Objectives: Currently, objective functional assessments are performed at the time of return to pl... more Objectives: Currently, objective functional assessments are performed at the time of return to play following an anterior cruciate ligament (ACL) reconstruction. While informative, by that time the majority of organized rehabilitation has been completed, leaving little time for clinicians to address remaining impairments. Further, few objective tests have been compared to faulty movement mechanics. Identifying objective clinical tests that can be administered early during recovery from an ACL reconstruction which predict long term joint mechanics would provide sufficient time to address the underlying deficits prior to return to play testing. Thus, the purpose of this study was to determine if objective clinical tests (60 second single leg step down test and quadriceps strength) administered 3 months after surgery predicted jump landing mechanics of the knee (knee extension moment, average loading rate, vertical impact peak) at 6 months following an ACL reconstruction. Methods: 29 s...
This study used magnetic resonance imaging (MRI) to determine whether changes in patellofemoral a... more This study used magnetic resonance imaging (MRI) to determine whether changes in patellofemoral alignment occur after initial treatment with the Protonics exercise device. The first scan was obtained before the device was used. After performing a set of exercises with no resistance on the device the device was removed, and a second scan was obtained. The same set of exercises was again performed with resistance on the device set at the appropriate level, and a final scan was obtained with the device removed. An isometric leg press was maintained as each image was obtained to simulate more closely a functional weight-bearing activity. Subjects were 26 women with complaints of patellofemoral pain. The main outcome measures were: patellar tilt angle, bisect offset, and lateral facet angle. Nonparametric repeated measures analysis of variance tests showed no differences between test conditions for any of the three measures of patellofemoral alignment. We conclude that after an initial treatment session using the Protonics system there is no change in patellofemoral alignment as determined by MRI.
After the passage of Title IX in 1972, women began competing in organized sports in large numbers... more After the passage of Title IX in 1972, women began competing in organized sports in large numbers. There was concern that women would have significantly higher injury rates than men. For the most part, these fears were unfounded. Sports injury rates between men and women are similar and, in general, seem to be sport-specific rather than gender-specifi~.~~, 37, 94, 99 There is, however, an increased predisposition (two to eight times) to anterior cruciate ligament (ACL) rupture in women., There are many theories and much research devoted to explaining why this difference in injury rate exists. Research has focused on intrinsic and extrinsic factors. Intrinsic factors are those that are individual, physical, and psychosocial.6 Intrinsic factors include joint laxity, hormonal influences, limb alignment, notch dimensions, and ligament size. The intrinsic causes tend to be more sex-specific and may not be modifiable. Most research into the cause of ACL injuries has been directed toward intrinsic causes. Extrinsic factors are those related to the type of sport, the environmental conditions, the conditioning of the athlete, and the equipment used.6 Unlike most intrinsic factors, extrinsic factors are potentially controllable or changeable. Extrinsic factors include conditioning, experience, skill, strength, muscle recruitment patterns, and landing techniques. Extrinsic
Following anterior cruciate ligament reconstruction (ACLR), patients present with greater trunk i... more Following anterior cruciate ligament reconstruction (ACLR), patients present with greater trunk ipsilateral lean, which may affect knee kinetics and increase re-injury risk. However, there has been little research into neuromuscular factors controlling the trunk and their relation to the knee between healthy and ACLR subjects. This is critical to establish in order to develop more directed and effective interventions. As compared to healthy control subjects, ACLR subjects will demonstrate increased erector spinae and rectus abdominis co-contraction, greater rectus abdominis force and greater hamstring force that is correlated to increased forward trunk lean. Cross-sectional study, Level of Evidence: 3. Eleven healthy and eleven ACLR subjects were matched for age, mass and height. Subjects were asked to run at a self-selected speed while instrumented gait analysis was performed. An anthropometrically scaled OpenSim model was created for each subject. Trunk and hamstring muscle forces...
Abnormal findings concentrated at the tibial tubercle. Here there is fragmentation and bone marro... more Abnormal findings concentrated at the tibial tubercle. Here there is fragmentation and bone marrow edema. The pattern is consistent with patellar insertional tendinitis/enthesitis. FINAL WORKING DIAGNOSIS: Acute tibial tubercle bony fragment avulsion in the setting of previous Osgood Schlatter's disease TREATMENT AND OUTCOMES: 1. Failed conservative therapy with hinged knee brace and long leg cast 2. Surgical removal of loose ossicle and tubercleplasty with long term outcomes still pending (No relationships reported) HISTORY HPI: 18 y/o male with a PMH of Goodpasture's syndrome presents with gradually worsening L knee pain that started about one month ago. Pain is located on medial side of L knee and described as stabbing pain. The pain is relieved by rest and aggravated by physical activity as well as prolonged standing. Associated symptoms include feeling of instability, locking and swelling. Ice and Ibuprofen did not improve symptoms, no history of trauma.
