RESUMEN
BACKGROUND: Patients with femoral trochlear dysplasia are at risk for chronic recurrent patellofemoral dislocations, with extreme cases often requiring a surgical procedure. Anteromedialization of the tibial tubercle with intraoperative femoral nerve stimulation and concurrent medial patella-femoral ligament (MPFL) reconstruction is a previously reported method of maximizing patello-femoral congruency. We hypothesize the Fulkerson osteotomy with intraoperative femoral nerve stimulation and concurrent MPFL reconstruction in patients with severe trochlear dysplasia provides equivalent postoperative clinical outcomes to the same procedure in patients with low level trochlear dysplasia. METHODS: 48 knees underwent Fulkerson osteotomy with intraoperative femoral nerve stimulation and concurrent MPFL reconstruction for recurrent lateral patellar dislocations. MRI, surgeon intraoperative assessment, and X-ray were used to assess degrees of trochlear dysplasia; inter-observer and intra-observer error were measured. The knees positive for severe dysplasia on MRI, intraoperative assessment, and X-ray were considered as a comparison cohort to the rest of the study population. We considered postoperative dislocation events and patellar tracking kinematics as outcome measures. Independent student t tests and Fisher exact tests were used to evaluate differences between groups. Significance was set at P<0.05. RESULTS: 11 knees were positive for severe dysplasia (SD) by combined MRI, surgeon intraoperative assessment, and X-ray with the remaining 37 knees categorized as low dysplasia (LD). No patients in either group exhibited apprehension or required re-operation. Mean sulcus angle in the SD group was 175.8 +-2.45 degrees (95% CI 171.0-180.6); the LD group mean sulcus angle was 154.3 +- 0.98 degrees (95% CI 152.4-156.2) (P<.001). Postoperatively there was no significant difference in dislocation events between the SD group (0/11) and the LD group (2/37) (P>0.999). Patellar maltracking decreased in both groups and there were no significant differences in estimates of patellofemoral congruency between the SD (2/11) and LD (8/37) (P>0.999) groups. CONCLUSION: The Fulkerson osteotomy with femoral nerve stimulation aimed at maximizing patellofemoral congruency may be an equally effective procedure for patients with either severe or mild trochlear dysplasia. LEVEL OF EVIDENCE: Level III, Retrospective comparative study.
Asunto(s)
Nervio Femoral , Osteotomía/métodos , Luxación de la Rótula/terapia , Procedimientos de Cirugía Plástica/métodos , Rango del Movimiento Articular/fisiología , Adolescente , Adulto , Estudios de Cohortes , Terapia Combinada , Estimulación Eléctrica/métodos , Femenino , Fémur/anomalías , Estudios de Seguimiento , Humanos , Cuidados Intraoperatorios/métodos , Inestabilidad de la Articulación/prevención & control , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Luxación de la Rótula/diagnóstico , Ligamento Rotuliano/cirugía , Articulación Patelofemoral/cirugía , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Juvenile particulated cartilage allograft (DeNovo NT®, Zimmer, Warsaw, IN) transplantation is a relatively new technology for the treatment of high-grade cartilage lesions. To date there is limited literature demonstrating its effectiveness and safety. The present study specifically looks at the short-term efficacy of DeNovo NT® allograft for symptomatic high-grade cartilage lesions of the patella. Clinical outcomes and complications are reported. METHODS: Seventeen cases of DeNovo NT® allograft transplantation at our institution were retrospectively reviewed from 2010 to 2013. Thirteen patients had the procedure performed for patellar lesions and are included in the present study. A chart review was performed to record demographic data, surgical technique, and complications. In addition, we analyzed preoperative and postoperative KOOS outcome scores. RESULTS: The mean age was 22.5 years (range, 14-34), with 3 males and 10 females. Mean follow-up was 8.2 months (range, 0.67-32.7). Six of the patients had concomitant anteromedialization of the tibial tubercle. DeNovo NT® allograft transplantation resulted in improvement for each outcome measure used. Overall KOOS score significantly improved from a mean of 58.4±15.7 to 69.2±18.6 (P = 0.04). Improvement in KOOS subscales of pain, ADL, and symptoms all approached but did not reach statistical significance (P values between 0.05 and 0.10). There were no infections or hardware complications. CONCLUSIONS: This series demonstrates that DeNovo NT® allograft transplantation for symptomatic high-grade cartilage lesions of the patella results in pain relief and improved outcomes in the short term. Further studies are needed to better evaluate this new technology. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
