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The article presents a study on the mechanical differences in lumbopelvic-hip movement of asymptomatic professional golfers with and without limited hip rotation during the golf swing. Topics covered include muscle imbalance, lumbopelvic kinematics, and the right and left axial rotation. Also mentioned is limited hip joint mobility as a key biomechanical marker of low back pain (LBP) in golfers.

Patients undergoing total hip arthroplasty are increasingly younger and have a higher demand concerning hip range of motion. To date, there is no clear consensus as to the amplitude of the “normal hip” in everyday life. It is also unknown if the physical examination is an accurate test for setting the values of true hip motion. The purpose of this study was: 1) to precisely determine the necessary hip joint mobility for everyday tasks in young active subjects to be used in computer simulations of prosthetic models in order to evaluate impingement and instability during their practice; 2) to assess the accuracy of passive hip range of motion measurements during clinical examination. A total of 4 healthy volunteers underwent Magnetic Resonance Imaging and 2 motion capture experiments. During experiment 1, routine activities were recorded and applied to prosthetic hip 3D models including nine cup configurations. During experiment 2, a clinical examination was performed, while the motion of the subjects was simultaneously captured. Important hip flexion (mean range 95°-107°) was measured during daily activities that could expose the prosthetic hip to impingement and instability. The error made by the clinicians during physical examination varied in the range of ±10°, except for flexion and abduction where the error was higher. This study provides useful information for the surgical planning to help restore hip mobility and stability, when dealing with young active patients. The physical examination seems to be a precise method for determining passive hip motion, if care is taken to stabilise the pelvis during hip flexion and abduction. [ABSTRACT FROM AUTHOR]

The article presents research which examined the imaging and functional outcomes of patients with shoulder dislocations who had arthroscopic simultaneous rotator cuff repair and bankart repair. Topics covered include impact of the repair on patients with Bankart lesions and superior labral injury. Also mentioned is the potential recurrence of the condition after the repairs.

The article presents research which examined the association of pelvic incidence with pincer as well as cam lesions. Topics covered include the regulation of pelvic orientation and lumbar lordosis as well as decrease in PI in patients with regulated pelvic orientation. Also mentioned is the examination of the conditions of participants' acetabulum, sacropelvis and proximal femur.

The article discusses a study which analyzed the prevalence of scapular malposition and dyskinesis as well as hip dysfunction in preadolescent and adolescent baseball players. Results show that compared with the preadolescent group, dominant shoulder scapular dyskinesis is highly prevalent in the adolescent group. It concluded the association of scapular dyskinesis with a higher mean coracoid distance.

Background: Injuries to the elbow joint in baseball pitchers appear common. There appears to be a correlation between shoulder range of motion and elbow injuries. Purpose: To prospectively determine whether decreased ROM of the throwing shoulder is correlated with the onset of elbow injuries in professional baseball pitchers. Study Design: Cohort study; Level of evidence, 2. Methods: For 8 consecutive years (2005-2012), passive range of motion of both the throwing and nonthrowing shoulders of all major and minor league pitchers within a single professional baseball organization were measured by using a bubble goniometer during spring training. In total, 505 examinations were conducted on 296 pitchers. Glenohumeral external rotation and internal rotation were assessed in the supine position with the arm at 90° of abduction and in the plane of the scapula. The scapula was stabilized per methods previously established. Total rotation was defined as the sum of external rotation and internal rotation. Passive shoulder flexion was assessed with the subject supine and the scapula stabilized per methods previously established. Elbow injuries and days missed because of elbow injuries were assessed and recorded by the medical staff of the team. Throwing and nonthrowing shoulder measurements were compared by using Student t tests; 1-tailed Fisher exact tests were performed to identify significant associations between shoulder motion and elbow injury. Nominal logistic regression was performed to determine the odds of elbow injury. Results: Significant differences were noted during side-to-side comparisons within subjects. There were 49 elbow injuries and 8 surgeries in 38 players, accounting for a total of 2551 days missed. Neither glenohumeral internal rotation deficit nor external rotation insufficiency was correlated with elbow injuries. Pitchers with deficits of >5° in total rotation in their throwing shoulders had a 2.6 times greater risk for injury. Pitchers with deficit of ≥5° in flexion of the throwing shoulder had a 2.8 times greater risk for injury. Conclusion: Bilateral differences in shoulder total rotation and flexion had a significant effect on the risk for elbow injuries in pitchers. Clinicians need to be aware of these findings and plan preventive programs that address these issues in hopes of reducing elbow injuries. [ABSTRACT FROM AUTHOR]

The article discusses research which compared biomechanical stability associated with single- and double-row reconstruction techniques for acute bony Bankart lesions in human cadaveric shoulders. Topics explored include the link between these lesions and glenohumeral dislocations which may be attributed to traumatic injuries, the preparation and biomechanical testing of specimens, and the fracture reduction recorded for both repair techniques.

The article discusses a study which evaluated the correlation between hip and shoulder rotational range of motion (ROM) in healthy professional baseball players. The dominant and nondominant hip and glenohumeral joints were measured for passive ROM variables. The study found no clinically meaningful differences in hip ROM between pitchers and position players and between lead leg and stance legs of all players as well as little or no relationship between the players' hip and glenohumeral ROM.

This study investigated the effect of different repetition durations on ratings of perceived exertion (RPE) in active muscles (RPE-AM) and the overall body (RPE-O). 19 male volunteers ( M age = 25.4 yr., SD = 3.5) performed strength training protocols with multiple sets matched by the number of sets and repetitions, intensity and rest interval but different repetition durations: 4 sec., 6 sec., or self-paced. Participants were asked to estimate their RPE-AM and RPE-O after each set. Training protocols with a 6-sec. repetition duration produced distinct responses on RPE during and after performance compared to 4-sec. and self-paced durations. However, there were no significant differences between 4-sec. and self-paced durations. [ABSTRACT FROM AUTHOR]

The article presents a study that evaluates the incidence of roof impingement by the native anterior cruciate ligament (ACL) in hyperextensible knees. The study examines the risk of roof impingement by anatomic placement of the ACL graft in hyperextensible knees. It urges surgeons to consider roof impingement after anatomic double-bundle ACLreconstruction in patients with a hyperextensible knee.

The article presents a study which aims to determine the efficiency of a rehabilitation programme over standard physiotherapy practices in the improvement of function in metal-on-metal hip resurfacing arthroplasty patients. It says that the participants completed other measures such as the Hip disability and Osteoarthritis Outcome Score (HOOS), quality of life, and the EuroQol (EQ-5D-3L). It concludes that a tailored physiotherapy approach improves functional outcomes in the patients.

The article focuses on a study conducted to report the prevalence of decreased hip range of motion in asymptomatic adolescent athletes and to correlate examination findings to signs of femoroacetabular impingement on radiographs and magnetic resonance imaging (MRI). The study performed physical examinations of 226 adolescent athletes. The study found that more than two thirds of patients had evidence of asymptomatic hip pathological lesions on MRI.

The article reports a study which was conducted to compare the potential autograft and osteochondral allograft sites in order to identify the best fit for glenoid augmentation. The results revealed that the autograft of the inferior coracoid and the osteochondral allograft of the lateral distal tibia were the best fit sites for glenoid augmentation based on their similar radii of curvature. The radius of curvature was found to be independent of the age, sex, height, or weight.

The article reports a study to compare the knee laxity and the dynamic tibial translation between children and adults; girls and boys and women and men. It was concluded that children had greater knee laxity than adults, whereas the dynamic tibial translation did not differ. In adults, knee laxity did not differ between the sexes, but dynamic tibial translation was greater in women.

