http://www.smarttjournal.com The latest research articles published by Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012-05-10T00:00:00Z Purpose: To evaluate the relative involvement of tibial stress injuries using high-resolution axial MR imaging and the correlation with MR and radiographic images. Methods: A total of 33 patients with exercise-induced tibial pain were evaluated. All patients underwent radiograph and high-resolution axial MR imaging. Radiographs were taken at initial presentation and 4 weeks later. High-resolution MR axial images were obtained using a microscopy surface coil with 60 x 60 mm field of view on a 1.5 T MR unit. All images were evaluated for abnormal signals of the periosteum, cortex and bone marrow. Results: Nineteen patients showed no periosteal reaction at initial and follow-up radiographs. MR imaging showed abnormal signals in the periosteal tissue and partially abnormal signals in the bone marrow. In 7 patients, periosteal reaction was not seen at initial radiograph, but was detected at follow-up radiograph. MR imaging showed abnormal signals in the periosteal tissue and entire bone marrow. Abnormal signals in the cortex were found in 6 patients. The remaining 7 showed periosteal reactions at initial radiograph. MR imaging showed abnormal signals in the periosteal tissue in 6 patients. Abnormal signals were seen in the partial and entire bone marrow in 4 and 3 patients, respectively. Conclusions: Bone marrow abnormalities in high-resolution axial MR imaging were related to periosteal reactions at follow-up radiograph. Bone marrow abnormalities might predict later periosteal reactions, suggesting shin splints or stress fractures. High-resolution axial MR imaging is useful in early discrimination of tibial stress injuries. http://www.smarttjournal.com/content/4/1/16 Takeo Mammoto Atsushi Hirano Yohei Tomaru Mamoru Kono Yuta Tsukagoshi Shinzo Onishi Naotaka Mamizuka Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, null:16 2012-05-10T00:00:00Z doi:10.1186/1758-2555-4-16 /content/figures/1758-2555-4-16-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 16 2012-05-10T00:00:00Z PDF Background: Basketball is the second most popular sport in Nigeria after football and is commonly played by adolescents. Prospective studies on adolescent basketball players in Nigeria are lacking. Such studies will help to develop injury counter-measures. Hence, this study aimed at determining the incidence and pattern of injuries among adolescent basketball players in Nigeria. Methods: A prospective observational study involving 141 adolescent basketball players (75 boys and 66 girls; with age range 15 - 18 years) who participated in the 2010 National Finals of the Nigeria Nestle Milo Basketball Competition. Basketball-related injury data were collected by an assessor during the competition using a standardized basketball injury report form. Data were analyzed using descriptive and inferential statistics. Results: A total of 32 injuries were recorded with an incidence of 22.7 injuries per 100 participants same for boys and girls. This is equivalent to 1.1 injury per match for boys and 0.9 injuries per match for girls. Jumping/landing was the most common cause of injury (28.1%, N = 9). Most of the injuries were at the lower extremities (75%, N = 24); with majority at the knee joint (40.6%, N = 13). Ligament sprain was the most common types of injury. The pattern of injuries among boys did not significantly differ from that of girls (P>0.05). Most injuries (N = 13, 41%) occurred in the offensive half of the court and cryotherapy was the most frequently used treatment modality. Conclusion: The overall incidence of match injury among adolescent amateur basketball players during a national competition in Nigeria was 22.7 injuries per 100 participants; equivalence of 1.0 injury per match. The pattern of injuries was similar in both genders and consistent with what has been previously reported in literature for adolescent basketball players. Exercise-based injury prevention programmes aimed at improving core strength and neuromuscular control at the lower limbs may help reduce the incidence of injuries. http://www.smarttjournal.com/content/4/1/15 Oluwatoyosi Babatunde Alex Owoeye Ashiyat Kehinde Akodu Bayonle Matt Oladokun Sunday Rufus Akinwumi Akinbo Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, null:15 2012-05-04T00:00:00Z doi:10.1186/1758-2555-4-15 /content/figures/1758-2555-4-15-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 15 2012-05-04T00:00:00Z PDF Background: The incidences of tendon injuries in certain sections of human or animal populations such asathletes are high, but every human or animal, regardless of age or level of activityexperiences some degree of tendon injury. In spite of the various investigations of injuriesand treatment, comprehensive studies dealing with the histological, ultrastructural andbiomechanical aspects of healing, load-bearing tendons are rare. This study was designed tocompare