The Y-Balance Test was developed as a test of dynamic postural control and has been shown to be p... more The Y-Balance Test was developed as a test of dynamic postural control and has been shown to be predictive of lower extremity injury. However, the relationship between hip strength and performance on the Y-Balance Test has not been fully elucidated. The goal of this study was to identify the relationship between components of isometric hip strength and the Y-Balance Test, to provide clinicians better guidance as to specific areas of muscle performance to address in the event of poor performance on the Y-Balance Test. Laboratory Study. Biomechanics Laboratory. Seventy-three healthy participants, 40 males and 33 females, volunteered for this study. None. Participants completed the Y-Balance Test on the right leg. We then measured peak isometric torque in hip external rotation, abduction, and extension. Correlations were calculated between torque measurements, normalized for mass, and Y-Balance Test performance. Significant relationships were used in linear regression models to determi...
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, Jan 4, 2017
Quadriceps strength and single-leg hop performance are commonly evaluated prior to return to spor... more Quadriceps strength and single-leg hop performance are commonly evaluated prior to return to sport after anterior cruciate ligament reconstruction (ACLR). However, few studies have documented potential hip strength deficits after ACLR, or ascertained the relative contribution of quadriceps and hip strength to hop performance. Patients cleared for return to sports drills after ACLR were compared to a control group. Participants' peak isometric knee extension, hip abduction, hip extension, and hip external rotation (HER) strength were measured. Participants also performed single-leg hops, timed hops, triple hops, and crossover hops. Between-limb comparisons for the ACLR to control limb and the non-operative limb were made using independent two-sample and paired sample t tests. Pearson's correlations and stepwise multiple linear regression were used to determine the relationships and predictive ability of limb strength, graft type, sex, and limb dominance to hop performance. Si...
Tunnel malposition is one of the most common technical reasons for anterior cruciate ligament rec... more Tunnel malposition is one of the most common technical reasons for anterior cruciate ligament reconstruction failure. Small changes in tunnel placement can result in significant differences in outcome. More anatomic placement of the tunnels can lead to greater knee stability and a more accurate reproduction of native knee kinematics. This Technical Note describes 2 tibial tunneleindependent methods to obtain anatomic femoral tunnel placement. The all-inside anteromedial portal technique requires only minimal surgical incisions but allows precise femoral tunnel placement. However, hyperflexion of the knee is required, adequate surgical assistance is necessary, and this technique may be susceptible to graft-tunnel mismatch. The outside-in technique may be more beneficial in obese patients, skeletally immature patients, or revision cases. On the downside, it does require an additional 2-cm surgical incision. This article also provides surgical pearls to fine-tune tibial tunnel placement. A lthough anterior cruciate ligament (ACL) reconstructions can fail for a variety of reasons, the most common technical error is incorrect tunnel placement, with the femoral tunnel more commonly misplaced than the tibial tunnel. 1-3 In fact, even small changes in tunnel placement have been shown to significantly affect knee kinematics after ACL reconstruction. 4 Epidemiologic data from the Multicenter ACL Revision Study (MARS) showed that 80% of failed ACL reconstructions were at least partially due to femoral tunnel malposition and 37% due to incorrect tibial tunnel placement. 3
Anterior cruciate ligament (ACL) injuries are associated with significant loss of strength in kne... more Anterior cruciate ligament (ACL) injuries are associated with significant loss of strength in knee extensor muscles that persists despite physical therapy. The underlying mechanisms responsible for this protracted muscle weakness are poorly understood; however, we recently showed significant myofiber atrophy and altered muscle phenotype following ACL injury. We sought to further explore perturbations in skeletal muscle morphology and progenitor cell activity following an ACL injury. Muscle biopsies were obtained from the injured and non-injured vastus lateralis of young adults (n=10) following ACL injury, and histochemical/immunohistochemical analyses were undertaken to determine collagen content, abundance of connective tissue fibroblasts, fibrogenic/adipogenic progenitor (FAP) cells, satellite cells, in addition to indices of muscle fiber denervation and myonuclear apoptosis. The injured limb showed elevated collagen content (p<0.05), in addition to a greater abundance of fibroblasts and FAPs (p<0.05) in the injured limb. Fibroblast content was correlated with increased accumulation of extracellular matrix in the injured limb as well. A higher frequency of interstitial nuclei were positive for phospho-SMAD3 in the injured limb (p<0.05), providing some evidence for activation of a fibrogenic program through transforming growth factor β following an ACL injury. The injured limb also displayed reduced satellite cell abundance, increased fiber denervation and DNA damage associated with apoptosis (p<0.05), indicating alterations within the muscle itself after the ligament injury. Injury of the ACL induces a myriad of negative outcomes within knee extensor muscles, which likely compromise the restorative capacity and plasticity of skeletal muscle, impeding rehabilitative efforts.