Asunto(s)
Cartílago/trasplante , Articulación de la Rodilla/cirugía , Rótula/cirugía , Adolescente , Adulto , Aloinjertos , Femenino , Humanos , Masculino , Estudios Retrospectivos , Trasplante Homólogo , Resultado del Tratamiento , Adulto JovenRESUMEN
Isolated PCL injuries have become more prevalent in recent years, possibly as a result of improved awareness and clinical recognition. However, the diagnosis can be difficult, and many of these injuries continue to go undiagnosed. Several clinical tests for PCL laxity have been described over the years, with varying degrees of sensitivity and clinical applicability. These include the posterior drawer, the Muller Quadriceps Active Test, Godfrey's Test, Trillat's reverse lachman/total translation test, and the Dynamic Posterior Shift. All of these tests require significant posterior laxity associated with complete PCL disruption to be positive. Use of the KT-1000 arthrometer, and several radiographic tests have also been developed to help with diagnosis and quantification of laxity. It is the purpose of this paper to review the technique and application of the established diagnostic tests for PCL deficiency, and to introduce two new tests employed by the senior author for nearly three decades. It is the authors' experience that these new tests are sufficiently sensitive to allow the examiner to detect the presence of PCL insufficiency even in the most difficult diagnostic situations with subtle laxity.
Asunto(s)
Inestabilidad de la Articulación/economía , Traumatismos de la Rodilla/diagnóstico , Ligamento Cruzado Posterior/lesiones , Adulto , Traumatismos en Atletas/diagnóstico , Femenino , Humanos , Masculino , Examen Físico , Rotura , Sensibilidad y EspecificidadAsunto(s)
Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla , Ligamentos Articulares/cirugía , Trasplante/métodos , Fenómenos Biomecánicos , Enfermedad Crónica , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/fisiopatología , Articulación de la Rodilla/anatomía & histología , Articulación de la Rodilla/fisiopatología , Ligamentos Articulares/anatomía & histología , Ligamentos Articulares/fisiopatología , Cuidados PosoperatoriosRESUMEN
Six fresh-frozen cadaver knee joints were used to study changes in retropatellar contact mechanics accompanying patella infera. The knees were tested on a servohydraulic testing machine under conditions simulating stair descent at 10 degrees, 30 degrees, 60 degrees, and 90 degrees of knee flexion. A slotted metallic block mechanism embedded in the region of the tibial tubercle allowed selective distal offset of the patellar tendon insertion so as to model conditions of 0, 6, 13, 19, and 25 mm of patella infera. Patellofemoral and quadriceps tendofemoral contact areas and contact stresses were recorded using Pressensor contact film and quantitated using digital image analysis. Patella infera significantly altered retropatellar contact mechanics. Contact areas migrated proximally on the patella and decreased in size with progressive severity of patella infera. However, the peak and spatial mean retropatellar contact stresses were not elevated correspondingly. Apparently, quadriceps tendofemoral contact was initiated at progressively lower angles of knee flexion as the patella infera progressed. Under conditions of extreme infera at high flexion angles, the magnitude of tendofemoral contact force approached that of retropatellar contact force. These data indicate that in patella infera, patellofemoral contact stresses are not elevated appreciably. Therefore, the disabling symptoms associated with patella infera may be due to factors other than local mechanical overload.