The article discusses a study carried out in Forth Worth, Texas to compare the shoulder range of motion (ROM) deficits of baseball players diagnosed with ulnar collateral ligament (UCL) tear to players without UCL tear. It describes that the study was made on 60 male competitive high school and collegiate baseball players, subsequently tested and analyzed for data. Subjects diagnosed with UCL tear showed greater deficits in total rota- tional motion (TRM) compared to those without UCL tears.

The article assesses the potential of remplissage repair in prevention of recurrent shoulder instability. A survey was made on the patients suffering from Hill-Sachs and Bankart lesions, who were then evaluated based on remplissage and Bankart repair. It led to significant improvement of active forward elevation and internal rotation compared with baseline assessment. It concludes that remplissage enables the surgeon to address large humeral defects with a low postoperative recurrence.

The article discusses a study comparing the efficacy of balance training linked with muscle strengthening or stretching, relative to no intervention, in the postural control of elderly women with osteoporosis. The modified Clinical Test of Sensory Interaction for Balance (CTSIBm), Limits of Stability Test, dynamometry and goniometry were used to measure the parameters. The results showed that both interventions are effective and the strengthening group was superior to the stretching group.

The article discusses a study that adopted a laboratory approach for a complete quantification of anterior arthroscopic reach with ankle in full plantar flexion. The results of computed tomography simulation demonstrate that the medial and lateral arthroscopic reaches, both are highly affected by clinical plantarflexion. The talar dome is shown to be accessible anterior to the anterior distal tibial rim.

The article discusses a study evaluating the postoperative appearance of arthroscopic remplissage which is a procedure for treatment of large High-Sachs lesions with anterior glemohumeral instability on high-resolution Magnetic resonance imaging (MRI). Measured parameters included signal intensity of tissue within the prior defect, signal intensity of the residual infraspinatus and degree of fatty infiltrate. Findings showed that clinical outcome was statisfying.

Background: Whether an Achilles tendon rupture is treated surgically or not, complications such as muscle weakness, decrease in heel-rise height, and gait abnormalities persist after injury. Purpose: The purpose of this study was to evaluate if side-to-side differences in maximal heel-rise height can be explained by differences in Achilles tendon length. Study Design: Case series; Level of evidence, 4. Method: Eight patients (mean [SD] age of 46 [13] years) with acute Achilles tendon rupture and 10 healthy subjects (mean [SD] age of 28 [8] years) were included in the study. Heel-rise height, Achilles tendon length, and patient-reported outcome were measured 3, 6, and 12 months after injury. Achilles tendon length was evaluated using motion analysis and ultrasound imaging. Results: The Achilles tendon length test-retest reliability (intraclass correlation coefficient = 0.97) was excellent. For the healthy subjects, there were no side-to-side differences in tendon length and heel-rise height. Patients with Achilles tendon ruptures had significant differences between the injured and uninjured side for both tendon length (mean [SD] difference, 2.6-3.1 [1.2-1.4] cm, P = .017-.028) and heel-rise height (mean [SD] difference, –4.1 to –6.1 [1.7-1.8] cm, P = .012-.028). There were significant negative correlations (r = 20.943, P = .002, and r = 20.738, P = .037) between the side-to-side difference in heel-rise height and Achilles tendon length at the 6- and 12-month evaluations, respectively. Conclusion: The side-to-side difference found in maximal heel-rise height can be explained by a difference in Achilles tendon length in patients recovering from an Achilles tendon rupture. Minimizing tendon elongation appears to be an important treatment goal when aiming for full return of function. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the effects of low level laser therapy in combination with a programme of exercises on pain, functionality, range of motion, muscular strength and quality of life in patients with osteoarthritis of the knee.Design: A randomized double-blind placebo-controlled trial with sequential allocation of patients to different treatment groups.Setting: Special Rehabilitation Services.Subjects: Forty participants with knee osteoarthritis, 2–4 osteoarthritis degree, aged between 50 and 75 years and both genders.Intervention: Participants were randomized into one of two groups: the laser group (low level laser therapy dose of 3 J and exercises) or placebo group (placebo laser and exercises).Main measures: Pain was assessed using a visual analogue scale (VAS), functionality using the Lequesne questionnaire, range of motion with a universal goniometer, muscular strength using a dynamometer, and activity using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire at three time points: (T1) baseline, (T2) after the end of laser therapy (three weeks) and (T3) the end of the exercises (11 weeks).Results: When comparing groups, significant differences in the activity were also found (P = 0.03). No other significant differences (P > 0.05) were observed in other variables. In intragroup analysis, participants in the laser group had significant improvement, relative to baseline, on pain (P = 0.001), range of motion (P = 0.01), functionality (P = 0.001) and activity (P < 0.001). No significant improvement was seen in the placebo group.Conclusion: Our findings suggest that low level laser therapy when associated with exercises is effective in yielding pain relief, function and activity on patients with osteoarthritis of the knees. [ABSTRACT FROM PUBLISHER]

Background: Meniscus allograft transplantation (MAT) has shown efficacy in relieving pain and improving knee joint function, but objective evaluation in a large number of patients is necessary to verify this effect.Hypothesis: Meniscus allograft transplantation relieves pain and improves function of the involved knee joint. Objective evaluation provides evidence of allograft integrity.Study Design: Case series; Level of evidence, 4.Methods: Of the 115 knees that underwent MAT from December 1996 to February 2009, 110 (95.7%) were followed up for more than 2 years and were enrolled in this study. Of these, 83 underwent lateral MAT, and 27 underwent medial MAT. Clinical outcomes were evaluated using the modified Lysholm score and Knee Society pain score. All knees underwent postoperative magnetic resonance imaging (MRI) and/or second-look arthroscopy to evaluate the integrity and position of the allografts, with allograft status classified as satisfactory, fair, or poor.Results: At a mean follow-up of 49.4 months, clinical improvement was achieved in 104 of the 110 knees (94.5%). Mean modified Lysholm score increased from 72.7 preoperatively to 92.3 at final follow-up (P < .001), and mean preoperative Knee Society pain score increased from 32.5 to 47.7 (P < .001). Of the 110 knees, 90 were evaluated by postoperative MRI alone, 2 by second-look arthroscopy alone, and 18 by both. Magnetic resonance imaging showed 12 gross tears and 6 small tears in the allograft. Mean extrusion of the allograft was 3.7 mm, and mean relative percentage of extrusion was 42.6%. Second-look arthroscopy showed 6 gross tears and 1 small flap tear. Classification by clinical outcome, MRI, and second-look arthroscopy graded 90 allografts (81.8%) as satisfactory, 8 (7.3%) as fair, and 12 (10.9%) as poor.Conclusion: Meniscus allograft transplantation using bone fixation resulted in significant symptomatic and functional improvements. Magnetic resonance imaging or second-look arthroscopy was necessary to assess allograft status even after favorable clinical outcome. Meniscus allograft transplantation with bone fixation is considered effective for symptomatic, totally meniscectomized knees. [ABSTRACT FROM PUBLISHER]

Background: A recent meta-analysis found that generalized joint hypermobility is a risk factor for knee injuries during contact sports. The effect of hypermobility on the incidence of injuries in elite-level professional soccer players is not known.Purpose: To compare the incidence of injury between hypermobile and nonhypermobile elite-level male professional soccer players.Study Design: Cohort study; Level of evidence, 2.Methods: Fifty-four players from an English Premier League soccer club were assessed for hypermobility, using the 9-point Beighton scale (threshold, 4 points or above), at the start of the 2009-2010 season. Time-loss injuries and individual exposure times were recorded during all club training sessions and matches throughout the entire season.Results: Mean ± standard deviation incidence of injuries was 11.52 ± 11.39 injuries/1000 h, and the prevalence of hypermobility was 33.3% (18 of 54 players). There were 133 injuries during 13 897.5 hours of exposure. During the season, hypermobile participants had a higher incidence of injuries (mean [95% confidence interval] difference, 15.65 [9.18-22.13] injuries/1000 h; P = .001) and were more likely to experience at least 1 injury, a reinjury, and a severe injury compared with nonhypermobile participants. There were 9 severe knee injuries in hypermobile participants, of which 6 were cartilage injuries.Conclusion: There was an increased incidence of injury in hypermobile elite-level professional soccer players from an English Premier League club, resulting in more missed days from training and match play. These findings suggest a need for routine screening for hypermobility in professional soccer. [ABSTRACT FROM PUBLISHER]

