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Epidemiology of athletic knee injuries: A 10-year study

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Abstract

The knee is an anatomically and biomechanically complex joint. Few studies have been published reporting the type and frequency of knee injuries. However, this information that may help to prevent, diagnose, and treat knee joint injuries. We have documented 17,397 patients with 19,530 sport injuries over a 10-year period of time. 6434 patients (37%) had 7769 injuries (39.8%) related to the knee joint. 68.1% of those patients were men and 31.6% were women. Almost 50% of the patients were between the ages of 20-29 (43.1%) at the time of injury. The injuries documented were ACL lesion (20.3%), medial meniscus lesion (10.8%), lateral meniscus lesion (3.7%), MCL lesion (7.9%), LCL lesion (1.1%), and PCL lesion (0.65%). The activities leading to most injuries were soccer (35%) and skiing (26%). LCL injury was associated with tennis and gymnastics, MCL with judo and skiing, ACL with handball and volleyball, PCL with handball, lateral meniscus with gymnastics and dancing, and medial meniscus with tennis and jogging.

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... Among sport-related injuries, knee injuries are most common accounting for 39% of those according to epidemiological studies [1], reaching as high as 73.9% [2]. The most commonly injured knee structures are the medial collateral ligament (MCL), the patellar tendon, the anterior cruciate ligament (ACL), and menisci [1,[3][4][5]. ...
... Among sport-related injuries, knee injuries are most common accounting for 39% of those according to epidemiological studies [1], reaching as high as 73.9% [2]. The most commonly injured knee structures are the medial collateral ligament (MCL), the patellar tendon, the anterior cruciate ligament (ACL), and menisci [1,[3][4][5]. Studies agree that lateral collateral ligament (LCL) injuries are far less common, representing only 1.1% of all knee injuries [1]. ...
... The most commonly injured knee structures are the medial collateral ligament (MCL), the patellar tendon, the anterior cruciate ligament (ACL), and menisci [1,[3][4][5]. Studies agree that lateral collateral ligament (LCL) injuries are far less common, representing only 1.1% of all knee injuries [1]. Therefore, it is difficult to draw conclusions regarding which life activities and sports present the greatest injury risk. ...
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Avulsion injuries of the LCL most commonly occur at the fibular insertion. Femoral LCL avulsion injuries have only been previously described in pediatric patients or as multiligament knee injury components among adults. This case series with comprehensive literature review describes for the first time 2 cases of isolated LCL femoral avulsion fractures in adults including conservative treatment outcomes. Both patients sustained a strong varus stress mechanism to their right knee, following sport injury or road traffic accident. For both patients, a complete radiographic evaluation including X-rays, MRI, and CT scan confirmed no other associated knee lesions. The femoral LCL avulsion fractures that were observed were minimally displaced and noncomminuted. Furthermore, imagery suggested preserved integrity at the superior lateral genicular artery, adjacent articular capsule, and IT band. Based on clinical and imaging evaluations, the decision was made to follow conservative treatment. By 10 weeks postinjury, both patients were asymptomatic with early radiological fracture healing evidence. Comparative varus stress radiographs at 20° knee flexion revealed no side-to-side differences and clinical exam showed no posterolateral rotatory instability. The second patient case presented with mild femoral LCL attachment calcification on follow-up CT-scan. Following a detailed analysis of anatomic injury characteristics, we suggest that patients with isolated femoral LCL avulsion fractures have low secondary displacement risk provided SLGA, articular capsule, and IT band integrity are present. In contrast to high-grade ligamentous and distal avulsion LCL injuries, we recommend conservative treatment for patients who sustain these lesions.
... -Traumatic meniscus injuries, due to an acute trauma in usually young and sportive patients and generally caused by a too high loading or twisting of the knee, often resulting in the onset of pain. Knee injuries correspond to approximately 40% of sport-related injuries and among them around 11% to medial meniscus injuries (more exposed to biomechanical forces compared to the lateral meniscus) and around 4% to lateral meniscus injuries [30]. Sports that are mainly at risk were reported to be: soccer, gymnastics, dancing, tennis, and jogging [30]. ...
... Knee injuries correspond to approximately 40% of sport-related injuries and among them around 11% to medial meniscus injuries (more exposed to biomechanical forces compared to the lateral meniscus) and around 4% to lateral meniscus injuries [30]. Sports that are mainly at risk were reported to be: soccer, gymnastics, dancing, tennis, and jogging [30]. -Degenerative meniscus injuries caused by slow degradation of the tissue in older patients. ...
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Walking, running, jumping, or even just standing up are habits that we all have to perform in our everyday lives. However, defects in tissues composing the knee joint can drastically alter our ability to complete those simple actions. The knee joint is made up of the interaction between bones (femur, tibia, and patella), tendons, ligaments, and the two menisci (lateral and medial) in order to ensure smooth body movements. The meniscus corresponds to a crescent-shaped fibrocartilaginous tissue, which is found in the knee joint between the femoral condyles and the tibial plateau. It plays a key role in the stability of the knee joint. However, it is quite vulnerable and therefore tears can occur within this tissue and compromise the proper function of the knee. Recently, numerous efforts have been made in order to find solutions to repair and regenerate the meniscus, supported by both bioengineering researchers and orthopedic surgeons. However, due to its poor healing capacity and its complex structure, the reconstruction of the meniscus remains particularly challenging. In this review, the current treatment options will be explained and the possibility of using organoids as building blocks for implant formation or as an in vitro three-dimensional model will be highlighted.
... Soccer is the most popular sport in the world among people in different countries [1], but it often presents a high risk of injuries for musculoskeletal damage [2]. A statistical analysis of sport injuries over a 10 year period recorded 19,530 total injuries in 17,937 recreationally active participants [3]. 35% of those occurred during participation in soccer, making it the activity with the most injuries [3]. ...
... A statistical analysis of sport injuries over a 10 year period recorded 19,530 total injuries in 17,937 recreationally active participants [3]. 35% of those occurred during participation in soccer, making it the activity with the most injuries [3]. Elite soccer players suffer between 1.5 and 7.6 injuries per 1000 h of training and between 12 and 35 injuries per 1000 h of matches [4]. ...
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Soccer is the world’s game, and keeping athletes healthy while playing the game has often been a focus of study. There is a high occurrence of musculoskeletal injuries reported in soccer. FIFA 11+ was developed as an intervention to help prevent such injuries. FIFA 11+ has previously been studied for its efficacy as an injury prevention program, but not for its effect on sports performance in an adolescent population. The purpose of this study was to look at the effect of implementing the FIFA 11+ intervention on strength, speed, and agility. Twenty youth soccer players were randomly divided into an intervention group (INT) and a control group (CON). The intervention lasted for eight weeks and performance assessments were completed pre- and post-intervention. Post-test INT knee flexor strength was significantly higher than pre-test scores (p < 0.05). INT also demonstrated significantly higher hamstring to quadriceps strength ratio (H/Q) after the intervention (p < 0.05), while the CON H/Q did not change significantly. 30-m sprint performance of both groups improved from pre- to post-test (p < 0.05). Shuttle run performance was significantly improved in post-test scores for INT players (p < 0.05), but did not change significantly for the CON players. It is suggested that implementing FIFA 11+ before training in young soccer players can lead to performance benefits as well as injury prevention benefits.
... The medial collateral ligament (MCL) is a major stabilizer as 1 of the 4 ligaments in the knee, 1 and it accounts for nearly 8% of all knee injuries. 23 These injuries are extremely common in athletic environments with an emphasis on sports such as judo, skiing, hockey, and rugby. ...
... 24 Knowledge of the injury mechanism facilitates expedient diagnosis and helps guide management; additionally, it lends insight into potential associated structures that may be affected by the same injury. 1 The most cited study out of the 50 collected for this analysis was "Epidemiology of Athletic Knee Injuries: A 10-Year Study" by Majewski et al, 21 published in The Knee. This article discusses the type and frequency of knee injuries to aid in prevention, diagnosis, and treatment of knee injuries. ...
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Background Medial collateral ligament (MCL) injury is a common orthopaedic knee injury with a plethora of published articles regarding evaluation, treatment, and outcome. Purpose To perform a comprehensive bibliometric analysis of the 50 most cited articles in MCL research. Study Design Cross-sectional study. Methods We performed a keyword search of the Institute for Scientific Information’s Web of Knowledge database for the identification of articles published before September 2021 encompassing the MCL. The conducted search yielded 9534 articles. The results were then filtered using predetermined guidelines and criteria, and the 50 most cited articles were selected for analysis. Extracted data included title, authors, citation count, year of publication, topic, journal, article type, country of origin, and level of evidence. Results The selected 50 articles ranged from 1976 to 2013. The largest proportion was classified as having level 4 evidence (n = 12; 24%). The majority of the articles were published in the decade from 2000 to 2009 (n = 17; 34%), followed by 1990 to 1999 (n = 16; 32%). The mean raw citation score per article was 133 (range, 74-422). The most popular topic discussed was surgical technique and outcome (n = 14; 28%), followed by anatomy and biomechanics (n = 13; 26%). Conclusion This study provides a comprehensive and objective measure of the most cited articles on MCL research. Knowledge of the characteristics of these most influential articles improves the understanding of MCL injury and can guide discussion for future research.
... Epidemiological studies reveal that the knee joint is one of the most affected articulations, with a quote of 30% of all injuries (Frey et al., 2019;Kim et al., 2015). Independent of the weight category, an anterior cruciate ligament (ACL) rupture is the most severe injury with high clinical relevance, causing up to one year of down time and a persistently reduced performance in 68% of affected athletes (Majewski et al., 2006). Akoto et al. provides numerical data on 4,659 judoka indicating that approximately 10% suffer an ACL injury during their career (Akoto et al., 2017) in combat while in direct or indirect contact situations with opponents (Koshida et al., 2010). ...
... Second, because this study was designed to develop a new defence strategy in judo, prospective longterm trials, including injury epidemiology during training and competitive fights, are needed to present to what extent this modified osoto-gari defence reaction reduces the incidence of ACL injuries compared to the common technique. Third, the study of (Majewski et al., 2006) indicates that the injury risk is greater when the opponent adopts a certain grip style different from that of the norm. We did not consider grip style as a factor in our study. ...
Article
In judo, an anterior cruciate ligament (ACL) injury is the most severe injury an athlete could experience. Most ACL ruptures occur when defending against an osoto-gari attack. This study aims to identify ACL risk factors during osoto-gari defence and implement a modified osoto-gari defence reaction, which is assumed to improve myoelectric patterns and ameliorate critical biomechanical risk factors for ACL injuries. Twenty-six elite judokas were enrolled in the cross-over trial (female: 6; male: 20). 3D kinematics and force dynamometrics were combined with electromyographical recordings to assess the effects of the common and the modified osoto-gari defence reaction. Compared to the common osoto-gari defence reaction (maximal knee flexion: 29 ± 12°; maximal valgus: 10 ± 5°; maximal valgus moment: 58 ± 17 Nm; peak internal rotation: 9 ± 5°), the modified osoto-gari defence reaction showed significantly reduced knee angles (31 ± 10° p < 0.05; 1 ± 0° p < 0.05; 31 ± 9 Nm p < 0.05; 3 ± 0° p < 0.05). The myoelectric activity of the hamstring increased (+5±% to +27±%, p < 0.05) in the modified compared to common defence reaction. The modified osoto-gari defence reaction reduced critical biomechanical risk factors and increased hamstring myoelectric activity. We recommend the implementation of the modified osoto-gari defence reaction in judo practice and seek to evaluate its long-term effectiveness in decreasing ACL injury incidences in elite judo.
... Meniscus tears are a common orthopedic injury, comprising 12-14% of orthopedic knee presentations with an annual incidence of 60-70 cases per 100,000 persons [1][2][3]. Knowledge of the functional and biomechanical role of the meniscus, and the anterior and posterior roots specifically, has evolved in the past few decades. Meniscus root tears (MRTs), defined as a complete radial tear within 1 cm of the tibial attachment point or a bony/soft tissue avulsion has grown in interest with mounting data showing poor native outcomes equivalent to subtotal meniscectomy [4,5]. ...
... Twelve to 14% of all orthopedic presentations involving the knee are due to a meniscus tear [3]. Meniscus root tears, in particular, were relatively unknown until Pagnani et al. described medial meniscus posterior root tears (MMPRTs) with associated meniscus extrusion in 1991 [38]. ...
