Stanley L. James

Injuries to runners

overuse syndromes. While there is abundant literature which describes the etiology, symptoms and management of various injuries sustained by runners, there is limited information regarding the incidence and distribution of these injuries with respect to such variables as classification, site (anatomic) and competitive event (running). A knowledge of the relative incidence, treatment and results of treatment of injuries to runners should provide not only a basis for better management but also a probable basis for increased utilization of preventive measures and earlier recognition and treatment of these injuries.

Asynchrony between subtalar and knee joint function during running

PURPOSE It has been suggested that during running proper coordination between subtalar joint pronation/supination and knee joint flexion/extension via tibial rotation is important to attenuate ground reaction impact forces (GRIF). Lack of coordination may produce over time a wide range of injuries. The goal of this study was to investigate the relationship between subtalar pronation/supination and knee flexion/extension with GRIF increases during distance running. METHODS Eight subjects ran under different speeds (a self-selected pace, 10% faster, 10% slower, and 20% faster) and over different obstacle heights (5%, 10%, and 15% of their standing height) on their self-selected pace. Sagittal, rear-view kinematic, and GRIF data were collected. The biomechanical results were also compared with data from a clinical evaluation of the subjects. RESULTS Speed changes and obstacle heights produced increases in GRIF and differences between rearfoot and knee angular velocities. The higher the obstacle and the faster the speed, the greater the GRIF and the greater the velocity differences. A change of the rearfoot angle curve from a unimodal (one minimum) to a bimodal (two minimums) parabolic configuration was also observed. The appearance of the second minimum was attributed to a lateral deviation of the tibia as a rebound effect due to the increased impact with the ground. The velocity differences between the actions of the subtalar and the knee joint, which in essence capture the antagonistic nature of their relationship, produced the highest correlation with the clinical evaluation. CONCLUSIONS It was suggested that a possible mechanism responsible for various running injuries could be lack of coordination between subtalar and knee joint actions. This mechanism may have potential for predicting runners with susceptibility to injury.

Partial calcaneal ostectomy for retrocalcaneal bursitis

Heel pain in runners is very common. Retrocalcaneal bursitis may be disabling to the competitive runner. When conservative treatment fails, surgery (partial cal caneal ostectomy) may be indicated. Ten patients un derwent partial calcaneal ostectomies at our clinic and returned to their desired level of activity within 6 months. When the surgeon adheres to the surgical principles outlined in this article, the results are uni formly good.

Reconstruction procedures for anterior cruciate ligament insufficiency: A computer analysis of clinical results

A pre- and postoperative study of 205 patients who had surgical reconstruction of the anterior cruciate lig ament (ACL) of the knee was evaluated with the use of a prototype computer program. An average followup of 4.1 years revealed a 27% improvement in subjective complaints and a 8% improvement in objective findings. The anterior drawer test was improved 25% and sub luxation of the lateral tibial plateau (ALRI) was improved 118% correlating highly (P < 0.001) with a good result. Seventy-four percent of patients had undergone medial meniscectomy, 58% lateral meniscectomy, and 41% had both menisci removed at followup after reconstruc tion. Ninety-two percent of the 121 patients responding to a final subjective complaint evaluation felt that their knee was significantly improved (average 6.1 years after reconstruction). The computer demonstrated a wide variation in the results of reconstruction within the intraarticular, extraarticular, and combined groups. The addition of associated procedures to the main recon structive procedure significantly affected the results. This study reveals improvement of subjective com plaints and objective findings after reconstructing the anterior cruciate ligament and proposes the use of computer analysis for specific evaluation of different procedures.

Patterns of tibial rotary torque in knees of healthy subjects

ABSTRACT OSTERNIG, LOUIS R., BARRY T. BATES, and STANLEY L. JAMES. Patterns of tibial rotary torque in knees of healthy subjects. Med. Sci. Sports Exercise. Vol. 12, No. 3, pp. 195–199, 1980. Discrepancies in measures of active tibial rotation have been attributed to methodological variability and failure to adequately control accompanying foot and thigh motion. The purpose of this study was to assess maximum active tibial rotation on twenty-eight males utilizing a technique designed to stabilize the foot and thigh. Eversion and inversion motions of the talocalcaneal joint were controlled by means of a special boot connected to an isokinetic dynamometer modified with a position potentiometer. The results revealed symmetry between contralateral limbs with mean total ranges of motion of 57° and 59° for the right and left legs, respectively when tested and 90° of knee flexion and 50° at 45° of flexion. Converting these data to internal and external rotary components disclosed significant discrepancies (21–38%) between two methods applied to determine rotary neutral position. No significant differences were found between contralateral limbs for maximum torque development at all positions measured. Both range of motion and torque were found to be less at 45° of knee flexion when compared to the 90° position. Force data showed that all subjects consistently generated 90–100% of their peak torque within the initial 5–10° of active rotation and sustained relatively high torque values throughout an additional 15–20° before sharply reducing force magnitudes. These data support the concept of “wind up” effect of the medial and lateral hamstring muscles contributing to the rapid development of torque. Symmetrical patterns of contralateral limbs in torque and range of motion indicate that post-surgical comparisons with the unoperated limb to assess certain functional states of the knee may be reasonably accurate.