Background: Meniscectomy and articular cartilage damage have been found to increase the prevalence of osteoarthritis after anterior cruciate ligament reconstruction, but the effect of knee range of motion has not been extensively studied.Hypothesis: The prevalence of osteoarthritis as observed on radiographs would be higher in patients who had abnormal knee range of motion compared with patients with normal knee motion, even when grouped for like meniscal or articular cartilage lesions.Study Design: Cohort study; Level of evidence, 3.Methods: We prospectively followed patients at a minimum of 5 years after surgery. The constant goal of rehabilitation was to obtain full knee range of motion as quickly as possible after surgery and maintain it in the long term. Range of motion and radiographs were evaluated at the time of initial return to full activities (early follow-up) and final follow-up according to International Knee Documentation Committee (IKDC) objective criteria. A patient was considered to have normal range of motion if extension was within 2° of the opposite knee including hyperextension and knee flexion was within 5°. Radiograph findings were rated as abnormal if any signs of joint space narrowing, sclerosis, or osteophytes were present.Results: Follow-up was obtained for 780 patients at a mean of 10.5 ± 4.2 years after surgery. Of these, 539 had either normal or abnormal motion at both early and final follow-up. In 479 patients who had normal extension and flexion at both early and final follow-up, 188 (39%) had radiographic evidence of osteoarthritis versus 32 of 60 (53%) patients who had less than normal extension or flexion at early and final follow-up (P = .036). In subgroups of patients with like meniscal status, the prevalence of normal radiograph findings was significantly higher in patients with normal motion at final follow-up versus patients with motion deficits. Multivariate logistic regression analysis of categorical variables showed that abnormal knee flexion at early follow-up, abnormal knee extension at final follow-up, abnormal knee flexion at final follow-up, partial medial meniscectomy, and articular cartilage damage were significant factors related to the presence of osteoarthritis on radiographs. Abnormal knee extension at early follow-up showed a trend toward statistical significance (P = .0544). Logistic regression showed the odds of having osteoarthritis were 2 times more for patients with abnormal range of motion at final follow-up; these odds were similar for those with partial medial meniscectomy and articular cartilage damage.Conclusion: The prevalence of osteoarthritis on radiographs in the long term after anterior cruciate ligament reconstruction is lower in patients who achieve and maintain normal knee motion, regardless of the status of the meniscus. [ABSTRACT FROM PUBLISHER]

Background: Posterolateral corner (PLC) injuries are difficult to diagnose and cause significant morbidity. The ideal method for the dial test and its accuracy remain unclear.Purpose: This study compares the accuracy of measuring tibial external rotation at the skeletal level to measuring the patella-tubercle angle (PTA) and the thigh-foot angle (TFA) in the supine position to assess the most accurate method to measure rotation during the dial test.Study Design: Controlled laboratory study.Methods: Measurements were compared simultaneously using rotational goniometers at a cutaneous splint over the tibia, at a foot splint, and directly from the tibial skeleton. Six lower limbs were used. The femur was held rigidly and the knee tested at 90° and 30° of flexion. External rotation torque up to 8 N·m was applied through the foot splint, and the rotations were measured by 2 testers.Results: Measurements at the tibial splint and directly on the tibia showed significant correlation at both knee flexion angles. The mean tibial external rotation was 24° at 90° of flexion and 26° at 30° of flexion (P < .05). The soft tissue effect caused the tibial splint to overestimate rotations by a mean of 6° and 9° at 90° and 30° of flexion, respectively. Foot splint measurements did not correlate significantly with tibial rotation, overestimating rotations by a mean of 103%. Intratester and intertester intraclass correlations were significant for the skin-mounted tibial splint measurements at both flexion angles but not for foot splint measurements at either flexion angles.Conclusion: Rotation of the foot did not accurately represent the tibial external rotation at the knee, which could be measured more accurately by an instrument resting on the skin via a molded tibial splint. These results suggest that the PTA, and not the TFA, should be used in the dial test. This would support the use of the supine position during the dial test.Clinical Relevance: The dial test is a commonly used method for diagnosing PLC injuries. This study helps to identify the ideal position and measuring points to use for this test; measurements based on the tibia were more accurate than those that used rotation of the foot. [ABSTRACT FROM AUTHOR]

Background: Advances in the management of Achilles tendon rupture have led to the development of immediate weightbearing protocols. These vary regarding which ankle-foot orthoses (AFOs) are used and the number of inserted heel wedges used within them.Purpose: This study was conducted to evaluate plantar pressure measurements and temporal gait parameters within different AFOs, using different numbers of heel wedges.Study Design: Controlled laboratory study.Methods: Fifteen healthy participants were evaluated using 3 different AFOs, with 4 different levels of inserted heel wedges. Therefore, a total of 12 conditions were evaluated, in a sequence that was randomly allocated to each participant. Pressure and temporal gait parameters were measured using an in-shoe F-Scan pressure system, and range of movement was measured using an electrogoniometer.Results: Ankle-foot orthoses that were restrictive in design, combined with a higher number of inserted heel wedges, reduced forefoot pressures, increased heel pressures, and decreased the amount of time spent in the terminal stance and preswing phase of the gait cycle (P = .029, .002, and .001).Conclusion: The choice of AFO design and the number of inserted heel wedges have a significant effect on plantar pressure measurements and temporal gait parameters. The implications of these changes need to be applied to the clinical management of acute Achilles tendon ruptures. This clinical management requires a balance between protected weightbearing and functional loading, requiring further research within a clinical context.Clinical Relevance: The biomechanical data from this research imply that a carbon-fiber AFO, with 1 heel raise, protects against excessive dorsiflexion while facilitating the restoration of near-normal gait parameters. This could lead to an accelerated return to function, avoiding the effects of disuse atrophy. This is in contrast to the rigid rocker-bottom AFO design with a greater number of heel-wedge inserts. However, research within a clinical context would be required to ascertain if these biomechanical advantages translate into a functional benefit for patients. The results should also be considered in relation to the amount of force a healing Achilles tendon can withstand. [ABSTRACT FROM AUTHOR]

Background: Hip muscle weakness has been proposed to contribute to patellofemoral malalignment and the development of the patellofemoral dysfunction syndrome (PFDS). However, from the retrospective studies that have addressed this issue, it is still unclear if hip muscle weakness is a cause or a consequence of PFDS.Purpose: This study was undertaken to investigate if hip muscle weakness is a predisposing factor for the development of PFDS.Study Design: Cohort study (prognosis); Level of evidence, 2.Methods: Before the start of a 10-week “start to run” program, the isometric strength of the hip flexor, extensor, abductor, adductor, and external and internal rotator muscles was measured in 77 healthy female novice runners. During the 10-week training period, patellofemoral pain was diagnosed and registered by an orthopaedic surgeon.Results: Statistical analysis revealed that there was no significant difference in strength of any of the assessed hip muscle groups between the runners who did and did not develop PFDS. Logistic regression analysis did not identify a deviation in strength of any of the assessed hip muscle groups as a risk factor for PFDS.Conclusion: The findings of this study suggest that isometric hip muscle strength might not be a predisposing factor for the development of PFDS. [ABSTRACT FROM AUTHOR]

