Search

Athletes can sustain a large variety of injuries from simple soft tissue sprains to complex fractures and joint dislocations. This article reviews and provides the most recent information for sports medicine professionals on the management of simple and complex joint dislocations, i.e., irreducible and/or associated with a fracture, from the sidelines without the benefit of imaging. For each joint, the relevant anatomy, common mechanisms, sideline assessment, reduction techniques, initial treatment, and potential complications will be discussed, which allow for the safe and prompt return of athletes to the field of play.

BackgroundThe treatment of trochlear cartilage lesions is challenging given the likely presence of other patellofemoral joint pathologies, the topography of the area, and the limited available treatment options. Only 1 other study has examined the effectiveness of autologous chondrocyte implantation for lesions of the patellofemoral joint.HypothesisPatients treated with autologous chondrocyte implantation for moderate to large isolated lesions located on the trochlea will report improvement in the modified overall condition scale score of the Cincinnati Knee Rating System at a minimum 2-year follow-up.Study DesignCase series; Level of evidence, 4.MethodsUsing modified scales of the Cincinnati Knee Rating System, 40 Cartilage Repair Registry patients rated their overall condition and symptoms at baseline and at a mean follow-up of 59 ± 18 months. Factors likely to affect outcomes also were analyzed.ResultsAt baseline, patients were between ages 16 to 48 years, had a mean total defect size of 4.5 cm2, and reported an overall condition score of 3.1 points (poor). Many failed a prior marrow-stimulation procedure (48%). Other procedures performed before baseline included tibiofemoral osteotomy in 23% and lateral release or Fulkerson for patella maltracking in 13%. Forty-three percent were receiving workers’ compensation at baseline. Patients reported statistically significant improvement in their mean overall condition (3.1 points preoperatively to 6.4 points postoperatively), pain (2.6 to 6.2 points), and swelling (3.9 to 6.3 points) scores. Eleven patients experienced 17 subsequent procedures, and no patients had a failed implantation.ConclusionAutologous chondrocyte implantation appears to improve function and reduce symptoms in young to middle-aged patients with symptomatic, full-thickness articular cartilage lesions of the trochlea.

Background Gender-based differences in injury rates have been reported in scholastic and collegiate basketball. The purpose of this study was to retrospectively compare injury rates in women's and men's professional basketball. Hypothesis Female professional basketball players are injured at a higher rate than are men. Study Design Cohort study (prevalence); Level of evidence, 2. Methods Women's National Basketball Association and National Basketball Association injury data were retrospectively reviewed for 6 full seasons. The frequency of all injuries and the rate of game-related injuries were calculated. Results Complete player profiles were obtained on 702 National Basketball Association athletes and 443 Women's National Basketball Association athletes who competed in their respective leagues during the data collection period. Total game exposures totaled 70 420 (National Basketball Association) and 22 980 (Women's National Basketball Association). Women's National Basketball Association athletes had a higher overall game-related injury rate (24.9 per 1000 athlete exposures; 95% confidence interval, 22.9-26.9; P < .05) when compared with National Basketball Association athletes (19.3 per 1000 athlete exposures; 95% confidence interval, 18.3-20.4) and sustained a higher rate of lower extremity injuries (14.6 per 1000 athlete exposures; 95% confidence interval, 13.1-16.2; P < .05) than seen in the National Basketball Association (11.6 per 1000 athlete exposures; 95% confidence interval, 10.8-12.4). The lower extremity was the most commonly injured body area (65%), and lateral ankle sprain (13.7%) was the most common diagnosis in both leagues. The incidence of game-related knee injury was higher in Women's National Basketball Association players. The incidence of anterior cruciate ligament injury in the National Basketball Association (n = 22, 0.8%) and Women's National Basketball Association (n = 14, 0.9%) accounted for 0.8% of the 4446 injuries reported. Conclusion The lower extremity is the most frequently injured body area in both leagues, and Women's National Basketball Association athletes are more susceptible than are National Basketball Association athletes. There were, however, few statistical differences in the actual injuries occurring between the 2 leagues.

