Mary Lloyd Ireland

Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies.

An estimated 80,000 anterior cruciate ligament (ACL) tears occur annually in the United States. The highest incidence is in individuals 15 to 25 years old who participate in pivoting sports. With an estimated cost for these injuries of almost a billion dollars per year, the ability to identify risk factors and develop prevention strategies has widespread health and fiscal importance. Seventy percent of ACL injuries occur in noncontact situations. The risk factors for non-contact ACL injuries fall into four distinct categories: environmental, anatomic, hormonal, and biomechanical. Early data on existing neuromuscular training programs suggest that enhancing body control may decrease ACL injuries in women. Further investigation is needed prior to instituting prevention programs related to the other risk factors.

Understanding and Preventing Noncontact Anterior Cruciate Ligament Injuries A Review of the Hunt Valley II Meeting, January 2005

The incidence of noncontact anterior cruciate ligament injuries in young to middle-aged athletes remains high. Despite early diagnosis and appropriate operative and nonoperative treatments, posttraumatic degenerative arthritis may develop. In a meeting in Atlanta, Georgia (January 2005), sponsored by the American Orthopaedic Society for Sports Medicine, a group of physicians, physical therapists, athletic trainers, biomechanists, epidemiologists, and other scientists interested in this area of research met to review current knowledge on risk factors associated with noncontact anterior cruciate ligament injuries, anterior cruciate ligament injury biomechanics, and existing anterior cruciate ligament prevention programs. This article reports on the presentations, discussions, and recommendations of this group.

Core stability measures as risk factors for lower extremity injury in athletes.

INTRODUCTION/PURPOSE Decreased lumbo-pelvic (or core) stability has been suggested to contribute to the etiology of lower extremity injuries, particularly in females. This prospective study compares core stability measures between genders and between athletes who reported an injury during their season versus those who did not. Finally, we looked for one or a combination of these strength measures that could be used to identify athletes at risk for lower extremity injury. METHODS Before their season, 80 female (mean age = 19.1 +/- 1.37 yr, mean weight 65.1 +/- 10.0 kg) and 60 male (mean age = 19.0 +/- 0.90 yr, mean weight 78.8 +/- 13.3 kg) intercollegiate basketball and track athletes were studied. Hip abduction and external rotation strength, abdominal muscle function, and back extensor and quadratus lumborum endurance was tested for each athlete. RESULTS Males produced greater hip abduction (males = 32.6 +/- 7.3%BW, females = 29.2 +/- 6.1%BW), hip external rotation (males = 21.6 +/- 4.3%BW, females = 18.4 +/- 4.1%BW), and quadratus lumborum measures (males = 84.3 +/- 32.5 s, females = 58.9 +/- 26.0 s). Athletes who did not sustain an injury were significantly stronger in hip abduction (males = 31.6 +/- 7.1%BW, females = 28.6 +/- 5.5%BW) and external rotation (males = 20.6 +/- 4.2%BW, females = 17.9 +/- 4.4%BW). Logistic regression analysis revealed that hip external rotation strength was the only useful predictor of injury status (OR = 0.86, 95% CI = 0.77, 0.097). CONCLUSION Core stability has an important role in injury prevention. Future study may reveal that differences in postural stability partially explain the gender bias among female athletes.

Core stability and its relationship to lower extremity function and injury.

&NA; Core stability may provide several benefits to the musculoskeletal system, from maintaining low back health to preventing knee ligament injury. As a result, the acquisition and maintenance of core stability is of great interest to physical therapists, athletic trainers, and musculoskeletal researchers. Core stability is the ability of the lumbopelvic hip complex to prevent buckling and to return to equilibrium after perturbation. Although static elements (bone and soft tissue) contribute to some degree, core stability is predominantly maintained by the dynamic function of muscular elements. There is a clear relationship between trunk muscle activity and lower extremity movement. Current evidence suggests that decreased core stability may predispose to injury and that appropriate training may reduce injury. Core stability can be tested using isometric, isokinetic, and isoinertial methods. Appropriate intervention may result in decreased rates of back and lower extremity injury.

Knee injuries in female athletes

SummaryFemale athletes are at increased risk for certain sports-related injuries, particularly those involving the knee. Factors that contribute to this increased risk are the differences in sports undertaken and in gender anatomy and structure. Gender differences include baseline level of conditioning, lower extremity alignment, physiological laxity, pelvis width, tibial rotation and foot alignment. Sports like gymnastics and cheerleading create a noncontact environment, but can result in significant knee injuries. In quick stopping and cutting sports, females have an increased incidence of anterior cruciate ligament (ACL) injury by noncontact mechanisms. Patellofemoral (PF) disorders are also very common in female athletes.Awareness of these facts helps the sports medicine professional make an accurate diagnosis and institute earlier treatment-focused rehabilitation with or without surgery. Further prospective and retrospective research is needed in areas of epidemiology, mechanisms, severity and types of knee injuries. The goal is to lessen the severity of certain knee injuries and to prevent others.

