Jarmo Karpakka

Risk Factors for Recurrent Stress Fractures in Athletes

Our aim was to identify factors predisposing athletes to multiple stress fractures, with the emphasis on biomechanical factors. Our hypothesis was that certain anatomic factors of the ankle are associated with risk of multiple stress fractures of the lower extremities in athletes. Thirty-one athletes (19 men and 12 women) with at least three separate stress fractures each, and a control group of 15 athletes without fractures completed a questionnaire focusing on putative risk factors for stress fractures, such as nutrition, training history, and hormonal history in women. Bone mineral density was measured by dual-energy x-ray absorptiometry in the lumbar spine and proximal femur. Biomechanical features such as foot structure, pronation and supination of the ankle, dorsiflexion of the ankle, forefoot varus and valgus, leg-length inequality, range of hip rotation, simple and choice reaction times, and balance in standing were measured. There was an average of 3.7 (range, 3 to 6) fractures in each athlete, totaling 114 fractures. The fracture site was the tibia or fibula in 70% of the fractures in men and the foot and ankle in 50% of the fractures in women. Most of the patients were runners (61%); the mean weekly running mileage was 117 km. Biomechanical factors associated with multiple stress fractures were high longitudinal arch of the foot, leg-length inequality, and excessive forefoot varus. Nearly half of the female patients (40%) reported menstrual irregularities. Runners with high weekly training mileage were found to be at risk of recurrent stress fractures of the lower extremities.

Surgical Treatment of Overuse Injuries to the Achilles Tendon

AbstractA clinical survey was made of 275 consecutive overuse injuries of the Achilles tendon in 228 patients (170 men; 58 women) operated on during the period 1980–1989 at the Clinic of Sports Medicine, Deaconess Institute of Oulu, Finland, (prospective material) and at the Department of Surgery of Oulu University Central Hospital (retrospective material); 60% of patients lived in Northern Finland, 22% elsewhere in Finland, and 18% abroad. Their mean age was 32 years, and 11.8% were athletes at the international level, 28.5% at the national level, and 19.7% at a district level; 39.5% were recreational athletes. There were more long- and middle-distance runners, joggers, and orienteers than other athletes. All the patients had undergone combinations of different modes of conservative treatment. The results of the operative treatment were excellent or good in 73.4% of cases, fair in 78.5%, and poor in 8.0%. There were 34 complications, of which 29 were wound complications; eight of these were treated surgically with good results. Thirty reoperations were needed by 22 patients because of recurrence of pain or operative failure. The total results including those of reoperations, were excellent or good in 219 cases (79.7%), fair in 54 (19.6%), and poor in 2 (0.7%).

Repair of partial quadriceps tendon rupture. Observations in 28 cases.

We operated on 28 patients with partial rupture of the quadriceps tendon. A simple excision of the scar tissue and closure of the tendon gave an excellent or good result in 25 patients. Ultrasonography was useful to confirm the diagnosis.

The effects of anabolic steroids on collagen synthesis in rat skeletal muscle and tendon A preliminary report

We measured the activities of prolyl 4-hydroxylase and galactosylhydroxylysyl glucosyltransferase (both en zymes of collagen biosynthesis) and the concentration of hydroxyproline in male rat soleus muscle and Achilles tendon during anabolic steroid treatment at 1 and 3 weeks. The rats were treated using a therapeutic dos age or a dosage that was five times the therapeutic level. After 1 week, the activity of prolyl 4-hydroxylase decreased significantly (P < 0.01) in both treated groups in the soleus muscle, but the activity of galac tosylhydroxylsyl glucosyltransferase decreased signifi cantly (P < 0.05) only in the group given a therapeutic dose. After 3 weeks, the activities were at the control level. In the Achilles tendon, the activity of prolyl 4- hydroxylase and the hydroxyproline concentration de creased significantly (P < 0.05) in the group given high doses at 3 weeks. Anabolic steroid treatment seems to have at least a transitory effect on collagen biosyn thesis in male rat muscle and tendon; in tendon this effect is seen only with high doses.

Stress avulsion fracture of the tarsal navicular An uncommon sports-related overuse injury

We report nine cases of stress-related avulsion fracture of the tarsal navicular in athletes. This uncommon over use injury is thought to occur following repetitive cyclic compressive loading secondary to an impingement of the tarsal navicular. The small dorsal triangular frag ment is best seen in weightbearing lateral view radio graphs and isotope scan and/or tomography help con firm the diagnosis. We feel that operative treatment is the method of choice in highly symptomatic cases and among top athletes because of the shorter recovery time.

Recurrent Stress Fractures in a Female Athlete with Primary Amenorrhea: A Case Report

AbstractWe report a case of a female endurance athlete with clinical problems related to a compulsory urge to exercise. The relationships among stress fractures, bone mineral density, amenorrhea, and eating disorders are also discussed.