Ivan Bojanić

Traumatic and Overuse Injuries Among International Elite Junior Rowers

Background Junior rowers have competed internationally for over 4 decades, and there are no epidemiological data available on traumatic and overuse injury in this population. Objective To define the types of musculoskeletal problems present in international elite-level junior rowers and to determine whether gender, physical stature, rowing discipline, and training programs affect the incidence of reported injuries. Study Design Descriptive epidemiology study. Methods Injury data were obtained from a total of 398 rowers (42% female, 58% male) who completed a 4-page questionnaire on injury incidence while participating at the Junior World Rowing Championships in Beijing, People’s Republic of China, in August 2007. Results Overall, 290 (73.8%) reported injuries involved overuse, and 103 (26.2%) were related to a single traumatic event. Female rowers were injured more frequently than male rowers (110.2 vs 90.5 injuries per 100 rowers). In both genders, the most common injury site was the low back followed by the knee and the forearm/wrist. The severity of reported injuries was incidental in 65.1%, minor in 21.4%, moderate in 10.4%, and major in 3.1% of cases. The rowers with traumatic injuries had less rowing experience than the uninjured rowers (median [C] ± interquartile range [Q] = 3 ± 3 years vs 4 ± 3 years; P = .043, Mann-Whitney test). Sweep rowers who changed rowing side during the current season had significantly more acute-onset low back injuries (P = .012, χ2 test) than those who did not change rowing side during the same period. The incidence of traumatic injuries was significantly lower in rowers who regularly performed more than 10 minutes of posttraining stretching (P = .030, χ2 test). Athletes who ran more than once a week had more overuse knee injuries than those who ran once or less per week (P = .033, χ2 test). Conclusion Elite junior rowers attending the World Rowing Championships reported predominantly overuse injuries of low severity during the current rowing season. Low back injuries were the most frequent complaint of elite-level junior rowers.

Arthroscopy and microfracture technique in the treatment of osteochondritis dissecans of the humeral capitellum: report of three adolescent gymnasts.

The aim of this paper is to report on three cases of symptomatic osteochondritis dissecans of the humeral capitellum in adolescent gymnasts, two females and one male. In all the cases arthroscopic surgery was performed. During arthroscopy, loose osteochondral fragments were removed, the defect was debrided and microfractures were performed. All the three patients regained the full range of motion of the affected elbow, and returned to the high-level gymnastics within a period of 5 months. At 12 months follow-up, all the three patients remained symptomless and were participating in high-level gymnastics. A combination of arthroscopy and the microfracture technique is a reliable method with excellent short-term results in the treatment of the osteochondritis dissecans of the elbow.

Stress fractures of the femoral shaft in athletes: a new treatment algorithm

Background: Femoral shaft stress fractures in athletes are not common but pose a great diagnostic challenge to clinicians. Because of few clinical signs, diagnosis and treatment are often delayed. Furthermore, if not treated correctly, these fractures are well known for complications and difficulties. Objective: To develop a well structured and reproducible treatment algorithm for athletes with femoral shaft stress fractures. Methods: The proposed algorithm is carried out in four phases, each lasting three weeks, and the move to the next phase is based on the result of the tests carried out at the end of the previous phase. Over nine years, we treated seven top level athletes, aged 17–21. In all athletes, diagnosis was based on physical examination, plain radiographs, and bone scan. Results: As a result of the treatment method, all the athletes were fully engaged in athletic activity 12–18 weeks after the beginning of treatment. After completion of the treatment, the athletes were followed up for 48–96 months. During the follow up, there was no recurrence of discomfort or pain, and all the athletes eventually returned to competition level. Conclusion: These results and data available from the literature suggest that the algorithm is the optimal treatment protocol for femoral shaft stress fractures in athletes, avoiding the common complications and difficulties.

Adverse effects of posterior lumbar interbody fusion using rhBMP-2.

