Haluk H. Oztekin

Score-Celebration Injuries Among Soccer Players A Report of 9 Cases

Background Professional and amateur soccer players often perform dramatic on-field feats of celebration after scoring a goal. Injuries may occur during these activities. Purpose With the aim of preventing such “score-celebration injuries” in the future, the authors examine these events in professional soccer players and discuss potential avenues for prevention. Study Design Case series; Level of evidence, 4. Methods Over the course of 2 seasons (1996-1998), 152 soccer players were evaluated at an orthopaedic clinic for injuries incurred during matches. Nine players (6%) had injured themselves while celebrating after scoring goals in a match. The type of celebration, injury type, treatment, and mean duration of recovery were noted. Results Seven of the 9 patients were male professional soccer players with ages ranging between 17 and 29 years (mean age, 24 years). The injuries occurred when the playing ground was natural turf in 8 cases; most injuries occurred in the second half of the game. The types of celebration maneuvers were sliding (prone or supine) and sliding while kneeling in 5 cases, piling up on jubilant teammates in 3 cases, and being tackled while racing away in 1 case. Injuries included ankle, clavicle, and rib fractures; medial collateral ligament sprain; low back strain; hamstring and adductor muscle strain; quadriceps muscle sprain; and coccyx contusion. The mean duration for recovery was 6.2 weeks. Rival team players were usually not responsible for such trauma. Conclusion Exaggerated celebrations after making a goal, such as sliding, piling up, and tackling a teammate when racing away, can result in serious injury. In addition to general measures for preventing soccer injuries, coaches and team physicians should teach self-control and behavior modification to minimize the risk of such injuries. More restrictive rules, which penalize such behavior, may assist in the prevention of score-celebration injuries.

Pain and affective distress before and after ACL surgery: A comparison of amateur and professional male soccer players in the early postoperative period

Pain thresholds and levels of distress before and in the early postoperative period after anterior cruciate ligament surgery were measured in professional and amateur male soccer players and compared. Between June 2005 and March 2007, 30 soccer players (10 amateur, 20 professional) with acute or chronic tears of the anterior cruciate ligament who were scheduled for a bone-tendon-bone ACL reconstruction procedure were enrolled in the study. Measures of pain intensity, depression and anxiety were assessed 1 day pre-operation and 1 week and 3 weeks post-operation (T1 T2 and T3). Pain was assessed using a visual analog scale (VAS), depression with the Beck Depression Inventory (BDI), and anxiety with both the state and trait forms of the State-Trait Anxiety Inventory (STAI). Scores on the VAS, BDI, and STAI in both groups were analyzed. The mean VAS scores at T1 and T2 in professional players were not significantly higher than those in amateur players (P>0.05). Professionals had significantly higher BDI scores at T1 and T2 (P<0.05), but this difference was not significant at T3 (P=0.12). High depression scores did not correlate with high pain scores. Pain scores between professional and amateur soccer players with ACL injuries were not significantly different pre-op or in the early post-op period. Depression was more common in professionals before and after their ACL surgery, but anxiety levels were not significantly different between the two groups.

Tarsal tunnel syndrome associated with a neurilemoma in posterior tibial nerve: A case report

Compression neuropathy of the posterior tibial nerve (PTN) and its branches in the tarsal tunnel is called tarsal tunnel syndrome (TTS) and has various aetiologies. Space-occupying lesions in the tunnel, such as neurilemomas, can cause such a disease. When a neurilemoma occupies the tarsal tunnel, it can compress the PTN directly or indirectly and results in restriction of the tunnel volume. Symptoms due to this restricted volume may vary in TTS. A case of neurilemoma of PTN in tarsal tunnel with a complaint of posteromedial ankle intermittent pain in a 20-year-old patient is presented here. A mass was observed at the ankle posteromedially during clinical examinations and the patient underwent magnetic resonance imaging (MRI) and radiological investigation. Radiographic evaluation of the ankle was normal. However, MRI was revealed a mass adjacent to the PTN in the tarsal tunnel. An ovoid, smooth-surfaced, encapsulated and eccentrically localized mass in the PTN was detected at surgery. The mass was excised from the nerve and pathological evaluation revealed a neurilemoma (schwannoma). Neurilemomas arising from the PTN in the tarsal tunnel should always be kept in mind as a differential diagnosis when a patient complains of a posteromedial ankle pain. Since it is a space-occupying lesion and encapsulated tumor in the tarsal tunnel, simple surgical resection is curative without a distinct morbidity.

