sided hip pain that proved to be secondary to triradiate cartilage overuse injury. MRI also revealed similar but milder findings on the left side. Distal radial and proximal humeral epiphyses, iliac bone, tibial tubercle, calcaneal and proximal 5th metatarsal apophyses are common sites of overuse injuries in the skeletally immature athletes. Radiological findings may resemble a Salter-Harris type I injury, but an insidious onset of the symptoms, absence of acute trauma, and bilaterality of MRI findings may help differentiate these entities.

Age-related changes in mechanical properties of the Achilles tendon. Waugh CM, Blazevich AJ, Fath F, Korff T

The stiffness of a tendon, which influences muscular force transfer to the skeleton and increases during childhood, is dependent on its material properties and dimensions, both of which are influenced by chronic loading. The aims of this study were to: (i) determine the independent contributions of body mass, force production capabilities and tendon dimensions to tendon stiffness during childhood; and (ii) descriptively document age-related changes in tendon mechanical properties and dimensions. Achilles tendon mechanical and material properties were determined in 52 children (5-12 years) and 19 adults. Tendon stiffness and Young's modulus (YM) were calculated as the slopes of the force-elongation and stress-strain curves, respectively. Relationships between stiffness vs. age, mass and force, and between YM vs. age, mass and stress were determined by means of polynomial fits and multiple regression analyses. Mass was found to be the best predictor of stiffness, whilst stress was best related to YM (< 75 and 51% explained variance, respectively). Combined, mass and force accounted for up to 78% of stiffness variation. Up to 61% of YM variability could be explained using a combination of mass, stress and age. These results demonstrate that age-related increases in tendon stiffness are largely attributable to increased tendon loading from weight-bearing tasks and increased plantarflexor force production, as well as tendon growth. Moreover, our results suggest that chronic increases in tendon loading during childhood result in microstructural changes which increase the tendon's YM. Regarding the second aim, peak stress increased from childhood to adulthood due to greater increases in strength than tendon cross-sectional area. Peak strain remained constant as a result of parallel increases in tendon length and peak elongation. The differences in Achilles tendon properties found between adults and children are likely to influence force production, and ultimately movement characteristics, which should be explicitly examined in future research.

MR imaging of ulnar collateral ligament injury in baseball players: Value for predicting rehabilitation outcome. Kim NR, Moon SG, Ko SM, Moon WJ, Choi JW, Park JY European journal of radiology 80(3):e422-6, 2011 DezBACKGROUND: To compare the MR findings of the ulnar collateral ligament (UCL) injury in baseball players between rehabilitation and reconstruction surgery.

MATERIALS AND METHODS: Thirty nine baseball players with clinical evidence of a UCL injury based on medial elbow pain and valgus instability were included. All patients received the rehabilitation treatment for more than six weeks. The elbow MR images of 27 patients not responding to rehabilitation treatment were reviewed that consequently had reconstruction surgery; in addition to 12 patients with improved symptoms with only rehabilitation treatment. The MR imaging was compared between the two treatment groups using the Pearson's chi-square test, and linear-by-linear association for the following features: the degree, signal intensity and site of the UCL injury on fat suppressed T2-weighted images.

RESULTS: High-grade partial tears and complete tears were more commonly seen in the group that had surgery (14 out of 27 patients, 52%; 8 out of 27 patients, 30%), and low-grade partial tears and intact continuity were more common in the group that had rehabilitation only (5 out of 12 patients, 42%; 5 out of 12 patients, 42%) (p=0.001). The injured UCL showed a fluid-like bright high or intermediate high signal intensity in the group that had surgery more frequently (14 out of 27 patients, 52%; 12 out of 27 patients, 44%), and intermediate high or low signal intensity was more frequent in the rehabilitation group (7 out of 12 patients, 58%; 3 out of 12 patients, 25%) (p=0.013). The UCL injury at the origin site was most commonly seen in both groups (23 out of 27 patients, 85%; 11 out of 12 patients, 92%, respectively) (p=0.496).

CONCLUSION: Preoperative MR imaging is useful for predicting the rehabilitation outcome of UCL injuries in baseball players.

Incidence and management of shoulder injuries in premier league professional football players. Pritchard C, Mills S, Funk L, Batty P

British journal of sports medicine 45(15):A15, 2011 dez Shoulder injuries in football are less common than lower limb injuries, but are often more serious than many other injuries and result in a longer time off play. No study has looked at the types of injuries and their interventions in professional footballers thus far. The aim was to review the serious shoulder injuries sustained in professional football over a period of four competitive seasons. Anonymous data was collected on all shoulder injuries claimed for from all English Premiership Football teams over four seasons. This data only applied to injuries that were claimed on health insurance from professional football clubs in the United Kingdom. It excluded minor injuries that did not require investigations or interventional treatment. There were 40 466 injury claims of which 3.3% were shoulder injuries (1335). This was equivalent to an average of 445 serious shoulder injuries per year. The percentage of shoulder injuries (injuries per year / total shoulder injuries) increased from 35% in the 2006-2007 season to 89% in the 2009-2010 season. There was also a steady increase in the number of MRI scans and injections, but not with MR arthrograms. There was an increase in the number of surgical interventions during the same time period. The vast majority of surgical procedures were arthroscopic stabilisations (26%) and labral repairs (23%). Stabilisations increased from 15% in 07-08 to 39% in 09-10 whereas the percentage of labral repairs has remained unchanged throughout. The incidences of significant shoulder injuries and surgery have increased in professional football. The majority of the surgery has been labral and stabilisation surgery. Further investigation is required to examine the causes for these trends and possible injury reduction.

Events leading to anterior cruciate ligament injury in World Cup Alpine Skiing: a systematic video analysis of 20 cases. Bere T, FlÃ¸renes TW, Krosshaug T, Nordsletten L, Bahr R

British journal of sports medicine 45(16):1294-302, 2011, Dez Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, PB 4014 Ullevål Stadion, Oslo 0806, Norway. Este endereço de e-mail está protegido de spam bots, pelo que necessita do Javascript activado para o visualizar .

Background The authors have recently identified three main mechanisms for anterior cruciate ligament (ACL) injuries among World Cup (WC) alpine skiers, termed as "the slip-catch", "the landing back-weighted" and "the dynamic snowplow". However, for a more complete understanding of how these injuries occur, a description of the events leading to the injury situations is also needed. Objective To describe the skiing situation leading to ACL injuries in WC alpine skiing. Methods Twenty cases of ACL injuries reported through the International Ski Federation Injury Surveillance System (FIS ISS)for three consecutive WC seasons (2006-2009) were obtained on video. Ten experts (9 WC coaches, 1 former WC athlete) performed visual analyses of each case to describe in their own words, factors they thought may have contributed to the injury situation related to different predefined categories: (1) skier technique, (2) skier strategy, (3) equipment, (4) speed and course setting, (5) visibility, snow and piste conditions and (6) any other factors. Results Factors related to the three categories, namely skier technique, skier strategy, and visibility, snow and piste conditions, were assumed to be the main contributors to the injury situations. Skier errors, technical mistakes and inappropriate tactical choices, were the dominant factors. In addition, bumpy conditions, aggressive snow, reduced visibility and course difficulties were assumed to contribute. Conclusion Based on this systematic video analysis of 20 injury situations, factors related to skier technique, skier strategy and specific race conditions were identified as the main contributors leading to injury situations.

A retrospective study looking at the incidence of 'stinger' injuries in professional rugby union players. Cunnane M, Pratten M, Loughna S

45(15):A19, 2011 Dez Brachial plexus injuries commonly occur in athletes participating in contact sports. One such injury, commonly known as 'stingers' or 'burners' (US) because of the associated feeling that occurs in the affected upper limb, also results in paraesthesia, weakness and pain. A retrospective study was undertaken examining the incidences of 'stinger' injuries in Premiership rugby union football players. Data was collected from 152 members of 1st team squads from 5 Premiership clubs via questionnaire designed to examine the frequency, symptoms, and effects of stinger injuries. 72% of players suffered from one or more stinger injury, and the range was from 0 to 20, over the course of the 2009-2010 season. The most common number of stingers was 0, and the average was 2.2 per player. The incidence of stingers was 2.5 times greater in the forwards (positions 1-8) than the backs (7-15), with the most commonly affected position being the 6-8 subgroup (the back row) which had an average of 4.4 stingers per season, the least was numbers 11 and 14 (wingers) suffering on average 0.7 per season. It appears that there is a correlation between the number of stingers sustained and the age of athlete, as well as the number of years playing professionally. The majority of injuries were reported when tackling (78%) and to a lesser extent when rucking (11%). The most commonly complained of symptoms were numbness, pain and reduction in range of movement. The majority (59%) of players reported no days with no/limited training off after the worst stinger in their memory. 95% of players who suffered from a stinger carried on playing without treatment or leaving the field. 75% of stinger injuries occurred during matches, with 4% during training, and 21% of players saying they occurred in both matches and training. In conclusion, stinger injuries do occur with a high frequency in rugby union, with forward positions being more at risk than others.

Midportion Achilles tendinosis and the plantaris tendon. Alfredson H.: British Journnal Sports Medicine,

2011,10 - 45(13):1023-5.Objectives When re-operating patients with midportion Achilles tendinosis, having had a poor effect of ultrasound (US) and Doppler-guided scraping, the author found the involvement of the plantaris tendon to be a likely reason for the poor result. The aim of this study was to investigate the occurrence of a plantaris tendon in close relation to the Achilles tendon in consecutive patients with midportion Achilles tendinosis undergoing treatment with US and Doppler-guided scraping. Material and methods This study includes 73 consecutive tendons with chronic painful midportion Achilles tendinosis, where US+Doppler examination showed thickening, irregular tendon structure, hypo-echoic regions, and localised high blood flow outside and inside the ventral Achilles midportion. The tendons were treated with US+Doppler-guided scraping, via a medial incision. If there was a plantaris tendon located in close relation to the medial Achilles, it was extirpated. Results An invaginated, or 'close by located', enlarged plantaris tendon was found in 58 of 73 (80%) tendons. Preliminary clinical results of the combined procedure, US + Doppler-guided surgical scraping and extirpation of the plantaris tendon, are very promising. Conclusions A thickened plantaris tendon located in close relation to the medial Achilles seems common in patients with chronic painful midportion tendinosis. The role of the plantaris tendon in midportion Achilles tendinosis needs to be further evaluated and should be kept in mind when treating this condition.

Injection treatments for patellar tendinopathy. van Ark M, Zwerver J, van den Akker-Scheek I

.: Bristish Journa of Sports Medicine, 2011,10 - 45(13):1068-76.Objective Injection treatments are increasingly used as treatment for patellar tendinopathy. The aim of this systematic review is to describe the different injection treatments, their rationales and the effectiveness of treating patellar tendinopathy. Methods A computerised search of the Medline, Embase, CINAHL and Web of Knowledge databases was conducted on 1 May 2010 to identify studies on injection treatments for patellar tendinopathy. Results 11 articles on seven different injection treatments (dry needling, autologous blood, high-volume, platelet-rich plasma, sclerosis, steroids and aprotinin injections) were found: 4 randomised controlled trials (RCTs), 1 non-RCT, 4 prospective cohort studies and 2 retrospective cohort studies. All studies reported positive results. The Delphi scores of the four RCTs ranged from 5 to 8 out of 9. Different and sometimes contradictory rationales were used for the injection treatments. Conclusion All seven different injection treatments seem promising for treating patellar tendinopathy. Unlike the other injection treatments, steroid treatment often shows a relapse of symptoms in the long term. Results should be interpreted with caution as the number of studies is low, few high-quality studies have been conducted and the studies are hard to compare due to different methodology. More high-quality studies using the same cross-cultural reliable and valid outcome measure are needed, as well as further research into the pathophysiology. Finally, some implications are provided for clinicians who want to use injection treatments as a part of their treatment for patellar tendinopathy, distinguishing between reactive and degenerative phase of patellar tendinopathy.

Incidence of midportion Achilles tendinopathy in the general population. de Jonge S, van den Berg C, de Vos RJ, van der Heide HJ, Weir A, Verhaar JA, Bierma-Zeinstra SM, Tol JL

: Bristish Journa of Sports Medicine, 2011,10 - 45(13):1026-8. Background Achilles tendon disorders, like Achilles tendinopathy, are very common among athletes. In the general population, however, knowledge about the incidence of Achilles tendinopathy is lacking. Design Cross-sectional study. Methods In a cohort of 57.725 persons registered in primary care, the number of patients visiting the general practitioner (GP) with diagnosis of mid-portion Achilles tendon problems was counted using computerised registration networks of GPs in 2009. Subsequently, the authors assessed associations of these rates with demographic characteristics. Results The incidence rate of Achilles tendinopathy is 1.85 per 1,000 Dutch GP registered patients. In the adult population (21-60 years), the incidence rate is 2.35 per 1,000. In 35% of the cases, a relationship with sports activity was recorded. Conclusion This is the first report on incidence rates of mid-portion Achilles tendinopathy in general practice. With an incidence of 1.85 per 1,000 registered persons, Achilles tendinopathy is frequently seen by GPs. The actual incidence might even be higher due to study limitations. More research on the frequency of this injury is required.

Effects of an intensive weight loss program on knee joint loading in obese adults with knee osteoarthritis. Aaboe J, Bliddal H, Messier SP, AlkjÃ¦r T, Henriksen M.: Osteoarthritis and cartilage, 2011,07 - 19(7):822-8.

OBJECTIVE: To determine the effect of an intensive weight loss program on knee joint loads during walking in obese patients with knee osteoarthritis (OA). METHODS: Participants included 157 obese knee OA patients that underwent a 16-week dietary intervention. Three-dimensional gait analyses were performed before and after the intervention at the participants' freely chosen walking speed. Knee joint compression forces, axial impulses, knee flexion angle and frontal and sagittal plane knee moments were calculated to determine the biomechanical effects of the weight loss.

RESULTS: 157 subjects (89% of the initial cohort) completed the 16-week intervention. The average weight loss of 13.7kg (P<.0001) corresponded to 13.5% of the baseline body weight. The weight loss resulted in a 7% reduction in knee joint loading, a 13% lower axial impulse, and a 12% reduction in the internal knee abductor moment (KAM). There were no clear effects on sagittal plane knee moments or peak knee flexion angle. Linear regression analyses adjusted for changes in walking speed showed that for every 1kg in weight loss, the peak knee load was reduced by 2.2kg. Thus, every kilo reduction in body weight was related to more than twice the reduction in peak knee force at a given walking speed.

CONCLUSION: Weight loss is an excellent short-term investment in terms of joint loading for patients with combined obesity and knee OA. The effects of sustained weight loss on disease progression and symptoms in relation to biomechanical factors remain to be shown.

Treatment of jones fracture nonunions and refractures in the elite athlete: outcomes of intramedullary screw fixation with bone grafting. Hunt KJ, Anderson RB.: The American journal of sports medicine, 2011 Set 39(9): 1948-54.

Background: Fractures of the proximal fifth metatarsal metaphysis (ie, the Jones fracture) can be problematic in the elite athlete because of a high incidence of nonunion and refracture with nonoperative treatment. Although these fractures are not common, athletes can suffer refracture or nonunion of a Jones fracture despite operative stabilization. This is often attributable to hardware of insufficient strength, aggressive postoperative rehabilitation, or biologic insufficiency at the fracture site. Purpose: The authors review the results of revision intramedullary screw fixation with cancellous autologous bone grafting or bone-marrow aspirate combined with demineralized bone matrix after refracture or nonunion of Jones fractures in elite athletes. Study Design: Case series; Level of evidence, 4. Methods: The authors retrospectively reviewed the clinical and radiographic outcomes and return to sport in 21 elite athletes undergoing treatment of Jones fracture refractures or nonunions. All patients underwent intramedullary screw fixation with autologous bone graft (12 patients), bone-marrow aspirate (BMA) + demineralized bone matrix (DBM) (8 patients), or no bone graft (1 patient). Results: All athletes were able to return to their previous level of athletic competition at an average of 12.3 weeks. All fractures showed clinical and radiographic evidence of compete cortical healing. Only 1 patient subsequently suffered a refracture. Conclusion: The authors recommend revision fixation with a large, solid screw (5.5 mm or larger) and autologous bone grafting for symptomatic refractures and nonunions of the proximal fifth metatarsal in elite athletes. Additional investigation is needed to determine whether BMA combined with DBM is an effective substitute for cancellous autograft.

The Effect of Lace-up Ankle Braces on Injury Rates in High School Basketball Players. McGuine TA, Brooks A, Hetzel S

.: The American journal of sports medicine, 2011 Set 39(9): 1840-8. BACKGROUND: Ankle injuries are the most common injury in basketball players. However, no prospective studies have been performed to determine if wearing lace-up ankle braces will reduce the incidence of ankle injuries in high school athletes. PURPOSE: This trial was undertaken to determine if lace-up ankle braces reduce the incidence and severity of acute first-time and recurrent ankle injuries sustained by high school basketball players. Design: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 1460 male and female basketball players from 46 high schools were randomly assigned to a braced or control group. The braced group players wore lace-up ankle braces during the 2009-2010 basketball season. Athletic trainers recorded brace compliance, athlete exposures, and injuries. Cox proportional hazards models (adjusted for demographic covariates), accounting for intracluster correlation, were utilized to compare time to first acute ankle injury between groups. Injury severity (days lost) was tested with the Wilcoxon rank-sum test. RESULTS: The rate of acute ankle injury (per 1000 exposures) was 0.47 in the braced group and 1.41 in the control group (Cox hazard ratio [HR] 0.32; 95% confidence interval [CI] 0.20, 0.52; P < .001). The median severity of acute ankle injuries was similar (P = .23) in the braced (6 days) and control group (7 days). For players with a previous ankle injury, the incidence of acute ankle injury was 0.83 in the braced group and 1.79 in the control group (Cox HR 0.39; 95% CI 0.17, 0.90; P = .028). For players who did not report a previous ankle injury, the incidence of acute ankle injury was 0.40 in the braced group and 1.35 in the control group (Cox HR 0.30; 95% CI 0.17, 0.52, P < .001). CONCLUSION: Use of lace-up ankle braces reduced the incidence but not the severity of acute ankle injuries in male and female high school basketball athletes both with and without a previous history of an ankle injury.

Surgical trends in bankart repair: an analysis of data from the american board of orthopaedic surgery certification examination. Owens BD, Harrast JJ, Hurwitz SR, Thompson TL, Wolf JM.: The American journal of sports medicine, 2011 Set 39(9): 1865-9.

BACKGROUND: Arthroscopic Bankart repair emerged in the 1990s as a minimally invasive alternative to open repair. The optimal technique of surgical stabilization of the unstable glenohumeral joint remains controversial. HYPOTHESIS: A review of the American Board of Orthopaedic Surgery (ABOS) data would show a trend toward an increasing number of arthroscopic versus open Bankart procedures. STUDY DESIGN: Descriptive epidemiology study. METHODS: A query of the ABOS database for all cases of open or arthroscopic Bankart repair from 2003 through 2008 was performed, as the CPT (Current Procedural Terminology) codes for arthroscopic repair were introduced in 2003. All cases coded with CPT codes for arthroscopic Bankart repair (29806) or open Bankart repair (23455) were reviewed. Additional data were obtained on the surgeons (year of procedure, geographic location, fellowship training, subspecialty examination area) as well as the patients (age, gender, follow-up length, complications, objective outcome measures [pain, deformity, function, and satisfaction]). RESULTS: From 2003 to 2008, a total of 4562 Bankart repair cases were reported, composing 8.6% of the total number of shoulder surgery cases in the ABOS database. From 2003 to 2005, 71.2% of Bankart repairs were arthroscopic, compared with 87.7% between 2006 and 2008 (P < .0001). Surgeons having obtained subspecialty training in sports medicine performed the majority (65.3%) of Bankart repairs. Over the entire period, sports-trained surgeons also performed a higher proportion of arthroscopic repairs (84.1%) compared with surgeons without this training (71.9%) (P < .0001). However, by 2008 both non-fellowship-trained and sports medicine fellowship-trained surgeons performed arthroscopic repair in 90% of cases. Surgeons in the Northeast region performed a significantly greater proportion of arthroscopic Bankart repairs (84.7%) than did surgeons in other regions (78.6%) (P < .0001) from 2003 to 2008. The most commonly reported complications were nerve palsy/injury and dislocation, with a rate of nerve injury of 2.2% in the open group compared to 0.3% in the arthroscopic group (P < .0001), and dislocation rate of 1.2% with open stabilization compared with 0.4% arthroscopically (P = .0039). CONCLUSION: Review of the ABOS data shows a trend toward arthroscopic shoulder stabilization over time, with the use of open repair declining. Reported complications were lower overall in the arthroscopic stabilization group when compared with open surgeries.

Prevalence of Jumper's Knee Among Nonelite Athletes From Different Sports: A Cross-Sectional Survey. Zwerver J, Bredeweg SW, van den Akker-Scheek I

.: The American journal of sports medicine, 2011 Set 39(9): 1984-8.BACKGROUND: The prevalence of jumper's knee among nonelite athletes from different sports is unknown. PURPOSE: This study was undertaken to determine the prevalence of jumper's knee in nonelite athletes from different sports and to determine potential risk factors for jumper's knee. Design: Cohort study (prevalence); Level of evidence, 2. METHODS: The authors interviewed 891 male and female nonelite athletes from 7 popular sports in The Netherlands: basketball, volleyball, handball, korfball, soccer, field hockey, and track and field. Using a specially developed questionnaire, information was obtained about individual characteristics (age, height, and weight), training background, previous and actual knee problems, and the VISA-P (Victorian Institute of Sport Assessment-Patella) score. RESULTS: The overall prevalence of current jumper's knee was 8.5% (78 of 891 athletes), showing a significant difference between sports with different loading characteristics. Prevalence was highest among volleyball players (14.4%) and lowest among soccer players (2.5%); it was significantly higher among male athletes (51 of 502 [10.2%]) than female athletes (25 of 389 [6.4%]) (?(2) = 3.91, P = .048). The mean duration of symptoms was 18.9 months (standard deviation [SD], 21.6; median value, 12.0; range, 2.0-59.8). The mean VISA-P score of the athletes with jumper's knee was 71.4 (SD, 13.8). Athletes with jumper's knee were significantly younger, taller, and heavier than those without jumper's knee. CONCLUSION: Prevalence of jumper's knee is high among nonelite athletes and varies between 14.4% and 2.5% for different sports. Jumper's knee is almost twice as common among male nonelite athletes compared with female athletes. Different sport-specific loading characteristics of the knee extensor apparatus, a younger age, a taller body stature, and higher body weight seem to be risk factors associated with patellar tendinopathy.

Is hip muscle weakness a predisposing factor for patellofemoral pain in female novice runners? A prospective study. Thijs Y, Pattyn E, Van Tiggelen D, Rombaut L, Witvrouw. E.: The American journal of sports medicine, 2011 Set 39(9):1877-82. E

BACKGROUND: Hip muscle weakness has been proposed to contribute to patellofemoral malalignment and the development of the patellofemoral dysfunction syndrome (PFDS). However, from the retrospective studies that have addressed this issue, it is still unclear if hip muscle weakness is a cause or a consequence of PFDS. PURPOSE: This study was undertaken to investigate if hip muscle weakness is a predisposing factor for the development of PFDS. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: Before the start of a 10-week "start to run" program, the isometric strength of the hip flexor, extensor, abductor, adductor, and external and internal rotator muscles was measured in 77 healthy female novice runners. During the 10-week training period, patellofemoral pain was diagnosed and registered by an orthopaedic surgeon. RESULTS: Statistical analysis revealed that there was no significant difference in strength of any of the assessed hip muscle groups between the runners who did and did not develop PFDS. Logistic regression analysis did not identify a deviation in strength of any of the assessed hip muscle groups as a risk factor for PFDS. CONCLUSION: The findings of this study suggest that isometric hip muscle strength might not be a predisposing factor for the development of PFDS.

Epidemiology of patellar tendinopathy in elite male soccer players. HÃ¤gglund M, Zwerver J, Ekstrand J.: The American journal of sports medicine, 39(9):1906-11. BACKGROUND: Patellar tendinopathy is common among athletes in jumping sports and in sports with prolonged repetitive stress of the knee extensor apparatus. The epidemiology in soccer is not well described. PURPOSE: This study was undertaken to investigate and describe the epidemiology of patellar tendinopathy in elite male soccer players and evaluate potential risk factors. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Between 2001 and 2009, the authors followed 51 European elite soccer clubs (2229 players) from 3 different cohorts: the Swedish First League cohort (SWE) and Union of European Football Associations (UEFA) Champions League cohort (UCL), both playing on natural grass; and the Artifical Turf cohort (ART), playing on third-generation artificial turf. Individual player exposure in training and matches and time-loss injuries were recorded. RESULTS: In total, 137 patellar tendinopathies were recorded, comprising 1.5% of all injuries and corresponding to an incidence of 0.12 injuries/1000 hours. Each season, 2.4% of players were affected, with most injuries (61%) resulting in absence up to 1 week or less. Twenty percent of tendinopathies were recurrent complaints. No significant difference in season prevalence (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.60-1.44; P = .74) or incidence (rate ratio [RR] 1.20; 95% CI, 0.82-1.75; P = .36) was observed between teams playing on artificial turf and natural grass, respectively. Multivariate logistic regression showed that a high total exposure hours (OR, 1.02 per 10-hour increase; 95% CI, 1.00-1.04; P = .033) was a significant risk factor for patellar tendinopathy, and increased body mass was borderline significant (OR, 1.15 per 5-kg increase; 95% CI, 1.00-1.33; P = .055). In addition, 2 acute partial tendon ruptures were recorded, but no total rupture. CONCLUSION: Although mainly mild in nature, patellar tendinopathy is a fairly common condition in elite soccer and the recurrence rate is high. Exposure to artificial turf did not increase the prevalence or incidence of injury. High total amount of exposure was identified as a risk factor for patellar tendinopathy.

Arthroscopic management of chronic patellar tendinopathy.

Pascarella A, Alam M, Pascarella F, Latte C, Di Salvatore MG, Maffulli N.: The American journal of sports medicine, 2011 Setembro 39(9):1975-83.
Background: In patients with patellar tendinopathy in whom nonoperative management is unsuccessful, surgery is an option to return to high levels of physical activity. Although open surgery is traditionally advocated, an arthroscopic approach may be safe and effective. Purpose: This study was undertaken to analyze medium- and long-term outcome of 64 patients undergoing arthroscopic surgery for the management of patellar tendinopathy after failing nonoperative treatment. Study Design: Case series; Level of evidence, 4. Methods: A total of 64 patients (73 knees), 27 of whom were professional athletes, with patellar tendinopathy refractory to nonoperative management underwent arthroscopic debridement of the adipose tissue of the Hoffa's body posterior to the patellar tendon, debridement of abnormal patellar tendon, and excision of the lower pole of the patella. Preoperative and postoperative evaluation was undertaken using the International Knee Documentation Committee (IKDC), Lysholm knee scale, and Victorian Institute of Sport Assessment-Patella (VISA-P) scores for all patients at 1 and 3 years. No patients were lost to follow-up. Forty-three and 29 patients were similarly assessed at 5 and 10 years, respectively, after surgery. Return to sports and rehabilitation was also assessed. Results: The IKDC, Lysholm, and VISA-P scores all significantly improved at 1 and 3 years' follow-up. The average preoperative IKDC score of 51.6 improved to 86.4 at both the 1- and 3-year stage. The average preoperative Lysholm score of 52.3 improved to 94.7 at 1-year follow-up and was 95.5 at 3-year follow-up. The average preoperative VISA-P score of 35.3 improved to 69.8 at the 1-year stage and was 70.7 at the 3-year follow-up. These scores remained significantly better for the patients assessed at 5 and 10 years' follow-up. There were no postoperative complications. Nineteen of the 27 professional athletes returned to sports at the same level. Seven patients developed pain after sports within 3 years after the operation, a failure rate of 7 of 73 knees (9.6%). All patients were able to return to sports by 3 months. Conclusion: Arthroscopic surgery for patients with patellar tendinopathy, refractory to nonoperative management, appears to provide significant improvements in symptoms and function, with improvements maintained for at least 3 years. These results suggest that some patients may not be able to achieve their presymptom sporting level; or if they do, they may participate in sports with some degree of residual symptoms. Limited data show that these improvements are maintained for up to 10 years. Early return to sports may also be achieved.

Are meniscus and cartilage injuries related to time to anterior cruciate ligament reconstruction?

Chhadia AM, Inacio MC, Maletis GB, Csintalan RP, Davis BR, Funahashi TT.: The American journal of sports medicine, 2011,Setembro 39(9):1894-9.
Background: Functional instability after anterior cruciate ligament injury can be successfully treated with ligament reconstruction. However, the associated meniscus and cartilage lesions often cannot be repaired and may have long-term detrimental effects on knee function. Purpose: The authors used the large database within the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry to evaluate time to surgery, age, and gender as risk factors for meniscus and cartilage injury and associations with meniscus repair rates in patients. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective review of the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry was performed. The associations between time to surgery, age, and gender with meniscus and cartilage lesions and meniscus repair were analyzed using binary logistic regression modeling to calculate odds ratios (ORs) while adjusting for potential confounding variables. Results: A total of 1252 patients met the inclusion criteria. The risk of medial meniscus injury increased only with time to surgery (6-12 months: OR = 1.81, 95% confidence internal [CI] 1.29-2.54, P = .001; and >12 months: OR = 2.19, 95% CI 1.58-3.02, P 12 months: OR = 0.41, 95% CI 0.25-0.67, P < .001) and increasing age (OR = 0.96 per year, 95% CI 0.94-0.98, P < .001). Conclusion: Increased risk of medial meniscus injury and decreased repair rate were strongly associated with increasing time to surgery. Increased risk of cartilage injury was associated with increasing age, increasing time to surgery, and male gender.

Anatomic single- and double-bundle anterior cruciate ligament reconstruction, part 2: clinical application of surgical technique. Karlsson J, Irrgang JJ, van Eck CF, Samuelsson K, Mejia HA, Fu FH.: The American journal of sports medicine, 2011,09, 39(9):2016-26. The anterior cruciate ligament has been and is of great interest to scientists and orthopaedic surgeons worldwide. Anterior cruciate ligament reconstruction was initially performed using an open approach. When the approach changed from open to arthroscopic reconstruction, a 2- and, later, 1-incision technique was applied. With time, researchers found that traditional arthroscopic single-bundle reconstruction did not fully restore rotational stability of the knee joint and a more anatomic approach to reconstruct the anterior cruciate ligament has been proposed. Anatomic anterior cruciate ligament reconstruction intends to replicate normal anatomy, restore normal kinematics, and protect long-term knee health. Although double-bundle anterior cruciate ligament reconstruction has been shown to result in better rotational stability in both biomechanical and clinical studies, it is vital to differentiate between anatomic and double-bundle anterior cruciate ligament reconstruction. The latter is merely a step closer to reproducing the native anatomy of the anterior cruciate ligament; however, it can still be done nonanatomically. To evaluate the potential benefits of reconstructing the anterior cruciate ligament in an anatomic fashion, accurate, precise, and reliable outcome measures are needed. These include, for example, T2 magnetic resonance imaging mapping of cartilage and quantification of graft healing on magnetic resonance imaging. Furthermore, there is a need for a consensus on which patient-reported outcome measures should be used to facilitate homogeneous reporting of outcomes.

Efficacy of treatment of trochanteric bursitis: a systematic review.

Lustenberger DP, Ng VY, Best TM, Ellis TJ.: Clinical journal of sport medicine, 2011, 21(5):447-53.

OBJECTIVE: Trochanteric bursitis (TB) is a self-limiting disorder in the majority of patients and typically responds to conservative measures. However, multiple courses of nonoperative treatment or surgical intervention may be necessary in refractory cases. The purpose of this systematic review was to evaluate the efficacy of the treatment of TB. DATA SOURCES: A literature search in the PubMed, MEDLINE, CINAHL, and ISI Web of Knowledge databases was performed for all English language studies up to April 2010. Terms combined in a Boolean search were greater trochanteric pain syndrome, trochanteric bursitis, trochanteric, bursitis, surgery, therapy, drug therapy, physical therapy, rehabilitation, injection, Z-plasty, Z-lengthening, aspiration, bursectomy, bursoscopy, osteotomy, and tendon repair. STUDY SELECTION: All studies directly involving the treatment of TB were reviewed by 2 authors and selected for further analysis. Expert opinion and review articles were excluded, as well as case series with fewer than 5 patients. Twenty-four articles were identified. According to the system described by Wright et al, 2 studies, each with multiple arms, qualified as level I evidence, 1 as level II, 1 as level III, and the rest as level IV. More than 950 cases were included. DATA EXTRACTION: The authors extracted data regarding the type of intervention, level of evidence, mean age of patients, patient gender, number of hips in the study, symptom duration before the study, mean number of injections before the study, prior hip surgeries, patient satisfaction, length of follow-up, baseline scores, and follow-up scores for the visual analog scale (VAS) and Harris Hip Scores (HHS). DATA SYNTHESIS: Symptom resolution and the ability to return to activity ranged from 49% to 100% with corticosteroid injection as the primary treatment modality with and without multimodal conservative therapy. Two comparative studies (levels II and III) found low-energy shock-wave therapy (SWT) to be superior to other nonoperative modalities. Multiple surgical options for persistent TB have been reported, including bursectomy (n = 2), longitudinal release of the iliotibial band (n = 2), proximal or distal Z-plasty (n = 4), osteotomy (n = 1), and repair of gluteus medius tears (n = 4). CONCLUSIONS: Efficacy among surgical techniques varied depending on the clinical outcome measure, but all were superior to corticosteroid therapy and physical therapy according to the VAS and HHS in both comparison studies and between studies. This systematic review found that traditional nonoperative treatment helped most patients, SWT was a good alternative, and surgery was effective in refractory cases.