Asunto(s)
Articulación de la Rodilla/fisiopatología , Rótula/fisiopatología , Humanos , Procesamiento de Imagen Asistido por Computador , Técnicas In Vitro , Articulación de la Rodilla/anatomía & histología , Articulación de la Rodilla/patología , Rótula/anatomía & histología , Rótula/patología , Rango del Movimiento Articular , Estrés Mecánico , SíndromeRESUMEN
The effect of long-term exercise on canine knees was studied to determine whether an increased level of lifelong weightbearing exercise causes degeneration, or changes that may lead to degeneration, of articular cartilage. Eleven dogs were exercised on a treadmill at 3 km/hr for 75 minutes 5 days a week for 527 weeks while carrying jackets weighing 130% of their body weight. Ten control dogs were allowed unrestricted activity in cages for the 550 weeks. At the completion of the study all knee joints were inspected for evidence of joint injury and degeneration. Articular cartilage surfaces from the medial tibial plateau were examined by light microscopy, the cartilage thickness was measured, and the intrinsic material properties were determined by mechanical testing. No joints had ligament or meniscal injuries, cartilage erosions, or osteophytes. Light microscopy did not demonstrate cartilage fibrillation or differences in safranin O staining of the tibial articular cartilages between the two groups. Furthermore, the tibial articular cartilage thickness and mechanical properties did not differ between the two groups. These results show that a lifetime of regular weightbearing exercise in dogs with normal joints did not cause alterations in the structure and mechanical properties of articular cartilage that might lead to joint degeneration.
Asunto(s)
Cartílago/lesiones , Traumatismos de la Rodilla/fisiopatología , Articulación de la Rodilla/fisiología , Condicionamiento Físico Animal/fisiología , Animales , Perros , Traumatismos de la Rodilla/etiología , Traumatismos de la Rodilla/veterinaria , Masculino , Condicionamiento Físico Animal/efectos adversos , Soporte de PesoRESUMEN
We report a case of a 17-year-old female pitcher with bilateral elbow osteochondritis dissecans. Osteochondritis of the elbow is a well-known disorder affecting pitchers and other individuals who sustain repetitive microtrauma to the elbow. Elbow osteochondritis has been described infrequently in female athletes. The incidence and reporting patterns of this disease are likely to increase as more female athletes participate in organized sports.
Asunto(s)
Osteocondritis , Adolescente , Animales , Béisbol/lesiones , Trastornos de Traumas Acumulados/complicaciones , Trastornos de Traumas Acumulados/etiología , Femenino , Humanos , Cuerpos Libres Articulares/complicaciones , Osteocondritis/diagnóstico , Osteocondritis/etiología , Osteocondritis/cirugía , ConejosRESUMEN
Rupture of the pectoralis major muscle is a rare clinical entity. Only few reports have discussed its MRI or CT features. We have reviewed the imaging features of four cases of complete rupture of the pectoralis major muscle. One case of acute injury underwent surgical repair. MRI is useful in delineating the site and extent of the rupture in relation to the musculotendinous junction, which will help the surgeons with possible treatment options and surgical planning. Because of the complex anatomy of the pectoralis major muscle near its insertion on the humerus and the signal characteristics of hematoma and edema in the muscle, axial T2-weighted images were most valuable for the evaluation of acute and subacute injuries. Axial T1-weighted images were helpful in delineating chronic injuries. CT is inferior to MRI for direct visualization of muscle rupture.
