[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Currently, there is no generally agreed measure available to quantify a subject's perceived severity of exercise-induced leg pain symptoms. The aim of this study was to develop and validate a questionnaire that measures the severity of symptoms that impact on function and sports ability in patients with exercise-induced leg pain. METHODS: The exercise-induced leg pain questionnaire for German-speaking patients (EILP-G) was developed in five steps: (1) initial item generation, (2) item reduction, (3) pretesting, (4) expert meeting and (5) validation. The resulting EILP-G was tested for reliability, validity and internal consistency in 20 patients with exercise-induced leg pain, 20 asymptomatic track and field athletes serving as a population at risk and 33 asymptomatic sport students. RESULTS: The patient group scored the EILP-G questionnaire significantly lower than both control groups (each p<0.001). Test-retest demonstrates an excellent reliability in all tested groups (Intraclass Correlation Coefficient, ICC=0.861-0.987). Concurrent validity of the EILP-G questionnaire showed a substantial agreement when correlated with the chronic exertional compartment syndrome classification system of Schepsis (r=-0.743; p<0.001). Internal consistency for the EILP-G questionnaire was 0.924. CONCLUSIONS: EILP-G questionnaire is a valid and reliable self-administered and disease-related outcome tool to measure the severity of symptoms that impact on function and sports ability in patients with exercise-induced leg pain. It can be recommended as a robust tool for measuring the subjectively perceived severity in German-speaking patients with exercise-induced leg pain.
British journal of sports medicine 12/2012; · 3.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The pivot shift test is a cornerstone in the clinical diagnosis of anterior cruciate ligament (ACL) deficiency. It can be difficult to perform in overweight patients or in those with long or bulky legs. We present an alternative method to perform the pivot shift test that recalls the judo technique of figure-of-four knee lock and eases the examination of the patient with anterior cruciate ligament deficiency. This modality of execution also makes the surgeon able to perform varus-valgus tests with small changes in hand positions. The surgeon, embracing with one arm the tibia of the affected limb, grasps with this hand the wrist of his free arm opposite to the affected limb. Then the surgeon hooks onto the posterior surface of the leg with his free hand. In this way, the surgeon can exert a moment on the limb of the patient, and can apply combined internal rotation, flexion, and valgus stress to perform the pivot shift test or simply varus or valgus force to perform the varus-valgus tests.
Bulletin of the NYU hospital for joint diseases 01/2011; 69(2):173-6.
[Show abstract][Hide abstract] ABSTRACT: Chronic exertional compartment syndrome (CECS) usually refers to myoneural ischemia from a reversible increase in tissue pressure within a myofascial compartment. CECS of the leg is well documented, as its first description by Mavor in 1956. CECS of the foot remains underdiagnosed, and has been reported in the literature only on an anecdotal basis. Wood Jones proposed that there were 4 compartments in the foot, but Manoli and Weber suggest that there are 9 separate compartments. Clinical signs and symptoms of CECS of the foot remain vague, diverse, and lack the consistency of its counterpart in the leg. The most effective treatment is a fasciotomy. We present a literature review of the condition to increase the awareness and high index of suspicion among the clinicians as the symptoms are often vague and, to consider the condition as part of the differential diagnosis.
Sports medicine and arthroscopy review 10/2009; 17(3):198-202. · 1.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We investigated differences in the intracompartmental pressures (ICP) of the leg in relation to various positions of the ankle joint in patients with chronic exertional compartment syndrome (CECS).
The study included 16 patients (10 males, 6 females; mean age 30+/-9 years, range 16 to 48 years) actively involved in various sports. Intracompartmental pressures were monitored with the use of slit catheters connected to a pressure transducer in 28 anterior and 14 deep posterior compartments before and after exercise during the following positions of the ankle joint: relaxed-resting, passive plantar flexion, neutral, and passive dorsiflexion. Alterations in ICP were assessed with reference to that measured in the relaxed-resting position of the ankle.
