George D. Rovere

Anabolic steroids: A review of the literature

The use of anabolic steroids by athletes is controversial. On the one hand, many athletes believe that steroids improve athletic performance and thus provide an advantage to those who use them. On the other hand, the medical and scientific communities believe that inadequate scientific data exist to support the claim that anabolic steroids can improve athletic performance while overwhelming scientific data demonstrate their deleterious effects. Therefore, a large information and credibility gap concerning anabolic steroids exists between the athletes and the medical and scientific communities. We believe that this gap can be closed if both groups are better informed about anabolic steroids. We provide a detailed review of the literature on anabolic steroids that provides to the reader the information needed to make an informed decision on the relative risks and benefits of anabolic steroids to the athlete.

Retrospective comparison of taping and ankle stabilizers in preventing ankle injuries

The effectiveness of taping and the effectiveness of wearing a laced stabilizer in preventing ankle injuries and reinjuries over six seasons of collegiate football practices and games were assessed retrospectively. For 1½ years the players all had taped ankles, and for the remaining 4½ years the players chose their type of ankle support. Over the entire period, the players chose high-top or low-top shoes as preferred. During 51,931 exposures to injury (46,789 practice-exposures and 5,142 game-exposures), the 297 players sustained 224 ankle injuries and 24 reinjuries. Tape was worn during 38,658 exposures to injury (233 players), stabilizers during 13,273 exposures (127 players). Tape had been worn when 159 of the injuries and 23 of the reinjuries occurred; a stabilizer had been worn when 37 of the injuries (P = 0.003) and one of the reinjuries occurred. The combination allowing the fewest injuries overall was low-top shoes and laced ankle stabilizers.

Prophylactic knee bracing in college football

We report on the number of knee injuries sustained by a major college football team during 2 full years when all players were required to wear laterally placed pro phylactic knee braces during all practice sessions and all games. We found that the incidence rates of knee injuries were higher when the braces were worn com pared to a similar period when the braces were not worn. There was also an increased number of ACL injuries during the brace period. Several indices char acterizing the nature of the injuries were analyzed and were found not to be altered significantly when the prophylactic braces were used. These facts lead us to question the efficacy of prophylactic knee braces in preventing knee injuries in college football. The use of the braces was associated with increased episodes of muscle cramping in the triceps surae muscle group, required the constant attention of coaches and trainers to remind the players to wear the braces and to apply them correctly, and was costly. These findings indicate the need for other carefully controlled clinical and bio mechanical studies of these devices before their routine use can be advocated.

Musculoskeletal injuries in theatrical dance students

Three hundred and fifty-two injuries in 185 theatrical dance students at the North Carolina School of the Arts were diagnosed and treated from September 1981 through May 1982, the most recent academic year. The total number of dancers enrolled in the school was 218; thus, 84.9% of the dance students were evaluated for an injury by a physician, with 87.8% of the injuries sustained during dance. Approximately one-fourth of the dance-related inju ries involved the foot or ankle. The injuries were usually not severe, and proved amenable to treatment by con servative measures.

Anterior cruciate-deficient knees: a review of the literature.

Injury to the anterior cruciate ligament may lead to functional instability, meniscal injury, and premature degenerative changes of the knee or, if treatment and rehabilitation are carried out carefully, to a functionally stable knee with no premature degenerative changes. Unfortunately, the complex anatomy of the three fiber bundles, consisting of multiple collagenous strands, which constitutes the anterior cruciate ligament com bined with variation of injuries to the ligament, with or without injury to other structures of the knee, makes any standardization of surgical treatment difficult. In this paper, we review the biomechanics of the knee, the anatomy and vascularization of the anterior cruciate ligament, the healing characteristics of ligamentous ma terial, and the types of surgical repair that have ap peared in recent articles. Those repairs can be divided into direct repair, extraarticular substitution and intraar ticular augmentation, freeze-dried fascia lata allografts, and temporary supportive prosthesis such as carbon fiber. Essential to the success of any surgical repair of the anterior cruciate-deficient knee is a prolonged, care fully organized rehabilitation program that allows ade quate healing and strengthening of the ligament before it is used normally again. The patients clear under standing of the importance of a prolonged rehabilitation is best established before the surgical procedure is done.

