Concussion in Head Trauma.

Concussion in the setting of facial trauma is an entity that can be overlooked. Having a high index of suspicion is critical in initial management and prompt treatment. Clinical signs can be common manifestations of a concussion. Serial examinations are important as these clinical manifestations can occur later in the hospitalization. Cognitive assessment tools can also give a baseline of a patient and can be used to assess recovery from a concussion. Assessment of the vestibular and oculomotor system can play a critical role in treatment. Prompt recognition and immediate treatment can help shorten the symptomatology and course of treatment.

Microsphere-based gradient implants for osteochondral regeneration: a long-term study in sheep.

BACKGROUND: The microfracture technique for cartilage repair has limited ability to regenerate hyaline cartilage. AIM: The current study made a direct comparison between microfracture and an osteochondral approach with microsphere-based gradient plugs. MATERIALS & METHODS: The PLGA-based scaffolds had opposing gradients of chondroitin sulfate and ß-tricalcium phosphate. A 1-year repair study in sheep was conducted. RESULTS: The repair tissues in the microfracture were mostly fibrous and had scattered fissures with degenerative changes. Cartilage regenerated with the gradient plugs had equal or superior mechanical properties; had lacunated cells and stable matrix as in hyaline cartilage. CONCLUSION: This first report of gradient scaffolds in a long-term, large animal, osteochondral defect demonstrated potential for equal or better cartilage repair than microfracture.

Preventive Effects of Eccentric Training on Acute Hamstring Muscle Injury in Professional Baseball.

BACKGROUND: Hamstring injuries are the second most common injury causing missed days in professional baseball field players. Recent studies have shown the preventive benefit of eccentric conditioning on the hamstring muscle group in injury prevention. Specifically, Nordic-type exercises have been shown to decrease the incidence of acute hamstring injuries in professional athletes. PURPOSE: This was a prospective study performed in coordination with a single Major League Baseball (MLB) organization (major and minor league teams) that targeted the effects of Nordic exercises on the incidence of acute hamstring injuries in the professional-level baseball player. STUDY DESIGN: Prospective cohort study; Level of evidence, 2. METHODS: The daily workouts of 283 professional baseball players throughout all levels of a single MLB organization were prospectively recorded. The intervention group participated in the Nordic exercise program and was compared with a randomly selected control group of professional athletes within the organization not participating in the exercise program. The incidence of hamstring injuries in both groups was compared, and the total number of days missed due to injury was compared with the 2 previous seasons. RESULTS: There were 10 hamstring injuries that occurred during the 2012 season among the 283 professional athletes that required removal from play. There were no injuries that occurred in the intervention group (n = 65, 0.00%; P = .0381). The number needed to treat (NNT) to prevent 1 hamstring injury was 11.3. The average repetitions per week of the injured group were assessed at multiple time points (2, 4, 6, and total weeks) prior to injury. There were significantly fewer repetitions per week performed in the injured group at all time points compared with overall average repetitions per week in the noninjured group (P = .0459, .0127, .0164, and .0299, respectively). After beginning the Nordic exercise program, there were 136 total days missed due to a hamstring injury during the 2012 season. This number was less than the 2011 season (273 days missed) and the 2010 season (309 days missed). CONCLUSION: Study results indicate the initiation of Nordic hamstring exercises may decrease the incidence of acute hamstring injuries and potentially decrease the total number of days missed due to injury in professional baseball players. CLINICAL RELEVANCE: The financial and competitive interest in professional baseball players is of large importance to the player, team, and fans. Prevention of injuries is as important to all parties involved as the treatment and rehabilitation following an injury. This prospective study shows the initiation of a simple, free exercise can reduce the incidence of hamstring injury in the professional-level baseball player.

Continuous gradients of material composition and growth factors for effective regeneration of the osteochondral interface.