Asunto(s)
Traumatismos en Atletas/diagnóstico , Imagen por Resonancia Magnética , Músculos Pectorales/lesiones , Adulto , Humanos , Masculino , Músculos Pectorales/patología , Rotura , Levantamiento de Peso/lesiones , Lucha/lesionesAsunto(s)
Articulación de la Rodilla/fisiopatología , Músculo Esquelético/fisiopatología , Dolor/fisiopatología , Biorretroalimentación Psicológica , Electromiografía , Terapia por Ejercicio , Humanos , Artropatías/fisiopatología , Artropatías/rehabilitación , Pierna/fisiopatología , Contracción MuscularRESUMEN
This article provides a review of the progress that has been made on the biomechanical, functional performance and epidemiological investigations into the effectiveness of prophylactic knee braces (PKBs) since the position statement against their use was issued in 1987 by the American Academy of Orthopaedics and a review of this subject was last published in Sports Medicine in 1989 by Montgomery and Korziris. The evolution of the salient design features of three surrogate knee models are reviewed along with the results of PKB effectiveness and safety factor testing. While still too limited in scope to be totally realistic, major advances have been made in the sophistication of the present biomechanics laboratory testing conditions. The on-the-field functional performance effects of wearing a knee brace are not always manifest in all individuals. The efficacy of PKBs remains in question but recent studies have taught us enough to put their use into perspective. While they may play some role, PKBs probably represent the least important factor in influencing the likelihood that a medial collateral ligament (MCL) sprain will occur. On the other hand, there is no evidence that such braces put added valgus pressure on some knees, or that wearing a brace is associated with an increased frequency or severity of knee or ankle injury. All else being equal, from the biomechanical studies, we know that whilst some braces are better than others, currently available PKBs can provide 20 to 30% greater resistance to a lateral blow, with the possibility that the anterior cruciate ligament (ACL) is given even greater protection than the MCL. This appears to be true when the lateral blow is of sufficient magnitude to cause significant medial joint line opening, but is not as great at the very lowest levels of impact. Regardless of the material they are made of, the most effective PKBs are those sufficiently stiff to prevent an external blow at the joint line from causing brace hinge contact with the knee tissues. Based on the superior results of the custom-fit functional braces, the most important future design feature appears to be the sizing and fitting of the thigh and tibial cuffs. On the negative side, the presence of a brace may slow an athlete's straight-ahead sprint speed and cause early fatigue to its wearer. This effect appears to vary from one brace to another according to its weight, design features, and pressure from the leg and thigh straps. However, it appears that knee braces do have the potential to restrict performance of the athlete for high-speed running but the effect is related to several factors. The weight of the brace resultant friction of the hinges, completeness of fit, and tightness of straps appear to be important. The most measurable effects include: increased muscular relaxation pressures; increased energy expenditure; and a related increase in blood lactate levels, maximal torque output, oxygen consumption and heart rate. On the other hand, experienced brace wearers and larger, stronger individuals displayed fewer, or no effects of donning a brace. Improvements in the protectiveness of the PKB are likely to accompany improvements in the ability to contour the braces to fit each individual's leg in the equipment room without the added expense of the cast-moulding process. Further improvement may be realised by friction-free polycentric joints, as well as an attachment system that minimises thigh and calf soft tissue compression perhaps by incorporating the braces into the trousers of the uniform to provide suspension from the waist.
Asunto(s)
Traumatismos en Atletas/prevención & control , Tirantes , Traumatismos de la Rodilla/prevención & control , Guías de Práctica Clínica como Asunto , Equipos de Seguridad , Lesiones del Ligamento Cruzado Anterior , Fenómenos Biomecánicos , Diseño de Equipo , Humanos , Articulación de la Rodilla/fisiología , Ligamento Colateral Medial de la Rodilla/lesiones , Deportes/fisiología , Esguinces y Distensiones/prevención & controlRESUMEN
OBJECTIVE: To determine the prevalence of the symptom of urinary incontinence during athletic endeavors among a group of nulliparous, elite college varsity female athletes. METHODS: All women currently participating in varsity athletics at a large state university were asked to fill out a questionnaire about the occurrence of urinary incontinence while participating in their sport and during activities of daily life. One hundred forty-four of 156 eligible women (92%) responded. RESULTS: The mean age was 19.9 years, and all women were nulliparous. Overall, 40 athletes (28%) reported urine loss while participating in their sport. The proportions in different sports were: gymnastics 67%, basketball 66%, tennis 50%, field hockey 42%, track 29%, swimming 10%, volleyball 9%, softball 6%, and golf 0%. Two-thirds of the women who noted urine loss during athletics were incontinent more often than rarely. There were no statistically significant relations between incontinence and amenorrhea, weight, hormonal therapy, or duration of athletic activity. Activities most likely to provoke incontinence included jumping, high-impact landings, and running. Forty percent and 17% of the women first noted incontinence during their sport while in high school and junior high school, respectively. CONCLUSIONS: Incontinence during physical stresses is common in young, highly fit, nulliparous women. This suggests that there is a continence threshold which, when exceeded, can result in urine loss, even in the absence of known risk factors for incontinence.
