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The article offers several information of general interests. The American Orthopaedic Society for Sports Medicine conducted its 2007 Annual Meeting in Calgary, Alberta, Canada wherein there was a constructive dialogue regarding common misconceptions on the procurement and processing of allografts commonly used in sports medicine. Meanwhile, several personalities in sports medicine were recipient of several awards given the sports medicine organization to individuals who had made valuable contribution to the field. Moreover, several research papers on sports medicine have been recognized by the sport medicine organization due the valuable information the papers shared.

The article reports developments related to the American Orthopaedic Society for Sports Medicine (AOSSM). The 2006 research awards were presented to investigators at the AOSSM Annual Meeting that was held on June 29 to July 2, 2006, in Hershey, Pennsylvania. The 2006 Aircast Award for Basic Science was given to Steven J. Svboda, Sally Mountcastle, and Dean C. Taylor. The AOSSM Self Assessment and Board Review Version 2 will be launched by the September 2006 end. The AOSSM patient education series, "Sports Tips," which is recently revived, is now available for purchase. A new members-only feature has been included in the AOSSM bimonthly newsletter, "Sports Medicine Update."

The article discusses the treatment approach for the acute Achilles Tendon Reruptures. Two approaches have been discussed by Rohit Kotnis and colleagues in their research paper "Dynamic Ultrasound as a Selection Tool for Reducing Achilles Tendon Reruptures." The approaches include surgical and non-surgical treatment. In the paper, they have used diagnostic ultrasound to determine, which patients with acute Achilles tendon ruptures should undergo surgical or nonsurgical treatment approaches.

The article focuses on the need of enhancing the quality of "The American Journal of Sports Medicine (AJSM)." It comments on the paper "An Assessment of the Methodological Quality of Research Published in The American Journal of Sports Medicine," by Brophy and others. The paper ranges outside the normal domain of the AJSM articles to study the journal itself. The authors compared all articles published in the AJSM from 1991 to 1993 to those that appeared from 2001 to 2003. For this ambitious undertaking, they reviewed 825 articles published during these periods. In addition to classifying each article by its overall design, the authors recorded the presence of certain qualities commonly considered desirable in a research study: presence of a specific hypothesis, prospective data collection, inclusion of a control group, randomized assignment of subjects, and blinding of patients, providers, or evaluators to treatment outcome. They found that most of these parameters changed in the direction that would generally be considered an improvement. Although the findings of Brophy and others are gratifying to the folks at the AJSM, there is need to point out that the ability of the editorial staff to bring about the observed improvement is limited.

The article presents news related to the American Orthopaedic Society for Sports Medicine (AOSSM). AOSSM has announced that The American Journal of Sports Medicine editor Bruce Reider, MD, has been named to lead the 2007 Traveling Fellows to the Pacific Rim in late summer 2007. Newly revised and redesigned, the AOSSM patient education series, "Sports Tips," is now available for purchase.

A response by Yilihamu Tuoheti to a letter to the editor about his article "Contact Area, Contact Pressure, and Pressure Patterns of the Tendon-Bone Interface After Rotator Cuff Repair" in the December 2005 issue is presented.

A letter to the editor in response to the article "Contact Area, Contact Pressure, and Pressure Patterns of the Tendon-Bone Interface After Rotator Cuff Repair" by Yilihamu Tuoheti in the December 2005 issue is presented.

The article offers information on the activities and developments undertaken by the American Orthopaedic Society for Sports Medicine (AOSSM) in the U.S. The society's new online library will be integrated into www.sportsmed.org and will be accessed by its members for free. AOSSM is now accepting abstracts for its 2009 annual meeting which will be held in Keystone, Colorado on July 9-12, 2009. It is proud to announce that it has named physician Douglas W. Brown as leader for the Asia-Pacific Traveling Fellows in the spring of 2009.

The article offers information on various developments in sports medicine. It is posed that the American Orthopaedic Society for Sports Medicine (AOSSM) will be working with the National Institutes of Health to create a new career development award devoted to orthopaedic sports medicine. The AOSSM Board of Directors has passed an anticipated pilot study on the prediction of treatment response to hyaluronic acid for knee osteoarthritis. Moreover, the AOSSM is set to launch a new journal entitled "Sports Health: An Interdisciplinary Approach."

The article reports developments within the American Orthopaedic Society for Sports Medicine (AOSSM). The Society will be publishing its second journal, "Sports Health: An Interdisciplinary Approach," intended for physicians and health personnel working with athletes. The application deadline for AOSSM's traveling fellow for 2008 will on October 15, 2007. The handbook "Prevention and Emergency Management of Youth Baseball and Softball Injuries" can be downloaded for free at AOSSM's web site.

A response by Karin Grävare Silbernagel, Roland Thomeé, Bengt I. Eriksson and Jon Karlsson to a letter to the editor about their article "Continued Sports Activity, Using a Pain-Monitoring Model, During Rehabilitation in Patients With Achilles Tendinopathy: A Randomized Controlled Study" in the February 16, 2007 issue is presented.

A letter to the editor in response to the article "Continued Sports Activity, Using a Pain-Monitoring Model, During Rehabilitation in Patients with Achilles Tendinopathy: A Randomized Controlled Study" in the February 16, 2007 issue is presented.

A letter to the editor in response to the article "Stress Fractures of the Base of the Fourth Metatarsal: Two Cases and Review of the Literature" in the March 2007 issue is presented.

A response by Carl Shearer to a letter to the editor on his article "Stress Fractures of the Base of the Fourth Metatarsal: Two Cases and Review of the Literature" in the March 2007 issue is presented.

A letter to the editor is presented in response to the article "The 6 Degrees of Freedom Kinematics of the Knee After Anterior Cruciate Ligament Deficiency: An In Vivo Imaging Analysis," by Guoan Li in the August 2006 issue of the journal.

The article focuses on the authority given to authors in "The American Journal of Sports Medicine" to choose reviewers for their work. Authors are also given the option to identify anyone whom they would like to exclude as a possible reviewer. This move arises from the journal's aim to make its contributors feel that their work has been reviewed with erudition and fairness. And the editorial staff tries to include at least one of their nominees among the reviewers.

