Clive E. Brewster

The effects of electrical stimulation on the quadriceps during postoperative knee immobilization

Immobilization of the knee after anterior cruciate liga ment (ACL) reconstructon results in marked thigh atro phy and decrease in quadriceps strength that may prolong the rehabilitation program of the injured athlete. Fifteen male volunteers undergoing ACL reconstruction were divided into two groups, stimulation (during im mobilization) and nonstimulation. Measurements of thigh circumference and isometric quadriceps strength were tested preoperatively, immediately after cessation of cast immobilization (6 weeks), and at 9 and 12 weeks postoperatively. The changes in circumference and strength between the first preoperative test and all subsequent tests were compared for statistical signifi cance (Students t-test, P < 0.5) between the two groups. The decrease in quadriceps strength of the stimulation group during immobilization was signifi cantly less than that of the nonstimulation group, al though later differences between the two groups were not significant. There were no significant differences in thigh atrophy between the two groups. In conclusion, isometric quadriceps torque decreases resulting from immobilization can be significantly lessened by appli cation of electrical stimulation during immobilization. Electrical stimulation to the quadriceps does not sig nificantly alter thigh circumference changes that occur during immobilization.

Cost Analysis of Outpatient Anterior Cruciate Ligament Reconstruction: Autograft versus Allograft

BackgroundPrior studies suggest the cost of allograft anterior cruciate ligament (ACL) reconstruction is less than that for autograft reconstruction. Charges in these studies were influenced by patients requiring inpatient hospitalization.Question/purposeWe therefore determined if allograft ACL reconstruction would still be less costly if all procedures were performed in a completely outpatient setting.MethodsWe retrospectively reviewed 155 patients who underwent ACL reconstruction in an ambulatory surgery center between 2001 and 2004; 105 had an autograft and 50 had an allograft. Charges were extracted from itemized billing records, standardized to eliminate cost increases, and categorized for comparison. Surgeon and anesthesiologist fees were not included in the analysis. Groups were compared for age, gender, mean total cost, mean cost of implants, and several other cost categories.ResultsThe mean total cost was

Acute Tears of the Medial Head of the Gastrocnemius

5465 for allograft ACL reconstruction and

Evaluation of residual instability after arthroscopic meniscectomy in anterior cruciate deficient knees

4872 for autograft ACL reconstruction. There were no differences in complications between the two groups.ConclusionsAllograft ACL reconstruction was more costly than autograft ACL reconstruction in the outpatient setting. The cost of the allograft outweighs the increased surgical time needed for harvesting an autograft.Level of Evidence Level II, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.

Revalidatie bij sporters na reconstructie van het unlnaire collaterale ligament

Twenty-five patients with acute tears of the medial head of the gastrocnemius were evaluated in follow-up from 1 to 3 years after injury. The patients were treated with a heel lift, calf sleeve, and physical therapy. The majority of the patients were men who injured their dominant lower extremity in one explosive episode. Cybex II testing revealed no significant difference in the plantarflexion strength of the noninjured and injured extremity after healing. All patients returned to their previous level of athletic activity.

Revalidatie van de knie na operatieve reconstructie van de voorste kruisband

Forty-five patients who underwent a partial meniscec tomy in an anterior cruciate deficient knee were fol lowed from 2 to 9 years. The average age at the time of the meniscectomy was 28.6 years. The majority of the patients were injured in recreational athletics. The subjects were evaluated preoperatively by a question naire and clinical examination, both of which were re peated at followup. The efficacy of the postsurgical rehabilitation was monitored with measurement of quadriceps and hamstring strength on the Cybex Dy namometer. All of the patients had a KT-1000 knee ligament arthrometer test at followup that was com pared with the clinical examination. Sixty-five percent of the subjects (13 of 20) with a Lachman and pivot shift of +1 returned to their previous activity level without limitation. Of the patients with a KT-1000 com pliance index of 1 mm, 70% (11 of 17) returned to the same athletic level. However, only 20% (2 of 11) of the patients with a clinical instability greater than +1 or a compliance index of 2 mm were able to perform without limitation. The location of the meniscal tear did not correlate with the functional outcome. Six patients re quired ACL reconstruction.

Rehabilitation of the Lower Extremity

Sporters die werpbewegingen moeten uitvoeren, zoals werpers bij honkbal en speerwerpers, stellen hun elleboog vaak bloot aan herhaaldelijke valguskrachten. Deze beweging kan het blessurerisico voor het ulnaire collaterale ligament (ucl) verhogen. Als het ucl gescheurd is, kan reconstructieve chirurgie nodig zijn om de sporter terug te brengen tot een niveau dat vergelijkbaar is met dat van voor de blessure.

Rehabilitation of the Upper Extremity

Het hier besproken postoperatieve revalidatieprogramma houdt rekening met en integreert nieuwe gegevens met betrekking tot het isometrisch plaatsen van de voorste-kruisbandplastiek, het revascularisatieproces en de biomechanische belasting. Eerste eis bij een speciaal voor de patient ontworpen behandelprotocol na een voorste-kruisbandreconstructie is dat het de patient terugbrengt in de status van voor het letsel. Er wordt zorg gedragen voor beperking van de belasting van de plastiek aan het eind van de extensie. Het blijft van het grootste belang in het programma technieken op te nemen ter verbetering van de beweeglijkheid en kracht, waarbij toch steeds wordt gewaakt voor de stabiliteit van het kniegewricht.

Modification of Quadriceps Femoris Muscle Exercises During Knee Rehabilitation

Measures to treat or repair the athlete’s injured lower extremity are only the necessary first steps in returning him or her to competition. The athlete also needs a full and appropriate course of rehabilitation. Exercises should be performed with constant consideration for the presence or absence of pain. If pain persists, this may indicate an incorrect performance of each exercise. Indeed, in applying any set of specific exercises, it is always best to perform an exercise using sound principles of mechanics against less resistance. Throughout rehabilitation, emphasize to the patient the importance of reporting any pain experienced during an exercise. With this information, the therapist can determine whether or not to continue that exercise at that time.

Rehabilitation of the Shoulder Following Rotator Cuff Injury or Surgery

In throwing and racquet sports, the dominant shoulder is usually the stronger and more flexible shoulder. An important factor in determinig the treatment goals is the level of competition the patient aspires to. An equally important factor, especially in team sports, is the specific playing position that the athlete holds since the type and amount of shoulder movement required will differ depending on that position. For example, in football the type and amount needed by a quarterback is quite different from that needed by an offensive lineman.