Article
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Purpose of Review The role of the meniscus in preserving the biomechanical function of the knee joint has been clearly defined. The hypothesis that meniscus root integrity is a prerequisite for meniscus function is supported by the development of progressive knee osteoarthritis (OA) following meniscus root tears (MRTs) treated either non-operatively or with meniscectomy. Consequently, there has been a resurgence of interest in the diagnosis and treatment of MRTs. This review examines the contemporary literature surrounding the natural history, clinical presentation, evaluation, preferred surgical repair technique and outcomes. Recent Findings Surgeons must have a high index of suspicion in order to diagnose a MRT because of the nonspecific clinical presentation and difficult visualization on imaging. Compared with medial MRTs that commonly occur in middle age/older patients, lateral meniscus root injuries tend to occur in younger males with lower BMIs, less cartilage degeneration, and with concomitant ligament injury. Subchondral insufficiency fractures of the knee have been found to be associated with both MRTs and following arthroscopic procedures. Meniscus root repair has demonstrated good outcomes, and acute injuries with intact cartilage should be repaired. Cartilage degeneration, BMI, and malalignment are important considerations when choosing surgical candidates. Meniscus centralization has emerged as a viable adjunct strategy aimed at correcting meniscus extrusion. Summary Meniscus root repair results in a decreased rate of OA and arthroplasty and is economically advantageous when compared with nonoperative treatment and partial meniscectomy. The transtibial pull-through technique with the addition of centralization for the medial meniscus is associated with encouraging early results.
... High risk of bias Linderoth et al. [30] 11.1% High risk of bias Lo et al. [26] 22.2% High risk of bias Lovell et al. [46] 70.0% Moderate risk of bias Majewski et al. [25] 40.0% High risk of bias Rajabi et al. [15] 100.0% ...
... Furthermore, in a 10-year study, Majewski et al. [25] (high risk of bias) described 37 cases of knee joint traumas in 123,653 TT players (with a coefficient rate of 0.03). ...
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Abstract: Background and Objectives: Table tennis represents one of the fastest ball games in the world and, as such, is characterized by unique physiological demands. Despite its popularity, there is a dearth of data related to table-tennis-related risk factors and injuries. Therefore, the present review was conducted to fill in this gap of knowledge. Material and Methods: The present review was designed as a scoping review. Eleven online databases were searched with no language/date limitations. Results: Forty-two investigations were retained in the present review. These studies indicated that tenosynovitis, benign muscle injuries, strains, and sprains were the most common injury types. In order, the most commonly affected anatomical regions were the lower limb, shoulder, spine, knee, upper limb, and trunk. When comparing the injury occurrence between training and competition, the results were contradictory. National/international athletes had higher indices of injury than regional players, even though other investigations failed to replicate such findings. According to some scholars, there was a difference between female and male athletes: in females, more injuries involved the upper limbs when compared to men who had more injuries to the lower limbs, while other studies did not find differences in terms of gender. Conclusions: Table tennis is generally considered at lower risk for injuries than other sports. However, the present scoping review showed that injuries can occur and affect a variety of anatomic regions. Sports scientists/physicians could utilize the information contained in the current review for devising ad hoc programs to adopt an effective/appropriate prevention strategy and to monitor table tennis players’ training load and to achieve maximal fitness, as these will reduce the risk of injuries. However, most of the studies included in our scoping review are methodologically weak or of low to- moderate evidence, being anecdotal or clinical case reports/case series, warranting caution when interpreting our findings and, above all, further high-quality research in the field is urgently needed.
... 84% of patients of this study were male and male out numbered females in all age groups in this study. Majewski et al [7] study showed, acute traumatic injuries of knee were common in age group 20-29 and 70% were male. In our study, traumatic injury to knee were found in 84% males. ...
... An anterior cruciate ligament (ACL) injury is one of the most common severe knee injuries in sports that typically occur during cutting, landing, and other sudden deceleration maneuvers [ 10,33,40 ]. There are approximately 200,000 ACL injuries and 100,000 ACL reconstructions in the United States each year [ 17,37 ]. ...
Article
PurposeAn anterior cruciate ligament (ACL) injury is one of the most common severe knee injuries in sports. The purpose of this review was to summarize the studies that directly quantified in vivo ACL loading as a function of knee motion in healthy individuals during static, slow-speed and athletic tasks.MethodsA systematic review of the literature in multiple databases was conducted using different combinations of the terms “anterior cruciate ligament” or “ACL” and “in vivo” combined with “tensile” “strain” “stress” “force” and “loading”.ResultsA total of 27 studies were identified. Eleven studies utilized strain sensors, while 16 studies applied imaging techniques. The numbers of studies for static or semi-static postures, slow-speed tasks, and athletic tasks were 12, 11 and 4, respectively.Conclusion There were strong and negative correlations between ACL elongation and knee flexion angles across different tasks. Peak ACL elongation mostly occurred when the knee flexion angle was minimal. Increased tibial anterior shear forces and patellar tendon forces would increase ACL loading when the knee is kept at a constantly small angle. In addition, a high patellar tendon force could be generated by preparatory quadriceps activation to load the ACL even when the lower extremity was not in contact with the ground during athletic tasks. Furthermore, while exercise modalities might affect peak ACL loading, the relationship between exercise intensities and ACL loading was complex and should not be assumed to be linear.
... Even if a low grade MCL injury is present, surgical intervention may still be warranted if there is other internal derangement. MCL tears are often accompanied by ACL tears, as was the case with our patient [9] . The ACL provides resistance to anterior displacement and internal rotation of the knee joint, and resistance to external rotation and varus-valgus angulation [10] . ...
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This report describes the identification and management of a Stener-like lesion of the medial collateral ligament of the knee in a 55-year-old woman. Patient underwent magnetic resonance imaging (MRI) following a skiing injury and was found to have a tear of the distal fibers of the superficial medial collateral ligament (MCL) complex, with displacement of the ligament superficial to the tendons inserting at the pes anserinus. Identification of a Stener-like lesion in the setting of MCL injury aids in selecting appropriate management. Prompt surgical intervention is warranted to achieve anatomic healing and prevent long-term valgus instability, chronic pain, and osteoarthritis.
... The LCL is the first restraint for knee varus in the entire range of motion [1,2]. LCL injuries often occur as part of PLC injuries associated with cruciate ligament injuries in sports injuries [3]; however, isolated LCL injuries are rare, and only a few cases have been reported [1,4,5,6]. LCL injuries are diagnosed using a manual varus stress test; however, it may be impossible to confirm instability, as in this case. ...
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Introduction: We report a rare case of surgical treatment for an isolated lateral collateral ligament (LCL) injury of the knee that was difficult to correctly diagnose considering physical findings alone of a judo athlete. Case Report:The 27-year-old man complained of pain on the lateral side of the right knee and discomfort and balance instability when climbing and descending stairs. During a judo match, he stepped on his right foot to prevent his opponent’s waza (techniques), causing forced varus on his knee in a slight flexion position. His right knee showed no apparent sway in the manual test, but pain around the fibular head was induced in the figure-of-four position, and the LCL could not be palpated. Joint instability was not detected on varus stress roentgenography, but magnetic resonance imaging showed signal changes and an abnormal course in the fibula head insertion at the distal part of the LCL. Although no instability was observed objectively, clinical findings diagnosed LCL as an isolated injury, and surgical treatment was performed. Six months after the operation, his symptoms improved, and he resumed competing in judo. Conclusion:To correctly diagnose an isolated LCL injury of the knee, it is important to consider patient history and physical findings. Repair of the injury could improve subjective symptoms, such as pain, discomfort, and balance instability, even if objective instability is not observed. Keywords:Lateral collateral ligament, knee, ligament repair, judo.
... A previous study showed that 32.6% of all sports injuries involve the knee joint 15 . In addition, an epidemiological study of 19,530 sports injuries found that ACL and MCL injuries occurred 20 and 8 times more frequently than PCL or LCL injuries, respectively 16 . Unlike ACL injuries, MCL injuries are usually treated conservatively. ...
Article
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Ligaments are collagenous connective tissues that connect bones. Injury of knee ligaments, namely anterior cruciate ligament (ACL) and medial collateral ligament (MCL), is common in athletes. Both ligaments have important functions, but distinct regeneration capacities. The capacity for recovery after injury also diminishes with age. However, cellular heterogeneity in the ligaments remains unclear. Here, we profiled the transcriptional signatures of ACL and MCL cells in mice using single-cell RNA sequencing. These ligaments comprise three fibroblast types expressing Col22a1, Col12a1, or Col14a1, but have distinct localizations in the tissue. We found substantial heterogeneity in Col12a1- and Col14a1-positive cells between ACL and MCL. Gene Ontology analysis revealed that angiogenesis- and collagen regulation-related genes were specifically enriched in MCL cells. Furthermore, we identified age-related changes in cell composition and gene expression in the ligaments. This study delineates cellular heterogeneity in ligaments, serving as a foundation for identifying potential therapeutic targets for ligament injuries. Cell heterogeneity in the mouse anterior cruciate ligament (ACL) and medial collateral ligament (MCL) is demonstrated using single-cell analysis with three types of fibroblasts identified, expressing Col14a1, Col12a1, or Col22a1.
... 1,2 The published frequency of ACL ruptures in the general community is 0.8 per 1000 inhabitants, although this figure is probable to increase in younger, more athletic individuals. 2,3 Although patients who suffer an ACL rupture and are treated with the technique that is currently considered the gold standard [ACL reconstruction (ACLR)] generally return to sport, 50% of ACLR patients experience osteoarthritis (OA) within 12-14 years. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Given the elevated frequency of ACL ruptures, especially in young patients, determining the elements that can make a contribution to the appearance of OA following ACL rupture is essential. ...
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Half of the individuals who experience an anterior cruciate ligament reconstruction (ACLR) suffer from knee osteoarthritis (OA) 12-14 years later. Elements that make a contribution to the appearance of OA following ACLR are anomalous anterior tibial displacement and anomalous tibial rotation in the course of the stance phase of walking (exhibited in 85% of operated knees). Individuals who undergo an early ACLR (5 days on average following anterior cruciate ligament [ACL] breakage) have an inferior frequency of radiographically apparent tibiofemoral OA at 32-37 years of follow-up than individuals with ACL rupture who did not experience the procedure. Nevertheless, the percentage of symptomatic OA, radiographically apparent patellofemoral OA and knee symptoms are alike in both groups. At 15 years of follow-up, 23% of knees that experienced an anatomic ACLR suffer from OA, while this percentage augments to 44% if the ACLR was non-anatomic. Knees of individuals who experience ACLR need total knee arthroplasty at an earlier age than healthy knees. Intra-articular injections of interleukin-1 receptor antagonist and corticosteroids may reduce the risk of OA after ACLR.
... In any sport, there are many positive effects on the body and health, nevertheless, knee injury is one of the commonly occurring injuries in sports, and it accounts 41 -42.1% of all sport injuries (Sancheti et al. 2010;Taunton et al. 2002). In a ten years study made by Majewski et al. (2006), from 17397 patients with injuries, 37% had 39.8% of injuries related to the knee joint. Almost a half of them (43.1%) were young people from 20 to 29 years old, and the proportion of men and women was 68.1% and 31.6%, ...
Thesis
There are many sports-related knee injuries, some of which involve the iliotibial band (ITT). This is a thicker part of the deep fascia of the thigh, called fascia lata. The fascia lata is a fibrous connective tissue composed of elastin fibers and networks of collagen fibers present in different layers of tissue. It has a stabilizing role in the joint and allows the transfer of forces between muscles, but its properties and strain mechanisms remain poorly understood. In this context, the strain mechanisms of the fascia lata during physiological knee movements were studied. Quantitative data of fascia lata strain fields were obtained in situ highlighting strain mechanisms in tension, compression, and shear. Therefore, the mechanical behavior of isolated fascia lata samples was analyzed with shear tests such as bias extension tests and traction of a large band tissue. The study of collagen fiber kinematics was also included. A first contribution to the finite element modelling of fascia behavior was also proposed. Finally, as the natural state of deformation of the fascia lata contributes to good knee mobility, an in situ study was set up to evaluate the impact on joint mobility and strain levels on fascia of a surgical tension-release technique, known as pie-crusting, applied to the ITT and which may be recommended in pathological cases. All the work carried out therefore provides new elements in the study of the mechanical behavior of fascia lata.
... The exclusion for both groups is the same which is having a history of knee joint disease that can affect angulation and femoral condyles distance of knee joints such as Rickets, Blount's disease. (Majewski et al., 2006) B. Instrument ...
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Genu varum and valgum can trigger for osteoarthritis and happened between 16-18 years old. The study aimed to find out the relationship between knee joint alignment and footballers activities. This was a cross-sectional study, with 64 participants from two groups and only participants whom were meet all inclusion criteria were joined. It showed the knee joint angle in comparison to the norm was very significant with p- value 0.000 and there was a connection to practicing football against knee joint alignment, more specifically varum. In conclusion, there is a significant relationship between practicing football and the knee joint as measured by degree og genu varum and vagum as differences were found in year and duration of training.
... A nterior Cruciate Ligament (ACL) reconstruction is one of the most common surgeries among athletes (1). There is a growing body of literature regarding postural control changes following ACL reconstruction (2). ...
