Wednesday, March 14, 2012

Glenoidplasty technique leads to higher likelihood of return to sport in throwing athletes

Glenoidplasty technique leads to higher likelihood of return to sport in throwing athletes

Lévigne C. Clin Orthop Rel Res. 2012. doi:10.1007/s11999-012-2294-7

Researchers from the Clinique du Parc Lyon in France have concluded that using glenoidplasty to treat posterior superior glenoid impingement is correlated with an increased likelihood of athletes returning to throwing sports.

Christophe Lévigne, MD, and colleagues retrospectively analyzed 27 athletes with a mean age of 27 years who underwent extensive posterior labral and partial tendinous tear debridement for internal impingement between 1996 and 2008. A CT scan revealed that in 21 shoulders, there were bony changes on the posterior glenoid rim, according to the abstract.

Of the 26 patients reviewed at a minimum 19-month follow-up, 18 patients returned to their normal sport levels, 6 patients had to change to a lower level of sport or to another sport entirely and 2 patients did not improve after the glenoidplasty. Researchers reported no posterior instability or complications and there was no reported arthritis or osteophytes in 15 patients who received radiographs between 20-month and 87-month follow-ups.

Degeneration of the knee joint in skeletally immature patients with a diagnosis of an anterior cruciate ligament tear: is there harm in delay of treatment?

Am J Sports Med. 2011 Dec;39(12):2582-7. Epub 2011 Sep 14.

Degeneration of the knee joint in skeletally immature patients with a diagnosis of an anterior cruciate ligament tear: is there harm in delay of treatment?

Source

Division of Orthopaedics, Children's Hospital of Philadelphia, PA 19104-4399, USA. lawrencej@email.chop.edu

Abstract

BACKGROUND:

In skeletally immature patients with an anterior cruciate ligament (ACL) tear and significant growth remaining, the risk of inducing a growth disturbance with early reconstruction must be balanced against the risk of further intra-articular damage by delaying treatment until closer to skeletal maturity.

HYPOTHESIS:

Increased time from injury to ACL reconstruction in children ≤14 years of age will be associated with increased meniscal and chondral injuries at the time of reconstruction.

STUDY DESIGN:

Cohort study; Level of evidence, 3.

METHODS:

With institutional review board approval, the records of a consecutive series of patients 14 years of age and younger who underwent ACL reconstruction between 1991 and 2005 were reviewed. Demographic, magnetic resonance imaging (MRI), and intraoperative findings were analyzed. Meniscal and articular cartilage injuries were graded. Logistic regression models using both univariable and multivariable regression procedures were used to identify factors independently associated with intra-articular lesions. Fisher exact test and Kaplan-Meier analysis were used to test for differences in intra-articular injuries by time from injury to surgery.

RESULTS:

Seventy patients were identified. Twenty-nine patients (41%) underwent reconstruction more than 12 weeks from the time of injury. Logistic regression analysis revealed time to surgical reconstruction (odds ratio, 4.1) and a history of a sense of knee instability (odds ratio, 11.4) to be independently associated with medial meniscal tears. Time to surgical reconstruction was also independently associated with medial and lateral compartment chondral injuries (odds ratios, 5.6 and 11.3, respectively). Testing time as a continuous variable, survivorship analysis also confirmed a significant association of time to reconstruction with medial meniscal injury as well as lateral and patellotrochlear cartilage injuries. When present, a delay in treatment of over 12 weeks (29 patients) was associated with an increase in the severity of medial meniscal tears (P = .011) and higher grade lateral and patellotrochlear chondral injuries (P = .0014 and P = .038, respectively).

CONCLUSION:

Young patients who underwent surgical reconstruction of an acute ACL tear >12 weeks after the injury were noted to have a significant increase in irreparable medial meniscal tears and lateral compartment chondral injuries at the time of reconstruction. When a subjective sense of knee instability was present, this association was even stronger.

The acute effects of a warm-up including static or dynamic stretching on countermovement jump height, reaction time, and flexibility.

Athletes in sports requiring lower-extremity power should use DS techniques in warm-up to enhance flexibility while improving performance.

Tuesday, March 13, 2012

Does pre-exercise static stretching inhibit maximal muscular performance? A meta-analytical review.

Scand J Med Sci Sports. 2012 Feb 8. doi: 10.1111/j.1600-0838.2012.01444.x. [Epub ahead of print]
 

Source

Motor Control and Human Performance Laboratory, School of Kinesiology, University of Zagreb, Zagreb, Croatia.

Abstract

We applied a meta-analytical approach to derive a robust estimate of the acute effects of pre-exercise static stretching (SS) on strength, power, and explosive muscular performance. A computerized search of articles published between 1966 and December 2010 was performed using PubMed, SCOPUS, and Web of Science databases. A total of 104 studies yielding 61 data points for strength, 12 data points for power, and 57 data points for explosive performance met our inclusion criteria. The pooled estimate of the acute effects of SS on strength, power, and explosive performance, expressed in standardized units as well as in percentages, were -0.10 [95% confidence interval (CI): -0.15 to -0.04], -0.04 (95% CI: -0.16 to 0.08), and -0.03 (95% CI: -0.07 to 0.01), or -5.4% (95% CI: -6.6% to -4.2%), -1.9% (95% CI: -4.0% to 0.2%), and -2.0% (95% CI: -2.8% to -1.3%). These effects were not related to subject's age, gender, or fitness level; however, they were more pronounced in isometric vs dynamic tests, and were related to the total duration of stretch, with the smallest negative acute effects being observed with stretch duration of ≤45 s. We conclude that the usage of SS as the sole activity during warm-up routine should generally be avoided.

Thursday, March 8, 2012

Pearls and Pitfalls of Single-bundle Transtibial Posterior Cruciate Ligament Reconstruction

Pearls and Pitfalls of Single-bundle Transtibial Posterior Cruciate Ligament Reconstruction

Epidemiology of Meniscal Injury Associated With ACL Tears in Young Athletes

Epidemiology of Meniscal Injury Associated With ACL Tears in Young Athletes

A total of 165 meniscal tears were observed in 140 participants. A meniscal tear was observed in 39.6% (140/353) of cadets who sustained an ACL tear at arthroscopy (95% confidence interval [CI], 34.5%-45%). Of the 140 cadets who sustained meniscal tears, 68 had isolated medial meniscal tears, 47 had isolated lateral meniscal tears, and 25 had medial and lateral meniscal tears.

No significant difference was found between acute vs delayed treatment and the incidence of meniscal tears.

Compared with other sports, wrestling and volleyball had the highest incidence of concomitant meniscal tears at 77% and 125%

http://www.orthosupersite.com/images/content/ORTHO/2012/10.3928_01477447-20120222-07-table3.jpg
Because of the nature of the service academy and the process by which injuries are documented, we are confident that we identified all ACL injuries and did not underreport rates. Most importantly, 352 of 353 ACL injuries underwent ACL reconstruction, allowing us to identify all meniscal tears. Despite our large and well-documented cohort, our rates of concomitant meniscal injury based on laterality, level of sport, mechanism of injury, timing of treatment, and sex did not reach statistical significance. 

Nice paper.