Deren ME, Digiovanni CW, Feller E.: Clinical journal of sport medicine, 2011 21(5):428-32

OBJECTIVE: : Previous studies on Internet sites indicate that some Web-based material on sport-related orthopedic disorders is biased, misleading, and conveying inaccurate health messages. Our hypothesis was that Web-based content on platelet-rich plasma (PRP) therapy from commercial sites is frequently imbalanced, biased, and incorrect. DESIGN: : In this descriptive epidemiological study, an Internet search was performed using the search engine Google using keywords "platelet-rich plasma" and "platelet-rich plasma therapy." Exclusion criteria were medical or scientific journal, encyclopedia, or medical reference articles. SETTING: : Publicly available Internet resources were examined. PARTICIPANTS: : Web-based resources identified through an Internet search engine. MAIN OUTCOMES MEASURES: : Using content analysis, we assessed each reference for factual accuracy, themes depicted, opinions, and recommendations. RESULTS: : Our search yielded a total of 44 articles, of which 26 unique articles met the inclusion criteria. Twenty of 26 articles (77%) made inappropriate statements regarding evidence, treatment, efficacy, or safety of PRP injections. Twenty-three articles (88%) were medically imbalanced, discussing only perspectives of physicians favoring the treatment. Only 8 articles (31%) discussed alternative treatment options. Twenty-two articles (85%) used individual dramatized patient experiences to demonstrate the effectiveness of PRP. Nineteen articles (73%) made unsubstantiated promises regarding health outcomes of PRP injections. Many accessed Internet sites were from medical practices or institutions where PRP therapy was used. CONCLUSIONS: : Our data indicate that some Web-based references to PRP therapy are biased and inaccurate. We are concerned that some readers will misinterpret such easily available, but poorly controlled, information, potentially leading to use of unproven therapies.

The incidence of and clinical approach to positive allograft cultures in anterior cruciate ligament reconstruction.

Fowler JR, Truant AL, Sewards JM.: Clinical journal of sport medicine, 2011, 21(5):402-4.

OBJECTIVE: : To define the incidence of positive allograft cultures in anterior cruciate ligament (ACL) reconstruction and to determine a clinical approach to a positive test. DESIGN: : Retrospective chart review, cohort series. SETTING: : Urban academic hospital. PATIENTS: : All patients who underwent anterior cruciate ligament reconstruction using allograft between January 2003 and December 2008. One hundred fifteen patients met the inclusion criteria. INTERVENTIONS: : Culture of allograft before surgical implantation. MAIN OUTCOME MEASURES: : Positive allograft culture. RESULTS: : Positive allograft cultures were obtained in 3 of 115 grafts (2.6%). Two cultures grew coagulase-negative Staphylococcus and 1 grew Escherichia coli, both from the broth only. CONCLUSIONS: : Positive cultures in ACL allografts have a reported incidence of 5.7% to 13.25%. Our current series shows an incidence of 2.6%. No patients who had a culture-positive allograft developed a clinical infection postoperatively. Routine preimplantation culture of soft tissue allografts cannot be recommended given the low incidence of positive culture and lack of correlation with clinical infection. In the presence of a positive preimplantation allograft culture without signs of clinical infection, our series and the 4 other published series in the literature demonstrate that antibiotic treatment is not indicated. In contrast, signs and symptoms of septic arthritis should be aggressively treated with irrigation, debridement, and intravenous antibiotics.

Clinical Journal of Sport Medicine: January 2011 - Volume 21 - Issue 1 - pp 31-36.

Platelet-Rich Plasma Treatment for Ligament and Tendon Injuries
Paoloni, Justin MBBS, PhD*; De Vos, Robert J MD†; Hamilton, Bruce MBChB*‡; Murrell, George A C MD, DPhil§; Orchard, John MBBS, MD¶
Clinical Journal of Sport Medicine: January 2011 - Volume 21 - Issue 1 - pp 37-45

Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review

Prevalence of radiological signs of femoroacetabular impingement in patients presenting with long-standing adductor-related groin pain .

A Weir, R J de Vos, M Moen, P Hölmich, J L Tol.: Br J Sports Med, 2011, 45:6-9.

Adding a physical exercise programme to brief intervention for low back pain patients did not increase return to work.

Hagen EM, Odelien KH, Ã˜delien KH, Lie SA, Eriksen HR.: Scandinavian journal of public health, 201011 38(7):731-8. Spine Clinic, Sykehuset Innlandet HF, Ottestad, Norway.

Scapulothoracic Dissociation

Michael C. Kreeger and Puneet Bhargava: Radiology October 2010 257:290-293
A 50-year-old intoxicated man was brought to a level 1 trauma center after falling from his bicycle into oncoming traffic. At the scene, he was unresponsive, with hypotension and tachycardia. Intubation was subsequently performed. At initial evaluation in the trauma center, he continued to be hypotensive and tachycardic, with decreased breath sounds on the right side. A right-sided throacostomy tube was subsequently placed. He had swelling in his right upper chest and right shoulder and a pulseless right upper extremity. The following radiograph and trauma computed tomographic (CT) image were obtained.
The initial trauma chest radiograph and anteroposterior CT scanogram revealed lateral displacement of the right scapula and a large axillary and right anterior chest wall soft-tissue mass. There was also a lateral sternoclavicular separation, a distal clavicle fracture, and an acromioclavicular separation. Anteroposterior bedside supine chest radiograph obtained in the trauma bay shows substantial lateral displacement of the right scapula and clavicle and lateral sternoclavicular separation (arrow). A right-sided throracostomy tube is in place. Anteroposterior contrast material--enhanced (150 mL of iohexol; Omnipaque 350, GE Healthcare, Little Chalfont, Buckinghamshire, England) CT scanogram of the chest, abdomen, and pelvis shows lateral displacement of right scapula and clavicle, as well as lateral sternoclavicular dislocation (arrow) and distal clavicle fracture (arrowhead). A CT angiogram of the chest revealed fracture and lateral displacement of the right scapula and clavicle, with active extravasation of contrast material into soft tissues in the right side of the chest and the right upper extremity with a large ...

Femoroacetabular Impingement: Evidence of an Established Hip Abnormality

Suzanne E. Anderson, Klaus A. Siebenrock, and Moritz Tannast: Radiology October, 2010 257:8-13.
Femoroacetabular impingement (FAI) syndrome occurs in young, very active individuals, usually in association with high-end sports-related activity or overparticipation in sports-related activity; it manifests as hip pain, restricted motion, positive impingement test results, and appropriate imaging findings; and it can be successfully treated in specific cases without advanced osteoarthritis. Although some of the underlying prearthritic abnormalities (eg, pistol grip deformity, Legg-Calvé-Perthes disease) have been well known for decades, the concept of FAI was not described until the early 1990s. The pathogenetic mechanism of FAI is now well established worldwide, with a history of some 15 years. It is well documented with research from several sites, and midterm surgical results are positive. Two main types of FAI have been described in relation to morphologic variations of the acetabulum and femoral head: pincer type and cam type, respectively. Although one of these types may predominate, patients commonly have a combination of both types.
FAI is characterized by a condition of contact arising from abnormal morphologic features of both sides of the hip joint--the acetabulum and the proximal femur--alone or in combination with a potentially excessive supraphysiologic range of motion (1-4). This is seen in male and female individuals aged 20-45 years who are physically active in sports and daily living. With excessive hip joint motion, the contact created by these morphologic features--these bone prominences of the acetabulum and/or femur--a limitation to the physiologic range of hip motion increases, typically in flexion and internal rotation, and is associated with hip joint pain. During sports and daily living activities, repetitive microtrauma of these osseous convexities occurs. As a consequence of this recurring irritation, there is labral degeneration at the labral-cartilage junction and subsequent labral avulsion and irreversible chondral damage. Initially, pain occurs owing to activity overparticipation; however, with time and beginning osteoarthritis ...

Type of sport is related to injury profile: a study on cross country skiers, swimmers, long-distance runners and soccer players. A retrospective 12-month study

Ristolainen L, Heinonen A, Turunen H, MannstrÃ¶m H, Waller B, Kettunen JA, Kujala UM.: Scandinavian Journal of Medicine & Science in Sports, 2010 20(3):384-93, ORTON Orthopaedic Hospital, ORTON Foundation, Helsinki, Finland.

This 12-month retrospective questionnaire compared the occurrence of sports injuries in 149 cross country skiers, 154 swimmers, 143 long-distance runners and 128 soccer players aged 15-35 years. Soccer had significantly more injuries (5.1 injuries/1000 exposure hour) than other sports (2.1-2.8, P<0.001). More runners than soccer players reported overuse injuries (59% vs 42%, P=0.005), locating typically in the foot in runners, soccer players and skiers. Swimmers reported overuse injuries in the shoulder more commonly than skiers (40% vs 1%, P<0.001), who also intensively load shoulders. Acute injuries in skiers (80%) and in swimmers (58%), and overuse injuries in skiers (61%), occurred during exercise other than own event. In soccer and running the absence time from sport because of injuries was significantly longer than in skiing and swimming. No severe permanent disabilities occurred due to injury but seven women quit sports because of injury. In conclusion, type of loading is strictly associated with the anatomical location of an overuse injury as shown by the difference in shoulder injury incidence between swimmers and cross country skiers. In some sports, a significant proportion of acute injuries occur in other than the main event.

The inguinal release procedure for groin pain: initial experience in 73 sportsmen/women

Mann CD, Sutton CD, Garcea G, Lloyd DM.: British Journal of Sports Medicine, 2009, 43(8):579-83. Department of Surgery, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK.

OBJECTIVE: To assess the impact of the laparoscopic inguinal release procedure with mesh reinforcement on athletes with groin pain. DESIGN: Prospective cohort study. SETTING: Private sector. PATIENTS: Professional and amateur sportsmen/women undergoing the inguinal release for groin pain. MAIN OUTCOME MEASUREMENTS: Change in patient's symptoms, functional limitation and time to resuming sporting activity following surgery. RESULTS: 73 sportsmen/women underwent laparoscopic inguinal release in the study period, 37 (51%) of whom were professionals. 95% were male with a median age of 30 years. Following operation, patients returned to light training at a median of 1 week, full training at 3 weeks (professionals-2 weeks) and playing competitively at 4 weeks (professionals-3 weeks). 74% considered themselves match-fit by 4 weeks (84% of professionals). Following surgery, there was a highly significant improvement in frequency of pain, severity of pain and functional limitation in both the whole cohort and professional group. 88% reported a return to full fitness at follow-up, with 73% reporting complete absence of symptoms. 97% of the cohort thought the operation had improved their symptoms. CONCLUSIONS: This study shows that the laparoscopic inguinal release procedure may be effective in the treatment of a subgroup of athletes with groin pain.

Platelet enriched plasma for acute muscle injury

Hamilton B, Knez W, Eirale C, Chalabi H.: Acta orthopaedica Belgica, 2010, 76(4):443-8, Division of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.

Hamstring muscle strains are among the most common injuries in sport, but despite increasing research into the epidemiology, aetiology and management the rates of both injury and re-injury remain high. Typically, hamstring injury management is conservative, but recently the use of autologous platelet enriched plasma (PEP), has been proposed as a treatment tool which may optimise muscle regeneration and enhance clinical outcomes. Unfortunately however, there remains little scientific evidence for the clinical use of these techniques in muscle injuries. This report outlines the current clinical evidence for the use of PEP in muscle injuries. A case report of a patient with a grade II semi-membranosus muscle strain, injected with PEP while concurrently using platelet inhibitors will illustrate the clinical, radiological and theoretical challenges of this new technique. Further clinical research into the clinical utility of PEP in muscle injury is required and it is incumbent on Sports Physicians and researchers to address this research deficit, if PEP is to live up to its high public profile.

Dysbaric osteonecrosis in recreational divers: a study using magnetic resonance imaging

Kenney IJ, Sonksen C.: Undersea & Hyperbaric Medicine : journal of the Undersea and Hyperbaric Medical Society, Inc, 2010, 37(5):281-8 Language: eng Country: United States Royal Alexandra Hospital, Eastern Road, Brighton, Sussex, United Kingdom.

OBJECTIVE: We set out to identify whether magnetic resonance imaging (MRI) would identify evidence of dysbaric osteonecrosis (DON) in a group of experienced recreational scuba divers. DESIGN: Local British Sub Aqua Club divers of at least Trainee Dive Leader grade were offered MRI scans (T1 and TIRM sequences) of hips, femora and shoulders. Anonymous images were interpreted separately by two radiologists, and cases not considered unequivocally normal were discussed for consensus opinion. RESULTS: Of 26 divers imaged, five merited discussion. Four of these were considered to show unrelated normal variants or incidental findings. Only one case (abnormalities in the right humerus and left femur) could have possibly represented osteonecrotic lesions. After obtaining plain radiographs and more detailed clinical and dive history, these lesions were considered "indeterminate" but probably not DON by both reviewers and after taking further specialist musculoskeletal MRI opinion. CONCLUSION: This study found no evidence that DON is a significant risk in recreational scuba diving and as such concurs with prevailing current opinion.

A prospective cohort study of hamstring injuries in competitive sprinters: preseason muscle imbalance as a possible risk factor.

Yeung SS, Suen AM, Yeung EW.: British journal of sports medicine, 2009, 43(8):589-94. Centre for Sports Training and Rehabilitation, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.

BACKGROUND: Hamstring injuries are common in sprinters. Identifying preseason risk factors is essential to target injury-prone athletes and develop injury preventive measures. OBJECTIVE: To investigate the incidence of hamstring muscle injury in sprinters over an athletic season and to explore the preseason predictor of this injury. DESIGN: Prospective cohort study. PARTICIPANTS: 44 sprinters from the Hong Kong Sports Institute, the Hong Kong Amateur Athletic Association and intercollegiate athletic teams were recruited. METHODS: Preseason assessment of hamstring flexibility, concentric and eccentric isokinetic peak torque and peak torque angle were obtained at the beginning of an athletic season. The athletes were followed over 12 months and were asked to report all injuries resulting from training and competition. RESULTS: Eight athletes sustained hamstring injuries over the season. The injury rate was 0.87 per 1000 h of exposure. The incidence of injuries was higher at the beginning of the season, with 58.3% injuries occurring in the first 100 h of exposure. Cox regression analysis revealed that athletes with a decrease in the hamstring : quadriceps peak torque ratio of less than 0.60 at an angular velocity of 180 degrees/s have a 17-fold increased risk of hamstring injury. CONCLUSION: Performing preseason hamstring : quadriceps peak torque ratio assessments may be useful to identify sprinters susceptible to hamstring injury.

Surgical Techniques and Outcomes After Anterior Cruciate Ligament Reconstruction in Preadolescent Patients

Christopher C. Kaeding, David Flanigan, Christopher Donaldson.: Arthroscopy: The Journal of Arthroscopic and Related Surgery, Volume 26, Issue 11 , Pages 1530-1538, November 2010

Purpose: To determine whether any anterior cruciate ligament (ACL) reconstruction technique is clinically superior in skeletally immature patients with wide-open physes. Methods: We searched Medline and Embase from 1966 to mid July 2009. Inclusion criteria required clinical studies of ACL reconstructions to define skeletally immature patients as having at least 1 of the following criteria: (1) chronologic age of less than 15 years in boys or less than 14 years in girls; (2) bone age of less than 15 years in boys or less than 14 years in girls; (3) Tanner stage I, II, or III; and (4) at least 10 cm of total growth after the reconstruction. Thirteen case series were identified and were evaluated for patient characteristics, surgical technique, clinical outcomes, and bone growth results. Results: Four studies used physeal-sparing techniques. Six studies used transphyseal techniques. Two studies used a combined technique, and a multicenter study reported results of both techniques. Within the physeal-sparing group, there were 2 studies that used an entirely extra-epiphyseal technique and 2 studies that used intra-epiphyseal techniques. Overall clinical outcomes were excellent, with growth complications being very rare in all of these series. Conclusions: Both physeal-sparing and transphyseal reconstructions can produce excellent clinical outcomes with a very low incidence of growth complications in Tanner stage II and III patients. Tanner stage I patients had excellent clinical results with physeal-sparing techniques (both extra- and intra-epiphyseal techniques). Not enough Tanner stage I patients underwent transphyseal techniques to support or discourage their use. This evidence supports considering the expansion of transphyseal reconstruction indications from Tanner stage IV patients to Tanner stage II and III patients. More studies evaluating transphyseal techniques in Tanner stage I patients are needed at this time.

Outcomes and Risks of Operative Treatment of Rupture of the Anterior Cruciate Ligament in Children and Adolescents

Karl-Heinz Frosch, Dirk Stengel, Tobias Brodhun, Immanuel Stietencron, Dirk Holsten, Christian Jung, Dominik Reister, Christine Voigt, Philipp NiemeyerMarkus Maier, Peter Hertel, Michael Jagodzinski, Helmut Lill.: Arthroscopy: The Journal of Arthroscopic and Related Surgery, Volume 26, Issue 11 , Pages 1539-1550, November 2010.

Purpose: The aim of this meta-analysis was to evaluate the clinical outcomes and risks of anterior cruciate ligament (ACL) surgery in children and adolescents. Methods: We electronically searched Medline, the Cochrane Controlled Trial Database, Embase, and Medpilot for studies on surgical treatment for ACL ruptures in skeletally immature patients. We extracted baseline demographics, follow-up intervals, surgical details (i.e., ligament suture or reconstruction, physeal-sparing or transphyseal techniques, type of transplant, and methods of fixation). Endpoints comprised rates of growth disturbances and reruptures, as well as knee function (measured by the International Knee Documentation Committee's documentation system and the Lysholm score). Unweighted overall effect sizes (risks, risk ratios [RRs], and means of functional scores) were estimated by use of crude nominators and denominators, and random-effects meta-regression analysis was used for weighted data synthesis. Results: A total of 55 articles reporting on 935 patients (median age, 13 years; range, 1.5 to 16 years) were suitable for the study. After a median follow-up of 40 months (range, 14 to 89 months), the weighted rate of leg-length differences or axis deviations was 1.8% (95% confidence interval [CI], 0% to 3.9%] and that of reruptures was 4.8% (95% CI, 2.9% to 6.7%). Excellent or good function (International Knee Documentation Committee grade A or B) was achieved in 84.2% (95% CI, 75.8% to 92.6%) of all knees, and Lysholm scores averaged 96.3 (95% CI, 95.5 to 97.2). Transphyseal reconstruction was associated with a significantly lower risk of leg-length differences or axis deviations compared with physeal-sparing techniques (1.9% v 5.8%; RR, 0.34; 95% CI, 0.14 to 0.81) but had a higher risk of rerupture (4.2% v 1.4%; RR, 2.91; 95% CI, 0.70 to 12.12). Sutures did not result in any growth disturbances, with a weighted rerupture rate of 4.6% (95% CI, 2.6 to 6.7). Fixation far from the joint line fared better than close fixation with regard to this endpoint (1.4% v 3.2%; RR, 0.42; 95% CI, 0.09 to 1.93). Bone–patellar tendon–bone grafts, which are also less likely to fail, were associated with higher risks of leg-length differences or axis deviations than were hamstrings (3.6% v 2.0%; RR, 1.82; 95% CI, 0.66 to 5.03). Meta-regression did not show a significant impact of the publication year on event rates. Conclusions: This meta-analysis showed low rates of leg-length differences or axis deviations and graft failures after ACL reconstruction in skeletally immature patients. Hamstring transplants may lower the risk of leg-length differences or axis deviations, and physeal-sparing techniques may increase the risk. Randomized controlled trials are needed to clarify important issues in managing ACL ruptures in children and adolescents. Level of Evidence: Level IV, meta-analysis of case series.

Increased risk of knee injuries and osteoarthritis in the non-dominant leg of former professional football players

Krajnc Z, Vogrin M, Recnik G, Crnjac A, Drobnic M, Antolic V.: Wiener klinische Wochenschrift, 2010, 122 Suppl 2:40-3, Department of Orthopedic Surgery, University Clinical Center Maribor, Maribor, Slovenia.

The aim of the study was to evaluate differences in knee injuries and osteoarthritis between the dominant and non-dominant legs of former professional football players. The study cohort comprised 40 retired professional players with an average age of 49.2 years. Participants completed a questionnaire about their sports and personal history with special emphasis on knee injuries/operations of the dominant and non-dominant leg. Bilateral standing knee radiographs were taken. Overall, 29 footballers (73%) had experienced at least one moderate or severe knee injury and 18 (40%) had undergone at least one knee operation during their career. Among those injured, 14 (35%) players had suffered a dominant knee injury and 22 (55%) a non-dominant knee injury. Evidence of osteoarthritis (Kellgren-Lawrence scale > or = 2) was found in 17 (43%) dominant and 23 (58%) non-dominant knees. Professional football players have a significant risk of knee injuries and early osteoarthritis with preponderance in the non-dominant leg.

Early Versus Late Start of Isokinetic Hamstring-Strengthening Exercise After Anterior Cruciate Ligament Reconstruction With Patellar Tendon Graft

Ufuk Sekir, Hakan Gur, Bedrettin Akova, Am J Sports Med, March 2010: 38 492-500. Department of Sports Medicine, Medical School of Uludag University, 16059 Gorukle, Bursa, Turkey

Backgound Hamstring strengthening after anterior cruciate ligament reconstruction is a vital component of the rehabilitation program. Purpose: The objective of this trial was to investigate the effects of hamstring isokinetic training used in the early phase of the rehabilitation program on the stability, strength, symptoms, and functional outcomes of patients throughout 12 months after anterior cruciate ligament surgery. Study Design: Randomized controlled clinical trial; Level of evidence, 2.

Methods: Forty-eight men underwent anterior cruciate ligament reconstruction with an ipsilateral bone–patellar tendon–bone autograft. The patients were randomly assigned to perform daily isokinetic hamstring exercises at postoperative 3 weeks (group I) or to perform daily isokinetic hamstring exercises at postoperative 9 weeks (group II). The patients were evaluated monthly for the first 4 months and at the 12th month for postoperative hamstring and quadriceps strength, as well as for knee function via the Cincinnati Knee Rating Scale and International Knee Documentation Committee form.

Results: Hamstring isometric strength at 30° of knee flexion (at the first and second months) and concentric isokinetic strength (at 2, 3, 4, and 12 months) at the angular velocity of 60 deg/s were significantly (P <.05-.01) greater in group I compared with group II. Average scores of the Cincinnati Knee Rating Scale for symptoms were significantly (P <.05-.001) higher in group I compared with group II at all evaluation periods. Walking and stair-climbing scores at 1, 2, 3, and 4 months and squatting score at all evaluation periods were also better (P <.05-.01) in group I compared with group II. In addition, group I exhibited better (P <.01-.001) Lachman test results compared with group II for all postoperative evaluation periods. The International Knee Documentation Committee final rating scores were significantly (P <.01) greater at 2, 3, and 4 months in group I compared with group II.

Conclusion: The results of this study suggest that hamstring as well as quadriceps strength can be increased via early hamstring strengthening after anterior cruciate ligament reconstruction with no negative impact on knee function.

Tibiofemoral alignment: contributing factors to noncontact anterior cruciate ligament injury

Boden BP, Breit I, Sheehan FT.: The Journal of bone and joint surgery. American volume, 2009, 91(10):2381-9. The Orthopaedic Center, 9711 Medical Center Drive, Suite 201, Rockville, MD 20850, USA.

BACKGROUND: The mechanisms of noncontact anterior cruciate ligament injury remain undefined. The purpose of this study was to identify the tibiofemoral alignment in the lateral compartment of the knee for three variations of a one-limb landing in noncontact sports activities: the safe, provocative, and exaggerated provocative positions. These positions were chosen on the basis of a previous study that measured the average joint angles of the limb at the point of ground contact for athletes who landed without injury (safe) and those who sustained an anterior cruciate ligament injury (provocative). It was hypothesized that, in the provocative positions, altered tibiofemoral alignment predisposes the knee to possible subluxation, potentially leading to an anterior cruciate ligament injury. METHODS: Magnetic resonance images were acquired for a single knee in twenty-five noninjured athletes for the three landing positions. The angle between the posterior tibial slope and the femur along with three distances (from the tibiofemoral point of contact to [1] the femoral sulcus point, [2] the posterior tibial point, and [3] the most anterior point of the circular posterior aspect of the condyle) were measured for each acquisition. RESULTS: The tibial slope relative to the femur was directed significantly more inferior to superior in the provocative and exaggerated positions than in the safe landing position. Similarly, as the limb transitioned from the safe to the provocative positions, the tibiofemoral joint contact point was significantly closer to the femoral sulcus point and to the most anterior point of the circular posterior portion of the lateral femoral condyle. CONCLUSIONS: As the limb moves toward the provocative landing position, the anatomical alignment based on slope and contact characteristics places the knee at possible risk for noncontact anterior cruciate ligament injury. An enhanced understanding of the mechanism of anterior cruciate ligament injury may lead to improved preventative strategies.

Shoulder injuries in the throwing athlete

Braun S, Kokmeyer D, Millett PJ.: The Journal of bone and joint surgery. American volume, 2009, 91(4):966-78. Steadman Hawkins Research Foundation, 181 West Meadow Drive, Suite 1000, Vail, CO 81657, USA.

Pathologic conditions in the shoulder of a throwing athlete frequently represent a breakdown of multiple elements of the shoulder restraint system, both static and dynamic, and also a breakdown in the kinetic chain. Physical therapy and rehabilitation should be, with only a few exceptions, the primary treatment for throwing athletes before operative treatment is considered. Articular-sided partial rotator cuff tears and superior labral tears are common in throwing athletes. Operative treatment can be successful when nonoperative measures have failed. Throwing athletes who have a glenohumeral internal rotation deficit have a good response, in most cases, to stretching of the posteroinferior aspect of the capsule.

Quality and content of Internet-based information for ten common orthopaedic sports medicine diagnoses

Starman JS, Gettys FK, Capo JA, Fleischli JE, Norton HJ, Karunakar MA.: The Journal of bone and joint surgery. American volume, 2010, 92(7):1612-8. Carolinas Medical Center, Charlotte, NC 28232, USA.

BACKGROUND: Although the use of the Internet to access health information has grown quickly, the emergence of quality controls for health information web sites has been considerably slower. The primary objective of this study was to assess the quality and content of Internet-based information for commonly encountered diagnoses within orthopaedic sports medicine. METHODS: Ten common diagnoses within the scope of orthopaedic sports medicine were chosen. Custom grading templates were developed for each condition, and they included an assessment of web-site type, the accountability and transparency of the information (Health On the Net Foundation [HON] score), and the information content. Information content was divided into five subcategories: disease summary, pathogenesis, diagnostics, treatment and complications, and outcomes and prognosis. Two popular search engines were used, and the top ten sites from each were independently reviewed by three authors. Data were evaluated for interobserver variability, HON scores, information content scores, and subgroup score comparisons. RESULTS: After eliminating duplicate sites, a total of 154 unique sites were reviewed. The most common web-site types were commercial (seventy-four sites) and academic (thirty-two sites). Average HON scores, on a 16-point scale, were 9.8, 9.5, and 8.5, for reviewers 1, 2, and 3, respectively. Average information content scores, on a 100-point scale, were 56.8, 56.0, and 54.8 for reviewers 1, 2, and 3, respectively. Average content scores in each subgroup ranged between 45% and 61% of the maximum possible score. The presence of the HONcode seal was associated with significantly higher HON (p = 0.0001) and content scores (p = 0.002). CONCLUSIONS: The quality and content of health information on the Internet is highly variable for common sports medicine topics. Patients should be encouraged to exercise caution and to utilize only well-known sites and those that display the HONcode seal of compliance with transparency and accountability practices.

Internal impingement of the shoulder in the overhead athlete.

The Journal of bone and joint surgery. American volume, 2009, 91(11):2719-28. Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.

Internal impingement of the shoulder refers to a constellation of pathologic conditions, including, but not limited to, articular-sided rotator cuff tears, labral tears, biceps tendinitis, anterior instability, internal rotation deficit, and scapular dysfunction. Physiologic adaptations to throwing include increased external rotation, increased humeral and glenoid retroversion, and anterior laxity, all of which may predispose an individual to internal impingement. Nonoperative treatment should always be attempted first, with a focus on increasing the range of motion and improving scapular function. When an operative intervention is chosen, it is important to address microinstability in order to have a good outcome and prevent failure.

Avulsion of the proximal hamstring origin. Surgical technique.

.: The Journal of bone and joint surgery. American volume, 2009, 91 Suppl 2:249-56.North Sydney Orthopaedic and Sports Medicine Centre, Crows Nest, Sydney, NSW, Australia.

BACKGROUND: The torn hamstring is a common athletic injury. The purpose of the present study was to review the clinical presentation of this injury, the diagnostic imaging findings, the surgical technique of reattachment, and the likely clinical outcome of surgery for the treatment of avulsion of the proximal hamstring origin. METHODS: Seventy-two consecutive reconstructions in seventy-one patients with avulsion of the proximal hamstring origin were performed at a single center. The mean age at the time of the operation was 40.2 years. The mean duration of follow-up was twenty-four months, and all patients with a minimum duration of follow-up of six months were included. There were no exclusions. Patients were independently reviewed, and the mean postoperative isotonic hamstring strength was compared with that on the uninjured side. RESULTS: Waterskiing was the most frequent cause of injury (twenty-one cases). The mean time between the injury and the operation was twelve months. The most common pathological finding was a complete avulsion of the proximal hamstring origin (sixty-three cases; 87.5%), with a mean retraction of 7 cm (range, 0 to 20 cm). The mean postoperative isotonic hamstring strength measured 84% (range, 43% to 122%) and the mean postoperative hamstring endurance measured 89% (range, 26% to 161%) when compared with the values on the contralateral side. CONCLUSIONS: It is important to distinguish proximal hamstring origin avulsions (for which we recommend early surgical repair) from the majority of hamstring muscle injuries (which respond well to nonoperative treatment). The present study suggests that, in cases of complete avulsion with hamstring retraction, a delay in surgical repair renders the repair more technically challenging, may increase the likelihood of sciatic nerve involvement, increases the need for postoperative bracing, and reduces postoperative outcome in terms of hamstring strength and endurance. Once the nature of the injury has been established, the surgical treatment of hamstring origin avulsions has predictable and satisfactory results.

Athletic activity after total joint arthroplasty.

William L. Heal, Sanjeev Sharm, Benjamin Schwartz and Richard Iorio, The Journal of bone and joint surgery. American volume, 2008, 90(10):2245-52. States Department of Orthopaedic Surgery, Lahey Clinic Medical Center, Burlington, MA 01805, USA.

Demand for total joint arthroplasty is projected to increase in the first three decades of the twenty-first century. With increasing frequency, patients who have a hip or knee replacement expect to, and choose to, participate in athletics following rehabilitation. In general, patients who have had a hip or knee replacement decrease their participation in, and intensity of, athletic activity following the total joint arthroplasty. The orthopaedic literature on athletic activity after total joint arthroplasty is limited to small retrospective studies with short-term follow-up. Expert opinion regarding appropriate athletic activity after total joint arthroplasty is available from the Hip Society and the Knee Society. When patients who have undergone joint replacements choose to participate in athletic activity, orthopaedic surgeons should provide information with which to evaluate the risk of sports activity and recommend appropriate athletic activity.

Adductor-related groin pain in recreational athletes: role of the adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections.

Schilders E, Talbot JC, Robinson P, Dimitrakopoulou A, Gibbon WW, Bismil Q. : The Journal of bone and joint surgery. American volume, 2009, 91(10):2455-60. Department of Orthopaedics, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, England.

BACKGROUND: Adductor dysfunction can cause groin pain in athletes and may emanate from the adductor enthesis. Adductor enthesopathy may be visualized with magnetic resonance imaging and may be treated with entheseal pubic cleft injections. We have previously reported that pubic cleft injections can provide predictable pain relief at one year in competitive athletes who have no evidence of enthesopathy on magnetic resonance imaging and immediate relief only in patients with findings of enthesopathy on magnetic resonance imaging. In this follow-up study, we attempted to determine if the same holds true for recreational athletes. METHODS: We reviewed a consecutive case series of twenty-eight recreational athletes who had presented to our sports medicine clinic with groin pain secondary to adductor longus dysfunction. A period of conservative treatment had failed for all of these athletes. The adductor longus origin was assessed with magnetic resonance imaging for the presence or absence of enthesopathy. All patients were treated with a single pubic cleft injection of a local anesthetic and corticosteroid into the adductor enthesis. The patients were assessed for recurrence of symptoms at one year after treatment. RESULTS: On clinical reassessment five minutes after the injection, all twenty-eight athletes reported resolution of the groin pain. Fifteen patients (Group 1) had no evidence of enthesopathy on magnetic resonance imaging, and thirteen patients (Group 2) had findings of enthesopathy on magnetic resonance imaging. At one year after the injection, five of the fifteen patients in Group 1 had experienced a recurrence; these recurrences were noted at a mean of fourteen weeks (range, seven to twenty weeks) after the injection. Four of the thirteen patients in Group 2 had experienced a recurrence of the symptoms at one year, and these recurrences were noted at a mean of eight weeks (range, two to nineteen weeks) after the injection. Overall, nineteen (68%) of the twenty-eight athletes had a good result following the injection. Of the remaining nine athletes, two were treated successfully with repeat injection; therefore, overall, twenty-one (75%) of the twenty-eight athletes had a good result after entheseal pubic cleft injection. CONCLUSIONS: Most recreational athletes with adductor enthesopathy have pain relief at one year after entheseal pubic cleft injection, regardless of the findings on magnetic resonance imaging. There were similarities between this group of recreational athletes and the competitive athletes in our previous study, in that the adductor enthesis was the source of pain and entheseal pubic cleft injection was a valuable treatment option. The main difference was that, in this group of recreational athletes, magnetic resonance imaging evidence of adductor enthesopathy did not correlate with the outcome of the injection.