the outcome of healing of the transverse sectioned superficial digital flexor tendon(SDFT) after 28 and 84 days post injury (DPI) in rabbits. Methods: Forty white New Zealand mature female rabbits were randomly divided into two equalgroups of 28 and 84 days post injury. After tenotomy and surgical repair of the left superficialdigital flexor tendon (SDFT), the injured legs were casted for 14 days. The weight of theanimals, tendon diameter, and clinical, radiographic and ultrasonographic evaluations wereconducted at weekly intervals. The animals were euthanized on 28 and 84 days post injury(DPI) and the tendons were evaluated for histopathological, ultrastructural, biomechanicaland percentage dry weight parameters. Results: Although the clinical, ultrastructural, morphological and biomechanical properties of theinjured tendons on day 84 showed a significant improvement compared to those of the 28DPI, these parameters were still significantly inferior to their normal contra-lateral tendons. Conclusions: This study showed that tendon healing is very slow and at 84 days post-injury themorphological and biomechanical parameters were still inferior to the normal tendons andmany collagen fibrils still had the same diameter as those seen at 28 DPI. http://www.smarttjournal.com/content/4/1/14 Ahmad Oryan Ali Moshiri Abdul-Hamid Meimandi-Parizi Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, null:14 2012-04-26T00:00:00Z doi:10.1186/1758-2555-4-14 /content/figures/1758-2555-4-14-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 14 2012-04-26T00:00:00Z PDF Steroid-induced osteonecrosis of the femoral condyle is a relatively uncommon condition andis often difficult to select appropriate treatment especially in young patients. Three youngmen (aged 25, 18, and 24) presented with severe pain and dysfunction of the knee diagnosedas steroid-induced osteonecrosis of the femoral condyle by magnetic resonance imaging(MRIs). Full-thickness cartilage defects sized 20 x 10, 15 x 10, and 30 x 20 mm respectivelywere classified as International Cartilage Repair Society Grade IV lesions and treated withosteochondral autograft transplantation. They were treated successfully with osteochondralautograft transplantation certificated by post-operative MRI and second look arthroscopy. http://www.smarttjournal.com/content/4/1/13 Norifumi Fujita Tomoyuki Matsumoto Seiji Kubo Takehiko Matsushita Kazunari Ishida Yuichi Hoshino Koji Nishimoto Masahiro Kurosaka Ryosuke Kuroda Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, null:13 2012-04-26T00:00:00Z doi:10.1186/1758-2555-4-13 /content/figures/1758-2555-4-13-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 13 2012-04-26T00:00:00Z PDF Background: The only three randomized trials on the treatment of MTSS were all performed in military populations. The treatment options investigated in this study were not previously examined in athletes. This study investigated if functional outcome of three common treatment options for medial tibial stress syndrome (MTSS) in athletes in a non-military setting was the same. Methods: The study design was randomized and multi-centered. Physical therapists and sports physicians referred athletes with MTSS to the hospital for inclusion. 81 athletes were assessed for eligibility of which 74 athletes were included and randomized to three treatment groups. Group one performed a graded running program, group two performed a graded running program with additional stretching and strengthening exercises for the calves, while group three performed a graded running program with an additional sports compression stocking. The primary outcome measure was: time to complete a running program (able to run 18 minutes with high intensity) and secondary outcome was: general satisfaction with treatment. Results: 74 Athletes were randomized and included of which 14 did not complete the study due a lack of progress (18.9%). The data was analyzed on an intention-to-treat basis. Time to complete a running program and general satisfaction with the treatment were not significantly different between the three treatment groups. Conclusion: This was the first randomized trial on the treatment of MTSS in athletes in a non-military setting. No differences were found between the groups for the time to complete a running program.Trial registrationCCMO; NL23471.098.08 http://www.smarttjournal.com/content/4/1/12 Maarten Hendrik Moen Leonoor Holtslag Eric Bakker Carl Barten Adam Weir Johannes Tol Frank Backx Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, null:12 2012-03-30T00:00:00Z doi:10.1186/1758-2555-4-12 /content/figures/1758-2555-4-12-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 12 2012-03-30T00:00:00Z XML Background: A screening of ulnar collateral ligament insufficiency is required for overhead throwers, since secondary pathologic changes result from an increased elbow valgus laxity. We developed a new manual method for assessing elbow valgus laxity and investigated the reliability of this