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Background: To evaluate intra and intersession reliability of the Center of Pressure (COP) parameters in Anterior Cruciate Ligament Reconstructed (ACLR) athletes with and without ankle vibration using a dual-task paradigm. Methods: Postural sway of 14 ACLR individuals was assessed during a single-leg stance on a force platform. COP parameters were assessed with manipulating sensory inputs via vision and ankle vibration under single and dual-task conditions. The outcome variables included COP displacement in medial-lateral (ML) and anterior-posterior (AP) range, mean velocity (mV), and area. During dual-task conditions, the auditory Stroop Task was applied. Intraclass correlation coefficient (ICC) values and standard error of measurement (SEM) were assessed for relative and absolute reliability. Results: The COP measures had moderate to very high intrasession reliability (ICC range: 0.51-0.93) for conditions with vibration and cognitive task, with the highest ICCs for mV and the lowest for area, regardless of eyes being open or closed. The intersession reliability was moderate to high for mV (ICC range: 0.60-0.82) and little to very high (ICC range: 0.21-0.97) for the range of ML and AP, as well as an area in conditions with vibration and cognitive task. Conclusion: The mV is the most reliable COP parameter for assessing postural control under ankle vibration and dual-task conditions for both operated and non-operated sides. During closed-eye conditions, the application of vibration affected the intersession reliability with decreased ICCs on the operated side and increased ICCs on the non-operated side.
... The knee is under strain in daily life and during sporting activities [4]. 20-25% of all knee injuries occur during exercise [5]. ...
Chapter
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Lattice structures are designed structures with excellent mechanical properties. Because of the continuous development of parametric design and additive manufacturing, lattice structures can be more easily applied to products design. Therefore, we explore how to combine different lattice structures through the parametric design of a knee pad. Our research shows the possibility of creating customized knee pads using lattice structures. The research can be divided into three parts: the understanding of lattice structures, the acquisition of user data, and the use of user data. In the first part, the mechanical properties of various lattice structures are compared to provide the selection basis of lattices in knee pads design. In the second part, the user’s knee pressure data are collected and analyzed with the self-made wearable pressure detection device. In the third part, through the generative design program developed for our research, the designs of customized knee pads are completed. Finally, we select one design solution for the 3D-printed prototype and conduct the user test.
... Ligament injuries are the most common pathology of the knee among athletes and ACL and MCL injuries account for most ligament problems (Bollen, 2000;Majewski et al., 2006). Following a ligament injury, other complications, including joint instability, dislocation and osteoarthritis, can occur, causing functional disability and a great societal economic burden. ...
Article
Polyethylene terephthalate (PET) artificial ligaments offer an unlimited source of ligaments without donor-site-related morbidity and with good mechanical properties for a rapid return to sporting activities. Developing PET artificial ligaments with excellent ligamentisation and ligament-bone healing is still a considerable challenge. This study aimed to investigate the effects of the profiled PET/collagen/calcium phosphate (PET/C/CaP) ligament upon cell growth, ligamentisation and ligament-bone healing in vitro and in vivo. Profiled PET/C/CaP filaments were made by melt-spinning process with 2 % CaP hybrid spinning and collagen coating. Rat mesenchymal stem cells (MSCs) were cultured on the profiled PET/C filaments for cytotoxicity, viability, scanning electron microscopy (SEM) and ligament-related gene expression analysis. MSCs’ osteogenic capacity on the profiled PET/CaP filaments was identified by detecting osteogenic gene expression and alizarin red S staining. For in vivo verification, an animal study was performed to evaluate the effect of the profiled PET/C/CaP ligament in a rabbit knee medial collateral ligament reinforcement reconstruction model. The graft ligamentisation and bone formation were investigated by SEM, histology, microcomputed tomography and mechanical tests. The profiled PET/C filaments enhanced MSC proliferation and ligament-related gene expression. Furthermore, they enhanced osteogenic gene expression, alkaline phosphatase activity and mineralisation of MSCs. The in vivo study indicated that the profiled PET/C/CaP ligament enhanced ligamentous matrix remodelling and bone formation. Therefore, their use is an effective strategy for promoting MSCs’ ligamentous and osteogenic potential in vitro and enhancing ligamentous matrix remodelling and bone formation in vivo.
... 1,2 Meniscal tears are one of the most common knee injuries, accounting for 12% to 14% of all orthopaedic presentations involving the knee. [3][4][5] Meniscal root tears were first described in 1991 by Pagnani et al., 6 and meniscal root tears posteriorly constitute 7% to 9% of all meniscal injuries diagnosed. 7,8 Meniscal root tears have been highly studied. ...
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Purpose To describe patient-reported clinical outcomes and complications of anatomic medial meniscal root reconstruction with gracilis autograft. Methods Data on patients who underwent arthroscopic medial meniscal root reconstruction with gracilis autograft were prospectively collected between 2017 and 2021 and retrospectively reviewed. The inclusion criteria were symptomatic posterior medial meniscal LaPrade type 2 root tears with no more than Outerbridge grade 2 chondrosis of any knee compartment with a minimum follow-up period of 1 year. Patients with ligamentous instability and those with Workers’ Compensation status were excluded. Patient-reported outcomes (12-item Short Form Survey [SF-12], visual analog scale [VAS], Western Ontario and McMaster Universities Arthritis Index [WOMAC], and Lysholm scores) were collected prospectively and analyzed retrospectively and were scored and recorded both preoperatively and at postoperative intervals. Data were analyzed using cubic spline regression models. The study was approved by the University of South Carolina Institutional Review Board. Results A consecutive series of 27 patients treated by a single surgeon were evaluated. Twenty-one patients were included for data analysis (4 were excluded per criteria and 2 were lost to follow-up) with an average age of 48.1 years (range, 16-63 years). There were 18 female and 3 male patients. The average follow-up time was 25.2 months (range, 12-42 months). At the postoperative time points captured by the data examined, improvements in Lysholm, WOMAC, VAS, and SF-12 physical component summary scores were found to be statistically significant (P < .001, 95% confidence interval). Improvements in SF-12 mental component summary scores, however, did not reach the level of statistical significance (P = .262). Body mass index greater than 35 and age greater than 50 years were not found to be negative predictors of outcomes. Average patient-reported outcomes at 2 years’ follow-up improved from preoperatively as follows: Lysholm score, from 50 to 82.9; WOMAC score, from 53.9 to 87.4; and VAS score, from 5.1 to 1.2. No serious complications were observed. Conclusions Patients undergoing posterior medial meniscal root reconstruction showed statistically significant improvements in Lysholm, WOMAC, SF-12 physical component summary, and VAS scores but not SF-12 mental component summary scores at short-term follow-up. No serious complications or clinical failures occurred, and no patients required revision surgery. Level of Evidence Level IV, case series.
... A rupture of the anterior cruciate ligament (ACL) is a common and devastating lower-extremity injury that frequently occurs in pivoting sports, such as handball and soccer. 1 Most patients expect to return to the preinjury level of sport after an ACL reconstruction (ACLR). 2 The reality is vastly different; only 65% of patients return to the sport's preinjury level. 3 Many studies have been conducted on patient subjective outcome measures related to return to sports (RTS) after ACLR. ...
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Background: Limited information is available on the experiences of patients during rehabilitation after anterior cruciate ligament reconstruction (ACLR). Aim: The current study aimed to identify factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. Method and design: A survey-based study with an online platform was used to identify factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. Seventy-two patients (age 27.8 [8.8] y) after ACLR participated. Data were analyzed and themes were identified by comparing categories and subcategories on similarity. Main findings: Positive patient experiences were room for own input, supervision, attention, knowledge, honesty, and professionalism of the physiotherapist. Additionally, a varied and structured rehabilitation program, adequate facilities, and contact with other patients were identified as positive patient experiences. Negative experiences were a lack of attention, lack of professionalism of the physiotherapists, a lack of sport-specific field training, a lack of goal setting, a lack of adequate facilities, and health insurance costs. Conclusions: The current study identified factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. These findings can help physiotherapists in understanding the patient experiences during rehabilitation after ACLR.
... Частота повреждений задней крестообразной связки (ЗКС), по данным разных авторов, варьирует от 1 до 47%, и они встречаются гораздо реже, чем травмы передней крестообразной связки [1][2][3]. ...
Article
The purpose of this study : to evaluate the results of conservative treatment of isolated grade II and III PCL rupture in athletes. Materials and methods . The study included 36 patients who were athletes at a professional level, with isolated PCL rupture, and have been treated non-operative in the period from 2012 to 2020. The non-operative protocol of isolated lesions of the PCL involve, bracing with posterior leg support, rehabilitation program determined by the symptoms and physical signs. Results. After 2 years from injury, the average score on the Tegner scale was 9 (5–10) (p=0.42). 32 (89%) patients returned to the previous level of sports activity, the average score on the Tegner scale was 9 (7–10). The mean time to return to sports-specific training was 10.6 (4–27) weeks, and the mean time to return to full competitive sport was 16.4 (10–40) weeks. Conclusion. The non-operative management of isolated, Hughston grade II and III PCL injuries gives excellent functional outcomes with a high proportion returning to the same level of sport.
... The ACL is the most frequently damaged knee ligament [41], with rates continuing to rise among active adolescent athletes [1][2][3]. Despite surgical interventions aimed at restoring mechanical integrity [5], approximately 17-19% of adolescent athletes will sustain a second ACL injury within 2 years following an ACL reconstruction [8,10,11]. ...
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Background Anterior cruciate ligament (ACL) rupture is a debilitating knee injury associated with sequela such as joint instability and progressive degeneration. Unfortunately, following surgical ACL reconstruction in adolescents, the rates of ACL graft failure range from 17 to 19%. A contributing factor to the high reinjury rate in this population may be the limited evidence regarding appropriate criteria for allowing unrestricted return-to-activities (RTA) postoperatively. Several systematic reviews have already sought to develop a consensus on what criteria should be utilized for releasing patients to unrestricted sports activities; however, these reviews have focused on adult populations, a group at much lower risk for reinjury. Our objective is to systematically examine the literature and identify the criteria used when determining unrestricted RTA following an ACL reconstruction in an adolescent population. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search will be performed of the MEDLINE/PubMed, Cochrane, Embase, CINAHL, and SPORTDiscus electronic databases. Searches will be conducted from January 1, 2000, until submission of the final review. Studies will be identified that include adolescent patients (10–18 years old) undergoing a primary ACL reconstruction and which have specified the criteria used to determine RTA. Each article will be independently screened by two reviewers. To supplement the electronic database search, citations within all included studies will be manually reviewed. Reviewers will record the RTA assessment utilized and the rates of ACL reinjury through a standardized data extraction sheet. Reviewers will resolve full-text screening and data extraction disagreements through discussion. Synthesis of the collected data will focus on compiling and mapping the most commonly used types of RTA criteria. Discussion This systematic review will determine the most commonly used RTA criteria in adolescent patients post-ACL reconstruction. This will help future interventions build more effective adolescent-specific RTA assessments through the validation of current RTA criteria as well as the implementation of new criteria according to the identified literature gaps.
... The medial collateral ligament (MCL) is the most frequently injured ligament of the knee: 3 it is injured in up to 40% of all knee injuries 6 and in 8% of knee injuries in athletes. 27 The anterior cruciate ligament (ACL) is injured in 95% of knees with multiligament injuries 12 ; combined ACL 1 MCL injuries are the most common of these 11 and are associated with anteromedial rotatory instability (AMRI). 45 Even in knees with clinically isolated ACL tears, there is abnormality of the MCL on magnetic resonance ...
Article
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Background There are many descriptions of medial collateral ligament (MCL) reconstruction, but they may not reproduce the anatomic structures and there is little evidence of their biomechanical performance. Purpose To investigate the ability of “anatomic” MCL reconstruction to restore native stability after grade III MCL plus posteromedial capsule/posterior oblique ligament injuries in vitro. Study Design Controlled laboratory study. Methods Twelve cadaveric knees were mounted in a kinematic testing rig to impose tibial displacing loads while the knee was flexed-extended: 88-N anteroposterior translation, 5-N·m internal-external rotation, 8-N·m valgus-varus, and combined anterior translation plus external rotation (anteromedial rotatory instability). Joint motion was measured via optical trackers with the knee intact; after superficial MCL (sMCL), deep MCL (dMCL), and posterior oblique ligament transection; and then after MCL double- and triple-strand reconstructions. Double strands reproduced the sMCL and posterior oblique ligament and triple-strands the sMCL, dMCL, and posterior oblique ligament. The sMCL was placed 5 mm posterior to the epicondyle in the double-strand technique and at the epicondyle in the triple-strand technique. Kinematic changes were examined by repeated measures 2-way analysis of variance with posttesting. Results Transection of the sMCL, dMCL, and posterior oblique ligament increased valgus rotation (5° mean) and external rotation (9° mean). The double-strand reconstruction controlled valgus in extension but allowed 5° excess valgus in flexion and did not restore external rotation (7° excess). The triple-strand reconstruction restored both external rotation and valgus throughout flexion. Conclusion In a cadaveric model, a triple-strand reconstruction including a dMCL graft restored native external rotation, while a double-strand reconstruction without a dMCL graft did not. A reconstruction with the sMCL graft placed isometrically on the medial epicondyle restored valgus rotation across the arc of knee flexion, whereas a reconstruction with a more posteriorly placed sMCL graft slackened with knee flexion. Clinical Relevance An MCL injury may rupture the anteromedial capsule and dMCL, causing anteromedial rotatory instability. Persistent MCL instability increases the likelihood of ACL graft failure after combined injury. A reconstruction with an anteromedial dMCL graft restored native external rotation, which may help to unload/protect an ACL graft. It is important to locate the sMCL graft isometrically at the femoral epicondyle to restore valgus across flexion.