The cervical spine of professional front-row rugby players: correlation between degenerative changes and symptoms.

Hogan BA, Hogan NA, Vos PM, Eustace SJ, Kenny PJ.: Irish journal of medical science, 2010-06 179(2):259-63. Department of Diagnostic Imaging, Sports Surgery Clinic, Santry Demesne, Dublin 9, Ireland.

BACKGROUND: Injuries to the cervical spine (C-spine) are among the most serious in rugby and are well documented. Front-row players are particularly at risk due to repetitive high-intensity collisions in the scrum. AIM: This study evaluates degenerative changes of the C-spine and associated symptomatology in front-row rugby players. MATERIALS AND METHODS: C-spine radiographs from 14 professional rugby players and controls were compared. Players averaged 23 years of playing competitive rugby. Two consultant radiologists performed a blind review of radiographs evaluating degeneration of disc spaces and apophyseal joints. Clinical status was assessed using a modified AAOS/NASS/COSS cervical spine outcomes questionnaire. RESULTS: Front-row rugby players exhibited significant radiographic evidence of C-spine degenerative changes compared to the non-rugby playing controls (P < 0.005). Despite these findings the rugby players did not exhibit increased symptoms. CONCLUSION: This highlights the radiologic degenerative changes of the C-spine of front-row rugby players. However, these changes do not manifest themselves clinically or affect activities of daily living.

Tibial Cartilage Damage and Deformation at Peak Displacement Compression During Simulated Landing Impact

Chen Hua Yeow, Yi Hao Ng, Peter Vee Sin Lee, and James Cho Hong Goh. Am J Sports Med, 2010, 38 816-823.

Background: Structural changes of articular cartilage at the point of peak displacement compression during a landing impact are unknown. Hypothesis: Extent of damage and deformation is significantly different for superficial, middle, and deep cartilage zones at peak displacement compression during simulated landing impact compared with after impact. Study Design: Controlled laboratory study.

Methods: Explants were extracted from porcine tibial cartilages and divided into 3 test conditions: nonimpact control, impact and release, and impact and hold. Impact compression, with peak deformation of 2 mm, was applied based on a single 10-Hz haversine to simulate landing impact. For impact and release, explants were subjected to formalin fixation on removal of load after impact. For impact and hold, explants were immediately immersed in formalin with peak deformation maintained at 2 mm. After fixation, the explants underwent histology, whereby Mankin scores and cartilage thicknesses were obtained. Results: Peak stresses of 9.8 to 28.1 MPa were noted during impact compression. For impact and release, substantial cartilage defects such as surface fraying and fissures were observed. For impact and hold, explants exhibited less severe matrix damage, such as superficial irregularities and tidemark disruption. Mankin scores were lower (indicating less damage; P <.05) in impact and hold than in impact and release condition. Superficial cartilage zone thickness was reduced (P <.05) in both impact and hold and impact and release conditions, relative to nonimpact control. Conclusion: Not only does the loading phase of impact compression play a role in introducing substantial damage and deformation to cartilage, the unloading phase contributes to overall cartilage damage by exacerbating fissure propagation from surface lesions. Clinical Relevance: Imaging of clinical injuries may underestimate the magnitude of cartilage compression that occurred during injury. Cartilage tissue engineering scaffolds must be designed to cope with the effects of loading and unloading phases, especially at the superficial zone, so that the repair site can function as well as does the neighboring native cartilage.

Clinical Sports Medicine Update: Management of Tarsal Navicular Stress Fractures: Conservative Versus Surgical Treatment: A Meta-Analysis

Joseph S. Torg, James Moyer, John P. Gaughan, and Barry P. Boden: Am J Sports Med, 2010, 38 1048-1053Purpose: This study was conducted to provide a statistical analysis of previously reported tarsal navicular stress fracture studies regarding the outcomes and effectiveness of conservative and surgical management.

Study Design: Systematic review.Methods: A systematic review of the published literature was conducted utilizing MEDLINE through Ovid, PubMed, ScienceDirect, and EBSCOhost. Reports of studies that provided the type of tarsal navicular stress fracture (ie, complete or incomplete), type of treatment, result of that treatment, and the time required to return to full activity were selected for analysis. Using a mixed generalized linear model with study as a random effect and treatment as a fixed effect, cases were separated and compared based on 3 different types of treatment: conservative, weightbearing permitted (WBR); conservative, non-weightbearing (NWB); and surgical treatment. The outcome of the treatment was recorded as either successful or unsuccessful based on radiographic and/or clinical healing of the fracture and time from onset of treatment to return to activity. Results: There was no statistically significant difference between NWB conservative treatment and surgical treatment regarding outcome (P = .6441). However, there is a statistical trend favoring NWB management (96% successful outcomes) over surgery (82% successful outcomes). Weightbearing as a conservative treatment was shown to be significantly less effective than either NWB (P = .0001) or surgical treatment (P <.0003). Conclusion: Non-weightbearing conservative management should be considered the standard of care for tarsal navicular stress fractures. The authors could find no advantage for surgical treatment compared with NWB immobilization. However, there is a statistical trend favoring NWB over surgery. Rest or immobilization with weightbearing was inferior to both other treatments analyzed. The authors concluded that conservative NWB management is the standard of care for initial treatment of both partial and complete stress fractures of the tarsal navicular.

Assessment of injuries sustained in mixed martial arts competition.

Scoggin JF, Brusovanik G, Pi M, Izuka B, Pang P, Tokumura S, Scuderi G.: American Journal of Orthopedics (Belle Mead, N.J.), 2010, 39(5):247-51. John A. Burns School of Medicine, Honolulu, Hawaii, USA.

Mixed martial arts (MMA) competitions have gained much popularity, and the sport is watched by many millions annually. Despite ongoing controversy, there have been no objective studies of the injuries sustained in MMA based on on-site evaluation. In the study reported in this article, we attempted to delineate injury patterns for MMA participants. We conducted an observational cohort study of MMA competitions held in Hawaii between 1999 and 2006. The study included 116 bouts, involving 232 "exposures" and 179 male participants between ages 18 and 40. All the fighters were examined by 1 of 4 physicians, both before and after each bout. Fighters were referred to an emergency department when necessary, and follow-up was recommended as needed. Among the 232 exposures were 55 injuries: 28 abrasions and lacerations (6 requiring on-site suturing or referral to an emergency department for suturing), 11 concussions (4 with retrograde amnesia), 5 facial injuries (2 nasal fractures, 1 tympanum rupture, 1 temporomandibular joint sprain, 1 Le Fort fracture), and 11 orthopedic injuries (3 metacarpal injuries, with 1 confirmed fracture; 1 acromioclavicular separation; 1 traumatic olecranon bursitis; 1 elbow subluxation; 1 midfoot sprain; 1 aggravation of elbow medial collateral ligament sprain; 1 elbow lateral collateral ligament strain; 1 trapezius strain; 1 Achilles tendon contusion). We describe the injuries sustained in MMA competition to make comparisons with other sports. We discuss distribution and mechanism of injuries as well as injury incidence based on on-site evaluation in MMA.

Review: imaging of groin pain in the athlete.

Davies AG, Clarke AW, Gilmore J, Wotherspoon M, Connell DA.: Skeletal Radiology, 2010, 39(7):629-44. Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.

Chronic groin pain is a common entity in the sporting population and causes considerable morbidity. The differential diagnosis is wide, and this article presents a review of the common causes with particular reference to anatomy, ultrasound and magnetic resonance imaging (MRI) findings.

Risk factors for elbow injuries among young baseball players.

Harada M, Takahara M, Mura N, Sasaki J, Ito T, Ogino T.: Journal of Shoulder and Elbow Surgery / American Shoulder and Elbow Surgeons, 2010, 19(4):502-7. Department of Orthopaedic Surgery, Yamagata University School of Medicine, Yamagata, Japan.

HYPOTHESIS: There are some risk factors that could predispose a young baseball player to elbow injuries. MATERIALS AND METHODS: Study participants were 294 baseball players aged 9 to 12 years old. A questionnaire, physical examination, and ultrasound imaging to investigate elbow injuries were performed. Data for the groups with and without elbow injuries were analyzed statistically using multivariate logistic regression models. RESULTS: Ultrasound imaging showed that 60 participants had elbow injuries, including medial epicondylar fragmentation in 58 and osteochondritis dissecans of the capitellum in 2. The odds ratio (95% confidence interval) of the risk factors that statistical analysis showed were significant were age older than 11 years, 2.82 (1.30-6.10); height exceeding 150 cm, 2.02 (1.07-3.82); pitching, 4.50 (2.42-8.37); daily training, 1.96 (1.02-3.79); range of motion (ROM) of external rotation of the shoulder below 130 degrees , 1.98 (1.01-3.87); muscle strength (MS) of external rotation of the shoulder exceeding 80 N, 4.11 (1.47-11.55); and MS of internal rotation of the shoulder exceeding 100 N, 2.04 (1.08-3.90). DISCUSSION: Risk factors for elbow injuries are age, height, pitcher, days of training, grip strength, range of motion of external rotation of the shoulder, and muscle strength of the shoulder. CONCLUSION: As new information, our results suggest that decrease of ROM of external rotation of the shoulder and increase of MS of external and internal rotation of the shoulder predispose elbow injuries.

Stress fractures of the metacarpal bones in adolescent tennis players: a case series.

Balius R, Pedret C, Estruch A, Hernández G, Ruiz-Cotorro A, Mota J.: The American Journal of Sports Medicine, 2010, 38(6):1215-20 Language: eng Country: United States Consell Català de l'Esport, Generalitat de Catalunya, Av. Paisos Catalans 12, Esplugues de Llobregat, Barcelona, Spain.

BACKGROUND: There are 12 reported cases of metacarpal stress fractures in athletes, with only 4 of them involving the second metacarpal. PURPOSE: The authors describe stress fracture of the second metacarpal bone in teenaged tennis players and the relationship with sport intensity and type of grip used. They also demonstrate that magnetic resonance imaging is the diagnostic study of choice to differentiate this entity from the most common cause of pain in this region of the hand in tennis players-the carpal boss. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Seven adolescent tennis players (mean age, 16.5 years; 6 female, 1 male) with dorsal hand pain produced by playing tennis were examined by radiographs and initial magnetic resonance imaging. In 2 cases, bone scintigraphy was performed. In the first 2 cases, the presumptive diagnosis was a carpal boss, but with this experience, the diagnostic evaluation of the last 5 cases was oriented toward a stress reaction at this level. Radiologic follow-up was performed. The authors also evaluated the grip type used by each tennis player. RESULTS: Clinical evaluation and imaging studies resulted in a diagnosis of stress injury of the second metatarsal in 6 of 7 cases, with the seventh case involving the third metacarpal. Initial imaging was positive in 3 cases, revealing an increased signal in the marrow without hairline crack and cortical thickening of the shaft or simply an increased signal in the marrow. In all cases, there was a history of recent increase in the sport training load. Six of the 7 tennis players were using a semi-Western or Western grip. CONCLUSION: Stress fractures of the second metacarpal are characteristic of adolescent tennis players and are associated with an increased intensity of tennis play and may be associated with use of the semi-Western or Western grip. Magnetic resonance imaging is the most useful tool for obtaining a definitive diagnosis.

The outcome of hip arthroscopy in Australian football league players: a review of 27 hips.

Singh PJ, O'Donnell JM.: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the Internation, 2010, 26(6):743-9. Mercy and Belbird Private Hospitals, 21 Erin Street, East Melbourne, Australia.

PURPOSE: The purpose of this study was to investigate on hip pathology found at hip arthroscopy in Australian Football League (AFL) players and describe our current treatments and outcomes. METHODS: From 2003 to 2008, 24 consecutive AFL players (27 hips) had arthroscopic hip surgery by use of the lateral position. Patients were assessed preoperatively and postoperatively with the modified Harris Hip Score (MHHS) and Nonarthritic Hip Score (NAHS) and postoperatively with a satisfaction survey. RESULTS: All hips were available for review. The mean duration of follow up was 22 months (range, 6 to 60 months). The mean age was 22 years (range, 16 to 29 years). The mean body mass index was 24 points (range, 21 to 26 points). The mean traction time was 21 minutes (range, 11 to 60 minutes). The most common pathology was a rim lesion, affecting 93% of cases. Microfracture was performed in 22%. Synovitis was found in 70%, and this was most commonly associated with a rim lesion. Labral pathology was present in 33%, the most common of which was labral separation. On the femoral side, 81% had cam impingement and underwent a femoral neck ostectomy. Rim lesions and labral pathology were the most commonly associated lesions. Also seen were loose os acetabuli in 7% and loose bodies in 7%. The former were associated with labral tears and required repair. The MHHS and NAHS improved in all patients postoperatively, and they maintained their improvement from 1 year up to 4 years. In all but 1 case, the players returned to playing at the AFL level and were satisfied with their outcome. CONCLUSIONS: Using hip arthroscopy, we have observed high satisfaction levels and return to preinjury levels of play in all but 1 case. Postoperative hip scores (MHHS and NAHS) have improved significantly, and this improvement has been maintained for up to 4 years. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Treatment of chondral defects in the athlete's knee.

Harris JD, Brophy RH, Siston RA, Flanigan DC.: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the Internation, 2010, 26(6):841-52. Department of Orthopaedics, Division of Sports Medicine Cartilage Repair Center, The Ohio State University Medical Center, 2050 Kenny Road, Columbus, OH 43221, USA.

PURPOSE: To determine which surgical technique(s) has improved outcomes and enables athletes to return to their preinjury level of sports and which patient and defect factors significantly affect outcomes after cartilage repair or restoration. METHODS: We conducted a search of multiple medical databases, evaluating studies of articular cartilage repair in athletes. RESULTS: We identified 11 studies for inclusion (658 subjects). Only 1 randomized clinical trial was identified. All other studies were prospective cohorts, case-control studies, or case series reporting results after either microfracture or autologous chondrocyte implantation (ACI) or osteoarticular transplantation (OATS). Eight different clinical outcomes measures were used. Better clinical outcomes were observed after ACI and OATS versus microfracture. Results after microfracture tended to deteriorate with time. The overall rate of return to preinjury level of sports was 66%. The timing of return to the preinjury level of sports was fastest after OATS and slowest after ACI. Defect size of less than 2 cm(2), preoperative duration of symptoms of less than 18 months, no prior surgical treatment, younger patient age, and higher preinjury and postsurgical level of sports all correlated with improved outcomes after cartilage repair, especially ACI. Results after microfracture were worse with larger defects. The rate of return to sports was generally lower after microfracture versus ACI or OATS, and if a patient was able to return to sports, performance was diminished as well. CONCLUSIONS: Management of chondral defects in the athlete is complex and multifactorial. There is little high-level evidence to support one procedure over another, although good short-term and midterm outcomes with a fair rate of return to preinjury level of sports can be achieved with cartilage repair and restoration in the athlete. LEVEL OF EVIDENCE: Level IV, systematic review.

White on white meniscal tears to fix or not to fix?

Gallacher PD, Gilbert RE, Kanes G, Roberts SN, Rees D.: The Knee, 2010, 17(4):270-3. Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, United Kingdom.

The mechanical disadvantage to articular cartilage following meniscectomy has been well documented in the literature. Meniscal repair in the avascular (white on white) is controversial and would be deemed inappropriate by many. We have developed criteria for repair in all meniscal tears. These are: The meniscus 1. must not be degenerated 2. must be reducible, without a rolled edge 3. the fixation must be considered sound. Between 1999 and 2008 our department prospectively collected data on meniscal repairs as part of a sports database. Four hundred and twenty three patients underwent repair during this time period. We identified 87 patients with no co existent ACL injury or instability. There were 73 males and 14 females with a mean age of 26 years (13-54). All tears were in the non peripheral (white on white) area. The criterion for failure was reoperation on the same meniscus requiring excision or re fixation. The mean follow up was 49 months (10-112). Twenty eight patients required further surgery on their repaired meniscus. There were eight re-repairs and 20 partial menisectomies. This represents a success rate of 68% (59/87). The mean pre operative Lysholm score was 61 (4-88) which rose to 75 (12-100) postoperatively, p=0.002. The mean pre op Tegner score was 6 (3-10) and this did not change significantly post operatively, mean 6 (0-10) p=0.4. Isolated white on white avascular meniscal tears can be successfully repaired in the majority of cases with a good clinical and functional result.

Fixation of detached osteochondritis dissecans lesions with bioabsorbable pins: clinical and histologic evaluation.

Yonetani Y, Matsuo T, Nakamura N, Natsuume T, Tanaka Y, Shiozaki Y, Wakitani S, Horibe S.: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the Internation, 2010, 26(6):782-9. Department of Sports Orthopaedics, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, Japan.

PURPOSE: The purpose was to evaluate the effect of fixation of detached free fragments of osteochondritis dissecans (OCD) (International Cartilage Repair Society OCD IV) on not only the clinical outcome, including functional and radiographic assessment, but also postoperative second-look arthroscopic and histologic evaluation. METHODS: Nine International Cartilage Repair Society OCD IV fragments were fixed with bioabsorbable pins made of poly-L-lactic acid after curettage of the bed and bone grafting. In 4 cases with severe cartilage damage in the fragments, after resection of the damaged part, trimmed fragments were fixed and osteochondral autologous transplantation was performed to cover the remaining defects. The follow-up period was at least 2 years (range, 2 to 3 years). Lysholm score and computed tomography (CT)/magnetic resonance imaging (MRI), second-look arthroscopy, and biopsy findings were examined postoperatively. RESULTS: All patients ultimately could return to previous sports activity, and the mean postoperative Lysholm score was 97 (range, 90 to 100). At 6 months, CT/MRI scans showed complete union and smooth continuity of articular surface in all cases. Second-look arthroscopy in 7 cases showed that fixed fragments were stable and that there were no progressive degenerative changes in the cartilage. Postoperative histologic examination in 4 cases showed almost normal cartilage from surface to bottom in terms of viability and quality. In addition, new bone trabeculae were covering dead bone trabeculae, which is called creeping substitution. CONCLUSIONS: Our study shows good short-term clinical results, as well as confirmation of healing on CT/MRI and second-look arthroscopy. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

High tibial osteotomies in the young active patient.

Wolcott M, Traub S, Efird C.: International Orthopaedics, 2010, 34(2):161-6. Department of Orthopaedics, University of Colorado, Boulder, CO, USA..

Unicompartmental changes in the knee of a young athlete remains a difficult and controversial problem in orthopaedics. Excessive premature loading of articular cartilage, most often the result of a knee injury, has been shown to result in increased degenerative changes and pain in the younger patient. Instability may also contribute to the degeneration of cartilage and must therefore be considered in the treatment of osteoarthritis in the young adult. High tibial osteotomy has been described as a treatment option for malalignment in the older, less active adult and has shown promising results in a younger, more active population. Osteotomies for instability are more controversial and should be considered in more complex injury patterns.

Injuries to kickers in American football: the National Football League experience.

Brophy RH, Wright RW, Powell JW, Matava MJ.: The American Journal of Sports Medicine, 2010, 38(6):1166-73. Sports Medicine Service, Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA.

BACKGROUND: Very little information is available regarding the incidence, causative mechanisms, and expected duration of time lost after injuries to kickers (placekickers and punters) in American football. HYPOTHESIS: Lower extremity musculotendinous injuries are the most common type of injury in American football kickers. The injuries related to punting differ from injuries related to placekicking. STUDY DESIGN: Descriptive epidemiologic study. METHODS: A retrospective review of all documented injuries to kickers in the National Football League over a 20-year period (1988-2007) was performed using the League's injury surveillance database. The data were analyzed from multiple perspectives, with emphasis on the type of kick or activity at the time of injury and the factors that affect return to play after injury. RESULTS: There were 488 total injuries over the 20-year period: 72% involved the lower extremity, 9% involved the lumbosacral spine, and 7% involved the head. Muscle-tendon injuries (49%) were the most common, followed by ligamentous injuries (17%). There was a significantly higher risk of injury in games (17.7 per 1000) than during practice (1.91 per 1000). Most injuries (93%) did not require surgery, and the mean time to return to play was 15 days if no surgery was necessary. Kickers over 30 years of age took longer to return to play (mean, 21 days) than younger kickers (mean, 12 days) after nonsurgical injuries (P = .03). Mean return to play after injuries that required surgery was 121 days. Lumbosacral soft tissue injury, lateral ankle sprains, and shoulder injuries were more likely to occur in punters than placekickers. CONCLUSION: Kicking athletes face a low risk of injury in professional American football. Injuries most commonly involve the lower extremities. Training and injury prevention efforts should reflect that punting is associated with different injuries than placekicking, and that older kickers take longer to recuperate than younger kickers after certain injuries.

MRI of ankle and lateral hindfoot impingement syndromes.

Donovan A, Rosenberg ZS.: AJR. American Journal of Roentgenology, 2010, 195(3):595-604. Department of Medical Imaging, Sunnybrook Health Sciences Centre, Rm. AG 278, 2075 Bayview Ave., Toronto, ON, Canada M4N 3M5.

OBJECTIVE: The objective of this article is to review the pathophysiology and clinical presentation of impingement syndromes at the ankle joint (anterolateral, anterior, anteromedial, posteromedial, and posterior) and the role of MRI in evaluating impingement at the ankle joint and at extraarticular locations, lateral to the ankle joint (talocalcaneal and calcaneofibular). CONCLUSION: MRI is valuable in assessing both osseous and soft-tissue abnormalities associated with impingement syndromes.

Distal semitendinosus ruptures in elite-level athletes: low success rates of nonoperative treatment.

Cooper DE, Conway JE.: The American Journal of Sports Medicine, 2010, 38(6):1174-8. The Carrell Clinic, 9301 N. Central Expressway, Dallas, TX 75231, USA.

BACKGROUND: No case series of isolated complete rupture of the distal semitendinosus tendon have been reported previously. PURPOSE: This study was undertaken to increase awareness and report the authors' treatment experience, particularly the less than favorable results of nonoperative initial treatment. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The authors identified 25 cases of distal semitendinosus tendon rupture over a 14-year period (1991-2005). All players were male professional (20), collegiate (4), or high-level amateur (1) athletes. Follow-up of 17 cases averaged 13 months (range, 4-55), and 8 patients were lost to follow-up. Eight Major League Baseball, 8 National Football League, and 1 National Hockey League athletes were included in this study. Early treatment experience always involved nonoperative treatment, including rest, modalities, and rehabilitation exercises, followed by functional progression. "Recovery" was defined by clinical criteria including clearance to return to play. Failure to improve with nonoperative treatment, and thus requiring surgical treatment, was deemed a failure of nonoperative treatment. There were 12 players who had initial nonoperative treatment. The authors had later experience with 5 players who had surgery early in the acute phase in hopes of speeding return to competition. RESULTS: In the nonoperative treatment group (12), 7 players recovered at an average of 10.4 weeks (range, 3-35). Five of these players (42%) failed initial nonoperative treatment (mean, 16.8 weeks) and subsequently had surgery to resect the torn tendon and surrounding scar tissue. These 5 players recovered at an average of 12.8 weeks postoperatively. In the acute surgery group, 5 players had surgery to resect the torn tendon and scar tissue within 4 weeks of injury. The acute-phase group had an average recovery of 6.8 weeks after surgery. CONCLUSION: Distal semitendinosus ruptures frequently (42%) do not recover after nonoperative treatment. Acute surgical resection of the completely ruptured semitendinosus tendon may speed recovery when the athlete has a tender mass and difficulty extending the knee fully in the stance phase of gate. Future investigation is warranted to compare the long-term outcome of nonoperative treatment with that after acute surgery.

Shoulder pain: a comparison of wheelchair basketball players with trunk control and without trunk control.

Yildirim NU, Comert E, Ozengin N.: Journal of back and musculoskeletal rehabilitation, 2010, 23(2):55-61. Abant Izzet Baysal University School of Physical Therapy and Rehabilitation, Bolu, Turkey.

The purpose of this study was to compare shoulder pain between wheelchair basketball players with trunk control and wheelchair basketball players without trunk control. Players were evaluated according the International Wheelchair Basketball Federation (IWBF) classification system. The study group comprised 60 wheelchair basketball players, who were rated according to the International Wheelchair Basketball Federation classification system. Players were divided into two groups according to their trunk control. Study participants completed an anonymous survey that included demographic data, medical history data, and the Wheelchair User's Shoulder Pain Index (WUSPI). There was no statistically significant difference between the two groups based on the number of years of wheelchair use, active sport years, weekly working hours, and weekly training hours (p> 0.05). Statistically significant differences were found between wheelchair basketball players with trunk control and wheelchair basketball players with trunk control with respect to the duration of their disability, the daily number of transfers made to wheelchair, and Performance Corrected Wheelchair User's Shoulder Pain Index (PC-WUSPI) score (p< 0.05). The total PC-WUSPI score was higher among players without trunk control (p< 0.05). Study findings suggest that the shoulder pain of wheelchair basketball players must be analyzed. Trunk stabilization is the key factor affecting the function of the shoulder and is of primary importance for appropriate loading of the shoulder joint's many forms of articulation.

Sonoelastography in the evaluation of painful Achilles tendon in amateur athletes.

Sconfienza LM, Silvestri E, Cimmino MA.: Clinical and experimental rheumatology, 2010, 28(3):373-8. Unità di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy.

OBJECTIVES: The purpose of our paper was to evaluate by sonoelastography the Achilles tendon of asymptomatic volunteers and of patients referring for chronic overuse-associated pain, also comparing these findings with those obtained with B-mode ultrasound (US). METHODS: This study had local Ethics Committee approval; all patients gave their written informed consent. Twelve patients (9 men, 3 women, median age 52.5 years, range 38-64 years) referred for unilateral Achilles tendon pain associated with amateur sporting activities and 18 healthy controls (11 men, 7 women, median age 54 years, range 27-64 years) were studied. US/sonoelastography were performed with a Logos EUB8500 system (Hitachi Ltd., Tokyo, Japan) equipped with a 10-6 MHz high-resolution broadband linear array, on 12 symptomatic tendons and 36 controls. The probe was positioned at the calcaneal enthesis, retrocalcaneal bursa, myotendineus juction, and in three different areas of the tendon body. The elastogram colour range was translated to a numeric score and the differences of tendon resilience were compared by the Kruskall-Wallis test. RESULTS: On US, symptomatic tendons showed increased tendon thickness (12/12 tendons vs. 8/36 controls, p<0.0001), interruption (5/12 vs. 0/36, p=0.0004), and fragmentation (5/12 vs. 0/36, p=0.0004). Disappearance of fibrillar echotexture was comparable in the two groups. Symptomatic tendons were harder, showing a prevalence of blue to green colour (p<0.0001). Loss of elasticity was associated with both fragmentation (p=0.0089) and loss of fibrillar texture (p=0.0019), and was inversely correlated with tendon thickness (p<0.0001). Sonoelastography showed no difference between symptomatic and control tendons at the enthesis and myotendineus junction. CONCLUSIONS: Sonoelastography shows increased stiffness in symptomatic enlarged Achilles tendons in comparison to normal ones.

Non-union of the clavicle after intramedullary nailing with a steel Kirschner wire

Faymonville C, Jubel A, Schiffer G.: Der Unfallchirurg, 2010, 113(4):326-9. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Univ.-Klinikum Köln, Kerpener Str. 62, 50924, Köln, Deutschland.

Elastically stable intramedullary nailing is a safe surgical procedure used to treat mid-shaft clavicular fractures of types A and B according to the Orthopaedic Trauma Association (OTA) classification. In the case reported intramedullary fixation with a Kirschner wire and an incorrectly performed surgical technique led to pseudoarthrosis (non-union). After revision surgery with an elastically stable titanium nail and a correct surgical technique, fracture healing was achieved.

Patterns of lower limb fractures sustained during snowsports in Otago, New Zealand.

Patton A, Bourne J, Theis JC.: The New Zealand medical journal, 2010, 123(1316):20-5. Orthopaedic Department, Lancaster Royal Infirmary, Lancaster, Lancashire, UK.

AIMS: The aim of this study was to determine the nature and circumstances of lower limb fractures caused by skiing and snowboarding at the Otago skifields that required operative treatment at Dunedin Hospital from 2002 to 2008. METHODS: Patients were retrospectively identified from clinical records. RESULTS: 108 cases were included in the study; 28 snowboarders and 80 skiers. Snowboarders had more fractures involving the ankle whereas skiers had more fractures of the proximal third of the tibia and fibula. Snowboarders were more likely to fracture the fibula compared to skiers. Nearly two-thirds of fractures in snowboarders were to the left limb whereas in skiers a laterality was not demonstrated. Most fractures were the result of falls but a greater proportion of snowboarders had jump-related injuries. CONCLUSIONS: Snowboarding related lower limb fractures are more likely to involve the ankle and be left sided. Skiing related lower limb fractures are more proximal with no laterality.

Osteochondrosis of the proximal phalanx of the hallux in adolescent footballers.

Lakshmana Das B, Zenios M, Prem H.: Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America, 2010, 19(4):379-81. Birmingham Childrens Hospital, Birmingham, UK.

We report two cases with radiographic appearances of osteochondrosis in the proximal phalanx of the big toe in adolescent footballers. The radiological findings were those of initial fragmentation with subsequent healing of the epiphysis. This is the first report of osteochondrosis at this site. Local pain was accompanied by swelling with restriction of dorsiflexion of the metatarsophalangeal joint of the big toe. The condition was self-healing over a 2-4-year period. It needs to be included in the differential diagnosis of painful hallux in adolescent footballers.

Impaired weight transfer persists at least four months after hip fracture and rehabilitation.

Nightingale EJ, Sturnieks D, Sherrington C, Moseley AM, Cameron ID, Lord SR.: Clinical rehabilitation, 2010, 24(6):565-73. Discipline of Physiotherapy, University of Sydney, Australia.

OBJECTIVE: To determine whether choice stepping reaction time performance is impaired in people after hip fracture and whether different aspects of choice stepping performance improve with rehabilitation. DESIGN: This study includes a secondary analysis of data obtained from participants in a randomized controlled trial of exercise after hip fracture. SETTING: Data were either collected in a hospital rehabilitation unit, research institute or participant homes. SUBJECTS: The hip fracture group (n = 91) were recruited from three rehabilitation hospitals in metropolitan Sydney. The control group (n = 77) were healthy age-, gender- and dwelling-matched controls, participating in unrelated studies of fall risk factors. MAIN MEASURES: Response time, movement time and total time components of the choice stepping reaction time test. RESULTS: Improvements in choice stepping reaction time were seen in people after hip fracture, during a 16-week rehabilitation period, however performance remained impaired (1808 +/- 663 ms), compared with matched controls (1029 +/- 255 ms, P<0.001). Further, choice stepping performance was significantly slower when transferring weight onto the affected leg (1271 +/- 615 ms), compared with the unaffected leg (1119 +/- 499 ms, P<0.001). CONCLUSIONS: Movement deficits are evident for an extended time frame following rehabilitation for hip fracture. The slower response time following the rehabilitation period highlights ongoing difficulties with weight transfer onto the affected leg.

Impairment in people with anterior cruciate ligament reconstruction in adjusting ground reaction force in running.

Hackney JM, Wade MG, Larson C, Smith JP, Rakow J.: Physiotherapy theory and practice, 2010, 26(5):289-96. Department of Physical Therapy, Missouri State University, Springfield, Missouri 65897, USA.

In healthy individuals, maximum vertical ground reaction force (MVGRF) remains close to constant during constant velocity running, despite variation in stiffness of the surface underfoot. Because the anterior cruciate ligament (ACL) possesses mechanoreceptors that influence recruitment of knee muscles, it may play a role in regulation of lower limb force output. This study was designed to examine the effect of recent ACL reconstruction on MVGRF in running. Seven patients who were 5-13 weeks post-ACL reconstruction and 7 healthy participants ran for 60 seconds in shoes modified with hard and with soft 1-cm outsoles. The MVGRF during running was measured for the ACL reconstructed and nonsurgical limbs of patients and limbs of healthy participants. The difference in MVGRF between running in hard and soft shoes was significantly greater in ACL reconstructed limbs than nonsurgical limbs (p = 0.003) and compared to limbs of healthy participants (p = 0.001). In contrast, a difference in MVGRF between shoes was not found between patients' nonsurgical limbs and those of healthy participants. A lack of mechanoreceptive feedback from the ACL graft may be among the factors explaining the difference between the ACL reconstructed limbs and the other two limb conditions.

Hook of the hamate fracture.

Gill NW, Rendeiro DG.: The Journal of orthopaedic and sports physical therapy, 2010, 40(5):325 Language: eng Country: United States Army-Baylor University Doctoral Fellowship in Orthopaedic Manual Physical Therapy, Brooke Army Medical Center, San Antonio, TX, USA.

The patient was a 44-year-old man who reported palmar/ulnar-sided right wrist pain after injuring his wrist while playing golf. Although pain and function were improved at 6 months following the injury with conservative treatment measures and golfing with a modified grip, the patient was still limited during golf. This prompted the ordering of additional wrist radiographs, which included a carpal tunnel view, that revealed a fracture at the base of the hook of the hamate. The patient was referred to an orthopaedic surgeon and underwent a hook of hamate excision, and at 12 weeks following surgery, he had returned to full golfing activities without limitations.

Brief communication: Transportation and trauma: Dog-sledding and vertebral compression in Alaskan Eskimos.

Legge SS.: American journal of physical anthropology, 2010, 141(4):632-7 Language: eng Country: United States Anthropology Department, Macalester College, St. Paul, MN 55105, USA.