method and its correlation with ultrasonographic assessment. Methods: We defined elbow valgus laxity as the difference between the shoulder external rotation angle (ER angle) measured with the elbow in 90 degrees flexion and that measured with the elbow in extension because ER angle measured with the elbow in 90 degrees flexion includes elbow valgus laxity and ER angle with the elbow in extension does not include it. ER angle measurement with the elbow in extension involved the use of a custom arm holder. Three examiners each measured elbow valgus laxity by the new method in 5 healthy volunteers. Intraobserver and interobserver reliability was evaluated by calculating the intraclass correlation coefficient. We then assessed 19 high-school baseball players with no complaints of shoulder or elbow pain. Elbow ultrasonography was performed with a 10-MHz linear transducer with the elbow in 90 degrees flexion, and the forearm in the neutral position, and the width of the medial joint space at the level of the anterior bundle was measured. Elbow valgus laxity assessed by ultrasonography was defined as the difference between the medial joint space width with gravity stress and that without gravity stress. Increased elbow valgus laxity assessed by both our method and ultrasonography was defined as the difference between the laxity of the elbow on the throwing side and that on the contralateral side. Pearson's correlation coefficient (r) was calculated to evaluate the relationship between increased elbow valgus laxity obtained by our manual method and that by ultrasonography. Results: Intraobserver reliability ranged from 0.92 to 0.98, and interobserver reliability was 0.70. The increased elbow valgus laxity assessed by our method was significantly correlated with that assessed by ultrasonographic assessment (P = 0.019, r = 0.53). Conclusions: Elbow valgus laxity can be assessed by our method. This method may be useful for screening for insufficiency of the ulnar collateral ligament. http://www.smarttjournal.com/content/4/1/11 Kenji Yasui Teruhisa Mihata Atsushi Takeda Chisato Watanabe Mitsuo Kinoshita Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, null:11 2012-03-19T00:00:00Z doi:10.1186/1758-2555-4-11 /content/figures/1758-2555-4-11-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 11 2012-03-19T00:00:00Z XML Anterior cruciate ligament (ACL) injuries continue to present in epidemic-like proportions, carrying significant short- and longer-term debilitative effects. With females suffering these injuries at a higher rate than males, an abundance of research focuses on delineating the sex-specific nature of the underlying injury mechanism. Examinations of sex-dimorphic lower-limb landing mechanics are common since such factors are readily screenable and modifiable. The purpose of this paper was to critically review the published literature that currently exists in this area to gain greater insight into the aetiology of ACL injuries in females and males. Using strict search criteria, 31 articles investigating sex-based differences in explicit knee and/or hip landing biomechanical variables exhibited during vertical landings were selected and subsequently examined. Study outcomes did not support the generally accepted view that significant sex-based differences exist in lower-limb landing mechanics. In fact, a lack of agreement was evident in the literature for the majority of variables examined, with no sex differences evident when consensus was reached. The one exception was that women were typically found to land with greater peak knee abduction angles than males. Considering knee abduction increases ACL loading and prospectively predicts female ACL injury risk, its contribution to sex-specific injury mechanisms and resultant injury rates seems plausible. As for the lack of consensus observed for most variables, it may arise from study-based variations in test populations and landing tasks, in conjunction with the limited ability to accurately measure lower-limb mechanics via standard motion capture methods. Regardless, laboratory-based comparisons of male and female landing mechanics do not appear sufficient to elucidate causes of injury and their potential sex-specificity. Sex-specific in vivo joint mechanical data, if collected accurately, may be more beneficial when used to drive models (e.g., cadaveric and computational) that can additionally quantify the resultant ACL load response. Without these steps, sex-dimorphic landing mechanics data will play a limited role in identifying the aetiology of ACL injuries in women and men. http://www.smarttjournal.com/content/4/1/10 Melanie Beaulieu Scott McLean Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, null:10 2012-03-15T00:00:00Z doi:10.1186/1758-2555-4-10 /content/figures/1758-2555-4-10-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 10 2012-03-15T00:00:00Z XML Background: Recent years have seen anterior cruciate ligament (ACL) reconstruction being performed in a broad range of