Surgeons
49 years of experience
Video profile
Accepting new patients
North Philadelphia East
Temple General Surgery
3401 N Broad St
Philadelphia, PA 19140
215-707-3040
Locations and availability (7)

Education ?

Medical School Score Rankings
Temple University Physicians (1961)
  • Currently 3 of 4 apples
Top 50%

Awards & Distinctions ?

Awards  
One of America's Leading Experts on:
Bone Fractures
Quadriplegia
Spinal Fractures
Spinal Stenosis
Appointments
Temple University School of Medicine
Clinical Professor adjunct, Orthopedics
Associations
American Board of Orthopaedic Surgery
Cervical Spine Research Society

Affiliations ?

Dr. Torg is affiliated with 3 hospitals.

Hospital Affilations

Score

Rankings

  • Temple University Hospital
    Orthopaedic Surgery
    3401 N Broad St, Philadelphia, PA 19140
    • Currently 1 of 4 crosses
  • Hahnemann University Hospital
    Orthopaedic Surgery
    230 N Broad St, Philadelphia, PA 19102
    • Currently 1 of 4 crosses
  • Temple University Hospital - Episcopal Campus
    100 E Lehigh Ave, Philadelphia, PA 19125
  • Publications & Research

    Dr. Torg has contributed to 107 publications.
    Title Noncontact Anterior Cruciate Ligament Injuries: Mechanisms and Risk Factors.
    Date November 2010
    Journal The Journal of the American Academy of Orthopaedic Surgeons
    Excerpt

    Significant advances have recently been made in understanding the mechanisms involved in noncontact anterior cruciate ligament (ACL) injury. Most ACL injuries involve minimal to no contact. Female athletes sustain a two- to eightfold greater rate of injury than do their male counterparts. Recent videotape analyses demonstrate significant differences in average leg and trunk positions during injury compared with control subjects. These findings as well as those of cadaveric and MRI studies indicate that axial compressive forces are a critical component in noncontact ACL injury. A complete understanding of the forces and risk factors associated with noncontact ACL injury should lead to the development of improved preventive strategies for this devastating injury.

    Title Management of Tarsal Navicular Stress Fractures: Conservative Versus Surgical Treatment: a Meta-analysis.
    Date July 2010
    Journal The American Journal of Sports Medicine
    Excerpt

    This study was conducted to provide a statistical analysis of previously reported tarsal navicular stress fracture studies regarding the outcomes and effectiveness of conservative and surgical management.

    Title Video Analysis of Trunk and Knee Motion During Non-contact Anterior Cruciate Ligament Injury in Female Athletes: Lateral Trunk and Knee Abduction Motion Are Combined Components of the Injury Mechanism.
    Date January 2010
    Journal British Journal of Sports Medicine
    Excerpt

    The combined positioning of the trunk and knee in the coronal and sagittal planes during non-contact anterior cruciate ligament (ACL) injury has not been previously reported.

    Title Video Analysis of Anterior Cruciate Ligament Injury: Abnormalities in Hip and Ankle Kinematics.
    Date April 2009
    Journal The American Journal of Sports Medicine
    Excerpt

    Most anterior cruciate ligament research is limited to variables at the knee joint and is performed in the laboratory setting, often with subjects postinjury. There is a paucity of information on the position of the hip and ankle during noncontact anterior cruciate ligament injury.

    Title Cervical Spinal Stenosis with Cord Neurapraxia: Evaluations and Decisions Regarding Participation in Athletics.
    Date August 2003
    Journal Current Sports Medicine Reports
    Excerpt