Vertebral compression, as evidenced by compression of the centrum, was observed within two Native Alaskan skeletal samples. Information was collected from 1,071 and 656 vertebrae from Golovin Bay and Nunivak Island, Alaska, respectively. In addition, patterns of compression related vertebral change in each collection were characterized by sex and location within the vertebral column. The overall frequencies of vertebral compression were 3.6% (n = 721) at Golovin Bay and 1.7% (n = 403) at Nunivak Island for all observable thoracic and lumbar vertebrae (T1-L5). There was no statistically significant difference in the occurrence of compression among adults between these two collections. When examining the thoracic and lumbar vertebral segments by sex, females at Golovin Bay (4.5%; n = 442) exhibited a significantly higher frequency of vertebral compression than females at Nunivak (1.0%; n = 203). However, this difference in occurrence of compression could be accounted for by the age distributions of the two samples. No difference was noted between the males of the two collections. Compression frequencies in both samples are discussed in relation to the modes of transportation historically utilized by each community.

Ultrasound imaging of the patellar tendon attachment to the tibia during puberty: a 12-month follow-up in tennis players.

Ducher G, Cook J, Spurrier D, Coombs P, Ptasznik R, Black J, Bass S.: Scandinavian journal of Medicine & Science in Sports, 2010, 20(1):e35-40. Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, Victoria, Australia.

This longitudinal study investigated the ultrasound appearance of the patellar tendon attachment to the tibia throughout puberty in young tennis players with and without Osgood-Schlatter disease (OSD). Twenty-eight competitive players (17 boys), aged 10.6-15.3 years, had bilateral ultrasound imaging of the patellar tendon attachment to the tibia at baseline and 1 year later. On each occasion, anthropometric measurements, pubertal status and injury history were recorded. Ultrasound appearance of the patellar tendon attachment was categorized into three stages: cartilage attachment, insertional cartilage and mature attachment. Stage 1 appearance, a large anechoic region with or without ossicles and irregularity of the apophysis that are classically associated with OSD, was found in eight players, seven of them were pain free. A majority (62%) of the patellar tendons in stage 1 at baseline progressed toward stage 2 or stage 3 1 year later. Likewise the patellar tendon attachment in most athletes with cartilage insertion showed progression to a mature enthesis over 1 year. The imaging appearance that is classically interpreted as OSD was common in asymptomatic knees. This ultrasonographic description of the patellar tendon attachment to the tibia during growth provides a reference for the assessment of bone tendon attachments in adolescents.

Navicular stress fracture in high-performing twin brothers: a case report.

Van Meensel AS, Peers K.: Acta Orthopaedica Belgica, 2010, 76(3):407-12. Department of Physical Medicine and Rehabilitation, University Hospitals Gasthuisberg-Pellenberg, Leuven, Belgium.

Navicular stress fractures mainly occur in sprinting and push-off athletes. Numerous predisposing factors have been implicated in their development. Within a six-week interval in the summer of 2009, twin brothers, both elite track and field athletes, presented to us with medial foot pain. Plain radiographs were negative but a radioisotope bone scan and CT scan revealed an incomplete navicular fracture in both of them. The fracture was typically located in the proximal dorsal cortex of the central portion of the navicular bone. The presence of such a stress fracture in high performing, monozygotic twins, has never been described. As extrinsic and intrinsic risk factors, their comparability of mechanical stresses and kinematics as well as a genetic predisposition can be put forward. This case report suggests that a complex interaction between mechanical and genetic risk factors exists in the development of navicular stress fractures.

Arthroscopic femoral osteoplasty/chielectomy for cam-type femoroacetabular impingement in the athlete.

Vaughn ZD, Safran MR.: Sports Medicine and Arthroscopy Review, 2010, 18(2):90-9. Department of Orthopaedic Surgery, Sports Medicine, Stanford University, Redwood City, CA 94063, USA.

Femoroacetabular impingement (FAI) represents an underlying bony abnormality of either the femoral head-neck junction or acetabulum, or most commonly, both. This often is associated with damage to intra-articular structures, primarily the labrum and chondral surfaces. Like pincer impingement, cam impingement has been associated with pain, limited hip range of motion, pain affecting athletic performance, and has been linked to the development of osteoarthritis. Cam impingement is the loss of offset of the femoral head-neck junction associated with loss of sphericity of the femoral head. Isolated cam impingement, although more common than isolated pincer impingement, it is much less common than both cam and pincer coexisting in people with FAI. Classically, the patient with isolated cam impingement is a young athletic male near 20 years of age. The classic pathology associated with the cam lesion is an acetabular articular cartilage injury in the anterosuperior acetabulum that is fairly well defined and may be deep, 1 to 1.5 cm from the acetabular rim, initially sparing the labrum, but eventually leading to labral detachment from the underlying bone. Treatment generally focuses on restoring the femoral head-neck offset by removing the excess bone. This article will review the underlying pathology of cam-type FAI, the evaluation and diagnosis, arthroscopic treatment, and reported outcomes.

Hyperbaric oxygen treatment of musculoskeletal disorders on the Sports medicine. State of the art

Drobnic F, Turmo A.: Medicina Clínica, 2010,13 134(7):312-5. Departamento de Fisiología del Deporte del CAR y Servicios Médicos del FCBarcelona, GIRSANE (Grup d' Investigació en el Rendiment i la Salut de l'Alt Nivell Esportiu), Barcelona, España.

Hyperbaric oxygen therapy (OHB) is a therapeutic modality based on the properties of partial pressure of oxygen, when breathing pure oxygen under hyperbaric conditions in a chamber designed for that purpose. Its indications in medicine are considered as primary, complementary or experimental depending on the evidence based effects. From different sectors of medicine, OHB has been recently proposed as a new tool for other pathologies, primarily in musculoskeletal disorders. In this paper, the state of the art of the influence from experimental studies is reviewed. Some considerations based on these studies are hypothesized as the minimum required to obtain good Results when this therapy is decided to be used as co adjuvant to standard treatment.

Glenoid labral repair in Major League Baseball pitchers

Ricchetti ET, Weidner Z, Lawrence JT, Sennett BJ, Huffman GR.: International Journal of Sports Medicine, 2010, 31(4):265-70. University of Pennsylvania School of Medicine, Orthopaedic Surgery, Philadelphia 19104, United States.

Little is known about outcomes of glenoid labral repair in Major League Baseball (MLB) pitchers. We hypothesized that following repair, pitching performance would not be significantly different from an uninjured cohort. Fifty-one pitchers were identified who pitched in at least one MLB game prior to undergoing isolated glenoid labral repair. For the three years prior to and following surgery, demographic and performance variables were analyzed for an association with labral injury and repair, and compared to a control cohort of MLB pitchers without history of repair. Following surgery, 72.5% of pitchers returned to MLB at a mean of 13.1 months with no significant change in performance. Starting pitchers had a higher risk of labral injury requiring repair (p< or =0.05). Pitchers that returned to play averaged more innings pitched in the seasons prior to surgery and had a higher body mass index than those that did not return to play (p< or =0.05). Approximately 70% of MLB pitchers undergoing labral repair can be expected to return to competition postoperatively with no significant change in performance. Starting pitchers are more likely to undergo repair, but pitchers with greater preoperative innings pitched per season have a greater likelihood of returning to play.

Patellar fracture after patellar stabilization

Lippacher S, Reichel H, Nelitz M.: Der Orthopäde, 2010, 39(5):516-8 . Orthopädische Universitätsklinik Ulm am RKU, Oberer Eselsberg 45, 89081, Ulm, Deutschland.

We report on a 20-year-old female patient with a fracture of the patella after she fell on"black ice" 2 months after medial patellofemoral ligament (MPFL) reconstruction for patellar instability. For reconstruction of the MPFL, a single hamstring tendon graft was passed through the medial intermuscular septum and was fixed to the superomedial pole of the patella. The fracture was reduced by wire cerclage. Intraoperatively it was shown that the fracture line went through the patellar drill hole. No complications occurred during the further postoperative period. The literature contains only a few case reports describing fractures of the patella after MPFL reconstruction without any specific trauma. In this case, an interruption in blood supply with resulting avascular necrosis was suspected as a causal factor.

Posterior sternoclavicular disruption with ipsilateral clavicle fracture in a nine-year-old hockey player.

Tompkins M, Bliss J, Villarreal R, Solga P.: Journal of Orthopaedic Trauma, 2010, 24(4):e36-9. Alpert Brown Medical School in Providence, RI, USA.

Posterior sternoclavicular joint disruptions are rare, and a concomitant fracture is even less common in the pediatric population. This case report concerns a posterior sternoclavicular joint disruption and ipsilateral medial clavicle fracture in a 9-year-old male hockey player. We describe the various imaging modalities that may be necessary for this injury, the complications to be considered in dealing with this injury as well as an internal fixation technique using FiberWire.

Predictors of functional ambulation and patient perception following total knee replacement and short-term rehabilitation.

Crosbie J, Naylor J, Harmer A, Russell T.: Disability and Rehabilitation, 2010, 32(13):1088-98. School of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia.

Purpose: To investigate whether measured and patient-perceived function 6 months after total knee replacement (TKR) can be predicted from factors measured during post-operative rehabilitation. Method: Retrospective analysis of data from a randomised clinical trial involving 100 patients after TKR. High- and low-performing subjects for pain, WOMAC score and 6-min walk test (6MWT) at 2, 8 and 26 weeks post-TKR were partitioned and analysed. Multiple stepwise regression analysis was applied to the contributing factors to determine associations with outcome. Results: Prediction of outcome was unconvincing based upon variables recorded at 2 weeks; however, status at 8 weeks was a better indicator of functional performance and perception at 26 weeks. 6MWT at 26 weeks could be predicted from VAS pain scores and 6MWT at 8 weeks (r = 0.789; p < 0.001). Prediction of pain and patient perceived function at 26 weeks was also dependent on performance in 6MWT at 8 weeks (r = 0.51; p < 0.05). Males and those with lower body mass index values demonstrated better functional outcomes. Conclusion: Functional status at 2 weeks post-surgery gives few indicators of ultimate status, possibly because of pain, joint swelling and other immediate post-operative factors. However, measurements taken at 8 weeks, following an outpatient-based exercise programme, provides a reasonable estimate of performance and response 26 weeks after surgery. Patient and clinician expectations for longer-term recovery could be informed by these findings.

Factors associated with calf muscle endurance recovery 1 year after achilles tendon rupture repair.

Bostick GP, Jomha NM, Suchak AA, Beaupré LA.: The Journal of Orthopaedic and Sports Physical Therapy, 2010, 40(6):345-51 . Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada.

Study Design: Cohort study. Methods: To describe calf muscle endurance recovery and to explore factors predictive of poor calf muscle endurance recovery 1 year after surgical repair of an Achilles tendon rupture (ATR). Background: ATR is a common Sports-related injury and is often managed with open surgical repair. After ATR repair most patients return to usual activities 6 months after surgery. However, calf endurance impairment can persist up to 6 years, possibly impacting performance of daily activities and sport. Methods: A secondary analysis of a 73-patient cohort from a randomized controlled trial assessing the effects of early weight bearing after surgical repair of an ATR was performed. Calf muscle endurance recovery was measured by single-heel raises using a customized counting device at 6 months and 1 year postoperatively. Descriptive statistics were used to outline recovery of calf muscle endurance. Physical and patient-reported outcomes were examined for their association with calf-muscle endurance recovery. Multiple linear regression analysis was performed to explore variables associated with recovery of calf endurance 1 year postoperatively. Results: Mean recovery of calf muscle endurance was 76% at 1 year. Multivariate regression analysis showed an association of being female, reporting no resting pain at 3 months, and physical functioning and calf endurance at 6 months, with better recovery of calf endurance at 1 year. Conclusions: Calf muscle endurance at 1 year remained impaired in a considerable portion of the sample. Pain, gender, and physical functioning are likely important factors in determining recovery of calf muscle endurance.

Isolated avulsion fracture of the subscapularis tendon with medial dislocation and tear of biceps tendon in a skeletally immature athlete: a case report.

Provance AJ, Polousky JD.: Current Opinion in Pediatrics, 2010, 22(3):366-8. Department of Orthopedics, The Children's Hospital Sports Medicine Program, University of Colorado School of Medicine, Aurora, Colorado 80045, USA.

Isolated avulsion fracture of the subscapularis from the lesser tuberosity of the humerus is rare in the pediatric population and only a couple of cases have been described in the literature. In our case, a 13-year-old young man suffered an avulsion of the subscapularis tendon from the lesser tuberosity of the humerus, accompanied by medial dislocation of the biceps tendon with degeneration and tear. The diagnosis was delayed until he completed several weeks of physical therapy. Special tests performed earlier in the primary care clinic or emergency department could have prevented prolonged symptoms and allowed earlier surgical intervention.

Morel-lavallée lesion in a professional american football player.

Matava MJ, Ellis E, Shah NR, Pogue D, Williams T.: American Journal of Orthopedics , 2010, 39(3):144-7 . Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA.

A Morel-Lavallée lesion is a relatively rare condition involving a closed, degloving injury to the pelvis, resulting in a blood-filled cystic cavity created by separation of the subcutaneous tissue from the underlying fascia. This injury typically occurs following high-speed trauma. We describe a case that occurred in a professional American football player who was treated with percutaneous decompression and evacuation of the hematoma. The player returned to playing football at the professional level 22 days after the injury without residual deformity or disability.

Arthroscopic excision of posterior ankle bony impingement for early return to the field: short-term results.

Noguchi H, Ishii Y, Takeda M, Hasegawa A, Monden S, Takagishi K.: Foot & Ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society, 2010-05 31(5):398-403. Ishii Orthopaedic and Rehabilitation Clinic, Orthopaedic Surgery, Gyoda, Saitama 361-0037, Japan.

BACKGROUND: We treated 12 cases of posterior ankle bony impingement in 12 athletes arthroscopically, and examined the operating methods, findings, and postoperative physical therapy and overall results. MATERIALS AND METHODS: The patients' average age was 21.4 years. The mean duration of postoperative followup was 33.8 months. A 2.7-mm, 30 degree arthroscope was inserted into the subtalar joint using posterolateral and accessory posterolateral portals. When the impinged fragment was visualized, it was carefully excised from the surrounding soft tissues. The operation was completed once the entire flexor hallucis longus tendon was seen. No cast immobilization was applied postoperatively, and physical therapy including limited weight bearing and range-of-motion exercises commenced within 24 hours after surgery. Beginning 3 weeks after surgery, the patients were permitted to gradually resume sports under the guidance of a physiotherapist. The AOFAS ankle-hindfoot score, the postoperative range of motion of the ankle and the time to recover were determined. RESULTS: The average postoperative AOFAS ankle-hindfoot score improved from 68.0 to 98.3 points. The mean preoperative range of motion of the ankle joint was improved from 59.2 degree to 68.4 degree. The average period to return to sports was 5.9 weeks. All patients reached full activity within 13 weeks after surgery. The surgical time ranged from 40 minutes to over 2 hours and was affected by the impingement condition. CONCLUSION: Arthroscopic treatment for posterior ankle bony impingement syndrome was minimally invasive and suitable for athletes who desire an early return to sports activity.

Irreducible open dorsal dislocation of the proximal interphalangeal joint: a case report.

Muraoka S, Furue Y, Kawashima M.: Hand surgery : an international Journal devoted to hand and upper limb surgery and related research : Journal of the Asia-Pacific Federation of Societ, 2010 15(1):61-4 Language: eng Country: Singapore Kawashima Orthopaedic Hospital, Oita 871-0012, Japan.

We report a rare case of open dorsal dislocation of the proximal interphalangeal joint which needed operative reduction. A 39-year-old man injured his right middle finger while playing baseball. There was a laceration on the proximal interphalangeal crease, and the condyles of the proximal phalanx protruded through the wound. The flexor tendons had slipped behind the radial condyle, and made reduction impossible. After the flexor tendons and volar plate were replaced back into their normal position, the reduction was successful. Finally, the patient had full and painless motion of the digit. We review the reported cases of this injury in the relevant literature.

Epidemiology and outcomes of Achilles tendon ruptures in the National Football League.

200912 2(6):283-6. North Carolina Orthopaedic Clinic, Division of Orthopaedic Surgery, and Fuqua Business School, Duke University, Durham, North Carolina, USA.

The purpose of this study is to document the epidemiology of Achilles tendon ruptures in the National Football League (NFL) and to quantify the impact of these injuries on player performance. A retrospective review of several online NFL player registries identified 31 Achilles tendon ruptures in NFL players between 1997 and 2002. Nineteen percent of injuries occurred during preseason play, while another 18% occurred during the first month of the official season. There was a postinjury reduction of 88%, 83%, and 78% in power ratings for wide receivers, running backs, and tight ends, respectively, over a 3-year period. There was a 95%, 87%, and 64% postinjury reduction in power ratings for linebackers, cornerbacks, and defensive tackles over a 3-year period. On average, players experienced a greater than 50% reduction in their power ratings following such an injury. Thirty-two percent (n = 10) of NFL players who sustained an Achilles tendon rupture did not return to play in the NFL.

Elderly kendo (Japanese fencing) player with Kienböck's disease in one wrist and Preiser's disease in the other wrist: a case report.

Iwasaki N, Masuko T, Funakoshi T, Minami A.: Hand surgery : an international Journal devoted to hand and upper limb surgery and related research : Journal of the Asia-Pacific Federation of Societ, 2010 15(1):47-51. Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.

Elderly patients suffering from avascular necrosis of a carpal bone in both wrists are extremely rare. We report a case of an elderly kendo (Japanese fencing) competitor who sustained Preiser's disease in the left hand following the occurrence of Kienböck's disease in the right hand. The current case demonstrates the importance of raising awareness of these diseases as potential sports-related problems in the elderly.

Comparative functional analysis of two different achilles tendon surgical repairs.

Quagliarella L, Sasanelli N, Notarnicola A, Belgiovine G, Moretti L, Moretti B.: Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society

201004 31(4):306-15. Sezione di Ingegneria Biomedica, Policlinico di Bari, piazza G. Cesare 11, Bari, Italy.

it BACKGROUND: A number of different surgical procedures have been developed to treat Achilles tendon injuries including open and mini-invasive type. The aim of the present work was to compare the functional outcome of two different techniques, applying a clinical and instrumented protocol. MATERIALS AND METHODS: Fifty-one subjects were enrolled in the study. The experimental group consisted of 34 patients with a ruptured Achilles tendon, 19 operated by open surgical reconstruction without reinforcement (Open Group), while 15 underwent a mini-invasive procedure (Mini-invasive Group); the Control Group consisted of 17 healthy subjects. The assessment was based on the standing vertical jump, in both 'countermovement jump' and 'squat jump' mode, studying the relative flight times and the coordination of movement of each limb. An accelerometer was fastened to each ankle to obtain an independent assessment of the movement of each limb. RESULTS: The surgically treated patients showed a comparable functional performance to that of the Control Group but despite this full recovery they showed a tendency to ''favor'' the affected limb. This finding was more marked in the Mini-invasive Group. The Control Group invariably showed better coordination of the movement of the two limbs than the two experimental groups. This was particularly apparent in the take-off phase, indicated by asymmetrical push-off of the two limbs. CONCLUSION: The jumping evaluation used in this study resulted in similar results between the open and the mini-invasive techniques.

Arthroscopic management of shoulder instabilities: anterior, posterior, and multidirectional.

Abrams JS, Bradley JP, Angelo RL, Burks R.: Instructional course lectures, 2010 59:141-55. Department of Orthopedics Surgery, Seton Hall University, School of Medical Education, Orange, NJ, USA.

Arthroscopy is considered a relatively new technique for the surgical repair of an unstable shoulder. Shoulder arthroscopy has grown in popularity and is considered the gold standard for treating carefully selected patients. Despite its increasing popularity, the procedure has a significant learning curve and has resulted in early higher recurrence rates when compared with patients treated with open techniques. With the addition of newer instrumentation, the refinement of techniques, and additional capsular plication and tensioning, outcomes for patients treated with shoulder arthroscopy should continue to improve. A major distinguishing feature in selecting appropriate candidates for shoulder arthroscopy is whether there have been significant bone changes resulting from dislocation recurrence. Recurrent anterior dislocation may create an anterior glenoid rim fracture, erosion loss from multiple recurrences, and an impression defect on the posterior aspect of the humeral head. The loss of contact area between the "ball and cup" may compromise the results of techniques that restore the anatomic restraints of soft tissues. Early intervention is becoming recognized as an important factor in patient selection for arthroscopic treatment. Imaging studies after traumatic injuries include radiographs, CT scans, possible articular contrast studies, and MRIs. These studies can identify and quantify rim fractures and the remaining articular contact in patients with recurrent subluxations, allowing for earlier appropriate intervention. Patients with significant bone loss may be best treated with an open procedure that allows grafting of the deficiency. Arthroscopic techniques to repair fractures or graft deficiencies continue to evolve. Rim fractures can be anatomically repaired with a suture anchor technique when recognized early. Rim erosion from chronic recurrent dislocations may require a combination of soft-tissue reattachment and coracoid grafting. Humeral head defects may require either soft-tissue or bone grafting to avoid engagement with the anterior edge of the glenoid. These techniques require arthroscopic skill and experience and are currently being performed as open procedures. In the future, it is likely that arthroscopy will be involved in the entire spectrum of treatment for shoulder instability.

The effect of a sports chiropractic manual therapy intervention on the prevention of back pain, hamstring and lower limb injuries in semi-elite Australian Rules footballers: a randomized controlled trial.

Hoskins W, Pollard H.: BMC Musculoskeletal Disorders, 2010 11:64. Macquarie Injury Management Group, Department of Chiropractic, Faculty of Science, Macquarie University, NSW 2109, Australia.

BACKGROUND: Hamstring injuries are the most common injury in Australian Rules football. It was the aims to investigate whether a sports chiropractic manual therapy intervention protocol provided in addition to the current best practice management could prevent the occurrence of and weeks missed due to hamstring and other lower-limb injuries at the semi-elite level of Australian football. METHODS: Sixty male subjects were assessed for eligibility with 59 meeting entry requirements and randomly allocated to an intervention (n = 29) or control group (n = 30), being matched for age and hamstring injury history. Twenty-eight intervention and 29 control group participants completed the trial. Both groups received the current best practice medical and sports science management, which acted as the control. Additionally, the intervention group received a sports chiropractic intervention. Treatment for the intervention group was individually determined and could involve manipulation/mobilization and/or soft tissue therapies to the spine and extremity. Minimum scheduling was: 1 treatment per week for 6 weeks, 1 treatment per fortnight for 3 months, 1 treatment per month for the remainder of the season (3 months). The main outcome measure was an injury surveillance with a missed match injury definition. RESULTS: After 24 matches there was no statistical significant difference between the groups for the incidence of hamstring injury (OR:0.116, 95% CI:0.013-1.019, p = 0.051) and primary non-contact knee injury (OR:0.116, 95% CI:0.013-1.019, p = 0.051). The difference for primary lower-limb muscle strains was significant (OR:0.097, 95%CI:0.011-0.839, p = 0.025). There was no significant difference for weeks missed due to hamstring injury (4 v 14, chi2:1.12, p = 0.29) and lower-limb muscle strains (4 v 21, chi2:2.66, p = 0.10). A significant difference in weeks missed due to non-contact knee injury was noted (1 v 24, chi2:6.70, p = 0.01). CONCLUSIONS: This study demonstrated a trend towards lower limb injury prevention with a significant reduction in primary lower limb muscle strains and weeks missed due to non-contact knee injuries through the addition of a sports chiropractic intervention to the current best practice management.

The application of osteopathic treatments to pediatric sports injuries.

Bolin DJ.: Pediatric Clinics of North America, 2010-06 57(3):775-94. Department of Sports Medicine, Family Medicine, The Via College of Osteopathic Medicine, Blacksburg, VA 24060, USA.

The application of manual techniques to pediatric athletic injuries has been considered alternative medicine. There are many injuries that are associated with loss of normal motion. Altered biomechanics can be readily identified and treated using manual methods. These include articular or thrust techniques, muscle energy, strain-counterstrain, and myofascial treatments, among others. Although there are few high-quality studies available, most available literature reports effectiveness of manual techniques in combination with therapeutic exercise for common pediatric motion restrictions.

Stress fractures: diagnosis and management in the primary care setting.

Patel DR.: Pediatric clinics of North America, 201006 57(3):819-27. Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, Kalamazoo, MI 49008, USA.

Stress fracture represents an overuse injury of the bone resulting from excessive repetitive stress. Diagnosis in most cases is based on clinical evaluation. Plain radiographs may show characteristic changes 2 to 4 weeks from onset of symptoms. Increasingly, magnetic resonance imaging is recognized as the study of choice in the evaluation of stress injury of the bone. Most stress fractures at low-risk sites can be managed in the primary care setting with conservative measures. From a primary care perspective, orthopedic or sports medicine consultation is considered for stress fractures at high-risk sites. This article reviews general principles of diagnosis and management of stress fractures in adolescents.

Management of the throwing shoulder: cuff, labrum and internal impingement.

Greiwe RM, Ahmad CS.: The Orthopedic clinics of North America, 201007 41(3):309-23. Department of Orthopaedic Surgery, Center for Shoulder, Elbow, and Sports Medicine, Columbia-Presbyterian Hospital, Columbia University, 622 West 168th Street, PH-11-Center, New York, NY 10032, USA.

Repetitive throwing or other overhead activity places great stress on the shoulder. As a result, the shoulder is a common site of injury in athletes. Addressing throwing-related injuries requires an understanding of throwing biomechanics and pathology. Nonoperative treatment is directed at restoring strength, flexibility, and neuromuscular control to the entire kinetic chain. Surgery is indicated when nonoperative treatment fails, and is directed at correcting labral, capsular, and rotator cuff pathology.

Relationship between low back pain and competitive sports activities during youth.

Hangai M, Kaneoka K, Okubo Y, Miyakawa S, Hinotsu S, Mukai N, Sakane M, Ochiai N.: The American Journal of Sports Medicine, 201004 38(4):791-6. Department of Orthopaedic Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575 Japan.

BACKGROUND: Low back pain is a significant problem not only for the adult, but also during youth. However, the relationship between low back pain during youth and the duration or types of competitive sports has not been clarified. HYPOTHESIS: Low back pain during youth is associated with the duration and types of competitive sports. STUDY DESIGN: Cross-sectional study; Level of evidence, 4. METHODS: Study participants were 4667 new university students who, from 2004 to 2006, answered a questionnaire concerning low back pain and their participation in competitive sports. The participants were divided into a "no" group (NO), a middle group (MID), and a high group (HI) based on the duration of participation in competitive sports. The answers to the questionnaire were analyzed using the Cochran-Mantel-Haenszel test. Furthermore, we selected students who had participated in the same sport for 5 or more years and categorized the students according to the type of sport. Differences in low back pain among the groups were analyzed using logistic regression with the NO group as the reference group. RESULTS: There were statistically significant linear associations in the NO, MID, and HI groups, with 50.0%, 61.8%, and 71.7%, respectively, of the students experiencing low back pain. Among the NO, MID, and HI groups, 4.4%, 5.7%, 9.6%, respectively, had experienced school absence due to low back pain; and 4.0%, 8.5%, and 14.6%, respectively had low back pain with associated lower extremity pain and numbness. All 8 sports groups that were analyzed had experienced low back pain significantly higher than the NO group, and the odds ratios differed by sport with the highest (3.8) for the volleyball group. CONCLUSION: Excessive exposure to competitive sports activities during youth was associated with low back pain and symptoms in the lower extremities, with the severity varying with the sport. To reduce low back pain in youth, factors that may be causing low back pain, such as sport-specific postures and motions, need to be investigated.

Sequential avulsions of the tibial tubercle in an adolescent basketball player.

Huang YC, Chao YH, Lien FC.: Journal of pediatric orthopaedics. Part B. ,201005 19(3):231-3. Departments of aEmergency Medicine bOrthopedics, Chiayi Christian Hospital, Chiayi, Taiwan.

Tibial tubercle avulsion is an uncommon fracture in physically active adolescents. Sequential avulsion of tibial tubercles is extremely rare. We reported a healthy, active 15-year-old boy who suffered from left tibial tubercle avulsion fracture during a basketball game. He received open reduction and internal fixation with two smooth Kirschner wires and a cannulated screw, with every effort to reduce the plate injury. Long-leg splint was used for protection followed by programmed rehabilitation. He recovered uneventfully and returned to his previous level of activity soon. Another avulsion fracture happened at the right tibial tubercle 3.5 months later when he was playing the basketball. From the encouragement of previous successful treatment, we provided him open reduction and fixation with two small-caliber screws. He recovered uneventfully and returned to his previous level of activity soon. No genu recurvatum or other deformity was happening in our case at the end of 2-year follow-up. No evidence of Osgood-Schlatter disease or osteogenesis imperfecta was found. Sequential avulsion fractures of tibial tubercles are rare. Good functional recovery can often be obtained like our case if we treat it well. To a physically active adolescent, we should never overstate the risk of sequential avulsion of the other leg to postpone the return to an active, functional life.

Athletic performance outcomes following lumbar discectomy in professional basketball players.

Anakwenze OA, Namdari S, Auerbach JD, Baldwin K, Weidner ZD, Lonner BS, Huffman GR, Sennett J.: Spine, 20100401 35(7):825-8. Department of Orthopaedic Surgery, The University of Pennsylvania, Philadelphia, PA 19104, USA.

STUDY DESIGN: Retrospective case-control study. OBJECTIVE: To quantify the athletic performance profiles after lumbar discectomy (LD) in a cohort of National Basketball Association (NBA) players in comparison with a control group of matched NBA players who did not undergo LD during the same study period. SUMMARY OF BACKGROUND DATA: LD provides symptomatic relief and improved functional outcomes in the majority of patients as assessed by validated measures such as Oswestry Disability Index, Visual Analog Scale, and Short Form-36 (SF-36). Among professional athletes, however, the goal of lumbar HNP treated by discectomy is not only to improve functional status but also, ultimately, to return the player to preinjury athletic performance levels. No study to date has compared the athletic performance profiles before and after discectomy in professional athletes. METHODS: An analysis of NBA games summaries, weekly injury reports, player profiles, and press releases was performed to identify 24 NBA players who underwent LD for symptomatic lumbar HNP between 1991 and 2007. A 1:2 case: control study was performed using players without history of lumbar HNP who were matched for age, position, experience, and body mass index as control subjects (n = 48). Paired t tests were conducted on the following parameters: games played, minutes per game, points per 40 minutes, rebounds per 40 minutes, assists per 40 minutes, steals per 40 minutes, blocks per 40 minutes, and shooting percentage. For each athletic performance outcome, between-group comparisons evaluating preindex to postindex season performance were done (index season = season of surgery). RESULTS: In the LD group, 18 of 24 players (75%) returned to play again in the NBA, compared with 42 of 48 players (88%, P = 0.31) in the control group. One year after surgery, between-group comparisons revealed statistically significant increase in blocked shots per 40 minutes in the LD (0.18) versus control group (-0.33; P = 0.008) and a smaller decrease in rebounds per 40 minutes in the LD (-0.25) versus control group (-1.42; P = 0.049). No other performance variable was found to be significantly different between the study and control group. CONCLUSION: Compared with a closely matched control cohort, we found that 75% of surgical patients returned to play again in the NBA, compared with 88% in control subjects who did not undergo surgery. For those players who returned, overall athletic performance was slightly improved or no worse than control subjects.

Anatomical and biomechanical assessments of medial tibial stress syndrome.

Bartosik KE, Sitler M, Hillstrom HJ, Palamarchuk H, Huxel K, Kim E.: Journal of the American Podiatric Medical Association, 2010 Mar-Apr 100(2):121-32. Biokinetics Research Laboratory, Athletic Training Division, Department of Kinesiology, Temple University, Philadelphia, PA 19122, USA.

BACKGROUND: Medial tibial stress syndrome is a common overuse injury in weightbearing, physically active individuals and in athletes. Most research associated with this condition is primarily based on static foot and lower-extremity measurements. METHODS: A cross-sectional design was used to assess a set of static and dynamic measurements to determine which anatomical factors (limb length, ankle dorsiflexion, first metatarsophalangeal joint extension, and arch height) and biomechanical factors (center-of-pressure excursion index, malleolar valgus index, and gait velocity) are associated with medial tibial stress syndrome. RESULTS: One-way analysis of variance models revealed that participants with medial tibial stress syndrome had significantly greater visual analog pain levels and slower gait velocity than noninjured controls (P = .05). No other significant differences were found between the two groups. CONCLUSIONS: Further investigation of these and other factors can help health professionals develop better strategies for the prevention and clinical intervention of medial tibial stress syndrome.

Young women's anterior cruciate ligament injuries: an expanded model and prevention paradigm.

Elliot DL, Goldberg L, Kuehl KS.: Sports Medicine (Auckland, N.Z.), 20100501 40(5):367-76. Division of Health Promotion & Sports Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon 97239-3098, USA.

Anterior cruciate ligament (ACL) injuries among young female athletes occur at rates three- to eight-times greater than in male competitors and, in general, females experience more sports injuries than males, when balanced for activity and playing time. ACL injuries are a particular concern, as they result in immediate morbidity, high economic costs and may have long-term adverse effects. While several closely monitored ACL injury preventive programmes have been effective, those efforts have not been uniformly protective nor have they achieved widespread use. To date, ACL injury prevention has focused on neuromuscular and anatomical factors without including issues relating more broadly to the athlete. Coincident with greater female sport participation are other influences that may heighten their injury risk. We review those factors, including early single sport specialization, unhealthy dietary behaviours, chronic sleep deprivation and higher levels of fatigue, substance use and abuse, and psychological issues. We augment existing models of ACL injury with these additional dimensions. The proposed expanded injury model has implications for designing injury prevention programmes. High school athletic teams are natural settings for bonded youth and influential coaches to promote healthy lifestyles, as decisions that result in better athletes also promote healthy lifestyles. As an example of how sport teams could be vehicles to address an expanded injury model, we present an existing evidenced-based sport team-centered health promotion and harm reduction programme for female athletes. Widening the lens on factors influencing ACL injury expands the prevention paradigm to combine existing training with activities to promote psychological well-being and a healthy lifestyle. If developed and shown to be effective, those programmes might better reduce injuries and, in addition, provide life skills that would benefit young female athletes both on and off the playing field.

