Prevalence of hip femoroacetabular impingement deformities in high-level (La Liga) male professional football players.

BACKGROUND: Femoroacetabular impingement (FAI) is considered one of the main causes of hip osteoarthritis in young adults, especially in athletes. In recent years, morphological changes in FAI in the hip have been linked to early and intense sports participation, but studying top-level athlete samples is not easy. This paper presents the prevalence of FAI radiological markers in 120 active white male professional football players in the Spanish First Division League (La Liga) and compares the morphological changes with those of a control group of healthy individuals without significant sport activity. METHODS: The precontract medical evaluation hip X-rays of 120 white male professional football players from four different First Division Spanish football teams were prospectively filed and retrospectively reviewed by a dedicated skeletal radiologist. The footballers' hip X-rays were compared with those of a control group of 80 healthy individuals (age-sex matched) without significant sport activity (obtained from routine work medical checks). RESULTS: The femoral head-neck deformity associated with the Cam type of femoroacetabular impingement was observed in 61.6% of professional football players and only in 11.6% of the control group (p <0.01). The presence of "herniation pit" (11.6%) and os acetabuli (13.3%) also reached statistical significance in the professional football players group. In the other analyzed parameters, no statistically significant differences between the groups were observed. CONCLUSIONS: White professional top-level football players have an increased incidence of abnormal lateral epiphyseal extension ("pistol grip deformity"), os acetabuli and herniation pits.

Modified Arthroscopic Latissimus Dorsi Transfer at the Infraspinatus Footprint With Anterior Extracortical Fixation.

Massive irreparable cuff tears may represent as many as 20% to 40% of total cases of operated rotator cuff tears and can be a challenging clinical problem. Many treatment options have been proposed for their treatment. Among these options, latissimus dorsi tendon transfer can be considered a good alternative, especially in young patients before they develop glenohumeral arthritic changes. This technique aims at rebalancing the shoulder with a functioning subscapularis muscle and restoring both active external rotation and elevation with the aid of a properly functioning deltoid muscle. The modified arthroscopic latissimus dorsi transfer at the infraspinatus footprint with anterior extracortical fixation rebalances the pair of forces acting on the shoulder, stabilizing it in the transverse plane, minimizing the risk of latissimus dorsi transferred rupture and associated complications.

Anterior Shoulder Instability Treated Through an Anterior Arthroscopic Approach.

Anterior shoulder instability remains one of the main indications for shoulder surgery. We present a modified way of treating anterior shoulder instability in the beach-chair position from an anterior arthroscopic approach through the rotator interval. This technique opens the rotator interval, which increases the working area and allows us to work without cannulae. Through this approach, we can treat all injuries comprehensively and, if necessary, switch to other arthroscopic techniques used for instability such as arthroscopic Latarjet or anterior ligamentoplasties.

Modified Dynamic Anterior Stabilization and Labroplasty for Anterior Shoulder Instability With Concomitant SLAP Lesion.

Several arthroscopic techniques to treat anterior shoulder instability have been described. Bankart repair may be insufficient in cases with some degree of bone loss, and arthroscopic Latarjet is technically challenging. It is not rare to find at the time of surgery a more extensive labral tear (SLAP lesion) or an insufficient anterior capsulolabral tissue. We describe for those cases a dynamic anterior stabilization where using the long head of the biceps we are treating the SLAP lesion and at the same time it provides the "sling effect" of a Latarjet procedure for the anterior instability.

Supplementary Tibial Fixation in Anterior Cruciate Ligament Reconstruction With Bone-Tendon-Bone Graft.

Good to excellent results at long-term follow-up have been published for anterior cruciate ligament reconstruction with bone-tendon-bone graft. Despite improvements in fixation devices, concerns regarding the stability of graft fixation on the tibial side remain. We present supplementary tibial fixation for anterior cruciate ligament reconstruction with bone-tendon-bone graft using a transosseous technique that is simple and inexpensive and avoids the risk of symptomatic hardware.

Anterior Shoulder Ligamentoplasty as a Treatment for Multidirectional Shoulder Instability.

Multidirectional shoulder instability represents an ongoing challenge for orthopaedic surgeons, and multiple techniques have been described to treat this condition. We present a modified anterior shoulder ligamentoplasty, in which we perform an inferior glenohumeral ligament (IHGL) anteroinferior and posteroinferior plication and, subsequently, an anterior reinforcement ligamentoplasty with an allograft through the subscapularis tendon, with humeral and glenoid fixation. This arthroscopic technique allows shoulder stability in the throwing position, as the humeral head is not uncovered in abduction, and external rotation by ascending the subscapularis tendon.

