Idiopathic scoliosis and spondylolysis in the female athlete. Tips for treatment.

Idiopathic scoliosis and spondylolysis can be common back problems in female athletes. Diagnosis and treatment can be difficult. With the notable trend toward increasing participation of women and girls in organized sports, it is necessary to know which sports carry additional risks for participants to have these two conditions develop and to determine treatment modalities. In general, idiopathic scoliosis is more prevalent in females and even may be higher in the athletes. Treatment options may include observation, the use of a brace, and surgery. In determining treatment, the type of sport and caliber of athlete must be considered in conjunction with the severity of the curve. Spondylolysis or a stress fracture of the posterior vertebral elements can be a common cause of back pain in an athlete. In many sports that are dominated by females (gymnastics, dancing, figure skating), the athletes carry a high risk of having spondylolysis or a stress fracture. Knowing the risk factors permits precise diagnosis and appropriate treatment. Treatment options include the use of a brace and surgery. In the current study, an extensive review of the literature in conjunction with the extensive experience of a well-established sports medicine clinic at the authors' institution is presented.

Bucket-handle tear of the medial plica.

PURPOSE: The etiology of pathological media plica of the knee is unknown. We describe two cases of large, torn medial plicae. The cases help understand the etiology and avoid diagnostic pitfalls. CASE SUMMARY: Two patients with medial knee pain and pseudolocking were found to have "bucket-handle" tears of the large medial plicae. The pseudolocking phenomenon was observed arthroscopically in an effort to understand causation. DISCUSSION: Direct trauma and lateral traction are hypothesized to lead to thickened, pathologic medial plicae. A history of locking usually leads the examiner to look for torn menisci or loose bodies. These cases show that a medial plica with a longitudinal split can behave in a manner that can be mistaken for locking. The mechanism by which this occurs gives insight about the condition's etiology. RELEVANCE: Present treatment for painful medial plica is physical therapy, occasional corticosteroid injection, and arthroscopic excision when these efforts fail. Based on the evidence from these cases, a reasonable first step after diagnosing a traumatic, painful medial plica might be to selectively strengthen the vastus medialis obliquus.

Back injuries in the young athlete.

Back pain in children and young athletes is very different from back pain in adults. Macrotrauma must be carefully evaluated and managed, even in the absence of definitive radiographic findings. Microtrauma must be suspected in at-risk athletes. These athletes require persistent diagnostic evaluation and may require SPECT bone scan to uncover a posterior element stress reaction. Atraumatic back pain requires the elimination of neoplastic, infectious, rheumatologic, or congenital causes.

Complications experienced in the rehabilitation of zone I flexor tendon injuries with dynamic traction splinting.

A retrospective review of all flexor tendon repairs done between January 1985 to June 1987 determined the complication rate with our method of rehabilitation. One hundred sixty-three flexor tendon lacerations in 83 patients were reviewed. Follow-up ranged from 6 to 42 months. All patients participated in the same 12-week rehabilitation protocol. All patients had passive motion exercises of the interphalangeal joints in the first 2 weeks. We believe that passive stretching of zone I injuries during the first 2 weeks contributed to the zone I complication rate. Of the 20 patients with zone I tendon-to-tendon repairs, 7 patients had significant complications. The 35% complication rate found with zone I injuries has prompted us to modify our postoperative rehabilitation protocol in zone I injuries.

Patella alta and the adolescent growth spurt.

The presence of patella alta has been linked to recurrent dislocation of the patella and the patello-femoral stress syndrome. It is not known whether patella alta is an inherited or acquired trait. To investigate the relationship of patella during the adolescent growth spurt, serial orthoroentgenograms (growth study films) were retrospectively analyzed in 19 patients. Two were found in whom proximal patella migration could be correlated (r = 0.85) with femoral growth rate. This was significant at the p = 0.01 level. Girls had a higher correlation of patella height to growth rate than boys. In certain cases, patella alta is an acquired rather than inherited condition; this supports the theory that overgrowth during the growth spurt can lead to patella alta in some individuals.

Arthroscopic percutaneous lateral patellar retinacular release.

Thirty-four arthroscopic lateral patellar retinacular releases in 26 patients were evaluated retrospectively. Patients were carefully assessed for residual pain; they were also evaluated by various physical examination criteria. In addition, objective measurements of quadriceps and hamstring strength were obtained with the Cybex II Isokinetic Dynamometer. The surgical technique and postoperative management are presented. Overall, there were 9% excellent results, 53% good results, 26% fair results, and 12% poor results. A total of 64.7% of the knees were improved by the procedure.