Objectives: Evaluate the relationship of hip and trunk muscle function with the Single Leg Step-D... more Objectives: Evaluate the relationship of hip and trunk muscle function with the Single Leg Step-Down test (SLSD).
Medicine & Science in Sports & Exercise, 1992
Although contusions of the thigh are common in all sports, a compartment syndrome from closed blu... more Although contusions of the thigh are common in all sports, a compartment syndrome from closed blunt trauma without a femur fracture is rare. Thigh compartment syndrome is unusual due to increased compliance of the thigh to accommodate increased expansion from hematoma or third space fluid. Compartment syndrome of the thigh is characterized by unrelenting pain, swelling, and limited knee range of motion. A single case of a thigh compartment syndrome caused by a direct blow to the anterior aspect of the thigh from a football helmet during kickoff occurred. Immediate thigh fasciotomy was performed. Early diagnosis with appropriate emergency treatment can avoid serious and permanent complications.
This article reviews the author&amp;amp;amp;amp;amp;amp;amp;amp;#39;s ten commandments for a ... more This article reviews the author&amp;amp;amp;amp;amp;amp;amp;amp;#39;s ten commandments for a balanced life as a team physician: (1) Do the right thing, always, no exceptions; (2) It&amp;amp;amp;amp;amp;amp;amp;amp;#39;s better to be an advocate than curse your competition; (3) Don&amp;amp;amp;amp;amp;amp;amp;amp;#39;t demand respect from players and coaches, earn it; (4) Loyalty is the weakest of human values (5) Communicate: Team physicians must always be available to athletic training staff; (6) In order to hit the mark, one must aim a little higher; (7) Enjoy your role as team physician; (8) Remember the five A&amp;amp;amp;amp;amp;amp;amp;amp;#39;s--Availability, Ability, Affability, Advocacy, and Affiliation; (9) Dare to care; and (10) Don&amp;amp;amp;amp;amp;amp;amp;amp;#39;t forget your family and friends.
Golf is a sport that can be played by athletes of all ages, both males and females, and by variou... more Golf is a sport that can be played by athletes of all ages, both males and females, and by various income earners. There have been various articles and book chapters looking at injuries in general and specific to golf. Most golf injuries are related to overuse syndromes, but can result from poor swing mechanics, poor core stability and strength, improper warm-up, and striking foreign objects. Injuries can be acute or chronic. When caring for golfers, it is important to understand the golf swing, swing biomechanics, and injuries both general and specific to golfers. In this chapter, we will review the swing and discuss a variety of injuries that can occur as well as the respective management of each injury.
Over 25 million children participate in school-sponsored sports, and an additional 20 million par... more Over 25 million children participate in school-sponsored sports, and an additional 20 million participate in extracurricular organized sports. Over the past decade, increased intensity of training, more pressure for success, new opportunities for structured play, and more organized advanced leagues and traveling teams have led to a corresponding increase in overuse injuries in the skeletally immature athlete. Perhaps the classic sports model for overuse injuries of the upper extremity is baseball. Throwing sports contribute to an increased incidence of elbow and shoulder injuries that might be related to intensity of training, throwing mechanics, and poor conditioning, including core strength. Specific areas of concern regarding overuse injuries in young athletes include such diagnoses as little leaguer's shoulder, little leaguer's elbow, osteochondritis dissecans of the elbow, tennis elbow, and distal radial epiphysitis. Ultimately, overuse injuries, and particularly physea...
Osteoid osteomas are small, benign bone tumors most commonly located in the proximal femur or tib... more Osteoid osteomas are small, benign bone tumors most commonly located in the proximal femur or tibia. The classic presentation is localized pain increasing in severity at night, and relieved by the use of anti-inflammatory medications. In a young athlete complaining of foot pain, many conditions should be included in the differential diagnosis. A case of osteoid osteoma of the os calcis in a teenage basketball player is presented.
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