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ABSTRACT: Synthetic playing surfaces have evolved considerably since their introduction in the 1960s. Today, third-generation turf is routinely installed in professional, collegiate, and community settings. Proponents of artificial surfaces tout their versatility and durability in a variety of climates. However, the health and injury ramifications have yet to be clearly defined. Musculoskeletal injury is largely affected by the shoe-playing surface interface. However, conclusive statements cannot be made regarding the risk of certain shoe-playing surface combinations because of the variety of additional factors, such as weather conditions, shoe wear, and field wear. Historically, clinical studies have indicated that higher injury rates occur on artificial turf than on natural surfaces. This conclusion is backed by robust biomechanical data that suggest that torque and strain may be greater on artificial surfaces than on natural grass. Recent data on professional athletes suggest that elite athletes may sustain injuries at increased rates on the newer surfaces. However, these surfaces remain attractive to athletes and administrators alike because of their durability, relative ease of maintenance, and multiuse potential.
The Journal of the American Academy of Orthopaedic Surgeons 05/2013; 21(5):293-302. · 2.66 Impact Factor
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ABSTRACT: Surgical management of shoulder pathologies has evolved tremendously during the past 3 decades, such that many lesions previously treated with open techniques are now addressed arthroscopically. Despite this movement, many surgeons and outcome studies continue to prefer open repairs as the gold standard, criticizing-with good reason-the reliability, reproducibility, and extended operative time of arthroscopic repairs, particularly with respect to anterior stabilizations and subscapularis repairs. With this in mind, we present the arthroscopic "subdeltoid approach," a novel standardized exposure technique for extracompartmental anterior shoulder arthroscopy. We define the subdeltoid space as the fascial plane bound superiorly by the acromion and coracoacromial ligament, medially by the coracoid and the conjoint tendon, inferiorly by the musculotendinous insertion of the pectoralis major to the humerus, and laterally by the lateral border of the humerus. When coupled with existing arthroscopic tools, this space dramatically enhances our ability to apply open techniques to some of the more challenging anterior shoulder pathoanatomy and expand the indications and efficacy of arthroscopy. This exposure technique has been used in more than 300 cases during the past decade to treat a myriad of shoulder pathologies, without any longstanding postoperative complications.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 01/2013; · 1.93 Impact Factor
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ABSTRACT: The evolution of synthetic playing surfaces began in the 1960s and has had an impact on field use, shoe-surface dynamics, and the incidence of sports-related injuries. Modern third-generation turfs are being installed in recreational facilities and professional stadiums worldwide. Currently, > two-thirds of National Football League teams, > 100 National Collegiate Athletic Association Division I football teams, and > 1000 high schools in the United States have installed synthetic playing surfaces. Those in favor of such playing surfaces note their unique combination of versatility and durability; they can be used in both ideal and inclement weather conditions. However, the more widespread installation and use of these surfaces have raised questions and concerns regarding the impact of artificial turf on the type and severity of sports-related injuries. There appears to be no question that the shoe-surface interface has a significant impact on such injuries. Independent variables such as weather conditions, contact versus noncontact sport, shoe design, and field wear complicate many of the results reported in the literature, thereby preventing an accurate assessment of the true risk(s) associated with certain shoe-surface combinations. Historically, studies suggest that artificial turf is associated with a higher incidence of injury. Furthermore, reliable biomechanical data suggest that both the torque and strain experienced by lower extremity joints generated by artificial surfaces may be more than those generated by natural grass fields. Recent data from the National Football League support this theory and suggest that elite athletes may sustain more injuries, even when playing on the newer artificial surfaces. By contrast, some reports based on data collected from lower-level athletes suggest that artificial turf may protect against injury. This review discusses the history of artificial surfaces, the biomechanics of the shoe-surface interface, and some common turf-related lower extremity injuries.
The Physician and sportsmedicine 11/2012; 40(4):66-72. · 1.02 Impact Factor
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ABSTRACT: The diagnosis and treatment of biceps tendon pathology remain controversial. These patients may be more resistant to conservative treatment than those patients with standard subacromial impingement. When conservative treatment fails, surgical options should be explored. Tenotomy and tenodesis of the biceps tendon have been described, although persistent pain, deformity, and muscle cramping have been frequently reported.
We describe a novel technique of biceps tenodesis by arthroscopic transfer of the long head of the biceps tendon to the anterior aspect of the lateral conjoint tendon using the subdeltoid space. The soft tissue transfer closely reproduces the native axis of pull of the biceps. It also allows soft tissue healing, which creates the normal "bungee" effect of the superior labrum/biceps anchor complex. This technique also allows the surgeon direct visualization during tenodesis to help prevent overtensioning of the tendon. Because of the early success of the procedure, we continue to use this technique with increasing frequency in appropriately indicated patients to access the anterior aspect of the shoulder extraarticularly.
Techniques in Shoulder and Elbow Surgery 02/2007; 8(1):29-36.
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ABSTRACT: Treatment of chronic, refractory biceps tendinitis remains controversial. The authors sought to evaluate clinical and functional outcomes of arthroscopic release of the long head of the biceps tendon.
In specific cases of refractory biceps tendinitis, site-specific release of the long head of the biceps tendon may yield relief of pain and symptoms.
Case series; Level of evidence, 4.
Fifty-four patients diagnosed with biceps tendinitis underwent arthroscopic release of the long head of the biceps tendon as an isolated procedure or as part of a concomitant shoulder procedure over a 2-year period. Patients were not excluded for concomitant shoulder abnormality, including degenerative joint disease, rotator cuff tears, Bankart lesions, or instability. Nine of 40 patients had an isolated arthroscopic release of the biceps tendon. At a minimum of 2 years, the American Shoulder and Elbow Surgeons; the University of California, Los Angeles; and the L'Insalata shoulder questionnaires as well as ipsilateral and contralateral metrics were used for evaluation.
The L'Insalata; University of California, Los Angeles; and American Shoulder and Elbow Surgeons scores were 77.6, 27.6, and 75.6, respectively. Seventy percent had a Popeye sign at rest or during active elbow flexion; 82.7% of men and 36.5% of women had a positive Popeye sign (P < .05); 68% were rated as good, very good, or excellent. No patient reported arm pain at rest distally or proximally; 38% of patients complained of fatigue discomfort (soreness) isolated to the biceps muscle after resisted elbow flexion.
Arthroscopic release of the long head of the biceps tendon is an appropriate and reliable intervention for patients with chronic, refractory biceps tendinitis. Cosmetic deformity presenting as a positive Popeye sign and fatigue discomfort were the primary complaints.
Although tenotomy is not the ideal intervention for patients of all ages with various shoulder abnormalities, data suggest that it may be an acceptable surgical intervention for a specifically selected cohort of individuals.
The American Journal of Sports Medicine 03/2005; 33(2):208-13. · 3.79 Impact Factor