Gender differences in noncontact anterior cruciate ligament injuries.

Female athletes have an increased incidence of ACL rupture. The cause of this increased injury rate is unclear, but it is most likely from a complex interplay between multiple variables. The relative risk of incurring an ACL injury is still low. The increased risk of ACL injury in women compared with men should not discourage female participation in sports. Instead, the focus should be on strategies to prevent injuries. Intrinsic factors are difficult or impossible to change; modifiable risk factors need to identified and prevention strategies should be employed.

A radiographic analysis of the relationship between the size and shape of the intercondylar notch and anterior cruciate ligament injury

Notch-view radiographs were obtained from 108 persons with anterior cruciate ligament (ACL) injuries (55 women, 53 men) and 186 with intact ACL (94 women, 92 men). Notch width, femur width, and notch width index were determined from each of the 294 radiographs. The notch was also categorized as either A-shaped or non-A-shaped. Intrarater and interrater reliability ranged from 0.82 to 0.99 for notch width and femur width, respectively. Reliability within and between raters for the classification of notch shape ranged from 0.80 to 1.0. Notch width was significantly influenced by a 10° change in knee angle when repeated radiographs were taken. Femur width was not affected by knee angle across this range. Analysis revealed a higher proportion of A-shaped notches among women than men. However, notch shape was not related to injury status. Results showed a smaller notch width and notch width index in ACL-injured patients regardless of notch shape or gender. A-shaped notches were smaller than non-A-shaped notches regardless of injury status or gender. Both notch width and notch width index were found to be significant indicators of ACL injury. Knowledge of the shape of the notch added no useful information in differentiating patients based on injury status. Thus, regardless of gender, individuals who possess smaller notch dimensions appear to be at greater risk of injury than individuals with larger notches.

Common compartment syndromes in athletes : treatment and rehabilitation

SummaryCompartment syndromes in athletes are rare, but they can also be limb-threatening events. Chronic exertional compartment syndrome (CECS) is a less emergent form where symptoms recur with repetitive loading or exertional activities. CECS is the most common form of compartment syndrome seen in athletes. Acute compartment syndromes may also occur in athletes secondary to direct trauma or may develop from pre-existing CECS.The leg is by far the most common site of compartment syndrome in athletes. The thigh, forearm, and foot are the next most common sites, although any fascially limited compartment can be affected. Awareness of the clinical presentation and pathophysiology of compartment syndromes can help the examiner make a prompt and accurate diagnosis.The treatment of acute compartment syndrome is emergent while the treatment of CECS is not. Conservative treatment and rehabilitation can be successful in treating CECS. Acute compartment syndromes must be treated immediately with surgical decompression. With CECS, if conservative treatment fails, surgical decompression is also indicated. Some authors have suggested that the results of surgical fasciotomy and rate of return to sport for athletes with CECS has not been uniform. If the diagnosis is accurate and carefully documented, a high degree of success with athletes returning to sport can be expected.

Acute fracture bipartite patella: case report and literature review

Disorders of the patella are the most common cause of anterior knee pain. The etiologies of anterior knee pain are reviewed. A case report of an acute displaced patella fracture in a bipartite union is presented. Bipartite patellar development, incidence, radiographic findings, and clinical symptoms follow. Treatment of excision of displaced fragment provides an excellent result.

Acute effects of the Protonics system on patellofemoral alignment: an MRI study

This study used magnetic resonance imaging (MRI) to determine whether changes in patellofemoral alignment occur after initial treatment with the Protonics exercise device. The first scan was obtained before the device was used. After performing a set of exercises with no resistance on the device the device was removed, and a second scan was obtained. The same set of exercises was again performed with resistance on the device set at the appropriate level, and a final scan was obtained with the device removed. An isometric leg press was maintained as each image was obtained to simulate more closely a functional weight-bearing activity. Subjects were 26 women with complaints of patellofemoral pain. The main outcome measures were: patellar tilt angle, bisect offset, and lateral facet angle. Nonparametric repeated measures analysis of variance tests showed no differences between test conditions for any of the three measures of patellofemoral alignment. We conclude that after an initial treatment session using the Protonics system there is no change in patellofemoral alignment as determined by MRI.