Significant increases in ICP were observed in both anterior and deep posterior compartments during dorsiflexion of the ankle, being 9.1+/-10.6 mmHg (p=0.0001) and 8+/-10.3 mmHg (p=0.001) in the anterior compartment, and 6.4+/-4.4 mmHg (p=0.0001) and 7.2+/-4.3 mmHg (p=0.001) in the deep posterior compartment before and after exercise, respectively. No significant increases were found in other positions of the ankle (p>0.05). While the lowest values of ICP were noted in the relaxed-resting position, plantar flexion of the ankle was associated with decreased ICP pressures.
Dorsiflexion of the ankle increases ICP significantly in both anterior and deep posterior compartments. The results of this study may have clinical implications for the conservative management of both CECS and tibial fractures.
[Show abstract][Hide abstract] ABSTRACT: To report the middle term outcome in male and female patients who underwent surgery for chronic recalcitrant Achilles tendinopathy.
We tried to match each of the 58 female patients with a diagnosis of tendinopathy of the main body of the Achilles tendon with a male patient with tendinopathy of the main body of the Achilles tendon who was within two years of age at the time of operation. A match accordingly was possible for 41 female subjects.
Female patients were shorter and lighter than male patients. They had similar BMI, lower calf circumference, similar side-to-side calf circumference differences, and greater subcutaneous body fat than men. Of the 41 sedentary patients, only 25 reported an excellent or good result. Of these, three had undergone a further exploration of the Achilles tendon. The remaining patients could not return to their normal levels of activity despite prolonged supervised post-operative physiotherapy, with cryotherapy, massage, ultrasound, pulsed magnetic, and laser therapy.
Females experience more prolonged recovery, more complications, and a greater risk of further surgery than males with recalcitrant Achilles tendinopathy.
Disability and Rehabilitation 06/2008; 30(20-22):1714-20. · 1.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To report the outcome of surgery for chronic recalcitrant Achilles tendinopathy in nonathletic and athletic subjects.
University teaching hospitals.
We matched each of the 61 nonathletic patients with a diagnosis of tendinopathy of the Achilles tendon with an athletic patient with tendinopathy of the main body of the Achilles tendon of the same sex and age (+/-2 years). A match was possible for 56 patients (23 males and 33 females). Forty-eight nonathletic subjects and 45 athletic subjects agreed to participate.
Open surgery for Achilles tendinopathy.
Outcome of surgery, return to sport, complication rate.
Nonathletic patients were shorter and heavier than athletic patients. They had greater body mass index, calf circumference, side-to-side calf circumference differences, and subcutaneous body fat than athletic patients. Of the 48 nonathletic patients, 9 underwent further surgery during the study period, and only 25 reported an excellent or good result. Of the 45 athletic subjects, 4 underwent further surgery during the study period, and 36 reported an excellent or good result. The remaining patients could not return to their normal levels of activity. In all of them, pain significantly interfered with daily activities.
Nonathletic subjects experience more prolonged recovery, more complications, and a greater risk of further surgery than athletic subjects with recalcitrant Achilles tendinopathy.
Clinical Journal of Sport Medicine 04/2006; 16(2):123-8. · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To ascertain whether there are differences in the histopathological appearance of tendinopathic Achilles and patellar tendons.
In males, we studied biopsies from tendinopathic Achilles (N = 28; average age 34.1 yr) and patellar tendons (N = 28; average age 32.1), Achilles tendons (N = 21; average age 61.8 yr) from deceased patients with no known tendon pathology, and patellar tendons (N = 15; average age 28.3) from patients undergoing anterior cruciate ligament reconstruction. Hematoxylineosin stained slides were interpreted using a semiquantitative grading scale (0: normal to 3: maximally abnormal) for fiber structure, fiber arrangement, rounding of the nuclei, regional variations in cellularity, increased vascularity, decreased collagen stainability, and hyalinization. All slides were assessed blindly twice, the agreement between two readings ranging from 0.170 to 0.750 (kappa statistics).
The highest mean score of tendinopathic Achilles tendons was not significantly different from that of tendinopathic patellar tendons (11.6 +/- 5 and 10.4 +/- 3, respectively). The ability to differentiate between an Achilles tendon and a patellar tendon was low.