Skimboarding: a new cause of water sport spinal cord injury.

Collier TR, Jones ML, Murray HH.: Spinal cord : the official Journal of the International Medical Society of Paraplegia, 201004 48(4):349-51. Emory University School of Medicine, Atlanta, GA, USA.

STUDY DESIGN: Case series. OBJECTIVE: To present three cases of spinal cord injuries associated with skimboarding and to suggest aspects of the sport that may be associated with spinal cord injury. SETTING: Shepherd Center, Atlanta, GA, USA. Spinal cord injury rehabilitation facility. METHODS: Three males, aged 17-23 years, sustained cervical spine fractures resulting in tetraplegia after skimboarding accidents. RESULTS: The patients admitted from Florida hospitals presented with tetraplegia resulting from both incomplete and complete spinal cord injuries. The ASIA Impairment Scale (AIS) neurologic levels ranged from C3 to C5. All were injured by being thrown from the skimboard riding into the waves in shallow water. All patients required surgical stabilization and inpatient rehabilitation. CONCLUSIONS: Previous studies on skimboarding have demonstrated the risk of extremity fractures and soft tissue injuries. Spinal cord injury should be considered an additional risk associated with skimboarding, particularly as the sport has grown in popularity and become more 'extreme' in the maneuvers performed. Increased education and awareness about the potential risk of spinal cord injury are essential.

Traumatic correction of Linburg-Comstock anomaly: a case report.

Old O, Rajaratnam V, Allen G.: Annals of the Royal College of Surgeons of England

201005 92(4):W1-3. Department of Hand Surgery, Selly Oak Hospital, University Hospital Birmingham Trust, Birmingham, UK.

Linburg-Comstock anomaly describes an anatomical variant of flexor tendons of the hand. Flexor pollicis longus (FPL) sends a connecting tendon to flexor digitorum profundus (FDP), causing simultaneous flexion at the distal interphalangeal joint (DIPJ) of the index finger when the interphalangeal joint (IPJ) of the thumb is flexed. Epidemiological studies have revealed a unilateral prevalence as high as 31% of individuals; however, the condition rarely causes symptoms. The anomaly can present with a restrictive flexor tenosynovitis, requiring explorative surgery to confirm the diagnosis and disconnection of the anomalous tendon slip to relieve symptoms. We describe the case of a rock climber who suffered a forced extension injury to the DIPJ of the right index finger, resulting in traumatic rupture of his anomalous FPL-FDP connecting tendon. This is the first reported case of rupture of a Linburg-Comstock anomaly. Through rupture of this anomalous tendon, the patient can be viewed as having corrected his aberrant tendon to conform with the more prevalent anatomical configuration and function. We identified the rupture using dynamic ultrasound of the wrist; to our knowledge, this technique has not been described previously in the literature. We recommend the use of this imaging modality to confirm diagnosis, thus avoiding explorative surgery.

Plantar shear stress distribution in athletic individuals with frictional foot blisters.

Yavuz. Department of Biomedical Engineering and Orthopedic Research Center (ND20), Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.

BACKGROUND: Foot blisters are common and painful nuisances in competitive sports and in military service. The pathogenesis of the problem is related to excessive frictional forces experienced on or under the foot. The incidence of foot blisters in marathon runners can reach 39%. Similarly, up to 42% of cadets in Reserve Officers' Training Corps camps might be prone to foot blisters. Although the problem usually disappears within 5 days, a single blister might be a major problem in competitive sports or in a wilderness setting. Military training and combat effectiveness might also be compromised by foot blisters. This study sought to reveal the distribution of plantar shear forces in athletic individuals and its relevance to foot blisters. METHODS: Three groups of 11 participants each were studied: blister, adult control, and pediatric control. A custom-built shear and pressure platform was used to collect plantar pressure and shear data while the participants walked over the device. Data were analyzed with repeated-measures analysis of variance. RESULTS: The blister group had significantly increased pressure and shear stress magnitudes compared with the other groups, although no significant group-site interaction was found. The shear-time integral values were increased approximately 50% at specific sites of the athletic feet, suggesting that contact time may play a role in blister formation. CONCLUSIONS: The biomechanical interaction on the plantar surface of a blister-prone person is different from that of individuals who are less prone to the problem.

Medial subtalar dislocation--case report

INTRODUCTION: Subtalar dislocation (SI) is a term that refers to an injury in which there is dislocation of the talonavicular and talocalcanear joint, although the tibiotalar joint is intact. CASE OUTLINE: A case of medial subtalar dislocation as a result of basketball injury, so-called "basketball foot", is presented. Closed reposition in i.v. anaesthesia was performed with the patient in supine position and a knee flexed at 90 degrees. Longitudinal manual traction in line of deformity was carried out in plantar flexion. The reposition continued with abduction and eversion simultaneously increasing dorsiflexion. It was made in the first attempt and completed instantly. Rehabilitation was initiated after 5 weeks of immobilization. One year after the injury, the functional outcome was excellent with full range of motion and the patient was symptom-free. For better interpretation of roentgenogram, bone model of subtalar dislocation was made using the cadaver bone. CONCLUSION: Although the treatment of such injury is usually successful, diagnosis can be difficult because it is a rare injury, and moreover, X-ray of the injury can be confusing due to superposition of bones. Radiograms revealed superposition of the calcaneus, tarsal and metatarsal bones which was radiographically visualized in the anterior-posterior projection as one osseous block inward from the talus, and on the lateral view as in an osteal block below the tibial bone. Prompt recognition of these injuries followed by proper, delicately closed reduction under anaesthesia is crucial for achieving a good functional result in case of medial subtalar dislocation.

The outcome of type II SLAP repair: a systematic review.

Gorantla K, Gill C, Wright RW.: Arthroscopy : the Journal of Arthroscopic & Related Surgery : official publication of the Arthroscopy Association of North America and the Internation, 2010, 26(4):537-45. Indiana University, Indianapolis, Indiana, USA.

PURPOSE: The purpose of this study was to systematically review the literature regarding the outcome of arthroscopic repair of type II SLAP lesions in order to assess the effectiveness of current methods of treatment. METHODS: We performed a systematic review of the results of repair of type II SLAP lesions. Inclusion criteria included outcome studies of repair of type II SLAP lesions with minimum 2-year follow-up and Level IV evidence or higher published in the English language in peer-reviewed Journals. RESULTS: There is no Level I or II evidence for SLAP repair outcome. Regarding the general outcome after type II SLAP repair, the percentage of good and excellent results ranged from 40% to 94%. Return to previous level of play ranged from 20% to 94%. Overhead athletes are the most challenging to return to the previous level of performance for this diagnosis, and their return rate reflects this. Five studies reported these results, and the rate of return ranged from 22% to 64% for baseball players. CONCLUSIONS: Arthroscopic repair of type II SLAP tears results in overall excellent results for individuals not involved in throwing or overhead sports. The results of type II SLAP repair in throwing or overhead athletes are much less predictable. Future studies should be prospective in nature and at least use a longitudinal prospective cohort design to determine predictors of outcome. LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.

Arthroscopic posterior cruciate ligament reconstruction in a skeletally immature patient: a new technique with case report.

Bovid KM, Salata MJ, Vander Have KL, Sekiya JK.: Arthroscopy : the Journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the Internation, 2010, 26(4):563-70. MedSport-Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan 48106-0391, USA.

Pediatric intrasubstance posterior cruciate ligament (PCL) injuries are rare but present a significant treatment challenge. Untreated instability may lead to further knee injury, including meniscal or chondral damage. Surgical intervention risks damage to the physis, growth arrest, and angular deformity. We present the case of a skeletally immature 11-year-old boy with a high-grade intrasubstance PCL injury reconstructed using an all-arthroscopic tibial inlay technique modified to minimize risk of physeal injury. The femoral tunnels were placed entirely within the epiphysis, and the tibial physis was minimally crossed with a small drill hole and suture material. At 17 months' follow up, the patient had returned to full activity, including sports. He had a grade 1 posterior drawer and no posterior sag. Radiographs showed no degenerative changes. Both the proximal tibial and distal femoral physes were widely patent with no angular deformity. The patient had a 1-cm leg length discrepancy, with the operative limb being longer. This technical note with a case report describes a novel physeal-sparing reconstruction of the PCL in a pediatric patient with open physes.

Hip adductor muscle strength is reduced preceding and during the onset of groin pain in elite junior Australian football players.

Crow JF, Pearce AJ, Veale JP, VanderWesthuizen D, Coburn PT, Pizzari T.: Journal of science and medicine in sport / Sports Medicine Australia, 2010, 13(2):202-4. School of Sport and Exercise Science, Victoria University, Australia.

Groin pain is a condition with a high prevalence in young Australian football players. It is considered that early identification of this condition allows for optimal management. Eighty-six players from two elite under-age Australian football sides were screened weekly for hip adductor muscle strength, using a hand-held dynamometer and for the onset of groin pain. The maximum variation in the average hip adductor muscle strength values of the sample was a 2.6% decrease from baseline in week 7 of the study. Twelve players (14% of the sample studied) reported groin pain for two consecutive weeks and were considered to have an onset of groin injury. The mean hip adductor muscle strength of these players was decreased significantly from baseline by an average of 11.75+/-2.50% at the week of pain onset (F=264.76 (1,11), p<0.001), and 5.82+/-5.16% in the week preceding the onset of pain (F=14.03 (1,10), p=0.004). These results confirm that hip adductor muscle strength is decreased both preceding and during the onset of groin injury in elite under-age Australian footballers.

Regeneration of mammalian skeletal muscle. Basic mechanisms and clinical implications.

Ciciliot S, Schiaffino S.: Current Parmaceutical Design, 2010, 16(8):906-14. Venetian Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy.

Mammalian skeletal muscles can regenerate following injury and this response is mediated by a specific type of stem cell, the satellite cell. We review here the three main phases of muscle regeneration, including i) the initial inflammatory response and the dual role of macrophages as both scavengers involved in the phagocytosis of necrotic debris and promoters of myogenic differentiation, ii) the activation and differentiation of satellite cells and iii) the growth and remodeling of the regenerated muscle tissue. Nerve activity is required to support the growth of regenerated myofibers and the specification of muscle fiber types, in particular the activation of the slow gene program. We discuss the regeneration process in two different settings. Chronic degenerative diseases, such as muscular dystrophies, are characterized by repeated cycles of segmental necrosis and regeneration involving scattered myofibers. In these conditions the regenerative capacity of satellite cells becomes exhausted with time and fibrosis prevails. Acute traumatic injuries, such as strain injuries common in sport medicine, cause the rupture of large myofiber bundles leading to muscle regeneration and formation of scar tissue and new myotendinous junctions at the level of the rupture. Mechanical loading is essential for muscle regeneration, therefore, following initial immobilization to avoid the risk of reruptures, early remobilization is required to induce correct growth and orientation of regenerated myofibers. Finally, we discuss the causes of age-dependent decline in muscle regeneration potential and the possibility of boosting regeneration in aging muscle and in muscular dystrophies.

Case report: absent C6 cervical pedicle in a collegiate football player.

Fowler JR, Moyer RA.: Clinical Orthopaedics and Related Research, 2010, 468(6):1693-6. Department of Orthopaedics, Temple University School of Medicine, 6th Floor Outpatient Building, 3401 N Broad Street, Philadelphia, PA 19140, USA.

Congenital absence of a cervical pedicle is a rare clinical finding with only 70 reported cases in the literature from 1946 until present. The congenitally absent pedicle has clinical importance owing to the frequency of misdiagnosis and inappropriate invasive treatments. We present the case of a 21-year-old college football player who experienced neck and shoulder pain after violent twisting of his neck by the face mask. The player walked off the field under his own power. He was sent to the locker room, where he underwent right shoulder and cervical spine radiographs. Initial review of the radiographs raised concern for a jumped right C6 facet. The patient then underwent CT and MRI of the cervical spine, confirming the diagnosis of an absent cervical pedicle. He was treated nonoperatively for a short time and completed the season. He had no symptoms at last followup at 8 months. The most frequent location of the absent cervical pedicle is at the C6 level, and the next most common is at the C5 level. Neural compression or instability is uncommon and nonsurgical treatment is the mainstay of treatment. Misdiagnosis can lead to inappropriate treatment such as halo or tong application with traction, which occurred in seven of 57 cases in one series, and exploratory surgery, which occurred in four of 57 cases.

Kümmell' s disease: A rare spine entity in a young adult.

Matzaroglou C, Georgiou CS, Assimakopoulos K, Saridis A, Khudiaev AT, Giannakenas C.: Hellenic Journal of Nuclear Medicine, 2010 Jan-Apr 13(1):52-5 Language: eng Country: Greece Department of Orthopaedic Surgery, University of Patra, University Hospital of Patra, 26504 Rio, Greece.

Over 100 years ago, Dr Hermann Kümmell described a rare clinical entity in which patients, after a trivial trauma and an asymptomatic period, developed a progressive vertebral body collapse and a painful kyphosis. We present the case of a 31years old heavy labourer, fitting Kümmell's criteria. The patient referred to us in an incapacitated state, due to persistent back pain. Radiographic examination revealed a body collapse of L1 vertebra. The patient had no previous medical record, other than a prolonged history of transient back pain episodes, related to heavy-weight lifting. Last attack was 1 year before presentation. Through course of time, he had undergone several clinical and radiological evaluations, by different orthopaedists, on different occasions, including the last episode, with no major findings. After an extensive workup, a percutaneous kyphoplasty of the affected vertebra was performed and a biopsy was obtained. The histologic examination of the specimen revealed vertebral osteonecrosis. A triggering pattern of repetitive spinal loading in hyperflexion is, for the first time, being recognized. We conclude that Kümmell's disease, although a rare condition, should be considered in any patient with refractory back pain symptoms. In such patients, vigorous follow-up turns to be of the essence.

Two patients with a complete proximal rupture of the hamstring.

Floor S, van der Veen AH, Devilee RJ.: Archives of Orthopaedic and Trauma Surgery, 201004 130(4):523-6. Leiden University Medical Center, Leiden, The Netherlands.

Two men visited our Emergency Room because of a water-ski-accident. At physical examination, there was hematoma at the upper leg with loss of strength at extension of the hip and flexion of the knee. Both patients had a palpable gap just distal of the ischial tuberosity. Further imaging by sonography and MR-scan showed a rupture of the proximal hamstring tendon. Treatment was operative refixation of the hamstring tendons at the ischial tuberosity. After treatment consisted of brace for 4 weeks after operation. Both patients returned to their pre-operatively sports, though at a lower level. Surgical treatment of a complete proximal rupture of the hamstrings is recommended in case of sportive patients.

Treating the boxer's fracture in Wales: a postal survey.

Jones R, Burdett S, Jefferies M, Guha AR.: Annals of the Royal College of Surgeons of England , 2010, 92(3):236-9; quiz 239. Department of Orthopaedics, Wrexham Maelor Hospital, Wrexham, UK..

INTRODUCTION: There is no standardised treatment for fifth metacarpal neck fractures. Treatment of this common fracture can vary from immediate mobilisation to immobilisation in a plaster cast for 3 weeks. There is no literature identifying current practice amongst surgeons. SUBJECTS AND METHODS: This survey's aim was to reveal current practice in Wales by means of a postal questionnaire sent to all Welsh orthopaedic consultants. RESULTS: The questionnaire had a 60% response rate. Results demonstrated varied opinion regarding the degree of displacement warranting reduction. Overall, 10% of surgeons reduce the fracture at 30 masculine of displacement, 29% at 40 masculine, 18% at 50 masculine and 20% at 60 masculine of displacement. The treatment was also very varied. Most surgeons preferred to treat these fractures with neighbour strapping (43%,) while others preferred plaster immobilisation (39%) or immediate mobilisation (10%.) Only 22% of surgeons discharge these patients back to the community after their first visit to out-patients while 13% offer two follow-up appointments. CONCLUSIONS: The treatment being offered for this common fracture in Wales is inconsistent. There is a need to develop evidence-based best practice guidelines which should standardise the treatment of this common injury. Perhaps, a large multicentre outcome study may enable this to be drawn up in the future.

Anterior inferior iliac spine avulsion fracture: a case report in soccer playing adolescent twins.

Reina N, Accadbled F, de Gauzy JS.: Journal of Pediatric Orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America, 2010, 19(2):158-60. Service d'Orthopédie, Hôpital des Enfants, Toulouse, France.

A case of anterior inferior iliac spine fracture in 13-year-old twins is reported. Anterior inferior iliac spine avulsion fracture in adolescent remains a little known entity. We report identical fractures sustained 1 year apart in twin brothers with the same mechanism. Both recovered fully after conservative treatment. A review of the literature retrieved only a few reports of cases. Of interest were the delay between both the fractures and the difference in height between the two individuals. This lesion is likely to be multifactorial with different factors among which are genetics, age, and skeletal maturation, repeat bone stress along with acute indirect trauma.

Correlations between injury, training intensity, and physical and mental exhaustion among college athletes.

Vetter RE, Symonds ML.: Journal of Strength and Conditioning Research / National Strength & Conditioning Association, 2010, 24(3):587-96. Health, Physical Education, Recreation, and Dance Department, Northwest Missouri State University, Maryville, Missouri, USA.

The primary purpose of this research was to obtain information concerning injury incidence and perceptions of training intensities and fatigue levels among college athletes via a survey study. A second purpose was to illuminate correlations between the collected data. This study employed an investigator-designed survey instrument administered to 411 NCAA Division II male and female athletes, with 149 completed responses. The survey included 3 themes: injury incidence, training intensity, and physical and mental exhaustion. Men and women spent 4.5 days per week training using moderate- and high-intensity levels. Fifty percent of the total number of athletes reported chronic injury. During the competition season, physical exhaustion occurred "frequently" 30.86 and 23.53% of the time with men and women, respectively. In the noncompetition season, physical exhaustion was "frequently" experienced 19.75 and 17.65% of the time among men and women, respectively. Statistically significant correlations (p < 0.05) were found with acute injury for men and chronic injury for women. Also, training intensity levels and physical and mental exhaustion for men and women were statistically significant. The current investigators found the training involved 2-3 hours of moderate to high intensity 4.5 days per week both during competition and noncompetition; women and men spent 2-3 hours of light intensity 1.31 and 1.45 days per week, respectively. Women and men in addition to training, engaged in 3.78 and 4.43 hours of leisure physical activity per week. The investigators recommend tapering, periodization, and rest to help avoid overuse syndrome, overreaching, and overtraining that leads to excessive physical and mental exhaustion and injury.

Osteochondritis dissecans of the patella in a XVII century player of the Florentine historic kickball.

Lippi D, Matucci-Cerinic M, Villari N, Fornaciari G, Mascalchi M.: The Knee, 2010, 17(2):172-3 History of Medicine, Department of Anatomy, Histology and Legal Medicine, University of Florence,

We report a case of osteochondritis dissecans in the patella of Francesco de' Medici, Prince of Capistrano, who lived from 1594 to 1614. He was known to play Florentine kick ball, a precursor of Rugby and American football, and speculate that trauma from this activity may have led to the lesion.

Male ironman triathletes lose skeletal muscle mass.

Knechtle B, Baumann B, Wirth A, Knechtle P, Rosemann T.: Asia Pacific Journal of Clinical Nutrition,

2010, 19(1):91-7. Facharzt FMH fur Allgemeinmedizin, Gesundheitszentrum St. Gallen, Vadianstrasse 26, 9001 St. Gallen, Switzerland.

We investigated whether male triathletes in an Ironman triathlon lose body mass in the form of fat mass or skeletal muscle mass in a field study at the Ironman Switzerland in 27 male Caucasian non-professional Ironman triathletes. Pre- and post-race body mass, fat mass and skeletal muscle mass were determined. In addition, total body water, hematological and urinary parameters were measured in order to quantify hydration status. Body mass decreased by 1.8 kg (p< 0.05), skeletal muscle decreased by 1.0 kg (p< 0.05) whereas fat mass showed no changes. Urinary specific gravity, plasma urea and plasma volume increased (p< 0.05). Pre- to post-race change (Delta) in body mass was not associated with ? skeletal muscle mass. Additionally, there was no association between Delta plasma urea and Delta skeletal muscle mass; Delta plasma volume was not associated with Delta total body water (p< 0.05). We concluded that male triathletes in an Ironman triathlon lose 1.8 kg of body mass and 1 kg of skeletal muscle mass, presumably due to a depletion of intramyocellular stored glycogen and lipids.

Bilateral quadriceps rupture in a patient with osteogenesis imperfecta. A case report.

Salcedo-Dueñas JA, Torres Castro C, Estrada Gómez JA, Algarín Reyes JA, Bello González A.: Acta Ortop Mex, 2009 Nov-Dec 23(6):386-9. Hospital Central Cruz Roja Mexicana.

We present the case of a 24-year-old patient with bilateral quadriceps rupture and history of type I congenital osteogenesis imperfecta diagnosed clinically and with ultrasound. Bilateral quadriceps tenoplasty was performed with an anterior approach and without any complications. The patient was discharged with bilateral neoprene knee-guards. The sutures were removed at the 21-day follow-up visit, rehabilitation was started at six weeks and the patient was doing well at the 2- and 3-month follow-up visits. Timely management and early rehabilitation contribute to decrease the risk of sequelae despite the poor functional prognosis.

Extent and time course of pain intensity upon treatment with a topical diclofenac sodium patch versus placebo in acute traumatic injury based on a validated end point: post hoc analysis of a randomized placebo-controlled trial.

Mueller EA, Kirch W, Reiter S.: Expert Opinion on Pharmacotherapy, 2010, 11(4):493-8.Technical University, Institute for Clinical Pharmacology, Medical Faculty, Dresden, Fiedlerstrasse 27, D-01307 Dresden, Germany.

OBJECTIVE: To investigate the extent and time course of pain intensity upon treatment with a topical diclofenac patch compared with placebo in acute traumatic sport injury based on a validated and established end point. METHODS: Post hoc analysis of a randomized, placebo-controlled, double-blind, multicentre, 1-week study in 120 patients with traumatic blunt soft tissue injury. Visual analogue scale (VAS) scores (in millimetres) for pain on movement were analysed. The mean absolute VAS changes in pain intensity from baseline over the study course were calculated for the diclofenac patch formulation (active) and placebo; mean differences between active and placebo were assessed twice daily during the first 3 days after enrolment and then once daily up to day 7. RESULTS: The diclofenac patch was consistently superior to placebo in relieving pain. The mean differences compared with placebo were greatest on day 2 (23.6 - 30.6 mm, p < 0.0001) and day 3 (24.5 - 24.6 mm, p < 0.0001). Diminishing differences were observed over the study course. CONCLUSION: The investigated diclofenac sodium patch provides clinically relevant pain relief in patients with acute traumatic injuries. Maximum effects versus placebo are detected at 2 - 3 days post-injury. This analysis may serve as useful information for the planning of clinical trials in acute traumatic injury.

Anterior cruciate ligament rupture secondary to a 'heel hook': a dangerous martial arts technique.

Baker JF, Devitt BM, Moran R.: Knee Surgery, Sports Traumatology, arthroscopy : official Journal of the ESSKA, 2010, 18(1):115-6. Sports Surgery Clinic, Santry Demesne, Dublin 9, Ireland.

The 'heel hook' is a type of knee lock used in some forms of martial arts to stress the knee and cause opponent to concede defeat. While the knee is in a flexed and valgus disposition, an internal rotation force is Applied to the tibia. Reports are lacking on serious knee trauma as a result of this technique. We report the case of a 32-year-old Mixed Martial Arts exponent who sustained complete anterior cruciate ligament rupture and an medial collateral ligament injury from the use of a 'heel hook'.

Return-to-play criteria following sports injury.

Clover J, Wall J.: Clinics in Sports Medicine, 2010, 29(1):169-75, table of contents. The SPORT Clinic, Riverside, CA 92501, USA.

Determining the criteria for an injured athlete's return to competition can be a confusing scenario when all the individuals involved are brought in. These may include the athlete, parents, guardians, coaches, family physician, the athletic trainer, and others. Providing a foundation from which all can understand the reasoning is key. It must be understood that the primary responsibility is to cause no harm to the athlete, while enabling him or her to participate at the highest level possible. This article discusses the importance of establishing guidelines, athletes' behavioral responses to RTP decisions, testing procedures, and the level of sport and intangible factors related to RTP criteria.

Concomitant rupture of achilles tendon and superior peroneal retinaculum: a case report.

Lee J, Schuberth JM.: The Journal of Foot and Ankle Surgery : official publication of the American College of Foot and Ankle Surgeons, 2010 Mar-Apr 49(2):176-8. San Francisco Bay Area Foot and Ankle Residency, Oakland, CA, USA.

A case of a concomitant rupture of the Achilles tendon and superior peroneal retinaculum is presented. This combination of injuries has only been reported once in the available literature. The intraoperative findings revealed a mid-substance failure of the superficial peroneal retinaculum, which is also a rare finding. It is suggested that mid-substance failure of this structure be included within the existing classification scheme for superficial peroneal retinacular tears. The authors also discuss the probable pathoanatomical features of these combined injuries and a proposed mechanism of injury.

How active are patients undergoing total joint arthroplasty?: A systematic review.

Naal FD, Impellizzeri FM.: Clinical Orthopaedics and Related Research, 2010, 468(7):1891-904. Department of Orthopaedic Surgery, Spital Netz Bern-Ziegler, Morillonstrasse 75, 3007, Berne, Switzerland.

BACKGROUND: Qualitative research studies regarding physical activity in patients undergoing total joint arthroplasty (TJA) unfortunately are sparse in the current literature. QUESTIONS/PURPOSES: To provide a foundation for future investigations, we performed a systematic review to identify the different instruments used to quantify physical activity in patients undergoing TJA and to determine how active these patients really are. METHODS: We systematically reviewed the literature on the bibliographic databases Medline, Cochrane Library, and EMBASE published until September 2008, focusing on studies assessing total physical activity in patients after or undergoing TJA. Results of those studies quantifying physical activity using accelerometers and pedometers were combined using meta-analytic methods. RESULTS: In the 26 studies included (n = 2460 patients), motion sensors and recall questionnaires were most commonly used. The research aims and goals varied widely among the studies and the results mainly were descriptive. Studies quantifying physical activity using pedometers and accelerometers suggested a weighted mean of 6721 steps/day (95% confidence interval [CI], 5744-7698). Steps per day determined by accelerometers were 2.2 times the steps measured by pedometers. Metaregression showed that walking activity decreased by 90 steps/day (95% CI, -156 to -23) every year of patient age. CONCLUSIONS: These results suggest patients undergoing TJA are less active than recommended to achieve health-enhancing activity levels (greater than 10,000 steps/day), but they appear more active than normally assumed in typical wear simulations. Future investigations have to evolve more standardization in the assessment and reporting of physical activity in TJA patients.

Case report: absent C6 cervical pedicle in a collegiate football player.

Fowler JR, Moyer RA.: Clinical Orthopaedics and Related Research, 201006 468(6):1693-6. Department of Orthopaedics, Temple University School of Medicine, 6th Floor Outpatient Building, 3401 N Broad Street, Philadelphia, PA 19140, USA.

Cervical spine injuries resulting from diving accidents in swimming pools: outcome of 34 patients.

Borius PY, Gouader I, Bousquet P, Draper L, Roux FE.: European Spine Journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Ce

201004 19(4):552-7. Pôle NeuroScience (Neurochirurgie), Centres Hospitalo-Universitaires, Université Paul-Sabatier, 31059 Toulouse, France.

Cervical spine injuries after diving into private swimming pools can lead to dramatic consequences. We reviewed 34 patients hospitalized in our center between 1996 and 2006. Data was collected from their initial admission and from follow-up appointments. The injuries were sustained by young men in 97% (mean age 27) and the majority happened during the summer (88%). Fractures were at C5-C7 in 70%. American Spinal Injury Association class (ASIA) on admission was A for 8 patients, B for 4, C for 4, D for 1, and E for 17. There were 23 surgical spine stabilizations. Final ASIA class was A for 6 patients, B for 1, C for 3, D for 5, and E for 18. The mean duration of hospitalization was 21.3 days in our neurosurgical center (mean overall cost: 36,000 Euros/patient) plus 10.6 months in rehabilitation center for the 15 patients admitted who had an ASIA class A to C. Mean overall direct cost for a patient with class A is almost 300,000 Euros, compared to around 10,000 Euros for patients with class D and E. In addition, a profound impact on personal and professional life was seen in many cases including 11 divorces and 7 job losses. Dangerous diving into swimming pools can result in spinal injuries with drastic consequences, including permanent physical disability and a profound impact on socio-professional status. Moreover, there are significant financial costs to society. Better prevention strategies should be implemented to reduce the impact of this public health problem.

Rehabilitation of acromioclavicular joint separations: operative and nonoperative considerations.

Cote MP, Wojcik KE, Gomlinski G, Mazzocca AD.: Clinics in Sports Medicine, 201004 29(2):213-28, vii. Department of Orthopaedic Surgery, University of Connecticut Health Center, Medical Arts & Research Building, Room 4017, 263 Farmington Avenue, Farmington, CT 06034, USA. Acromioclavicular joint (AC) separations are one of the most common injuries seen in orthopedic and sports Medicine practices, accounting for 9% of all injuries to the shoulder girdle. Various operative and nonoperative treatment schemes have been described for the management of AC joint injuries. Although there is controversy about the efficacy of surgical reconstruction versus nonoperative intervention for grade III type injuries, grade I and II separations seem to respond favorably to conservative management. Conversely, grades IV, V, and VI often require surgical reconstruction. Regardless of the type of injury, rehabilitation as a part of conservative management and postoperative care plays an important role in the management of these injuries. This article presents a rehabilitation approach to treatment of acromioclavicular separations pre- and postoperatively.

Rehabilitation of biceps tendon disorders in athletes.

Ryu JH, Pedowitz RA.: Clinics in Sports Medicine, 201004 29(2):229-46, vii-viii. Tulane Medical School, 3915 St Charles Avenue, #209, New Orleans, LA 70115, USA.

The diagnosis and management of an active patient with biceps disease can be challenging for the treating physician. A careful review of the function, anatomy, and pathology of biceps in conjunction with a thorough, knowledgeable history and physical examination can yield a working diagnosis in this challenging patient population. The physician must also be aware of the Physiology of postsurgical repair and advocate appropriate rehabilitation activities that correlate with the timeline of secure tissue healing. This article focuses on nonsurgical rehabilitation and postoperative rehabilitation of biceps tendon injuries.

Rehabilitation after autologous chondrocyte implantation in athletes.

Nho SJ, Pensak MJ, Seigerman DA, Cole BJ.: Clinics in Sports Medicine, 201004 29(2):267-82, viii. Cartilage Restoration Center, Division of Sports Medicine, Department of Orthopedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Rush Medical College of Rush University, 1725 West Harrison Street, Suite 1063, Chicago, IL 60607, USA.

Over the years a variety of cartilage restorative procedures have been developed for athletes to address focal, full-thickness cartilaginous defects in the knee joint, including microfracture, osteochondral autografts, osteochondral allografts, autologous chondrocyte implantation (ACI), and most recently, next-generation ACI involving scaffolds or cell-seeded scaffolds. Since its introduction, ACI has yielded some very promising results in athletes and nonathletes alike. Rehabilitation following ACI requires an in-depth understanding of joint mechanics, and knowledge of the biologic and biomechanical properties of healing articular cartilage. A patient-, lesion-, and sports-specific approach is required on the part of the trainer or physical therapist to gradually restore knee joint function and Strength so that the athlete may be able to return to competitive play. This article reviews the rehabilitation protocols for injured athletes following an ACI procedure.

Two patients with a complete proximal rupture of the hamstring.

Floor S, van der Veen AH, Devilee RJ.: Archives of Orthopaedic and Trauma Surgery,

Two men visited our Emergency Room because of a water-ski-accident. At physical examination, there was hematoma at the upper leg with loss of Strength at extension of the hip and flexion of the knee. Both patients had a palpable gap just distal of the ischial tuberosity. Further imaging by sonography and MR-scan showed a rupture of the proximal hamstring tendon. Treatment was operative refixation of the hamstring tendons at the ischial tuberosity. After treatment consisted of brace for 4 weeks after operation. Both patients returned to their pre-operatively sports, though at a lower level. Surgical treatment of a complete proximal rupture of the hamstrings is recommended in case of sportive patients.

Treating the boxer's fracture in Wales: a postal survey.

Jones R, Burdett S, Jefferies M, Guha AR.: Annals of the Royal College of Surgeons of England

201004 92(3):236-9; quiz 239. Department of Orthopaedics, Wrexham Maelor Hospital, Wrexham, UK.

Introduction: There is no standardised treatment for fifth metacarpal neck fractures. Treatment of this common fracture can vary from immediate mobilisation to immobilisation in a plaster cast for 3 weeks. There is no literature identifying current practice amongst surgeons. Subjects and Methods: This survey's aim was to reveal current practice in Wales by means of a postal questionnaire sent to all Welsh orthopaedic consultants. Results: The questionnaire had a 60% response rate. Results demonstrated varied opinion regarding the degree of displacement warranting reduction. Overall, 10% of surgeons reduce the fracture at 30 masculine of displacement, 29% at 40 masculine, 18% at 50 masculine and 20% at 60 masculine of displacement. The treatment was also very varied. Most surgeons preferred to treat these fractures with neighbour strapping (43%,) while others preferred plaster immobilisation (39%) or immediate mobilisation (10%.) Only 22% of surgeons discharge these patients back to the community after their first visit to out-patients while 13% offer two follow-up appointments. Conclusions: The treatment being offered for this common fracture in Wales is inconsistent. There is a need to develop evidence-based best practice guidelines which should standardise the treatment of this common injury. Perhaps, a large multicentre outcome study may enable this to be drawn up in the future.

