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BACKGROUND: Most anterior cruciate ligament research is limited to variables at the knee joint and is performed in the laboratory setting, often with subjects postinjury. There is a paucity of information on the position of the hip and ankle during noncontact anterior cruciate ligament injury. HYPOTHESIS: When landing after maneuvers, athletes with anterior cruciate ligament injury (subjects) show a more flatfooted profile and more hip flexion than uninjured athletes (controls). STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: Data from 29 videos of subjects were compared with data from 27 videos of controls performing similar maneuvers. Joint angles were analyzed in 5 sequential frames in sagittal or coronal planes, starting with initial ground-foot contact. Hip, knee, and ankle joint angles were measured in each sequence in the sagittal plane and hip and knee angles in the coronal plane with computer software. The portion of the foot first touching the ground and the number of sequences required for complete foot-ground contact were assessed. Significance was set at P< .05. RESULTS: In sagittal views, controls first contacted the ground with the forefoot; subjects had first ground contact with the hind-foot or entirely flatfooted, attained the flatfoot position significantly sooner, had significantly less plantar-flexed ankle angles at initial contact, and had a significantly larger mean hip flexion angle at the first 3 frames. In coronal views, no significant differences in knee abduction (initial contact) or hip abduction angle were found between groups; knee abduction was relatively unchanged in controls but progressed in subjects. CONCLUSION: Initial ground contact flatfooted or with the hindfoot, knee abduction and increased hip flexion may be risk factors for anterior cruciate ligament injury. [ABSTRACT FROM AUTHOR]

BACKGROUND: Female college basketball and soccer athletes have higher rates of anterior cruciate ligament injury than do their male counterparts. Rates of anterior cruciate ligament injuries for women and men in collegiate lacrosse have not been examined. Understanding anterior cruciate ligament injury patterns in lacrosse, a full-contact sport for men and noncontact sport for women, could further injury prevention efforts. HYPOTHESES: Female anterior cruciate ligament injury rates will decrease over time owing to longer participation in sports. Lacrosse anterior cruciate ligament injury rates will be lower than rates in basketball and soccer possibly owing to beneficial biomechanics of carrying a lacrosse stick. STUDY DESIGN: Cohort study (Prevalence); Level of evidence, 2. METHODS: Data from the National Collegiate Athletic Association Injury Surveillance System were analyzed to compare men's and women's anterior cruciate ligament injuries in basketball, lacrosse, and soccer over 15 years. RESULTS: Anterior cruciate ligament injury rates in women's basketball and soccer were 0.28 and 0.32 injuries per 1000 athlete exposures, respectively, and did not decline over the study period. In men's basketball, injury rate fluctuated between 0.03 and 0.13 athlete exposures. Rates of anterior cruciate ligament injury did not significantly change in men's soccer over the study period. The rate of anterior cruciate ligament injury in men's lacrosse (0.17 athlete exposures, P < .05) was significantly higher than in men's basketball (0.08 athlete exposures) and soccer (0.12 athlete exposures). Injury rate in women's lacrosse (0.18 athlete exposures, P < .05) was significantly lower than in women's basketball and soccer. CONCLUSION: There was no discernable change in rate of anterior cruciate ligament injury in men or women during the study period. Men's lacrosse is a high-risk sport for anterior cruciate ligament injury. Unlike basketball and soccer, the rates of anterior cruciate ligament injury are essentially the same in men's and women's lacrosse. The level of allowed contact in pivoting sports may be a factor in determining sport-specific anterior cruciate ligament risk. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are few epidemiologic studies of cheerleading injuries. PURPOSE: To develop a profile of catastrophic injuries in cheerleading and to describe relevant risk factors. STUDY DESIGN: Retrospective cohort study. METHODS: We reviewed 29 of 39 incidents of cheerleading injuries reported to the National Center for Catastrophic Sports Injury Research from 1982 to 2002. RESULTS: Twenty-seven of the injured cheerleaders were women. There were 1.95 direct catastrophic injuries per year or 0.6 injuries per 100,000 participants. The rate of injuries among college cheerleaders was five times that of high school participants. The most common stunts performed at the time of injury were a pyramid (9) or a basket toss (8). Catastrophic injuries included 17 severe head injuries, resulting in 13 skull fractures and 2 deaths; 8 cervical fractures or major ligament injuries; 3 spinal cord contusions; and 1 concomitant head injury and cervical fracture. CONCLUSIONS: Suggestions for reducing catastrophic injuries in cheerleaders include enhancing the number and training of spotters, mandating floor mats for complex stunts, restricting complex stunts when surfaces are wet, and encouraging safety certification of coaches. Pyramids and basket tosses should be limited to experienced cheerleaders who have mastered all other skills and should be performed with spotters and landing mats. [ABSTRACT FROM AUTHOR]

Supracondylar stress fractures are rare and can cause anterior knee pain. Persistent, intense pain occurs in the knee and distal thigh and may be mistaken for patellofemoral pain syndrome unless the fracture is identified by radiographic modalities (MRI or bone scan). Two cases of supracondylar femoral stress fractures in female runners highlight the need to seek proximal pathologies when patients report knee pain that cannot be explained by other conditions. [ABSTRACT FROM AUTHOR]

Stress fractures can occur in almost any bone in the body, with the lower extremity weightbearing bones, especially the tibia, tarsals, and metatarsals, being affected most frequently. Although the cause of these fractures is multifactoral, repetitive physical forces without adequate rest are the primary culprits. Stress fractures may be broadly classified as low-risk or high-risk injuries. Low-risk stress fractures, the topic of this review article, can be diagnosed through a thorough history, physical examination, and radiographs. Nuclear scintigraphy is occasionally necessary for confirmation, especially for fractures of the spine and pelvis. When diagnosed early and treated with restriction of activity, low-risk stress fractures have a favorable prognosis. [ABSTRACT FROM AUTHOR]

An understanding of the etiology and prevention of noncontact ACL injuries has lagged behind diagnosis and treatment. However, a growing research implicates hormonal, anatomic, environmental, and neuromuscular factors that may predispose athletes, particularly women, to these injuries. Specific factors may include estrogen levels, the shape of the intercondylar notch, playing style, and neuromuscular control of the quadriceps and hamstring muscles. Prevention programs that involve proprioception, plyometrics, strength training, and improved jumping, stopping, and turning techniques show promising results. [ABSTRACT FROM AUTHOR]