Tendinopathic Achilles and patellar tendons show a similar histological picture. It was not possible to identify whether a specimen had been harvested from an Achilles or a patellar tendon on the basis of histological examination. The general pattern of degeneration was common to both tendinopathic Achilles and patellar tendons. A common, as yet unidentified, etiopathological mechanism may have acted on both these tendon populations.
Medicine & Science in Sports & Exercise 10/2004; 36(9):1470-5. · 4.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The goal of the study was to report the prevalence of the lesions of the articular cartilage of the femoral condyles and tibial plateau in patients with a symptomatic anterior cruciate ligament (ACL)-deficient knee undergoing day-case arthroscopy.
Case series study.
We studied 378 skeletally mature patients (average age, 27.3 years; range, 16-50 years; 282 men and 84 women), part of a sample of 1,978 patients undergoing a primary knee arthroscopy between January 1986 and August 1993. The articular cartilage lesions were classified according to Outerbridge by a single observer. We assessed the relationship between time of injury and articular cartilage lesions and between meniscal lesions and articular cartilage lesions.
A complete ACL tear was found in all 378 knees. Of these, 157 showed at least one lesion of the articular cartilage. The medial femoral condyle (MFC) showed the highest frequency of articular cartilage lesions, especially in the weight-bearing portion. Patients with a bucket-handle tear of the medial meniscus had greater degeneration of the MFC than those with other meniscal tears. A meniscal tear was associated with a greater degree of articular damage. The second most common lesion was a combined lesion of the medial and lateral compartments, followed by isolated lateral compartment lesion. A time-dependent pattern of development of articular cartilage lesions was identified.
In patients with more advanced degenerative changes, the time from injury to arthroscopy was significantly longer than in patients with lesser articular surface abnormalities, and the presence of a meniscal tear was associated with a greater degree of articular cartilage damage. Patients with a symptomatic ACL-deficient knee and an associated tear of the medial meniscus are at high risk of having a lesion of the articular surface of the weight bearing area of the knee.
Arthroscopy The Journal of Arthroscopic and Related Surgery 10/2003; 19(7):685-90. · 3.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate sensitivity, specificity, reproducibility, and predictive value of palpation of the painful arc sign and of the Royal London Hospital test in 10 patients with Achilles tendinopathy and in 14 asymptomatic subjects.
University teaching hospital.
Ten male athletes on the waiting list for exploration of one of their Achilles tendons for tendinopathy of the main body of the tendon attended a special clinic. Each was invited to bring at least one athlete of the same sex in the same discipline aged within 2 years of themselves with no history and no symptoms of Achilles tendinopathy. A total of 14 controls were thus recruited.
Pain and tenderness following performance of palpation, the painful arc sign, and the Royal London Hospital test.
There were no statistically significant differences at the 5% level among the effects of investigator or between morning and afternoon measurements for any of the three measurement methods. There was no evidence of a difference of the three assessment methods (p > 0.05). When the three methods were combined, the overall sensitivity was 0.586 (confidence interval [CI], 0.469-0.741), and the overall specificity was 0.833 (CI, 0.758-0.889).
In patients with tendinopathy of the Achilles tendon with a tender area of intratendinous swelling that moves with the tendon and whose tenderness significantly decreases or disappears when the tendon is put under tension, a clinical diagnosis of tendinopathy can be formulated, with a high positive predictive chance that the tendon will show ultrasonographic and histologic features of tendinopathy.
Clinical Journal of Sport Medicine 01/2003; 13(1):11-5. · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patellar tendon injuries constitute a significant problem in a wide variety of sports. Despite the morbidity associated with patellar tendinopathy, its management is often anecdotal, with no evidence-based protocols available. This article summarizes the clinical features, describes recent advances in investigation of this condition, and outlines conservative and surgical treatment options.
(C) 2000 Lippincott Williams & Wilkins, Inc.
Sports Medicine and Arthroscopy Review 12/1999; 8(1). · 2.64 Impact Factor