Repair of the Posterior Lateral Meniscal Root Tear: Suture Anchor Fixation Through the Outside-In Anterior Cruciate Ligament Reconstruction Femoral Tunnel.

Posterior lateral meniscus root tears are defined as tears that occur within 9 mm of the posterior lateral meniscus insertion or as avulsions of the insertion. If root tears are left unrepaired, functional alterations and early degenerative changes occur in the affected compartment. Several surgical techniques have been described to reattach the posterior horn of the lateral meniscus, including transtibial pull-out technique and side-to-side repair technique. This surgical technique reports an alternative way to repair posterior lateral meniscus root tears that are associated with or without an anterior cruciate ligament graft tear. The technique involves the placement of a suture anchor on the lateral meniscus root footprint through the outside-in anterior cruciate ligament femoral tunnel, which minimizes the possibility of iatrogenic lesions and facilitates repair.

Large variability exists in the management of posterolateral corner injuries in the global surgical community.

PURPOSE: The management of posterolateral corner (PLC) injuries has significantly evolved over the past 2 decades. The purpose of this study was to determine the current worldview of key concepts on the diagnosis, treatment strategy, and rehabilitation for patients presenting with PLC injuries. METHODS: A 12-question multiple-choice online survey was designed to address key questions in the diagnosis, treatment, and rehabilitation of PLC injuries. The survey was distributed to the most important international sports medicine societies worldwide. Clinical agreement was defined as > 80% of agreement in responses and general agreement was defined as > 60% of agreement in responses. RESULTS: 975 surgeons completed the survey with 49% from Europe, 21% from North America, 12% from Latin America, 12% from Asia, and smaller percentages from Africa and Oceania. Less than 14% of respondents manage more than ten PCL injuries yearly. Clinical agreement of > 80% was only evident in the use of MRI in the diagnosis of PLC injury. Responses for surgical treatment were split between isometric fibular-based reconstruction techniques and anatomically based fibular and tibial-based reconstructions. A general agreement of > 60% was present for the use of a post-operative brace in the early rehabilitation. CONCLUSION: In the global surgical community, there remains a significant variability in the diagnosis, treatment, and postoperative management of PLC injuries. The number of PLC injuries treated yearly by most surgeons remains low. As global clinical consensus for PLC remains elusive, societies will need to play an important role in the dissemination of evidence-based practices for PLC injuries. LEVEL OF EVIDENCE: IV.

Posterolateral corner of the knee: an expert consensus statement on diagnosis, classification, treatment, and rehabilitation.

PURPOSE: To develop a statement on the diagnosis, classification, treatment, and rehabilitation concepts of posterolateral corner (PLC) injuries of the knee using a modified Delphi technique. METHODS: A working group of three individuals generated a list of statements relating to the diagnosis, classification, treatment, and rehabilitation of PLC injuries to form the basis of an initial survey for rating by an international group of experts. The PLC expert group (composed of 27 experts throughout the world) was surveyed on three occasions to establish consensus on the inclusion/exclusion of each item. In addition to rating agreement, experts were invited to propose further items for inclusion or to suggest modifications of existing items at each round. Pre-defined criteria were used to refine item lists after each survey. Statements reaching consensus in round three were included within the final consensus document. RESULTS: Twenty-seven experts (100% response rate) completed three rounds of surveys. After three rounds, 29 items achieved consensus with over 75% agreement and less than 5% disagreement. Consensus was reached in 92% of the statements relating to diagnosis of PLC injuries, 100% relating to classification, 70% relating to treatment and in 88% of items relating to rehabilitation statements, with an overall consensus of 81%. CONCLUSIONS: This study has established a consensus statement relating to the diagnosis, classification, treatment, and rehabilitation of PLC injuries. Further research is needed to develop updated classification systems, and better understand the role of non-invasive and minimally invasive approaches along with standardized rehabilitation protocols. LEVEL OF EVIDENCE: Consensus of expert opinion, Level V.

Long-term results of total knee arthroplasty after failed high tibial osteotomy.