Background: The relevance of knee-specific subjective measures of outcome to patients has not been evaluated for cartilage repair procedures. Purpose: The aim of this study was to identify which instrument out of the Knee injury Osteoarthritis Outcome Score and the International Knee Documentation Committee Subjective Knee Form measures symptoms and disabilities most important to postoperative articular cartilage repair patients. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Data were collected from 58 participants of an Internet knee forum via a self-reported online questionnaire consisting of demographic and surgical data, the Tegner activity scale, and 49 consolidated items from the Knee injury Osteoarthritis Outcome Score and the International Knee Documentation Committee Subjective Knee Form. Item importance, frequency, and frequency-importance product were calculated. Results: Overall, the International Knee Documentation Committee Subjective Knee Form was the highest scoring instrument in all categories. However, 2 of the Knee injury Osteoarthritis Outcome Score subscales ("function in sport and recreation" and "knee-related quality of life") scored higher on mean importance and frequency-importance product than the overall International Knee Documentation Committee Subjective Knee Form score. Conclusion: The International Knee Documentation Committee Subjective Knee Form provided the best overall measure of symptoms and disabilities that are most important to this population of postoperative articular cartilage repair patients. This brings into question the validity of using the Knee injury Osteoarthritis Outcome Score in shorter-term-less than 10 years-studies. Issues related to sports activity appear to be highly valued and very pertinent to evaluation of outcomes for this patient group. [ABSTRACT FROM AUTHOR]

Background: The tackle is the most dangerous facet of play in rugby union, but little is known about risk factors for tackle injuries. Purpose: To estimate the injury risk associated with various characteristics of tackles in professional rugby union matches. Study Design: Descriptive epidemiology study. Method: All 140 249 tackles in 434 professional matches were coded from video recordings for height and direction of tackle on the ball carrier, speed of tackler, and speed of ball carrier; injuries were coded for various characteristics, including whether the tackler or ball carrier required replacement or only on-field assessment. Results: There were 1348 injury assessments requiring only on-field treatment and 211 requiring player replacement. The inciting event and medical outcomes were matched to video records for 281 injuries. Injuries were most frequently the result of high or middle tackles from the front or side, but rate of injury per tackle was higher for tackles from behind than from the front or side. Ball carriers were at highest risk from tackles to the head-neck region, whereas tacklers were most at risk when making low tackles. The impact of the tackle was the most common cause of injury, and the head was the most common site, but an important mechanism of lower limb injuries was loading with the weight of another player. Rates of replacement increased with increasing player speed. Conclusion: Strategies for reducing tackle injuries without radically changing the contact nature of the sport include further education of players about safe tackling and minor changes to laws for the height of the tackle. [ABSTRACT FROM AUTHOR]

Background: Osteochondral lesions of the talus are relatively uncommon but may be a cause of significant pain and disability in symptomatic patients. Hypothesis: Arthroscopic treatment of osteochondral lesions of the talus will result in good long-term clinical outcomes in the majority of patients. Study Design: Case series; Level of evidence, 4. Methods: Fifty patients with chronic osteochondral lesions of the talus underwent arthroscopic treatment. Average age was 32 years (range, 12-72 years). Average follow-up was 71 months (range, 24-152 months). Treatment consisted of either drilling of the osteochondral lesions of the talus in situ (n = 4), excision of the osteochondral lesions of the talus and abrasion arthroplasty (n = 6), or excision of the osteochondral lesions of the talus and drilling (n = 40). Preoperative and intraoperative staging of the osteochondral lesions of the talus was performed. Follow-up evaluation included 3 clinical rating systems: Alexander, modified Weber, and American Orthopaedic Foot and Ankle Society Ankle/Hindfoot scores. Results: There were 72% excellent/good, 20% fair, and 8% poor results on the Alexander scale. According to the modified Weber scale, there were 64% excellent/good, 30% fair, and 6% poor results. The average American Orthopaedic Foot and Ankle Society Ankle/Hindfoot score was 84 (range, 34-100). We found no correlation between plain radiographs, computed tomography, or magnetic resonance imaging staging and clinical results. However, there was significant correlation between arthroscopic stage and clinical outcome. Seventeen patients had been seen 5 years previously and evaluated using the same criteria; 35% demonstrated a deterioration in their result over time. Conclusion: Arthroscopic treatment of chronic symptomatic osteochondral lesions of the talus results in good clinical outcomes in the majority of patients. However, pain and functional limitation may persist in some patients, especially those noted to have unstable osteochondral defects at the time of arthroscopy. [ABSTRACT FROM AUTHOR]

Background: Low-intensity pulsed ultrasound has been reported to be effective in promoting tendon healing. However, its optimal time and duration has not yet been determined. Hypothesis: Tendons at different stages of healing may respond differently to low-intensity pulsed ultrasound. In the present study, the timing effects of low-intensity pulsed ultrasound on tendon healing were investigated in a rat model with a patellar tendon graft harvest lesion. Study Design: Controlled laboratory study. Methods: Sixty Sprague-Dawley rats underwent central third patellar tendon donor site harvest. Low-intensity pulsed ultrasound sonication was then delivered to the injured knees at day 1, 14, or 28 after harvest for 2, 4, or 6 weeks. Tendon samples were harvested at day 14, 28, and 42 after lesion for histological examination and mechanical testing. Results: A 2-week session of low-intensity pulsed ultrasound applied from day 1 postlesion (D1-2W) significantly improved the ultimate mechanical strength of the healing tendons from 23.1 ± 8.5 MPa to 36.6 ± 9.0 MPa. Low-intensity pulsed ultrasound did not improve healing when it was given at later stages in D15-2W and D29-2W. When low-intensity pulsed ultrasound treatment was extended from 2 weeks (D1-2W) to 4 weeks (D1-4W) or 6 weeks (D1-6W), the beneficial effects on tendon healing became insignificant. Histological examination showed that low-intensity pulsed ultrasound sonication at late healing stages may disturb remodeling with a poor collagen fiber alignment. Conclusion: Low-intensity pulsed ultrasound promoted restoration of mechanical strength and collagen alignment in healing tendons only when applied at early healing stages. Clinical Relevance: The present findings indicate that low-intensity pulsed ultrasound may be an effective treatment to reduce tendon donor site morbidity. [ABSTRACT FROM AUTHOR]

The article presents a cohort study which examines the strength imbalances and prevention of hamstring injury in professional soccer players. 687 players were isokinetically tested in preseason and a complete follow-up was obtained in 462 players, for whom 35 hamstring injuries were recorded. According to the authors, the outcomes showed that isokinetic intervention gives rise to the preseason detection of strength disorders, a factor that increases the risk of hamstring injury. Furthermore, the restored normal strength profile decreases the muscle injury incidence.

The article focuses on the comparison of 3-dimensional obliquity and anisometric characteristics of anterior cruciate ligament graft positions using surgical navigation, which allows continuous intraoperative monitoring of ACL graft anisometry. It was presumed that ACL Grafts positioned in an anteromedial and posterolateral bundle will have distinct anistometric profiles and 3-dimensional obliquities. Using the surgical navigation system from a controlled laboratory study, five cadeveric knees were examined that relevantly provides anisometry and 3-dimensional obliquity data for several graft positions.

The article discusses a medical study on the use of the biceps interposition technique to repair a massive rotator cuff tears. Over 31 shoulders with irreparable massive rotator cuff tears and associated degenerative lesions of the biceps tendons underwent into an analysis conducted between April 2000 and April 2004 through open and arthroscopic procedures. It has been analyzed that the biceps tendon interposition technique for massive rotator cut off tears offers a possible improvement in the clinical outcomes. Moreover, augmentation technique with the use of tenotomized biceps is useful in bridging the gap in immobile massive rotator cuff tears.

