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Varus tension testing was performed on 26 matched pairs of tibias after high tibial osteotomy with three different fixation techniques--Coventry stepped staple, Mansat staple blade, and modified tension-band. Biomechanical testing revealed that in group I the Coventry stepped staple and Mansat staple blade yielded similar force at failure values of 132.44 +/- 29.29 and 137.34 +/- 40.84, respectively. In group II, the varus force at failure value was 170.45 +/- 83.95 for the modified tension band device versus 115.27 +/- 67.21 for the Coventry stepped staple device. In group III, the varus force at failure value was 180.26 +/- 82.36 for the modified tension band device versus 109.14 +/- 60.96 for the Mansat staple blade. The findings in this study suggest that the modified tension band technique provides a greater varus force at failure value, approximately 160-170%, compared to the other two techniques. In addition, this device is easy to apply and less expensive, and most orthopaedic surgeons are already familiar with its use.

Strength, stretching, and rehabilitation methods for the shoulder have been previously described and have been universally applied; nevertheless, many throwing athletes continue to develop overuse injuries. The pitching process tends to increase external rotation and limit internal rotation of the shoulder joint. Our technique involves a modified stretching method of the posterior shoulder musculature. The athlete lies prone with the elbow flexed 90 degrees. With the shoulder abducted 90 degrees, in neutral flexion/extension, and 90 degrees or more of internal rotation, the scapula protrudes posteriorly. By depressing the inferior angle of the scapula toward the thoracic wall, the infraspinatus muscle and posterior joint capsule are effectively isolated and stretched. Manual stabilization of the scapula onto the chest wall transfers the internal rotation movements to the glenohumeral joint, as opposed to sharing the movement with the scapulothoracic articulation. This method improves the efficacy of the internal rotation stretching exercise for the glenohumeral joint. Such an addition to traditional stretching methods may increase the efficiency of the least effective component. We conclude that this modification to traditional programs should be an integral part of the training and rehabilitation program of any athlete requiring near maximal performance of the shoulder.

Twenty-six adult cadavers were utilized in an anatomic study designed to measure intramedullary femoral alignment in relation to the anterosuperior iliac spine. Fifty femurs were measured to determine the reliability of the anterosuperior iliac spine as an accurate landmark for distal femoral resection in total knee arthroplasty (TKA). A precision machined stainless steel U-shaped parallel alignment guide was fabricated and inserted into the femoral canals of intact adult cadavers. The guide's relationship to the anterosuperior iliac spine was measured and recorded. All hips were maintained in neutral alignment. Independent variables recorded included gender, knee alignment, and side of lower extremity. The range for medial deviation was 1-28 mm for the right femur and 2-25 mm for the left femur (average, 8.5 mm). The range for lateral deviation was 3-14 mm for the right femur and 2-17 mm for the left femur (average, 10.3 mm). There was no statistical correlation between the independent variables of side measured, gender, and measured offset at the anterosuperior iliac spine. Based on this highly variable pattern of alignment, utilizing simulated intraoperative technique, use of the anterosuperior iliac spine does not provide a landmark accurate enough to repeatedly produce a distal femoral resection within 2 degrees-3 degrees of ideal. Use of the anterosuperior iliac spine may lead to less than ideal femoral resection and malpositioning of total knee components.

The purpose of this study was to investigate the ergogenic effect of oral inosine (IN) supplementation (6,000 mg.d-1 for 2 d) upon 3-mile run time (3MTIME) and VO2 peak. Nine highly trained endurance runners participated in a double-blind, placebo (PL), crossover study. Each subject undertook an IN or PL trial, consisting of three exercise tests: a submaximal warm-up run (SUBRUN), a competitive 3-mile treadmill run (3MRUN), and a maximal treadmill run (MAXRUN) to determine VO2 peak and time to exhaustion (MAXTIME). Additional measurements during the 3MRUN and MAXRUN included oxygen uptake (VO2), ventilation (VE), respiratory exchange ratio (R), and ratings of perceived exertion (RPE); blood samples were also taken prior (PRERUN) to the SUBRUN test and following the SUBRUN, 3MRUN, and MAXRUN tests in order to assess glucose, pyruvate, lactate, phosphorus, 2,3-DPG, hemoglobin, and uric acid. Analyses of the data revealed no significant effect of oral IN supplementation either upon 3MTIME (IN = 18.31 +/- 1.21; PL = 18.33 +/- 1.15 min) or VO2 peak (IN = 58.6 +/- 5.1; PL = 60.7 +/- 4.5 ml O2.kg-1.min-1) or upon other dependent variables. MAXTIME was significantly longer during the PL trial (P less than 0.05), suggestive of a possible impairment effect of oral IN supplementation. Based upon our data, we conclude that IN is not an effective ergogenic aid to enhance athletic performance of an aerobic nature.

The anterior cruciate ligament (ACL) was excised bilaterally in the knee joint of three dogs and was replaced in a conventional manner with a composite polyglycolic acid (PGA) and Dacron braided ligament prosthesis. In one knee of each dog, the ligaments were wrapped with a free synovial graft taken from the suprapatellar pouch in an attempt to keep the prosthesis extrasynovial, while the ligaments in the opposite three knees were left uncovered and thus directly exposed to synovial fluid. The dogs were killed at approximately one year postoperation, and microscopic sections of all ligaments were taken. The three knees with the synovial sheath showed a significantly greater bulk of fibrous tissue along the ligament scaffold grossly and a greater abundance of collagen producing cells microscopically, compared to the unwrapped ligaments. The gross and microscopic findings were identical in each of the three knees with the covered ligaments and were equally consistent in the three that had been left unprotected from the synovial fluid. These findings suggest that a free synovial graft may simulate the normal protective role of the synovial membrane and allow and/or induce collagen ingrowth in synthetic or autogeneic tissue stints for the repair of acute cruciate ligament tears.