... ACL injuries have caused a great deal of concern in sport due to the severe consequences such as losing exercise time, negative performance effects, early onset of knee osteoarthritis, and decreased knee function [5,6]. The risk of ACL injury is 2 to 8 times greater in women than men [7,8]. The most common mechanism of ACL injury is non-contact and one of the most common activities that may lead to the ACL injury is jump-landing [9]. ...
Article
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Background Gender differences in muscle activity during landing have been proposed as a possible contributing factor to the greater incidence of anterior cruciate ligament injuries in women. Conflicting results among a few studies in this regard makes it impossible to reach correct conclusions. Objectives The aim of this study was systematic review and the meta-analysis of previous studies which have compared the electromyographic activity of lower limb muscles in gluteus muscles (maximus and medius), quadriceps (rectus femoris, vastus medialis and lateralis), hamstrings (biceps femoris and semimembranosus), and gastrocnemius in men and women in jump–landing task. Methods A systematic search of the PubMed, SCOPUS, Science Direct databases was performed for eligible articles in October 2020. Cross-sectional studies that compared the muscle activity of male and female athletes without a history of previous injury in the jump–landing task were included. Unisex and non-athlete's studies were extracted from the included studies. The data were synthesized using a fixed and random effects model. Results Eight studies involving 145 participants were included. All participants were people who participated in regular exercises. The meta-analysis of timing and muscle activity was performed in the feedforward (pre contact) and feedback (post contact) stages. There were no significant differences in the muscle activity of biceps femoris (MD = −12.01; 95% CI − 51.49 to 27.47; p = 0.55; I² = 87%), vastus medialis (MD = −53.46; 95% CI − 129.73 to 22.81; p = 0.17; I² = 91%), semimembranosus (MD = 1.81; 95% CI − 6.44 to 10.07; p = 0.67; I² = 0%), gluteus medius (MD = −3.14; 95% CI − 14.24 to 7.96; p = 0.58; I² = 48%), and rectus femoris (MD = −5.83; 95% CI − 14.57 to 2.92; p = 0.19; I² = 87%) in the pre contact phase between two sexes. There was a significant difference between men and women in the activity of vastus lateralis muscle in the post contact phase (MD = −34.90; 95% CI − 48.23 to − 21.57). No significant difference was observed between the men and women in the timing of semimembranosus (MD = 23.53; 95% CI − 14.49 to 61.54; p = 0.23; I² = 56%) and biceps femoris muscle activity (MD = −46.84; 95% CI − 97.50 to 3.83; p = 0.07; I² = 82%). Conclusion The results showed that in all lower limb muscles except vastus lateralis there were no significant differences between muscle activity and muscle contraction timing in both sexes before and after foot contact. Therefore, it can be concluded that the reason for the greater susceptibility of ACL injuries in women than men is maybe related to other factors such as biomechanical and hormonal. Additional good quality research in this regard is required to strengthen these conclusions.
... Anterior cruciate ligament (ACL) injuries are one of the most common knee pathologies sustained during athletic participation [1], with incidence rates reported to be 0.05 and 0.08 per 1000 exposures for males and females, respectively [2]. These injuries are particularly prevalent in sports that require frequent changes of direction and landing tasks, such as basketball, soccer, football and hockey [2] and are associated with substantial convalescence [3] and costs [4,5]. ...
Article
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Anterior cruciate ligament (ACL) injuries are one of the most common knee pathologies sustained during athletic participation and are characterised by long convalescence periods and associated financial burden. Muscles have the ability to increase or decrease the mechanical loads on the ACL, and thus are viable targets for preventative interventions. However, the relationship between muscle forces and ACL loading has been investigated by many different studies, often with differing methods and conclusions. Subsequently, this review aimed to summarise the evidence of the relationship between muscle force and ACL loading. A range of studies were found that investigated muscle and ACL loading during controlled knee flexion, as well as a range of weightbearing tasks such as walking, lunging, sidestep cutting, landing and jumping. The quadriceps and the gastrocnemius were found to increase load on the ACL by inducing anterior shear forces at the tibia, particularly when the knee is extended. The hamstrings and soleus appeared to unload the ACL by generating posterior tibial shear force; however, for the hamstrings, this effect was contingent on the knee being flexed greater than ~ 20° to 30°. The gluteus medius was consistently shown to oppose the knee valgus moment (thus unloading the ACL) to a magnitude greater than any other muscle. Very little evidence was found for other muscle groups with respect to their contribution to the loading or unloading of the ACL. It is recommended that interventions aiming to reduce the risk of ACL injury consider specifically targeting the function of the hamstrings, soleus and gluteus medius.
Article
: Patellar instability represents a common problem with an evolving understanding and multifactorial pathoetiology. Treatment plans should be based on the identification of contributing anatomical factors and tailored to each individual patient. ➤: Risks for recurrent instability are dependent on several patient-specific factors including patella alta, increased tibial tubercle-to-trochlear groove (TT-TG) distance, trochlear dysplasia, younger skeletal age, and ligamentous laxity. ➤: Cartilage or osteochondral lesions and/or fractures are commonly observed in first-time patellar dislocation, and magnetic resonance imaging (MRI) should be strongly considered. Advanced imaging modalities, such as computed tomography (CT) or MRI, should also be obtained preoperatively to identify predisposing factors and guide surgical treatment. ➤: Medial patellofemoral ligament (MPFL) reconstruction with anatomical femoral tunnel positioning is associated with lower recurrence rates compared with MPFL repair and has become a common and successful reconstructive surgical option in cases of instability. ➤: Lateral retinacular tightness can be addressed with lateral retinacular release or lengthening, but these procedures should not be performed in isolation. ➤: Tibial tubercle osteotomy is a powerful reconstructive tool in the setting of underlying skeletal risk factors for instability and can be of particular benefit in the presence of increased TT-TG distance (>20 mm), and/or in the setting of patella alta. ➤: The indications for trochleoplasty are still developing along with the clinical evidence, but trochleoplasty may be indicated in some cases of severe trochlear dysplasia. Several surgical techniques have indications in specific clinical scenarios and populations, and indications, risks, and benefits to each are progressing with our understanding. ➤: Combined femoral derotational osteotomy and MPFL reconstruction can be considered for patients with a femoral anteversion angle of >30° to improve patient outcomes and reduce recurrence rates.
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Objective To describe the characteristics of static, dynamic and perceptive body balance in professional league youth soccer players. Method Descriptive, cross-sectional design. Context Soccer players from the Caldas Soccer League. Manizales-Colombia. Participants 40 youth male soccer players with an age range between 17 and 20 years old belonging to the sub-17 and sub-20 categories at the professional level of a nationally recognized club, Manizales-Colombia. Measurements Romberg test to assess static balance. Stability limits test that allows to evaluate the dynamic stability and the displacement of the centers of pressure. Cumberland Ankle Instability Test Questionnaire (CAIT), which is a self-reported outcome questionnaire that rates the level of functional ankle disability. Results There are no significant changes between the balance tests eyes open and eyes closed, therefore, there are no significant variations between body balance; greater center of gravity of the right foot compared to the left, which represents less stability of this hemibody; statistical difference between the feet according to the CAIT questionnaire. Conclusions For the analysis of balance in soccer players, it is necessary to observe motor control, the functional and physiological component and understand the factors associated with sports practice such as pain, decreased muscle strength, muscle fatigue, disability, among others, which are contemplated through the CAIT questionnaire, thus establishing the measurable balance and perceptive results of the soccer player.
Article
كرة القدم هي واحدة من أكثر الرياضات التي تمارس على نطاق واسع لأنها الرياضة الاكثر شعبية على مستوى العالم. ومع ذلك ، ازداد عدد لاعبي كرة القدم المعرضين لخطر إصابة الطرف السفلي. يهدف البحث الى التعرف على تأثير برنامج (FIFA 2011+) في تقليل اصابات الجزء السفلي (الكاحل، الركبة ، العضلات الرباعية، العضلات الضامة، عضلة السمانة) على لاعبي خماسي كرة القدم الهواة في محافظة واسط . واستخدم الباحث المنهج التجريبي ذو المجموعة التجريبية الواحدة باستخدام القياس القبلي والبعدي، وتكونت عينة البحث من 85 لاعب خماسي كرة القدم من الهواة، واستنتج الباحث من دراسته أن برنامج FIFA 11+ فعال في الحد من الإصابات الرياضية في الجزء السفلي لدى لاعبي خماسي كرة القدم الهواة. وقد اوصى الباحث بالعمل على تبني حملة على مستوى البلد تنفذ برنامج الوقاية من الإصابات FIFA 2011+ بين لاعبي كرة القدم الذكور من قبل الاتحاد العراقي لكرة القدم ولكافة الفئات لما له من فوائد كبيرة في الحد من وقوع الاصابات الرياضية في الجزء السفلي.
Article
Objective: Prophylactic knee braces (PKBs) are widely used by athletes in pivoting and landing sports and have the potential to influence knee movement and alignment, thus modulating anterior cruciate ligament (ACL) injury risk. This systematic review analyses current evidence on the biomechanical effects that PKBs have in the prevention of ACL injuries. Data sources: The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Searches were conducted on PubMed, Web of Science, Scopus, Ovid MEDLINE, EMBASE, Cochrane, and CINAHL for studies published from inception until May 31, 2021. Included studies assessed the effects of PKBs on biomechanical variables associated with ACL injuries in landing or pivoting tasks, comparing between braced and unbraced conditions. Main results: A total of 234 articles were identified; from which, 14 controlled, laboratory, biomechanical studies were included in this review. The effects of PKBs on knee biomechanics could be divided into kinematic variables in the coronal, sagittal, and transverse planes; and common kinetic variables, such as ground reaction force (GRF) and ACL load/strain. Also, PKBs were found to have protective effects in coronal and transverse plane kinematics, but results in the sagittal plane were inconclusive. Assessing knee kinetics, PKBs were advantageous in decreasing ACL load/strain but had no significant effect on GRF. Conclusions: Prophylactic knee braces may serve to reduce ACL injury risk by modulating knee coronal and transverse plane movements and ACL load/strain during high-risk maneuvres. Precise recommendations are limited by study heterogeneity. More prospective studies are needed to assess ACL injury risk during high-risk sports using specific PKBs.
Chapter
This chapter discusses the evaluation and management of sports trauma in the human knee, focusing on “on-field” and outpatient settings. We begin with general principles in the evaluation and management of acute knee injuries in the outpatient setting, with focuses on diagnosis and temporizing management. We review common mechanisms of injury and specific injuries for a variety of the most popular sports globally, focusing in turn on injuries which are unique to specific sports. We review examination maneuvers and imaging tests valuable in the diagnosis of sports injuries of the knee. We review the details of management for these injuries after presentation in the office setting, with a special focus on rehabilitation and return-to-play. Finally, for various sports and injuries we briefly discuss on-field management at the time of acute injury.
Article
Introduction: Successful outpatient anterior cruciate ligament (ACL) reconstruction hinges on effective analgesia. Routinely, oral narcotic agents have been the preferred analgesic postoperatively in orthopaedic surgery. However, these agents have several known adverse effects and are associated with a potential for abuse. This study evaluates the efficacy of ketorolac, a nonsteroidal anti-inflammatory drug with analgesic properties, as an adjuvant agent for postoperative pain control after ACL reconstruction. Methods: Adult patients undergoing primary ACL reconstruction were prospectively enrolled. Exclusion criteria involved patients with a history of bleeding diathesis, renal dysfunction, chronic analgesia use, or alcohol abuse. Eligible patients were randomized into one of two groups. The control group received a standard-of-care pain protocol involving oxycodone-acetaminophen 5 to 325 on discharge. The ketorolac group additionally received intravenous ketorolac postoperatively and 3 days of oral ketorolac on discharge. Pain levels and total narcotic utilization were recorded three times per day for the first 5 days after surgery. Pain and functional outcomes were obtained at 2 and 6 weeks postoperatively. Results: The final analysis included 48 patients; the mean age of the cohort was 32 ± 11.6 years, and 60.4% of patients were female. No differences were observed in preoperative demographics, comorbidities, and preoperative functional scores between the two groups. Over the first 5 days after surgery, patients in the ketorolac group consumed a mean of 45.4% fewer narcotic pills than the control group (P < 0.001). In addition, mean postoperative pain scores were 22.36 points lower for patients in the ketorolac group (P < 0.001). There was no difference in functional outcome scores at up to 6 weeks postoperatively or adverse events between the two groups with no reported cases of gastrointestinal bleeding. Discussion: The use of adjunctive intravenous and short-term oral ketorolac substantially reduces narcotic utilization and pain levels after ACL reconstruction. Clinicaltrialgov registration number: NCT04246554.