The article provides information on the outcomes of anatomic characteristics of the repaired meniscus with postoperative arthrography combined with computed tomography (arthro-CT), particularly the dimensions and healing of the repaired meniscus. According to the statistical analysis, the interobserver error rates for postoperative magnetic resonance imaging (MRI) and postoperative arthro-CT were calculated based on measurements obtained by 2 orthopaedic investigators, different from the senior surgeons and blinded to other measurements and meniscal status. In conclusion, the modern technique using all-inside fixation or outside-in sutures provided good clinical and anatomic outcomes.

Background: Women who participate in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than men. Purpose: To prospectively determine if female athletes with decreased passive knee joint restraint (greater joint laxity) and greater side-to-side differences in knee laxity would be at increased risk of anterior cruciate ligament injury. Study Design: Case control study; Level of evidence, 3. Methods: From 1558 female soccer and basketball players who were prospectively screened, 19 went on to tear their anterior cruciate ligaments. Four height- and mass-matched control subjects were selected from the uninjured screened athletes for comparison with each of the 19 injured subjects, making a total of 95 subjects (19 injured; 76 uninjured). Generalized joint-laxity tests and anterior-posterior tibiofemoral translation were quantified using the CompuKT knee arthrometer. A multivariable logistic regression model was constructed to determine predictors of anterior cruciate ligament injury status from recorded laxity measures. Results: A multivariable logistic regression model (chi-square = 18.6; P = .002) used the independent variables laxity measures of knee hyperextension (P = .02), wrist and thumb to forearm opposition (P = .80), fifth-finger hyperextension > 900 (P = .71), side- to-side differences in anterior-posterior tibiofemoral translation (P = .002), and prior knee injury (P = .22) to predict anterior cruciate ligament-injury status. The validated C statistic, or validated area under the receiver operating characteristic curve, was 0.72. For every 1.3-mm increase in side-to-side differences in anterior-posterior knee displacement, the odds of anterior cruciate ligament-injured status increased 4-fold (95% confidence interval, 1.68-9.69). A positive measure of knee hyperextension increased the odds of anterior cruciate ligament-injured status 5-fold (95% confidence interval, 1.24-18.44). Conclusion: The current results indicate that increased knee-laxity measures may contribute to increased risk of anterior cruciate ligament injury. The methods to quantify knee joint laxity in this report may be used in conjunction with measures of neuromuscular control of the knee joint to identify high-risk female athletes with high accuracy. Once high-risk female athletes are identified, they may be targeted to the appropriate interventions to reduce injury risk. [ABSTRACT FROM AUTHOR]

Background: Tears of the ulnar collateral ligament (UCL) of the elbow are common injuries in overhead athletes that may be career-ending if left untreated. Purpose: The goal of this systematic review was to review all published reports of UCL reconstruction in overhead athletes, determine which techniques were associated with better outcomes, and assess the strengths and weaknesses of current data. Study Design: Systematic review. Methods: A systematic review of published studies evaluating reconstruction of the UCL in overhead athletes was performed using the Ovid Medline database. All studies with a cohort of athletes who underwent UCL reconstruction with a minimum of 1 year follow-up were included, resulting in a total of 8 Level Ill (retrospective cohort) studies. A database compiled variables of interest, including demographic variables, surgical techniques, Conway-Jobe ratings, and percentage and type of complications. Additionally, studies were evaluated for evidence of selection, performance, detection, and exclusion biases. Results: Demographic data were similar between studies. Overall, 83% of patients in all studies had an excellent result. There was an overall 10% complication rate, with the most common complication being postoperative ulnar neuropathy, which occurred in 6% of patients. Transition to the muscle-splitting approach was associated with better outcomes than detachment of the flexor-pronator mass, as there was only a 70% rate of excellent results and a 20% rate of postoperative ulnar neuropathy in patients treated with detachment of the flexor-pronator mass compared with 87% excellent results and a 6% rate of postoperative ulnar neuropathy in patients treated with a muscle-splitting approach. Abandoning obligatory ulnar nerve transposition was associated with better outcomes, as there was only a 75% rate of excellent results and a 9% rate of postoperative ulnar neuropathy in patients treated with obligatory ulnar nerve transposition compared with 89% excellent results and a 4% rate of postoperative ulnar neuropathy in patients who did not have obligatory ulnar nerve transposition. The docking technique was associated with better outcomes, as there was a 76% rate of excellent results and an 8% rate of ulnar neuropathy in patients treated with a figure-of-8 technique com- pared with 90% excellent results and a 3% rate of postoperative ulnar neuropathy in patients treated with the docking technique and 95% excellent results and a 5% rate of postoperative ulnar neuropathy in patients treated with a modified docking technique. Conclusion: The evolution in surgical techniques, most notably use of a muscle-splitting approach to the flexor-pronator mass, decreased handling of the ulnar nerve, and use of the docking technique, have resulted in improved outcomes and reduced complications. Although injury to the UCL was once a career-ending injury in overhead athletes, development and continued evolution of UCL reconstruction have made return to previous or higher level of athletic participation in sports highly likely. Future research should continue to utilize higher levels of evidence and compare new graft fixation techniques in an attempt to further improve the ability of overhead athletes to return to sports. [ABSTRACT FROM AUTHOR]

Background: It is still unclear whether long-distance running has a deleterious effect on joint health; therefore, this study was undertaken to examine the rate of recovery from alterations occurring at the knee joint in marathon runners due to loading. Hypothesis: Tibial, patellar, and meniscal cartilaginous volumes are able to recover adequately from changes due to repeated loading immediately after cessation. Study Design: Controlled laboratory study. Methods: Twenty knees of male athletes were studied (mean age, 38 ± 14 years). The participants ran 20 km around a predetermined and precisely measured course. Cartilaginous volume was measured by magnetic resonance imaging before the run (60-min rest before exercise), immediately after the run (3-min delay), and after a recovery period of 1 hour. Results: After the 20-km run, there was a significant transient decrease in cartilage volume. After 1 hour of rest, no significant reduction of cartilage volume was measured for the patella (-2.1%), the tibia (-1.2%), the lateral meniscus (-3.2%), or the medial meniscus (-5.9%). However, the values recorded for the menisci were borderline, which indicates that recovery of meniscus volume lags behind that of articular cartilage. Conclusion: Our data indicate a clear tendency toward rapid recovery of the cartilaginous and meniscal volumes at the knee. The results of this study lead to the assumption that the cartilage and the menisci are well able to adapt to the loads caused by running. Investigation of more subtle changes would require more specific magnetic resonance imaging techniques, including T2-weighted mapping and T1 -weighted rho sequences, to assess cartilage biochemistry. Clinical Relevance: The articular structures were investigated on a general magnetic resonance imaging level and were found to recover rapidly so that exercise could be continued after a short time without reservation. [ABSTRACT FROM AUTHOR]

