Barton Branam

Lateral ankle ligament anesthesia significantly alters single limb postural control.

Lateral ankle anesthesia has been used as a model to explore effects of ligament deafferentation related to ankle sprain on single limb postural control with conflicting results. Time-to-boundary (TTB) is a postural control measurement technique found to be sensitive in detecting subtle deficits in postural control in those with chronic ankle instability. The objective of this study was to determine the effects of lateral ankle ligament anesthesia on TTB measures of single limb postural control in healthy adults. Twenty-two healthy adults with no history of lower extremity injury within the past 6 months or balance disorders participated in the study. All subjects received a lidocaine injection to the lateral ankle structures on one of two testing days. On both testing days, subjects performed 3 eyes open and 3 eyes closed, 10-s trials of barefoot single limb stance on a forceplate. The dependent variables were the mean of TTB minima(s) and standard deviation of TTB minima(s) in mediolateral (ML) and anteroposterior (AP) directions. Separate condition (anesthesia, control) by vision (eyes open, eyes closed) ANOVAs with repeated measures were used for each TTB variable to determine the effects of anesthesia on postural control. Alpha level was set a priori at p≤0.05. The anesthesia day TTBAP magnitude (p=0.008) and variability (p=0.044) measures were significantly lower than the control day, regardless of vision. Anesthesia of the lateral ankle ligamentous structures significantly reduced the magnitude and variability of TTBAP measures. These findings are similar to deficits found in those with chronic ankle instability.

Allografts in knee surgery.

The use of musculoskeletal allograffs in knee surgery is expanding as outcome studies continue to delineate roles for ligament, meniscal, and osteochondral allouraffs.

Atypical lumbar disc herniation: a case report.

BACKGROUND CONTEXT This is a case report of a right posterolateral L5-S1 disc herniation that migrated to the left cephalad level to impinge on the left L5 nerve root as it exited the dura. The resultant free fragment migration is a rare variation of a posterolateral disc disruption. PURPOSE The purpose is to report a rare variation of lumbar disc herniation not previously reported in the literature. STUDY DESIGN/SETTING Case report. PATIENT SAMPLE A 60-year-old white woman. OUTCOME MEASURES Resolution of the patients left lower extremity symptoms. METHODS Not applicable. RESULTS The patient experienced resolution of most of her left lower extremity symptoms after a slightly modified microscopically assisted lumbar hemilaminectomy, discectomy and nerve root decompression. CONCLUSIONS This is a rare right to left migration of a sequestrated disc herniation, which was effectively treated with surgery.

Indications for Two-Incision (Outside-In) Anterior Cruciate Ligament Reconstruction.

Anterior cruciate ligament (ACL) reconstruction is a commonly performed procedure. Drilling the femoral tunnel independent of the tibial tunnel has become popular as surgeons strive to create tunnels in the anatomic locations of the femoral and tibial attachments of the native ligament. The 2-incision technique effectively and reproducibly accomplishes this goal. The 2-incision technique for ACL reconstruction is a valuable tool in the skillset of the reconstructive knee surgeon. Indications for the 2-incision surgery are reviewed in detail. Furthermore, technical tips, complications, and outcomes are discussed.

Chronic (Ten Years) Ischial Tuberosity Avulsion Fracture Nonunion Treated with Fragment Excision and Simultaneous Primary Repair of the Hamstring Tendon

Ischial tuberosity avulsion fractures are infrequent injuries that primarily affect adolescent athletes1-8. Ischial avulsions can be easily mistaken for hamstring injuries and therefore missed on initial presentation1,6. Whereas some of these fractures heal spontaneously, they often can progress to painful nonunion1,2,9,10. Painful nonunion of an ischial avulsion fracture is generally treated operatively with open reduction and internal fixation. To our knowledge, three years is the longest time span reported in the literature between ischial tuberosity avulsion fracture injury and nonunion repair1,2,8,9,11,12. We present a case of a chronic ischial tuberosity avulsion fracture nonunion with a ten-year delay between the initial injury and definitive surgical management via fragment excision and primary hamstring repair. This case report presents a viable option for repair of chronic, painful ischial tuberosity avulsion nonunion. Furthermore, it demonstrates that patients can benefit from this procedure, even after an extensive interval from the index injury. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A twenty-seven-year-old professional skater presented with chronic pain in the right buttock. She reported that the pain had intensified after reinjuring the buttock during a roller derby scrimmage three weeks prior to presentation. Pertinent past medical history included an ischial avulsion fracture diagnosed ten years prior at an outside institution, which had been treated conservatively. Of note, she had experienced chronic pain in the ischial region throughout her adult life. On physical examination, she had tenderness posteriorly and medially over the ischium. She had pain with resisted leg extension and resisted knee flexion, and decreased range of motion at the hip. There was no tenderness in the …