The American journal of sports medicine
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Forty-six limbs in 28 patients were surgically treated for exertional compartment syndrome. One group of 16 patients (26 limbs) underwent a fasciotomy for exertional anterior compartment syndrome (Group 1). A second group of 12 patients (20 limbs) underwent a fasciotomy for exertional deep posterior compartment syndrome (Group 2). ⋯ In Group 2, 13 of 20 limbs (65%) had satisfactory results (5 excellent and 8 good) and 7 (35%) had unsatisfactory results (4 fair and 3 poor). Those patients who had an unsatisfactory outcome did so within 6 months. Patients in Group 1 had a significantly higher rate of satisfactory results than those in Group 2 (P < 0.05).
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We reviewed the meniscal status of 176 consecutive patients undergoing anterior cruciate ligament reconstruction acutely (less than 6 weeks from injury), subchronically (6 weeks to 12 months from injury), and chronically (more than 12 months from injury). The commonest tear was the single longitudinal vertical split of the medial meniscus. There was an increasing incidence of meniscal tears as the injury became more chronic, with a significant (P < 0.001) increase in medial meniscal tears; the incidence of lateral meniscal tears remained relatively constant. ⋯ All 21 medial menisci and all 5 lateral meniscal tears had healed; however, 1 lateral meniscus had torn along the line of the sutures. At an average followup of 40 months, 92% of the repaired menisci were still in situ and 8% that had required resection were related to the recurrence of anterior cruciate ligament instability. This study highlights the increasing incidence of meniscal injury in chronic anterior cruciate ligament insufficiency with the meniscal tears becoming more complex and therefore less amenable to suture.(ABSTRACT TRUNCATED AT 250 WORDS)
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We describe spear tackler's spine, a clinical entity that constitutes an absolute contraindication to participation in tackle football and other collision activities that expose the cervical spine to axial energy inputs. A subset of football players were identified who demonstrated: 1) developmental narrowing (stenosis) of the cervical canal; 2) persistent straightening or reversal of the normal cervical lordotic curve on erect lateral roentgenograms obtained in the neutral position; 3) concomitant preexisting posttraumatic roentgenographic abnormalities of the cervical spine; and 4) documentation of having employed spear tackling techniques. From data obtained by the National Football Head and Neck Injury Registry and the senior author's practice, 15 cases of spear tackler's spine were identified during 1987 to 1990. ⋯ Four cases resulted in permanent neurologic deficits: quadriplegia, 2; incomplete hemiplegia, 1; and residual long track signs, 1. Permanent neurologic injury occurred as the result of axial loading of a persistently straightened cervical spine from use of head-impact playing techniques. We suggest that individuals who possess the aforementioned characteristics of spear tackler's spine be precluded from participation in collision activities that expose the cervical spine to axial energy inputs.
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We have reported an unusual case of pectoralis major muscle rupture and repair. There were three interesting aspects of this case. ⋯ Finally, we reported on the use of suture anchors to secure the avulsed tendon. We recommend the early use of MRI for diagnosis and in planning treatment of suspected pectoralis major muscle ruptures.
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A knowledge of the patterns of injury to the components of the iliotibial tract allows a clearer interpretation of motion limits testing in patients with abnormal anterior tibial translation of the knee (anterior cruciate ligament-deficient knees). Eighty-two consecutive patients with acute knee injuries were classified as anteromedial-anterolateral rotatory instability (anterior cruciate ligament-deficient) based on the abnormal motion demonstrated by clinical examination tests for instability. At surgery, injuries to the intraarticular and extraarticular anatomic structures were identified and correlated to the abnormal grades of motion demonstrated by the knee motion limits examination. ⋯ Injuries to the anatomic components of the iliotibial tract were confirmed in 76 (93%) of the knees. These injuries correlated highly with variations in grades of abnormal motion detected by the following tests: lateral joint line opening at 30 degrees (r2 = 0.05); Lachman test (r2 = 0.08); pivot shift (r2 = 0.16); and anterior translation at 90 degrees of flexion (r2 = 0.34). Thus, injuries to the components of the iliotibial tract are thought to contribute to the variation in grades of abnormal motion observed in this complex subgroup of anterior tibial translation instabilities.