    Cervical spinal cord neurapraxia (CCN) leads to transient episodes ranging from paresthesia to paresis to plegia (complete paralysis), and occurs in athletes with some demonstrable degree of cervical spinal stenosis. Determination of spinal stenosis requires demonstrating a sagittal diameter of the spinal canal less than 14 mm from C4 to C6. Because radiologic techniques vary affecting the accuracy of this measure, a ratio method was developed comparing the spinal canal to the vertebral body width, demonstrating that a ratio of less than 0.8 is indicative of cervical spinal stenosis. Although this has high sensitivity (93%), the low predictive value of 0.2% makes this a poor screening tool for athletic participation. Further complicating the challenge of determining which athletes are at risk for quadriplegia are data showing that athletes who suffered permanent injury did not recall transient episodes of CCN, and conversely none of the athletes with CCN later developed permanent neurologic injury. Nevertheless, 56% of football athletes returning to sport after an episode of CCN experienced a recurrence as determined by survey data. Those with CCN and documented ligamentous instability, magnetic resonance imaging evidence of cord defects or swelling, neurologic symptoms or signs for greater than 36 hours, or more than one recurrence have an absolute contraindication.

    Title Complications of Joint Arthroplasty in Patients with End-stage Renal Disease on Hemodialysis.
    Date May 2002
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    The mortality and morbidity after hip and knee arthroplasty were reviewed retrospectively during a 3-year period in 14 patients who had chronic renal failure and who were receiving hemodialysis. The patients had a primary total hip or knee replacement, or a revision arthroplasty or resection arthroplasty. Four of the patients (29%) died in the hospital during the postoperative period. One of the seven patients (14%) having a primary joint replacement died, whereas three of the seven patients (86%) having a revision or resection died. Every patient had multiple medical comorbidities, and every patient had a complication. The results indicate that arthroplasty procedures, especially revisions and resections, in this patient population are associated with a high rate of complications and death, and that in-depth informed consent should be provided for all patients contemplating these procedures. Meticulous treatment of medical comorbidities is mandatory. Finally, data in the literature and in the current report question whether joint arthroplasty procedures should be done in patients with end-stage renal disease who are receiving hemodialysis.

    Title Injuries to the Cervical Spine in American Football Players.
    Date March 2002
    Journal The Journal of Bone and Joint Surgery. American Volume
    Title Retrospective Report on the Effectiveness of a Polyurethane Football Helmet Cover on the Repeated Occurrence of Cerebral Concussions.
    Date April 1999
    Journal American Journal of Orthopedics (belle Mead, N.j.)
    Excerpt

    This report reviews the literature and unpublished data and presents survey results related to the use of a polyurethane football helmet cover. Two hundred forty-five individuals, identified by the helmet manufacturer as having purchased at least one device, were sent a survey after the 1992, 1993, and 1994 football seasons; 155 (63.3%) of the surveys were returned. The questionnaire, designed to be completed by the athlete, required a detailed history of concussions occurring both prior to and during the period the device was used. Individuals used the device as a result of having incurred at least one concussion. Rates of concussion reoccurrence while the device was worn were grouped by the number of previous concussions (1, 2, 3, or 4+) that occurred over a 4year period prior to use of the device. The rate of concussion reoccurrence was 2.4%, 7.3%, 15.8%, and 33.3%, respectively, over a 4-year period. The range appeared to reflect a parallel relationship between pre- and post-device concussion experiences: the more concussions experienced prior to adopting the device, the higher the rate of concussion reoccurrence while using the device. The natural history of repeated occurrences of concussive events may not be affected by the use of a polyurethane football helmet cover. We suggest that such a device not be routinely used prophylactically, but instead be reserved for individuals with 1 to 2 prior concussion injuries. However, at this time, we neither recommend nor discommend the device.

    Title The Search for the Holy Grail: a Century of Anterior Cruciate Ligament Reconstruction.
    Date January 1998
    Journal American Journal of Orthopedics (belle Mead, N.j.)
    Excerpt

    A perspective on the history of the development of anterior cruciate ligament reconstruction is presented. The lack of critical analyses establishing the relative effectiveness of many previously described procedures is documented.

