Quadriceps tendon autograft and platelet rich plasma injection to treat chronic Achilles tears-a minimum two-year follow-up.

BACKGROUND: The possibility of using a bone-tendon quadriceps tendon graft and platelet rich plasma (PRP) injection to enhance healing capability, to solve the defect created by stump retraction in chronic Achilles tendon ruptures was studied in a series of 8 patients. METHODS: A series of 8 patients studied prospectively and followed for more than 24 months is presented. Results were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score, and evaluating pain, level of activity, footwear restrictions, and satisfaction. Statistical analysis was done by the sign test for matched pairs and Wilcoxon signed-rank test. Alpha error was set at 0.05. RESULTS: Preoperatively, patients showed an average AOFAS score of 77.25 (range, 67-88). After surgery, AOFAS score showed a marked improvement in all the cases, with an average of 95.6 (range, 87-100). Improvement in AOFAS score results was statistically significant, both for sign test for matched pairs (P=0.008) and for Wilcoxon signed-rank test (P=0.012). All of the patients were satisfied with the results of the procedure, and would undergo it again. CONCLUSIONS: Autologous quadriceps tendon graft (in bone-tendon configuration) has proved as a simple technique that offers good results to patients with tissue defects in the Achilles tendon.

Injuries of the obturator muscles in professional soccer players.

PURPOSE: Obturator externus and internus muscular tears are uncommon injuries. Only a few case reports exist, mainly in high-level athletes. Our aim is to describe a series of obturator externus and internus muscular tears in professional soccer players. METHODS: Injury data from four teams from the First Division of the Spanish Soccer League were collected over a total of four seasons. Any soccer player who sustained an injury to either the obturator externus or internus identified on magnetic resonance (MRI) was included. All injured players were treated non-operatively with a goal of returning to play as fast as possible. RESULTS: Sixteen players sustained injuries to the obturator externus and internus during matches or training sessions. The main complaint was anterior hip pain with a physical examination showing pain during internal rotation or external rotation of the flexed hip. The MRI documented 12 muscular tears of the obturator externus, and 4 muscular tears of the obturator internus. All injuries were treated conservatively based on physical therapy, analgesic medications, and underwent a symptoms-based rehabilitation protocol. Mean return to play was 11.5  ±  8.8 days. CONCLUSION: Although uncommon, tears of the obturator externus and internus occur in professional soccer players. The MRI scan was essential to the location, classification, and evaluation of the injury size. The clinical relevance of our investigation is based on the relatively benign prognosis of these injuries. LEVEL OF EVIDENCE: IV.

Quadriceps autograft to treat Achilles Chronic tears: a simple surgical technique.

BACKGROUND: Chronic Achilles tendon tears could hinder patients and represent a challenge to surgeons. Although many different surgical techniques have been proposed for reconstruction of a neglected Achilles tendon rupture, there is no clear evidence to support one technique over the others, but the use of a technique that could allow for an "anatomical" reconstructions seems desirable. METHODS: The present paper describes a new anatomic Achilles tendon reconstruction for chronic tears, using a quadriceps tendon autograft as graft source, with PRP injected into the graft and the neighbor tissue, and fixation in a bone trough with a simple small fragments screw. RESULTS: Autologous quadriceps tendon graft seems an excellent option, although -surprisingly- has received little attention until now. CONCLUSIONS: Autologous Quadriceps tendon graft (in bone-tendon configuration) is a simple technique that could allow surgeons to reconstruct tissue defects in the Achilles tendon with non-expensive hardware.

Arthroscopic reduction of a chronically dislocated reversed shoulder arthroplasty.

We present the case of a 64-year-old female patient who had a traumatic dislocation of a reversed shoulder arthroplasty that was unnoticed for 5 weeks and that was reduced arthroscopically. Arthroscopy of the shoulder, as in other joints with prostheses, can facilitate the treatment of conditions that would otherwise require the use of open surgery to solve them and that might become more frequent because of the widespread use of reversed shoulder arthroplasties, which have a high rate of dislocation.

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.

Stress fractures of the femur after ACL reconstruction with transfemoral fixation.

The ACL reconstruction with hamstring tendons has become increasingly popular, in part because it is assumed that the complication rate associated with the technique and their severity are lower than with patellar tendon. Two cases of stress reaction of the medial supracondylar area of the femur after ACL reconstruction with hamstring tendons using BioTransfix (Arthrex, Naples, FL, USA) devices for fixation within femur are presented. Both patients were professional athletes (one soccer and one basketball player), and it is hypothesized that the accelerated rehabilitation program used might have represented a risk factor for stress fractures when associated with the guide pin exit hole in the medial femoral cortex. To our knowledge, no such cases have been published to date, but it is important to consider this possibility if an unexplained pain arises in the rehabilitation process of an ACL reconstruction using transfemoral fixation.

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.