Background: The management of acute acromioclavicular (AC) joint dislocation is controversial. Purpose: The authors describe a surgical technique involving securing the clavicle to the coracoid process using suture anchors for the treatment of acute AC joint injury. Study Design: Case series; Level of evidence, 4. Methods: Twenty patients were evaluated retrospectively, clinically, and radiographically, for a mean of 41.2 months. Results: At last follow-up, the mean Constant score for the 20 patients was 89.5. Eighteen patients (90%) maintained complete AC joint reduction in both anteroposterior and axillary views. Slight loss of reduction was noted in 2 patients (10%), but their functional outcomes were good. No fixation failure or pulling out of suture anchors was encountered. Conclusion: This minimally invasive technique using a suture anchor for the treatment of acute AC dislocation is easily performed. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown comparable biomechanical properties of double-row fixation versus double-row fixation with a knotless lateral row. SutureBridge is a construct that secures the cuff with medial row mattress suture anchors and knotless lateral row fixation of the medial suture ends. Recent completely knotless constructs may lead to lesser clinical outcomes if the construct properties are compromised from lack of suture knots. Hypothesis: A completely knotless construct without medial row knots will compromise the biomechanical properties in both cyclic and failure-testing parameters. Study Design: Controlled laboratory study. Methods: Six matched pairs of cadaveric shoulders were randomized to 2 groups of double row fixation with SutureBridge: group 1 with medial row knots, and group 2 without medial row knots. The specimens were placed in a materials test system at 30° of abduction. Cyclic testing to 180 N at 1 mm/sec for 30 cycles was performed, followed by tensile testing to failure at 1 mm/sec. Results: Data included cyclic and failure data from the materials test system and gap data using a video digitizing system. All data from paired specimens were compared using paired Student t tests. Group 1 had a statistically significant difference (P < .05) for gap formation for the 1St (3.47 vs 5.05 mm) and 30th cycle (4.22 vs 8.10 mm) and at yield load (5.2 vs 9.1 mm). In addition, there was a greater energy absorbed (2805 vs 1648 N-mm), yield load (233 vs 183.1 N), and ultimate load (352.9 vs 253.9 N) for group 1. The mode of failure for the majority (4/6) of group 2 was lateral row failure, whereas all group 1 specimens failed at the clamp. Conclusion: Although lateral row knotless fixation has been shown not to sacrifice structural integrity of this construct, the addition of a knotless medial row compromises the construct leading to greater gapping and failure at lower loads. Clinical Relevance: This may raise concerns regarding recently marketed completely knotless double row constructs. [ABSTRACT FROM AUTHOR]

Background: It is not known whether nonisometric femoral graft attachment diminishes the effectiveness of medial patellofemoral ligament reconstruction. Purpose: To determine whether a nonisometric femoral attachment point is associated with differences in contact area and pressure in the patellofemoral joint as compared with an isometric attachment point. Study Design: Controlled laboratory study. Methods: Eleven cadaveric knees were amputated and secured in a loading fixture. The quadriceps tendon was clamped 5 cm above the proximal pole of the patella and fixed to a plate. Colinear compressive forces were applied. Forces were set to achieve isometric quadriceps moments at 30°, 45°, 60°, and 90° of knee flexion. Contact areas and pressures were measured using a sensor system. Initially, isometric reconstruction was done using the known isometric femoral attachment point of the posterior medial epicondyle. The attachment was then revised in each specimen to the known nonisometric femoral attachment of the adductor tubercle. Results: Before medial patellofemoral ligament reconstruction, average facet patellofemoral contact area and pressure generally increased with angle of knee flexion. With few exceptions, initial versus postprocedure data and isometric versus nonisometric contact area and pressure data did not differ significantly at any angle tested. Percentage contact area and contact pressure in the medial facet did not differ significantly from the initial percentage for either attachment, and no difference was found in the percentage medial contact area or pressure for isometric versus nonisometric attachment at the angles tested. Conclusion: Use of the nonisometric attachment point of the adductor tubercle in medial patellofemoral ligament reconstruction did not appear to alter knee contact area or contact pressures as compared with isometric femoral attachment at the posterior medial epicondyle. Clinical Relevance: In medial patellofemoral ligament reconstruction, patellofemoral contact area and pressure may not be adversely affected by use of the nonisometric femoral attachment point used in this study. [ABSTRACT FROM AUTHOR]

Background: Injury of a popliteal fossa artery during orthopaedic knee surgery is very rare but has serious consequences. The risk of vascular trauma during orthopaedic procedures may be increased when there is abnormal branching of the popliteal artery with an aberrant anterior tibial artery originating above the popliteus muscle and coursing between the posterior tibial cortex and ventral margin of the popliteus muscle. Preoperative identification of this anatomical variant may help avoid these injuries. Hypothesis: The aberrant anterior tibial artery is present in a substantial portion of the population and can be visualized by magnetic resonance imaging. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Retrospective review of 1116 consecutive knee magnetic resonance imaging studies was performed to evaluate the prevalence of an aberrant anterior tibial artery. Images were reviewed by 3 musculoskeletal radiologists. Results: The aberrant anterior tibial artery was present in 23 of 1116 extremities for a prevalence of 2.1%. The aberrant artery was most easily identified on axial and sagittal magnetic resonance imaging scans. Conclusion: The aberrant anterior tibial artery is a relatively common normal variant, and magnetic resonance is an excellent modality for detection of the artery close to the posterior joint capsule and tibial cortex. Clinical Relevance: The anatomy suggests the aberrant anterior tibial artery may be at greater risk of injury in orthopaedic procedures such as high tibial osteotomy, revision total knee arthroplasty, lateral meniscal repair, posterior cruciate ligament reconstruction, and screw fixation for tibial tubercle osteotomy. Careful inspection of preoperative magnetic resonance imaging studies may alert the surgeon to the presence of this anatomical variant. [ABSTRACT FROM AUTHOR]

Background: Medial opening-wedge high tibial osteotomy has been gaining popularity in recent years, and autogenous iliac crest bone is the gold standard graft; however, the surgical time, risk, and morbidity associated with its harvest are significant. The question of a satisfactory bone-graft substitute has yet to be clearly answered. Hypothesis: A coriticocancellous proximal tibial wedge allograft is a satisfactory graft choice when evaluating union in medial opening-wedge high tibial osteotomy. Study Design: Case series; Level of evidence, 4. Methods: Fifty consecutive patients who underwent medial opening-wedge high tibial osteotomy from May 2001 to May 2006 were included in the study. The amount of correction ranged from 5° to 17.50, with a mean of 10.1°. Forty patients had fixation with a stainless steel plate and!screws and 10 with a titanium interlocking plate and screws. The graft used in each case was a corticocancellous proximal tibial wedge allograft. No osteoinductive supplements were added. Patients started continuous passive motion immediately after surgery and began weightbearing at 8 weeks (if bone healing was progressing). Clinical and radiographic evaluation was performed monthly until full union and twice thereafter. Follow-up ranged from 5 months to 6 years, with a mean of 2.1 years. Results: The average time to bone union was 12.1 weeks (range, 8-24). Two patients (4%) had a nonunion, defined as not healed at 6 months. Only 1 patient (a nonunion patient) had loss of correction at the osteotomy site, defined as collapse of the opening wedge (this occurred at 6 months after surgery). There were no cases of infection, no wound-healing problems, no cases of arthrofibrosis, and!no neurovascular injuries. Conclusion: When union is assessed, a corticocancellous proximal tibial wedge allograft is a satisfactory graft choice in medial opening-wedge high tibial osteotomy. [ABSTRACT FROM AUTHOR]

