Anterior Cruciate Ligament Injuries in Female Athletes.

This JAMA Insights discusses anterior cruciate ligament (ACL) injuries in female athletes, including modifiable and nonmodifiable sex-based risk factors and the implementation of ACL injury prevention programs.

Achilles Tendon Injuries Requiring Surgical Treatment in the Pediatric and Adolescent Population: A Case Series.

ABSTRACT: Pediatric Achilles tendon injuries requiring surgical treatment are considered rare and have not been well described. A retrospective chart review was conducted from 2010 to 2020 to identify cases of acute Achilles tendon rupture or laceration that required surgical repair in individuals 19 years or younger. A total of 24 individuals with acute Achilles tendon ruptures (n = 8) and lacerations (n = 16) were identified. All spontaneous ruptures occurred in skeletally mature individuals during sports. One subject was on minocycline at the time of injury, while two had a body mass index (BMI) ≥ 99% for age. Another had a history of clubfoot surgery on the injured side. Patients with lacerations were younger (9.9 ± 3.3 vs 16.3 ± 1.6 years) and had lower BMI (17.3 ± 3.8 vs. 28.0 ± 9.4) than those with spontaneous ruptures. The majority of cases had good outcomes with no postoperative complications.

Acute on chronic cervical myelopathy causing cervical segmental myoclonus in a high-level wheelchair athlete: a case report.

INTRODUCTION: This is a 20-year-old wheelchair athlete with history of caudal regression syndrome and cervical canal stenosis who developed spinal segmental myoclonus following routine intubation for an elective procedure. CASE PRESENTATION: This patient is a 20-year-old man with history of caudal regression syndrome and chronic cervical stenosis. He is a high-level wheelchair racer and paralympic hopeful. This patient initially presented 18 months prior with shoulder abduction weakness. He was found to have cervical stenosis at C4, C5 on MRI. Neurosurgical treatment was not needed at that time as symptoms resolved. On this encounter, he presented for an elective urologic surgical procedure. Glidescope intubation was performed with notable cervical extension. In the Post Anesthesia Care Unit, the patient began experiencing twitching movements in his pectoral muscles bilaterally as well as left deltoid and biceps. His findings were consistent with myoclonus due to his cervical myelopathy. He was initially started on levetiracetam, but experienced dizziness. His symptoms were finally controlled with clonazepam. Neurosurgery performed cord decompression and fusion with resolution of his symptoms. DISCUSSION: There are few cases of myoclonus secondary to myelopathy documented in literature. The current recommended treatments, levetiracetam and/or benzodiazepines, were successful in managing the myoclonus in this patient. However, cord decompression is necessary to avoid progression of myelopathic symptoms. In conclusion, myoclonus can be a presenting symptom of myelopathy and warrants further investigation, especially in patients with known spinal cord or vertebral pathology.

Systematic review of cervical pedicle dimensions and projections.

STUDY DESIGN: A systematic review of the published literature was conducted specifically looking at studies reporting linear dimension and angular projection data on the anatomy of the cervical pedicle (C1-C7) via radiography or direct measurement. OBJECTIVE: This study aimed to report a more accurate set of dimension data and identify differences based on race and gender, increasing the sample size by aggregating similar data of prior studies measuring the cervical pedicle in Asian, European/American, male, and female populations. SUMMARY OF BACKGROUND DATA: A wide variation in the reports of the dimensions and projections of the cervical pedicle exist partly due to the uniqueness of this structure as well as the effects of small sample sizes and variable races and genders of sample populations of previous studies. METHODS: An extensive literature search was executed, and identified articles were reviewed. A comprehensive database was constructed for synthesis of the identified studies. Subgroups were determined based on the type of population (race, gender, location of study) and radiographic or direct cadaveric measurement. Descriptive statistics were used to analyze and compare these subgroups including: means, standard deviations, and Student t test with the Bonferroni adjustment. RESULTS: In total, the current study reports on 33 studies with the measurements of 1311 partial and complete cervical spines. At a 95% confidence interval statistically significant differences between races were found only at C3 and C4 levels in the pedicle axis length. Male-to-female significant differences existed only at the pedicle axis length of C5 in the Asian population, while sex differences existed in the outer pedicle width and height of C3, C4, C5, C6, and C7 in the European/American population. CONCLUSION: The current study has found that there is no statistical difference in measuring the cervical pedicle via radiography (CT) or directly. There are more significant differences comparing the cervical pedicles of males and females in the European/American population than exists in the Asian population (specifically in pedicle width and height). There are also significant differences at C3 and C4 cervical pedicle between the Asian and European/American population (specifically in the pedicle axis length and transverse angle).