Background: Range of motion deficits in shoulder external rotation (ER), internal rotation (IR), total rotation range of motion (ER + IR), and horizontal adduction (HA) have been retrospectively associated with overhand athletes’ arm injuries.Hypothesis: The authors expected the incidence of upper extremity injury in high school softball and baseball players with side-to-side shoulder range of motion deficits to be greater than the incidence of upper extremity injury in players with normal shoulder range of motion.Study Design: Cohort study (prognosis); Level of evidence, 2.Methods: High school softball and baseball players (N = 246) participated. Before the start of the season, passive shoulder ER, IR, and HA were assessed at 90° of abduction with the scapula stabilized. Relative risk (RR) was calculated to examine range of motion measure, by categorical criteria, and risk of upper extremity injury.Results: Twenty-seven shoulder and elbow injuries (9 softball, 18 baseball) were observed during the season. The dominant shoulder of all injured players and baseball players displayed a significant decrease in HA (P = .05) and IR (P = .04). The dominant shoulder total rotation of injured baseball players displayed a significant decrease (mean difference = 8.0° ± 0.1°; P = .05) as compared with the dominant shoulder of uninjured baseball players. Players who displayed a decrease of ≥25° of IR in the dominant shoulder were at 4 times greater risk of upper extremity injury compared with players with a <25° decrease in IR, especially for baseball players. While we observed a 1.5 to 2 times increased risk of injury for the 10° to 20° loss in rotational range of motion for the overall sample and baseball, the risk estimates were not statistically significant (P > .05).Conclusion: There are large mean deficits in shoulder IR and HA between injured and noninjured players, but not in ER or total rotation. Passive shoulder IR loss ≥25° as compared bilaterally was predictive of arm injury. Shoulder range of motion deficits differed between sports and appeared more predictive of injury for baseball players. [ABSTRACT FROM AUTHOR]

Background: The long-term radiographic and subjective results of patients with posterior lateral meniscus root tears left in situ at the time of anterior cruciate ligament reconstruction has not been reported.Hypothesis: The authors hypothesized that patients who had posterior lateral meniscus root tears left in situ would have statistically significantly lower subjective scores and greater joint-space narrowing as compared with a control group.Study Design: Cohort study; Level of evidence, 3.Methods: Thirty-three patients who had isolated posterior lateral meniscus root tear and >5 years objective and subjective follow-up were evaluated and compared with a matched control group without meniscal tears based on sex, chronicity of tear, age, and follow-up time. Patients were evaluated subjectively and objectively using the International Knee Documentation Committee criteria.Results: The mean objective follow-up time was 10.6 ± 4.5 years. The mean subjective total score was 84.6 ± 14 in the study group versus 90.5 ± 13 in the control group (P = .09). Radiographs showed lateral joint-space narrowing rated as normal in 19, mild in 10, moderate in 3, and severe in 1 versus the control group, which was normal in 28 and mild in 5 patients. The measured amount of lateral joint-space narrowing compared with the other knee was 1.0 ± 1.6 mm in the study group versus 0 ± 1.1 mm in the controls on 45° flexed posteroanterior radiographs (P < .006).Conclusion: At a mean of 10 years’ follow-up of posterior lateral meniscus root tears left in situ, mild lateral joint-space narrowing was measured without significant differences in subjective or objective scores compared with controls. This study provides a baseline that can be used to compare the results of procedures used to treat these tears in other manners. [ABSTRACT FROM AUTHOR]

Background: Active range of motion deficit is one of the alleged negative influencing factors of rotator cuff repair. Recently, with the popularity of reverse total shoulder arthroplasty (RTSA), there is a tendency toward performing RTSA in cases of nonarthritic large-to-massive tears with pseudoparalysis.Hypothesis: Rotator cuff repair in patients with active motion deficit may yield inferior outcome.Study Design: Cohort study; Level of evidence, 3.Methods: Among 195 complete repairs of large-to-massive rotator cuff tears, 35 patients experienced painful pseudoparalysis preoperatively. Propensity score matching (1-to-1) was performed between pseudoparalytic and nonpseudoparalytic groups. Finally, 29 patients in each group were matched using the following variables: age, gender, dominance, onset period, aggravation period, number of tendons involved, retraction, operation method (arthroscopic or mini-open), rows of repair (single or double), number of anchors, and fatty degeneration of the supraspinatus, infraspinatus, and subscapularis. At least 1 year after surgery (mean, 30.5 months), range of motion, visual analog scale for pain and satisfaction, Constant score, Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES) score, and University of California, Los Angeles shoulder rating scale (UCLA score) were evaluated. Healing of repaired cuffs was evaluated by computed tomography arthrography.Results: Range of motion was improved in both groups after rotator cuff repair. Active forward elevation had significantly improved postoperatively in the pseudoparalytic group (P < .001). All functional outcome scores improved at the final follow-up visit compared with preoperative values (all P < .05). Preoperative Constant, ASES, and UCLA scores were significantly inferior in the pseudoparalytic group, but all except the Constant score showed no differences between the 2 groups at the final follow-up (P = .04). Postoperatively, 7 patients (24.1%) in the pseudoparalytic and 1 (3.4%) in the nonpseudoparalytic group showed pseudoparalysis (P = .03). Among 37 patients who underwent postoperative computed tomography arthrography, cuff healing was achieved in 6 of 18 (33.3%) in the pseudoparalytic and 9 of 19 (47.4%) in the nonpseudoparalytic group (P = .385).Conclusion: Recovery from pseudoparalysis after rotator cuff repair was evident in a large portion of the study group, and postoperative function and cuff healing were not different according to the presence of pseudoparalysis. Considering possible complications and longevity of RTSA, rotator cuff repair should be the first-line treatment option for large-to-massive tears. [ABSTRACT FROM AUTHOR]

Background: Outcomes of arthroscopic type II superior labral anterior posterior (SLAP) repairs have been reported with success. However, published data regarding outcomes of revision arthroscopic type II SLAP repairs are lacking.Hypothesis: Outcomes of revision arthroscopic type II SLAP repairs are inferior to those of primary repairs.Study Design: Case series; Level of evidence, 4.Methods: A retrospective chart review was performed to identify patients who had undergone revision arthroscopic type II SLAP repairs at our institution. Patients who underwent concomitant rotator cuff repairs or labral repairs for instability were excluded. Twelve patients were contacted, and the following outcome data were prospectively gathered: American Shoulder and Elbow Surgeons (ASES) score, patient satisfaction level, return to work, return to sports, and physical examination. Demographics and intraoperative report data were also collected from the charts.Results: The mean age at the time of revision arthroscopic type II SLAP repairs was 32.6 years (range, 19-67 years) with a mean follow-up of 50.5 months (range, 8-81 months). There were 5 workers’ compensation patients and 6 overhead athletes. Pain was the chief complaint at the time of initial and revision SLAP repairs. The mean ASES score was 72.5, patient satisfaction level was 6.4 (scale of 0-10), mean return to work was at 57.8% of the previous level, and mean return to sports was at 42.2% of the previous level. In overhead athletes, mean return to sports was at 41.3% of the previous level, and none of the 4 baseball players returned to preinjury level. The mean values for all outcome data and range of motion values were lower in workers’ compensation patients. There were no reported complications, but 2 patients required additional arthroscopic surgeries.Conclusion: Arthroscopic revision type II SLAP repairs yield worse results than primary repairs as reported in the literature, with workers’ compensation patients and overhead athletes doing especially worse. A larger prospective study of this relatively rare procedure is needed to better determine which patients may benefit from this procedure. [ABSTRACT FROM AUTHOR]