The article describes the case of three teenage athletes with Salter-Harris III distal femur fractures and proposes a mechanism of injury related to the sequence of closure of the distal femoral physis in the teenage patient. The authors found that Salter-Harris III fractures of the medial femoral condyle are rare entities and that they have many similarities to juvenile Tillaux fractures of the distal tibia. The authors also found that the pull of the medial collateral ligament (MCL) and posterior cruciate ligament (PCL) on the medial femoral condyle during valgus stress may initiate a fracture.

Background: Although many posterior cruciate ligament (PCL) injuries are in combination with posterolateral corner (PLC) injuries, there has been little research on combined injury reconstruction; the literature includes differing recommendations. Hypothesis: Combined PCL plus PLC reconstruction corrects the abnormal posterior translation, varus, and external rotation laxities caused by combined PCL plus PLC deficiency. Furthermore, double-bundle PCL plus PLC reconstruction restores laxity closer to normal than single-bundle PCL plus PLC reconstruction. Study Design: Controlled laboratory study. Methods: Cadaveric knee kinematics were measured electromagnetically in 9 knees with posterior drawer, external rotation, and varus rotation loads applied at sequential stages: intact, PCL-deficient, PCL plus PLC-deficient, double-bundle PCL plus modified Larson PLC reconstruction, and single-bundle PCL plus modified Larson PLC reconstruction. Each graft was tensioned using a laxity-matching protocol. Results: There was no significant difference between single-bundle and double-bundle PCL reconstruction, in combination with the modified Larson reconstruction, at any angle of flexion. Both combined reconstructions restored posterior drawer, external rotation, and varus laxity so that they did not differ significantly from normal. Conclusion: In combined PCL plus PLC deficiency, combined PCL plus PLC reconstruction restored all major laxity limits to normal across the range of knee flexion examined. Double-bundle PCL reconstruction was not better than single-bundle reconstruction in this context. Clinical Relevance: The added complexity of double-bundle reconstruction does not seem to be justified by these results. In combined PCL plus PLC-deficient knees, combined single-bundle PCL plus modified Larson PLC reconstruction was sufficient to restore posterior drawer, external rotation, and varus laxity to normal. [ABSTRACT FROM AUTHOR]

Background: Recent studies have shown that the posterior cruciate ligament (PCL) is composed of a continuum of fiber regions that display characteristic mechanical behavior under different motion and loading conditions. Hypothesis: The anterior, central, and posterior fiber regions of the PCL differentially contribute to control of posterior translation of the tibia. Study Design: Controlled laboratory study. Methods: Nine intact, fresh-frozen cadaveric knees were instrumented with excursion wires implanted within the anterior, central, and posterior fiber regions of the PCL. In groups of 3, patterns of incremental posterior tibial translation using a 74-N posterior force were analyzed as a function of the variable linear separation distance between tibial and femoral fiber region attachment sites during posterior drawer testing at knee flexion angles of 20° and 90° before and after sequential fiber region section. Results: At 20° of knee flexion, there was no statistical difference in the relatively small amount of posterior tibial translation, regardless of whether the anterior, central, or posterior fibers were alone transected (P = .350). At 90° of knee flexion, whether the posterior fibers were cut first, second, or third (order of section), the incremental difference in posterior tibial translation this produced was significantly different (P = .039). For the fiber regions combined, the third fiber region section resulted in a significantly larger incremental translation than did either the first or second section with the knee flexed 90° (P < .001). After transection of all fiber regions, significantly more total posterior tibial translation occurred at 90° versus 20° of flexion (P = .002). Conclusions: This study shows that fiber regions within the PCL have unique characteristics and behave differently in response to posterior drawer forces. Clinical Relevance: This study provides additional information on the complex mechanical behavior of the PCL and suggests that some partial tears (ie, those involving 1 or 2 fiber regions) may only result in minimal posterior translation during drawer testing at 90°. [ABSTRACT FROM AUTHOR]

Background: No prospective surveillance system exists for monitoring the outcome of cruciate ligament surgery. Purpose: This article is intended to describe the development and procedures of the Norwegian National Knee Ligament Registry (NKLR), including baseline results from the first 2 years of operation. Study Design: Cohort study (prevalence); Level of evidence, 1. Methods: The NKLR was established on June 7, 2004 to collect information prospectively on all cases of cruciate ligament reconstruction surgery in Norway. Information on the details of surgery is gathered through a registration form completed by the surgeon postoperatively, and a validated knee outcome score form is completed by the patients preoperatively and at follow-ups on all patients at 2, 5, and 10 years postoperatively. Hospital compliance was examined in 2005 and 2006. Results: A total of 2793 primary cruciate ligament reconstruction surgeries were registered by 57 hospitals. This corresponds to an annual population incidence of primary anterior cruciate ligament reconstruction surgeries of 34 per 100000 citizens (85 per 100 000 citizens in the main at-risk age group of 16-39 years). After 21 months of operation, the NKLR had an overall compliance of 97% when compared with the hospital records. Conclusions: A national population-based cruciate ligament registry has been developed, implemented, and maintained in Norway. The registry will each year enroll approximately 1500 primary cruciate ligament reconstruction cases. It is expected that inadequate procedures and devices can be identified, as well as prognostic factors associated with good and poor outcomes, at least for the most frequent categories. [ABSTRACT FROM AUTHOR]

Background: No studies to date have evaluated the injury patterns in professional arena football. The purpose of this study is to describe the characteristics of general injury patterns in the Arena Football League. Hypotheses: (1) Game injury rates are higher than are practice injury rates, (2) a small number of injuries are related to collision with the boards, and (3) athletes playing on both offense and defense have higher injury rates than do athletes playing either offense or defense alone. Study Design: Descriptive epidemiology study. Methods: A retrospective review of injury data including 1199 injuries over a 4-year period from February 2002 to December 2005, inclusive of preseason and postseason practices and competition, was conducted. Data regarding the injured body part, position of the player, nature of injury, mechanism of injury, missed playing time, playing surface, and when the injury occurred were collected and analyzed. Results: Injury rates during practice were 14.6 injuries per 1000 exposures and game injury rates were 111.3 per 1000 exposures. Few recorded injuries (2.2%) involved a collision with the sideline boards. Conclusion: Game injury rates are higher than are practice injury rates. Athletes playing on both offense and defense did not have higher injury rates in games than did athletes playing either offense or defense. The sideline boards used in the Arena Football League did not appear to contribute dramatically to the injury rates. Despite the differences between arena and stadium football, Arena Football League injury patterns are similar to published collegiate football injury patterns. [ABSTRACT FROM AUTHOR]

