[Proposal of health care program for workers of Large Organized Distribution]. / Proposta di programma di sorveglianza sanitaria nei lavoratori della grande distribuzione organizzata.

The whole of trading enterprises with many average/big saling-centres forms what is today commonly known as Large Organized Distribution (LOD). The main risks regarding the people working in the LOD are: MM, repetitive motion of upper limbs, fixed postures, unfavourable microclimatic conditions and, moreover, the probability of labour accidents. In order to analyse the risks due to MM and false postures, we have used the ergonomic software "Classic Jack" distributed by EAI-UGS, which has been very helpful to find out the most dangerous labour operations (e.g. charging and discharging of goods, fragmentation and reassembling of manufactures, goods-shelving, branding and labelling). We have, then, suggested a programme of health surveillance that includes a medical examination, eventual x-ray exams, specialized examination and a posturologic visit. This posturologic visit has got an olistic diagnostics approach, whose research after the causes that could be responsible for the checked diseases concerns not only the damaged area, but also other parts of the body (ocular system, auditive system, podalic system, masticatory apparatus).

The effect of the squat exercise on anterior-posterior knee translation in professional football players.

Although the squat exercise is considered essential for optimal athletic performance, controversy exists regarding the effect on knee stability. The purpose of this prospective study was to determine the effect of squat exercises on in vivo knee joint stability of professional football players. Thirty-two subjects with normal knees participated in a 21-week off-season training program. Subjects performed power squat exercises with barbell loads of 130% to 200% body weight twice weekly. Both knees of each subject were tested by a single examiner with a knee ligament arthrometer before the training program and at 12 and 21 weeks. Passive displacements were recorded at 67, 89, and 133 N with the knee at 30 degrees and 90 degrees of flexion. Active testing was performed with the knee in the same positions. Student's paired t-tests were used to compare pre- and postexercise measures. For all subjects, no significant differences were found between pre- and postexercise results for active and passive tests. Of the 2440 measurements taken, only 8 demonstrated increased excursions greater than 2 mm. This study demonstrates no significant increases in anterior-posterior tibiofemoral translation in athletes using the squat exercise as part of their off-season training program.

Arthroscopically assisted reconstruction of the anterior cruciate ligament with use of autogenous patellar-ligament grafts. Results after twenty-four to forty-two months.

The results of the first sixty-nine consecutive patients who had had seventy arthroscopically assisted reconstructions of the anterior cruciate ligament with use of an autogenous patellar-ligament graft at our institution were reviewed retrospectively. Sixty-seven patients (sixty-eight knees) were available for evaluation after a minimum of two years. All patients had been managed with early, postoperative range-of-motion exercises and a standardized program of physical therapy. At the time of the most recent follow-up evaluation, the median ligament score, according to the rating system of The Hospital for Special Surgery, was 93 of a possible 100 points. Of the sixty-eight knees, forty-four were rated excellent; fifteen, good; six, fair; and three, poor. Eighteen knees had symptoms related to the patellofemoral joint and sixty-three had a full range of motion; two knees had had manipulation for loss of flexion. At the follow-up evaluation, KT-1000 arthrometric measurements were obtained for both knees of fifty-six patients. Eighty-four per cent of the patients had an increase of three millimeters or less in anterior-posterior displacement of the tibia on the reconstructed side compared with the normal side, while 93 per cent had an increase of four millimeters or less. Postoperatively, there was no apparent association between changes in the Insall-Salvati patellar ligament-to-patella ratios and pain in the patellofemoral joint. The results of the arthroscopically assisted reconstructions combined with use of early range-of-motion exercises were comparable with those reported after open reconstruction and immobilization of the limb in a plaster cast. The frequency of pain in the patellofemoral joint and the need for manipulation because of loss of motion were decreased after the arthroscopically assisted procedures.

Measurement reproducibility of two commercial knee test devices.

Objective evaluation of patients' knee motion using mechanical devices, whether for diagnostic purposes or for assessing rehabilitative procedures, requires that these devices be reproducible, in order to avoid errors independent of the patients' condition. This study prospectively evaluates the reproducibility of two commercial knee test systems, the KT 1000 Knee Ligament Arthrometer and the Genucom Knee Analysis System, by performing repeated measurements on twenty normal men. Average knee motion, between-subject variance, and within-subject variance were determined by performing repeat tests on the same day and one week later. No significant difference was found between measurements taken on the two different test days, but the within-subject variation was high. We found that larger applied forces or moments resulted in a larger variation in mean displacements. However, the percent variation about the mean (coefficient of variation) decreased with increasing applied loads. The coefficient of variation for the KT 1000 varied from 8 to 33% and for the Genucom, from 13 to 87%. On an individual basis, large variations were found in repeated measures for both devices. To minimize errors, we recommend that repeated tests be performed, higher forces and moments utilized, and specific flexion angles be used for each device and test. Even under these conditions, caution must be exercised when evaluating individual subjects.