Pelvic fractures resulting from snowboarding.

Ogawa H, Sumi H, Sumi Y, Shimizu K.: The American Journal of Sports Medicine, 201003 38(3):538-42. Department of Orthopaedic Surgery, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194 Japan.

Background: Information regarding pelvic fractures sustained during snowboarding is scant. Purpose: To analyze the epidemiologic data, injury patterns, and types of pelvic fractures sustained during snowboarding. Study design: Case series; Level of evidence, 4. Methods: We analyzed the epidemiologic factors, injury patterns, and types of pelvic fractures in 145 patients with snowboarding-related pelvic fractures who were admitted to our institution from the 1998-1999 to the 2006-2007 ski season. Results: The incidence of snowboarding-related pelvic fractures was 0.102 per 10 000 ski lift tickets, which amounted to 2% of all snowboarding-related fractures (fifth most common type of fracture among all snowboarding-related fractures). Of the pelvic fractures, 85.5% were stable (type A according to the Tile classification) and 14.5% were unstable (types B and C according to the Tile classification). Isolated sacral fractures had the second-highest incidence (24.1%) after pubic bone and/or ischium fractures (46.9%). A distinct female prevalence was seen (52.4%). Jumps and isolated falls were the main mechanisms of injury (80%), and the incidence of collision was significantly higher in the unstable group than in the stable group (P = .037). In all, 57.9% patients classified their skill level as "intermediate," and only 9.7% of patients had received professional snowboarding lessons. A total of 30 subjects (20.8%) had other injuries along with pelvic fractures; the patients with multiple injuries were significantly more frequent in the unstable group than in the stable group (P = .035). Conclusions: Pelvic fractures resulting from snowboarding accidents included a higher proportion with isolated sacral fractures in the stable group and a lower prevalence of associated injuries in the unstable group compared with those resulting from other causes.

Anterior inferior iliac spine avulsion fracture: a case report in soccer playing adolescent twins.

Reina N, Accadbled F, de Gauzy JS.: Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America, 201003 19(2):158-60. Service d'Orthopédie, Hôpital des Enfants, Toulouse, France.

Ulnar collateral ligament injury of the thumb metacarpophalangeal joint.

Ritting AW, Baldwin PC, Rodner CM.: Clinical Journal of Sport Medicine : official Journal of the Canadian Academy of Sport Medicine, 201003 20(2):106-12. From the Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut 06030, USA.

Injury to the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal (MCP) joint is a common entity encountered by the sports physician and orthopedic surgeon. The term "gamekeeper's thumb," which is sometimes used incorrectly to mean any injury to this ligament, refers to a chronic injury to the UCL in which it becomes attenuated through repetitive stress. In contrast, the term "skier's thumb" refers to an acute ligament injury as seen in skiers who fall on an abducted thumb or athletes who sustain a valgus force on an abducted thumb. If the patient allows a clinical examination, valgus stress testing can diagnose a complete UCL rupture when there is no solid endpoint with the thumb held in 30 degrees of MCP flexion and with the thumb held in extension. In cases with complete UCL tears, operative treatment has been shown to produce excellent results and is recommended. If there is a firm endpoint to valgus stress testing, a partial UCL tear is diagnosed and nonoperative treatment usually favored.

Minute amounts of intraarticular gas mimicking torn discoid lateral menisci.

Jordanov MI, Block JJ.: Journal of Magnetic Resonance Imaging : JMRI, 201003 31(3):698-702 Language: eng Country: United States Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2675, USA.

Presented are two cases of minute amounts of vacuum phenomena within the central portion of the lateral compartments of two knee joints, mimicking torn discoid lateral menisci. In each case, only the gradient echo images were able to correctly characterize the minute quantities of intraarticular gas by demonstrating "blooming" magnetic susceptibility artifact. The signal characteristics of the intraarticular gas were identical to those of fibrocartilage on all of the remaining routine, fast spin echo, "sports protocol" magnetic resonance imaging sequences.

Anterior cruciate ligament injuries: etiology and prevention.

Brophy RH, Silvers HJ, Mandelbaum BR.: Sports Medicine and Arthroscopy Review, 201003 18(1):2-11. Washington University in St. Louis School of Medicine, Department of Orthopaedic Surgery, St. Louis, MO, USA.

The relatively high risk of noncontact anterior cruciate ligament (ACL) rupture among female athletes has been a major impetus for investigation into the etiology of this injury. A number of risk factors have been identified, both internal and external to the athlete, including neuromuscular, anatomical, hormonal, shoe-surface interaction, and environmental, such as weather. The anatomic and neuromuscular risk factors, often gender related, are the focus of most ACL injury prevention programs. Although studies have shown that biomechanic- centered prevention programs can reduce the risk of ACL injury, many questions remain unanswered. More Research is needed to increase our understanding of the risk factors for ACL injury; how injury prevention programs work and can the clinical application of such programs be optimized.

Correlations between injury, training intensity, and physical and mental exhaustion among college athletes.

Vetter RE, Symonds ML.: Journal of Strength and Conditioning Research / National Strength & Conditioning Association, 201003 24(3):587-96. Health, Physical Education, Recreation, and Dance Department, Northwest Missouri State University, Maryville, Missouri, USA.

The primary Purpose of this Research was to obtain information concerning injury incidence and perceptions of training intensities and fatigue levels among college athletes via a survey study. A second Purpose was to illuminate correlations between the collected data. This study employed an investigator-designed survey instrument administered to 411 NCAA Division II male and female athletes, with 149 completed responses. The survey included 3 themes: injury incidence, training intensity, and physical and mental exhaustion. Men and women spent 4.5 days per week training using moderate- and high-intensity levels. Fifty percent of the total number of athletes reported chronic injury. During the competition season, physical exhaustion occurred "frequently" 30.86 and 23.53% of the time with men and women, respectively. In the noncompetition season, physical exhaustion was "frequently" experienced 19.75 and 17.65% of the time among men and women, respectively. Statistically significant correlations (p < 0.05) were found with acute injury for men and chronic injury for women. Also, training intensity levels and physical and mental exhaustion for men and women were statistically significant. The current investigators found the training involved 2-3 hours of moderate to high intensity 4.5 days per week both during competition and noncompetition; women and men spent 2-3 hours of light intensity 1.31 and 1.45 days per week, respectively. Women and men in addition to training, engaged in 3.78 and 4.43 hours of leisure physical activity per week. The investigators recommend tapering, periodization, and rest to help avoid overuse syndrome, overreaching, and overtraining that leads to excessive physical and mental exhaustion and injury.

Imaging and ultrasound-guided steroid injection of internal oblique muscle strains in baseball pitchers.

Stevens KJ, Crain JM, Akizuki KH, Beaulieu CF.: The American Journal of Sports Medicine

201003 38(3):581-5 Language: eng Country: United States Stanford University Medical Center, Department of Radiology, 300 Pasteur Drive, Room S-062A, Stanford, CA 94305, USA.

Background: Internal oblique muscle injuries are common in professional baseball pitchers and may require a prolonged convalescence of up to 10 weeks. Most strains can be diagnosed clinically, but imaging can be helpful to assess the severity of injury, which may predict recovery and return to play. Hypothesis: Ultrasound-guided injection of steroid and local anesthetic into the muscle tear can speed recovery and subsequent return to play. Study design: Case series; Level of evidence, 4. Methods: Three professional baseball pitchers with acute tears of the internal oblique muscle confirmed by magnetic resonance imaging underwent ultrasound-guided injection of steroid and local anesthetic. Results: All 3 patients experienced significant pain relief within a few days of the injection and were able to pitch at full speed within 3 weeks of injury (mean, 21 days) and return to able status by 5 weeks (mean, 30.7 days). The 3 athletes continue to pitch in Major League Baseball 36 months, 36 months, and 14 months, respectively, after injury, and none have sustained reinjury during this time. Conclusion: Therapeutic injection of steroids and anesthetic under ultrasound guidance appears to speed recovery and rehabilitation in professional baseball pitchers with acute side strains.

Osteochondritis dissecans of the patella in a XVII century player of the Florentine historic kickball.

Lippi D, Matucci-Cerinic M, Villari N, Fornaciari G, Mascalchi M.: The Knee, 201003 17(2):172-3 History of Medicine, Department of Anatomy, Histology and Legal Medicine, University of Florence, Italy.

Associations among hip and shoulder range of motion and shoulder injury in professional baseball players.

Scher S, Anderson K, Weber N, Bajorek J, Rand K, Bey MJ.: Journal of Athletic Training,

Context: The overhead throwing motion is complex, and restrictions in range of motion (ROM) at the hip may place additional demands on the shoulder that lead to injury. However, the relationship between hip and shoulder ROM in athletes with and without a history of shoulder injury is unknown. Objective: To (1) determine if differences exist in hip and shoulder ROM between professional baseball players with a history of shoulder injury and those with no history of shoulder injury and (2) assess relationships between hip and shoulder ROM in these players. Design: Cross-sectional study. PATIENTS OR OTHER Participants: Fifty-seven professional baseball players. Main outcome measures(s): Outcome measures consisted of hip extension and internal rotation, shoulder internal and external rotation, glenohumeral internal-rotation deficit, and history of shoulder injury. Differences in shoulder and hip ROM were assessed with a 1-way analysis of variance. Associations between hip and shoulder ROM were assessed with linear regression. Results: Nonpitchers with a history of shoulder injury had more external rotation and less internal rotation of the shoulder than nonpitchers with no history of shoulder injury. Glenohumeral internal-rotation deficit was greater in both pitchers and nonpitchers with a history of shoulder injury. The relationship between dominant hip extension and shoulder external rotation was significant for pitchers with a history of shoulder injury and nonpitchers with a history of shoulder injury. Conclusions : Shoulder injury may be associated with specific measures of hip and shoulder ROM, and hip extension and shoulder external rotation may be related in baseball players with a history of shoulder injury. Additional Research is necessary to understand the specific mechanisms of shoulder injury in the throwing athlete.

Subperiostal direct scapular fracture in a child.

Burda R, Cibur P, Kitka M.: Rozhledy v chirurgii : mesícník Ceskoslovenské chirurgické spolecnosti

201002 89(2):146-7. Klinika úrazovej chirurgie, Fakultná nemocnica Louisa Pasteura, Kosice, Slovenská republika. Este endereço de e-mail está protegido de spam bots, pelo que necessita do Javascript activado para o visualizar Isolated scapular fractures are relatively uncommon injuries, the are often associated with other injuries. Isolated volarly displaced scapular fracture in a child with dislocation, which mimic scapular winging, is much more seldom. We present a case of child with above mentioned scapular fracture, which was treated non operatively. Dislocation was reduced in effort to reduce risk of constricted motion in shoulder due to dislocation.

Anterior dislocation of the shoulder associated with Bankart lesion in a patient with Poland's syndrome: a case report and review of the literature.

Zwolak P, Schnurr C, Hackenbroch M, Eysel P, Michael JW.: International Journal of Sports Medicine, 201002 31(2):130-2. University of Cologne, Department of Orthopaedic Surgery, Cologne, Germany.

Poland's syndrome is a rare congenital entity characterized by unilateral partial or total hypoplasia of the major pectoralis muscle, breast and/or ipsilateral hand abnormalities. It has been reported in association with various structural and functional abnormalities. We report about a 23-year-old male kick-boxer with Poland's syndrome who presented in our department the history of two traumatic anterior shoulder dislocations due to boxing and self-reductions. Physical examination showed an instability of the left shoulder, and the MRI scans demonstrated a Bankart lesion. The patient had been treated with an arthroscopic Bankart repair; reattachment of the detached antero-inferior labrum down to the glenoid and repairing of the inferior gleno-humeral ligament complex. To our knowledge this is a first case report of a patient presenting with traumatic anterior shoulder dislocations due to kick-boxing associated with Poland's syndrome.

Minimally invasive repair of an impingement induced partial tear of the anterior Achilles tendon in a top level athlete

201001 148(1):80-2 Language: ger Country: Germany Orthopädische Abteilung, Sportmedizinisches Institut, Frankfurt am Main. Este endereço de e-mail está protegido de spam bots, pelo que necessita do Javascript activado para o visualizar AIM: A rarely described Achilles tendon lesion resulting from Haglund's disease and its repair is presented. METHOD: An analysis of the respective clinical records was carried out. Results: Haglund's resection was performed from a 3 cm lateral transverse approach. A coincidental anterior Achilles tendon partial tear was repaired by transversal U-sutures. Conclusions: A minimally invasive repair of a partial tear of the anterior Achilles tendon is feasible and effective.

Cervical fracture with transient tetraplegia in a youth football player: case report and review of the literature.

Molinari R, Molinari WJ.: The Journal of Spinal Cord Medicine, 2010 33(2):163-7.University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA.

Background / Objective: Serious cervical spinal injuries in organized youth football are rare. Cervical fracture with neurologic injury is rarely reported in organized youth football players with no pre-existing risk fractures for transient tetraplegia. Methods: Case report and literature review. Results: After being improperly tackled by an opponent of significantly larger body size, a player sustained a C7 posterior cervical fracture with transient tetraplegia. He was immobilized in a cervical collar and sent to a level 1 trauma center for evaluation. Initial examination showed bilateral paresthesia of the limbs with normal motor function (ASIA D). Initial radiographs of the cervical spine showed a displaced extension-compression fracture of the C7 spinous process. Magnetic resonance imaging of the cervical spine showed edema in the spinal cord in the region of the injury along with significant posterior injury. Imaging studies showed normal volumetric measurements of the spinal canal and no pre-existing risk factors for spinal stenosis or spinal cord injury. Radiographs showed that cervical fracture was healed at 9-month follow-up examination. At 1-year follow-up, the patient was asymptomatic. Radiographs showed healed fracture with no residual instability and full range of cervical spine motion on flexion-extension views. Conclusions : This case underscores the potential for serious cervical spinal injuries in organized youth sports when players are physically overmatched, and improper tackling technique is used.

Male ironman triathletes lose skeletal muscle mass.

Knechtle B, Baumann B, Wirth A, Knechtle P, Rosemann T.: Asia Pacific Journal of Clinical Nutrition, 2010 19(1):91-7. Facharzt FMH fur Allgemeinmedizin, Gesundheitszentrum St. Gallen, Vadianstrasse 26, 9001 St. Gallen, Switzerland.

Bilateral quadriceps rupture in a patient with osteogenesis imperfecta. A case report

Salcedo-Dueñas JA, Torres Castro C, Estrada Gómez JA, Algarín Reyes JA, Bello González A.: Acta Ortop Mex, 2009 Nov-Dec 23(6):386-9. Hospital Central Cruz Roja Mexicana.

Mueller EA, Kirch W, Reiter S.: Expert Opinion on Pharmacotherapy, 201003 11(4):493-8.Technical University, Institute for Clinical Pharmacology, Medical Faculty, Dresden, Fiedlerstrasse 27, D-01307 Dresden, Germany.

Objective: To investigate the extent and time course of pain intensity upon treatment with a topical diclofenac patch compared with placebo in acute traumatic sport injury based on a validated and established end point. Methods: Post hoc analysis of a randomized, placebo-controlled, double-blind, multicentre, 1-week study in 120 patients with traumatic blunt soft tissue injury. Visual analogue scale (VAS) scores (in millimetres) for pain on movement were analysed. The mean absolute VAS changes in pain intensity from baseline over the study course were calculated for the diclofenac patch formulation (active) and placebo; mean differences between active and placebo were assessed twice daily during the first 3 days after enrolment and then once daily up to day 7. Results: The diclofenac patch was consistently superior to placebo in relieving pain. The mean differences compared with placebo were greatest on day 2 (23.6 - 30.6 mm, p < 0.0001) and day 3 (24.5 - 24.6 mm, p < 0.0001). Diminishing differences were observed over the study course. Conclusions: The investigated diclofenac sodium patch provides clinically relevant pain relief in patients with acute traumatic injuries.

Maximum effects versus placebo are detected at 2 - 3 days post-injury. This analysis may serve as useful information for the planning of clinical trials in acute traumatic injury.

Anterior cruciate ligament rupture secondary to a 'heel hook': a dangerous martial arts technique.

Baker JF, Devitt BM, Moran R.: Knee Surgery, Sports Traumatology, Arthroscopy : official Journal of the ESSKA,201001 18(1):115-6. Sports Surgery Clinic, Santry Demesne, Dublin 9, Ireland.

Early postoperative maximal strength training improves work efficiency 6-12 months after osteoarthritis-induced total hip arthroplasty in patients younger than 60 years.

Husby VS, Helgerud J, Bjørgen S, Husby OS, Benum P, Hoff J.: American Journal of Physical Medicine & Rehabilitation, 2010 Abril 89(4):304-14. Sør-Trøndelag University College, Trondheim, Norway.

Objective: To assess physical outcome of early maximal strength training after total hip arthroplasty. Design: Six- and 12-mo follow-up of 24 (22) total hip arthroplasty patients randomly assigned to 4 wks of maximal strength training and conventional rehabilitation and to conventional rehabilitation only was conducted. After the intervention period, all patients attended conventional rehabilitation. Outcome measures were hip abduction and leg press strength, gait patterns, work efficiency, maximal oxygen consumption, and health-related quality of life. Results: Work efficiency was significantly higher in the strength training and conventional rehabilitation group compared with the conventional rehabilitation-only group after 6 and 12 mos by 29% and 30%, respectively. Leg press for the healthy leg and rate of force development for the operated leg were significantly higher in the strength training and conventional rehabilitation group compared with the conventional rehabilitation-only group 12 mos postoperatively by 36% and 74%, respectively. Conclusion: This study demonstrates higher work efficiency after 6 and 12 mos and improved rate of force development after 12 mos in total hip arthroplasty patients who performed early maximal strength training combined with conventional rehabilitation after total hip arthroplasty surgery compared with total hip arthroplasty patients receiving conventional rehabilitation only. However, the study indicates that a prolonged maximal strength training program and aerobic endurance training are required to fully recover total hip arthroplasty patients.

Non-pharmacological approaches for the treatment of osteoarthritis.

Rannou F, Poiraudeau S.: Best practice & Research. Clinical Rheumatology , 2010 Fev 24(1):93-106 INSERM, U747, Laboratoire de Pharmacologie, Toxicologie et Signalisation Moléculaire, Paris F-75006, France.

For the most part, non-pharmacological approaches are recommended for osteoarthritis treatment. This recommendation is based mainly on biomechanical observations leading to a modulation of the symptomatic loading joint. Approaches include orthoses, insoles, exercise, diet and patient education. The approach used for each osteoarthritis site must be adapted for the individual patient. Here, we use an evidence-based approach, including the European League Against Rheumatism (EULAR) and Osteoarthritis Research Society International (OARSI) recommendations, to summarize the non-pharmacological treatments available for knee, hip and hand osteoarthritis and to help the physician in daily clinical practice.

Osteocartilaginous lesions of the talus in soccer players.

Seijas R, Alvarez P, Ares O, Steinbacher G, Cuscó X, Cugat R.: Archives of Orthopaedic and Trauma Surgery, 2010 (Março) 130(3):329-33. Orthopedic and Trauma Surgery, Fundación García Cugat, Hospital Quiron, Plaza Alfonso Comín 5-7, Barcelona, Spain.

Objective: The objective of this study is to describe the results of arthroscopic debridement for talar lesions in a population of soccer players. Patients: Patients were sixteen soccer players with osteochondral talar lesions, treated surgically between 1999 and 2004. Interventions: All patients were diagnosed clinically. Complementary imaging studies included X-ray, scintigraphy, and magnetic resonance imaging. All patients underwent arthroscopic debridement. Main outcome measurements: At 3.56 years of follow up, patient status was assessed using a visual analog scale (VAS) and the Ogilvie-Harris scale. The mean time to return to sports at the same level as that before the start of symptoms was evaluated. Results: The Ogilvie-Harris score showed 81.75% excellent results and 18.25% good results. The VAS score was 0.26 (0-2.2). Among the total, 93.75% of patients resumed sports activities at the same level as that before surgery. Conclusions: Arthroscopic debridement of talar osteochondral lesions in soccer players provides excellent results. We consider this option the treatment of choice in this population.

The use of platelet-rich plasma in arthroscopy and sports medicine: optimizing the healing environment.

Lopez-Vidriero E, Goulding KA, Simon DA, Sanchez M, Johnson DH.: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the Internation, 2010, 26(2):269-78. Department of Orthopaedics, The Ottawa Hospital, Ottawa, Ontario, Canada.

Platelet-rich plasma (PRP) is a new technology focused on enhancing the healing response after injury of different tissue types. PRP is prepared by withdrawal of patients' peripheral blood and centrifugation to obtain a highly concentrated sample of platelets, which undergo degranulation to release growth factors with healing properties. It also contains plasma, cytokines, thrombin, and other growth factors that are implicated in wound healing and have inherent biological and adhesive properties. The prepared concentrate is then injected back into the patient at the site of morbidity. This may be intralesional, intra-articular, or surrounding the involved tissue bed. PRP preparations have been used therapeutically in various medical fields from implantology to vascular ulcers, with a more recent evolution and promising results in the field of sports medicine and arthroscopy. Sports medicine patients desire a rapid return to their preinjury level of function, and PRP may have certain applications that will speed recovery in cases of tendon, ligament, muscle, and cartilage disorders. In particular, anterior cruciate ligament reconstruction has shown better autograft maturation, improved donor site morbidity, and pain control, in addition to improved allograft incorporation. By acceleration of the biological integration of the graft by use of PRP, patients may undergo faster, more intensive rehabilitation programs and return to sports more rapidly. Because of its autogenous origin, easy preparation, and excellent safety profile, the advent of PRP has opened another therapeutic door for sports medicine physicians and orthopaedic surgeons. Future directions of PRP include improving the results of arthroscopic and related surgery, in addition to delineating correct dosage, timing, and quantification, as well as ideal techniques of PRP application.

Activity scale for arthroplasty patients after total hip arthroplasty.

Domzalski T, Cook C, Attarian DE, Kelley SS, Bolognesi MP, Vail TP.: The Journal of Arthroplasty, 2010, 25(1):152-7. Department of Orthopaedics, Duke University Medical Center, Durham, North Carolina 27708, USA.

The purpose of the Activity Scale for Arthroplasty Patients (ASAP) is to develop and validate a self-report questionnaire that demonstrated discrimination of functional gains, low burden, appropriate concurrent validity, and was not limited by ceiling effects. We identified 128 high-functioning hip arthroplasty patients from our database who completed a 25-item ASAP and Lower Extremity Functional Scale questionnaires and a set of anchor questions. Factor analysis identified 10 items associated with 2 distinct factors: (1) activities and (2) running and running-related environments. These 10 items were retained and were identified as the ASAP. The ASAP may be useful in high-level hip arthroplasty patients where other scales fail to capture activities secondary to ceiling effects. In addition, the scale burden is minimized by inclusion of only 10 items.

Anterior cruciate ligament reconstruction and concomitant articular cartilage injury: incidence and treatment.

Brophy RH, Zeltser D, Wright RW, Flanigan D.: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the Internation

201001 26(1):112-20. Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA.

Purpose: Articular cartilage injuries commonly occur in conjunction with anterior cruciate ligament (ACL) injury. The exact incidence of this combined injury pattern, as well as the optimal treatment for it, has not been well studied in the literature. The purpose of this study was to systematically review the literature regarding the incidence of concomitant articular cartilage and ACL injury and the results of combined surgical treatment of these injuries. Methods: We performed a systematic review of studies investigating the incidence of articular cartilage injury in conjunction with ACL injury and the results of combined surgical treatment for these injuries. Results: On the basis of 5 studies in the literature, the incidence of severe articular cartilage injury in acute ACL tears is between 16% and 46%. On the basis of 3 studies on combined osteochondral autografts and ACL reconstruction and 2 studies on combined autologous chondrocyte implantation and ACL reconstruction, patients can have reasonable short-term outcomes after combined surgery. Conclusions: Articular cartilage injury is often encountered at the time of ACL reconstruction, and combined surgery can result in reasonable outcomes. Additional studies are needed to better define both the incidence of combined injury and the outcome, particularly in the long term, after these procedures.

Comparison of magnetic resonance imaging findings in anterior cruciate ligament grafts with and without autologous platelet-derived growth factors.

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the Internation, 2010, 26(1):50-7. Department of Orthopedics and Sports Medicine, Clínica Las Condes, Santiago.

Purpose: To determine whether the use of platelet-rich plasma gel (PRPG) affects magnetic resonance imaging (MRI) findings in the anterior cruciate ligament (ACL) graft during the first year after reconstruction. Methods: A prospective single-blinded study of 50 ACL reconstructions in 50 patients was performed. In group A (study group) PRPG was added to the graft with a standardized technique, and in group B (control group) no PRPG was added. An MRI study was performed postoperatively between 3 and 9 months in group A and between 3 and 12 months in group B. The imaging analysis was performed in a blind protocol by the same radiologist. Results: The mean heterogeneity score value at the time of MRI, assigned by the radiologist, was 1.14 in group A and 3.25 in group B. Both groups were comparable in terms of sex and age (P < .05). The mean time to obtain a completely homogeneous intra-articular segment in group A (PRPG added) was 177 days after surgery, and it was 369 days in group B. Using the quadratic predictive model, these findings show that group A (PRPG added) needed only 48% of the time group B required to achieve the same MRI image (P < .001). Conclusions: ACL reconstruction with the use of PRPG achieves complete homogeneous grafts assessed by MRI, in 179 days compared with 369 days for ACL reconstruction without PRPG. This represents a time shortening of 48% with respect to ACL reconstruction without PRPG.

Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics.

Ferber R, Noehren B, Hamill J, Davis IS.: The Journal of Orthopaedic and Sports Physical Therapy, 2010, 40(2):52-8. Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

Study design: Cross-sectional experimental laboratory study. Objective: To examine differences in running mechanics between runners who had previously sustained iliotibial band syndrome (ITBS) and runners with no knee-related running injuries. Background: ITBS is the second leading cause of knee pain in runners and the most common cause of lateral knee pain. Despite its prevalence, few biomechanical studies have been conducted to better understand its aetiology. Because the iliotibial band has both femoral and tibial attachments, it is possible that atypical hip and foot mechanics could result in the development of ITBS. Methods: The running mechanics of 35 females who had previously sustained ITBS were compared to 35 healthy age-matched and running distance-matched healthy females. Comparisons of hip, knee, and ankle 3-dimensional kinematics and internal moments during the stance phase of running gait were measured. Results: The ITBS group exhibited significantly greater peak rearfoot invertor moment, peak knee internal rotation angle, and peak hip adduction angle compared to controls. No significant differences in peak rearfoot eversion angle, peak knee flexion angle, peak knee external rotator moment, or peak hip abductor moments were observed between groups. Conclusion: Females with a previous history of ITBS demonstrate a kinematic profile that is suggestive of increased stress on the iliotibial band. These results were generally similar to those reported for a prospective study conducted within the same laboratory environment.

Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention.

Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG.: The Journal of Orthopaedic and Sports Physical Therapy, 2010, 40(2):67-81. University of Wisconsin School of Medicine and Public Health, Department of Orthopedics and Rehabilitation, Madison, WI 53706-1532, USA.

Hamstring strain injuries remain a challenge for both athletes and clinicians, given their high incidence rate, slow healing, and persistent symptoms. Moreover, nearly one third of these injuries recur within the first year following a return to sport, with subsequent injuries often being more severe than the original. This high reinjury rate suggests that commonly utilized rehabilitation programs may be inadequate at resolving possible muscular weakness, reduced tissue extensibility, and/or altered movement patterns associated with the injury. Further, the traditional criteria used to determine the readiness of the athlete to return to sport may be insensitive to these persistent deficits, resulting in a premature return. There is mounting evidence that the risk of reinjury can be minimized by utilizing rehabilitation strategies that incorporate neuromuscular control exercises and eccentric strength training, combined with objective measures to assess musculotendon recovery and readiness to return to sport. In this paper, we first describe the diagnostic examination of an acute hamstring strain injury, including discussion of the value of determining injury location in estimating the duration of the convalescent period. Based on the current available evidence, we then propose a clinical guide for the rehabilitation of acute hamstring injuries, including specific criteria for treatment progression and return to sport. Finally, we describe directions for future research, including injury-specific rehabilitation programs, objective measures to assess reinjury risk, and strategies to prevent injury occurrence.

Subtalar dislocation

Seeger JB, Clarius M.: Der Unfallchirurg, 2009 Dez 112(12):1066-9. Stiftung Orthopädische Universitätsklinik Heidelberg, Heidelberg, Deutschland. Joern.Bengt.

Subtalar dislocations represent uncommon injuries of the foot. Leitner [7] described the relationship between medial and lateral dislocations as 6:1. The mechanism is a trauma in plantar flexion/supination of the forefoot with a fixed hindfoot.Immediate reduction, which can usually be performed as a closed reduction is the aim of the treatment. The reduction should be performed under anesthesia in the operating room (OR) and under OR conditions in case the closed reduction shows no success. Subsequently, x-rays and CT scans should be performed in two planes in order to rule out concomitant injuries at the processus posterior tali and the talar head, as bony fragments can necessitate an operative intervention in the case of an interposition of the articulation.In terms of aftercare an immobilization of 6 weeks with a lower leg cast is suggested in the literature. In the presented case an early functional therapy with 2 weeks cast and 4 weeks with a therapy boot could achieve good clinical results.

Are swimming or aerobic exercise better than conventional exercise in ankylosing spondylitis patients? A randomized controlled study.

Karapolat H, Eyigor S, Zoghi M, Akkoc Y, Kirazli Y, Keser G.: European Journal of Physical and Rehabilitation Medicine, 2009, 45(4):449-57. Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Ege University, Izmir, Turkey.

Aim: The aim of the study was to compare the effects of conventional exercise (CE), swimming and walking on the pulmonary functions, aerobic capacity, quality of life, Bath indexes and psychological symptoms in patients with ankylosing spondylitis (AS). Methods: Forty-five patients were randomised into either swimming (group 1), walking (group 2), CE group (group 3). Patients in Group 1 performed CE and swimming, patients in Group 2 performed CE and walking and patients in Group 3 performed CE only. Exercise sessions were performed three times a week for a period of six weeks. Patients were assessed before and after the rehabilitation program, with respect to, pulmonary function test (forced vital capacity [FVC, mL], forced expiration volume in one second [FEV1, mL], FEV1/FVC (%) and vital capacity [VC, mL]), maximal oxygen uptake (pV.O2), 6-minute walking test (6MWT), Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index, Nottingham Health Profile and Beck Depression Inventory. Results: There were significant increases in pVO2 and 6MWT after treatment in Groups 1 and 2 (P<0.05). FeV1, FVC and VC improved significantly with treatment in all three groups (P<0.05). A statistically significant improvement was observed in energy, emotional reaction and physical mobility sub-scores of NHP in three exercise groups after completion of the exercise program (P<0.05). Conclusions: Swimming, walking and CE had beneficial effects on the quality of life and pulmonary functions. Aerobic exercises such as swimming and walking in addition to CE increased functional capacities of patients.

Ultrasonographically detected changes in Achilles tendons and self reported symptoms in elite gymnasts compared with controls--an observational study.

Emerson C, Morrissey D, Perry M, Jalan R.: Manual Therapy, 2010, 15(1):37-42. Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London E1 4DG, UK.

There are no published data on the prevalence of Achilles tendinopathy in gymnasts. 40 elite gymnasts and 41 controls of mean (SD) age 16.3 (2.1) years had bilateral AT thickness (at 3 points along the tendon in longitudinal and transverse views) and abnormality measured using ultrasound (US). Data on a history of AT symptoms were gathered using a questionnaire. Among female gymnasts there were 17.5% of Achilles tendons (ATs) with current symptoms, compared with none of the controls (chi(2)=6.2, p<0.05). Similarly, among male gymnasts 12.5% of ATs were currently symptomatic, compared with none of the controls (chi(2)=6.62, p<0.01). US scanning showed gymnasts had significantly (p<0.001 to p<0.05) thicker ATs for 5 out of 6 measures, and had more irregular longitudinal AT thickness (p<0.05). 32.5% of female gymnast ATs had US abnormalities, compared with 6.2% of female control ATs (chi(2)=7.43, p<0.01). Similarly, 35% of male gymnast ATs had US abnormalities, compared with 4% of male control ATs (chi(2)=7.43, p=0<01). There was no relationship between AT symptoms and US-detected abnormalities in the gymnasts. Achilles tendinopathy is a common problem in gymnasts. The poor correlation between signs and symptoms suggests pathology is not always symptomatic.

Ward round--Late presentation of acute compartment syndrome in the thigh.

Bates J, Wamisho BL, Griffin M, Nyamulani N.: Malawi Medical Journal , 2009, 21(2):85, 87.

Acute compartment syndrome of the thigh is rare but has been described as a result of femur fracture and also thigh contusion in sports injury. Emergency fasciotomy has routinely been the recommended treatment. We describe a patient with a closed femur fracture, initially without any syndrome whilst on traction, and required surgical intervention. He was found to have a large haematoma associated with significant muscle damage in the posterior compartment. This case is unusual in that symptoms started 12 days after injury possibly after manipulation of the leg whilst on traction. Diagnosis is mainly clinical with an earliest alarming sign being disproportional increasing pain on passive stretch of the group of muscles. A high index of suspicion and prompt intervention are required to diagnose and treat compartment syndrome and prevent irreversible damage.

