The effect of bracing on the collateral ligaments of the knee.

Disruption of the ligamentous structures of the knee is commonly seen in competitive sports. The role of prophylactic and functional bracing is controversial. Currently, prophylactic bracing has not been shown, conclusively, to be protective. Functional braces appear to have a capacity to provide some protective effect.

Prevention of ligament injuries to the knee.

Disruption of the ligamentous structures of the knee are commonly seen in competitive sports. Factors affecting the rate of injury include the sport, the participant, conditioning and technique, the level of competition, rules enforcement, the type of playing surface, and footwear. The role of prophylactic and functional bracing is controversial. Currently, prophylactic bracing has not been shown, conclusively, to be protective. Functional braces appear to have a capacity to provide some protective effect.

The effect of knee braces on lateral impact loading of the knee.

Disruption of the medial supporting structures of the knee occurs commonly in contact sports such as American football and lacrosse. A limited number of clinical and laboratory studies currently document the effectiveness of bracing. The purpose of this project was to determine if commercially available bracing could be shown to produce objective evidence of medial stabilization of the knee. Our model involves the use of a cadaver lower extremity with a fixed foot and suspended femur with a free knee and a lateral impact load applied simulating a clipping injury. Force transducers were placed on the ACL and medial collateral ligament (MCL) and an electrogoniometer was attached to the extremity. The prophylactic braces studied had a limited capacity to protect the MCL from direct lateral stress with the knee in full extension. In flexion or with a change in direction of the load, the protective effect is greatly reduced. The functional braces had a capacity to limit abduction and rotational stresses on the MCL in flexion and extension.

A biomechanical study of the static stabilizing effect of knee braces on medial stability.

The purpose of this project was to determine if commercially available braces could be shown to produce objective evidence of medial stabilization of the knee. Commercially available athletic braces were evaluated for their effect on abduction forces applied to a cadaver knee with no instability and with experimentally created medial instability. Under computer control, abduction forces were applied while simultaneous data were obtained from an electrogoniometer and transducers applied to the anterior cruciate ligament and the superficial medial collateral ligament at 0 degrees, 15 degrees, and 30 degrees of flexion. Our results showed a reduction in abduction angle using functional braces, whereas prophylactic braces demonstrated little or no protective effect.

Pitfalls to avoid in diagnosing pain in the athlete.

Symptoms in the competitive athlete frequently are assumed to be related to overuse. A limited number of these patients will have orthopedic problems not related to their activity. This article outlines specific examples of bone tumors, infections, and metabolic causes of pain in the athlete.

A review of nonoperative treatment of Jones' fracture.

Sir Robert Jones, in 1902, described a transverse fracture of the proximal diaphysis of the fifth metatarsal, which he treated conservatively with good results. Since that time, classification into acute and chronic categories by several authors has been proposed and most agree with the relatively high incidence of non-union. Controversy exists concerning operative versus nonoperative primary treatment especially in athletes. The purpose of this study was to determine if nonoperative treatment could be used effectively in treating these fractures. A retrospective study of nine patients with 10 Jones' fractures was completed. The cases were categorized as acute or chronic by clinical history and radiographic appearance. The average age was 23.6 years. There were eight males and one female. In this group, competitive athletes sustained chronic fractures, while acute fractures occurred in nonathletes. Treatment consisted of a short leg nonweightbearing cast until radiographic and clinical healing occurred, followed by 6 weeks of limited activity. Mean clinical and radiographic union of chronic fractures was 9.4 weeks; acute fractures, 22 weeks. All competitive athletes returned to their preinjury level of competition at an average of 12 weeks following initiation of treatment. There was one refracture. Our data indicate that nonoperative treatment of early chronic or subacute fractures without intramedullary sclerosis can compare favorably with surgical treatment procedures reported in other studies in returning athletes to play postinjury. We suggest serious consideration be given to the method herein as a form of primary treatment of the early chronic Jones' fracture without intramedullary sclerosis.

A review of scaphoid fracture healing in competitive athletes.