Reconstruction of the chronically insufficient anterior cruciate ligament with the central third of the patellar ligament.

The results of reconstruction of the anterior cruciate ligament with the central third of the patellar ligament as a free, autogenous, non-vascularized graft were retrospectively reviewed at our institution. Eighty reconstructions in seventy-nine patients were evaluated after a minimum of two years. In forty-eight (60 per cent) of the knees, the reconstruction was augmented with an extra-articular lateral sling of iliotibial band. The patients were evaluated with a physical examination, a KT-1000 arthrometer, radiographs, a subjective questionnaire, and a revision of the scale of The Hospital for Special Surgery for rating ligaments. Postoperatively, seventy-six (95 per cent) of the eighty knees no longer gave way, and the pivot-shift test was negative in sixty-seven (84 per cent) of the knees. The average score on the ligament-rating scale was 93 points. All of the patients who had clinical instability at the time of the most recent follow-up had associated ligamentous instability that had not been appreciated or addressed at the time of reconstruction. Arthrometric evaluation revealed that the laxity differed by three millimeters or less from that of the untreated knee in sixty (76 per cent) of the treated knees. In the patient who had bilateral reconstruction, the laxity was the same in both knees. Seventeen patients, who had more than three millimeters of translation, also had additional related ligamentous instability, most commonly posterolateral instability and insufficiency of the medial collateral ligament. We think that major associated ligamentous instability predisposes the reconstruction to failure and should be corrected in conjunction with the reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

The iliotibial band lateral sling procedure and its effect on the results of anterior cruciate ligament reconstruction.

The effect of iliotibial band "lateral sling" augmentation on long-term outcome in ACL reconstruction using free autogenous central-third patellar tendon was evaluated retrospectively. Eighty reconstructions were reviewed; the minimum followup was 2 years and the average was 4 years. Sixty percent of the procedures involved supplementation with a lateral sling. By both clinical evaluation and KT-1000 measurement, there were no differences in the results of patients with lateral sling augmentation and those without it. In addition, 40% of patients had chronic pain and/or swelling related to the lateral sling. We do not currently recommend the routine use of a lateral sling augmentation for ACL reconstruction using central-third patellar tendon.

Primary repair with semitendinosus tendon augmentation of acute anterior cruciate ligament injuries.

A retrospective review of 72 acute ACL injuries in 70 athletically active patients (50 recreational and 20 competitive athletes) treated with primary repair and semitendinosus tendon augmentation was conducted (mean follow-up time, 38.5 months). All patients had open primary multiple loop depth-varying suture repair and semitendinosus tendon augmentation at a mean injury to surgery interval of 9.1 days. Fifty-one cases (70.8%) were supplemented with an extraarticular procedure consisting in all cases of an iliotibial band lateral sling reinforcement. All patients underwent 6 weeks of postoperative immobilization followed by a graduated rehabilitation regimen lasting a mean 7.2 months. In 22 of the ACL tears, no other associated injury could be defined at arthrotomy, while in 27, significant medial collateral ligament injuries were noted. Lateral meniscal injuries (24) were more commonly noted than medial meniscal injuries (19). Good to excellent subjective results were reported in 82%, while 77.1% returned to preinjury sport level and participation without limitation. One patient developed "giving way" symptoms and overall, only four patients did not return to sports participation. Objective examination revealed 93.1% to have a 1+ or less Lachman test and 86.1% to have a negative pivot shift. Of 60 knees tested, 93.3% had KT-1000 side-to-side difference values (measured at 25 degrees +/- 5 degrees of flexion with an 89 N load) of less than or equal to 3 mm of anterior displacement. A 100 point Hospital for Special Surgery ligament rating score was used with 25 points assigned to subjective, 45 points to objective, and 30 points to functional assessment. The mean score at followup was 93.1. Analysis of results in patients with or without an extraarticular reinforcement revealed no difference in objective outcome. The incidence of patellofemoral pain was 27.8%. Thirty knees had some degree of loss of range of motion. Loss of terminal flexion was noted in 29, while 5 had loss of terminal extension. No correlation could be found between patellofemoral pain and diminished range of motion. Generalized ligamentous laxity was found in 37.1% of the patients; this was not associated with a poor result. This study suggests that primary repair with semitendinosus tendon augmentation of acute ACL injuries with a graduated rehabilitation regimen provides good subjective, and excellent functional and objective, results in active patients that were followed for more than 3 years.