Medial synovial shelf plica syndrome: Treatment by intraplical steroid injection

Medial synovial shelf plica syndrome is caused by ac quired thickening and inflammation of a commonly present residual embryonic synovial fold. Treatment with a local injection into the plica and surrounding synovium of a steroid and a long-acting local anesthetic was tested in a series of 30 patients to see if more involved and expensive treatment could be avoided. Thirty-one knees were studied and treated prospec tively ; rigid criteria for making the diagnosis were main tained. Twenty-two (73%) patients had complete relief of pain and full return to activity; five patients had some amelioration of their symptoms and partial return to activity; and three patients had poor results. Two of the poor results were secondary to errors in diagnosis, and one was secondary to the presence of mature fibrosis confirmed during subsequent arthroscopic re section. As a control, ten patients were injected with long-acting local anesthetic alone. In all ten, symptoms were relieved only for the duration of the anesthetic. Intraplical steroid injection appears to be a reasonable, prudent, initial step in the treatment of medial synovial shelf plica syndrome. For competitive athletes, it pro vides very short morbidity and the ability to return to full practice and participation in a very short period of time.

Frequency, associated factors, and treatment of breaststroker's knee in competitive swimmers

Thirty-six competitive breaststroke swimmers were in terviewed and examined for knee pain specifically re lated to the breaststroke kick. Eighty-six percent of the subjects had a history of at least one episode of breast stroke knee pain, while 47.2% had breaststroke knee pain that occurred at least once a week. There was a significant relationship between more frequent knee pain and increasing swimmers age, increasing years of competitive swimming, increasing breaststroke train ing distance, and decreasing warm-up distance. The subjects with frequent knee pain were found to have less internal rotation at the hip joint. The most common site of breaststroke knee pain was the medial portion of the knee, with specific sites differing among the individuals. The medial synovial plica syndrome may be a cause of breaststroke knee pain, since 47% of subjects with weekly knee pain had tender, thickened medial plicae. Palpation of those pli cae produced pain similar to that experienced with the breaststroke kick. The findings in this study suggest that reducing or eliminating breaststroke training distance should be an initial measure in treatment. Applications of ice, changes in kick technique, stretching exercises to in crease hip rotation, and administration of aspirin may also be effective. The breaststroke training distance should be increased very gradually in the early season, and warm-up distance should be adequate to help prevent the symptoms of breaststrokers knee.

The role of ultrasound in the early diagnosis of myositis ossificans: A case report

Myositis ossificans may contribute to prolonged morbidity following sports trauma. Current imaging techniques (e.g., roentgenography, computed tomography, contrast angiography) do not provide adequate serial visualization of the developing lesion until calcifications begin to appear, are too expensive for serial evaluation, or are invasive. We describe ultrasound imaging of a lesion that later developed myositis ossificans, and discuss the potential of ultrasonography as a diagnostic tool in the management of early myositis ossifi-

Spontaneous septic arthritis complicating rheumatoid arthritis.

Thirteen cases (in twelve patients) of septic arthritis complicating rheumatoid arthritis are reported. One ankle, one metacarpopophalangeal joint, one shoulder, and ten knees were involved. Staphylococcus aureus was cultured from twelve joints and Escherichia coli, from one. Treatment consisted of repeated needle aspirations in two patients, arthrotomy with Penrose drainage in six, and arthrotomy with through-and-through irrigation in four. Needle aspiration was the least effective therapy. The authors recommend as the treatment of choice: systemic antibiotic therapy and immediate arthrotomy followed by through-and-through irrigation with fluid containing the appropriate antibiotics.

Low Back Pain in Athletes

In brief: Low back pain in seasoned athletes is not common, but when present it can limit participation. While direct blows or hyperlor-dotic positions can cause low back pain in certain sports, the most common cause is overuse and resultant strains or sprains of the paravertebral muscles and ligaments. Such injuries cause acute pain and spasm, which sometimes do not appear for 24 hours or longer. Diagnosis is based on history, ruling out of systemic maladies, physical examination, and, if necessary, supplemental tests such as x-rays, myelograms, and bone scans. Treatment of low back pain due to overuse is, sequentially, bed rest and ice for 24 to 36 hours, heat and massage, analgesics as needed, and a lumbosacral support until flexion and strengthening exercises have returned the damaged part to normal.