The American journal of sports medicine
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A small femoral notch width index has been reported as a predictive factor for anterior cruciate ligament injury and implicated in the higher incidence of anterior cruciate ligament injuries in female athletes. Notch-plasty has been recommended for the unaffected knees of patients who have torn one anterior cruciate ligament and whose notch width index falls one standard deviation below "normal". However, the symmetry of the notch width index has not been specifically studied. ⋯ Finally, there was no difference in notch width index between patients with and without anterior cruciate ligament tears. These findings suggest that the notch width index alone is not the critical etiologic factor in the patient with a unilateral anterior cruciate ligament tear. Furthermore, the increased incidence of anterior cruciate ligament tears in female patients compared with male patients in the same sports cannot be attributed to notch width index alone.
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We wanted to use biomechanical testing in a cadaveric model to compare the Broström repair, the Watson-Jones reconstruction, and a new anatomic reconstruction method. Eight specimens were held in a specially designed testing apparatus in which the ankle position (dorsiflexion-plantar flexion and supination-pronation) could be varied in a controlled manner. Testing was done with intact ligaments and was repeated after sectioning of the anterior talofibular ligament and the calcaneofibular ligament and after a Broström repair, a Watson-Jones reconstruction, and a new anatomic reconstruction were performed. ⋯ The increase in ankle joint laxity observed after sectioning of both the anterior talofibular and calcaneofibular ligaments was significantly reduced by the three reconstructive techniques, although not always to the level of the intact ankle. Joint motion was restricted after the Watson-Jones procedure compared with that in the intact ankle. Unlike the Watson-Jones procedure, the ligament or graft force patterns observed during loading after the Broström repair and the new anatomic technique resembled those observed in the intact ankle.
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In this 3-year longitudinal study, we studied lumbar mobility and the occurrence of low back pain among 98 adolescents who were free of previous severe low back pain: 33 nonathletes (16 boys, 17 girls), 34 boy athletes (ice hockey and soccer players) and 31 girl athletes (figure skaters and gymnasts). During the followup, low back pain lasting longer than 1 week was reported by 29 athletes (15 boys and 14 girls) and by 6 nonathletes (3 boys and 3 girls). ⋯ The girls in the lowest tertile of maximal lumbar extension at baseline had a relative risk of 3.4 to have future low back pain compared with those in the highest tertile. We conclude that the low individual physiologic maximum of lower segment lumbar extension mobility may cause overloading of the low back among athletes involved in sports with frequent maximal lumbar extension and that it predicts future low back pain.
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The anatomic proximity of several neurovascular structures remains a major concern to the surgeon interested in performing arthroscopic capsular release. We evaluated the anatomic relationships between the released capsule and the axillary nerve, posterior circumflex humeral artery, and brachial artery in a frozen cadaveric model. With the aid of electrocautery, seven cadaveric shoulders underwent complete arthroscopic capsular release. ⋯ Anatomic dissection revealed an average distance from the capsular release to the axillary nerve of 7.04 mm (95% confidence interval, 5.62, 8.47), to the posterior circumflex humeral artery of 8.2 mm (95% confidence interval, 6.41, 9.99), and to the brachial artery of 15.97 mm (95% confidence interval, 9.85, 22.09). As the axillary nerve was followed medially from the released capsule, the inferior border of the subscapularis muscle became interposed between the capsule and the axillary nerve. This limited anatomic study shows that a relatively safe margin between the capsule and the neighboring neurovascular structures can be obtained by releasing the capsule within 1 cm of the glenoid rim.