Recent improvements in anterior cruciate ligament (ACL) reconstruction have been notable for strategies to improve ACL healing and to improve graft placements. The controversial choice of 1-bundle or 2-bundle grafts requires an advanced knowledge of native ACL insertional anatomy and an appreciation for the kinematic effects of graft placements. Understanding the limitations of surgical techniques to place tunnels is important. Once grafts are placed, new biologic strategies to promote intra-articular and intraosseous healing are evolving. Although these biologic engineering strategies are currently experimental, they are projected for clinical application in the near future. [ABSTRACT FROM AUTHOR]

Background: Women with anterior cruciate ligament reconstruction have different neuromuscular strategies than noninjured women during functional tasks after ligament reconstruction and rehabilitation. Hypothesis: Landing from a jump creates high loads on the knee creating dynamic instability in women with anterior cruciate ligament reconstruction, whereas noninjured women have stable knee landing mechanics. Study Design: Controlled laboratory study. Methods: Fifteen noninjured women and 13 women with anterior cruciate ligament reconstruction performed 5 trials of a single-legged 40-cm drop jump and 2 trials of a 20-cm up-down hop task. Multivariate analyses of variance were used to compare hip and knee joint kinematics, knee joint moments, ground-reaction forces, and electromyographic findings between the dominant leg in noninjured women and reconstructed leg in women with anterior cruciate ligament reconstruction. Results: No statistically significant differences between groups were found for peak hip and knee joint angles for the drop jump task. Statistically significant differences in neuromuscular activity (P = .001) and anterior-posterior knee shear forces (P < .001) were seen in women with anterior cruciate ligament reconstruction compared with noninjured women in the drop jump task. However, no statistically significant differences (P > .05) between groups were found for either peak hip and knee joint angles, peak joint kinetics, or electromyographic findings during the up-down hop task. Conclusion: Women with anterior cruciate ligament reconstruction have neuromuscular strategies that allow them to land from a jump similar to healthy women, but they exhibit joint moments that could predispose them to future injury if they participate in sports that require jumping and landing. [ABSTRACT FROM AUTHOR]

Background: Wrestling holds worldwide popularity, and large numbers of United States high school and college males participate. However, the sport's arduous nature results in high injury rates. Hypothesis: Wrestling injury rates and patterns will differ between high school and college practice and match exposures. Study Design: Descriptive epidemiology study. Methods: Wrestling-related injury data were collected during the 2005-2006 academic year from 74 nationally representative high schools via High School Reporting Information Online (RIO) and from 15 Division I, II, and III colleges via the National Collegiate Athletic Association Injury Surveillance System. Results: Certified athletic trainers reported 387 injuries among participating high school wrestlers during 166279 athlete-exposures, for an injury rate of 2.33 injuries per 1000 athlete-exposures. Nationally, high school wrestlers sustained an estimated 99676 injuries and 8741 skin infections during the 2005-2006 season. In college, 258 injuries occurred among participating wrestlers during 35 599 athlete-exposures, for an injury rate of 7.25 injuries per 1000 athlete-exposures. The injury rate per 1000 athlete-exposures was higher in college than high school (rate ratio [RR] = 3.11, 95% confidence interval [CI]: 2.66-3.64) and was higher in matches than in practice in high school (RR = 2.12, 95% Cl: 1.73-2.59) and college (RR = 5.07, 95% CI: 3.96-6.50). Diagnoses in greater proportions of college wrestlers included lacerations (injury proportion ratio [IPR] = 5.98, 95% Cl: 2.27-15.74) and cartilage injuries (IPR = 2.69, 95% Cl: 1.26-5.74). Body parts injured in greater proportions of high school wrestlers included elbow (IPR = 3.90, 95% CI: 1.66-9.14) and hand (IPR = 2.59, 95% CI: 1.21-5.54). Almost half of all injured high school (44.9%) and college (42.6%) wrestlers resumed wrestling within <1 week. Skin infections represented 8.5% and 20.9% of all reported high school and college events, respectively, and frequently affected the head/face/neck (50.0%). Conclusions: Rates and patterns of wrestling injury differ between high school and college and between practice and matches. [ABSTRACT FROM AUTHOR]

Background: A treatment algorithm and screening examination have been developed to guide patient management and prospectively determine potential for highly active individuals to succeed with nonoperative care after anterior cruciate ligament rupture. Objective: To prospectively characterize and classify the entire population of highly active individuals over a 10-year period and provide final outcomes for individuals who elected nonoperative care. Methods: Inclusion criteria included presentation within 7 months of the index injury and an International Knee Documentation Committee level I or II activity level before injury. Concomitant injury, unresolved impairments, and a screening examination were used as criteria to guide management and classify individuals as noncopers (poor potential) or potential copers (good potential) for nonoperative care. Results: A total of 832 highly active patients with subacute anterior cruciate ligament tears were seen over the 10-year period; 315 had concomitant injuries, 87 had unresolved impairments, and 85 did not participate in the classification algorithm. The remaining 345 patients (216 men, 129 women) participated in the screening examination a mean of 6 weeks after the index injury. There were 199 subjects classified as noncopers and 146 as potential copers. Sixty-three of 88 potential copers successfully returned to preinjury activities without surgery, with 25 of these patients not undergoing anterior cruciate ligament reconstruction at the time of follow-up. Conclusion: The classification algorithm is an effective tool for prospectively identifying individuals early after anterior cruciate ligament injury who want to pursue nonoperative care or must delay surgical intervention and have good potential to do so. [ABSTRACT FROM AUTHOR]

Objective: To clarify the determinants of dynamic knee stability early after anterior cruciate ligament injury. Study Design: Cohort study (diagnosis); Level of evidence, 1. Methods: Three hundred forty-five consecutive patients who were regular participants in International Knee Documentation Committee level I/Il sports before injury and had an acute isolated anterior cruciate ligament injury from the practice of a single orthopaedic surgeon underwent a screening examination including clinical measures, knee laxity, quadriceps strength, hop testing, and patient self-reported knee function a mean of 6 weeks after injury when impairments were resolved. Independent t tests were performed to evaluate differences in quadriceps strength and anterior knee laxity between potential copers and noncopers. Hierarchical regression was performed to determine the influence of quadriceps strength, preinjury activity level, and anterior knee laxity on hop test performance, as well as the influence of timed hop, crossover hop, quadriceps strength, preinjury activity level, and anterior knee laxity on self-assessed global function. Results: Neither anterior knee laxity nor quadriceps strength differed between potential copers and noncopers. Quadriceps strength influenced hop test performance more significantly than did preinjury activity level or anterior knee laxity, but the variance accounted for by quadriceps strength was low (range, 4%-8%). Timed hop performance was the only variable that affected self-assessed global function. Conclusion: Traditional surgical decision making based on passive anterior knee laxity and preinjury activity level is not supported by the results, as neither is a good predictor of dynamic knee stability. A battery of clinical tests that capture neuromuscular adaptations, including the timed hop test, may be useful in predicting function and guiding individualized patient management after anterior cruciate ligament injury. [ABSTRACT FROM AUTHOR]