PURPOSE: Sometimes, total knee replacement (TKR) is performed after a tibial osteotomy. It is not known if the osteotomy influences the clinical process of a TKR. The aim of this study was to look at the clinical outcome of a TKR after high tibial osteotomy (HTO) compared to a TKR with no HTO. METHODS: Between 1995 and 2005, 41 post-HTO TKRs (group A) with a minimum follow-up of ten years were selected. In parallel, it was selected a control group undergoing simple TKR, consisting of 41 patients (group B) matched with group A. The Knee Society Knee Score (KS), Knee Score Functional Score (FS), the Oxford Knee Score (OKS), and the range of motion (ROM) were used for evaluation at one, five and ten years after surgery. The Insall-Salvatti ratio (ISR), the posterior tibial slope (PTS), and the joint height line (JHL) were also measured both pre-operatively and post-operatively. RESULTS: No differences were found between both groups in KS, FS, OKS, and ROM at the pre-operative stage or at any of the post-operative controls. Higher patellar height was found in group A, both pre-operatively and post-operatively (p < 0.005), and the same for PTS pre-operative (p < 0.001) and post-operative (p < 0.05). No differences were found regarding the JHL. Post-operative differences were found among the post-HTO subgroups at the FS (p < 0.02), the OKS (p < 0.05), and the ROM (p < 0.01) as a function of whether there was a varus or a valgus deformity before the TKR. CONCLUSION: A HTO was not determinant for having a worse outcome at the TKR, even when there were radiographic differences. The coronal alignment with valgus deformity pre-TKR after a HTO showed better functional results than in the case of varus deformity. Level of evidence III.

Opening wedge high tibial osteotomy: plate position and biomechanics of the medial tibial plateau.

PURPOSE: To ascertain whether changing position and size of the spacer may modify the load and displacement of the tibial plateau when performing an opening wedge high tibial osteotomy. METHODS: Fifteen sawbones tibia models were used. In the axial plane, the anterior, medial, and posterior thirds of the tibial plateau were marked, and the medial and posterior thirds were called "point 1" and "point 2", respectively. A 7.5-mm-stainless steel indenter was used to apply the load over these two points: the load applied to point 1 simulated the load to that site when the knee was extended, and the load to point 2 simulated the load to the same area when the knee was flexed. Maximum load (N) and displacement (mm) were calculated. RESULTS: The system was shown to withstand higher loads with less displacement when the plate was posterior than it could do with the plate in the middle position. Significant differences were also found when comparing the anterior and middle position of the plate with the greatest displacement when the plate was anterior. The differences were increased when comparing the anterior and posterior positions of the plate. No statistical differences (n.s.) were found when using different spacers. The maximum stiffness was achieved if the plate was posterior and in point 1 indenter position, in which the force vector stands on the points of the lateral and medial supports (Fµ = 198.8 ± 61.5 N). The lowest stiffness was observed when the plate was anterior, and the force was applied to point 2 (Fµ = 29.7 ± 5.1 N). CONCLUSIONS: Application of the plate in a more posterior position provides greater stability.

Vertical versus horizontal suture configuration for the repair of isolated type II SLAP lesion through a single anterior portal: a randomized controlled trial.

PURPOSE: To compare the clinical and functional outcomes of the repair of an isolated type II SLAP lesion by 2 different configuration techniques (vertical v horizontal suture) through a single anterior portal. METHODS: We designed a prospective, double-blinded, randomized clinical trial. A junior orthopaedic surgeon, who made the initial diagnosis, used a 10-point visual analog scale for pain and subjective instability and the American Shoulder and Elbow Surgeons (ASES) scoring system and evaluated the range of motion. After a diagnostic arthroscopy that ascertained the presence of an isolated type II SLAP lesion, patients were randomized to receive either vertical suture configuration (group 1) or horizontal suture configuration (group 2), both through a single anterior portal. Thirty-two patients were included in the study. The mean follow-up time was 37 months. RESULTS: The mean postoperative ASES score was 91.9 in group 1 versus 95.8 in group 2 (P > .05). The differences observed from preoperative ASES score for both groups to postoperative ASES score were statistically significant. The differences observed in preoperative range of motion from the contralateral healthy shoulder and the affected shoulder in both groups were all clinically and statistically significant. Comparing the overall range of motion of the affected limb postoperatively with the range of motion of the contralateral healthy shoulder and between both groups, we found no statistically significant differences in forward flexion (P = .067), external rotation (P = .101), or internal rotation (P = .343). CONCLUSIONS: The results of this study suggest that the repair of an isolated type II SLAP lesion through a single anterior portal is clinically and functionally beneficial to patients regardless of the suture configuration performed (vertical or horizontal suture) because no differences were observed between these configurations after repair of an isolated type II SLAP lesion. LEVEL OF EVIDENCE: Level I, randomized controlled trial.