Asunto(s)
Deportes , Incontinencia Urinaria de Esfuerzo/epidemiología , Adolescente , Adulto , Femenino , Humanos , Incidencia , Paridad , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios , Universidades , Incontinencia Urinaria de Esfuerzo/etiologíaRESUMEN
We studied midfoot sprains in collegiate football players to define and document incidence, mechanisms, injury patterns, and disabilities. Twenty-three athletes with 24 injuries from 1987 through 1991, with a mean followup of 30.8 months, were identified for the study. The injuries occurred in 4% of the football players per year with offensive linemen incurring 29.2% of the injuries. The location of maximal tenderness on physical examination was an important prognostic indicator such that injuries with medial and global midfoot tenderness to palpation had the longest time loss from participation and time until full healing. Lateral midfoot sprains required short periods of disability, and players were able to return to participation with the use of an orthosis. Nineteen athletes with 20 injuries responded to a questionnaire. Four players reported residual functional problems. Only 1 of these players had to modify his recreational activities because of pain. The other players remained very active with only mild complaints of pain after high-demand activities. Midfoot sprains were associated with acute disability that required prolonged restriction from competition, but for most players the long-term residual problems were minor.
Asunto(s)
Traumatismos de los Pies , Fútbol Americano/lesiones , Esguinces y Distensiones/epidemiología , Absentismo , Actividades Cotidianas , Tirantes , Moldes Quirúrgicos , Edema/epidemiología , Estudios de Seguimiento , Pie/diagnóstico por imagen , Pie/fisiopatología , Fútbol Americano/fisiología , Humanos , Incidencia , Iowa/epidemiología , Masculino , Huesos Metatarsianos/diagnóstico por imagen , Huesos Metatarsianos/lesiones , Dolor/epidemiología , Pronación , Radiografía , Traumatismos de los Tejidos Blandos/epidemiología , Traumatismos de los Tejidos Blandos/etiología , Traumatismos de los Tejidos Blandos/fisiopatología , Férulas (Fijadores) , Esguinces y Distensiones/clasificación , Esguinces y Distensiones/diagnóstico por imagen , Esguinces y Distensiones/etiología , Esguinces y Distensiones/fisiopatología , Huesos Tarsianos/diagnóstico por imagen , Huesos Tarsianos/lesiones , Universidades , Soporte de PesoRESUMEN
We evaluated the relationship of cervical spinal stenosis with the occurrence of "stingers" in collegiate football players who participated at our institution from 1987 through 1991. Preparticipation cervical spine radiographs of 266 players were used to measure Torg ratio. Forty players with stingers were identified: 34 had an extension-compression mechanism; 6 had a brachial plexus stretch mechanism. Time-loss neck injuries occurred in 31 players; the remaining 195 players were asymptomatic. The mean Torg ratio was significantly smaller for the stinger group (P = 0.02). The Torg ratio was less than 0.8 at 1 or more levels in 47.5% of the stinger group, 32.3% of the time-loss neck pain group, and 25.1% of the asymptomatic group. No player with a brachial plexus stretch mechanism had a mean Torg ratio less than 0.8, but 20.6% of the players with an extension-compression mechanism had a mean Torg ratio less than 0.8. Players with a Torg ratio less than 0.8 had 3 times the risk of incurring stingers. We conclude that cervical spinal stenosis increases the risk for having stingers with complicated clinical courses.
