Selene G. Parekh

The Morbidity Associated With Osteochondral Harvest From Asymptomatic Knees for the Treatment of Osteochondral Lesions of the Talus

Background Mosaic autogenous osteochondral transplantation has been used to treat large osteochondral defects. Hypothesis There is potential, previously unrecognized donor-site morbidity associated with osteochondral harvest from asymptomatic knees for the treatment of talar osteochondral defect lesions. Study Design Case series; Level of evidence, 4. Methods Fifteen patients underwent mosaic osteochondral transplantation to treat a talar osteochondral defect lesion, with 11 patients available for follow-up. A Lysholm knee score was used to assess donor-site morbidity at a mean follow-up of 47 months (range, 7-77 months). Mean age was 29 years (range, 21-44 years). A single surgical team performed the mosaicplasties. Significance was determined using the Student t test. Results All patients had asymptomatic knees preoperatively. Mean postoperative Lysholm score was 81 (range, 49-100). By Lysholm criteria, 5 rated as excellent, 2 as good, and 4 as poor. No significant difference was detected in terms of the harvest method or the number of grafts obtained from those having an excellent rating versus those having a good/poor rating. Patients rated as good/poor cited knee instability in daily activities as the most common problem. One had knee pain and patellar instability after osteochondral harvest by lateral arthrotomy that required a subsequent lateral retinacular release and tibial tubercle osteotomy. Conclusion This study demonstrates that donor-site morbidity after osteochondral harvest can be significant. In this population, those who experienced a decline in knee function had problems performing activities of daily living. When performing these procedures, the authors recommend that surgeons consider these risks and discuss them with their patients.

Outcomes of Anterior Cruciate Ligament Injuries to Running Backs and Wide Receivers in the National Football League

Background Anterior cruciate ligament injuries are common in professional football players, and their career impact is unclear. Purpose To quantify the affect of anterior cruciate ligament injuries on professional football player performance. Study Design Cohort study (prognosis); Level of evidence, 2. Methods Anterior cruciate ligament injury data from the National Football League were collected during a 5-year period (1998-2002) for running backs and wide receivers. Recorded variables included player age, experience, position, time to return to competition, and yearly total yards and touchdowns. Power ratings (total yards divided by 10 plus touchdowns multiplied by 6) were calculated for the injury season as well as for the 3 seasons before and after injury. A control group consisted of all running backs and wide receivers without an identified anterior cruciate ligament injury who competed in the 2000 season. Results Data were analyzed for 31 running backs and wide receivers with 33 anterior cruciate ligament injuries. More than one fifth of players never returned to a National Football League game. Returning players first competed in a game 55.8 ± 5.4 weeks (mean ± standard error) after injury. For the 24 anterior cruciate ligament–injured players with a minimum total power rating (sum of all 7 seasons) of 200 points, power rating per game played decreased from 9.9 ± 1.1 preinjury to 6.5 ± 0.9 postinjury. This decline in power rating per game played was statistically significant (P =. 002) when compared with the change for the 146 control players. Conclusion Nearly four fifths of National Football League running backs and wide receivers who sustain an anterior cruciate ligament injury return to play in a game. On return to competition, player performance of injured players is reduced by one third.

Operative Treatment for Peroneal Tendon Disorders

Peroneal tendon disorders are rare, are frequently missed, and can be a source of lateral ankle pain. Magnetic resonance imaging is the standard method of radiographic evaluation of peroneal tendon disorders; however, diagnosis and treatment are based primarily on the history and physical examination. Peroneal tenosynovitis typically responds to conservative therapy, and operative treatment is reserved for refractory cases. Operative treatment is frequently required for peroneal tendon subluxation and consists of anatomic repair or reconstruction of the superior peroneal retinaculum with or without deepening of the retromalleolar groove. Operative treatment of peroneal tendon tears is based on the amount of remaining viable tendon. Primary repair and tubularization is indicated for tears involving <50% of the tendon, and tenodesis is indicated for tears involving >50% of the tendon.

Lesser Toe Deformities

Abstract Lesser toe deformities are caused by alterations in normal anatomy that create an imbalance between the intrinsic and extrinsic muscles. Causes include improper shoe wear, trauma, genetics, inflammatory arthritis, and neuromuscular and metabolic diseases. Typical deformities include mallet toe, hammer toe, claw toe, curly toe, and crossover toe. Abnormalities associated with the metatarsophalangeal (MTP) joints include hallux valgus of the first MTP joint and instability of the lesser MTP joints, especially the second toe. Midfoot and hindfoot deformities (eg, cavus foot, varus hindfoot, valgus hindfoot with forefoot pronation) may be present, as well. Nonsurgical management focuses on relieving pressure and correcting deformity with various appliances. Surgical management is reserved for patients who fail nonsurgical treatment. Options include soft‐tissue correction (eg, tendon transfer) as well as bony procedures (eg, joint resection, fusion, metatarsal shortening), or a combination of techniques.