Article
Purpose: To characterize patellofemoral morphology, determine radiological cutoff values based on computed tomography (CT) images, and clarify predominant anatomic risk factors in young patients with recurrent patellar dislocation (RPD). Methods: A total of 212 knees (age 23.0 ± 5.3 years, female: male = 110:102) with CT-confirmed RPD were enrolled for analysis. The control group was matched by age and sex (2:1). Patellofemoral and trochlear morphology, patellofemoral alignment, and other parameters were assessed by CT. Standardized methods were used for measurements. Receiver operating characteristic (ROC) curves and the areas under the ROC curve (AUCs) were used to assess accuracy in diagnosing RPD. The index of union (IU) was employed to identify a cutoff value for risk. A binary logistic regression model (Forward, LR) was constructed, and standardized coefficients were calculated to compare the relative strength of different predictors. Factors included in the model were employed to calculate distributions in the studied population. Results: The majority of measurements showed a significant difference between the RPD and control groups when comparing mean values. The AUC value was favorable for sulcus depth and significantly better than that for other trochlear morphology parameters (P < 0.0001). Cutoff values were 0.58 for the Wiberg index, 153.3° for the sulcus angle, 3.6 mm for the sulcus depth, 1.94 for the trochlear width ratio, 16.2° for the lateral trochlear inclination, 17.2° for the patellar lateral tilt, 25.5° for the congruence angle, 1.2 for the patellar height [Caton-Deschamps index (CDI)], 6.1° for the knee rotation, and 16.4 mm for the tibial tubercle-trochlear groove (TT-TG) distance. A binary logistic regression model (χ2 = 20.826, P = 0.008) including the Wiberg index, sulcus depth, congruence angle, patellar height (CDI), and TT-TG distance was constructed for RPD (P ≤ 0.015), which showed excellent diagnostic performance, as indicated by an AUC of 0.989 (95% CI, 0.979 to 0.998). Sulcus depth showed the strongest relationship with RPD, followed by the congruence angle and Wiberg index, as indicated by the standardized coefficients - 1.43, 1.02, and 0.97, respectively. Eighty-seven percent of the RPD population had sulcus depth ≤ 3.6 mm. Conclusions: This study provides a systematic reference of cutoff values based on CT data. The combination of five anatomic risk factors (sulcus depth, congruence angle, Wiberg index, TT-TG distance, and CDI) may be an excellent predictor of RPD as initial risk assessment. Sulcus depth, as the most frequently observed anatomic risk factor, showed the best diagnostic performance among trochlear morphological parameters and the strongest relationship with RPD, followed by the congruence angle and Wiberg index. In clinical practice, the sulcus depth, congruence angle, Wiberg index, TT-TG distance, and CDI with the proposed cutoff values can be used in combination to evaluate RPD. When assessing trochlear morphology, sulcus depth is recommended as the best radiological parameter. Level of evidence: Level III.
Article
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This study aimed to investigate the appropriate size of scaffold implantation on stress distribution and evaluate its mechanical and biomechanical properties considering hydrolysis. The meniscus acts as a load distribution in the knee, and its biomechanical properties are essential for the development of the PGA scaffold. We established a novel meniscal scaffold, which consists of polyglycolic acid (PGA) covered with L‐lactide‐ε‐caprolactone copolymer (P[LA/CL]). After 4 weeks of hydrolysis, the scaffold had a 7% volume reduction compared to the initial volume. In biomechanical tests, the implantation of scaffolds 20% larger than the circumferential and vertical defect size results in greater contact stress than the intact meniscus. In the mechanical evaluation associated with the decomposition behavior, the strength decreased after 4 weeks of hydrolysis. Meanwhile, in the biomechanical test considering hydrolysis, contact stress and area equivalent to intact were obtained after 4 weeks of hydrolysis. In conclusion, the implantation of the PGA scaffold might be a useful alternative to partial meniscectomy in terms of mechanical properties, and the PGA scaffold should be implanted up to 20% of the defect size.
Article
Purpose The purpose of this study was to investigate biomechanical differences of medial patellofemoral ligament (MPFL) reconstruction, medial quadriceps tendon femoral ligament (MQTFL) reconstruction and a combination of these techniques to restore lateral patellar constraint and contact pressures. Methods Eight fresh frozen cadaver knees were mounted to a custom jig with physiologic quadriceps tendon loading. Flexion angles and contact pressure (CP) were dynamically measured using Tekscan® pressure sensors and Polhemus® Liberty 6 degree of freedom (6DOF) positioning sensors in the following conditions: 1. Intact 2. MPFL and MQTFL deficient 3. MPFL reconstructed 4. Combined MPFL + MQTFL reconstructed 5. MQTFL reconstructed Lateral patellar translation was tested using horizontally directed 30N force applied at 30° of knee flexion. The knees were flexed in dynamic fashion and CP values were recorded for 10°, 20°, 30°, 50°, 70°, and 90° degrees of flexion. Group differences were assessed with ANOVA’s followed by pairwise comparisons with Bonferroni correction. Results MPFL (p=0.002) and combined MPFL/MQTFL (p=0.034) reconstruction significantly reduced patellar lateralization from +19.28% (9.78%, 28.78%) in the deficient condition to -17.57% (-27.84%, -7.29%) and -15.56% (-33.61%, 2.30%) respectively. MPFL reconstruction was most restrictive and MQTFL reconstruction the least -7.29% (-22.01%, 7.45%). No significant differences were found between the three reconstruction techniques. Differences in CP between the three reconstruction techniques were not significant (<0.02 MPa) at all flexion angles. Conclusion The present study found no significant difference for patellar lateralization and patellofemoral CP between MPFL, combined MPFL/MQTFL and MQTFL reconstruction. All 3 techniques resulted in stronger lateral patellar constraint compared to the native state while the MQTFL reconstruction emulated the intact state the closest. Clinical relevance Various surgical techniques for medial patellofemoral complex reconstruction can restore patellar stability with similar patellofemoral articular pressures.
Article
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Anterior cruciate ligament (ACL) rupture represents one of the most recurrent knee injuries in soccer players. To allow a safe return to sport after ACL reconstruction, standardised and reliable procedures/criteria are needed. In this context, wearable sensors are gaining momentum as they allow obtaining objective information during sport-specific and in-the-field tasks. This paper aims at proposing a sensor-based protocol for the assessment of knee stability and at quantifying its reliability. Seventeen soccer players performed a single leg squat and a cross over hop test. Each participant was equipped with two magnetic-inertial measurement units located on the tibia and foot. Parameters related to the knee stability were obtained from linear acceleration and angular velocity signals. The intraclass correlation coefficient (ICC) and minimum detectable change (MDC) were calculated to evaluate each parameter reliability. The ICC ranged from 0.29 to 0.84 according to the considered parameter. Specifically, angular velocity-based parameters proved to be more reliable than acceleration-based counterparts, particularly in the cross over hop test (average ICC values of 0.46 and 0.63 for acceleration- and angular velocity-based parameters, respectively). An exception was represented, in the single leg squat, by parameters extracted from the acceleration trajectory on the tibial transverse plane (0.60≤ICC≤0.76), which can be considered as promising candidates for ACL injury risk assessment. Overall, greater ICC values were found for the dominant limb, with respect to the non-dominant one (average ICC: 0.64 and 0.53, respectively). Interestingly, this between-limb difference in variability was not always mirrored by LSI results. MDC values provide useful information in the perspective of applying the proposed protocol on athletes with ACL reconstruction. Thus, The outcome of this study sets the basis for the definition of reliable and objective criteria for return to sport clearance after ACL injury.
Article
Background and Objectives: The common fibular nerve (CFN) has anatomical variance between individuals as it transitions from the posterior thigh to the anterior leg. The nerve’s course around the fibular neck is of particular interest, where it becomes vulnerable to injury at the lateral knee. Therefore, we sought to compare factors that may predict distal CFN variability, such as height, age, sex, fibular length, and proximal sciatic variations, which individually or cumulatively play a role in predicting clinically significant locations where the CFN commonly transitions among certain populations. Methods: In this cadaveric study, twenty anatomically-fixed specimens were analyzed, ten males and ten females. Data gathered included age, sex, height, CFN transition point measured from the proximal head of the fibular to the point 90 degrees off the midline of the fibula where the CFN courses around the fibular neck, fibular length, and proximal sciatic nerve variations characterized based on the Beaton and Anson classification system. Factors were compared and statistical values were generated. Results: There was a statistically significant difference between CFN transition points compared to fibular lengths, heights, and between sexes. Sciatic nerve (SN) bifurcation levels and exits were bilaterally identical on all cadavers. All SN exits were Beaton and Anson type 1 (undivided nerve below and undivided piriformis), and bifurcation levels were 20% high, 25% middle, and 55% low. Conclusions: This study highlights the importance of considering a person’s height, fibular length, and sex when addressing injuries involving the CFN at the lateral leg.
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Radiomics and machine learning-based methods offer exciting opportunities for improving diagnostic performance and efficiency in musculoskeletal radiology for various tasks, including acute injuries, chronic conditions, spinal abnormalities, and neoplasms. While early radiomics-based methods were often limited to a smaller number of higher-order image feature extractions, applying machine learning-based analytic models, multifactorial correlations, and classifiers now permits big data processing and testing thousands of features to identify relevant markers. A growing number of novel deep learning-based methods describe magnetic resonance imaging- and computed tomography-based algorithms for diagnosing anterior cruciate ligament tears, meniscus tears, articular cartilage defects, rotator cuff tears, fractures, metastatic skeletal disease, and soft tissue tumors. Initial radiomics and deep learning techniques have focused on binary detection tasks, such as determining the presence or absence of a single abnormality and differentiation of benign versus malignant. Newer-generation algorithms aim to include practically relevant multiclass characterization of detected abnormalities, such as typing and malignancy grading of neoplasms. So-called delta-radiomics assess tumor features before and after treatment, with temporal changes of radiomics features serving as surrogate markers for tumor responses to treatment. New approaches also predict treatment success rates, surgical resection completeness, and recurrence risk. Practice-relevant goals for the next generation of algorithms include diagnostic whole-organ and advanced classification capabilities. Important research objectives to fill current knowledge gaps include well-designed research studies to understand how diagnostic performances and suggested efficiency gains of isolated research settings translate into routine daily clinical practice. This article summarizes current radiomics- and machine learning-based magnetic resonance imaging and computed tomography approaches for musculoskeletal disease detection and offers a perspective on future goals and objectives.
Article
Objectives To systematically evaluate the literature and estimate the prevalence, incidence, and burden of gradual-onset knee injuries in team ball-sports. Design Systematic review with meta-analysis. Method Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, SPORTDiscus, SCOPUS) were searched from inception to June 2021. Cohort studies of team ball-sports reporting the number of gradual-onset knee injuries were included. Study quality was assessed using a modified Newcastle-Ottawa scale. Studies were pooled using a Freeman-Tukey Double arcsine transformation (prevalence) and a Poisson random effects regression model (incidence, burden). Results Forty-nine studies that captured gradual-onset knee injuries (unclassified, patellofemoral pain, tendinopathies, and iliotibial band friction syndrome) across 15 team ball-sports were included. For unclassified gradual-onset knee injuries, prevalence was 4 % (95 % Confidence Interval (CI) 2 % to 7 %, I² = 96 %), incidence was 0.32 per 1000 player-hours (95 % CI 0.25 to 0.43, I² = 88 %), and burden was 3.24 days lost per 1000 player-hours (95 % CI 1.95 to 5.37, I² = 99 %). For patellofemoral pain, prevalence was 6 % (95 % CI 1 % to 13 %, I² = 93 %), and incidence was 0.07 per 1000 player-hours (95 % CI 0.04 to 0.12, I² = 67 %). For tendinopathies, prevalence was 1 % (95 % CI 0 % to 2 %, I² = 68 %), incidence was 0.07 per 1000 player-hours (95 % CI 0.04 to 0.11, I² = 76 %), and burden was 2.14 days lost per 1000 player-hours (95 % CI 1.23 to 3.71, I² = 92 %). Conclusion Estimates of prevalence, incidence and burden generated from this systematic review quantify the extent of gradual-onset knee injuries in team ball-sports. Further research is required to assess whether age, sport, and participation level are predictors of gradual-onset knee injuries.
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El fútbol es el deporte universalmente más popular y el más extendido, lo que implica, además, ser uno de los deportes de equipo con mayor IL. Las lesiones afectan de manera negativa al rendimiento del deportista y del equipo. El objetivo de este estudio fue conocer las lesiones producidas a lo largo de la temporada 2016/2017 de la primera y segunda división española en función del tipo de lesión, posición del jugador, minuto en que se produce la lesión y la edad del jugador. Se trata de un estudio descriptivo, en el cual la muestra fue conformada por los jugadores de los 42 equipos de la Liga Santander y la Liga 123 del fútbol español. Las lesiones más comunes han sido las lesiones musculares (>50%), aumentando en la Liga 123 hasta el 75% de la incidencia. Los deportistas que más lesiones sufrieron fueron los defensas (>40%) mientras que los porteros registraron el menor IL (<4%). Este hecho se puede deber a la menor distancia recorrida tanto a una intensidad normal como a la distancia recorrida a alta intensidad. Los deportistas comprendidos entre los 21 y los 29 años padecieron un mayor número de lesiones (>35%) y, además, ocurrieron en gran parte durante la segunda mitad del partido.
