Leif Swärd

Disc degeneration and associated abnormalities of the spine in elite gymnasts : a magnetic resonance imaging study

The thoracolumbar spine was examined by magnetic resonance imaging (MRI) and the history of back pain was analyzed in 24 male elite gymnasts (age range, 19–29 years) and in 16 male nonathietes (age range, 23–36 years). Disc degeneration, defined as reduced disc signal intensity, was significantly more common in athletes (75%) than in nonathletes (31%). The gymnasts also had a higher incidence of other abnormalities of the thoracolumbar spine, and there was a significant correlation between reduced disc signal intensity and the other abnormalities among the gymnasts. There were also significant correlations between back pain and reduced disc signal intensity and abnormal vertebral configuration when the gymnasts and the nonathletes were pooled. Male elite gymnasts run a high risk of developing severe abnormalities of the thoracolumbar spine, and they often have a history of back pain.

Back pain and radiologic changes in the thoraco-lumbar spine of athletes

Back pain and radiological changes of the thoracolumbar spine were investigated in 142 top athletes, representing wrestling, gymnastics, soccer and tennis (age range 14-25 years). All groups of athletes reported back pain at high frequencies (50-85%). Male gymnasts had significantly increased incidence and severity of back pain as compared to the rest of the athletes. Radiological abnormalities occurred in 36-55% of the athletes. Reduced disc height, Schmorls nodes and change of configuration of vertebral bodies correlated with back pain (P<0.05, P<0.01 and P<0.05): Significant covariation between these types of abnormalities was found. Athletes with great demands on the back are thus subjected to an increased risk of symptomatic damage of the spine.

Comparison of Two Anatomic Reconstructions for Chronic Lateral instability of the Ankle Joint

Two anatomic reconstructions for correction of chronic lateral ankle joint instability were compared. In a pro spective, randomized study, 60 patients were allocated to one of two treatment groups: reconstruction of the ligaments as described by Karlsson et al. (Group I) or with the modification of the Broström procedure as described by Gould et al. (Group II). The functional results were evaluated with a scoring scale, and the mechanical stability with standardized stress radio graphs. The minimum follow-up period was 2 years. The functional results were satisfactory in 27 of 30 (90%) patients in Group I and 25 of 30 (83%) in Group II. There was no significant difference between the groups regarding mechanical stability. The mean an terior talar translation in Group I was 7.1 mm (range, 4 to 10) at followup, compared with 6.7 mm (range, 3 to 9) in Group II. The corresponding values for talar tilt were 4.9° (range, 0° to 8°) in Group I and 4.4° (range, 0° to 8°) in Group II. The duration of operation time was significantly longer in Group II and surgical complica tions were more frequent, probably due to the more extensive surgical exposure. This study showed that the majority of patients with chronic ankle instability can be successfully treated with anatomic reconstruc tion of the lateral ankle ligaments. Mechanical stability was restored with both methods.

Kinematics and laxity of the knee joint after anterior cruciate ligament reconstruction: pre- and postoperative radiostereometric studies.

Background Injury of the anterior cruciate ligament changes the kinematics of the knee joint. In studies of cadaveric knees, investigators have examined the effect of anterior cruciate ligament reconstruction on knee kinematics, but the effect on dynamic knee motion is not known. Hypothesis Reconstruction of the anterior cruciate ligament restores knee kinematics to normal. Study Design Prospective cohort study. Methods Nine patients were examined preoperatively and 1 year after reconstruction. Continuous radiostereometric exposures were performed at a speed of two to four exposures per second while the patients ascended an 8-cm high platform. Tibial rotation and tibial and femoral translation were measured with radiostereometric analysis. Results Tibial rotation and tibial and femoral translation were not significantly different after anterior cruciate ligament reconstruction compared with preoperative measurements. A radiostereometric evaluation of anterior knee laxity revealed restoration to within 1 mm of that on the uninjured side. Further evaluation of knee function using the Lysholm score, the Tegner activity level score, the International Knee Documentation Committee evaluation system score, and measurements of laxity using the KT-1000 arthrometer revealed significant improvements after reconstruction. Conclusion Kinematics of the anterior cruciate ligament injured knee did not change significantly after ligament reconstruction, but the functional results were satisfactory and knee laxity was diminished.

Back pain and radiological changes in the thoraco-lumbar spine of athletes. A long-term follow-up

From 1996 to 1999, back pain and radiological changes in the thoraco‐lumbar spine were investigated in 134 former top athletes, representing wrestling, gymnastics, soccer and tennis (age 27–39 years) and a group of 28 non‐athletes of comparable age. This is a long‐term follow‐up investigation of a previous radiological study of the spine with clinical correlation. Despite significantly more radiological abnormalities among the athletes, they did not report higher frequency of back pain than the non‐athletes. A decrease in disc height or new disc height reduction in one or more of the intervertebral discs between the two examinations correlated significantly with back pain at follow‐up.