Background: Ballet movements require a limited base of support; thus, ballet dancers require a high level of postural control. However, postural stability in ballet dancers is still unclear and needs to be understood.Purpose: To evaluate ballet dancers’ postural stability in performing single-leg standing, the en pointe task, and the first and fifth positions and to determine differences in task performance among healthy nondancers, healthy dancers, and dancers with ankle sprains.Study Design: Controlled laboratory study.Methods: Injured dancers, uninjured dancers, and nondancers were recruited for this study (N = 33 age-matched participants; n= 11 per group). The tasks tested were single-leg standing with eyes open and closed, first position, fifth position, and en pointe. Center of pressure parameters were calculated from the ground-reaction force collected with 1 force plate. Analysis of variance was used to assess the differences of center of pressure parameters among 3 groups in single-leg standing; independent t test was used to examine the differences of center of pressure parameters between injured and uninjured dancers.Results: During single-leg standing, injured dancers had significantly greater maximum displacement in the medial-lateral direction and total trajectory of center of pressure, compared with the uninjured dancers and nondancers. During the first and fifth positions, the injured dancers demonstrated significantly greater standard deviation of center of pressure position in the medial-lateral and anterior-posterior directions, compared with the uninjured dancers. During en pointe, the injured dancers had significantly greater maximum displacement in the medial-lateral direction and the anterior-posterior direction, compared with the uninjured dancers.Conclusion: The injured and uninjured dancers demonstrated differences in postural stability in the medial-lateral direction during single-leg standing and the ballet postures. Although the injured dancers received ballet training, their postural stability may still be inferior to that of the nondancers.Clinical Relevance: This study is a first step in understanding that injured ballet dancers do not have the same postural stability as uninjured dancers and that it is even inferior to that of nondancers, which is important to understand for further study on rehabilitation. The future development of effective balance training programs for ballet dancers with ankle injuries should emphasize improvements in medial-lateral directional balance. [ABSTRACT FROM AUTHOR]

Background: The treatment of lateral ankle instability is challenging when the remaining ligamentous tissue is insufficient. Anatomic reconstruction with a tendon graft is a good option that can produce a stable ankle and avoid the complications of a non-anatomic tenodesis procedure.Hypothesis: A new technique for anatomically reconstructing the lateral ligaments of the ankle using an extensor digitorum longus tendon graft of the fourth toe will be effective for treating lateral ankle instability with chronic ligamentous insufficiency.Study Design: Case series; Level of evidence, 4.Methods: Twenty-four patients were treated with anatomic reconstruction of the ligaments using the long extensor tendon of the fourth toe. The mean age was 35.7 years (range, 16-53 years). The minimum follow-up was 24 months (range, 24-57 months; mean, 37 months). There were 17 cases of chronic ligamentous insufficiency, 3 failed Brostrom operations, and 4 others. Preoperative and postoperative Karlsson scales were used to analyze the functional results. The anterior displacement and the talar tilt angle on standard stress radiography of the talocrural joint were measured preoperatively and at the time of last follow-up for comparison.Results: The results on the Karlsson scale increased from 48.0 ± 4.2 points preoperatively to 92.2 ± 3.8 points at the latest follow-up (P < .01). Radiographically, the mean anterior displacement was 6.7 ± 1.2 mm before operation and 3.4 ± 0.6 mm at the latest follow-up (P < .01). The mean talar tilt angle was 12.3° ± 1.1° before the operation and 4.3° ± 0.8° at the latest follow-up (P < .01).Conclusion: Anatomic reconstruction of the lateral ankle ligaments using the long extensor tendon of the fourth toe appears to be an effective surgical option for chronic insufficiency of the lateral ankle ligament. [ABSTRACT FROM AUTHOR]

Background: Hamstring muscle strains often recur. The authors studied the effect of the grade of initial injury on the subsequent risk of reinjury.Hypothesis: No difference in reinjury rate between acute low-grade (grades I and II) and high-grade (III and IV) hamstring muscle strains would be seen.Study Design: Cohort study (prognosis); Level of evidence, 1.Methods: Between 1999 and 2007, the authors managed 165 elite track and field athletes with acute, first-time unilateral hamstring muscle strains. Strains were classified into 4 grades (I, II, III, and IV) based on knee active range of motion deficit at 48 hours. The same rehabilitation protocol was prescribed, and the rate of reinjury was recorded during the following 24 months.Results: The average time to return to sport after initial injury was 7.4 days for grade I injuries, 12.9 days for grade II injuries, 29.5 days for grade III injuries, and 55.0 days for grade IV injuries. At follow-up, 23 of the 165 athletes (13.9%) had experienced a second hamstring muscle strain. Of the 75 athletes with a grade I injury, 7 (9.3%) had experienced a recurrence after 24 months. Of the 58 athletes with a grade II injury, 14 (24.1%) experienced a recurrence. Of the 26 athletes with a grade III injury, 2 (7.7%) experienced a recurrence, and of the 6 athletes with a grade IV injury, none had experienced a recurrence after 24 months.Conclusion: Low-grade hamstring muscle lesions appear to lead to a higher risk of reinjury than high-grade hamstring muscle lesions. However, there were disproportionately fewer high-grade injuries than low-grade injuries. Objective clinical findings can accurately determine the risk of reinjury after acute hamstring muscle strains in elite track and field athletes. [ABSTRACT FROM AUTHOR]

Background: There is an assumption that baseball athletes who reside in warm-weather climates experience larger magnitude adaptations in throwing shoulder motion and strength compared with their peers who reside in cold-weather climates.Hypotheses: (1) The warm-weather climate (WWC) group would exhibit more pronounced shoulder motion and strength adaptations than the cold-weather climate (CWC) group, and (2) the WWC group would participate in pitching activities for a greater proportion of the year than the CWC group, with the time spent pitching predicting throwing shoulder motion and strength in both groups.Study Design: Cross-sectional study; Level of evidence, 3.Methods: One hundred uninjured high school pitchers (50 each WWC, CWC) were recruited. Rotational shoulder motion and isometric strength were measured and participants reported the number of months per year they pitched. To identify differences between groups, t tests were performed; linear regression was used to determine the influence of pitching volume on shoulder motion and strength.Results: The WWC group pitched more months per year than athletes from the CWC group, with the number of months spent pitching negatively related to internal rotation motion and external rotation strength. The WWC group exhibited greater shoulder range of motion in all planes compared with the CWC group, as well as significantly lower external rotation strength and external/ internal rotation strength ratios. There was no difference in internal rotation strength between groups, nor a difference in the magnitude of side-to-side differences for strength or motion measures.Conclusion: Athletes who reside in cold- and warm-weather climates exhibit differences in throwing shoulder motion and strength, related in part to the number of months spent participating in pitching activities. The amount of time spent participating in pitching activities and the magnitude of range of motion and strength adaptations in athletes who reside in warm-weather climates may make these athletes more susceptible to throwing-related injuries. [ABSTRACT FROM AUTHOR]

Background: After reinsertion on the humerus, the rotator cuff has limited ability to heal. Growth factor augmentation has been proposed to enhance healing in such procedure.Purpose: This study was conducted to assess the efficacy and safety of growth factor augmentation during rotator cuff repair.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: Eighty-eight patients with a rotator cuff tear were randomly assigned by a computer-generated sequence to receive arthroscopic rotator cuff repair without (n = 45) or with (n = 43) augmentation with autologous platelet-rich fibrin matrix (PRFM). The primary end point was the postoperative difference in the Constant score between the 2 groups. The secondary end point was the integrity of the repaired rotator cuff, as evaluated by magnetic resonance imaging. Analysis was on an intention-to-treat basis.Results: All the patients completed follow-up at 16 months. There was no statistically significant difference in total Constant score when comparing the results of arthroscopic repair of the 2 groups (95% confidence interval, —3.43 to 3.9) (P = .44). There was no statistically significant difference in magnetic resonance imaging tendon score when comparing arthroscopic repair with or without PRFM (P = .07).Conclusion: Our study does not support the use of autologous PRFM for augmentation of a double-row repair of a small or medium rotator cuff tear to improve the healing of the rotator cuff. Our results are applicable to small and medium rotator cuff tears; it is possible that PRFM may be beneficial for large and massive rotator cuff tears. Also, given the heterogeneity of PRFM preparation products available on the market, it is possible that other preparations may be more effective. [ABSTRACT FROM AUTHOR]