Clinical evaluation of the proximal tibiofibular joint in knees with severe tibiofemoral primary osteoarthritis

Despite the coexistence of primary arthritic involvement of the tibiofemoral and proximal tibiofibular joints (PTFJ), clinical features of the PTFJ in knees with severe femorotibial arthritis have not been described to date. The PTFJ in knees with primary osteoarthritis may be a source of lateral knee pain after total knee arthroplasty operations. This study seeks to address whether there is a relationship between the clinical findings and degeneration of the PTFJ in knees with severe tibiofemoral primary osteoarthritis. Sixty knees in 34 consecutive patients (31 females and 3 males; mean age 71 years; range 61-86 years) with Kellgren-Lawrence grades III-IV primary femorotibial arthritis were enrolled in this study in order to collect clinical data regarding the PTFJ. Radiographs showed 23 PTFJs were grade IV, 14 were grade III, and 23 were grade II. With regard to the type of PTFJ, 13 joints were horizontal and 47 were oblique. Pain and tenderness were observed in 13 PTFJs upon clinical exam (two horizontal and 11 oblique PTFJ types; grade II in five, grade III in two, and grade IV in six). Lateral hamstring tightness was found in 28 knees (24 oblique and four horizontal PTFJ types; grade II in 10, grade III in two, and grade IV in 16). Ten of the 28 PTFJs in knees with lateral hamstring tightness were painful during the physical examination. No significant relationship was found between PTFJ exam findings and PTFJ type (Fishers Exact test, p=0.713), PTFJ grade of arthritis (chi(2) test, p=0.700), or between hamstring tightness and PTFJ type (chi(2) test, p=0.194). However, hamstring tightness was significantly correlated with the grade of arthritis in the PTFJ (chi(2) test, p=0.004). Although degenerative disease of the PTFJ is commonly associated with degenerative disease of the knee joint, radiographic findings of the PTFJ in patients with severe degenerative knee osteoarthritis and varus malalignment do not correlate with clinical findings.

A new self-diagnostic test for biceps femoris muscle strains.

ObjectiveWe compared a self-performed diagnostic test that we have been using since 1987, with other commonly used clinical tests for biceps femoris muscle-strain injuries. SettingPrivate practice focusing on sports injuries. PatientsOne-hundred forty professional male soccer players (ages 17 to 33 years) with a history and clinical findings of a pulled hamstring muscle (patients with direct trauma were excluded) had an ultrasound-proven grade I or II biceps femoris muscle injury. InterventionsIn these ultrasound-positive patients, the “taking off the shoe” test (TOST) was performed by the patient himself on both the affected and unaffected legs; and the physician then performed the resisted range of motion, passive range of motion, and active range of motion tests. ResultsThe TOST had a sensitivity and specificity of 100%, and a positive predictive value and an negative predictive value of 100% for biceps femoris injury as found on ultrasound. The other muscle tests had an average sensitivity of 57%, specificity of 100%, accuracy of 79%, and negative predictive value of 70%. ConclusionThis preliminary, nonblinded observational study of the TOST found it to be more reliable than other commonly used clinical tests for hamstring tears. The clinical value of this easy-to-perform test should be evaluated in a prospective fashion.

A contribution to Pisani's sign for diagnosing lateral meniscal cysts: a technical report.

This article describes modified physical examination maneuvers for diagnosing lateral meniscal cysts. The typical presentation of lateral meniscal cysts usually makes their clinical diagnosis simple, but a wide variation in size may sometimes lead to misdiagnosis. We evaluated the effect of leg rotations on the cystic swelling at 45° of knee flexion. Eleven consecutive patients with positive Pisani’s sign were evaluated prospectively. Lateral mid-third joint-line swelling was most prominent at 30–45° of knee flexion. With the knee held at 45° of flexion, the prominence was also inspected during internal and external rotation of the leg. The masses became noticeably more prominent with external rotation, and completely disappeared with internal rotation. With external rotation of the leg, even doubtful lateral meniscal cysts became apparent. Disappearance of the cystic mass with internal rotation further confirms the diagnosis.

Second-toe length and forefoot disorders in ballet and folk dancers.

