Limb preference impacts single-leg forward hop limb symmetry index values following ACL reconstruction.

Following anterior cruciate ligament (ACL) reconstruction limb dominance for performing tasks is not considered when making rehabilitation progression decisions. The purpose of this study was to determine if strength and functional outcomes differ between individuals who injured their preferred or nonpreferred jumping limb and to determine if these same outcomes differ between individuals who injured their preferred or nonpreferred limb used to kick a ball. A secondary purpose was to determine the association of quadriceps strength and single-leg forward hop performance with patient self-reported function. Forty individuals with ACL reconstruction (age = 20.0 ± 4.6 years, height = 174.2 ± 12.7 cm, mass = 71.2 ± 12.7 kg, time since surgery = 5.3 ± 0.8 months) were included in the study. Primary outcome measures included, International Knee Documentation Committee Subjective Knee Form (IKDC) scores, quadriceps limb symmetry index (LSI) values, and single-leg forward hop LSI values. Limb preference was defined two ways, kicking a ball and performing a unilateral jump. There were no significant differences between groups based on injury to the preferred limb to kick a ball for any of the outcome variables. Individuals who injured their nonpreferred jumping limb demonstrated significantly (p = 0.05, d = 0.77) lower single-leg forward hop LSI values (81.1% ± 19.5%) compared to individuals who injured their preferred jumping limb (94.1% ± 12.6%), but demonstrated no differences in IKDC scores or quadriceps LSI values. Quadriceps LSI and single-leg forward hop LSI explained 73% of the variance in IKDC scores, but quadriceps LSI had the strongest association (r = 0.790). These findings suggests that limb preference influences single forward hop LSI values and should be considered following ACL reconstruction.

Quadriceps muscle activation and radiographic osteoarthritis following ACL revision.

PURPOSE: Quadriceps strength and activation may play an important role in the recovery from ACL revision surgery. The purpose of this study was to describe quadriceps strength and central activation ratio (CAR) and correlate with radiographic findings in patients with ACL revision surgery. METHODS: Twenty-one patients who were on average 47.5 ± 21.1 months [range: 14-85 months] post-revision ACL reconstruction. We performed knee joint physical examination and radiographic evaluation. Quadriceps strength testing consisted of maximal voluntary isometric contractions (MVIC) with the knee bent to 90-degrees bilaterally. We calculated quadriceps central activation ratio using the superimposed burst technique. Radiographs (bilateral standing antero-posterior in knee flexion and lateral in full extension) were evaluated by a fellowship-trained orthopedic surgeon using the International Knee Documentation Committee (IKDC) grading system. RESULTS: Mean CAR was 83.9 ± 12.0% on the reconstructed limb and 85.5 ± 9.5% on the contralateral limb. Average, normalized MVIC torque was 2.5 ± 1.0 Nm/kg on the reconstructed limb and 2.7 ± 1.0 N m/kg for the contralateral limb. Patient age at the time of follow-up evaluation was related to severity of knee joint degeneration, particularly the medial, anterior and patellofemoral compartments. Younger patients with lower CARs tended to have more severe degeneration in the patellofemoral joint. Older patients with lower normalized MVIC torque values tended to exhibit more severely graded degeneration in the patellofemoral joint. CONCLUSION: Bilateral quadriceps central activation deficits and radiographic osteoarthritis are evident in patients with revision ACL reconstruction.

Quadriceps Strength Influences Patient Function More Than Single Leg Forward Hop During Late-Stage ACL Rehabilitation.

BACKGROUND: A comprehensive battery of tests are used to inform return to play decisions following anterior cruciate ligament (ACL) reconstruction. Performance measures contribute to patient function, but it is not clear if achieving symmetrical performance on strength and hop tests is sufficient or if a patient also needs to meet minimum unilateral thresholds. HYPOTHESIS/PURPOSE: To determine the association of quadriceps strength and single-leg forward hop performance with patient-reported function, as measured by the IKDC Subjective Knee Form (IKDC), during late-stage ACL rehabilitation. A secondary purpose was to determine which clinical tests were the most difficult for participants to pass. STUDY DESIGN: Descriptive Laboratory Study. METHODS: Forty-eight individuals with a history of ACL-R (32 female, 16 male; mean±SD age=18.0±2.7 y; height=172.4±7.6 cm; mass=69.6±11.4 kg; time since surgery=7.7±1.8 months; IKDC=86.8±10.6) completed the IKDC survey, quadriceps isometric strength, and single-leg forward hop performance. The relationship between IKDC scores and performance measures (LSI and involved limb) was determined using stepwise linear regression. Frequency counts were used to determine whether participants met clinical thresholds (IKDC ≥ 90%, quadriceps and single-leg forward hop LSI ≥ 90%, quadriceps peak torque ≥ 3.0 Nm/kg, and single-leg forward hop ≥ 80% height for females and ≥ 90% height for males). RESULTS: Quadriceps LSI and involved limb peak torque explained 39% of the variance in IKDC scores while measures of single-leg forward hop performance did not add to the predictive model. Nearly 90% of participants could not meet established clinical thresholds on all five tests and quadriceps strength (LSI and peak torque) was the most common unmet criteria (71% of participants). CONCLUSIONS: During late-stage ACL rehabilitation deficits in quadriceps strength contribute more to patient function and are greater in magnitude compared to hop test performance. LEVEL OF EVIDENCE: Cross-Sectional Study, Level 3.