patients, regardless of age, sex and occupation, thanks to great advances in surgical techniques, surgical instruments and basic research. In cases of ACL reconstruction, bone-patellar tendon-bone (BTB) graft or hamstring graft are frequency used. However, potential complications associated with tunnel enlargement due to soft tissue graft such as hamstring were reported. On the other hand, an altered rotational axis resulting in significantly greater translation of the lateral compartment in the single bundle compared with double bundle ACL reconstruction was reported.Method and procedureA reconstruction procedure was modified for the ACL using a double bundle that is the combination of BTB and gracilis tendon composite autograft. Two tibial and two femoral bone tunnels are used to reconstruct two bundles of ACL; an anteromedial bundle (AMB) and a posterolateral bundle (PLB). The femoral bone tunnels are created just posterior to the resident's ridge. The tibial bone tunnels are created at the center of AM and PL tibial attachment, respectively. BTB is fixed in the AM tunnels produced on the anatomical points of tibia and femur. The gracilis graft is fixed in an anatomical PL tunnel produced. The mean width of BTB is 7 mm, since10 mm graft is sometimes not suitable for patients, especially small Asian people and females. For these patients, 10 mm graft is bigger than one third of patella tendon width. Conclusion: The devised surgical procedure based on a combination of BTB and gracilis autograft is suitable reconstruction method for patients who have small or medium width of patellar tendon such as Asian people and females. This technique is also applicable to revision surgery. http://www.smarttjournal.com/content/4/1/9 Takuya Tajima Etsuo Chosa Keitarou Yamamoto Nami Yamaguchi Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, null:9 2012-03-14T00:00:00Z doi:10.1186/1758-2555-4-9 /content/figures/1758-2555-4-9-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 9 2012-03-14T00:00:00Z XML A case of recurrent hemarthrosis of the knee after a mobile-bearing unicompartmental knee arthroplasty (UKA; Oxford UKA) is described. A 58-year-old man met with a road traffic accident 10 months after UKA. He developed anteromedial pain and hemarthrosis of the knee joint 1 month after the accident, which required multiple aspirations. Physical examination showed no instability. Plain radiograph revealed no signs of loosening. All laboratory data, including bleeding and coagulation times, were within normal limits. Diagnostic arthroscopy demonstrated loosening of the femoral component. Any intraarticular pathology other than nonspecific synovitis was ruled out. The loose femoral component and polyethylene meniscal bearing were revised. Since then, hemarthrosis has not recurred. http://www.smarttjournal.com/content/4/1/8 Kotaro Yamakado Hitoshi Arakawa Seigaku Hayashi Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, null:8 2012-02-21T00:00:00Z doi:10.1186/1758-2555-4-8 /content/figures/1758-2555-4-8-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 8 2012-02-21T00:00:00Z XML Trochleoplasty is the theoretical solution to persistent symptoms (pain and/or instability) related to trochlear dysplasia where there is not only a trochlear flatness but also a trochlear prominence. The threshold of prominence indicating surgical intervention has as yet not been determined. A bump of 5 mm is generally accepted as the inferior limit. Given the interventional nature of this demanding procedure, it should be proposed in selected cases after considerable discussion with the patient. Trochleoplasty is indicated as a primary procedure for major trochlear dysplasia with a prominence > 5 mm. Stabilization is obtained in most of the cases with the risk of residual mild anterior knee pain. It is also indicated as a salvage procedure when a previous surgery failed. Despite the reputation of the procedure, the published results are encouraging in terms of prevention of re-dislocation, satisfaction index, and radiological outcomes. Post-operative stiffness is the main complication, which may require manipulation under anaesthesia or arthroscopic arthrolysis. There are few other complications reported and to date secondary necrosis of the trochlea has not been reported. Technically speaking, the deepening trochleoplasty is a difficult procedure without reliable landmarks. We propose a recession wedge trochleoplasty which is an easier procedure. It is never undertaken as an isolated procedure, but always in conjunction with other realignment procedures of the extensor apparatus according to the "a la carte" surgery concept. http://www.smarttjournal.com/content/4/1/7 Philippe Beaufils Mathieu Thaunat Nicolas Pujol Sven Scheffler Roberto Rossi Mike Carmont Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, null:7 2012-02-21T00:00:00Z doi:10.1186/1758-2555-4-7 /content/figures/1758-2555-4-7-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 7 2012-02-21T00:00:00Z XML