Treatment of severe brain ischemia with di- and tri-Calciphor (dimer and trimer of 16,16'-dimethyl prostaglandin B1).

Following 20 min occlusion of both carotid arteries, female gerbils were subjected to treatment with di- or tri-Calciphor (dimer or trimer of 16,16'-dimethyl prostaglandin B1). Dimer was injected i.p. at 5 and 10 mg/kg at 5 min and again at 24 h, 30 min and 24 h, 60 min and 24 h or 180 min and 24 h postischemia (N = 25/group). Trimer was given i.p. at 5, 10 or 15 mg/kg at 5 min and 24 h postischemia (N = 25/group.) The controls (N = 25) were injected with the vehicle. Neurological status and postischemic survival of the animals were monitored for 14 days postischemia. Survival of the treated gerbils was significantly improved following the treatment with either di- or tri-Calciphor administered at 10 mg/kg at 5 min and 24 h postischemia (36 vs. 68% di- and 64% tri-Calciphor, P less than 0.05), and with di-Calciphor at 5 mg/kg at 180 min and 24 h postischemia (64%). All other treatment regimens with either drug resulted in a numerical, statistically insignificant improvement. In addition, treatment with either drug reduced the intensity of postischemic neurological impairment. Treatment with di-Calciphor injected at 10 mg/kg at 5 min and 24 h post 20 min ischemia substantially reduced the period of postischemic locomotor hyperactivity. The drug had no impact on either body temperature or blood pressure. There is evidence that the effects of Calciphor may be mediated via calcium regulatory mechanisms. The results of the present study are discussed in the light of such possibility.

Foot inversion-eversion and knee kinematics during walking.

The purpose of this study was to monitor selected aspects of the three-dimensional kinematics of the knee during walking with regular shoes and with modified shoes that induced either pronation or supination of the foot. Steinmann traction pins were inserted into the right tibia and femur of five adult men who had apparently normal lower extremities. Target clusters mounted onto the pins were filmed by four cine cameras operating at 100 frames/sec. Two trials per subject were analyzed for each of the three experimental conditions: regular running shoes, running shoes with a 10 degree valgus wedge, and running shoes with a 10 degree varus wedge. The different types of footwear induced only minor kinematic changes at the knee during the stance phase of walking. The angular patterns of the tibiofemoral joint were modified by less than 1 degree, whereas the translatory patterns were altered by 2 mm. Immediately following foot-strike, the valgus-wedge shoes caused the tibia to rotate internally 4 degrees more than the varus-wedge shoes, but at the tibiofemoral joint no consistent differences in the pattern of internal-external rotation between normal and modified footwear were measureable. These findings suggest that, in the healthy lower extremity, increased internal and external tibial rotation is resolved at the hip joint, with changes at the tibiofemoral joint that barely are detectable with the techniques used in this study.

Women athletes with menstrual irregularity have increased musculoskeletal injuries.

We have performed a retrospective three-phase study to evaluate the effect of menstrual status upon musculoskeletal injuries in women athletes. Initially, we collected the menstrual and running histories of women participants in a regional 10-km footrace. In this study, 61% of the respondents to our questionnaire reported a continuous running program, and 39% reported an interruption of at least 3 months of their running program. The most common cause for interruption was injury. Those who had interrupted their running were more likely to have had irregular or absent menses and less likely to have been using oral contraceptives than the group of continuous runners. Secondly, we obtained information on the relationship between bone injury and menstrual status by reviewing the sports medicine records of 207 collegiate women athletes. We found that X-ray-documented fractures occurred in 9% of women athletes with regular menses and in 24% of women athletes with irregular or absent menses. Subsequently, we collected data from a larger population of more serious, but still recreational runners, participating in a national 10-km race. Each portion of this study has yielded similar results: those women who had been injured during their running program were more likely to have had absent or irregular menses, were less likely to have used oral contraceptives, and had been running for more years. We conclude that premenopausal women who have absent or irregular menses, while engaged in vigorous exercise programs, are at increased risk for musculoskeletal injury.

The Ellison iliotibial-band transfer for a torn anterior cruciate ligament of the knee. Long-term follow-up.