The injury profile of Karate World Championships: new rules, less injuries.

The aim of this paper is to document the injury rate in high-level modern competitive karate after a change of competition rules was implemented in the year 2000, and to compare it with the injury rate found before the rules were changed. A prospective recording of the injuries resulting from 2,762 matches in three consecutive World Karate Championships (representing 7,425 min of active fighting) was performed, and compared with the results from 2,837 matches from the three last World Karate Championships (representing 7,631 min of active fighting) held before the change of competition rules. In total, 497 injuries were recorded, with an incidence of 0.180 injuries per match or 6.7 per 100 min of active fighting. There were 1,901 male category fights (in which 383 injuries were recorded), and 861 female category fights (in which 114 injuries were recorded). The global injury incidence was almost double with the old rules compared to the one with the new rules [OR 1.99, 95% CI (1.76-2.26); p < 0.00001]. In male category, the risk of injury was higher before the rules were changed [OR 1.81, 95% CI (1.56-2.09); p < 0.00001], and also in female category [OR 2.71; 95% CI (2.64-2.80); p < 0.00001]. The rate of severe injuries was not different before and after the change of rules. The implementation of the new competition rules in competitive karate has been associated with a significant reduction in injury rate, making competition safer for athletes.

Injury profile in competitive karate: prospective analysis of three consecutive World Karate Championships.

The goal of this paper was to document the injury rate in modern competitive karate. A prospective recording of the injuries resulting from 2,837 matches in three consecutive World Karate Championships (WKC) was performed. Eight hundred and ninety-one injuries were recorded, with an incidence of 0.31 injuries per match or 157.03 injuries per 1,000 athlete exposures. Occurrence of injuries was higher among lighter categories, under 60 kg in males (0.56) and under 53 kg in females (0.42). Punches (737, 82.7%) caused more injuries than kicks (75, 7.3%). The injuries were most commonly located in the face (646, 72.5%) followed by the head (103, 11.6%) and lower limbs (57, 6.4%). The injuries consisted primarily of contusions (448, 50.3%) epistaxis (144, 16.2%) and lacerations (122, 13.7%) followed by concussions (34, 3.8%) and sprains (31, 3.5%). There was some kind of external haemorrhage in 296 injuries (33.7%). The injury rate was similar in the three WKC but the number of severe injuries declined from 1996 to 2000. We conclude that competitive karate is associated with a relatively high injury rate; in one in every three matches medical attention is required, but mainly for minor injuries. Severe injuries are rare.

Complications of open reduction and internal fixation of ankle fractures.

This article discusses the complications after open reduction and internal fixation of ankle fractures. Complications are classified as perioperative (malreduction, inadequate fixation, and intra-articular penetration of hardware), early postoperative (wound edge dehiscence, necrosis, infection and compartment syndrome), and late (stiffness, distal tibiofibular synostosis, degenerative osteoarthritis, and hardware related complications). Emphasis is placed on preventive measures to avoid such complications.

Elongación femoral con fijador externo monolateral: análisis estadístico de los resultados y complicaciones en 144 casos consecutivos

Se presentan los resultados y complicaciones de 114 elongaciones femorales consecutivas mediante osteogénesis a distracción con fijador externo monolateral. La longirud media de elongación fue de 11,3 cm o 48 por ciento de la longitud inicial. Se observó una mayor incidencia de complicaciones y cirugías adicionales por porcentaje de elongación en elongaciones asimétricas que en pacientes displásicos (p=0-010 y p=0.023 respectivamente). Los segmentos con osteotomía metafisiaria presentaron una incidencia mayor de complicaciones y de cirugías adicionales (p=0.031 y p=0.042 respectivamente). Los pacientes con 14 o más años presentaron una incidencia mayor de complicaciones (p=0.047) y un aumento significativo del índice de maduración (p=0.019), que no se correlacionaba con un aumento paralelo de las complicaciones debidas a la pobre formación de hueso