Semimembranosus tendon viewed through an isolated medial meniscus capsular avulsion: a case report.

The semimembranosus is a key component of the complex anatomy of the posteromedial knee. Its multiple distal insertions are intimately associated with the posterior capsule, medial meniscus, and posterior oblique ligament. Visualization of the semimembranosus is possible during arthroscopy when a significant posteromedial capsular injury is present. This typically occurs only in the setting of significant trauma, with associated injury to the other posteromedial knee structures. We present a case of an isolated medial meniscus capsular avulsion, with minimal trauma, in which the semimembranosus tendon is clearly visualized during arthroscopic meniscal repair.

Meniscal repair: indications and techniques.

Meniscal tears are exceedingly common. Because the meniscus serves many vital functions to the knee joint, the preservation of meniscal tissue through meniscal repair is ideal. However, not all meniscal tears are amenable to repair, and each case must be critically assessed for repair suitability. It has been well documented that meniscal healing is enhanced in the setting of concurrent anterior cruciate ligament (ACL) reconstruction. This may influence the indications for repair, as well as the repair technique. Meniscal repair techniques have evolved over time from initial open repairs to inside-out and outside-in suture repairs to newer all-inside repair devices. The current gold standard remains inside-out vertical mattress suture repairs. All-inside repairs are best reserved for special circumstances, such as in the setting of concurrent ACL reconstruction.

Weight changes in spouses of gastric bypass patients.

BACKGROUND: The effectiveness of gastric bypass for weight loss has been demonstrated. No study has documented the effect of this surgery on patient spouses' weight. Excess leftover food may be consumed by the spouses of gastric bypass patients, which may increase the total caloric intake compared to the preoperative intake. This investigation tested the hypothesis that there would be a significant change in patient spouse's weight. METHODS: Patients who underwent Roux-en-Y gastric bypass (RYGBP) > or = 12 months before were included. Preoperative weights of their spouses were requested before RYGBP surgery. Current weights of spouses were collected > or = 12 months postoperatively. Chi-squared tests were used for statistical analysis. RESULTS: 63 patients were included in this study. 1 patient was divorced and current data was not available. 3 patients' spouses themselves had RYGBP during the study period, and their average weight loss was 49 kg. Of the spouses who had a significant change in weight (but did not have a RYGBP), 13 lost weight and 20 gained weight. In this subgroup of spouses, 75% (15/20) of obese spouses gained weight compared to only 38% (5/13) non-obese spouses (P <0.04). CONCLUSIONS: Patients' spouses who are obese are more likely to have weight gain while the patients lose weight after RYGBP. Preoperative counseling should be offered to spouses of potential bariatric surgery patients, especially to spouses who are obese. This phenomenon suggests that obese spouses of bariatric patients should be counselled regarding weight gain or even be considered for candidates for bariatric surgery.

Internet use in the bariatric surgery patient population.

BACKGROUND: Many patients rely on the Internet for gathering medical information. Bariatric patients appear to explore the Internet for information regarding weight loss surgery. This investigation studied the hypothesis that Internet use is common among the bariatric population. METHODS: From Oct 1 to Dec 31, 2003, every patient who visited our bariatric clinic was asked to fill out a questionnaire. This survey contained questions concerning use of the Internet and E-mail. RESULTS: Of the 127 respondents, 89% owned a computer, had Internet access, and had an E-mail address. 85% of the patients had searched the Internet for bariatric information, and 98% of these patients (91/93) found the information useful. Of the patients who had access to the Internet, 36% searched for information about the hospital, 40% about the clinic, and 54% about the surgeon. Most of the patients believed that all doctors and all clinics should be available via E-mail (88% and 92% respectively). CONCLUSIONS: Most patients who come to a bariatric clinic are Internet savvy. It is helpful for bariatric surgeons and clinics to post information about themselves on the Internet and to be available via E-mail.

Massive rotator cuff tear in an adolescent athlete: a case report.

Full-thickness rotator cuff tears in the young athlete are a rare injury. These injuries typically result from an acute traumatic event in a contact athlete, as opposed to overuse injuries more commonly seen in throwing athletes. Acute tears may be initially overlooked, with the symptoms attributed to other, more common causes, such as cuff contusion or brachial plexus neuropraxia ("stinger" or "burner"). If undiagnosed, the tear may progress to an irreparable state at the time of eventual diagnosis. Therefore, rotator cuff tear must be included in the differential for acute shoulder injuries in the young athlete. This article presents a case of an adolescent athlete with a traumatic, massive rotator cuff tear that was diagnosed and managed promptly with excellent outcome.

All-inside meniscal repair.

All-inside meniscal repair has gained widespread popularity over recent years. The devices and techniques have rapidly evolved, resulting in increased ease of use and reduced surgical times and risk to the neurovascular structures. Despite these advances, inside-out suture repairs remain the current gold standard, with proven long-term results. All-inside techniques must continue to be compared to inside-out meniscal repair.