Background: Glenohumeral internal rotation deficit (GIRD) indicates a 20° or greater loss of internal rotation of the throwing shoulder compared with the nondominant shoulder.Purpose: To determine whether GIRD and a deficit in total rotational motion (external rotation + internal rotation) compared with the nonthrowing shoulder correlate with shoulder injuries in professional baseball pitchers.Study Design: Case series; Level of evidence, 4.Methods: Over 3 competitive seasons (2005 to 2007), passive range of motion measurements were evaluated on the dominant and nondominant shoulders for 170 pitcher-seasons. This included 122 professional pitchers during the 3 seasons of data collection, in which some pitchers were measured during multiple seasons. Ranges of motion were measured with a bubble goniometer during the preseason, by the same examiner each year. External and internal rotation of the glenohumeral joint was assessed with the participant supine and the arm abducted 90° in the plane of the scapula, with the scapula stabilized anteriorly at the coracoid process. The reproducibility of the test methods had an intraclass correlation coefficient of .81. Days in which the player was unable to participate because of injury or surgery were recorded during the season by the medical staff of the team and defined as an injury.Results: Pitchers with GIRD (n = 40) were nearly twice as likely to be injured as those without but without statistical significance (P = .17). Pitchers with total rotational motion deficit greater than 5° had a higher rate of injury. Minor league pitchers were more likely than major league pitchers to be injured. However, when players were injured, major league pitchers missed a significantly greater number of games than minor league pitchers.Conclusion: Compared with pitchers without GIRD, pitchers with GIRD appear to be at a higher risk for injury and shoulder surgery. [ABSTRACT FROM AUTHOR]

Background: The posterolateral corner of the knee consists of static and dynamic stabilizing structures. Knee injuries often include the posterolateral structures. The popliteus muscle-tendon unit is known as the major dynamic stabilizer of the posterolateral corner.Hypothesis: The dynamic stabilization of the posterolateral structures of the knee via the popliteus muscle-tendon unit during a squatting exercise follows a constant activation pattern.Study Design: Controlled laboratory study.Methods: Within the pilot study, 6 volunteers performed 2 exercises to verify the electrode position scheme and to analyze crosstalk. In the main study 2 static exercises (standing and standing with knees flexed 90°) and 2 dynamic exercises (isolated popliteus muscle activation and squats) were recorded in 17 volunteers. Electromyograms were obtained of the popliteus, medial and lateral gastrocnemius, and quadriceps muscles. Knee angle-related muscle activity was recorded.Results: In the pilot study it was assumed that the chosen electrode position allowed selective measurement of popliteus muscle activity. In the main study the mean popliteus onset angle was 43° ± 14° of flexion; activity lasted through the reversal point of the squat to 58° ± 21° of flexion during extension movement. Popliteus activity during all testing cycles revealed that the activity in the standing position is the smallest. The highest activity was recorded during the squat and the popliteus muscle-tendon unit exercise.Conclusion: This study demonstrates an activation pattern of the popliteus muscle-tendon unit with high interindividual differences in the onset angles. A constant activation during the reversal phase of the squatting exercise could be observed.Clinical Relevance: Reconstructive procedures of the posterolateral structures often include reconstruction of the popliteus muscle-tendon unit. Reconstructive procedures are usually done in a static manner, thus not addressing the dynamic stabilizing structure in a true functional way. The findings of the current study may be a useful contribution to the ongoing discussion of this topic. [ABSTRACT FROM AUTHOR]

Background: Enhanced primary anterior cruciate ligament repair, in which suture repair is performed in conjunction with a collagen-platelet composite to stimulate healing, is a potential new treatment option for anterior cruciate ligament injuries. Previous studies have evaluated this approach at the time of anterior cruciate ligament disruption.Hypothesis: Delaying surgery by 2 or 6 weeks would have a significant effect on the functional outcome of the repair.Study Design: Controlled laboratory study.Methods: Sixteen female Yorkshire pigs underwent staged, bilateral surgical anterior cruciate ligament transections. Anterior cruciate ligament transection was initially performed on 1 knee and the knee closed. Two or 6 weeks later, enhanced primary repair was performed in that knee while the contralateral knee had an anterior cruciate ligament transection and immediate repair. Biomechanical parameters were measured after 15 weeks in vivo to determine the effect of delay time relative to immediate repair on the healing response.Results: Yield load of the repairs at 15 weeks was decreased by 40% and 60% in the groups where repair was delayed for 2 and 6 weeks, respectively (P = .01). Maximum load showed similar results (55% and 60% decrease in the 2- and 6-week delay groups, respectively; P = .011). Linear stiffness also was adversely affected by delay (50% decrease compared with immediate repair after either a 2- or 6-week delay, P = .011). Anterior-posterior laxity after 15 weeks of healing was 40% higher in knees repaired after a 2-week delay and 10% higher in those repaired after a 6-week delay (P = .012) when tested at 30° of flexion, but was not significantly affected by delay when tested at 60° or 90° (P = .21).Conclusion: A delay between anterior cruciate ligament injury and enhanced primary repair has a significant negative effect on the functional performance of the repair.Clinical Relevance: As future investigations assess new techniques of anterior cruciate ligament repair, the timing of the repair should be considered in the design and the interpretation of experimental studies. [ABSTRACT FROM AUTHOR]

Background: Double-row arthroscopic rotator cuff repairs were developed to improve initial biomechanical strength of repairs to improve healing rates. Despite biomechanical improvements, failure of healing remains a clinical problem.Purpose: To evaluate the anatomical results after double-row arthroscopic rotator cuff repair with ultrasound to determine postoperative repair integrity and the effect of various factors on tendon healing.Study Design: Case series; Level of evidence, 4.Methods: Forty-eight patients (49 shoulders) who had a complete arthroscopic rotator cuff repair (double-row technique) were evaluated with ultrasound at a minimum of 6 months after surgery. Outcome was evaluated at a minimum of 1-year follow-up with standardized history and physical examination, visual analog scale for pain, active forward elevation, and preoperative and postoperative shoulder scores according to the system of the American Shoulder and Elbow Surgeons and the Simple Shoulder Test. Quantitative strength was measured postoperatively.Results: Ultrasound and physical examinations were performed at a minimum of 6 months after surgery (mean, 16 months; range, 6 to 36 months) and outcome questionnaire evaluations at a minimum of 12 months after surgery (mean, 29 months; range, 12 to 55 months). Of 49 repairs, 25 (51%) were healed. Healing rates were 67% in single-tendon tears (16 of 24 shoulders) and 36% in multitendon tears (9 of 25 shoulders). Older age and longer duration of follow-up were correlated with poorer tendon healing (P < .03). Visual analog scale for pain, active forward elevation, American Shoulder and Elbow Surgeons scores, and Simple Shoulder Test scores all had significant improvement from baseline after repair ( P < .0001).Conclusion: Increased age and longer duration of follow-up were associated with lower healing rates after double-row rotator cuff repair. The biological limitation at the repair site, as reflected by the effects of age on healing, appears to be the most important factor influencing tendon healing, even after maximizing repair biomechanical strength with a double-row construct. [ABSTRACT FROM AUTHOR]

