Walton W. Curl

Isolated tear of the anterior cruciate ligament: 5-year follow-up study.

During the period 1967 to 1971, 64 cadets at the United States Military Academy, West Point, New York, had surgical repair for isolated tear of the anterior cruciate ligament. In a 5-year follow-up study to determine the functional impairment, present disability, and reinjury to the knee, 32 of the 64 patients were located and evaluated by radiographic examination and either by interview or by questionnaire. Twenty-two were commissioned to full duty. 23 had attended ranger or airborne school, and 16 had been in combat. Impairment of ordinary activities was noted by 12 and impairment of athletic endeavors by 24; pain by 71%; swelling by 66%; stiffness by 71%; and instability by 94%. Seventeen of the 32 had had a significant reinjury after the repair of the anterior cruciate ligament. Clinically, we can diagnose the isolated tear of the anterior cruciate ligament by four essential ingredients--a pop at time of injury, inability to continue participation, gross swelling of knee, and maximal swelling within 12 hr. The mechanism of injury is usually deceleration and change of direction, not contact with another player. The follow-up study on this small series indicates that the patients have progressive deterioration of the knee.

Operative ankle arthroscopy: Long-term followup

Ankle arthroscopy has become an accepted procedure for the treatment of various intraarticular disorders. More than 100 ankle arthroscopies have been per formed at our institution since 1983. To better define the role of arthroscopic surgery in the treatment of ankle disorders, we evaluated the preoperative exami nation and indications, operative data, and radiographs of those patients with a minimum of 1 year of followup. Fifty-eight ankles in 57 patients were identified; their average follow-up period was 25 months (range, 12 to 49 months). Preoperative diagnoses were synovitis (26), trans chondral defects of the talus (17), degenerative joint disease (8), and osteophytes or loose bodies (7). Sub jective results were good or excellent in 64% of cases. The best overall results were achieved in patients with synovitis (77%) and transchondral defects of the talus (71 %). Degenerative joint disease patients did not do well. They had only 12% good or excellent results and a 43% rate of subsequent fusion. Complications in cluded superficial and deep infections, temporary and permanent paresthesias, and hemarthroses; the overall complication rate was 15%. In conclusion, operative ankle arthroscopy can be useful in selected patients. It is an effective surgical procedure in patients with synovitis and transchondral defects of the talus. The benefits and long-term results are less predictable with loose bodies and impinging osteophytes; the results are poor with degenerative joint disease. There appears to be a significant risk of complication with ankle arthroscopy; however, with proper indications, a thorough knowledge of anatomical landmarks, and meticulous technique, good results can be obtained.

Arthroscopic treatment of chronic synovitis of the ankle

Arthroscopic synovectomy is a valuable tool in treating synovitis of the knee joint. We have identified a group of patients who benefit from ankle synovectomy. To determine the indications and long-term results of arthroscopic synovectomy of the ankle, we evaluated the history, preoperative examination, roentgenograms, and operative data of patients who underwent this procedure and had a minimum of 2 years of follow-up. Sixteen patients who underwent arthroscopic ankle synovectomy were identified. Sprains and inversion-type injuries were common in this young patient group. All had failed conservative therapy. Operative findings revealed hypertrophic synovium in all cases. Good or excellent results were obtained in 75% of patients, using a subjective and functional evaluation scale. Complications were one deep infection, one superficial infection, and one temporary sensory paresthesia. Chronic synovitis, or anterior soft-tissue impingement, was responsive to arthroscopic treatment and results did not deteriorate over time.

Chondral and osteochondral injuries. Diagnosis and management.

Osteochondral lesions are relatively common and usually occur as a result of trauma. They often are unrecognized acutely and lead to osteochondral defects and eventually osteoarthritis. Detection of these lesions has been aided by bone scan, CT, and MR imaging. Acute osteochondral fragments can be replaced and internally fixed. Chronic osteochondral defects can be treated with several methods designed to stimulate healing by either fibrocartilage or healing by transplantation of bone and cartilage or cartilage alone. The goal of all treatment methods is to provide a stable, congruent joint surface, restore function, and prevent the evolution of osteoarthritis in the injured joint.

High School Football Injuries: Evaluation

An epidemiologic survey of the literature on high school football injuries revealed methodologic problems. These numerator-denominator inconsistencies and other con founding factors are discussed. The authors suggest a more reliable system of reporting these parameters to further reduce the risk of high school football injuries.