Early functional treatment for acute ligament injuries of the ankle joint

Eighty‐six patients with acute (<24 h) grade II or III lateral ligament ruptures were randomized into two different non‐surgical treatment groups. The main difference in treatment protocols between the two groups was during the first week after injury. Group I (n=46) was to receive functional treatment using specially designed compression pads, elevation of the injured foot (24 h), repeated elastic wrapping (compression bandage followed by ankle tape), early full weight‐bearing and proprioceptive range‐of‐motion training. Group II (n=40) was to receive conventional treatment with an elastic bandage, partial weight bearing and crutches until the pain subsided. One week after the injury, patients from both groups were given identical rehabilitation instructions. No early surgery was performed. The mean follow‐up period was 18 months. The functional results were satisfactory in 91% of the patients in group I and in 87% of the patients in group II (NS). Five patients had been operated on due to recurrent instability, two in group I and three in group II (NS). The mean sick leave was significantly shorter in group I; 5.6±4.2 days compared with 10.2±6.8 days in group II. Return to sports activities was also significantly earlier in group I, 9.6±4.8 days compared with 19.2±9.5 days in group II. In this study, non‐surgical treatment of acute grade II and III ligament injuries of the ankle produced satisfactory results in the majority of patients. Early functional treatment resulted in shorter sick leave and facilitated an earlier return to sports, but it did not influence the final results.

Anthropometric Characteristics, Passive Hip Flexion, and Spinal Mobility in Relation to Back Pain in Athletes

Anthropometric characteristics, passive hip flexion, and spinal mobility were examined and back pain was registered in 116 top Swedish male athletes representing four different sports (wrestling, gymnastics, soccer, tennis). Differences in stature, body weight, passive hip flexion, mobility of the spine in forward flexion, and asymmetry of the back were found when each group of athletes was compared with the rest of the athletes. These differences could be explained by a natural selection of individuals with the physical constitution required for the sport concerned, but they may also be a long-term effect of training. A small sacral inclination, defined as the sacro-horizontal angle, correlated significantly with back pain.

The thoracolumbar spine in young elite athletes. Current concepts on the effects of physical training.

Due to the increased interest in physical fitness and to the fact that athletes start their training at younger ages the risk for injuries to the growing individual has increased. The spine, as with the rest of the skeleton, is at greater risk of injury during growth, especially during the adolescent growth spurt. Back pain is more common among athletes participating in sports with high demands on the back than other athletes and nonathletes. Disc degeneration, defined as disc height reduction on conventional radiographs and reduced disc signal intensity on MRI, has been found in a higher frequency among wrestlers and gymnasts than nonathletes. Abnormalities of the vertebral bodies including abnormal configuration, Schmorls nodes and apophyseal changes are common among athletes. These abnormalities are similar to those found in Scheuermanns disease. Athletes with these types of abnormalities have more back pain than those without. Spondylolysis has been found in higher frequencies than expected among athletes representing many different sports. Spondylolysis has been reported in up to 50% of athletes with back pain. Scoliosis has been found in up to 80% of athletes with an asymmetric load on the trunk and shoulders, such as javelin throwers and tennis players. The scoliosis, however, is a small curvature and does not cause back pain.SummaryDue to the increased interest in physical fitness and to the fact that athletes start their training at younger ages the risk for injuries to the growing individual has increased. The spine, as with the rest of the skeleton, is at greater risk of injury during growth, especially during the adolescent growth spurt.Back pain is more common among athletes participating in sports with high demands on the back than other athletes and nonathletes.Disc degeneration, defined as disc height reduction on conventional radiographs and reduced disc signal intensity on MRI, has been found in a higher frequency among wrestlers and gymnasts than nonathletes.Abnormalities of the vertebral bodies including abnormal configuration, Schmorl’s nodes and apophyseal changes are common among athletes. These abnormalities are similar to those found in Scheuermann’s disease. Athletes with these types of abnormalities have more back pain than those without.Spondylolysis has been found in higher frequencies than expected among athletes representing many different sports. Spondylolysis has been reported in up to 50% of athletes with back pain.Scoliosis has been found in up to 80% of athletes with an asymmetric load on the trunk and shoulders, such as javelin throwers and tennis players. The scoliosis, however, is a small curvature and does not cause back pain.

Total dislocation of the hip joint after arthroscopy and ileopsoas tenotomy

AbstractThe hip is a highly stable joint. Non-traumatic dislocation of the hip is extremely uncommon. In this article, we report two cases of non-traumatic hip dislocations following hip arthroscopy. In both cases, capsulotomy and ileopsoas tenotomy had been performed. These cases raise questions about the importance of the natural stabilisers of the hip. Level of evidence V.

Diagnostic value of ultrasonography in partial ruptures of the Achilles tendon

We evaluated 37 patients with surgically treated Achilles tendon disorders, comparing findings of pre operative ultrasonography with findings at surgery, to investigate the reliability of ultrasonography in diagnos ing partial ruptures of the Achilles tendon. Discontinuity of tendon fibers, focal sonolucencies, and localized tendon swelling were positive findings suggestive of partial ruptures. We found the use of ultrasonography to be safe and reliable, with a sensitivity of 0.94, a specificity of 1.00, and an overall accuracy of 0.95.