-
[show abstract]
[hide abstract]
ABSTRACT: Objective functional outcomes following isolated radial lateral meniscus tears in the athlete between the ages of 14-25 are not clearly defined. The objective of this study was to determine whether patients following lateral meniscectomy demonstrate lower extremity asymmetries relative to control athletes 3 months after surgery. We hypothesized that following lateral meniscectomy, athletes aged 14-25 years old would demonstrate altered landing biomechanics compared to sex, age, height, weight, and sport-matched controls.
A total of 18 subjects were included in this study. Nine patients (7 men and 2 women, 20.1 ± 2.8 years) who had undergone first-time isolated radial lateral meniscus tears were tested 3 months following partial lateral meniscectomies and compared to nine sex, age, height, weight, and sport-matched controls (7 men and 2 women, 19.7 ± 3.1 years). A ten-camera motion analysis system and two force platforms were used to collect three trials of bilateral drop landings. A 2X2 ANOVA was used to test the interaction between side (involved vs. uninvolved) and group (patient vs. control).
The patient group landed with a decreased internal knee extensor moment compared to the uninvolved side and controls (interaction P < 0.05). The involved limb quadriceps isokinetic torque was not decreased compared to the contralateral or control (n.s.). Decreased knee extensor moments were significantly associated with reduced measures of function (IKDC scores: r = 0.69; P < 0.05).
Athletes who return to sport at approximately 3 months following a partial lateral meniscectomy may employ compensation strategies during landing as evidenced by reduced quadriceps recruitment and functional outcome scores. Clinicians should focus on improving quadriceps function during landing on the involved leg in an attempt to decrease residual limb asymmetries.
Case-control study, Level III.
Knee Surgery Sports Traumatology Arthroscopy 04/2011; 19(10):1716-21. · 2.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The knee is a mobile functional anatomical unit which plays a key role in recreational function. In the last three decades, the knee has received a great deal of attention in the sports medicine literature, particularly in respect to isolated ligament pathology and management. In reference to combined multiple ligament pathology, a more limited number of articles exist, and indeed lead to confusing management. Although hundreds of publications address the topic of surgical correction of the anterior cruciate ligament (ACL), debate continues regarding clinical intervention for the patient with combined ACL and medial collateral ligament (MCL) management. Issues exist which the clinician must consider, including which structures require repair, timing of surgical intervention, and rehabilitation approaches. This article will attempt to define a treatment algorithm for the clinician to consider with simultaneous injury to the ACL and MCL.
North American journal of sports physical therapy (NAJSPT) 11/2008; 3(4):204-11.
-
[show abstract]
[hide abstract]
ABSTRACT: Female athletes participating in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than do male athletes.
Prescreened female athletes with subsequent anterior cruciate ligament injury will demonstrate decreased neuromuscular control and increased valgus joint loading, predicting anterior cruciate ligament injury risk.
Cohort study; Level of evidence, 2.
There were 205 female athletes in the high-risk sports of soccer, basketball, and volleyball prospectively measured for neuromuscular control using 3-dimensional kinematics (joint angles) and joint loads using kinetics (joint moments) during a jump-landing task. Analysis of variance as well as linear and logistic regression were used to isolate predictors of risk in athletes who subsequently ruptured the anterior cruciate ligament.
Nine athletes had a confirmed anterior cruciate ligament rupture; these 9 had significantly different knee posture and loading compared to the 196 who did not have anterior cruciate ligament rupture. Knee abduction angle (P<.05) at landing was 8 degrees greater in anterior cruciate ligament-injured than in uninjured athletes. Anterior cruciate ligament-injured athletes had a 2.5 times greater knee abduction moment (P<.001) and 20% higher ground reaction force (P<.05), whereas stance time was 16% shorter; hence, increased motion, force, and moments occurred more quickly. Knee abduction moment predicted anterior cruciate ligament injury status with 73% specificity and 78% sensitivity; dynamic valgus measures showed a predictive r2 of 0.88.
Knee motion and knee loading during a landing task are predictors of anterior cruciate ligament injury risk in female athletes.
Female athletes with increased dynamic valgus and high abduction loads are at increased risk of anterior cruciate ligament injury. The methods developed may be used to monitor neuromuscular control of the knee joint and may help develop simpler measures of neuromuscular control that can be used to direct female athletes to more effective, targeted interventions.