High School Football Injuries: Identifying the Risk Factors

This epidemiologic survey of the literature on the factors contributing to the high number of high school football injuries consolidates the current information on the characteristics and risk factors associated with these injuries. To reduce the incidence of knee sprains and strains, the most common injuries to this population, the following preventive recommendations are pre sented : 1) optimum maintenance of playing fields; 2) use of the soccer-style shoe; 3) noncontact and con trolled activities in practice sessions; and 4) increased vigilance over technique during injury-prone preseason practices. The authors conclude that more research into factors such as exposure time and activity at injury will further reduce the risk to the high school football player.

The Anterior Cruciate Ligament: Radiographic and Clinical Signs of Successful and Unsuccessful Repairs

Our ten-year observation of anterior cruciate ligament injuries in an active athlete population shows that radiographic evidence of instability and joint deterioration are reliable clinical signs. Radiographic findings in the rotatory unstable knee are subtle six months after injury, but on standard roentgenographic views, which include the notch view, they appear in a sequential order from peaking of the intercondylar tubercles to buttressing osteophytosis. These are objective signs of progressive deterioration that should be a warning to the patient. The early and progressive radiographic signs portend further deterioration if stability is not obtained by restriction of activities, bracing, or reconstruction. Physicians and sports injury specialists should recognize these findings early and offer counsel to the patient at risk.

Aging and exercise: are they compatible in women?

The benefits of physical exercise and fitness have long been understood. With the aging of society and longevity of women relative to men, interest finally is being given to the female population. There are many benefits to maintaining an active lifestyle as women age. These benefits include maintenance of bone mineral density and prevention of osteoporosis, decreased susceptibility to falls, and decreased susceptibility to breast cancer and other chronic diseases. There are great psychologic benefits to maintaining an active lifestyle, and the connection between cardiovascular fitness and lowering the incidence of cardiac disease is well established. Finally, physical activity and exercise can decrease the symptoms of arthritis. The Centers for Disease Control recommends at least 30 minutes of moderately intensive activity on most days of the week. In older women, the loss of lean body mass (sarcopenia) can be diminished through a strength training program. With these benefits of maintaining an active lifestyle, healthcare providers should become proactive in emphasizing the benefits of physical activity to the older female population.

Agility Training Following Anterior Cruciate Ligament Reconstruction

The treatment program after anterior cruciate ligament (ACL) injury or reconstruction at the United States Military Academy embraces the four cornerstones of rehabilitation--strength, aerobic fitness, coordination, and confidence. It is divided into six phases--presurgery, to prepare the patient for postoperative rehabilitation; postoperative (or postinjury), to allow healing and to prevent thrombosis and muscle atrophy; early healing, to maintain muscle tone and joint motion in a protective device; late healing (water stage), to begin proprioceptive and agility training while regaining joint motion; healed (land stage), to gain greater agility and confidence in controlled situations; competition, to demonstrate if the rehabilitation program has been successful. This paper concentrates on the criteria for advancing from the water phase to the land phase and then to competition. The patient reverts to the preceding phase if pain or swelling is apparent. Full participation in competition is not permitted unless the patient masters all phases and can compete in athletics without fear of reinjury.

Isolated tear of the anterior cruciate ligament: 5-year followup study.

T h e coauthors of the article (Figs 1 and 2) selected as a classic for this symposium shared similar backgrounds and interests. John A. Feagin, Jr., was born in San Antonio, TX, in 1934. A 1955 graduate of the U.S. Military Academy, West Point, West Point, NY, he continued his education at Duke University School of Medicine, Durham, NC, from which he obtained his medical degree in 1961. After his orthopaedic residency at Walter Reed General Hospital, Washington DC, and service in Vietnam, Dr. Feagin returned to West Point where he was the team physician from 1967 to 1971. After this assignment, he spent 1 year as a fellow with John Charnley in Wrightington, England. He then went to Letterman Hospital in San Francisco, CA, where he directed the Army Joint Replacement Fellowship Program. Dr. Feagin returned to West Point as commander of the U.S Army Hospital, West Point, from 1978 to 1979. After leaving the army in 1979, he worked in Jackson, WY for 10 years before joining the orthopaedic faculty of Duke University in 1989. He is a leading expert in the field of sports medicine in the United States. He is a founding member of the American Orthopaedic Society for Sports Medicine and served as its president from 1985 to 1986.