To the Editor We read with great interest the recent article on the use of recombinant human bone morphogenetic protein 2 soaked into an absorbable collagen sponge (rhBMP-2/ ACS) in the posterior lumbar interbody fusion (PLIF) written by Meisel et al. [13]. However, a few corrections and clarifications are required to update this otherwise exceptionally significant article. Meisel et al. [13] mentioned a sheep distal femur model in which transient peri-implant osteolysis with regard to BMP overfilling and hyper-concentration has been observed [1], but several examples are present in the literature that clarify the pathophysiology and the relevance of the vertebral osteolysis much better. For instance, Seeherman and Wozney [15] have shown that a collagen sponge soaked with rhBMP-2 and placed in contact with trabecular bone of the distal femoral core defect in nonhuman primates resulted in significant transient bone resorption at 2 weeks after the surgery. This was not the case when they used a carrier with slower release of rhBMP (calcium phosphate matrix). The rapid release of rhBMPs at the bone surface which is in contact with the collagen sponge creates favorable conditions for significant osteoclastic reaction prior to the bone formation phase. According to a review of the interaction of BMPs with osteoclast lineage cells, BMPs in most of the reports had a stimulatory effect that up-regulated formation of osteoclasts, their bone resorptive capacity, or both of these phenomena [5]. As Meisel et al. [13] emphasized the note of Boden et al. [1] that parity between the distal femur and the central region of the vertebra may not be fully warranted as a clinically relevant spine model, we would like to emphasize a very significant article published by Laursen et al. [10] in this very Journal 10 years ago which definitively presents a relevant spinal model. It was the first report of trabecular bone resorptions after a clinical application of rhBMPs/ACS in proximity of vertebral bodies. The first report of trabecular bone resorptions after a clinical application of rhBMPs to our best knowledge was identified in a manuscript of Howell et al. [8]. The loss of bone volume in some of the cases after the rhBMP-2/ACS local alveolar ridge preservation or augmentation was noted between the 4and 8-week time points. Anyway, Laursen et al. [10] treated five patients with single-level unstable burst fracture and no neurological impairment with intracorporal rhBMP-7 transplantation, posterior fixation and posterolateral fusion. Radiographic and computed tomography (CT) evaluation after 3 and 6 months showed severe resorption of the whole anterior column at the site of transplantation, but after a year, new bone had started to fill in at the area of resorption. In all cases, there was a loss of correction with regard to anterior and middle column height and sagittal balance at the latest follow-up. Based on the obtained data, the authors by ethical obligation discontinued and redesigned the study. At this moment, we are interested in whether or not Meisel et al. [13] considered discontinuing and redesigning their study after they faced such vertebral resorptions in their patients at 3 months postoperatively (enrollment of the patients lasted from January until June of 2004). We had to emphasize that back in 2004 only a few researchers had some information about the resorptions and their clinical impacts, but that information for some reason has not been presented to T. Smoljanovic (&) I. Bojanic D. Delimar Department of Orthopaedic Surgery, Clinical Hospital Center Zagreb, School of Medicine, Zagreb University, Zagreb, Croatia e-mail: drsmoljanovic@yahoo.com

Relationship between 2000-m rowing ergometer performance times and World Rowing Championships rankings in elite-standard rowers

Abstract In this study, we evaluated the extent to which 2000-m rowing ergometer performance times predicted final rankings at the World Rowing Championships in a sample of 638 rowers of both sexes and body-mass classifications (i.e. open-category and lightweight rowers). Rowing ergometer performance times were examined using a questionnaire, and in 17 of 23 events they were positively correlated (P ≤ 0.049) with the final rankings at the Championships. The highest correlations were for the ergometer performance times achieved by rowers in lightweight mens single sculls (r = 0.78; P = 0.005), womens single sculls (r = 0.75; P = 0.002), mens single sculls (r = 0.72; P = 0.004), and lightweight mens double sculls (r = 0.72; P < 0.001). We used linear regression to establish regression equations to predict final rankings based on 2000-m rowing ergometer performance times for each event in which there was a correlation greater than r = 0.50. Although correlations in 12 events met this criterion, the large standard errors of the estimate hindered ranking predictions in all of the studied events. Regression equations could be used to determine the most probable 2000-m ergometer performance time for a rower to achieve specific rankings at the World Rowing Championships.

Osteochondritis dissecans of the elbow: excellent results in teenage athletes treated by arthroscopic debridement and microfracture.

Aim To extend the microfracture procedure, which has been proven successful on osteochondritis dissecans (OCD) lesions in the knee and ankle, to OCD lesions in the elbow. Methods Nine young patients were treated by arthroscopic debridement and microfracture by a single surgeon. The average age at operation was 15.0 years (median 15; range 12-19). The average length of the follow-up was 5.3 years (median 5; range 2-9). The follow-up included physical examination and patient interview with elbow function scoring. Success of treatment was determined according to pre-operative and follow-up Mayo Elbow Performance Index scores and the patients’ return to sports. Results Eight patients scored excellent results on the follow-up and 1 scored a good result. Four out of 9 patients were able to increase their training intensity, 2 returned to the same level of activity, 2 changed sports (due to reasons unrelated to the health of their elbow), and 1 left professional sports and started training only recreationally. No patients stopped participating in sports altogether. Conclusions We advocate arthroscopic microfracturing, followed by a strict rehabilitation regime, as a highly effective treatment for OCD of the humeral capitellum.