Asunto(s)
Fútbol Americano/lesiones , Enfermedades del Sistema Nervioso Periférico/etiología , Estenosis Espinal/complicaciones , Adulto , Plexo Braquial/lesiones , Vértebras Cervicales , Humanos , Masculino , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Estudios RetrospectivosRESUMEN
This is the second of 2 articles on a 3-year investigation of medial collateral ligament sprains of the knee to assess the effectiveness of prophylactic knee braces in NCAA Division I college football players. Position, string, type of session, and daily brace wear were recorded. The injury rates for braced and unbraced knees were used to create an incidence density ratio. The data were stratified and simultaneously controlled for position, string, and session and evaluated for their statistical significance. The 987 Big Ten players generated 155,772 knee exposures over the study period (50% braced). Noticeable differences existed in the rates of injury for the braced and unbraced knees in almost every position during practices, depending on player or nonplayer status. When the influential factors of position, string, and session are considered, there is a consistent but not statistically significant tendency for the players wearing preventive knee braces to experience a lower injury rate than for their unbraced counterparts. For starters and substitutes in the line positions, as well as the linebackers and tight ends, there was a consistent trend toward a lower injury rate in both practices and games. The braced players in the skill positions (backs/kickers), at least during games, exhibited a higher injury rate.
Asunto(s)
Tirantes/estadística & datos numéricos , Fútbol Americano/lesiones , Ligamento Colateral Medial de la Rodilla/lesiones , Esguinces y Distensiones/epidemiología , Traumatismos en Atletas/epidemiología , Traumatismos en Atletas/prevención & control , Tirantes/clasificación , Fútbol Americano/clasificación , Fútbol Americano/estadística & datos numéricos , Humanos , Incidencia , Masculino , Medio Oeste de Estados Unidos/epidemiología , Estudios Prospectivos , Factores de Riesgo , Esguinces y Distensiones/prevención & controlRESUMEN
In this prospective, multiinstitutional analysis of medial collateral ligament sprains in college football players, we categorized 987 previously uninjured study subjects according to frequency of wearing preventive knee braces, studied the patterns by which 47 of 100 injuries occurred to unbraced knees, and identified several extrinsic, sport-specific risk factors shared for both braced and unbraced knees. The attendance, brace wear choice, position, string, and session of each participant were recorded daily; medial collateral ligament sprains were reported whenever tissue damage was confirmed. Both the likelihood of wearing braces and risk of injury without them was highly dependent on session (games/practices), position group (line, linebacker/tight end, skill), and string group (players/nonplayers). Subjects wearing braces often faced a high injury risk to their unbraced knees, a finding compatible with the opinion that braces were a necessary evil, best worn when concern over danger of injury outweighed desire for speed and agility. It is concluded that to avoid misinterpretations due to the confounding influence of brace wear selection bias, accurate investigation of daily brace wear patterns is required. Then, before considing the impact of preventive knee braces, a repartitioning of the data base is essential to assure that only similar groups will be compared.
Asunto(s)
Tirantes/estadística & datos numéricos , Fútbol Americano/lesiones , Ligamento Colateral Medial de la Rodilla/lesiones , Esguinces y Distensiones/epidemiología , Traumatismos en Atletas/epidemiología , Traumatismos en Atletas/prevención & control , Traumatismos en Atletas/psicología , Actitud , Tirantes/clasificación , Estudios Transversales , Diseño de Equipo , Fútbol Americano/clasificación , Fútbol Americano/psicología , Fútbol Americano/estadística & datos numéricos , Humanos , Masculino , Medio Oeste de Estados Unidos/epidemiología , Proyectos Piloto , Vigilancia de la Población , Estudios Prospectivos , Factores de Riesgo , Esguinces y Distensiones/prevención & control , Esguinces y Distensiones/psicologíaRESUMEN
Fractures occur in athletes and dramatically influence performance during competitive and recreational activities. Fractures occur in athletes as the result of repetitive stress, acute sports-related trauma and trauma outside of athletics. The literature provides general guidelines for treatment as well as a variety of statistics on the epidemiology of fractures by sport and level of participation. Athletes are healthy and motivated patients, and have high expectations regarding their level of function. These qualities make them good surgical candidates. Although closed treatment methods are appropriate for most sports fractures, an aggressive approach to more complicated fractures employing current techniques may optimize their subsequent performance.