BACKGROUND Although there is no ideal foot type for classical dancers, second-toe length seems to be a factor in the etiology of foot disorders in ballet dancers. METHODS We investigated the relationship between second-toe length and foot disorders in 30 ballet dance students and 25 folk dance students. Second-toe length in relation to the hallux (longer or equal/shorter), hallux deformities, first metatarsophalangeal joint inflammation, number of callosities, and daily pain scores were recorded in both groups and compared. RESULTS There was no statistically significant difference in toe length between the two groups (P>.05). Ballet dancers with equal-length or shorter second toes had lower pain scores, less first metatarsophalangeal joint inflammation, and fewer callosities in their feet compared with dancers with longer second toes. CONCLUSIONS Second-toe length seems to be a factor in the development of forefoot disorders in classical ballet dancers but not folk dancers. Dancers who have equal-length or shorter second toes in relation to the hallux may have fewer forefoot disorders as dance professionals.

Time Lost from Play in Foot and Ankle Injuries of Professional Soccer Players

Objective: Ankle and foot injuries are common in professional soccer players, but the relation between injury severity and time lost from play is not well known. The aim of this study is to investigate the relationship between diagnosis, injury severity and time lost to play of professional soccer players with severe ankle and foot injuries with reviewing the recent literature. Design: Prospective evaluation of retrospectively collected data and review of the literature. Setting: Primary private practice. Patients: The medical records of two hundred lower extremity injuries of professional soccer players who admitted to our private clinic during the 2003-2004 professional national soccer league season were reviewed. Collected data of sixty-six players with severe ankle and foot injuries were included in the study. Type of injury, diagnosis, treatment, injury severity and finally, time lost from play were evaluated from the medical records. Injury severity (‘severe’ if >28 days, ‘moderate’ if between 8-28 days) and time lost from play were calculated from medical records and by telephone interviews with the players. Results: Most injuries (n=20, 32%) occurred during player-to-player contact. The most common diagnosis was ankle sprain (30.3%) with anterior talofibular ligament injury. Most (55%) hindfoot injuries were Achilles tendinopathy with or without rupture. Treatment was surgical in 23 patients (35%). The mean time lost from play for players with severe foot and ankle injuries was 61days (range 21-240 days); after Achilles tendon ruptures, the mean time lost was 180 days. Injury severity was severe (>28 days lost from play) in 64% patients and moderate (8-28 days lost from play) in 36% patients. Conclusion: Time lost to play can dramatically increase by the presence of severe ankle and foot injuries. Serious ankle and foot injuries in this study resulted in players being out of professional competition for about two months.

Symptomatic Entrapment of an Anomalous Semimembranosus Muscle by the Semitendinosus Tendon in a Professional Soccer Player A Case Report

Bulent Zeren,* MD, Haluk H. Oztekin, MD, Hakan Boya, MD, and Ozal Ozcan, MD From the *Center for Orthopaedics and Sports Traumatology, Karsiyaka, Izmir, Turkey, Baskent University, School of Medicine, Department of Orthopaedics and Traumatology, Izmir Zubeyde Hanim Hospital, Izmir, Turkey, and Afyon Kocatepe University, School of Medicine, Department of Orthopaedics and Traumatology, Afyonkarahisar, Turkey

Symptomatic “Bucket-Handle Tear” of the Medial Patellar Plicae in Three Patients Congenital or Acquired?

on the medial wall of the knee joint and runs obliquely downward to insert into the synovium covering the medial infrapatellar fat pad. Joyce and Harty in 492 cadaveric dissections found a 30% incidence of medial patellar plica, but this ranges from 18.5% to 55% according to McGinty. Repetitive microtrauma or direct macrotrauma usually causes fibrosis, thickening, and even tearing of such plicae. A symptomatic tear or rupture of a plica after trauma is very rare, the oldest report being Johansen’s case of a ruptured medial patellar plica, published in the Norwegian literature in 1989. In 1994, Matsusue et al divided symptomatic “type D plicae” into 3 groups: those with a fenestration, reduplication, or tear. Four of their 20 patients had torn plicae, which they named “subgroup C.” Two years later, the term bucket-handle-like tear was used by Gerbino and Micheli in their description of torn medial patellar plicae, and they proposed a mechanism of tearing by direct or indirect forces. In 2002, White postulated patella dislocation as a mechanism of such a tear. To date, only 2 articles described patients with a buckethandle type of tear of medial patellar plicae. We describe here 3 patients, all professional soccer players, with this type of tear in the medial patellar plicae. All 3 types of tears required arthroscopic excision for symptom relief.