BackgroundStudies that compare the effectiveness of different cartilage repair treatments are needed to update treatment algorithms.HypothesisAutologous chondrocyte implantation provides greater improvement in overall condition score than does debridement at a minimum of 3 years’ follow-up.Study DesignCohort study; Level of evidence, 3.MethodsCohorts for debridement and autologous chondrocyte implantation each included 58 Cartilage Repair Registry patients who met study criteria. A retrospective analysis was performed on prospectively collected baseline and follow-up data.ResultsPatients in the autologous chondrocyte implantation and debridement groups had similar demographics and chondral lesions at baseline. However, more autologous chondrocyte implantation patients failed a previous debridement or marrow stimulation procedure than did debridement patients. Follow-up outcome assessments were completed by 54 autologous chondrocyte implantation patients and 42 debridement patients. Eighty-one percent of the autologous chondrocyte implantation patients and 60% of the debridement patients reported median improvements of 5 points and 2 points, respectively, in the overall condition score. Autologous chondrocyte implantation patients also reported greater improvements in the median pain and swelling scores than did debridement patients. The treatment failure rate was the same for both autologous chondrocyte implantation and debridement patients. Eighteen autologous chondrocyte implantation patients and 1 debridement patient had at least 1 subsequent operation.ConclusionAlthough patients treated with debridement for symptomatic, large, focal, chondral defects of the distal femur had some functional improvement at follow-up, patients who received autologous chondrocyte implantations obtained higher levels of knee function and had greater relief from pain and swelling at 3 years.

The reasons why many patients seemingly benefit from arthroscopic treatment of osteoarthritis of the knee remain obscure. The purpose of this pilot study was to determine if a placebo effect might play a role in arthroscopic treatment of this condition. After giving full informed consent, including full knowledge of the possibility and nature of a placebo surgery, five subjects were randomized to a placebo arthroscopy group, three subjects were randomized to an arthroscopic lavage group, and two subjects were randomized to a standard arthroscopic debridement group. The physicians performing the postoperative assessment and the patients remained blinded as to treatment. Patients who received the placebo surgery reported decreased frequency, intensity, and duration of knee pain. They also thought that the procedure was worthwhile and would recommend it to family and friends. Thus, there may be a significant placebo effect for arthroscopic treatment of osteoarthritis of the knee. The small numbers in this preliminary study preclude a valid statistical analysis, and no conclusions can be drawn regarding the superiority of one treatment over another. A larger study is needed to evaluate fully the efficacy of an arthroscopic procedure for this condition and to decide if it is reasonable to expend health care resources for this treatment; the larger study should include a placebo control group.

We examined seven cadaveric knees to determine the radiographic location of the native anterior cruciate ligament insertion sites as well as the location of tun nels used in anterior cruciate ligament reconstruction. Posteroanterior and lateral views at several flexion angles were taken with radiopaque markers around the insertions of the native anterior cruciate ligament and subsequent reconstruction tunnels. The femoral inser tion was best seen on the 60° notch view. On the lateral view, the femoral tunnel was easily seen as it crossed the roof of the intercondylar notch; however, because of the angle of the tunnel, the actual entrance into the knee may be well distal and anterior to this location. The tibial insertion and tunnel were easily seen at any flexion angle. The center of the insertion was 40% of the tibial diameter from the anterior mar gin. The lateral view in extension allowed determina tion of the tibial tunnel's location in relation to the intercondylar notch roof, but by itself did not allow accurate determination of the femoral tunnel's position. Notch and extension lateral radiographs together pro vided sufficient information for evaluation of anterior cruciate ligament graft position in a convenient, cost- effective format. Neither view by itself provides enough information to evaluate the position of the graft.

Eight cadaveric lower extremities were examined by three experienced knee surgeons in blinded fashion. The knees were examined with intact anterior cruciate ligaments, sectioned anteromedial bundles, and completely sec tioned anterior cruciate ligaments to evaluate detectable laxity changes. Lachman, anterior drawer, lateral pivot shift, and KT-1000 arthrometer testing were performed. Optimized biplanar radiography using a defined spatial co ordinate reference system was performed with a 30- pound anterior force at 30° of flexion to confirm clinical findings. Physical examination and arthrometertesting de tected no difference between intact and partially sectioned anterior cruciate ligaments; these ligaments were signifi cantly different than completely sectioned ligaments, with the Lachman test being the most sensitive. Despite consistent clinical detection of complete sec tioning of the anterior cruciate ligament by both physical examination and arthrometer testing, neither method proved accurate in the diagnosis of isolated tears of the anteromedial bundle, but both did show that partially sectioned anterior cruciate ligament closely resembled intact ligament and differed significantly from com pletely sectioned ligament, as confirmed by radiologic data. Clinically diagnosed "partial tear" is likely to be complete rupture of the anterior cruciate ligament. His torically, clinically diagnosed partial tears of the anterior cruciate ligament have tended to "progress" to symp tomatic instability. Our data imply these patients may have had functionally incompetent ligaments from time of injury and, in fact, were demonstrating the expected natu ral history of an anterior cruciate ligament-deficient knee.