Background: Comparisons of surgically and nonsurgically treated Achilles tendon ruptures have demonstrated that those treated with surgery allow earlier motion and tend to show superior results. However, early motion enhances tendon healing with or without surgery and may be the important factor in optimizing outcomes in patients with Achilles tendon rupture. Hypothesis: There is no difference in the outcome of acute Achilles tendon rupture treated nonoperatively or operatively if controlled early motion is allowed as part of the rehabilitation program. Study Design: Randomized, controlled clinical trial; Level of evidence, 1. Methods: Patients with acute rupture of the Achilles tendon were randomized to surgery or no surgery, with both groups receiving early motion controlled in a removable orthosis, progressing to full weightbearing at 8 weeks from treatment. Both groups were followed prospectively for 12 months with measurements of range of motion, calf circumference, and the Musculoskeletal Functional Assessment Instrument (MFAI) outcome score; any reruptures and any complications were noted. Results: Both groups were comparable for age and sex. There were no significant differences between the 2 groups in plantar flexion, dorsiflexion, calf circumference, or the MFAI scores measured at 2, 8, 12, 26, or 52 weeks. One patient in each group was noncompliant and required surgical rerepair of the tendon. There were no differences in complications and a similar low number of reruptures in both groups. Conclusion: This study supports early motion as an acceptable form of rehabilitation in both surgically and nonsurgically treated patients with comparable functional results and a low rerupture rate. There appears to be no difference between the 2 groups, suggesting that controlled early motion is the important part of treatment of ruptured Achilles tendon. [ABSTRACT FROM AUTHOR]

Background: Avascular meniscal tears are a common and costly problem for which current treatment options are limited. Hypothesis: A bioabsorbable conduit will allow for vascular tissue ingrowth that is associated with histologic and biomechanical evidence for avascular meniscal tear healing superior to that associated with meniscal trephining in dogs. Study Design: Controlled laboratory study. Methods: Twenty-five dogs underwent medial arthrotomy with creation of anterior and posterior tears in the medial menisci (N = 50 tears). The dogs were assigned treatments for their menisci: conduit (n = 29 tears) or trephine (n = 21 tears). Dogs were assessed for lameness by subjective scoring after surgery and sacrificed at 6, 12, or 24 weeks and assessed for articular cartilage damage, gross and histologic appearance of the operated menisci, and maximal load-to-failure values using tensile testing of meniscal tears. Tears were considered to demonstrate biomechanical integrity when histologic partial to complete healing was noted in conjunction with a measured load to failure that was significantly greater than controls. Results: Based on histologic assessment, the conduit was associated with complete (n = 4) or partial (n = 5) healing in all avascular defects at 12 and 24 weeks after surgery in this study. No healing was seen in defects treated by trephination and repair. No lameness associated with surgery or meniscal treatment was noted after 4 weeks. No articular cartilage damage was noted in any joint. At both 12 and 24 weeks, mean load to failure for normal menisci (43.2 N and 28.6 N, respectively) was significantly (P < .017) higher than conduit-treated (22.3 N and 16.0 N, respectively) and trephine-treated (0.6 N and 2.1 N, respectively) menisci, and load to failure for conduit-treated menisci was significantly (P ≤ .05) higher than trephine-treated menisci. Biomechanical integrity was noted in 10 of 14 conduit-treated menisci. Conclusion: Conduit treatment resulted in functional healing with bridging tissue and biomechanical integrity in 71 % of avascular meniscal defects for up to 6 months after surgery. No functional healing was noted in avascular meniscal tears treated by trephination and suture repair. Clinical Relevance: Clinical studies using the conduit in humans may be appropriate to determine the safety and efficacy of the device for cases of avascular and poorly vascularized meniscal tears, where the device can be successfully implanted from tear to meniscal rim, the tears can be surgically repaired, and patient compliance can be ensured. [ABSTRACT FROM AUTHOR]

Background: Autologous chondrocyte implantation (ACI) is an expensive treatment option for focal cartilage defects, and commercial funding of research is associated with a study reaching a positive conclusion. The purpose of this analysis is to compare outcomes (and levels of evidence) between published ACI outcome studies that were commercially funded and studies that were not commercially funded. Hypothesis: Commercially funded ACI literature could be commercially biased. Study Design: Comparative meta-analysis. Methods: MEDLINE was searched for human, knee, Ad, nonmembrane, English language, and clinical outcome studies. Studies were evaluated with regard to funding status (commercially funded or not commercially funded), outcomes, and levels of evidence. Outcomes and levels of evidence were evaluated and compared for commercially funded studies versus those that were not commercially funded. Results: Twenty-three studies were included; 16 (70%) were commercially funded. Pooled clinical outcome measures data were not significantly different (Lyshoim, Modified Cincinnati, patient-reported Cincinnati, Tegner, pain Visual Analog Scale) when com- paring commercially funded studies with those that were not commercially funded. However, distribution of levels of evidence was significantly lower (P = .045) for commercially funded studies. Conclusion: Reassuringly, commercial funding of ACI studies did not result in a difference in published clinical outcomes versus those that were not commercially funded. However, the lower levels of evidence of commercially funded studies suggests that commercially funded ACI studies may be of less value to surgeons desiring to practice evidence-based medicine, and, in the future, commercial entities funding medical research could selectively fund studies of the highest levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Grade Ill syndesmosis sprains are usually treated with internal fixation. Limited information is available on early weightbearing and early return to activity after operative treatment for grade Ill syndesmosis sprains. Hypothesis: Treatment of grade Ill syndesmosis sprains in intercollegiate athletes with internal fixation, early range of motion, and early weightbearing can lead to rapid return to sport with minimal complications and no ankle problems in midterm follow-up. Study Design: Case series; Level of evidence, 4. Methods: We evaluated a consecutive series of intercollegiate athletes treated operatively with 4.5-mm cortical screw fixation for grade Ill syndesmosis sprains. At 1 week after surgery, patients were allowed to begin range of motion exercises, progressive weightbearing, and gradually return to full activity as tolerated. Outcome measures included time to return to full activity and, at final follow-up, the Sports Ankle Rating System scores. Results: Six male intercollegiate college athletes met the inclusion criteria for this study. The average time for return to full activity was 41 days (range, 32-48 days). There were no intraoperative complications or complications when resuming in-season sport activities with the screw in place. One screw broke during removal. At an average follow-up of 34.3 months, using the Sports Ankle Rating System, the average clinical rating score was 96.2, the average quality-of-life measure was 96.7, and the average single assessment numeric evaluation was 95.3. Radiographs at final follow-up showed no mortise widening or lateral talar subluxation. Two patients had mild degenerative changes on lateral radiographs with anterior tibial osteophytes. Conclusions: In selective cases, athletes can return to full activity as early as 6 weeks after internal fixation of grade Ill syndesmosis sprains. [ABSTRACT FROM AUTHOR]