Shoulder injuries in US high school baseball and softball athletes, 2005-2008.

Center for Injury Research and Policy, Research Institute at Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205, USA.

Objective: The objective of this study was to determine factors that are involved in shoulder injury rates among high school athletes who participate in organized baseball and softball. Methods: Baseball- and softball-related injury data were collected during the 2005-2008 academic years from approximately 74 nationally representative high schools via High School Reporting Information Online. Results: Certified athletic trainers reported 91 baseball shoulder injuries and 40 softball shoulder injuries during 528147 and 399522 athlete exposures, respectively. The injury rate was 1.72 injuries per 10000 athlete exposures for baseball and 1.00 injuries per 10000 athlete exposures for softball. Muscle strain/incomplete tears were the most common injuries in both baseball (30.8%) and softball (35.0%). In practices, throwing, not including pitching, caused more than half of softball injuries (68.2%) as compared with competition injuries (23.5%; injury proportion ratio [IPR]: 2.90 [95% confidence interval (CI): 1.17-7.15]; P = .015), whereas pitching was the most common mechanism in causing shoulder injuries during baseball practice (41.9%) compared with competitions (25.6%; IPR: 1.64 [95% CI: 0.88-3.04]; P = .17). Eighty-one percent of the baseball shoulder injuries and 82.5% of the softball shoulder injuries were new. Ten percent of baseball athletes and 5.3% of softball athletes sustained injuries that required surgery (IPR: 1.40 [95% CI: 0.32-6.10]; P = .93). Injuries that were sustained while the athlete was on the pitcher's mound were significantly more likely to result in surgery than any other field position (IPR: 2.64 [95% CI: 1.65-4.21]; P = .0061). Injured baseball players were more than twice as likely to be pitchers. Conclusions: Although rates and patterns of shoulder injuries are similar between baseball and softball players, injury rates and patterns differ between field positions within each sport, as well as by injury severity and the athletes' year in school.

Successful ACL reconstruction with a variant of the pes anserinus.

Patel S, Trehan RK, Railton GT.: Journal of Orthopaedics and Traumatology, 2009, 10(4):203-5. Department of Trauma and Orthopaedics, University College Hospital, London, NW1 2BU, UK.

An anatomical variant of the pes anserinus encountered during anterior cruciate ligament reconstructive surgery which has not been previously described is discussed. During routine harvesting, the sartorius fascia was incised and the semitendinosus and gracilis tendons were identified. At the distal portion, it was noted that each tendon gave off an additional tendinous slip. The slip from the semitendinosus tendon had attached to the gracilis tendon and vice versa, thereby creating a double pes anserinus. This variant was used to construct the graft, and at 1 year review the patient had returned to full sporting activities with no complications encountered.

Risk factors for volleyball-related shoulder pain and dysfunction.

Reeser JC, Joy EA, Porucznik CA, Berg RL, Colliver EB, Willick SE.: PM & R : the Journal of Injury, Function, and Rehabilitation, 2010, 2(1):27-36. Office of Research Integrity and Protections, Marshfield Clinic Research Foundation, 1000 North Oak Ave., Marshfield, WI 54449, USA.

Objective: To identify risk factors for volleyball-related shoulder pain and dysfunction. Design: Cross-sectional, observational. Setting: National championship sporting event. Particpants: Competitors at the 2006 National Intramural & Recreational Sports Association Collegiate Club Volleyball Championship competition were invited to volunteer for the study. A total of 422 athletes returned questionnaires, of whom 276 also underwent a structured physical examination. Assessement of risk factors: Study participants provided information on any history of volleyball-related shoulder pain or dysfunction. The simple shoulder test (SST) and a visual analog scale permitted subjects to quantify the extent of their perceived functional limitation. Subjects also were invited to undergo a physical examination in which dynamic scapular positioning, glenohumeral range of motion, shoulder girdle strength, and core stability were assessed. Main outcome results: Standard statistical methods of comparison and tests of association were used to identify risk factors for shoulder pain among participating volleyball athletes. Results: Approximately 60% of participants reported a history of shoulder problems. Attackers and "jump" servers were more likely to have shoulder problems than setters, defensive specialists, and "float" servers. Nearly half of the athletes who reported shoulder problems perceived some associated functional limitation, with female athletes providing lower SST scores than male athletes (9.0 versus 10.1, P = .001). Athletes reporting shoulder pain and dysfunction were more likely to have SICK scapula scores of 3 or greater (P = .010). Participants who demonstrated core instability also had greater SICK scapula scores (3.9 versus 2.9, P = .038), and were more likely to report a history of shoulder problems (chi2 = 8.83, P = .032). Although the authors observed a significant mean left-right difference of 8.9 degrees in available glenohumeral internal rotation among participating athletes, this deficit was not associated with shoulder problems. However, there was an association between asymmetric coracoid tightness /pectoral shortening and shoulder pain (P = .030), as well as for restricted shoulder flexion in the sagittal plane and shoulder problems (P = .015). Conclusions: Although most risk factors for volleyball-related shoulder problems are similar to those identified for other overhead sports, there appear to be additional volleyball-specific risk factors that may reflect the biomechanical demands of the sport. An understanding of modifiable risk factors is critical to providing optimal care for overuse injuries and may facilitate future efforts to prevent shoulder problems among volleyball athletes.

Return to sports participation after articular cartilage repair in the knee: scientific evidence.

Mithoefer K, Hambly K, Della Villa S, Silvers H, Mandelbaum BR.: The American Journal of Sports Medicine, 2009, 37 Suppl 1:167S-76S. Harvard Vanguard Orthopedics and Sports Medicine, 291 Independence Drive, Chestnut Hill, MA 02467, USA.

Background: Articular cartilage injury in the athlete's knee presents a difficult clinical challenge. Despite the importance of returning injured athletes to sports, information is limited on whether full sports participation can be successfully achieved after articular cartilage repair in the knee. Hypothetisis: Systematic analysis of athletic participation after articular cartilage repair will demonstrate the efficacy of joint surface restoration in high-demand patients and help to optimize outcomes in athletes with articular cartilage injury of the knee. Study design: Systematic review. Methods: A comprehensive literature review of original studies was performed to provide information about athletic participation after articular cartilage repair. The athlete's ability to perform sports postoperatively was assessed by activity outcome scores, rate of return to sport, timing of the return, level of postoperative sports participation, and the continuation of athletic activity over time. Results: Twenty studies describing 1363 patients were included in the review, with an average follow-up of 42 months. Return to sports was possible in 73% overall, with highest return rates after osteochondral autograft transplantation. Time to return to sports varied between 7 and 18 months, depending on the cartilage repair technique. Initial return to sports at the preinjury level was possible in 68% and did not significantly vary between surgical techniques. Continued sports participation at the preinjury level was possible in 65%, with the best durability after autologous chondrocyte transplantation. Several factors affected the ability to return to sport: athlete's age, preoperative duration of symptoms, level of play, lesion size, and repair tissue morphology. Conclusion: Articular cartilage repair in the athletic population allows for a high rate of return to sports, often at the preinjury level. Return to sports participation is influenced by several independent factors. The findings provide pertinent information that is helpful for the clinical decision-making process and for the management of the athlete's postoperative expectations.

Timing of reconstruction of the anterior cruciate ligament in athletes and the incidence of secondary pathology within the knee.

Kennedy J, Jackson MP, O'Kelly P, Moran R.: The Journal of Bone and Joint surgery. British volume

2010 92(3):362-6. Department of Orthopaedics, Sports Surgery Clinic, Santry Demesne, Santry, Dublin 9, Ireland.

We reviewed a single-surgeon series of 300 athletic patients who had undergone reconstruction of the anterior cruciate ligament in order to establish the relationship between the timing of the reconstruction and the incidence of meniscal and chondral pathology. The patients were divided into five groups according to the time from their injury to surgery as follows: less than two months, two to six months, six to 12 months, 12 to 18 months and more than 18 months. The presence of meniscal tears was recorded and chondral pathology was scored according to the system of the French Society of Arthroscopy. There was a significantly higher chance of a medial meniscal tear occurring in patients undergoing reconstruction after one year from their injury (odds ratio (7.99, p = 0.004). The odds of having a lateral meniscal tear did not change significantly with an increasing interval to reconstruction. The chance of patients developing degenerative changes was found to be significantly higher in the groups operated on after six months from injury (odds ratio 4.04, p = 0.005). We advocate that patients with deficiency of the anterior cruciate ligament should be counselled that there is a significant relationship between the duration of the instability of their knee and the subsequent incidence of both chondral changes and meniscal tears. In order to minimise these risks, we recommend that reconstruction be performed within the first year from injury.

Arthroscopic management of osteochondritis dissecans of the capitellum: mid-term results in adolescent athletes.

Journal of Pediatric oOthopedics, 2010, 30(1):8-13. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA.

Background: The optimal treatment of osteochondritis dissecans (OCD) of the capitellum in adolescent athletes remains challenging. The purpose of this study was to investigate the mid-term results of arthroscopic treatment of OCD of the capitellum in a series of adolescents. Methods: We identified 25 consecutive patients at our institution that underwent arthroscopic treatment for OCD of the capitellum since 1999. Ten elbows were treated by arthroscopic debridement and drilling alone, whereas 12 elbows required additional mini-arthrotomies for bone grafting or the removal of large loose bodies after arthroscopy. The clinical charts and operative reports of these patients were retrospectively reviewed for relevant clinical information including age, sport, character of symptoms, preoperative and postoperative range of motion, return to sport, and postoperative complications. Twenty-one patients (22 elbows) were reached to determine their current elbow function and athletic activity using the Single Assessment Numerical Evaluation score. Results: The average age of the patients in our series was 13.1 years. All patients participated in organized athletics that involved the upper extremity and had undergone an average of 10.2 months of nonoperative treatment before surgery. At a mean follow-up of 48 months, the patients gained an average of 17 degrees of extension and 10 degrees of flexion after surgery. Both the improvement in flexion and extension were statistically significant compared with the preoperative range of motions (P=0.001, P=0.01). When patients were asked to rate their elbow function from 0% to 100% using the Single Assessment Numerical Evaluation score, the average rating was 87%. Eighteen of 21 patients (86%) returned to participate in their sport at their preinjury level. Conclusion: Arthroscopic management of capitellar OCD in adolescent athletes results in significantly improved range of motion and a high rate of return to athletics. Accompanying arthrotomy may be required for large loose body removal or bone grafting.

Platelet-rich plasma: new clinical application: a pilot study for treatment of jumper's knee.

Kon E, Filardo G, Delcogliano M, Presti ML, Russo A, Bondi A, Di Martino A, Cenacchi A, Fornasari PM, Marcacci M. Injury , 2009 40(6):598-603. Biomechanics Laboratory, Department of Orthopaedic.

This study describes a simple, low-cost, minimally invasive way to apply PRP growth factors to chronic patellar tendinosis; 20 male athletes with a mean history of 20.7 months of pain received treatment, and outcomes were prospectively evaluated at 6 months follow-up. No severe adverse events were observed, and statistically significant improvements in all scores were recorded. The results suggest that this method may be safely used for the treatment of jumper's knee, by aiding the regeneration of tissue which otherwise has low healing potential.

Match and training injuries in rugby league: a review of published studies.

King DA, Hume PA, Milburn PD, Guttenbeil D.: Sports Medicine, 2010, 40(2):163-78. Emergency Department, Hutt Valley District Health Board, Lower Hutt, New Zealand.

Rugby league is an international collision sport played by junior, amateur, semiprofessional and professional players. The game requires participants to be involved in physically demanding activities such as running, tackling, passing and sprinting, and musculoskeletal injuries are common. A review of injuries in junior and senior rugby league players published in Sports Medicine in 2004 reported that injuries to the head and neck and muscular injuries were common in senior rugby league players, while fractures and injuries to the knee were common in junior players. This current review updates the descriptive data on rugby league epidemiology and adds information for semiprofessional, amateur and junior levels of participation in both match and training environments using studies identified through searches of PubMed, CINHAL, Ovid, MEDLINE, SCOPUS and SportDiscus databases. This review also discusses the issues surrounding the definitions of injury exposure, injury rate, injury severity and classification of injury site and type for rugby league injuries. Studies on the incidence of injuries in rugby league have suffered from inconsistencies in the injury definitions utilized. Some studies on rugby league injuries have utilized a criterion of a missed matchas an injury definition, total injury incidences or a combination of both time-loss and non-time-loss injuries, while other studies have incorporated a medical treatment injury definition. Efforts to establish a standard definition for rugby league injuries have been difficult, especially as some researchers were not in favour of a definition that was all-encompassing and enabled non-time-loss injuries to be recorded. A definition of rugby league injury has been suggested based on agreement by a group of international researchers. The majority of injuries occur in the match environment, with rates typically increasing as the playing level increases. However, professional level injury rates were reportedly less than semiprofessional participation. Only a few studies have reported training injuries in rugby league, where injury rates were reported to be less than match injuries. Approximately 16-30% of all rugby league injuries have been reported as severe, which places demands upon other team members and, if the player returns to playing too early, places them at an increased risk of further injuries. Early research in rugby league identified that ligament and joint injuries were the common injuries, occurring primarily to the knee. More recently, studies have shown a change in anatomical injury sites at all levels of participation. Although the lower limb was the frequent injury region reported previously, the shoulder has now been reported to be the most common injury site. Changes in injury site and type could be used to prompt further research and development of injury reduction programmes to readdress the issue of injuries that occur as a result of participation in rugby league activities. Further research is warranted at all participation levels of rugby league in both the match and training environments to confirm

Influence of rugby practice on shoulder internal and external rotators strength.

Edouard P, Frize N, Calmels P, Samozino P, Garet M, Degache F.: International Journal of Sports Medicine, 2009 30(12):863-7. Department of Physical Medicine and Rehabilitation, University Hospital of Saint-Etienne, Jean Monnet University, Saint-Etienne, France.

Shoulder injuries are frequent in rugby, and muscular deficiency and/or imbalance of the internal (IR) and external (ER) shoulder rotators are considered as probable mechanisms of shoulder injuries. The purpose of this study was to investigate whether the rotators strength imbalances occur in rugby players by comparing IR and ER strength and ER/IR ratios between rugby players (RP) and nonathletic subjects. Fourteen RP and 19 healthy nonathletic subjects were evaluated in this cross-sectional controlled study with a Con-Trex ((R)) dynamometer. IR and ER isokinetic strength were performed at 60 degrees . s (-1) and 240 degrees . s (-1) in concentric, and 60 degrees . s (-1) in eccentric, for both sides. Strength values were higher for RP than nonathletic ones ( P<0.05), but if peak torque was normalised to body weight, there were no significant differences. There was no significant effect of laterality on the IR and ER peak torque, and no significant influence of rugby and/or laterality on the ER/IR ratio. In conclusions, our results reported no rotators muscles imbalance in RP as a possible risk factor of glenohumeral injury.

Current concepts in pediatric and adolescent arthroscopy.

Siparsky PN, Kocher MS.: Arthroscopy, 200912 25(12):1453-69. St Mary's Hospital, San Francisco, California, USA.

Arthroscopy continues to grow as a treatment modality for pediatric and adolescent orthopaedic pathologies. In recent years arthroscopic procedures previously reserved for adult patients have become more frequently used in the treatment of younger individuals. Advancements in arthroscopic instrumentation including smaller arthroscopes and tools have made the constraint of smaller joint spaces in the pediatric and adolescent populations less of a limiting factor when addressing surgical options for care. This is valuable considering the consistent increase in pediatric sports- and activity-related injuries, of which many are treatable arthroscopically. Currently, arthroscopy is indicated for the treatment of various chronic and acute injuries of the shoulder, elbow, wrist, hip, knee, and ankle. This review aims to highlight the current literature regarding arthroscopy in this population while also offering treatment algorithms, rehabilitation guidelines, and surgical tips for various pathologies in pediatric and adolescent patients.

Injuries in youth soccer.

Injury rates in youth soccer, known as football outside the United States, are higher than in many other contact/collision sports and have greater relative numbers in younger, preadolescent players. With regard to musculoskeletal injuries, young females tend to suffer more knee injuries, and young males suffer more ankle injuries. Concussions are fairly prevalent in soccer as a result of contact/collision rather than purposeful attempts at heading the ball. Appropriate rule enforcement and emphasis on safe play can reduce the risk of soccer-related injuries. This report serves as a basis for encouraging safe participation in soccer for children and adolescents.

Slit fracture through two adjacent cervical vertebrae: case report and review of the literature.

Hendershot TL, Leclercq TA, Chirico P.: The West Virginia, Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA.

We report the case of a 15 year old male who presented complaining of neck pain and upper extremity radicular symptoms one day post trampoline trauma. He was diagnosed with a nondisplaced vertical or "slit fracture" at C5 and C6. It is believed that the mechanism of injury, trampoline trauma, allowed this unusual fracture. A review of the literature provides some insight regarding speed of force and fracture displacement that may have relevance in this particular case. A review of the literature failed to find a previous report of such an event.

Spontaneous Achilles tendon ruptures treated with a mini-open technique: clinical and functional evaluation.

De Carli A, Vadalà A, Ciardini R, Iorio R, Ferretti A.: The Journal of sports medicine and physical fitness. Orthopedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, La Sapienza University, Rome, Italy.

Aim and Methods: Spontaneous ruptures of the Achilles tendon are frequent among occasional and high level athletes. Despite the frequency of this problem, there is no agreement about the treatment of this pathology. The purpose of this study was to show the results of 20 consecutive patients (14 males and 6 females) surgically treated between 1995 and 2001 with a mini-open technique (mean follow-up: 52 months; range 20-95 months). Postoperatively, all these patients were assessed with a new functional scoring scale and a functional jumping test (Ergo-Jump Bosco System). Results: A very low rate of minor complications have been reported and most of these patients are now practicing their favoured sport at the same pre-injury level. Conclusions: Mini open repair should be considered an excellent method of treatment of this pathology, with a very low rate of complications. The authors recommend this technique for young professional and occasional athletes.

Consensus statement on epidemiological studies of medical conditions in tennis, April 2009

Background: The reported incidence, severity and nature of injuries sustained in tennis vary considerably between studies. While some of these variations can be explained by differences in sample populations and conditions, the main reasons are related to differences in definitions and methodologies employed in the studies. Objective: This statement aims to review existing consensus statements for injury surveillance in other sports in order to establish definitions, methods and reporting procedures that are applicable to the specific requirements of tennis. Design: The International Tennis Federation facilitated a meeting of 11 experts from seven countries representing a range of tennis stakeholders. Using a mixed methods consensus approach, key issues related to definitions, methodology and implementation were discussed and voted on by the group during a structured 1-day meeting. Following this meeting, two members of the group collaborated to produce a draft statement, based on the group discussions and voting outcomes. Three revisions were prepared and circulated for comment before the final consensus statement was produced. Results: A definition of medical conditions (injuries and illnesses) that should be recorded in tennis epidemiological studies and criteria for recording the severity and nature of these conditions are proposed. Suggestions are made for recording players’ baseline information together with recommendations on how medical conditions sustained during match play and training should be reported. Conclusions: The definitions and methodology proposed for recording injuries and illnesses sustained during tennis activities will lead to more consistent and comparable data being collected. The surveillance procedures presented here may also be applicable to other racket sports.

Hip flexibility and strength measures: reliability and association with athletic groin pain

Objective: Groin pain commonly affects football players and can be associated with prolonged recovery periods. Understanding the relationship between groin pain and reliable measures of hip flexibility and strength may facilitate the development of optimal rehabilitation and prevention strategies. In this study, the reliability and association with athletic groin pain of hip flexibility and strength measures were investigated. Methods: A cohort of 29 football players (15–21 years) participating in junior elite competitions (Australian Rules football and soccer) were recruited. The intra-rater reliability (n = 13) and inter-rater reliability (n = 12) of various hip flexibility (bent knee fall out test, hip internal rotation, hip external rotation) and strength (hip abduction, hip internal rotation, hip external rotation, hip adduction (squeeze test)) measures were investigated using intraclass correlation coefficients (ICC). Reliable hip flexibility and strength measures were compared between football players with (n = 10) and without (n = 19) groin pain. Results: The bent knee fall out test, hip internal rotation flexibility and the squeeze test demonstrated acceptable (ICC>0.75) intra-rater and inter-rater reliability, while hip external rotation flexibility and hip abduction strength demonstrated acceptable intra-rater but not inter-rater reliability. Hip internal and external rotation strength tests were not found to be reliable. Football players with groin pain had significantly reduced force production on the squeeze test (p>0.05). Conclusion: Several hip flexibility and strength measures were found to be reliable. Only the squeeze test discriminated between football players with and without groin pain.

The epidemiology of ankle injuries occurring in English Football Association academies

Objective: To ascertain the epidemiology of ankle injuries in elite youth football. Design: Retrospective analysis of prospectively collected injury data from English Football Association (FA) academies. Setting: Forty-one FA football academies, between 1998 and 2006. Participants: For the complete seasons studied, a total of 14 776 players was registered from U9 to the U16 age category, a mean of 2463 players per year. All ankle injuries of sufficient severity to miss 48 h or more of training were studied, 2563 injuries in total. Main Outcome Measure: The incidence and burden of ankle injuries in this population and factors associated with injury. Results: There was a mean incidence of one ankle injury per player per year, and a mean of 20 training days and two matches were missed per ankle injury. Increased injury rates were seen in older players, in competition and later in each half of match time. Peaks in injury were observed early in the season and after the winter break. In competition, more injuries were associated with a contact situation than in training. Eighty-eight injuries (3.4%) required a lay-off of 3 months or more and in 18 (0.7%) cases the player failed to return to training. In total, 52 290 training days and 5182 match appearances were lost through ankle injury. The majority of injuries were sprains, but more severe injuries occurred accounted for 3.9% of the total. Conclusions: Ankle injuries are common in young football players and are often severe, with prolonged loss of training time. This has potential far-reaching implications, both on and off the field.

Upper extremity injuries in golf.

.:The Physician and Sportsmedicine, 37(1):92-62009. Saint Louis University School of Medicine, Belleville, IL 62220, USA.

Golf is an asymmetric sport with unique patterns of injury depending upon the skill level. Higher handicap players typically experience injuries that result from swing mechanics, whereas lower handicap and professional players have overuse as the major cause of their injuries. The majority of shoulder injuries affecting golfers occur in the nondominant shoulder. Common shoulder injuries include subacromial impingement, rotator cuff pathology, glenohumeral instability, and arthritis involving the acromioclavicular and/or glenohumeral joints. Lead arm elbow pain resulting from lateral epicondylosis (tennis elbow) is the leading upper extremity injury in amateur golfers. Tendon injury is the most common problem seen in the wrist and forearm of the golfer. Rehabilitation emphasizing improvement in core muscle streng is important in the treatment of golf injury. Emerging treatments for tendinopathy include topical nitrates, ultrasound-guided injection of therapeutic substances, and eccentric rehabilitation. There is evidence supporting physiotherapy, and swing modification directed by a teaching professional, for treatment of upper extremity golf injuries. This article focuses on upper extremity injuries in golf, including a discussion of the epidemiology, causes, diagnosis, treatment, and prevention of injuries occurring in the shoulder, elbow, wrist, and hand.

Chin-up-induced bilateral anterior shoulder dislocation: a case report.

The Journal of Emergency Medicine. 37(4):400-2, 2009. Department of Emergency Medicine, Morristown Memorial Hospital, 100 Madison Avenue, Box 8, Morristown, NJ 07962-1965, USA.

Background: Simultaneous bilateral shoulder dislocations are extremely rare occurrences. Objective: We present an unusual case where the patient suffered simultaneous bilateral anterior shoulder dislocations during chin-up exercises. To our knowledge, this mechanism has not been previously reported. Case report: A 44-year-old woman presented to the Emergency Department (ED) complaining of bilateral shoulder pain while doing chin-up exercises. She was completing her workout when she developed severe pain to both of her shoulders with associated parasthesias to both hands and the right forearm. The patient was found to have bilateral anterior shoulder dislocations; both were reduced using procedural sedation and traction-countertraction techniques. Conclusion: The mechanics of chin-up exercises places the glenohumeral joint in a position of instability, increasing the likelihood of dislocation.

Arthroscopic repair of L-shaped tear of the anterior band of the inferior glenohumeral ligament complex in a pediatric patient: a technical note.

.: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 17(12):1454-7, 2009. Section of Shoulder and Elbow Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, 1725 West Harrison Street, Suite 1063, Chicago, IL 60612, USA.

The present study reports on a case of a 10-year-old patient with recurrent right shoulder instability after a traumatic event leading to a mid-substance tear of the anterior band of the inferior glenohumeral ligament complex in an L-shaped pattern. Arthroscopic repair consisting of a 2.4 mm bioabsorbable suture anchor at the apex and a four PDS sutures placed through the capsulolabral junction leads to an anatomic repair with excellent short-term results similar to those found in other studies. The injury pattern is thought to be about 1% of shoulder dislocations, but tear pattern recognition is critical for a successful repair and clinical result.

Rotator cuff tendinopathy.

British Journal of Sports Medicine, 43(4):236-41, 2009. La Therapy Department, Chelsea and Westminster NHS Healthcare, 369 Fulham Road, London SW10 9NH, UK.

Purpose: A review was conducted to synthesise the available research literature on the pathogenesis of rotator cuff tendinopathy. Relevance: Musculoskeletal disorders of the shoulder are extremely common, with reports of prevalence ranging from one in three people experiencing shoulder pain at some stage of their lives to approximately half the population experiencing at least one episode of shoulder pain annually. Pathology of the soft tissues of the shoulder, including the musculotendinous rotator cuff and subacromial bursa, is a principal cause of pain and suffering. Conclusions: The pathoaetiology of rotator cuff failure is multifactorial and results from a combination of intrinsic, extrinsic and environmental factors. The specialised morphology of the rotator cuff, together with the effects of stress shielding, may contribute to the development of rotator cuff tendinopathy. Profound changes within the subacromial bursa are strongly related to the pathology and resulting symptoms. A considerable body of research is necessary to more fully understand the aetiology and pathohistology of rotator cuff tendinopathy and its relationship with bursal pathology. Once this knowledge exists more effective management will become available.

Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment?

. British Journal of Sports Medicine, 43(4):259-64, 2009. Therapy Department, Chelsea and Westminster NHS Healthcare, 369 Fulham Road, London SW10 9NH, UK.

Disorders of the shoulder are extremely common, with reports of prevalence ranging from 30% of people experiencing shoulder pain at some stage of their lives up to 50% of the population experiencing at least one episode of shoulder pain annually. In addition to the high incidence, shoulder dysfunction is often persistent and recurrent, with 54% of sufferers reporting ongoing symptoms after 3 years. To a large extent the substantial morbidity reflects (i) a current lack of understanding of the pathoaetiology, (ii) a lack of diagnostic accuracy in the assessment process, and (iii) inadequacies in current intervention techniques. Pathology of the rotator cuff and subacromial bursa is considered to be the principal cause of pain and symptoms arising from the shoulder. Generally these diagnostic labels relate more to a clinical hypothesis as to the underlying cause of the symptoms than to definitive evidence of the histological basis for the diagnosis or the correlation between structural failure and symptoms. Diagnosing rotator cuff tendinopathy or subacromial impingement syndrome currently involves performing a structured assessment that includes taking the patient's history in conjunction with performing clinical assessment procedures that generally involve tests used to implicate an isolated structure. Based on the response to the clinical tests, a diagnosis of rotator cuff tendinopathy or subacromial impingement syndrome is achieved. The clinical diagnosis is strengthened with the findings from supporting investigations such as blood tests, radiographs, ultrasound, magnetic resonance imaging (MRI), computed axial tomography (CT), radionucleotide isotope scan, single photon emission computed tomography, electromyography, nerve conduction and diagnostic analgesic injection. This process eventually results in the formation of a clinical hypothesis, and then, in conjunction with the patient, a management plan is decided upon and implemented. This paper focuses on the dilemmas associated with the current process, and an alternative method for the clinical examination of the shoulder for this group of patients is proposed.

Evaluation of team-doctor actions during football games in Japanese professional football.

Takahashi M, Fukuoka S, Nagano A. Journal of Science and Medicine in Sport / Sports Medicine Australia, 12(6):611-3, 2009.

Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Japan.

There have been many studies on football (soccer) match injuries both in national leagues and international tournaments, including the World Cup. However, no previous study on the number and types of actions taken by a team-doctor during a football season has been investigated. The aim of this study is to investigate what actions and how much a team doctor acts during professional football matches in a typical season of the Japanese professional football league (J-League). Injuries were prospectively recorded by team doctors with a Japanese professional league club during the 2004 season. Data recorded by the attending doctor after each match included information relating to the injury, time of occurrence and actions taken by the doctor in response to the injuries. The activity of the doctor was graded into 6 categories (grade A to F). During the 42 official matches held throughout the 2004 season, a total of 67 doctor-actions were taken. The overall doctor-action frequency rate (DAFR) was 1.6 actions per match. This study demonstrated how the team doctor acts during an average football match, and provides some useful information for team-doctors who attend football matches.

Epidemiology of injuries in competition taekwondo: a meta-analysis of observational studies.

Lystad RP, Pollard H, Graham PL. Journal of science and medicine in sport / Sports Medicine Australia, 12(6):614-21, 2009.

This paper aims to review and collate the epidemiological data of injuries in competition taekwondo as reported in the literature, make recommendations, and suggest further research. The electronic databases AMED, AusportMed, CINAHL, MEDLINE, PubMed, and SPORTDiscus were searched from inception to March 2008. Fourteen prospective cohort studies reporting the incidence of injuries in taekwondo were included. Two reviewers independently extracted data and assessed trial quality using the STROBE statement. Homogenous studies were combined in a pooled analysis using a Poisson random effects regression model. Poisson regression showed an overall mean injury rate of 79.3 per 1000 athlete-exposures (95% confidence interval 22.8, 275.4). Neither age, gender nor level of play were significant in the analysis. The most common injury location and type were found to be the lower limb and contusion, respectively, and were invariably associated with contact. Although taekwondo players are exposed to a substantial risk of sustaining injuries, the majority of injuries appeared to be of minimal severity. Modifications to the competition rules and protective equipment may be warranted. Future studies should adhere to recommended operational definitions, utilise a standardised injury classification system, and report injury rates using multiple denominators in order to facilitate inter- and cross-sport comparisons.

Posterior dislocation of the sternoclavicular joint and epiphyseal disruption of the medial clavicle with posterior displacement in sports participants.

Laffosse JM, Espié A, Bonnevialle N, Mansat P, Tricoire JL, Bonnevialle P, Chiron P, Puget J. : The Journal of bone and joint surgery. British volume, 92(1):103-9, 2010.

We retrospectively analysed the clinical results of 30 patients with injuries of the sternoclavicular joint at a minimum of 12 months' follow-up. A closed reduction was attempted in 14 cases. It was successful in only five of ten dislocations, and failed in all four epiphyseal disruptions. A total of 25 patients underwent surgical reduction, in 18 cases in conjunction with a stabilisation procedure. At a mean follow-up of 60 months, four patients were lost to follow-up. The functional results in the remainder were satisfactory, and 18 patients were able to resume their usual sports activity at the same level. There was no statistically significant difference between epiphyseal disruption and sternoclavicular dislocation (p > 0.05), but the functional scores (Simple Shoulder Test, Disability of Arm, Shoulder, Hand, and Constant scores) were better when an associated stabilisation procedure had been performed rather than reduction alone (p = 0.05, p = 0.04 and p = 0.07, respectively). We recommend meticulous pre-operative clinical assessment with CT scans. In sternoclavicular dislocation managed within the first 48 hours and with no sign of mediastinal complication, a closed reduction can be attempted, although this was unsuccessful in half of our cases. A control CT scan is mandatory. In all other cases, and particularly if epiphyseal disruption is suspected, we recommend open reduction with a stabilisation procedure by costaclavicular cerclage or tenodesis. The use of a Kirschner wire should be avoided.

Injury patterns in Division I collegiate swimming.

Wolf BR, Ebinger AE, Lawler MP, Britton CL.: The American journal of sports medicine, 37(10):2037-42, 2009.

Department of Orthopaedic Surgery, University of Iowa Hospital and Clinics, USA.

Background: In the last 25 years, it is estimated that over 42,000 male and female swimmers have competed at the National Collegiate Athletic Association (NCAA) Division I-A level. Despite the magnitude of these numbers, little is known about the epidemiology of collegiate swimming injuries. Purpose: To describe the pattern of injuries incurred for one NCAA Division I collegiate men's and women's swimming team over 5 seasons. Study design: Descriptive epidemiology study. Methods: Musculoskeletal and head injuries reported in the Sports Injury Management System for a Division I swimming team from 2002-2007 were identified. Gender, body part, year of eligibility, position, stroke specialty, scholarship status, and team activity during which the injury occurred and lost time were recorded. Risk of injury was assessed relative to gender, stroke specialty, and year of eligibility. Results: From 2002-2007, 44 male and 50 female athletes competed for the University of Iowa swimming and diving team. The overall injury rates were estimated as 4.00 injuries per 1000 exposures for men and 3.78 injuries per 1000 exposures for women. Thirty-seven percent of injuries resulted in missed time. The shoulder/upper arm was the most frequently injured body part followed by the neck/back. Freshman swimmers suffered the most injuries as well as the highest mean number of injuries per swimmer. A significant pattern of fewer injuries in later years of eligibility was also demonstrated. The relative risk (RR) for injury was higher among nonfreestyle stroke specialties (RR, 1.33 [1.00-1.77]). Injury most often occurred as a result of, or during, practice for all swimmers. However, 38% of injuries were the result of team activities outside of practice or competition, such as strength training. No significant relationship was found between occurrence of injury and gender or scholarship status. There was no significant relationship between body part injured and stroke specialty. An increased number of total injuries and an increased risk of injuries in freshman collegiate swimmers were found. Conclusion: Particular attention should be given to swimmers making the transition into collegiate level swimming. These data also suggest that injury surveillance and potential prevention strategies should focus on the shoulder for in-pool activities and the axial spine for cross-training activities.