High Tibial Osteotomy

High Tibial Osteotomy is a valuable tool for young active patients with osteoarthritis that is isolated to a single compartment. Recently, more surgeons have migrated to the use of the medial opening wedge technique in the hope that some of the complications associated with the lateral closing wedge can be avoided. This article describes the preoperative evaluation, surgical procedure, postoperative rehabilitation, and its potential pitfalls. Our goal is to provide a concise easy-to-read manual for the procedure.

Fatigue effects in running.

Effects of fatigue were assessed on 12 female subjects who were filmed at two stages of a maximal-effort, gross physical performance task (running). Comparisons were then made between selected temporal and kinematic parameters describing the activity: The results appear to support the concept that fatigue does not simply produce a uniform reduction in the components of a movement pattern but, rather, changes their relationship completely.

Rotary mechanics after pes anserinus transplant: A method for dynamic assessment

Since the medial hamstring muscles are primarily responsible for flexion and inward rotation of the tibia, various surgical techniques have been designed to alter functions of these muscles and to control anteromedial rotary instability resulting from ligamentous trauma. One such technique, the &dquo;pes anserinus transplant,&dquo; as developed by Slocum and Larson,’ was devised to control rotary mstability through changing the insertion of the common tendon of the gracilis and semitendinosus

Biomechanical Factors Associated With Achilles Tendinopathy and Medial Tibial Stress Syndrome in Runners

Background: There is disagreement in the literature regarding whether the excessive excursion or velocity of rearfoot eversion is related to the development of 2 common running injuries: Achilles tendinopathy (AT) and medial tibial stress syndrome (MTSS). An alternative hypothesis suggests that the duration of rearfoot eversion may be an important factor. However, the duration of eversion has received relatively little attention in the biomechanics literature. Hypothesis: Runners with AT or MTSS will demonstrate a longer duration of eversion but not greater excursion or velocity of eversion compared with healthy controls. Study Design: Controlled laboratory study. Methods: Forty-two runners participated in this study (13 with AT, 8 with MTSS, and 21 matched controls). Participants were evaluated for lower extremity alignment and flexibility, after which a 3-dimensional kinematic and kinetic running gait analysis was performed. Differences between the 2 injuries and between injured and control participants were evaluated for flexibility and alignment, rearfoot kinematics, and 3 ground-reaction force metrics. Binary logistic regression was used to evaluate which variables best predicted membership in the injured group. Results: Injured participants, compared with controls, demonstrated higher standing tibia varus angles (8.67° ± 1.79° vs 6.76° ± 1.75°, respectively; P = .002), reduced static dorsiflexion range of motion (6.14° ± 5.04° vs 11.19° ± 5.10°, respectively; P = .002), more rearfoot eversion at heel-off (–6.47° ± 5.58° vs 1.07° ± 2.26°, respectively; P < .001), and a longer duration of eversion (86.02% ± 15.65% stance vs 59.12% ± 16.50% stance, respectively; P < .001). There were no differences in the excursion or velocity of eversion. The logistic regression (χ2 = 20.84, P < .001) revealed that every 1% increase in the duration of eversion during the stance phase increased the odds of being in the injured group by 1.08 (95% CI, 1.023-1.141; P = .006). Conclusion: Compared with healthy controls, runners currently symptomatic with AT or MTSS have a longer duration of eversion but not greater excursion or velocity of eversion. Clinical Relevance: Static measures of the tibia varus angle and dorsiflexion range of motion, along with dynamic measures of the duration of eversion, may be useful for identifying runners at risk of sustaining AT or MTSS.

Foot Kinematics Differ Between Runners With and Without a History of Navicular Stress Fractures

Background: A navicular stress fracture (NSF) is a common and high-risk injury in distance runners. It is not clear whether there are differences in foot structure and function between runners who have and those who have not sustained an NSF. Purpose/Hypothesis: This study compared foot structure, range of motion, and biomechanics between runners with a history of unilateral NSFs and runners who had never sustained this injury. The hypothesis was that runners with a history of NSFs will have less dorsiflexion and subtalar range of motion in a clinical examination and greater rearfoot eversion and higher eversion velocity while running than either the noninvolved feet or healthy controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Seven runners who sustained an NSF were matched with 7 controls without this injury history. Participants underwent a clinical orthopaedic examination, followed by a 3-dimensional running gait analysis. Clinical examination variables, foot kinematics, and ground-reaction forces were compared between injured and noninjured feet within the NSF group and between the NSF group and control group. Results: The NSF group demonstrated less plantar flexion on the clinical examination than the control group (P = .034, effect size [ES] = 0.69). The involved feet of the NSF group demonstrated greater rearfoot eversion excursion, greater eversion velocity, and reduced forefoot abduction excursion than either the noninvolved feet of the NSF group (P = .015, ES = 1.73; P = .015, ES = 1.86; and P = .015, ES = 0.96, respectively) or the control group (P = .012, ES = 1.40; P = .016, ES = 0.49; and P = .005, ES = 1.60, respectively). Conclusion: There are differences in foot kinematics but not ground-reaction forces, foot structure, or passive range of motion between runners who have and those who have not sustained an NSF. Runners who demonstrate increased rearfoot eversion and reduced forefoot abduction during stance may be more at risk for developing NSFs.