The American Journal of Sports Medicine 05/2005; 33(4):492-501. · 3.79 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The results of 11 patients who underwent simultaneous arthroscopically assisted anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction for acute (n=7) or chronic (n=4) multiligamentous knee injuries were reviewed. Seven patients were treated with a bone-patellar tendon-bone (BPTB) autograft for the ACL reconstruction and an Achilles allograft for the PCL reconstruction, three patients with ipsilateral/contralateral BPTB autografts, and one patient with BPTB allograft for ACL and Achilles allograft for PCL. Seven patients were operated on acutely (<3 months postinjury), and 4 were treated for chronic conditions. At follow-up, all patients were subjectively and functionally evaluated with a Lysholm Knee Scoring Scale. Average patient age at surgery was 29 years, and average postoperative follow-up was 28.4 months. Average postoperative Lysholm score was 87.7 (range: 49-100). Four of 11 patients reported occasional mild pain, 2 occasional swelling, and 4 infrequent instability. No patient required a postoperative manipulation to regain his or her range of motion and 10 of the 11 returned to their previous activity level postoperatively. Of the 10 patients able to return for clinical examination, 2 demonstrated a loss of flexion <5 degrees compared to the other side, 7 demonstrated a mild postoperative posterior drawer at 90 degrees (6 at 1+, 1 at 2+), 3 demonstrated a positive Lachman (grade 1), whereas no patient demonstrated any posterior lateral corner instability. The average anterior active difference on KT-1000 was 2.6 (range: 0-6). Simultaneous reconstruction of the ACL and PCL, although technically difficult, is feasible and yields good to excellent functional results.
The journal of knee surgery 11/2003; 16(4):191-6.
-
[show abstract]
[hide abstract]
ABSTRACT: Sixty-eight skeletally mature New Zealand white rabbits were used to study the effects of iontophoresis- and injection-delivered sodium phosphate dexamethasone (DX) on the morphologic, histologic, microscopic, and biomechanical properties of uninjured rabbit patellar tendons over an initial 14-d period.
Three control (untreated, placebo iontophoresis, and placebo injection) groups and two treatment (iontophoresis and injection) groups underwent serum, ELISA tendon, histology, electron microscopy, and biomechanical analysis.
Serum DX levels were detectable and quantifiable in both treatment groups at 1 h but were significantly greater (P < 0.05) in the injected group (11.29 ng.mL-1) compared with the iontophoresis group (6.34 ng.mL-1). The most significant histologic finding was a lack of a cellular inflammatory response in the DX-treated groups at 24 h. Ultrastructural analysis produced no significant differences between size or size ratio of collagen fibrils among any groups. Morphologic examination revealed only injection puncture marks seen in appropriate tendons. Biomechanical testing produced disruption at the patellar insertion in 81% of the specimens. No injected tendon failed at the injection site. Normalized biomechanical properties included: 1) Stiffness increased in control and iontophoresis groups from 1 to 24 h, then gradually declined; the DX-injected specimens showed a similar but delayed effect. 2) Peak load at failure for iontophoresis and control groups was greatest at 24 h. The DX-injected group again showed a delayed response. 3) In general, total energy to failure revealed no significant differences between groups at any time period.
It appears that iontophoresis or injection-delivered DX may produce anti-inflammatory effects without significantly altering ultrastructural or biomechanical characteristics of the rabbit patellar tendon within an initial 14-d period.
Medicine & Science in Sports & Exercise 08/2002; 34(8):1294-301. · 4.43 Impact Factor
-
The American Journal of Sports Medicine 32(5):1310-2. · 3.79 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In recent years, various investigators have begun using lasers in the treatment of shoulder instability.
Arthroscopic laser-assisted capsular shift is an effective treatment for patients with multidirectional shoulder instability.
Retrospective cohort study.
We retrospectively identified 28 patients (30 shoulders) with multidirectional shoulder instability who were unresponsive to nonoperative management and who had undergone the laser-assisted capsular shift procedure. Twenty-five patients (27 shoulders) with an average follow-up of 28 months were available for review. All patients underwent a physical examination and completed a general questionnaire; the University of California, Los Angeles, shoulder rating scale; the Western Ontario Shoulder Instability Index; and the Short-Form 36 quality of life index.
In 22 shoulders, results of the procedure were considered a success because the patients had no recurrent symptoms and at latest follow-up had required no further operative intervention. In five shoulders, results were considered a failure because of recurrent pain or instability and the need for an open capsular shift procedure. With recurrent instability as a measure of failure, the overall success rate was 81.5%.
Our results with laser-assisted capsular shift are comparable with the results of other open and arthroscopic techniques in relieving pain and returning athletes to their premorbid function.
The American Journal of Sports Medicine 30(3):322-8. · 3.79 Impact Factor