Background: Although most people can lead near-normal lives with a limited but functional arc of elbow motion, athletes may find loss of terminal extension severely impairing.Hypothesis: Arthroscopic contracture release is effective in restoring full elbow extension in athletes whose loss of terminal extension impairs their intensities and/or levels of performance in sport.Study design: Case series; Level of evidence, 4.Methods: Between 1997 and 2007, 24 athletes (26 elbows; mean age, 38 years [range, 12-58]) whose chief complaint was limited elbow extension (≤35°) underwent arthroscopic release of contractures (average follow-up, 33 months [range, 12-88]). All the patients were classified according to a sport-specific scoring system using the subjective patient outcome for return to sports score and the summary outcome determination score.Results: All 26 elbows improved subjectively and objectively with surgery. Of the 26 elbows, 25 were rated by the patients as normal (n = 15) or near-normal (n = 10) at final follow-up. Pain during intense sporting activities was absent in 17, mild and occasional without affecting performance in 6, and severe enough to affect performance in 1. Of the 24 patients (26 elbows), 22 patients (23 elbows) returned to the same sport at the same level of intensity and performance as before injury. Two patients (3 elbows) returned to the same sport but failed to reach their preinjury levels of performance. Extension improved in all patients, with the average flexion contracture decreasing from 27° ± 7° (range, 10°-35°) to 6° ± 9° (range, 10° of hyperextension to 25°; P < .001). Lack of extension was not a residual impairment factor in any patients. Three patients developed delayed-onset ulnar neuropathy after surgery, 2 of which were treated by subcutaneous transposition. All 3 resolved completely, 2 within the first 6 weeks; the other took longer than a year.Conclusion: The arthroscopic release of contractures is a predictable technique to achieve a highly functional elbow in athletes. [ABSTRACT FROM AUTHOR]

Background: Pelvis and trunk motions during baseball pitching are associated with ball velocity. Thus, limits in hip flexibility may adversely affect pitching biomechanics and the ability to generate ball velocity.Hypotheses: Professional baseball pitchers will have less passive range of motion in the nondominant hip and the measured ranges of motion of both the nondominant and dominant hips will correlate with biomechanical parameters of the lower extremity among professional pitchers.Study Design: Cross-sectional study; Level of evidence, 3.Methods: Nineteen healthy professional baseball pitchers volunteered for testing. Fluid goniometry was used to measure passive range of motion of adduction (ADD), abduction (ABD), internal rotation, external rotation, total arc of rotation, and total arc of ADD + ABD. Pitching biomechanical data were collected using an automated 3-dimensional motion analysis system while participants threw fastballs.Results: Pitchers possessed significantly less passive range of motion in the nondominant hip when compared with the dominant hip for all ranges. Total arc of rotation of the nondominant hip correlated with ball velocity (r = .50). Total arc of ADD + ABD in the nondominant hip and ABD in the nondominant hip were correlated with stride length (r = —.72 and .70, respectively). Dominant hip ABD (r = .63), total arc of rotation in the nondominant hip (r = —.45), and total arc of ADD + ABD of the dominant hip (r = .44) were correlated with trunk separation. Total arc of ADD + ABD of the nondominant hip (r = —.52) and total arc of rotation of the dominant hip (r = —.44) were correlated with pelvic orientation.Conclusion: Passive range of motion is smaller in the nondominant hip than the dominant hip among professional pitchers. The measured disparity between the hips is significantly correlated with various pitching biomechanical parameters of the trunk and pelvis. Future research is required to investigate a causal relationship between less hip passive range of motion and both ball velocity and pitching biomechanics. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were 1 ) to understand which anatomic variables are associated with failed endoscopic exposure of Zenker's diverticulum and 2) to enable preoperative selection of patients suitable for endoscopic repair of Zenker's diverticulum on the basis of anatomic variables. Methods: We performed a prospective, Institutional Review Board-approved study of 30 patients undergoing attempted endoscopic repair of Zenker's diverticulum. Three categorical variables (sex. presence of maxillary dentition, and Mallampati score) and 6 continuous variables (age, neck circumference, hyomental distance, neck length, neck extension, and body mass index [BMI]) were collected before operation and then correlated to successful endoscopic exposure of the Zenker's pouch by use of a Fisher's exact test and Student's t-test, respectively. Results: Exposure was unsuccessful in 9 of 30 patients (30%). Factors that correlated significantly with exposure failure included a shorter neck length (7.2 ± 1.2 cm; p = 0.047), a shorter hyomental distance (5.0 ± 1.1 cm; p = 0.004), and a higher BMI (27.2 ±4.0 kg/m2; p = 0.05). The presence of maxillary dentition did not reach significance in exposure failure, but did show a trend toward an association. Conclusions: Surgical exposure in endoscopic repair of Zenker's diverticulum tends to be significantly less successful in patients with short necks, decreased hyomental distance, and/or a high BMI. An open approach should be considered in this patient population. [ABSTRACT FROM AUTHOR]

Background: Impaired postoperative range of motion remains one of the most frequent complications after anterior cruciate ligament reconstruction.Purpose: This study was undertaken to determine the preoperative factors associated with prolonged range of motion deficit after anterior cruciate ligament reconstruction.Study Design: Cohort study; Level of evidence, 3.Methods: Between January 2007 and March 2008, a consecutive series of 217 patients underwent anterior cruciate ligament reconstruction and were reviewed at 6 weeks and 3 months after surgery. In this series, all data of patients who required a further surgery for arthrolysis until December 2009 were studied. Goniometric range of motion measurement was performed the day before surgery and at 6 weeks and 3 months postoperatively. Bone contusions were analyzed on preoperative magnetic resonance imaging (MRI). All MRI scans were performed in the 6 months before surgery. Seven potential risk factors—age, sex, limited preoperative range of motion, meniscal lesions, bone contusion(s), operative delay less than 45 days, and rehabilitation—were assessed using univariate analysis. The correlations between the significant factors previously identified were analyzed further using multivariate logistic regression analysis.Results: Limited preoperative range of motion (P < .001), typical bone contusions of the lateral compartment (P < .001), operative delay less than 45 days ( P = .003), and female sex (P = .049) were found to be significantly correlated with delayed recovery. The limited preoperative mobility and the presence of typical contusions were strongly correlated (P < .001). In the group of patients who underwent surgery within 45 days, delayed recovery was strongly correlated with limited preoperative mobility (P = .0008) and to the presence of typical contusions (P < .001). Arthrolysis was correlated with delayed range of motion (odds ratio [OR], 8.2; 95% confidence interval [CI], 1.9-50; P =.001) and bone bruise (OR, 7.6; 95% CI, 1.7-46.1; P = .002).Conclusion: Preoperative limited range of motion and typical bone bruises of the lateral femoral condyle and tibial plateau are major risk factors for a difficult rehabilitation after anterior cruciate ligament reconstruction. [ABSTRACT FROM PUBLISHER]

Objectives: To correlate venous haemodynamic parameters of lower limbs and amplitude of ankle mobility with the clinical, aetiological, anatomical and pathological classification (CEAP) for venous disease. Methods: Two hundred and eighty-four lower limbs of 142 Caucasian women were evaluated and distributed in six groups according to the CEAP classification: Group I = C0 and C1 (n = 24); Group II = C2 (n = 30); Group III = C3 (n = 27); Group IV = C4 (n = 23); Group V = C5 (n = 20) and Group VI = C6 (n = 18). Goniometric examinations of ankle joints and air plethysmography (APG) were performed. Analysis of variance and the Bonferroni correction, Kruskal-Wallis' non-parametric and Dunn tests were utilized for statistical analysis with the level of significance being set at 5% (P value < 0.05). Results: There were significant restrictions in ankle mobility seen by goniometry at the C5 stage. In addition, significant changes in the venous-filling index were identified at C2, changes in the ejection fraction at C4 and changes in the residual volume fraction at the C4 stage. Conclusion: The evolution of the clinical state of ankles affected by venous diseases is correlated to a reduction of joint mobility and haemodynamic alterations identified using APG. [ABSTRACT FROM AUTHOR]

