The American journal of sports medicine
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Comparative Study
Comparative injury rates of uninjured, anterior cruciate ligament-deficient, and reconstructed knees in a skiing population.
To evaluate the risks of skiing after anterior cruciate ligament injury with or without reconstruction, we performed a 3-year study of 5646 skiers employed by a large ski resort. All skiers underwent knee ligament examinations before entering the study. The participants were divided into three groups based on whether they had never had an anterior cruciate ligament injury (N = 4748), were unilaterally deficient of the ligament (N = 138), or had undergone a unilateral reconstruction of the ligament at least 1 year before (N = 274). ⋯ The differences between each of the three groups were significant. Injuries to ligament-intact knees were less severe, with 13% requiring surgery, while 39% of the injuries in the ligament-deficient and 41% of the injuries in the reconstructed-ligament knees required surgery. The rates of injury for the graft types were not significantly different, but skiers with a semitendinosus/gracilis tendon autograft were significantly more likely to rupture their graft than skiers with a patellar tendon autograft.
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We evaluated the difficulty, accuracy, and safety of establishing a low anterior 5-o'clock portal for anterior capsulolabral repair in patients positioned in the beach-chair position during shoulder arthroscopy. An initial 5-o'clock portal was created using an inside-out technique as described by Davidson and Tibone. During establishment of the portal, significant force was required to lever the humeral head laterally, and chondral indentations were noted in several specimens. ⋯ The bottom (5-o'clock position) and top (3-o'clock position) pins varied from 12 to 20 mm from the musculocutaneous and axillary nerves. The bottom pin was located within 2 mm of the cephalic vein and varied from medial to lateral in different specimens. We do not recommend the use of a 5-o'clock portal using an inside-out or outside-in technique for patients positioned in the beach-chair position during shoulder arthroscopy because of the potential for cephalic vein or articular cartilage injury.
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Using a cadaveric model, we evaluated the effect of knee and ankle position on the displacement of the severed ends of an Achilles tendon transected at three different points. In six cadaveric legs the Achilles tendon was severed transversely, then marked with radiopaque wire suture. The distance between the wire markers was measured on radiographs taken in different positions of ankle and knee flexion. ⋯ With the ankle fixed in 60 degrees of plantar flexion, knee position had no significant effect on the displacement of the severed ends of the Achilles tendon. Overall, the effect of knee flexion was neither statistically significant nor clinically significant, as the increase in displacement of the severed ends of the Achilles tendon was only 3 mm from 0 degrees to 120 degrees of knee flexion. These results suggest that the nonoperative treatment of Achilles tendon ruptures requires immobilization in maximal ankle plantar flexion, and that immobilization of the knee may not be necessary to achieve tendon-edge apposition.
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Comparative Study
The in vivo assessment of tibial motion in the transverse plane in anterior cruciate ligament-reconstructed knees.
Twenty-one knees with acutely injured anterior cruciate ligaments were reconstructed with patellar tendon autografts. Eight of the knees had concomitant medial ligament injuries that were not addressed surgically. Follow-up evaluation (average, 25 months) included computed tomography measurements to analyze transverse-plane laxity in both translation and rotation. ⋯ External rotation averaged 9.1 degrees in group I knees and 7.4 degrees in group II knees. The eight knees with concomitant medial ligament injuries were analyzed separately; external rotation without anterior load in group I was 9.5 degrees, compared with 5 degrees in group II. This difference was significant (P < 0.01).