A fractured scaphoid is a common disabling injury occurring in contact sports. Plaster immobilization is the most frequently used form of therapy. However, the rules governing most amateur sports do not allow an unyielding form of immobilization distal to the elbow. We describe a method of treating scaphoid fractures with custom-made Silastic (Dow Corning Wright, Arlington, TN) casts for competitive athletes. A retrospective review of 14 scaphoid fractures occurring in athletes competing in contact sports was completed to determine if effective immobilization could be maintained with this technique. The study covered a 10 year period with an average followup of 3.9 years (range 2 to 9 years). Ten of 11 middle third scaphoid fractures healed uneventfully. One nonunion occurred following a 7 week delay in diagnosis. Two of three proximal third scaphoid fractures went on to nonunion, while the third healed after a prolonged period of treatment. Our data indicate that nondisplaced middle third scaphoid fractures can be effectively immobilized for competition in contact sports with the custom-made Silastic cast described.

Rupture of the distal tendon of the biceps brachii. Operative versus non-operative treatment.

We did Cybex testing of thirteen patients who had had a rupture of the distal tendon of the biceps brachii. The tests were performed fifteen months to six years after injury. The ten patients who had had a surgical repair through the two-incision technique showed a return to normal levels of strength and endurance with regard to both flexion of the elbow and supination of the forearm. The three patients who had had conservative treatment showed a remaining deficit in those parameters which was clinically evident in several activities, such as use of a screwdriver or baseball bat.

Fracture separation of the olecranon ossification center in adults.

Traumatic disruption of an incompletely fused olecranon physis in adults has been reported on only one occasion by O'Donoghue in 1942, while stress fractures of the olecranon physis have been well-recognized and reported. A series of three adult males with traumatic disruption of an incompletely fused olecranon physis was studied. Two were competing in football at the time of the injury, while a third patient sustained the injury during a fall. All of our patients were former throwing athletes and all sustained a direct blow to the dominant elbow at the time of the fracture. In our study, as well as O'Donoghue's reported case, sclerotic fracture margins were noted. Open reduction, internal fixation (ORIF) required and subsequent fibrous union occurred. Two patients chose bone grafting and returned to competitive athletics, while the third patient functioned well at a sedentary level with a fibrous union. These cases suggest a high incidence of fibrous union following ORIF. Primary bone grafting is recommended in an effort to restore normal function with one primary procedure, particularly, in the competitive athlete.

Review of meniscal injury and associated sports.

Meniscal injuries produce disability in a large portion of the population, and sports injuries are a common cause. Nicholas emphasized the importance of epidemiologic studies in an effort to better define the risk of various sports. There are significant regional differences in sports-related meniscal injuries depending upon the popularity of specific sports. Although publications in the European literature document some of these variations, there is little epidemiologic documentation of the variation in specific areas of the United States. Meniscectomies performed in Syracuse, New York, from 1973 to 1982 were reviewed. Sports-related meniscal injuries were tabulated and compared against all other causes. Our results indicate that the incidence of meniscal injury resulting in meniscectomy is 61 per 100,000 population. The sex ratio was three males to one female. Medial versus lateral meniscus injury was 81 versus 19%. Football had a 75% predominance of medial meniscectomy; basketball, 75%; wrestling, 55%; skiing, 78%; and baseball, 90%. Our data indicate that there are differences in the ratio of medial versus lateral meniscal disruption associated with specific sports activities. Medial meniscal injuries were, nevertheless, consistently more common in all of our categories except wrestling, where the frequency of lateral meniscal tear is nearly equal to that of medial meniscal tear. Additionally, the right knee is at a greater risk of meniscal injury in basketball than in other sports or the general population, and female skiers are at equal or greater risk of meniscal injury compared to male skiers.

Current concepts in the diagnosis and treatment of musculotendinous injuries.

A strain, by definition, is a stretching or tearing of a musculotendinous unit. The degree of disability associated with this injury is dictated by the location and severity of the injury and the specific needs of the patient. A strain can be arbitrarily classified as first, second, or third degree. A first-degree strain consists of minimal stretching of the musculotendinous unit without permanent injury; a second-degree strain indicates partial tearing of the musculotendinous unit; and a third-degree strain indicates complete disruption of a portion of this unit. Swelling, bleeding, and localized discomfort accompany the injury which may produce temporary disability. Initial treatment following an acute strain should consist of the use of ice, immobilization of the musculotendinous unit, and subsequent rehabilitation. Depending on the degree of disability and the specific structure injured, surgery may be indicated. Rehabilitation to a normal state following the initial healing phase is required prior to return to athletic competition.