Most contemporary biomaterial designs for osteochondral regeneration utilize monolithic, biphasic, or even multiphasic constructs. We have introduced a microsphere-based approach to create a continuous gradient in both material composition and encapsulated growth factors. The gradients were fabricated by filling a cylindrical mold with opposing gradients of two different types of poly(D,L-lactic-co-glycolic acid) microspheres. The chondrogenic microspheres were loaded with transforming growth factor-ß1, whereas the osteogenic microspheres contained bone morphogenetic protein-2 with or without nanophase hydroxyapatite. The gradient scaffolds (material gradient only, signal gradient only, or material/signal gradient combination) or blank control scaffolds were implanted in 3.5 mm-diameter defects in rabbit knees for 6 or 12 weeks. This is the first in vivo evaluation of these novel gradient scaffolds in the knee. The gross morphology, MRI, and histology indicated that the greatest extent of regeneration was achieved when both signal and material gradients were included together. This combination resulted in complete bone ingrowth, with an overlying cartilage layer with high glycosaminoglycan content, appropriate thickness, and integration with the surrounding cartilage and underlying bone. The results suggest that osteochondral regeneration may benefit from biomaterials that integrate a continuous gradient in both material composition and encapsulated growth factors.

Evaluation of a Schanz pin technique for posterior cruciate ligament tensioning during reconstruction.

Maximum anterior positioning of the tibia relative to the femur during posterior cruciate ligament (PCL) reconstruction is essential for achieving a tight graft and stable joint. A Schanz pin inserted in the proximal tibia is sometimes used to pull the proximal tibia forward during tensioning of the graft in PCL reconstruction. This study was designed to evaluate whether this technique provides more anterior translation than the traditional anterior drawer technique. Eight fresh-frozen cadaveric knees were tested using both methods in randomized order: pulling anteriorly on a 5-mm Schanz pin in the proximal tibia or a leather strap behind the calf designed to simulate a surgeon's hand performing an anterior drawer maneuver. An anteriorly directed force was applied from 0 to 60 N, and the sagittal position of the tibia in relation to the femur was recorded using a mini C-arm. Tests were performed first on the intact knees, again after the PCL had been cut, and again following transection of the popliteal-fibular ligament. We found a statistically significant (p < 0.05) increase in tibial translation, ranging between 1 and 2 mm, when the tibia was pulled by the Schanz pin compared with the strap under every set of conditions. This greater anterior translation could improve the stability of the postreconstructed knee.

Initial fixation and cyclic loading stability of knotless suture anchors for rotator cuff repair.

This study evaluated the resistance to gapping and the mode of failure for 2 knotless suture anchor systems used for rotator cuff repair compared with the performance of a conventional titanium anchor system. Eight matched pairs of fresh-frozen humeri were dissected free of all soft tissues and scanned to measure bone mineral density (BMD). The suture anchor systems tested were the TwinFix 5.0 Titanium (Smith & Nephew, Andover, MA), Bioknotless RC (DePuy Mitek, Norwood, MA), and Magnum (Opus Medical, San Juan Capistrano, CA), and each was inserted into each humerus. Cyclic, tensile loading was applied through the suture loop for 5000 cycles, or until failure, by using a servohydraulic testing machine. Gapping distances, defined as increasing elongation of the bone/anchor/suture system, were continuously measured. Total cycles to failure and mechanism of failure were documented. Mean initial (first cycle) and final (last cycle) gapping distances were 3.81 mm and 5.36 mm for the TwinFix 5.0, 4.02 mm and 5.34 mm for the Bioknotless RC, and 3.56 mm and 4.98 mm for the Magnum anchors. No significant difference was detected among mean gap openings (P > .05). However, the Bioknotless RC had more early failures (5) than the other 2 implants (1 each), approaching significance (P = .07). Trials of the Bioknotless RC that did not fail early were found to have significantly less gap opening than the other 2 systems for both initial (1.89 mm vs 3.82 mm for the TwinFix 5.0 and 3.56 mm for the Magnum) and final (2.00 mm vs 4.68 mm for the TwinFix 5.0 and 4.24 mm for the Magnum) gap opening. BMD was a significant predictor of initial (P = .029) and final (P = .008) gap opening, whereas the site of anchor insertion was a significant predictor of final displacement. The Opus Magnum was comparable with a conventional suture anchor, but the Mitek Bioknotless RC showed a trend toward early failure. Biomechanical analysis of knotless suture anchor systems can demonstrate trends among implants in an experimental setting. Knowledge of these trends could influence implant selection.