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Currently, there is no suitable solution for the point-of-care diagnosis of knee injuries. A potential portable and low-cost technique for accessing and monitoring knee injuries is bioimpedance measurement. This study validated the feasibility of the bipolar electrode configuration for knee bioimpedance measurement with two electrodes placed on a fixed pair of knee acupuncture locations called Xiyan. Then, the study collected 76 valid samples to investigate the relationship between bioimpedance and knee injuries, among whom 39 patients have unilateral knee injuries, and 37 individuals have healthy knees. The self-contrast results indicated that knee injuries caused a reduction of bioimpedance of the knee by about 5% on average, which was detectable at around 100 kHz (p $\approx$ 0.001). Furthermore, the results analyzed by principal component analysis and support vector machines show that the detection sensitivity can reach 87.18% using the leave-one-out cross-validation. We also proposed a low-cost and portable bioimpedance measurement device that meets the needs for measuring knee joint bioimpedance.
Chapter
Worldwide, knee joint complaints are most frequent in all age groups. Trauma, inflammation, infection, tumor, or aging that can damage the knee joint are detected with an MRI. MRI represents a standard technique for assessing knee joint anatomical structures, and it supports diagnosis, disease monitoring, or treatment planning. However, the reading and assessment of knee MRIs are time-consuming and can result in misdiagnosis. Therefore, it is crucial to elaborate intelligent and standardized methodologies of MRI investigation, to discover various knee lesions, increase diagnostic efficiency, and reduce bias or error in the evaluation due to human limitations such as fatigue, to name only one of them. This article reviews recent works that address the application of deep learning and discusses the related challenges in knee joint MRI analysis.
Chapter
Compared to other knee ligament injuries, posterior cruciate ligament (PCL) injuries are relatively uncommon. Injuries of the PCL represent a particularly challenging clinical entity ranging from partial tears amenable to nonoperative treatment with dynamic bracing, to acute grade III and combined injuries requiring multiligament reconstructions. Because of the spectrum of injury severity, an algorithmic approach must be utilized, including posterior stress view radiographs, to differentiate between injuries amenable to conservative treatment and those requiring surgical reconstruction. When indicated, the preferred reconstruction of the authors is an arthroscopic double bundle transtibial reconstruction. This reconstruction technique is based on restoring the native anatomy and biomechanics of the PCL and its two bundles. This is accomplished using two femoral reconstruction tunnels to independently recreate the anterolateral and posteromedial bundles using Achilles and anterior tibialis allografts, respectively. Both grafts are then fixed independently in a single tibial tunnel according to their distinct and codominant biomechanical functions. This reconstruction technique has been validated both biomechanically and clinically, demonstrating excellent clinical outcomes in both isolated and multiligament reconstructions.
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Abstract Passive translational tibiofemoral laxity has been extensively examined in posterior cruciate ligament (PCL) insufficient patients and belongs to the standard clinical assessment. However, objective measurements of passive rotational knee laxity, as well as range of tibiofemoral motion during active movements, are both not well understood. None of these are currently quantified in clinical evaluations of patients with PCL insufficiency. The objective of this study was to quantify passive translational and rotational knee laxity as well as range of anterior–posterior and rotational tibiofemoral motion during level walking in a PCL insufficient patient cohort as a basis for any later clinical evaluation and therapy. The laxity of 9 patient knees with isolated PCL insufficiency or additionally posterolateral corner (PLC) insufficiency (8 males, 1 female, age 36.78 ± 7.46 years) were analysed and compared to the contralateral (CL) knees. A rotometer device with a C-arm fluoroscope was used to assess the passive tibiofemoral rotational laxity while stress radiography was used to evaluate passive translational tibiofemoral laxity. Functional gait analysis was used to examine the range of anterior–posterior and rotational tibiofemoral motion during level walking. Passive translational laxity was significantly increased in PCL insufficient knees in comparison to the CL sides (15.5 ± 5.9 mm vs. 3.7 ± 1.9 mm, p
Article
Resumen Antecedentes El fútbol constituye una práctica deportiva que empieza a edades tempranas y exige una gran demanda física, sobre todo de los miembros inferiores. Objetivo Determinar la incidencia de lesiones, así como su naturaleza y relación con la posición de juego y categoría en una población de futbolistas federados masculinos jóvenes en sus diferentes categorías no seniors durante una temporada deportiva. Material y método Se realizó un estudio observacional retrospectivo mediante cuestionarios autorrellenables en 128 futbolistas pertenecientes a los equipos del fútbol base del Marbella club de fútbol. Resultados Se registraron un total de 254 lesiones. La categoría juvenil presenta una incidencia más alta (p = 0,002). Las lesiones más numerosas fueron los esguinces de tobillo y las lesiones musculares de gemelos. Conclusiones La incidencia lesional guarda una relación directa con la categoría no siendo así con la posición de juego. Los programas de prevención de lesiones deben adecuarse a las exigencias de cada categoría en futbol base.
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Background Both the superficial medial collateral ligament (sMCL) and the deep MCL (dMCL) contribute to the restraint of anteromedial (AM) rotatory instability (AMRI). Previous studies have not investigated how MCL reconstructions control AMRI. Purpose/Hypothesis The purpose was to establish the optimal medial reconstruction for restoring normal knee kinematics in an sMCL- and dMCL-deficient knee. It was hypothesized that AMRI would be better controlled with the addition of an anatomically shaped (flat) sMCL reconstruction and with the addition of an AM reconstruction replicating the function of the dMCL. Study Design Controlled laboratory study. Methods A 6 degrees of freedom robotic system equipped with a force-torque sensor was used to test 8 unpaired knees in the intact, sMCL/dMCL sectioned, and reconstructed states. Four different reconstructions were assessed. The sMCL was reconstructed with either a single-bundle (SB) or a flattened hamstring graft aimed at better replicating the appearance of the native ligament. These reconstructions were tested with and without an additional AM reconstruction. Simulated laxity tests were performed at 0°, 30°, 60°, and 90° of flexion: 10 N·m valgus rotation, 5 N·m internal and external rotation (ER), and an AM drawer test (combined 134-N anterior tibial drawer in 5 N·m ER). The primary outcome measures of this force-controlled setup were anterior tibial translation (ATT; in mm) and axial tibial rotation (in degrees). Results Sectioning the sMCL/dMCL increased valgus rotation, ER, and ATT with the simulated AM draw test at all flexion angles. SB sMCL reconstruction was unable to restore ATT, valgus rotation, and ER at 30°, 60°, and 90° of flexion to the intact state ( P < .05). Flat MCL reconstruction restored valgus rotation at all flexion angles to the intact state ( P > .05). ER was restored at all angles except at 90°, but ATT laxity in response to the AM drawer persisted. Addition of an AM reconstruction improved control of ATT relative to the intact state at all flexion angles ( P > .05). Combined flat MCL and AM reconstruction restored knee kinematics closest to the intact state. Conclusion In a cadaveric model, AMRI resulting from an injured sMCL and dMCL complex could not be restored by an isolated SB sMCL reconstruction. A flat MCL reconstruction or an additional AM procedure, however, better restored medial knee stability. Clinical Relevance In patients evaluated with a combined valgus and AM rotatory instability, a flat sMCL and an additional AM reconstruction may be superior to an isolated SB sMCL reconstruction.
Article
Background A “Stener-like” lesion of the knee is defined as a distal avulsion of the superficial medial collateral ligament (sMCL) with interposition of the pes anserinus between the ligament and its tibial insertion—a displacement impeding anatomic healing. Because of the scarcity of these injuries, the literature is limited to case reports and small case series. Purpose To assess the effect of surgical repair of acute Stener-like lesions of the sMCL on the following outcomes: return to preinjury level of sporting function; time to return to preinjury level of sporting function; functional performance; injury recurrence; and any other complications. Study Design Case series: Level of evidence, 4. Methods This prospective single–surgeon study included 23 elite athletes with a mean age of 27.2 years (range, 19-37 years). Of the participants, 20 were men (87%) and 3 were women (13%). The mean body mass index was 23.1 ± 2.3. A total of 16 athletes were soccer players (70%) and 7 were rugby players (30%), with isolated acute, traumatic Stener-like lesions of the sMCL of the knee confirmed on preoperative magnetic resonance imaging. Surgical repair was undertaken with primary suture anchor repair with ligament repair or reconstruction system (LARS) augmentation. Predefined outcomes were recorded at regular intervals after surgery. The minimum follow–up time was 24 months (range, 24-108 months) from the date of surgery. Results The mean time from injury to surgical intervention was 9 days (range, 3-28 days). Overall, 15 (65%) athletes had isolated distal sMCL injuries requiring anatomic suture anchor repair at the distal tibial insertion site only, and 8 (35%) athletes had concomitant injuries of the proximal and distal sMCL and required anatomic suture anchor repair at the proximal and distal attachment sites. Ten athletes required LARS augmentation at the time of the index operation. All study patients returned to their preinjury level of sporting activity in professional soccer or rugby. The mean time from surgical intervention to return to full sporting activity was 16.8 ± 2.7 weeks. At 6 and 24 months’ follow–up, all patients had Tegner scores of 10. At a 2–year follow–up, all study patients were still participating at their preinjury level of sporting activity. Three patients developed complications around the LARS that required further surgery to remove synthetic material; however, this did not affect function. Conclusion Surgical repair of acute Stener-like lesions of the sMCL is associated with a high return to preinjury level of sporting function, excellent functional performance, and a low risk of recurrence at short–term follow-up in elite athletes.
Chapter
Paddle is a racket sport, which has gained popularity, played in pairs and using its own rackets and balls. The sport itself presents specificities that can influence the injury pattern. In comparison with tennis, the game takes place on a smaller field, delimited by glass surfaces which implies an increased speed, short displacements, and many changes of direction. This condition could have a negative impact in the ankle, knee, or lower back. The serve is made from below, while in tennis it is made from top. This fact could save shoulder injuries, but the wrist and forearm are more forced. As sport qualities, paddle uses motor anticipation, explosive force, reactive speed (acceleration and deceleration), resistance, flexibility, and agility. There is little evidence about the biomechanical singularities of the paddle and the injury pattern. From the available studies, it was concluded that the most common overuse injury site among senior players is the elbow, and the lower back among junior players, whereas knee injuries are the most common acute injuries, taking into account that movements are mainly lateral and pivoting. With the progressive increase in associative and professional, more frequent assistance from physiotherapy care is necessary. The repetition of specific actions and gestures can be a determinant factor in paddle musculoskeletal injuries. Such knowledge may assist in determining practical implications for equipment improvement injury prevention and preventive programs.
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BACKGROUND: Acute tears of the posterior cruciate ligament (PCL) have been more commonly reported in males than females, with males constituting between 60 and 84% of isolated and combined PCL injuries. However, there is a paucity of studies comparing the injury patterns between males and females. This study aimed to evaluate the differences in patterns of isolated PCL tears and associated injuries between males and females on magnetic resonance imaging (MRI). METHODS: Patients with PCL tears were identified through an institutional database. Two musculoskeletal imaging radiologists independently reviewed each case to describe injury patterns as well as the presence and severity of concurrent injuries. After applying exclusion criteria, male and female cohorts were compared for differences in injury patterns and the presence of concurrent injuries. Linear regression analysis was performed to assess for differences in injury patterns related to age. RESULTS: A search yielded 322 consecutive patients with PCL injury. After reviewing MRI exams and applying exclusion criteria, the cohorts included 79 patients (21 female and 58 male). Overall, females with PCL tears were more likely to sustain concurrent injuries to the posteromedial corner (71.4% vs. 25.9%, p < 0.001), anterior cruciate ligament (14.3% vs. 0%, p = 0.003), partial injury to the medial collateral ligament (23.8% vs. 6.9%, p = 0.037), and lateral meniscus (38.1% vs. 3.5%, p < 0.001). Comparison of patients with Grade 3 PCL injuries showed that this type of injury occurred at a greater age in females when compared to males (46.0±22.1 vs. 32.3±13.5, p=0.019). Regression analysis between age and injury pattern in patients with Grade 3 PCL tears revealed significant findings only in female patients, with a positive correlation between age and distal location of the PCL tear (R2 = 0.5937, p = 0.003). We also observed significant negative correlations between age and associated injuries of the ACL (R2 = 0.3623, p = 0.038), and lateral retinaculum (R2 = 0.3325, p = 0.049). CONCLUSION: We observed significant sex differences in the number and type of accompanying injuries with acute PCL injuries. Complete PCL injuries were found to occur at a greater age in females, with an age-dependent distribution of PCL injury location and number of accompanying injuries. Further studies are needed to understand the role of these findings in the treatment and outcomes after PCL injury.
