Andrew S. Levy

Chondral Delamination of the Knee in Soccer Players

This study reports on the diagnosis and treatment of chondral delamination in the knees of soccer players. The authors attempted to provide a clinical standard for comparison with emerging cartilage repair techniques. Twenty-three consecutive chondral fractures in a ho mogeneous population of athletes were evaluated us ing physical examination, magnetic resonance imag ing, and arthroscopic examination. All knees were treated with debridement to a stable border and re moval of the calcified cartilage base. Results were graded using the scoring system advocated by propo nents of chondral transplant. All patients reported pain that limited soccer activities. Effusions occurred in 48%, joint line tenderness in 33%, and crepitus in 19% of the knees. Results from magnetic resonance imag ing correlated with arthroscopic examination in 21 % of the knees. Arthroscopic examinations revealed lesions on the medial femoral condyle in eight patients, the patella in six, the lateral femoral condyle in six, and the trochlea in three. Athletes returned to play at an aver age of 10.8 weeks. Repeat arthroscopic procedures in eight cases revealed fibrocartilage at the initial site. There were 6 excellent, 9 good, 0 fair, and 0 poor results at their 1-year followup examinations (15 knees). The definitive diagnosis of chondral delamina tion relies on a thorough arthroscopic probing of the articular surface. The early functional results of this treatment compare favorably with the autologous transplantation technique. Caution, however, is recom mended when treating articular cartilage injuries be cause no long-term data exists on whether any treat ment modality can prevent the development of degenerative joint disease.

Intra- and Interobserver Reproducibility of the Shoulder Laxity Examination

The present study evaluates the inter- and intraobserver reproducibility of clinical examination of glenohumeral laxity in the unanesthetized shoulder. Forty-three asymptomatic Division I collegiate athletes underwent bilateral shoulder laxity examination initially and again after 3 months. Translation of the humeral head on the glenoid fossa in the anterior, posterior, and inferior directions was graded by four physicians who were blinded to their own previous grading and that of the other examiners. Overall intraobserver reproducibility of examination was 46%. When grades 0 and 1 were equalized, overall intraobserver reproducibility improved to 74%. For both the equalized and non-equalized reproducibility values reported by all examiners, the kappa values for intraobserver correlation were less than 0.5, which suggests that correlations were not better than those achieved by chance alone. Overall interobserver reproducibility was 47%. When grades 0 and 1 were equalized, interobserver reproducibility improved to 78%. Kappa values were greater than 0.5 only in equalized posterior and inferior laxity. The data demonstrate that the laxity examination of the unanesthetized shoulder is not easily reproducible in either intra- or interobserver comparison. Equalization of grade 0 and grade 1 laxity improves both intra- and interobserver reproducibility. We recommend caution when determining diagnosis and treatment based on this examination.

Glenohumeral Translation in the Asymptomatic Athlete's Shoulder and Its Relationship to Other Clinically Measurable Anthropometric Variables

To determine the degree of shoulder translation in uninjured athletes, we examined 76 Division I colle giate athletes (44 women and 32 men) for passive range of motion in both shoulders and for knee and elbow hyperextension. Translation was based on a scale of 0 to 3+. Shoulders with symptoms of pain or a history of instability or dislocation were excluded from this study. Forty-six shoulders had 0 anterior transla tion, 75 had 1+, and 31 had 2+. Thirteen shoulders had 0 posterior translation, 56 had 1 +, and 83 had 2+. Thirty-eight shoulders had 0 inferior translation, 105 had 1 +, and 9 had 2+. No shoulder had translation of 3+ in any direction. Twenty-four athletes, 12 men and 12 women, had translational asymmetry of a minimum of one grade in at least one direction. No shoulder was asymmetric in all three directions. There was a signif icant correlation between dominant hand and in creased translation; 19 of 24 athletes with asymmetric shoulders had greater translation in the nondominant extremity. There was no relationship between transla tion and range of motion, knee or elbow hyperexten sion, thumb-to-forearm distance, or years spent in sports participation. Asymmetry of shoulder translation may exist in the normal shoulder. This review shows that up to 2+ translation in any direction cannot be considered abnormal.