Dorsiflexion deficit during jogging with chronic ankle instability.

Journal of science and medicine in sport / Sports Medicine Australia, 12(6):685-7, 2009.

The purpose of the study was to determine whether individuals with chronic ankle instability (CAI) demonstrate altered dorsiflexion/plantar flexion range of motion (ROM) compared to controls during jogging. The case control study took place in a university motion analysis laboratory. Fourteen volunteers participated in the study, seven suffered from CAI (age 25+/-4.2 years, height 173+/-9.4 cm, mass 71+/-8.1kg) and seven were healthy, matched controls (age 25+/-4.5 years, height 168+/-5.9 cm, mass 67+/-9.8kg). All subjects jogged on an instrumented treadmill while a ten-camera motion analysis system collected three-dimensional kinematics of the lower extremities. The main outcome measure was sagittal plane (dorsiflexion/plantar flexion) range of motion of the ankle throughout the gait cycle. CAI subjects had significantly less dorsiflexion compared to the control group from 9% to 25% during jogging (4.83+/-0.55 degrees ). CAI subjects demonstrated limited ankle dorsiflexion ROM during the time of maximal dorsiflexion during jogging. Limited dorsiflexion ROM during gait among individuals with CAI may be a risk factor for recurrent ankle sprains. These deficits should be treated appropriately by rehabilitation clinicians.

Evidence-based treatment of hamstring tears.

Copland ST, Tipton JS, Fields KB.: Current Sports Medicine Reports, 8(6):308-14, 2009.

Moses H. Cone Sports Medicine Fellowship and Family Medicine Residency, Moses Cone Health System, Greensboro, NC, USA.

Hamstring tears are exceedingly common in a variety of athletic populations and contribute to a significant amount of morbidity and time lost from sport. Many modifiable and non-modifiable risk factors have been identified with hamstring injury. There is strong evidence that Nordic hamstring exercises can decrease the risk of hamstring injury, limited evidence that sports specific anaerobic interval training and isokinetic strengthening can reduce injury rates, and limited evidence that daily static stretching after injury can increase recovery rate. The majority of medical, surgical, and rehabilitative intervention studies have limitations based on the total number of hamstring injuries included in a given study, reliance on retrospective cohort studies, and conclusions based on case series that limit the utility of the information. Most do not provide a level of evidence greater than expert opinion.

Chronic lumbar paraspinal compartment syndrome: a case report and review of the literature.

A 25-year-old male weightlifter felt increasing intractable low back pain during training but denied any acute injury. The physical examination, blood parameters, radiographs and MRI were unremarkable. He had been treated non-operatively by various means, with only temporary relief. The pressures in the lumbar paraspinal compartment were abnormally high and he was treated by surgical decompression. This gave rapid relief, he returned to training, and one year later the pain had not recurred.

Case reports: a Stener-like lesion of the medial collateral ligament of the knee.

Corten K, Hoser C, Fink C, Bellemans J.: Clinical orthopaedics and related research , (1):289-93, 2009.

Knee and Sports Orthopaedic Department, Catholic University Hospitals, Weligerveld 1, 3212 Pellenberg, Belgium.

When the superficial fibers of the medial collateral ligament of the knee are torn without tearing of the deep fibers, the anterior superficial fibers may displace over the pes anserinus tendons, so that healing back to the tibial insertion site may be jeopardized. As only the anterior superficial and not the posterior superficial or deep fibers are disrupted, the knee will not have increased valgus laxity in extension whereas there is not a firm end point in 30 degrees flexion. The clinical findings could be confused with those of a Grade 2 medial collateral ligament sprain that generally is not associated with displacement of the anterior fibers over the pes anserinus tendons. We describe the diagnostic findings confirmed with surgical exploration of two Stener-like disruptions of the medial collateral ligament of the knee.

Junge A, Engebretsen L, Mountjoy ML, Alonso JM, Renström PA, Aubry MJ, Dvorak J

Background: Standardized assessment of sports injuries provides important epidemiological information and also directions for injury prevention. Purpose: To analyze the frequency, characteristics, and causes of injuries incurred during the Summer Olympic Games 2008. STUDY DESIGN: Descriptive epidemiology study. Methods: The chief physicians and/or chief medical officers of the national teams were asked to report daily all injuries newly incurred during the Olympic Games on a standardized injury report form. In addition, injuries were reported daily by the physicians at the medical stations at the different Olympic venues and at the polyclinic in the Olympic Village. Results: Physicians and/or therapists of 92 national teams covering 88% of the 10,977 registered athletes took part in the study. In total, 1055 injuries were reported, resulting in an incidence of 96.1 injuries per 1000 registered athletes. Half of the injuries (49.6%) were expected to prevent the athlete from participating in competition or training. The most prevalent diagnoses were ankle sprains and thigh strains. The majority (72.5%) of injuries were incurred in competition. One third of the injuries were caused by contact with another athlete, followed by overuse (22%) and noncontact incidences (20%). Injuries were reported from all sports, but their incidence and characteristics varied substantially. In relation to the number of registered athletes, the risk of incurring an injury was highest in soccer, taekwondo, hockey, handball, weightlifting, and boxing (all >or=15% of the athletes) and lowest for sailing, canoeing/kayaking, rowing, synchronized swimming, diving, fencing, and swimming. Conclusion: The data indicate that the injury surveillance system covered almost all of the participating athletes, and the results highlight areas of high risk for sport injury such as the in-competition period, the ankle and thigh, and specific sports. The identification of these factors should stimulate future research and subsequent policy change to prevent injury in elite athletes.

Sports after surgical treatment of a herniated lumbar disc: a prospective observational study

Weber J, Schönfeld C, Spring A.: Zeitschrift für Orthopädie und Unfallchirurgie, 147(5):588-92, 2009.

Lumbar discectomy is the most frequent spinal surgical procedure in Germany. Surgeons vary widely in their preferences with regard to patients' return to sports after spinal surgery. The self-reported sporting activity before and after microdiscectomy was evaluated in a prospective observational study with 5 year follow-up. Method: One hundred and five patients (mean age 45.4 years) with self-reported sporting activity before lumbar single-level discectomy were re-evaluated after 5 years. The clinical outcome was graded using a modified Prolo scale (pain and medication). Results: Based on the Prolo scale, an excellent (n = 80) or good (n = 17) outcome was achieved in 92.4% of patients. Altogether, 91.4% of patients (n = 96) resumed sporting activities: 87 patients returned to their previous sport. Only 8.6% of the patients (n = 9) were unable to return to sports, for various reasons (e.g., poor general health, lumbar pain, or lack of time). The mean time until return to sports after operation was 5.8 months (range 6 weeks to 24 months).The recurrence rate was 5.7% (n = 6), with 3 of the herniations occurring before the return to sporting activities (after 1, 2 and 7 months). Conclusions: The success rate of single-level microdiscectomy in athletes was frequently good or excellent, with over 90% of patients able to return to sports. The reherniation rate after postoperative athletic activity was comparable with results reported in the literature.

Golf after total knee arthroplasty: do patients return to walking the course?

Backgroung: Golf provides an opportunity for relatively low-impact exercise for nearly all age groups and is considered a recommended activity for patients after total knee arthroplasty. Hypothetisis: We hypothesized that total knee arthroplasty would afford patients increased ability to participate in and enjoy golf, allowing a large percentage of these patients to walk the golf course. Study design: Case series; Level of evidence, 4. Methods: Surveys were sent to 151 golfers who had undergone primary total knee arthroplasty from 1995 to 2000. The detailed survey included 33 questions specific to the patients' golf performance, enjoyment of golf, frequency of participation, timing of return to play, presence of pain, use of a cart, and related golf-specific issues. Results: We received and evaluated 93 responses (62%). Fifty-seven percent reported they had returned to golf within 6 months after total knee arthroplasty. Eighty-one percent of respondents reported golfing as frequently, or more frequently, than before knee replacement. Notably, golfers reported less pain while golfing after total knee arthroplasty than before (13% vs 83%; P < .0001), and 94% of respondents reported currently enjoying golf as much as or more than before surgery. Twenty-eight percent of respondents stated that they walked the course, rather than using a motorized golf cart, before surgery, while only 14% walked the course after surgery (P = .02). Conclusion: In this population of golfers, total knee arthroplasty reliably relieved pain that had been previously experienced while golfing, and increased or maintained this group's enjoyment of playing golf. However, 86% of these patients reported using a cart while golfing. Further patient education is needed regarding the potential health benefits of walking during golf after total knee arthroplasty.

Chronic exertional compartment syndrome of the forearm in motocross racers: findings on MRI.

Gielen JL, Peersman B, Peersman G, Roelant E, Van Dyck P, Vanhoenacker F, Roeykens J.: Skeletal radiology, 38(12):1153-61, 2009.

Introduction: The purpose of this prospective study was to demonstrate the findings of MRI in motocross racers with chronic exertional compartment syndrome (CECS) of the forearm. Materials and Methods: Racers with proven CECS and without CECS and male individuals not involved in strenuous activities with the forearm were included. Signal intensity (SI) and signal-to-noise ratio (SNR) obtained before and after exercise were compared (D-SNR). Results: Magnetic resonance imaging after exercise showed an increase in SI and SNR in the muscles on T2-WI. The SI increase was obvious in the flexor digitorum superficialis (FDS) and profundus (FDP) in all CECS patients. In addition, a minor SI and SNR increase in the extensor carpi radialis longus (ECRL) was noted. In the non-symptomatic group of motocross racers, there was only a minor increase in SI and the SNR, which was similar in the FDP and ECRL muscles. In the untrained individuals a remarkable increase in the SI and SNR of the FDS/FDP-ECRL was noted. This increased SI and SNR was not present in the majority of non-symptomatic racers. Conclusion: Post-exertional MRI produces significant findings in CECS of the forearm. The motocross racers without post-exertional oedema in the FDP/FDS had no CECS.

Effect of anterior cruciate ligament reconstruction and meniscectomy on length of career in National Football League athletes: a case control study.

Brophy RH, Gill CS, Lyman S, Barnes RP, Rodeo SA, Warren RF.: The American Journal of Sports Medicine, 37(11): 2102-7, 2009.

Background: Meniscal and anterior cruciate ligament (ACL) injuries are common in college football athletes. The effect of meniscectomy and/or ACL surgery on the length of an athlete's career in the National Football League (NFL) has not been well examined. Hypothesis: Athletes with a history of meniscectomy or ACL surgery before the NFL combine have a shorter career than matched controls. Study design: Case-control study; Level of evidence, 3. Methods: A database containing the injury history and career NFL statistics of athletes from 1987-2000 was used to match athletes with a history of meniscectomy and/or ACL surgery, and no other surgery or major injury, to controls without previous surgeries. Athletes were matched by position, year drafted, round drafted, and additional injury history. Results: Fifty-four athletes with a history of meniscectomy, 29 with a history of ACL reconstruction, and 11 with a history of both were identified and matched with controls. Isolated meniscectomy reduced the length of career in years (5.6 vs 7.0; P = .03) and games played (62 vs 85; P = .02). Isolated ACL surgery did not significantly reduce the length of career in years or games played. Comparing the athletes with meniscectomy or ACL reconstruction to athletes with combined ACL reconstruction and meniscectomy, a history of both surgeries, resulted in a shorter career in games started (7.9 vs 35.1; P <.01), games played (41 vs 63; P = .07), and years (4.0 vs 5.8; P = .08) than a history of either surgery alone. Conclusion: A history of meniscectomy, but not ACL reconstruction, shortens the expected career of a professional football player. A combination of ACL reconstruction and meniscectomy may be more detrimental to an athlete's durability than either surgery alone. Further research is warranted to better understand how these injuries and surgeries affect an athlete's career and what can be done to improve the long-term outcome after treatment.

Wrist fusion in posttraumatic brachial plexus palsy. Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, VA 23501, USA.Plastic and reconstructive surgery, 124(6):2027-39, 2009.

BACKGROUND: Devastating brachial plexus injury with multiple root avulsions results in wrist instability, imbalance, and inability of patients to control the placement of their hand in space. In this study, results of wrist arthrodesis were analyzed in relation to factors such as age, severity score, and additional hand reanimation procedures. Indices of patient satisfaction were also measured using the Terzis and Disabilities of the Arm, Shoulder and Hand questionnaires. METHODS: Between January of 1978 and January of 2006, 97 patients with posttraumatic plexopathies underwent secondary procedures for hand reanimation. Sixty-one of these patients had wrist fusion. Arthrodesis was performed between the radius and third metacarpal using mainly a rigid plate; iliac bone graft was used in the majority of patients. Thirty-one patients underwent muscle transfers (45 free muscles) and 11 had tendon transfers in the wrist fusion group to enhance finger function. Patient self-assessment was carried out using the Terzis and Disabilities of the Arm, Shoulder and Hand questionnaires. RESULTS: All patients' wrists fused. Patients with free-muscle transfer for finger flexion and extension achieved superior muscle grading compared with patients without wrist fusion, but this was not significant. A total of 35 patients (57.37 percent) answered the questionnaires; 97.14 percent were satisfied with wrist stability and 88.57 percent reported that the procedure enhanced the overall upper limb function. The Disabilities of the Arm, Shoulder and Hand score was 59.14 +/- 12.9, which means moderate ability in daily activities. CONCLUSIONS: Wrist fusion in patients with brachial plexus palsy is recommended as a complementary procedure, offering a stable, painless carpus, with improvement of overall upper limb function and appearance.

Vertical dislocation of the patella: report of 2 cases. Shwetty, S., Ramesh, B., et al.: Department of Orthopedics & Trauma, Glan Clwyd Hospital, Bodelwyddan, Rhyl, United Kingdom.Orthopedics, 32(10), 2009.

Vertical dislocation of the patella is rare and usually occurs as a result of blunt trauma. The patella rotates around a vertical axis. It can be diagnosed by its typical clinical features. This article presents a case of 2 patients with vertical dislocation who presented with high-impact injuries and had classic signs of a vertically dislocated patella. Unlike lateral patella dislocation, reduction under sedation is usually not possible. This is mainly due to increased tension within the quadriceps mechanism, which makes reduction difficult. The other factor that makes reduction difficult is that the patella could be wedged in the femoral condyles. Both patients underwent multiple unsuccessful attempts at reduction in the emergency department. These were later successfully reduced under general anesthesia and both patients went on to make an uneventful recovery. Multiple attempts without adequate relaxation could not only cause chondral damage but could also could endanger the extensor mechanism.

Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy.Cook, J. L., Purdam, C. R.: Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.

Overuse tendinopathy is problematic to manage clinically. People of different ages with tendons under diverse loads present with varying degrees of pain, irritability, and capacity to function. Recovery is similarly variable; some tendons recover with simple interventions, some remain resistant to all treatments. The pathology of tendinopathy has been described as degenerative or failed healing. Neither of these descriptions fully explains the heterogeneity of presentation. This review proposes, and provides evidence for, a continuum of pathology. This model of pathology allows rational placement of treatments along the continuum. A new model of tendinopathy and thoughtful treatment implementation may improve outcomes for those with tendinopathy. This model is presented for evaluation by clinicians and researchers.

The potential role of prophylactic/functional knee bracing in preventing knee ligament injury. Rishiraj, N., Taunton, J. E., et al: School of Physiotherapy, University of Otago, Dunedin, New Zealand. Sports medicine (Auckland, N.Z.), 39(11):937-60, 2009.

It is estimated that knee injuries account for up to 60% of all sport injuries, with the anterior cruciate ligament (ACL) accounting for almost half of these knee injuries. These knee injuries can result in high healthcare costs, as an ACL injury is often associated with surgery, long and costly rehabilitation, differing degrees of impairment and potential long-term consequences such as osteoarthritis. The interest in ACL injury prevention has been extensive for the past decade. Over this period, many ACL (intrinsic and extrinsic) injury risk factors have been identified and investigated by numerous researchers. Although prevention programmes have shown potential in decreasing knee ligament injuries, several researchers have suggested that no conclusive evidence has been presented in reducing the rate and/or severity of ACL injuries during sporting competition. Knee braces have been available for the last 30 years and have been used to assist individuals with ACL-deficient and ACL-reconstructed knees. However, research is limited on the use of knee braces (prophylactic and functional) to potentially prevent knee ligament injury in the non-injured population. One possible explanation for the limited research could be that the use of these devices has raised concerns of decreased or impaired athletic performance. In summary, the review of subjective and some objective publications suggests that a functional knee brace may offer stability to an ACL-deficient knee joint; however, research is limited on the use of a knee brace for prophylactic use in non-injured athletes. The limited research could be a result of fear of performance hindrance that has led to poor knee brace compliance.

The gluteal triangle: a clinical patho-anatomical approach to the diagnosis of gluteal pain in athletes.

Franklyn-Miller, A., Falvey, E., McCroy, P.: Centre for Health, Exercise and Sports Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria 3010 Australia.British Journal of Sports Medicine, 43(6), 2009.
Gluteal pain is a common presentation in sports medicine. The aetiology of gluteal pain is varied, it may be referred from the lower back, mimic other pathology and refer to the hip or the groin. The complex anatomy of the buttock and pelvis, variability of presentation and non specific nature of signs and symptoms make the diagnostic process difficult. To date the approaches to this problem have focused on individual pathologies. The paper proposes a novel educational system based on patho-anatomic concepts. Anatomical reference points were selected to form a diagnostic triangle, which provides the discriminative power to restrict the differential diagnosis, and form the basis of ensuing investigation. This paper forms part of a series addressing the three dimensional nature of proximal lower limb pathology. The 3G approach (groin, gluteal and greater trochanter triangles) acknowledges this, permitting the clinician to move throughout the region, considering pathologies appropriately. These papers should be read in conjunction with one another in order to fully understand the conceptual approach.

Road traffic accidents and the elderly.Abou-Raya, S., Elmeguid, L. A.: Geriatric Unit, Internal Medicine Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. Geriatrics & Gerontology international, 9(3):290-7, 2009
AIM: To identify and evaluate the causes and characteristics of road traffic accidents (RTA) and to analyze injury patterns in elderly road traffic victims in order to apply appropriate measures for the prevention of RTA in the elderly. METHODS: Two hundred and fifty-eight elderly road traffic victims admitted to the Emergency and Traumatology Departments of our institution were enrolled. Complete data about the circumstances surrounding the accident, mechanism of injury, specific injury, comorbid conditions and drug history were recorded. All subjects underwent a physical and mental function examination. RESULTS: The majority of road traffic victims were pedestrians. Most elderly pedestrian accidents were due to falls. Accidents by elderly car drivers occurred frequently at intersections. Craniocerebral and extremity injuries formed the majority of the injuries in pedestrian and cyclist victims whereas chest injuries were commoner in car accident victims. Medical problems and medication usage was common among RTA victims. CONCLUSION: The fragility of elderly car occupants and pedestrians should be taken into consideration and strategies aimed at the road-user safety including periodic medical screening, improvement of road structure and facilities, and the improved design of motor vehicles should be implemented.

The patient was a 21-year-old male who was referred to physical therapy with a 1-week history of right knee pain and stiffness following an injury of traumatic onset. While attempting to jump off of both legs to dunk a basketball during a game, the patient heard and felt a pop in his right knee that was associated with an immediate onset of pain and swelling. He was unable to bear weight following the injury and, therefore, immediately went to the emergency department, where radiographs were completed and interpreted as negative for a fracture. However, the patella for the right knee was superiorly displaced. The patient was issued crutches and referred to physical therapy. At the time of the initial physical therapy examination, the patient was still not able to bear full weight on the right lower extremity or actively fully extend his right knee. Due to concern over possible meniscal, medial collateral ligament, or patellar tendon involvement, the patient's physician was contacted and magnetic resonance imaging was ordered. Five days later, the patient presented with decreased knee effusion and the special tests for the medial collateral ligament and meniscus were negative. However, the patient was still not able to actively extend his knee, suggesting a possible rupture of the patellar tendon, which was later confirmed on magnetic resonance imaging. Surgical repair of the patellar tendon was performed 2 weeks later.

Acute dislocation of the proximal tibiofibular joint.Hsieh, CH, Chen, JC. Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanThe Journal of orthopaedic and sports physical therapy, 200911; 39(11):826, 2009. The patient was a 19-year-old female who reported an acute onset of lateral left knee pain while participating in a 3-legged race. The patient reported to the emergency department immediately following the injury. Observation revealed prominence along the lateral aspect of the knee. The patient was unable to bear weight on her left lower extremity and her symptoms were exacerbated with extension of the knee. Although the initial radiographs of the left knee and lower leg showed no apparent fracture, a widening of the interosseous space between the tibia and the fibula and an altered position of the fibular head were noted on the anterior to posterior radiographic view. On the lateral radiographic view there was anterior displacement of the left fibula compared to the right. These radiographic findings suggested an anterolateral dislocation of the fibular head, the diagnosis of which was confirmed upon the completion of axial computed tomography. Successful closed reduction was achieved and the patient was treated with a period of protected weight bearing on crutches, progressing to full weight bearing over 6 weeks. At 1 year following the injury, the patient was participating in all regular activities of daily living without pain or instability. Early detection and immediate reduction of an acute dislocation of the proximal tibiofibular joint are important to prevent long-term disability.

Bicycle-related injuries in children: disturbing profile of a growing problem.

Klin, B., Rosenfeld-Yehoshua, N., et al. Department of pediatric surgery, Assaf Harofeh Medical Center, Zerifin, Israel.

CONTEXT: We observed a changing pattern of bicycle-related injuries in children, with the focus changing from head trauma to thoracic and abdominal injuries, and a trend to increasingly severe injuries. OBJECTIVE: To assess the changing injury pattern, and investigate the development of preventive measures to improve safety. DESIGN, SETTING, AND PARTICIPANTS: Retrospective record review of 142 paediatric patients admitted to our Department of Paediatric Surgery between 1996 and 2005 following bicycle-related injuries. Clinical, laboratory, diagnostic, and therapeutic aspects were analysed. Additional information concerning children's bicycle-related injuries in Israel was obtained from the Gertner Institute (Israel National Center for Trauma and Emergency Medicine Research) and from Beterem (The National Center for Children's Safety & Health, the Safe Kids Israeli Chapter) National Report on Child Injuries in Israel 2006. MAIN OUTCOME MEASURES: The nature and severity of injuries were reviewed, and two 5-year periods compared-from 1996 to 2000 (53 children-Group 1), and from 2001 to 2005 (89 children-Group 2). RESULTS: Head trauma was more common in the Group 1 patients (52.6% vs. 45.2%), but skull fractures and intracranial haemorrhage occurred more frequently in Group 2 (28.5% vs. 16.7%; 21.3% vs. 8.3%, respectively). Injury to the stomach or duodenum, kidneys and liver were all more common in Group 2. Splenic injury occurred with equal frequency in both groups, but more severe injuries were seen in Group 2. More children in Group 2 required intensive care (31% vs. 19.3%). CONCLUSIONS: There is a changing pattern of bicycle-related injuries in children, with chest and abdominal injuries dominating, and an increasing incidence of more severe injury. These findings are important in decision-making regarding preventive measures.

Quadriceps tendinosis and patellar tendinosis in professional beach volleyball players: sonographic findings in correlation with clinical symptoms.

Pfirrmann, C. W., Josst, B., Pirkl, C., Aitzetmuller, G., & Lajtai, G.. European Radiology, 18(8), 1703-1709, 2008.

The purpose of this investigation was to assess quadriceps and patellar tendinosis in professional beach volleyball players and to correlate ultrasound findings with clinical symptoms. During a grand-slam beach volleyball tournament, all 202 athletes (100 men and 102 women) were invited to participate. Sixty-one athletes (38 male, mean age of 29.6, 23 female, mean age of 27.1) were included. The dominant leg was right in 51 athletes (84%) and left in 10 athletes (16%). Lysholm knee score and pain during the game was assessed using a visual analogue scale. Sonography of the quadriceps tendon and the patellar tendon was performed by a blinded sonographer. Sonographic findings were compared between both legs and correlated to clinical findings using a regression analysis. Quadriceps tendinosis was diagnosed in 13 (21%, dominant leg)/21 (34%, non-dominant leg), patellar tendinosis in 13(21%)/18(30%). Only sonographic findings at the quadriceps tendon were significantly associated with pain: thickness of the quadriceps tendon (mean diameter 6.9 mm/7.1 mm, significant for both legs P = 0.011/P = 0.030), abnormal echo texture (11/16; P = 0.001/P = 0.228), areas with positive power Doppler signals (mean number 0.3/0.4; P = 0.049/0.346), calcifications (mean number: 0.9/1.1; P = 0.021/0.864). A relationship between findings at patellar tendon was not found. Quadriceps tendinosis is as common as patellar tendinosis in professional beach volleyball players. Thickening and structure alteration of the quadriceps tendon is associated with anterior knee pain during beach volleyball.

Are the take-off and landing phase dynamics of the volleyball spike jump related to patellar tendinopathy?

Bisseling, R. W., Hof, A. L., Bredeweg, S. W., Zwerver, J., & Mulder, T.. British Journal of Sports Medicine, 42(6), 483-489, 2008.

The causal mechanism of the chronic sports injury patellar tendinopathy is not well understood. The aim of the present study was to compare ankle and knee joint dynamics during the performance of the volleyball spike jump between healthy volleyball players (n = 8) and asymptomatic volleyball players with previous patellar tendinopathy (n = 7). A cross-sectional design and inverse dynamics were used to estimate ankle and knee joint dynamics. From these multiple biomechanical variables, a logistic regression was performed to estimate the probability of the presence or absence of previous patellar tendinopathy among the volleyball players studied. Several biomechanical variables improved the prediction of the presence or absence of previous patellar tendinopathy. For landing, ankle plantar flexion at the time of touch-down, and knee range of motion during the first part of impact, and for take-off, loading rate of the knee extensor moment during the eccentric countermovement phase of take-off were predictive. As interaction effects, the presence or absence of previous patellar tendinopathy were correctly predicted by ankle and knee range of motion during the first part of impact, by loading rate of the knee extensor moment during the eccentric phases of take-off and landing, and by knee angular velocity during the eccentric phases of take-off and landing. Smaller joint flexion during the first part of landing impact, and higher rate of knee moment development during the eccentric phases of the spike-jump landing sequence, together with higher knee angular velocities, might be risk factors in the development of patellar tendinopathy in volleyball players.

Anthropometric risk factors for patellar tendon injury among volleyball playerers.

Malliaras, P., Cook, J. L., & Kent, P. M.. British Journal of Sports Medicine, 41(4). 259- 63, 2007.

Abnormal imaging in the patellar tendon reveals pathology that is often associated with knee pain. Anthropometric measures of body size and mass, such as height, weight and waist-to-hip ratio (WHR), have been individually associated with abnormal imaging. The aim of this study was to investigate the anthropometric factors that have the strongest relationship with abnormal imaging in volleyball players. Height, weight, body mass index (BMI), waist girth, hip girth and WHR were measured in a cohort of 113 competitive volleyball players (73 men, 40 women). The univariate (ANOVA) and multivariable (discriminant function analysis) association between abnormal imaging and these anthropometric factors were investigated. No significant association was found in the female volleyball players. A significant univariate association was observed between abnormal imaging and heavier weight, greater BMI, larger waist and hip girth and larger WHR in the male volleyball players. Waist girth was the only factor that retained this association in a multivariable model (p<0.05). Men with a waist girth greater than 83 cm seem to be at greater risk of developing patellar tendon pathology. There may be both mechanical and biochemical reasons for this increased risk.

HaHamstring Strain Injuries: Factors that Lead to Injury and Re-Injury.

Physical Examination of the Overhead Athlete's Shoulder.

Radiographic findings in restrained hip joints associated with ACL rupture.

Extensor hood syndrome--osteophytic irritation of digital extensor tendons in rock climbers.

Effect of walking speed and severity of hip osteoarthritis on gait variability.

Magnetic resonance imaging-documented chondral injuries about the knee in college football players: 3-year national football league combine data.

Osseous deficits after anterior cruciate ligament injury and reconstruction: a systematic literature review with suggestions to improve osseous homeostasis.

Stress fractures: classification and management.

Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review

Prevalence of radiological signs of femoroacetabular impingement in patients presenting with long-standing adductor-related groin pain .

Adding a physical exercise programme to brief intervention for low back pain patients did not increase return to work.

Arthroscopic management of chronic patellar tendinopathy.

Are meniscus and cartilage injuries related to time to anterior cruciate ligament reconstruction?

Efficacy of treatment of trochanteric bursitis: a systematic review.

Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review

Prevalence of radiological signs of femoroacetabular impingement in patients presenting with long-standing adductor-related groin pain .

Adding a physical exercise programme to brief intervention for low back pain patients did not increase return to work.

Scapulothoracic Dissociation

Femoroacetabular Impingement: Evidence of an Established Hip Abnormality

Type of sport is related to injury profile: a study on cross country skiers, swimmers, long-distance runners and soccer players. A retrospective 12-month study

The inguinal release procedure for groin pain: initial experience in 73 sportsmen/women

Platelet enriched plasma for acute muscle injury

Dysbaric osteonecrosis in recreational divers: a study using magnetic resonance imaging

A prospective cohort study of hamstring injuries in competitive sprinters: preseason muscle imbalance as a possible risk factor.

Surgical Techniques and Outcomes After Anterior Cruciate Ligament Reconstruction in Preadolescent Patients

Outcomes and Risks of Operative Treatment of Rupture of the Anterior Cruciate Ligament in Children and Adolescents

Increased risk of knee injuries and osteoarthritis in the non-dominant leg of former professional football players

Early Versus Late Start of Isokinetic Hamstring-Strengthening Exercise After Anterior Cruciate Ligament Reconstruction With Patellar Tendon Graft

Tibiofemoral alignment: contributing factors to noncontact anterior cruciate ligament injury

Shoulder injuries in the throwing athlete

Quality and content of Internet-based information for ten common orthopaedic sports medicine diagnoses

Internal impingement of the shoulder in the overhead athlete.

Avulsion of the proximal hamstring origin. Surgical technique.

Athletic activity after total joint arthroplasty.

Adductor-related groin pain in recreational athletes: role of the adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections.

The cervical spine of professional front-row rugby players: correlation between degenerative changes and symptoms.

Tibial Cartilage Damage and Deformation at Peak Displacement Compression During Simulated Landing Impact

Clinical Sports Medicine Update: Management of Tarsal Navicular Stress Fractures: Conservative Versus Surgical Treatment: A Meta-Analysis

Assessment of injuries sustained in mixed martial arts competition.

Review: imaging of groin pain in the athlete.

Risk factors for elbow injuries among young baseball players.

Sports activity after total hip resurfacing.

Stress fractures of the metacarpal bones in adolescent tennis players: a case series.

The outcome of hip arthroscopy in Australian football league players: a review of 27 hips.

Treatment of chondral defects in the athlete's knee.

White on white meniscal tears to fix or not to fix?

Fixation of detached osteochondritis dissecans lesions with bioabsorbable pins: clinical and histologic evaluation.

High tibial osteotomies in the young active patient.

Injuries to kickers in American football: the National Football League experience.

MRI of ankle and lateral hindfoot impingement syndromes.

Distal semitendinosus ruptures in elite-level athletes: low success rates of nonoperative treatment.

Shoulder pain: a comparison of wheelchair basketball players with trunk control and without trunk control.

Sonoelastography in the evaluation of painful Achilles tendon in amateur athletes.

Non-union of the clavicle after intramedullary nailing with a steel Kirschner wire

Patterns of lower limb fractures sustained during snowsports in Otago, New Zealand.

Osteochondrosis of the proximal phalanx of the hallux in adolescent footballers.

Impaired weight transfer persists at least four months after hip fracture and rehabilitation.

Impairment in people with anterior cruciate ligament reconstruction in adjusting ground reaction force in running.

Hook of the hamate fracture.

Brief communication: Transportation and trauma: Dog-sledding and vertebral compression in Alaskan Eskimos.

Ultrasound imaging of the patellar tendon attachment to the tibia during puberty: a 12-month follow-up in tennis players.

Navicular stress fracture in high-performing twin brothers: a case report.

Arthroscopic femoral osteoplasty/chielectomy for cam-type femoroacetabular impingement in the athlete.

Hyperbaric oxygen treatment of musculoskeletal disorders on the Sports medicine. State of the art

Glenoid labral repair in Major League Baseball pitchers

Patellar fracture after patellar stabilization

Posterior sternoclavicular disruption with ipsilateral clavicle fracture in a nine-year-old hockey player.

Predictors of functional ambulation and patient perception following total knee replacement and short-term rehabilitation.

Factors associated with calf muscle endurance recovery 1 year after achilles tendon rupture repair.

Isolated avulsion fracture of the subscapularis tendon with medial dislocation and tear of biceps tendon in a skeletally immature athlete: a case report.

Morel-lavallée lesion in a professional american football player.

Arthroscopic excision of posterior ankle bony impingement for early return to the field: short-term results.

Irreducible open dorsal dislocation of the proximal interphalangeal joint: a case report.

Epidemiology and outcomes of Achilles tendon ruptures in the National Football League.

Elderly kendo (Japanese fencing) player with Kienböck's disease in one wrist and Preiser's disease in the other wrist: a case report.

Comparative functional analysis of two different achilles tendon surgical repairs.

Arthroscopic management of shoulder instabilities: anterior, posterior, and multidirectional.

The effect of a sports chiropractic manual therapy intervention on the prevention of back pain, hamstring and lower limb injuries in semi-elite Australian Rules footballers: a randomized controlled trial.

The application of osteopathic treatments to pediatric sports injuries.

Stress fractures: diagnosis and management in the primary care setting.