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Hospital based studies of occupational risk factors for knee disorders are complicated by the possibility of selective referral to hospital of people whose work is made difficult by their symptoms. To explore the extent of such bias and to assess the association of meniscal injury with occupational activities. A questionnaire was mailed to a community sample of 2806 men aged 20-59 years in southern England. This asked about lifetime occupational and sporting activities, and any history of knee symptoms lasting 24 hours or longer. Rates of hospital referral were compared in symptomatic men according to their occupational activities. In a nested case-control investigation, the occupational activities of 67 men who reported meniscectomy were compared with those of 335 controls. Among 1404 men who responded to the questionnaire, the lifetime prevalence of knee symptoms was 54%, and in 70% of cases the symptoms had started suddenly, usually while playing sport. Symptomatic men whose work entailed kneeling or squatting were more likely to be referred to an orthopaedic surgeon than the average (28% and 31% versus 24%), especially if they experienced locking of the knee (69% and 73% versus 43%). In the nested case-control study, meniscectomy was associated with playing soccer and work that involved regular kneeling or squatting. Results suggest that hospital referral for knee symptoms is influenced to some extent by patients' occupational activities. Playing soccer is confirmed as a strong risk factor for knee cartilage injury.
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Rupture of the anterior cruciate ligament (ACL) of the knee is a commonly occurring injury in the athletic population. Associated meniscal and chondral injury is well recognised. This occurs both at the time of index injury and also secondarily over time in the ACL-deficient knee as a result of several related pathways culminating in osteoarthritis. ACL reconstruction is a well established surgical technique for treatment of symptomatic instability in ACL-deficient knees but the role of ACL reconstruction in the prevention of osteoarthritis remains unclear. This article reviews the contemporary literature on the pathophysiology of chondral and meniscal loss in ACL-injured knees and the role of current treatment techniques, including surgical reconstruction of ligamentous, meniscal and chondral pathology, in altering the natural history of the ACL-deficient knee.
Article
Epidemiology of Sports Injuries - A 25-Year Analysis of an Outpatient Department of Sports Orthopaedics and Traumatology. In a 25-years period (1972-1997) 30603 sportsmen, having a total of 34742 sports related injuries, were treated in our outpatient-department specialized in sports orthopaedics and traumatology. All cases were systematically recorded and analysed right from the beginning. This is the most extensive clinical statistics currently known. The absolutly highest incidence rate of sports-related injuries is seen in common disciplines like soccer with 10493 (34,3%), skiing with 3632 (11,9%), handball 2307 (7,5%), tennis 1643 (5,4%) and Volleyball 1550 (5,1 %). 3/4 were male. The distribution of age shows a significant peak between 20 and 29 years of age, whereas in women we found a wide plateau between 10 and 39 years. Compared to earlier investigations we have an increase of injuries in higher age. In 72,4% the lower extremities are mainly effected, followed by the upper extremities (21,8%) and the spine with 3,0%. With increasing tendency knee injuries take main part (36,6% -12708 cases) followed by injuries of the ankle (19,9% -6920 cases), shoulder (7,7%), lower leg (7,0%) and fingers (5,8%). Main diagnosis were: distortion (32,6%); ruptures of ligaments and menisci (21,5%); fractures (10,5%) and lesions of muscles and tendons (8,8%). Comparing our 15- and 25-years studies we found an interesting significant increase of injuries in skiing, tennis and physical exercising by 25%, in cycling four times. New disciplines like squash, snowboarding, mountainbiking and inlineskating have been added. All together the number of injuries is distributed to 87 different disciplines. In 1998 26,7 million sportsmen (one third of the German population) were member of the German Sports Association (DSB). The number of annual accidents in sports and sporting sparetime activities is estimated at about 1,5-2 million, that's 25-30% of all accidents. The analysis of almost 35000 treated sports injuries and further evaluation of more than 5000 orthopaedic examinations of top athletes are useful for analysis comparing single disciplines.
Article
Analysis of a special outpatient department of sports orthopaedics covers a 15-year period (1972-1986); the department studies by us was initially part of the Orthopaedic Hospital of the University of Heidelberg, whereas later on we continued our studies at the Sports Clinic in Stuttgart-Bad Cannstatt. A grand total of 13,296 sportsmen treated in these departments was assessed, having a total of 15,212 injuries or lesions/damage due to sports activities. All cases were systematically recorded right from the beginning. In 1986, 19.3 million Federal German sportsmen were members of the Federal German Sports Association (DSB), i.e. 31.4 % of the populations. The number of sports-related accidents that occurred per year is estimated at 1.5 million, i.e. more than 15 % of the total number of accidents. The absolutely highest incidence rate of accidents is seen in popular sports such as football (i.e. “soccer”, the most widely practised sport in the Federal Republic), skiing, handball, volleyball, track-and-field athletics, and gymnastics and physical training. The major part of the accidents involves the lower extremities (66.6 %), followed by the arms (22.8 %) and the vertebral column (4.7 %). In respect of diagnoses, lesions of capsular ligaments are by far the most frequent ones. “Distortions” are stated to occur in 32.9 % of the cases, severe injuries such as fractures, luxations and ruptures of ligaments representing a total of 33.6 %. The incidence rate of contusions is increasing (12.6 %), and so is that of lesions of the muscles and tendons (10.4 %). 76.5 % of the injured persons are men, with an age bracket peak at 20-29 years, followed by the group of 10-19 years. Analysis of the lesions yields valuable pointers to possibilities of accident or injury prevention within the individual sports categories.
Article
Analysis of a special outpatient department of sports orthopaedics covers a 15-year period (1972-1986); the department studies by us was initially part of the Orthopaedic Hospital of the University of Heidelberg, whereas later on we continued our studies at the Sports Clinic in Stuttgart-Bad Cannstatt. A grand total of 13,296 sportsmen treated in these departments was assessed, having a total of 15,212 injuries or lesions/damage due to sports activities. All cases were systematically recorded right from the beginning. In 1986, 19.3 million Federal German sportsmen were members of the Federal German Sports Association (DSB), i.e. 31.4% of the populations. The number of sports-related accidents that occurred per year is estimated at 1.5 million, i.e. more than 15% of the total number of accidents. The absolutely highest incidence rate of accidents is seen in popular sports such as football (i.e. "soccer", the most widely practised sport in the Federal Republic), skiing, handball, volleyball, track-and-field athletics, and gymnastics and physical training. The major part of the accidents involves the lower extremities (66.6%), followed by the arms (22.8%) and the vertebral column (4.7%). In respect of diagnoses, lesions of capsular ligaments are by far the most frequent ones. "Distortions" are stated to occur in 32.9% of the cases, severe injuries such as fractures, luxations and ruptures of ligaments representing a total of 33.6%. The incidence rate of contusions is increasing (12.6%), and so is that of lesions of the muscles and tendons (10.4%). 76.5% of the injured persons are men, with an age bracket peak at 20-29 years, followed by the group of 10-19 years. Analysis of the lesions yields valuable pointers to possibilities of accident or injury prevention within the individual sports categories.
Article
Female athletes are at increased risk for certain sports-related injuries, particularly those involving the knee. Factors that contribute to this increased risk are the differences in sports undertaken and in gender anatomy and structure. Gender differences include baseline level of conditioning, lower extremity alignment, physiological laxity, pelvis width, tibial rotation and foot alignment. Sports like gymnastics and cheerleading create a noncontact environment, but can result in significant knee injuries. In quick stopping and cutting sports, females have an increased incidence of anterior cruciate ligament (ACL) injury by noncontact mechanisms. Patellofemoral (PF) disorders are also very common in female athletes. Awareness of these facts helps the sports medicine professional make an accurate diagnosis and institute earlier treatment-focused rehabilitation with or without surgery. Further prospective and retrospective research is needed in areas of epidemiology, mechanisms, severity and types of knee injuries. The goal is to lessen the severity of certain knee injuries and to prevent others.
Article
We reviewed the records of 315 patients receiving an arthroscopically assisted stabilizing procedure for an acute anterior cruciate ligament injury incurred while alpine skiing to evaluate associated meniscal injuries. Meniscal injuries were classified by type, location, and treatment of the tear. Of the 317 knees operated on, all demonstrated an anterior cruciate ligament tear at arthroscopy. Ninety-eight percent of the injuries (310) were diagnosed within 3 days of injury, and 97% (307) were reconstructed within 28 days of injury. All tears occurred in the intrasubstance of the ligament; 32% were isolated injuries and 68% were combined with other injuries. In 159 patients with 170 meniscal tears 141 of the tears (83%) were lateral and 29 (17%) were medial. The injury triad of anterior cruciate ligament-medial collateral ligament-lateral meniscus was seen nine times as often as the anterior cruciate ligament-medial collateral ligament-medial mensicus combination.
Article
The incidence of sport injuries in Switzerland is twice as high compared to traffic injuries. Soccer and alpine skiing play the most important role in sport injuries. For the last twenty winter seasons all winter sport injuries were analysed at the hospital of Davos. About 85% are injuries caused by alpine skiing resulting in a total of 24,684 for the last twenty years. There is a great decline in the incidence of lower leg fractures with a contrary development of knee injuries. The treatment-quotient (amount of knee injuries in alpine skiers per 10(4) kilometers of vertical drop skied) has increased over the last seasons. Nowadays one part of four skiing injuries is an injury of the knee ligaments. In skiing areas favored by beginners, we have observed an incidence of knee ligament injuries three times as high compared to other areas. Since 1986 we have evaluated 206 patients operated for knee ligament injuries, 44% with unidirectional and 56% with multidirectional instabilities. We report about the preoperative data.
Article
In Switzerland the incidence of sport injuries is twice as high as traffic injuries. Soccer and alpine skiing are the major reasons for such injuries. Nowadays one out of four skiing injuries is an injury of the knee ligaments. Especially in skiing areas favored by beginners, we observed an incidence of knee ligament injuries three times as high compared to other areas. Since 1986 we evaluated 206 patients which were operated for knee ligament injuries. In 44% the direction of instability was unidirectional, most of them in the anterior direction. 115 patients had combined instabilities, 86% of those were anteromedial. 179 patients (87%) were followed up for at least 20 months. The knee was evaluated with the scoring system of the OAK (Orthopädische Arbeitsgruppe Knie der Schweizerischen Gesellschaft für Orthopädie) and judged by four criterias (pain/swelling; movement/force; stability and function). As expected, unidirectional instabilities show better results than multidirectional. The mean value of the total score for isolated medial collateral injuries was 95.3 of 100, for isolated anterior instabilities 90.4 and for combined antero-medial instabilities 86.7 Altogether 2/3 of the patients showed very good results in stability but, 4/5 showed good results in function, so 4/5 of the patients and their physicians considered the final result as good to very good and 2/3 of those patients are back to sports, only two percent do no more sports at all.
Article
The new presentations to the Cork Sports' Clinic over a one year period 1.1.90 to 31.12.90 were examined. We looked at the age and sex distribution of the presenting population, the type and site of injury, the sport played and the treatment and outcome of the injury. 126 new cases presented in 1990. 107 (85%) were male. The three commonest sports featured were all contact ones. The knee was the commonest site of injury (46.8% of cases) with 73.1% of injuries occurring in the lower limb. 73% of cases presented between the ages of 15 to 29 years. The majority of patients had improved on follow-up. Nine were referred to an orthopaedic service-five fractures and four serious ligamental injuries. The Cork Sports' Clinic works adjacent to a busy accident and emergency department. There is a definite need for our clinic in conjunction with the casualty department.
Article
The pattern and prevalence of knee injuries among athletes are different in Asia, Europe, and North America because of factors such as the different sporting cultures of the regions and the type of favorite sports. Sampling and data bias and the variable levels of diffusion of sports in the different parts of the world also are responsible for the variation. In this review, the knee emerges as the most commonly injured part of the body; such injuries present significant problems of mechanical block or instability that may compromise athletic performance. Sports specific injuries are delineated, and specific groups, such as children and adolescents, female, and master athletes, are reviewed in light of the characteristic patterns of knee injuries. Differences in the patients' attitude, health care systems, and consultations of traditional medical practitioners produce major differences in management styles. However, it is encouraging to find a concerted effort on all continents in the search for a better understanding of knee injuries and a more satisfactory coordination between clinical and basic science research in this field.
Article
To document the conditions seen by medical practitioners at a multidisciplinary sports medicine clinic during a 12-month period on the basis of site of injury, pathology, and sport played. A coding system for anatomical region, pathology, and sport played was designed. The total number of patient diagnoses coded and entered for analysis was 2,429. The most common sports involved were Australian football 322 (13.3%), distance running 299 (12.3%), netball/basketball 210 (8.6%), racquet sports 140 (5.8%), and track running 135 (5.6%). The most commonly injured region was the knee with 668 presentations (27.5%), followed by the upper limb (8.8%). The most frequently diagnosed pathology was overuse/inflammation with 1,115 (45.9%). Other pathologies diagnosed were partial ligament sprains 316 (13.0%), muscle strain 99 (4.1%), compartment syndrome 85 (3.5%), and third-degree ligament tear (3.5%). The most common diagnoses seen were patellofemoral syndrome, lumbar spine disorders, rotator cuff tendinitis, lateral ligament ankle sprain, medial meniscus tear, medial collateral ligament knee sprain, lateral meniscus tear, achilles tendinosis, anterior cruciate ligament tear and sacroiliac joint inflammation. A study of this nature provides valuable information both to the epidemiologist and clinician.