Background: The overhead throwing athlete has unique range of motion characteristics of the shoulder and elbow. Numerous theories exist to explain these characteristics; however, the precise cause is not known. Although it is accepted that range of motion is altered, the acute effect of baseball pitching on shoulder and elbow range of motion has not been established. Hypothesis: There will be a reduction in passive range of motion immediately after baseball pitching. Study Design: Controlled laboratory study. Methods: Sixty-seven asymptomatic male professional baseball pitchers participated in the study. Passive range of motion measurements were recorded using a customized bubble goniometer for shoulder external rotation, shoulder internal rotation, total shoulder rotational motion, elbow flexion, and elbow extension on the dominant and nondominant arms. Testing was performed on the first day of spring training. Measurements were taken before, immediately after, and 24 hours after pitching. Results: A significant decrease in shoulder internal rotation (-9.5°), total motion (-10.7°), and elbow extension (-3.2°) occurred immediately after baseball pitching in the dominant shoulder (P < .001). These changes continued to exist 24 hours after pitching. No differences were noted on the nondominant side. Conclusion: Passive range of motion is significantly decreased immediately after baseball pitching. This decrease in range of motion continues to be present 24 hours after throwing. High levels of eccentric muscle activity have previously been observed in the shoulder external rotators and elbow flexors during pitching. These eccentric muscle contractions may contribute to acute musculotendinous adaptations and altered range of motion. The results of this study may suggest a newly defined mechanism to range of motion adaptations in the overhead throwing athlete resulting from acute musculoskeletal adaptations, in addition to potential osseous and capsular adaptations. [ABSTRACT FROM AUTHOR]

Background: Despite improvements in the clinical assessment of rotator cuff injuries, shortcomings exist in diagnosing rotator cuff tears. Purpose: To formulate a clinical rotator cuff functional index for predicting rotator cuff tears based on handheld dynamometer measurements for shoulder strength testing and to assess its ability to diagnose a rotator cuff tear. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Preoperative handheld dynamometer measurements, including supraspinatus, external rotation, internal rotation, adduction, and lift-off force, were compared in 100 patients with full-thickness rotator cuff tears (> 1.0 cm) and 100 patients with no rotator cuff injury (confirmed by arthroscopy). Using multiple logistic regression analysis, the rotator cuff functional index and index for rotator cuff tear size were formulated in which 100 represented excellent rotator cuff function and less than 0 indicated a full-thickness supraspinatus tear. Each patient's index was calculated to determine its clinical value in predicting a rotator cuff tear; the Pearson correlation coefficient was established for the rotator cuff functional index for rotator cuff size. Results: Two handheld dynamometer measurements predicted a rotator cuff tear (P < .001, r = 0.53), with rotator cuff functional index = 1.27 * supraspinatus (N) - 0.72 * adduction (N) - 11.6, but not tear size (r = 0.38). In predicting a rotator cuff tear (rotator cuff functional index < 0 = rotator cuff tear; rotator cuff functional index > 0 = no tear), the rotator cuff functional index had 83% sensitivity, 79% specificity, 80% positive predictive value, 82% negative predictive value, likelihood ratio of 4.0 for a positive test result and 0.2 for a negative test result and an accuracy of 81%. Conclusion: The 2 most useful tests for determining a rotator cuff tear with a handheld dynamometer were supraspinatus force and adduction force (as negative control). A functional index based on these measurements was able to rule out a rotator cuff tear and predict the presence but not the size of the tear. [ABSTRACT FROM AUTHOR]

Background: Physicians involved with the care of baseball players have noted elbow range of motion changes in pitchers. Objective data regarding the extent of these changes have rarely been documented. Hypothesis: Dominant and nondominant elbow range of motion differences are common in baseballpitchers, and these differences are related to player age, amount and length of time professionally pitched, and history of surgical procedures on the dominant extremity. Study Design: Cross-sectional study; Level of evidence, 4. Methods: Thirty-three professional pitchers were evaluated for elbow range of motion during spring training preseason physical examination. Dominant and nondominant elbow range of motion including flexion, extension, supination, and pronation were measured with a goniometer. Range of motion measures from the dominant and nondominant sides were compared. Baseball records were reviewed for arm dominance, age, years of professional pitching, professional innings pitched, and history of elbow surgery. These factors were evaluated for their possible association with range of motion for each side and the difference between sides. Results: Statistically significant differences between dominant and nondominant sides were noted for elbow extension (dominant decreased 7.9° ± 7.4°, P < .0001), flexion (dominant decreased 5.5° ± 7.8°, P = .0003), and total flexion-extension arc (dominant decreased 13.3° ± 13.7°, p < .0001). No significant difference between sides was found for the supination or pronation measures. No correlation was noted for age, pitching history, surgery, or arm dominance and the motion differences. Conclusion: Professional pitchers demonstrate elbow flexion and extension differences between dominant and nondominant elbows. No correlation was found between motion differences and age, pitching history, surgery, or arm dominance. [ABSTRACT FROM AUTHOR]

Background: Few long-term studies have compared the efficacy of shoulder stabilization using arthroscopic or open procedures. Purpose: To directly compare the outcomes of shoulder stabilization using arthroscopic transglenoid sutures versus open capsulolabral repairs. Study Design: Uncontrolled retrospective review. Methods: Fifty patients (30 arthroscopic and 20 open) were followed for a minimum of 5 years (mean, 68 months). Pain, motion, strength, function, stability, patient satisfaction, radiographs, and ability to return to preinjury activity levels were evaluated. Results: The arthroscopic group had a 17% (5 of 30) dislocation rate and a 60% (18 of 30) rate of instability. Sixty-seven percent (6 of 9) of patients participating in collision sports had repeat instability. Eight of 18 patients with instability required open repair for persistent symptoms. There were no limitations of motion following arthroscopic stabilization. The open group had no episodes of dislocations or instability. Forty-five percent (9 of 20) had some loss of external rotation (range, 10°-40°) with a mean loss of 18. The one failure in this group had a 40° loss of external rotation and difficulty with recreational activity. No patients participating in collision sports had repeat instability. Conclusion: We recommend open stabilization for patients participating in collision sports (for example, football, wrestling) or activities where better stability is required. For those participating in sports where performance may be compromised by loss of external rotation (such as swimming), newer arthroscopic techniques are recommended. [ABSTRACT FROM AUTHOR]

Objective: To establish the intra- and inter-rater reliability of composite finger flexion (CFF), and to compare this with goniometry. Design: Fifty-one physiotherapists and occupational therapists took part in the study. The hand of a normal subject was splinted in three different positions. Using a goniometer and a ruler alternately, each therapist measured both the proximal interphalangeal joint and CFF of three digits, following a standardized protocol. This process was repeated three times. Setting: Eighteen NHS hospital sites in the UK. Results: The two measurement methods produced different ranges and standard deviations for each digit. The repeatability coefficient shows that repeated intra-rater goniometric measures fall within 4-5 degrees of each other 95% of the time. Inter-rater goniometric measures fall within 7-9 degrees. Repeated intra-rater CFF measures fall within 5-6 mm of each other, whereas inter-rater fall within 7-9 mm. The influence of occupation, experience in hand therapy, years of practice and routine use were found to have no effect on reliability. Scaling of the two methods of measurement allowed comparison between them to be made. CFF and goniometry are equally reliable when comparing inter-rater reliability, but goniometry displays less variability than composite finger flexion for intra-rater measurements. Conclusion: In this study involving a subject with normal joints, goniometry is more reliable than CFF when only one measurer is involved. However, CFF may be a useful alternative where multiple joint measures are required, or when goniometry is impracticable. [ABSTRACT FROM AUTHOR]