We studied the long-term results of the Ellison technique of extra-articular transfer of the iliotibial band, without advancement of the biceps tendon, as the sole operative treatment for a torn anterior cruciate ligament. Thirty-two patients (thirty-two knees) were evaluated an average of eleven years (range, seven to fifteen years) after the operation. The average age at the time of the operation was twenty-two years (range, sixteen to thirty-four years). Eighteen patients (56 per cent) had a modified Lysholm score of less than 84 points, indicating symptoms during the activities of daily living. Only six patients (19 per cent) had a subjectively normal knee (a modified Lysholm score of more than 94 points). The most common reason for a poor subjective score was the presence of symptoms of instability, in twenty-four patients (75 per cent). Twenty-four patients (75 per cent) had a positive pivot-shift test and twenty-nine patients (91 per cent), a positive Lachman test. Twelve patients (38 per cent) had severe (grade 3 or 4) radiographic changes. The radiographs of the knee appeared normal (grade 0) in only eight patients (25 per cent). There was a significant association between a meniscal injury and radiographic changes (p < 0.05). Fourteen patients (44 per cent) had subsequent procedures due to persistent instability or pathological changes in the articular cartilage or in a meniscus. There was a significant decline in the subjective and objective knee scores in the twenty-one patients who were evaluated at both two and eleven years. The number of patients who had a positive pivot-shift test increased from five (24 per cent) to sixteen (76 per cent). Subjectively, the number of patients who had a good result decreased from fourteen (67 per cent) to five (24 per cent). Objectively, nine patients (43 per cent) had a rating of good at two years; this fell to three (14 per cent) at eleven years. Symptomatic instability, pain, and a positive pivot-shift test were the most common reasons for a poor result. Because of the decline in the subjective and objective scores, we no longer recommend the Ellison procedure as the sole operative treatment for a torn anterior cruciate ligament of the knee.

Three-dimensional kinematics of the human knee during walking.

Three-dimensional kinematics of the tibiofemoral joint were studied during normal walking. Target markers were fixed to tibia and femur by means of intra-cortical traction pins. Radiographs of the lower limb were obtained to compute the position of the target markers relative to internal anatomical structures. High-speed cine cameras were used to measure three-dimensional coordinates of the target markers in five subjects walking at a speed of 1.2 m s-1. Relative motion between tibia and femur was resolved according to a joint coordinate system (JCS). The measurements have identified that substantial angular and linear motions occur about and along each of the JCS axes during walking. The results do not, however, support the traditional view that the so-called 'screw home' mechanism of the knee joint operates during gait.

Fractures and refractures in intercollegiate athletes. An eleven-year experience.

This report on fractures and refractures in intercollegiate athletes covers an 11-year period from the early Fall of 1968 through the Spring of 1979. Two hundred thirty-one fractures occurred in 219 athletes. Of these athletes, 185 were male and 34 were female. Fractures occurred in 18 sports. Of these 18, football, basketball, wrestling, and soccer led in number for Men's (M) teams, and gymnastics, lacrosse, and volleyball led for Ladies' (L) teams. (Because of this institution's early involvement with Title IX, and the strong position taken by our administration, our teams are designated Gentlemen (Men for short), which constitute the LIONS, and Ladies, which make up the LADY LIONS.) No fractures were noted in the other 11 intercollegiate teams of cheerleading (M and L), bowling (M and L), golf (M and L), fencing (L), rifle (coed), tennis (M and L), and volleyball (M). Boxing, ice hockey, rugby, soccer, and synchronized swimming are club sports at the Pennsylvania State University and are not included in this study. The most common of the 17 fracture sites were the finger, hand, face, foot, nose, and leg, regardless of sport or gender. Fourteen of fifteen refractures occurred in collision/contact sports, and essentially the same mechanical forces caused both fractures. In football most fractures occurred during highly successful seasons.

Anterolateral rotatory instability of the knee. An analysis of the Ellison procedure.

In an attempt to correct anterolateral rotatory instability of the knee, 30 consecutive patients underwent a surgical procedure similar to that described by Ellison (Ellison AE: A modified procedure for the extra-articular replacement of the anterior cruciate ligament. American Orthopaedic Society for Sports Medicine Symposium, New Orleans, LA, July 15, 1975), called the iliotibial band transfer. Fashioning the passageway for the transfer closer to the attachment of the fibular collateral ligament on the femur and meticulous fascial closure over the transplant were not found to be crucial to success. Twenty-nine of the 30 patients were injured during athletic activities, and the remaining patient was injured in a motorcycle accident. They often complained of an unstable knee with symptoms of pain and giving way. Twenty-eight patients with a minimum followup of nine months (the average followup was 25 months) were evaluated subjectively by an interview and by objective clinical examination. Subjective results (including asymptomatic return to their previous level of athletic activity) and clinical improvement of anterolateral rotatory instability (based on the flexion-extension-valgus test or the Slocum anterolateral rotatory instability test) were encouraging. Areas of concern were that a small number of patients developed asymptomatic varus instability and a few had relative strength deficits which may or may not have long-term significance.

Meniscus repair in the anterior cruciate deficient knee.