Article
Skiing is a winter sport enjoyed by approximately 200 million people worldwide. An overall injury rate of approximately 3 per 1000 skier-days means that skiing certainly is the riskiest sport undertaken by adults on a routine basis. However, the data suggest that one can anticipate years of enjoyable recreation free from injury. Many troubling injuries, particularly to the lower leg, have shown a steady decline over the past 20 to 30 years because of advances in boot design and binding capabilities. In addition, as information has been gathered regarding the importance of proper maintenance and adjustments, equipment now available can protect a skier more effectively than at any time in the past. Nevertheless, skiing continues to present inherent risks that can be minimized through the following strategies: 1. Enroll in a conditioning program before skiing that focuses on strength and endurance components particularly of the legs and back. 2. Have equipment that is compatible with the skier both from the standpoint of size and expertise. 3. Have equipment adjusted professionally. 4. Do routine testing of binding releases each day before beginning to ski. 5. Ski under control at speeds that are consistent with ability. 6. Stop skiing before fatigue becomes the limiting factor.
Article
To add to the area of triathlon research by providing much needed prevalence data on knee injury in triathletes. An incidental "in field" sampling technique was used to interview 58 triathletes aged between 15 and 55 years about knee injury during a triathlon event. The sample comprised 46 men and 12 women. Most knee injuries occurred during the running event (72%) and affected the lateral side of the knee (38%). In all, 78% of the sample sought treatment from a healthcare professional. The study has provided much needed prevalence data on chronic knee injury in triathletes.
Article
To define the causes of injuries to players in English professional football during competition and training. Lost time injuries to professional and youth players were prospectively recorded by physiotherapists at four English League clubs over the period 1994 to 1997. Data recorded included information related to the injury, date and place of occurrence, type of activity, and extrinsic Playing factors. In all, 67% of all injuries occurred during competition. The overall injury frequency rate (IFR) was 8.5 injuries/1000 hours, with the IFR during competitions (27.7) being significantly (p < 0.01) higher than that during training (3.5). The IFRs for youth players were found to increase over the second half of the season, whereas they decreased for professional players. There were no significant differences in IFRs for professional and youth players during training. There were significantly (p < 0.01) injuries in competition in the 15 minute periods at the end of each half. Strains (41%), sprains (20%), and contusions (20%) represented the major types of injury. The thigh (23%), the ankle (17%), knee (14%), and lower leg (13%) represented the major locations of injury, with significantly (p < 0.01) more injuries to the dominant body side. Reinjury counted for 22% of all injuries. Only 12% of all injuries were caused by a breach of the rules of football, although player to player contact was involved in 41% of all injuries. The overall level of injury to professional footballers has been showed to be around 1000 times higher times higher than for industrial occupations generally regarded as high risk. The high level of muscle strains, in particular, indicates possible weakness in fitness training programmes and use of warming up and cooling down procedures by clubs and the need for benchmarking players' levels of fitness and performance. Increasing levels of injury to youth players as a season progresses emphasizes the importance of controlling the exposure of young players to high levels of competition.
Article
In a 25-years period (1972-1997) 30,603 sportsmen, having a total of 34,742 sports related injuries, were treated in our outpatient-department specialized in sports orthopaedics and traumatology. All cases were systematically recorded and analysed right from the beginning. This is the most extensive clinical statistics currently known. The absolutely highest incidence rate of sports-related injuries is seen in common disciplines like soccer with 10,493 (34.3%), skiing with 3632 (11.9%), handball 2307 (7.5%), tennis 1643 (5.4%) and volleyball 1550 (5.1%). 3/4 were male. The distribution of age shows a significant peak between 20 and 29 years of age, whereas in women we found a wide plateau between 10 and 39 years. Compared to earlier investigations we have an increase of injuries in higher age. In 72.4% the lower extremities are mainly effected, followed by the upper extremities (21.8%) and the spine with 3.0%. With increasing tendency knee injuries take main part (36.6%--12,708 cases) followed by injuries of the ankle (19.9%--6920 cases), shoulder (7.7%), lower leg (7.0%) and fingers (5.8%). Main diagnosis were: distortion (32.6%); ruptures of ligaments and menisci (21.5%); fractures (10.5%) and lesions of muscles and tendons (8.8%). Comparing our 15- and 25-years studies we found an interesting significant increase of injuries in skiing, tennis and physical exercising by 25%, in cycling four times. New disciplines like squash, snowboarding, mountainbiking and inlineskating have been added. All together the number of injuries is distributed to 87 different disciplines. In 1998 26.7 million sportsmen (one third of the German population) were member of the German Sports Association (DSB). The number of annual accidents in sports and sporting spare time activities is estimated at about 1.5-2 million, that's 25-30% of all accidents. The analysis of almost 35,000 treated sports injuries and further evaluation of more than 5000 orthopaedic examinations of top athletes are useful for analysis comparing single disciplines.
Article
The objective was to estimate the prevalence of knee instability among active athletes and to investigate potential associations to type, amount and duration of sports participation. Based on a questionnaire, 339 athletes provided information about different features of occupation, sports activity and knee instability. The 12-month period prevalence of knee instability and constant or recurrent knee instability, and absence from sport and absence from work due to knee instability, was 22%, 14%, 5% and 1%, respectively. Knee instability as such, and constant or recurrent knee instability were found to be positively associated with female gender and different features of occupational work. In conclusion, knee instability is a commonly reported phenomenon among active athletes. It was found to be independent of the type and the amount of sports activity but highly dependent on female gender, type and amount of occupational work.
Article
20 to 25% of all the injuries are due to traumas of the knee since forty years. The amount of serious sprains has been in constant increasing during the last four decades. The ratio of one to two in 1960 between and ankle injuries was of six to one in 1987. The inversion of this ratio is probably due to the evolution of technics from 1960 forth, to plastic shoes with thicker soles, to the wrong adjustment of binding and to the higher speed of the skiers thanks to better mending of tracks. The frequency of injury of ligamental structures is higher for the internal lateral ligament and for the anterior cruciate ligament. A valgus associated to internal leg rotation in consequence of blocking of internal edge and of forward falling causes internal lateral ligament injury. The three lesional mechanisms of the anterior cruciate ligament are the valgus connected with external rotation, the anterior draw caused by the shoe in case of backward falling and the association valgus-flexion-internal rotation ("foot-phantom"). These lesions of ligaments are often connected with lesions of the external meniscus and with osseous contusions concerning the external femoral condyle and the external tibial plate.
Article
The anterior cruciate ligament has been shown to be particularly susceptible to injury during alpine skiing. Tibial torque is an important injury mechanism, especially when applied to a fully extended or fully flexed knee. We wanted to record the forces generated in the anterior cruciate ligament with application of tibial torque to cadaveric knees in different positions. Controlled laboratory study. Thirty-seven fresh-frozen cadaveric knees were instrumented with a tibial load cell that measured resultant force in the anterior cruciate ligament while internal and external tibial torques were applied to the tibia at full extension, 90 degrees of flexion, full flexion, and forced hyperflexion. At each knee flexion position, mean force generated by 10 N.m of internal tibial torque was significantly higher than the mean generated by 10 N.m of external tibial torque. Mean forces generated by tibial torque at 90 degrees of flexion were relatively low. During flexion-extension without tibial torque applied mean forces were highest (193 N) when the knee was hyperflexed. Application of internal tibial torque to a fully extended or fully flexed knee represents the most dangerous loading condition for injury from twisting falls during skiing. Understanding of the mechanisms of falls can be used to design better equipment and to better prevent or treat injury.
Article
Injuries of the extensor mechanism of the knee occur frequently during sport activity. For a successful treatment they must be diagnosed early. Besides osseous structures the patellar tendon, the patella, the quadriceps muscle and tendon, retinacula and bursae can be affected. After initial clinical examination there are different noninvasive imaging modalities available for assessment of bone, cartilage, ligaments, tendons and soft tissue. Conventional radiographs are still the basic imaging tool for the clinician. Additional information about the osseous status is provided by computed tomography, whereas sonography plays an important role concerning diagnosis of soft tissue injuries. For the detection of cartilagenous, ligamentous or tendon lesions MRI is the superior non-invasive imaging modality.
Article
Alpine skiing is a global winter recreational sport with 15 million participants in the United States alone, and an overall injury rate of 2.5 per 1,000 ski person-days. Isolated injury to the anterior cruciate ligament (ACL) or the medial collateral ligament (MCL) is common among ski injuries; however, combined injury to these structures is rare. Controversy in the management of ACL instability following alpine ski injury is diminishing with improvements in the techniques of intra-articular cruciate reconstruction. However, the management of the combined ACL-MCL injury remains something of an enigma. Evidence exists to support both surgical and nonsurgical management strategies for the medial structures, but little consensus exists for the timing of the repair. This paper highlights the mechanisms of ski injuries that can result in combined injury to the ACL and MCL. The anatomy and biomechanics of the medial complex as it relates both to stability and operative repair are reviewed, and literature on the techniques and indications used for MCL repair in the setting of a combined injury is presented. On the basis of this review, we believe that an injury to the MCL does not need to be repaired if the ACL is reconstructed after a combined injury.
Article
The epidemiology of posterior cruciate ligament (PCL) injuries has not been well clarified. Isolated and combined PCL injuries are a frequently missed diagnosis. A better understanding of typical injury mechanisms may help in more accurate diagnosis of these injuries. In this study the epidemiology of PCL insufficiency in 494 patients was retrospectively analysed. Stress-radiography was used to quantify posterior tibial displacement. The mean age at the time of injury was 27.5+/-9.9 years. Traffic accidents (45%) and athletic injuries (40%) were the most common injury causes. Motorcycle accidents (28%) and soccer-related injuries (25%) accounted for the main specific injury causes. The most common injury mechanisms were dashboard injuries (35%) and falls on the flexed knee with the foot in plantar flexion (24%). The mean side-to-side difference of posterior tibial displacement on posterior stress-radiographs in 90 degrees of flexion was 13.4+/-4.7 mm. According to the posterior displacement values, 232 (47%) patients had isolated PCL ruptures, while 262 (53%) patients with a posterior displacement of >12 mm were classified as having a combined posterior instability. There were significantly more combined PCL lesions due to vehicular trauma as compared with athletic trauma ( p<0.0001). In many PCL lesions, initiation of an adequate treatment regimen is delayed despite typical injury mechanisms and symptoms. In the future, a better understanding of the epidemiology of PCL injuries should enable us to diagnose the injury more reliably through a detailed history and a thorough physical and radiographic examination in the acute setting.
Injury patterns at the 2002 Winter Olympics were similar to those in recreational winter athletes, although injury rates were higher. The high rates of injury compared with reported rates in recreational athletes reflect the intensity of the competition and the high speeds of the athletes. In addition, rates are artificially elevated because we were not able to count the number of practice runs by each athlete, only the number of races. The highest rates of injuries resulting in positive MR imaging or plain radiographs were in snowboarders (28/1000 races), followed by alpine skiers (20/1000). In all of the winter sports, the most commonly injured joint was the knee (37 injuries), and the most common knee injury was the ACL tear. Injuries to the foot and ankle were second in frequency (15 injuries). It is interesting that three of the ankle injuries were syndesmosis sprains; this may be an underreported injury in winter sports. There were 12 injuries to the upper extremity, all but two to the shoulder. Back complaints were frequent, but only seven patients had significant imaging abnormalities found in the lumbar spine: two stress fractures of the pedicles, one acute pedicle fracture, one spondylolysis, and four disc protrusions.
Article
The current study deals with the results of the examination of 685 patients, who were treated in the department of traumatology in the KKH Garmisch-Partenkirchen during the winter season 99/00 and 00/01. The study included 259 injured carvers (120 female, 139 male) with an average age of 33.9 years and 426 injured conventional skiers (212 female, 214 male) with an average age of 33.2 years. The aim of the investigation was to compare both ski groups concerning injuries, the pathomechanism and the skiing experience. The results of the investigation showed that the knee injuries of carvers were more severe than in the conventional skiers. The difference was significant (p < 0.05).
Epidemiologie von Sportver-letzungen Deutsche Zeitschrift fü r
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Pfister A, Pfö W, Rosemeyer B. Epidemiologie von Sportver-letzungen Deutsche Zeitschrift fü r Sportmedizin 1985;10:291 – 4.
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Epidemiologie von Sportverletzungen
  • A Pfister
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  • B Rosemeyer
Pfister A, Pförringer W, Rosemeyer B. Epidemiologie von Sportverletzungen Deutsche Zeitschrift fü r Sportmedizin 1985;10:291 -4.