Asunto(s)
Traumatismos en Atletas/terapia , Fracturas Óseas/clasificación , Adolescente , Adulto , Factores de Edad , Niño , Fracturas Óseas/terapia , HumanosRESUMEN
Stress fractures are overuse injuries of bone. Basketball players are particularly prone to develop the notoriously "troublesome" stress fractures of the foot and leg. This article reviews the pathogenesis, epidemiology, diagnosis, and treatment of stress fractures, with specific emphasis on the care of the basketball athlete.
Asunto(s)
Baloncesto/lesiones , Traumatismos de los Pies , Fracturas por Estrés , Traumatismos de la Pierna , Fracturas por Estrés/diagnóstico , Fracturas por Estrés/etiología , Fracturas por Estrés/terapia , Humanos , Traumatismos de la Pierna/diagnóstico , Traumatismos de la Pierna/etiología , Traumatismos de la Pierna/terapiaRESUMEN
A prospective study was established to record the patterns of injury incurred by all members of women's college gymnastics team. Twenty-six women were followed over a 4-year period (53 gymnast seasons) from 1983 to 1987. To identify which injuries resulted in persisting impairment, these same athletes were contacted again 3 years later. The 26 athletes sustained 106 injuries. Sixty (57%) of these were of acute onset and were related to an identifiable gymnastics event. The remaining 46 (43%) were of gradual onset or overuse injuries. For the follow-up phase, 22 of the 26 women were contacted from 10 to 70 months (38.5 average) after completion of their gymnastics careers. Forty-five percent of the injuries recorded in their competitive years still bothered them at the time of followup, especially low back, ankle, great toe, shoulder, and knee injuries. Athletic and recreational activity exacerbated the complaints. Twenty-nine percent felt that their sports activity level was now limited. Forty-six percent felt that their injury was at less than full recovery, yet most felt that they were capable of strenuous physical activity and continued to be active despite complaints such as pain and stiffness.
Asunto(s)
Gimnasia/lesiones , Adulto , Traumatismos del Tobillo/epidemiología , Traumatismos en Atletas/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Iowa/epidemiología , Traumatismos de la Rodilla/epidemiología , Estudios ProspectivosRESUMEN
Thirty-nine patients treated with total meniscectomy younger than 16 years of age were studied. The average follow-up period was 21 years; 71% of the patients reported pain; 68%, stiffness; 54%, swelling; and 41%, giving way. Approximately half the patients described progression of symptoms, but only 27% were asymptomatic. Only 10% noted limitations at work, but 62% had limitations in sports. Twelve percent have had further knee surgery. Forty-nine percent received unsatisfactory subjective/functional ratings. On physical examination, 25% of patients had range of motion loss of greater than 5 degrees, 22% had thigh atrophy of greater than 1 cm, and 20% developed substantial instability. Overall, 27% received unsatisfactory objective ratings. Ninety percent of patients had abnormal roentgenograms. Changes occurred predominantly in the meniscectomized compartment. Forty-four percent of patients had unsatisfactory roentgenographic ratings. Overall ratings indicated that 63% of patients' results rated unsatisfactory. More unsatisfactory results occurred in patients with a follow-up period of longer than 26 years, in those with substantial instability, and in males. Few differences existed between medial and lateral meniscectomies or with increasing durations of symptoms preoperatively.