Sports medicine and arthroscopy review
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Sports Med Arthrosc · Dec 2006
ReviewEvidence-based approach to treatment of acute traumatic syndesmosis (high ankle) sprains.
Ankle sprains in the athlete are one of the most common injuries, and syndesmosis or "high-ankle" sprains seem to being diagnosed at an increasing rate. As a result, there has been a heightened interest in recognizing and treating these difficult injuries on a timely basis, particularly in the athlete. Although the recognition and diagnosis of these injuries have improved, there still exists a paucity of information on optimal conservative and operative management. ⋯ The current diagnostic tests are not very specific. Because this is a spectrum of injury, there is a lot of variability in the time lost from sport. It is clear that we need a much more definitive diagnostic process for this injury that allows us to predict the severity of the injury, time loss from sport, and the treatment required.
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Sports Med Arthrosc · Dec 2006
ReviewPosterolateral corner injuries of the knee: anatomy, diagnosis, and treatment.
Injuries to the posterolateral corner of the knee continue to be a complex problem for orthopedic surgeons. Early recognition and treatment are important factors in the patient's long-term outcome. ⋯ This article will discuss the anatomy, diagnosis, and treatment options to improve the surgeon's understanding of posterolateral knee injuries. The senior author's technique for anatomic reconstruction of the posterolateral corner of the knee and the rehabilitation protocol are described.
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Concussions remain one of the most troublesome injuries sports physicians face. Studies suggest recovery takes hours to weeks, but at what point is the concussed brain no longer at increased risk for reinjury is unknown. Physicians must be alert to the symptoms of concussion and be familiar with the available tools to assess neurocognitive dysfunction. ⋯ A player with any signs or symptoms of a concussion should not be allowed to return to the current game or practice and should be monitored closely for deterioration of symptoms. Return-to-play should be individually based and proceed in a step-wise manner. The ongoing risk-benefit analysis of return-to-play must currently be based on experience, corollary data from traumatic brain injuries in animals and humans, and limited prospective data with sports-related concussions.
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Sports Med Arthrosc · Dec 2006
ReviewTreating the initial anterior shoulder dislocation--an evidence-based medicine approach.
This manuscript presents the best available evidence to answer questions regarding the treatment of the patient with an initial anterior shoulder dislocation. The highest levels of evidence available offer the following conclusions: (1) of the many methods to reduce the dislocated shoulder, little data exist to identify the best method. Recommendations are based on low levels of evidence (levels 4 and 5). (2) Premedication with intra-articular lidocaine has fewer complications and requires a shorter time in the emergency room than intravenous sedation with no detectable differences in reduction success rates (level 1). (3) Postreduction immobilization in external rotation may reduce recurrence (level 2), but immobilization in internal rotation does not (level 1). (4) Arthroscopic surgery significantly reduces recurrence compared to a nonoperative approach (level 1), and (5) there are limited data on features that would allow a safe return to play. Expert opinion suggests that return is allowed when motion and strength are nearly normal, and the athletes can engage in sport-specific activities, however, the athlete is at risk for recurrence while playing (levels 4 and 5).