Epidemiology and Outcomes of Achilles Tendon Ruptures in the National Football League

The purpose of this study is to document the epidemiology of Achilles tendon ruptures in the National Football League (NFL) and to quantify the impact of these injuries on player performance. A retrospective review of several online NFL player registries identified 31 Achilles tendon ruptures in NFL players between 1997 and 2002. Nineteen percent of injuries occurred during preseason play, while another 18% occurred during the first month of the official season. There was a postinjury reduction of 88%, 83%, and 78% in power ratings for wide receivers, running backs, and tight ends, respectively, over a 3-year period. There was a 95%, 87%, and 64% postinjury reduction in power ratings for linebackers, cornerbacks, and defensive tackles over a 3-year period. On average, players experienced a greater than 50% reduction in their power ratings following such an injury. Thirty-two percent (n = 10) of NFL players who sustained an Achilles tendon rupture did not return to play in the NFL.

Tendon Disorders of the Foot and Ankle, Part 3: The Posterior Tibial Tendon

This article provides a review of posterior tibial tendon pathology and the authors’ preferred management. The tibialis posterior musculotendinous unit is the most powerful inverter of the foot and an important dynamic stabilizer of the arch. In the stance phase of the gait cycle, it serves as an initiator of both ankle plantar flexion and subtalar inversion. This creates a rigid midfoot by stabilizing the transverse tarsal joint, and allows for increased power generation by the gastrocsoleus complex through toe-off. Injuries to the posterior tibialis tendon include traumatic laceration and dislocation, as well as tenosynovitis and tendinopathy, which can lead to attenuation and rupture. If these injuries are not addressed, significant clinical deformity and disability can result.

Tendon Disorders of the Foot and Ankle, Part 2 Achilles Tendon Disorders

Disorders of the Achilles tendon include both acute and chronic ruptures as well as a spectrum of chronic overuse injuries involving inflammatory and degenerative changes within the tendon and surrounding tissues. These injuries are relatively common in athletes as well as among the general population. There is no consensus on the optimal treatment of Achilles tendon disorders. The goals of this review are to develop a current understanding of the anatomy and diagnostic evaluation of the Achilles tendon, and to present current treatment options and the authors’ preferred surgical techniques for operative management of Achilles tendon disorders.

Tendon Disorders of the Foot and Ankle, Part 1 Peroneal Tendon Disorders

Pathologic abnormality of the peroneal tendons is an uncommon but underappreciated source of lateral hindfoot pain and dysfunction that can be difficult to distinguish from lateral ankle ligament injuries. When left untreated, peroneal tendon disorders can lead to persistent lateral ankle pain and substantial functional problems. Unfortunately, the treatment recommendations for these disorders are primarily based on case series and expert opinion. The goals of this review are to develop a current understanding of the anatomy and diagnostic evaluation of the peroneal tendons, and to present current treatment options and the authors’ preferred surgical techniques for operative management of peroneal tendon lesions.

Surgical treatment for chronic disease and disorders of the achilles tendon

&NA; Chronic Achilles tendon disorders range from overuse syndromes to frank ruptures. Numerous forms of treatment have been used, depending on the nature of the disorder or injury. Ultrasonography and magnetic resonance imaging are commonly used for evaluation. The spectrum of disease comprises paratenonitis, tendinosis, paratenonitis with tendinosis, retrocalcaneal bursitis, insertional tendinosis, and chronic rupture. However, there is no clear consensus on what defines a chronic Achilles disorder. Nonsurgical therapy is the mainstay of treatment for most patients with overuse syndromes. Surgical techniques for overuse syndromes or chronic rupture include débridement, local tissue transfer, augmentation, and synthetic grafts. Local tissue transfer most commonly employs either the flexor hallucis longus or flexor digitorum longus tendon to treat a chronic rupture. Reports on long‐term outcomes are needed before useful generalizations can be made regarding treatment.

Prophylactic Bracing Decreases Ankle Injuries in Collegiate Female Volleyball Players

Background Ankle injuries account for the highest percentage of injuries among female collegiate volleyball players. Since 1998, all female volleyball players at the authors’ institution have worn bilateral double-upright padded ankle braces at all times. Purpose To review the authors’ experience with this brace in preventing ankle injuries that result in a loss of play. Study Design Case series; Level of evidence, 4. Methods Injury data, preparticipation medical histories, and total exposure data were collected prospectively on all female volleyball players at the authors’ institution from 1998 to 2005. Injuries and exposures were defined based on established National Collegiate Athletic Association Injury Surveillance System criteria. Injury rate was calculated as the number of injuries per 1000 exposures. The National Collegiate Athletic Association female volleyball injury data from 1998 to 2005 were used for comparison. Results During the study period, there were a total of 13 500 exposures and 1 injury in our group yielding an injury rate of 0.07 per 1000 exposures. Nearly half of our athletes had a preparticipation history of ankle sprains, yet only 1 ankle injury occurred during all of our braced exposures. Conclusion There were 811 710 exposures and 797 injuries in the National Collegiate Athletic Association comparison group with an increased injury rate of 0.98 per 1000 exposures (P = .001). Prophylactic use of a double-upright ankle brace significantly reduced the ankle injury rate compared with that reported by the National Collegiate Athletic Association. From these data, it appears that the use of such a brace is an effective way to decrease the incidence of ankle injuries in this active but vulnerable group of athletes.