Local anesthesia in outpatient knee arthroscopy: A comparison of efficacy and cost

This study was performed to compare the efficacy, cost-effectiveness, and safety of general, regional, and local anesthesia when performing outpatient knee arthroscopy. The study consisted of two portions. A retrospective review of 256 outpatient knee arthroscopies was performed. The types of anesthesia used were general endotracheal, regional (epidural or spinal), and local. Comparisons were made between operative procedure, anesthesia procedure time, need for supplemental anesthesia, recovery room time and cost, pharmaceutical cost, and complications. A prospective study consisted of 100 consecutive outpatient knee arthroscopies performed using local anesthesia. Data identical to the retrospective portion were obtained. Visual analog scales were used in a patient questionnaire completed at the first postoperative visit to assess patient satisfaction with local anesthesia. The retrospective data showed similar demographics and operative procedures performed in the three study groups. The difference between operative time and total anesthetic time for the local group was 35 minutes less than for regional, and 23 minutes less than for the general group. These differences were statistically significant (P < or = .05). Total pharmaceutical cost was significantly less for the local group (P < or = .05). Recovery room cost for the local anesthesia group averaged

Knee Injuries in Women Collegiate Rugby Players

134 compared with

The orthopedic and social outcome of open tibia fractures in children.

450 for regional and

Pulmonary Barotrauma: Diagnosis in American Football Players Three Cases In Three Years

527 for general. This difference was significant (P < or = .05). There were 19 complications with general anesthesia, 16 with regional anesthesia, and 2 with local. There were two regional and two local cases that needed subsequent general anesthesia. The prospective data showed nearly identical time and cost data. The patient questionnaire showed nearly universal acceptance and satisfaction with the use of local anesthesia. The use of local anesthesia for outpatient knee arthroscopy is safe, effective, and well accepted. The use of local anesthesia was shown to save a minimum of

Osteochondral Autograft Replacement

400 per case compared with the other anesthetic methods studied.

Function of the long head of the biceps at the shoulder: electromyographic analysis*

We evaluated the prevalence and patterns of knee injuries in 810 women collegiate rugby players. Injuries that resulted in players missing at least one game were recorded and a questionnaire was used to delineate players rugby and knee injury history. There were 76 total knee injuries in 58,296 exposures. This resulted in a 1.3 knee injury rate per 1000 exposures. Twenty-one anterior cruciate ligament tears were reported for a 0.36 incidence per 1000 exposures. Other injuries in cluded meniscal tears (25), medial collateral ligament sprains (23), patellar dislocations (5), and posterior cruciate ligament tears (2). Sixty-one percent of the medial collateral ligament sprains occurred in rugby forwards and 67% of anterior cruciate ligament tears occurred in rugby backs. All other injuries occurred with equal frequency in backs and forwards. This study demonstrates that knee injury rates in womens colle giate rugby are similar to those reported for other wom ens collegiate sports. The overall rate of anterior cru ciate ligament injury in womens rugby, however, is slightly higher than that reported for women soccer and basketball players.

Rotator cuff repair: the effect of double-row fixation versus single-row fixation on three-dimensional repair site (SS-03)

To determine whether the accepted principles of management of open tibia fractures apply to children, 40 consecutive open fractures of the tibial shaft in skeletally immature patients were retrospectively reviewed. Attempts were made to evaluate the functional and social impact of open tibia fractures in children. All open fractures were initially treated by rapid irrigation and debridement which was repeated every 48 hours until soft tissues stabilized. The average age was 10.1 years and average follow up was 26 months (range: 18 to 84). There were 16 grade I, 10 grade II, and 14 grade III open fractures. The grade III fractures were further subdivided into 6 grade IIIA, 7 grade IIIB, and 1 grade IIIC. The average time to union was 7.5 and 11.0 weeks in the grade I and II fractures respectively, with no infections and no delayed unions. In grade III fractures, the average time to union was 15 weeks, with 1 infection and 3 delayed unions. Bone grafting using autogenous iliac crest was performed on 2 patients. The children surveyed missed an average of 4.1 months of school and 33% had to repeat a year. Twenty-five percent of the children complained of nightmares involving the events of the accident. Chronic pain despite solid union was found in 30% of patients. Forty percent of those surveyed (7 grade III fractures) complained of a limp. The low incidence of soft tissue complications and infections in the study population supports applying in children the same basic soft tissue management principles of open fracture treatment as used in adults. While bone stabilization options are limited in children, the rate of successful union without adjunctive bone grafting is much higher than that of adults treated under similar protocols. Routine early iliac crest bone grafting is unnecessary. The prevalence of gait abnormality despite fracture union should be taken into account during the patients rehabilitation. The extensive time missed from school and resulting scholastic setback should not be underestimated.