Current cardiology problems in sports medicine.

The cardiologist involved in the evaluation of the competitive athlete requires knowledge of the normal variations seen on clinical examination and laboratory studies. There is limited information in the literature, currently, that provides guidelines for decision making in the face of cardiac abnormalities. This paper outlines our experience with athletes and cardiac disease. Recommendations are given as guidelines for specific activity allowances.

Septic hip in pelvic fractures with urologic injury: a case report, review of the literature and discussion of the pathophysiology.

In patients with fractures of the pubic rami and acetabulum and a rupture of the bladder or urethra, there is a risk of septic arthritis developing in the traumatized hip. Infected material from the lacerated urinary tract can communicate by a fistulous tract with the hip joint. Since the symptoms of hip infection in this setting would differ significantly from acute hematogenous septic arthritis, the attending physician must be alert to this possibility for early diagnosis to be made and appropriate treatment instituted. Every attempt should be made to maintain the sterility of the urine throughout the course of treatment, in the hope of preventing the delayed sequelae of unrecognized hip infection. The possibility of this complication must be anticipated to prevent early joint destruction.

Prearthrotomy diagnostic evaluation of the knee: review of 100 cases diagnosed by arthrography and arthroscopy.

The results of 100 prearthrotomy evaluations of the knee including clinical examinations, arthrography, and arthroscopy were correlated with surgical findings. Arthroscopy was most accurate for meniscal lesions involving the central edge and anterior horn, anterior cruciate lesions, and chondromalacia. Arthrography was most accurate for midbody and peripheral tears. The combined accuracy of arthrography and arthroscopy in diagnosing all pathology within the 100 operated knees was 97%. Our results indicate that prearthrotomy arthroscopy and arthrography are complementary examinations and not mutually exclusive.

Organochlorine residues in harp seal (Phagophilus groenlandicus) tissues, Gulf of St. Lawrence, 1971, 1973.

Levels of p,p'-DDT, p,p'-TDE, p,p'-DDE, dieldrin, polychlorinated biphenyls (PCBs), and HCB were determined in certain tissues of 31 harp seals (P hagophilus groenlandicus) taken from the Gulf of St. Lawrence during 1971 and 1973. The seals ranged in age from less than two weeks to 18 years. Mean concentrations of PCBs and sigma DDT in the various tissues were about the same sigma DDT levels were 1.64--9.88 ppm in adult seal blubber and 1.08--3.73 ppm in seal pup blubber. Organochlorine levels in harp seal samples taken in 1973 were similar to those reported by other workers for samples collected in the Gulf of St. Lawrence during 1967-71.

Jejunal perforation occurring in contact sports.

Two cases of jejunal rupture following blunt trauma, occurring in participants of contact sports, have been reported. Additionally, a possible mechanism of injury is described.

Residues of atrazine and N-deethylated atrazine in water from five agricultural watersheds in Québec.

Atrazine (2-chloro-4-ethylamino-6-isopropylamino-s-triazine) and N-deethylated atrazine (2-chloro-4-amino-6-isopropylamino-s-triazine) were monitored (1974 and 1975) in five rivers which drained agricultural areas in the Yamaska river basin of Québec. Water samples were collected frequently from April to December each year from sites near the outflow of each river. The water samples were extracted with benzene, chloroform, or ethyl acetate and the extracts were analyzed by gas chromatography using a Hall electrolytic conductivity detector and an alkali-flame detector. Atrazine and N-deethylated atrazine residues ranged in concentration from 0.01 to 26.6 microgram/L and less than 0.01 to 1.34 microgram/L, respectively, over the monitoring period. The highest levels of atrazine were observed in July each year and they coincided with the herbicide spraying season in this region and with occasional heavy rainfall events. Discharges (kg/yr) of atrazine from the five rivers were related to corn-growing area in each watershed. Losses of atrazine ranged from 0.1 to 2.9% of the atrazine that was estimated to have been applied in each watershed.