Localized pigmented villonodular synovitis of the knee: diagnostic challenge and arthroscopic treatment: a report of three cases

Abstract. The localized form of pigmented villonodular synovitis (LPVS) is a lesion characterized by focal involvement of the synovial membrane. The knee is the most commonly affected joint. We report three cases of LPVS of the knee which were not diagnosed upon clinical evaluation. The aim is to bring the attention of clinicians to this pathological entity, which is often regarded as extremely rare and is therefore not considered in the early differential diagnosis of various knee derangements. Diagnostic and therapeutic arthroscopy was performed. The lesions were completely resected and patohistological findings confirmed the diagnosis of LPVS. All of our three patients have remained asymptomatic at 8, 10, and 12-month follow-ups.

Surgical treatment of diaphyseal stress fractures of the fifth metatarsal in competitive athletes: long-term follow-up and computerized pedobarographic analysis.

BACKGROUND Proximal diaphyseal stress fractures of the fifth metatarsal are common in athletes. Conservative treatment has been shown to result in high rates of delayed union, nonunion, and refracture, so internal fixation has become the treatment of choice in competitive athletes. METHODS Twenty top-level athletes with diaphyseal stress fractures fixed with intramedullary malleolar screws were evaluated. Functional outcome was assessed by American Orthopaedic Foot and Ankle Society midfoot score. Static and dynamic maximum vertical force and peak plantar pressures were evaluated with a computerized pedobarograph. RESULTS Mean follow-up from surgery to interview was 10.3 years (range, 3.5-19.0 years). Clinical healing was 95%, and there has been one refracture (5%). The mean time from surgery to return to sport was 9 weeks (range, 5-14 weeks). Twelve athletes (60%) returned to a higher level of training, 7 (35%) to the same level, and 1 (5%) to a lower level compared with the level of training before injury. Average American Orthopaedic Foot and Ankle Society midfoot score was 93.8 (range, 85-100). During the computerized pedobarographic evaluations, 18 patients (90%) presented with varus of the metatarsus and the midfoot and 2 (10%) presented with a normal plantigrade foot. CONCLUSIONS Intramedullary malleolar screws can yield reliable and effective healing of fifth metatarsal stress fractures in athletes. Varus of the metatarsus and the midfoot were predisposing factors for stress fractures in this population of competitive athletes, and all were recommended to wear orthoses until their competitive careers were completed.

Pentadecapeptide BPC 157 (PL 14736) improves ligament healing in the rat

We improved medial collateral ligament (MCL) healing throughout 90 days after surgical transection. We introduced intraperitoneal, per‐oral (in drinking water) and topical (thin cream layer) peptide therapy always given alone, without a carrier. Previously, as an effective peptide therapy, stable gastric pentadecapeptide BPC 157 (GEPPPGKPADDAGLV, an anti‐ulcer peptide effective in inflammatory bowel disease therapy (PL 14736)) particularly improved healing of transected tendon and muscle and wound healing effect including the expression of the early growth response 1 (egr‐1) gene. After MCL transection BPC 157 was effective in rats when given once daily intraperitoneally (10 µg or 10 ng/kg) or locally as a thin layer (1.0 µg dissolved in distilled water/g commercial neutral cream) at the site of injury, first application 30 min after surgery and the final application 24 h before sacrifice. Likewise, BPC 157 was effective given per‐orally (0.16 µg/ml in the drinking water (12 ml/day/rat)) until sacrifice. Commonly, BPC 157 µg‐ng‐rats exhibited consistent functional, biomechanical, macroscopic and histological healing improvements. Thus, we suggest BPC 157 improved healing of acute ligament injuries in further ligament therapy.

Arthroscopic retrieval of metal foreign bodies from the knee joint after war wounds

From 1991 to 1995 metal bodies were removed from 16 knee joints (in 16 patients) using arthroscopic procedures. In 14 patients the wound resulted from explosive devices and in two from rifle bullets. Nine patients had more than one wound. Arthroscopy was performed on average 8.23 months after the injury took place (ranging from 14 days to 4 years). One metal foreign body was retrieved from 13 patients, two from two and four from one patient. The size of the metal foreign bodies varied from 2 to 24 mm, with an average of 8.61 mm. Different degrees of joint damage were present in all but one patient. The metal bodies were found in the posterolateral angle by the popliteus tendon in four patients, in three of whom the metal bodies went into this position during arthroscopy.