From 1979 to 1986, isolated repair of a peripheral vascular zone meniscal tear was performed in 22 patients (23 menisci) who had ACL insufficiency. For various reasons none of these patients underwent repair or reconstruction of their ACL. The meniscus repair was done by open arthrotomy in 12 cases and by arthroscopic techniques in 11 cases. The purpose of this study was to evaluate the success rate of a meniscal repair in an anterior cruciate deficient knee. The average age of the patients at the time of surgery was 25 years and the average followup was 56 months. Six patients (26%) had mild occasional pain not requiring medication and one patient had moderate pain requiring nonnarcotic pain medication. Eight patients (26%) had occasional giving way episodes and one of them underwent ACL reconstruction 5 years later because of frequent giving way. One patient required a postoperative manipulation for inadequate range of motion, but there were no neurovascular injuries or infections. There were three patients (13%) who had failed repairs or a retear and required subsequent subtotal meniscectomies. None of the other patients had any clinical symptoms or signs of a meniscal tear. There were no significant differences between the results of open or arthroscopic repair. Even though the failure rate of meniscus repair may be greater in an unstable knee, we conclude that meniscus repair is not contraindicated in an anterior cruciate deficient knee.

Saphenous nerve entrapment at the adductor canal.

A retrospective study of 30 patients who met the clinical criteria for saphenous nerve entrapment at the adductor canal is described. Patients experienced symptoms, usually anterior knee pain, for an average of 36 +/- 7 months. Each patient received an average of 1.9 +/- 0.4 saphenous nerve blocks at the adductor canal during treatment. Baseline pain level (measured by the visual analog scale) was 6.4 +/- 0.3. Final pain level at followup was significantly decreased (2.8 +/- 0.5, P less than 0.001). Eighty percent of patients had improved after a series of blocks. Age, medications taken, number of blocks performed, and length of followup were unrelated to outcome. Length of symptoms did significantly correlate with final pain level (r = 0.39, P less than 0.05). The diagnosis of this syndrome, description of the saphenous nerve block at the adductor canal, and the possible etiology are presented.

The effect of a pneumatic leg brace on return to play in athletes with tibial stress fractures.

A total of 18 competitive and recreational athletes were enrolled in a randomized, prospective study looking at the effect of pneumatic leg braces on the time to return to full activity after a tibial stress fracture. All patients had positive bone scans and 15 had positive radiographic findings by Week 12. There were two treatment groups. The traditional treatment group was treated with rest and, after 3 pain-free days, a gradual return to activity. The pneumatic leg brace (Aircast) group had the brace applied to the affected leg and then followed the same return to activity guidelines. The guidelines consisted of a detailed functional progression that allowed pain-free return to play. The brace group was able to resume light activity in 7 days (median) and the traditional group began light activity in 21 days (median). The brace group returned to full, unrestricted activity in 21 +/- 2 days, and the traditional group required 77 +/- 7 days to resume full activity. The Aircast pneumatic brace is effective in allowing athletes with tibial stress fractures to return to full, unrestricted, pain-free activity significantly sooner than traditional treatment.

Manpower Loss in Football: A 12-Year Study at The Pennsylvania State University.

In brief: All the injuries and illnesses that resulted in days lost from football participation were tabulated for a 12-year period. Each occurrence (2,186) and the number of days lost (11,730) were ranked in 11 categories. Knee injuries (495) were the most numerous and resulted in the most lost days (4,426). The ankle category ranked second in both groups. Illness did not contribute significantly in either group. Games produced 33% of all injuries; more than 70% of head injuries occurred during games but only 14.3% of strains occurred during games. Time-loss knee injuries occurred in 18% of the players; 93 surgical procedures were performed, and there were 13 cases of repeat knee surgery.

Ununited fracture of the lateral condyle of the humerus. A 50 year follow-up.

This is a case report of a 74-year-old man with an ununited fracture of the lateral condyle of the humerus of 50 years duration. There was minimal loss of motion, a moderate cubitis valgus deformity, and a definite ulnar nerve palsy. Despite the deformity and ulnar palsy, he was able to provide for himself and to perform satisfactorily as a laborer.

The accessory soleus muscle.

The accessory soleus muscle, as a clinically significant finding, has been infrequently reported in the English literature. Prior to the advent of the computerized tomography (CT) scanner, the diagnosis could only be suspected and was confirmed only at surgery. The CT scanner assists in differential diagnosis of a painful ankle mass and reveals the size and extent of the mass as well as its density. The density determinations in this case were most consistent with a muscle mass and led to the preoperative diagnosis of an accessory soleus muscle.

The saphenous nerve: an external method for identifying its exit from the adductor canal.

The saphenous nerve is the largest and longest branch of the femoral nerve. At its proximal origin, it travels with the femoral artery. The nerve passes lateral to medial in the adductor canal to emerge subcutaneously and supply the medial side of the knee. This investigation analyzes the course of the nerve in 24 lower extremities (12 right, 12 left) and offers a standardized measuring system for externally pinpointing the nerve's exit from the canal. This study may benefit physicians who treat patients with knee pain of obscure etiology. It probably will have direct application to saphenous nerve injection by physicians as part of a pain-management program.