Background: Strengthening exercises for the scapular muscles are used in the treatment of scapulothoracic dysfunction related to shoulder injury. In view of the intermuscular and intramuscular imbalances often established in these patients, exercises promoting lower trapezius (LT), middle trapezius (MT), and serratus anterior (SA) activation with minimal activity in the upper trapezius (UT) are recommended. Hypothesis: Of 12 commonly used trapezius strengthening exercises, a selection can be performed for muscle balance rehabilitation, based on a low UT/LT, UT/MT, or UT/SA muscle ratio. Study Design: Controlled laboratory study. Methods: Electromyographic activity of the 3 trapezius parts and the SA was measured in 45 healthy subjects performing 12 commonly described scapular exercises, using surface electromyography. Results: For each intramuscular trapezius ratio (UT/LT, UT/MT), 3 exercises were selected for restoration of muscle balance. The exercises side-lying external rotation, side-lying forward flexion, prone horizontal abduction with external rotation, and prone extension were found to be the most appropriate for intramuscular trapezius muscle balance rehabilitation. For the UT/SA ratio, none of the exercises met the criteria for optimal intermuscular balance restoration. Conclusion: In cases of trapezius muscle imbalance, some exercises are preferable over others because of their low UT/LT and UT/MT ratios. Clinical Relevance: In the selection of rehabilitation exercises, the clinician should have a preference for exercises with high activation of the LT and MT and low activity of the UT. [ABSTRACT FROM AUTHOR]

Background: Many studies suggest that gamma irradiation decreases allograft strength in a dose-dependent manner. No study has demonstrated that this decrease in strength translates into higher clinical failures. Hypothesis: Irradiation of allograft tissue will lead to higher early clinical failure in anterior cruciate ligament (ACL) reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Medical records were reviewed for 90 consecutive patients who had received Achilles allograft reconstruction for unilateral primary ACL injuries at one institution between July 2001 and June 2002. One half of patients received nonirradiated Achilles allograft and the other half received irradiated Achilles allograft at a dose range of 2.0 to 2.5 Mrad. The ACL allograft reconstructions were performed using the same surgical technique. The rehabilitation program was identical for both groups. All clinical failures were recorded. Results: At least 6 months' follow-up was available on 42 subjects in the nonirradiated group and 33 subjects in the irradiated group. A significant difference was noted in early failure rates between the groups (P < .01). The nonirradiated group had 1 in 42 (2.4%) catastrophic failure. In the irradiated group, 11 of 33 (33%) Achilles tendon grafts failed. Conclusions: Less than satisfactory results led the senior authors to discontinue the use of irradiated allografts in ACL surgery. Continued research into alternatives to gamma irradiation is needed. [ABSTRACT FROM AUTHOR]

Background: There is a low level of evidence about clinical results after anterior cruciate ligament (ACL) revision reconstruction using autologous hamstring tendon grafts. Hypothesis: Anterior cruciate ligament revision reconstruction improves knee stability but shows inferior results for functional and subjective outcome and knee stability compared with primary reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Between October 1997 and July 2005, 166 single-stage or 2-stage revision AOL reconstructions were done using different graft types. One hundred twenty-four cases underwent a single-stage revision reconstruction with autologous hamstring tendon grafts. At the time of data analysis, 67 cases fulfilled the criteria of minimum 2-year follow-up. Five patients were lost to follow-up (follow-up rate, 91%). Four patients (6%) who experienced graft rupture were counted as failures but not subjected to further detailed analysis. Because of loss to follow-up and exclusion criteria (n = 12), 50 patients were included in the study. For a comparative matched-group analysis, patients with a primary hamstring tendon graft ACL reconstruction were selected out of a database with minimum 2 years' follow-up (N = 284). Patients were followed using the International Knee Documentation Committee (IKDC) and Lysholm scores, KT-1000 arthrometer testing, and additional functional tests. Results: Four of 62 available patients (6.5%) in the revision group experienced graft failure, which was comparable to 16 of 284 (5.6%) in the primary reconstruction group. When the 2 matched groups of 50 patients were further compared, postoperative IKDC results showed no significant differences between groups. The manual maximum KT-1 000 arthrometer side-to-side difference was 2.1 ± 1.6mm for the revision group and 2.2 ± 1.1 mm for the primary reconstruction group. The Lysholm score was significantly better in the primary reconstruction group (P = .014). The incidence of postoperative positive pivot-shift test results was not significantly different. The primary reconstruction group showed significantly less extension deficits. Functional testing revealed significantly better results for the primary reconstruction group for stair climbing, squatting, knee bending, and duck walk. Conclusions: In our patient series, primary ACL reconstruction showed significantly better results in Lysholm score, although the IKDC score and objective knee stability showed no significant difference between the groups. Thus, parameters other than measurable knee stability must be responsible for the inferior results of the revision reconstruction group. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that women involved in similar activities as men are at increased risk for anterior cruciate ligament injuries. Hypothesis: The incidence rate of complete anterior cruciate ligament tears for men and women in our athletic, college-aged population is similar. Study Design: Descriptive epidemiology study. Methods: Students graduating in class years 1994 to 2003 at our institution who sustained complete anterior cruciate ligament tears were assessed for mechanism of injury and type of sport played at time of injury. We calculated the incidence proportion, an estimation of risk, by gender and class year, and the incidence proportion ratio comparing men and women by class year. We also calculated incidence rates by gender and type of sport played and incidence rate ratios comparing men and women. Results: There were 353 anterior cruciate ligament injuries in the 10 classes studied. We found an overall, 4-year incidence proportion of 3.24 per 100 (95% confidence interval, 2.89-3.63) for men and 3.51 (95% confidence interval, 2.65-4.65) for women (incidence proportion ratio, 1.09 [95% confidence interval, 0.80-1.47]). The overall anterior cruciate ligament injury rate, excluding male-only sports, was significantly greater in women (incidence rate ratio, 1.51 [95% confidence interval, 1.03-2.21]). We found significantly greater injury rates among women in a gymnastics course (incidence rate ratio, 5.67 [95% confidence interval, 1.99-16.16]), indoor obstacle course test (incidence rate ratio, 3.72 [95% confidence interval, 1.25-11.10]), and basketball (incidence rate ratio, 2.42 [95% confidence interval, 1.05-5.59]). Conclusion: We found little gender difference in the overall risk of an anterior cruciate ligament tear; however, there were gender differences in injury rates when specific sports and activities were compared and when male-only sports were removed from the overall rate assessment. [ABSTRACT FROM AUTHOR]