    Title Management Guidelines for Participation in Collision Activities with Congenital, Developmental, or Postinjury Lesions Involving the Cervical Spine.
    Date January 1998
    Journal Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine
    Excerpt

    OBJECTIVE: Conditions involving the cervical spine in athletes requiring a management decision are numerous. This report presents appropriate guidelines for return to collision activities in those with congenital, developmental, or postinjury lesions. DATA SOURCES: Information was compiled from > 1,200 cervical spine lesions documented by the National Football Head and Neck Injury Registry and an extensive literature review. DATA SYNTHESIS: Available data as well as a clinical understanding of injury mechanisms have resulted in the development of reasonable management guidelines. Each of the congenital, developmental, and posttraumatic conditions presented are determined to present either no contraindication, relative contraindication, or an absolute contraindication to sport participation on the basis of a variety of parameters. Conditions included in the discussion are odontoid anomalies; spina bifida occulta; atlanto-occipital fusion; Klippel-Feil anomalies; cervical canal stenosis; spear tackler's spine; traumatic conditions of the upper, middle, and lower cervical spine, including ligamentous injuries and fractures; intervertebral disc injuries; and postcervical spine fusion. CONCLUSION: The proposed guidelines should be used in the decision-making process in conjunction with other such factors as the age, experience, ability of the individual, level of participation, and position played, as well as the attitude and desires of the athlete and his or her parents following an informed discussion of the problem with particular regard to potential risk.

    Title Cervical Cord Neurapraxia: Classification, Pathomechanics, Morbidity, and Management Guidelines.
    Date December 1997
    Journal Journal of Neurosurgery
    Excerpt

    One hundred ten cases of the transient neurological phenomenon, cervical cord neurapraxia (CCN), are presented. The authors established a classification system for CCN, developed a new computerized measurement technique for magnetic resonance (MR) imaging, investigated the relationship of the cervical cord to the canal, and analyzed clinical, x-ray, and MR data. One hundred nine males and one female were included in the study; the average age of the participants was 21 years (range 13-33 years). All episodes occurred during sports participation; 87% occurred while the patient was playing football. Follow-up review lasting an average of 3.3 years was available for 105 patients (95%). Narrowing of the sagittal diameter of the cervical canal in the adult spine was confirmed to be a causative factor. Cervical cord neurapraxia was not associated with permanent neurological injury and no permanent morbidity occurred in patients who returned to contact activities. Of the patients returning to contact activities, 35 (56%) experienced a recurrent episode. The risk of recurrence was increased with smaller spinal canal/vertebral body ratio (p < 0.05), smaller disc-level canal diameter (p < 0.05), and less space available for the cord (p < 0.05). There was no correlation between either the classification of the CCN episode or the disease noted on MR imaging and x-ray films and the risk of recurrence. The authors conclude that: 1) CCN is a transient neurological phenomenon and individuals with uncomplicated CCN may be permitted to return to their previous activity without an increased risk of permanent neurological injury; 2) congenital or degenerative narrowing of the sagittal diameter of the cervical canal is a causative factor; 3) the overall recurrence rate after return to play is 56%; and 4) the risk of recurrence is strongly and inversely correlated with sagittal canal diameter and it is useful in the prediction of future episodes of CCN (p < 0.001). These data will enable the physician to counsel individuals regarding a predicted risk of recurrence based on canal measurements.

    Title Suggested Management Guidelines for Participation in Collision Activities with Congenital, Developmental, or Postinjury Lesions Involving the Cervical Spine.
    Date September 1997
    Journal Medicine and Science in Sports and Exercise
    Excerpt

    Many conditions involving the cervical spine in the athlete require a management decision. The purpose of this paper is to present appropriate guidelines for return to collision activities in those with congenital, developmental, or post-injury lesions. Information compiled from over 1200 cervical spine lesions documented by the National Football Head & Neck Injury Registry, an extensive literature review, as well as an understanding of injury mechanisms have resulted in reasonable management guidelines. Each of the congenital, developmental, and post-traumatic conditions presented are determined to present either no contraindication, relative contraindication, or an absolute contraindication on the basis of a variety of parameters. Conditions included in the discussion are: odontoid anomalies; spina bifida occulta; atlanto-occipital fusion; Klipple-Feil anomalies; cervical canal stenosis; spear tackler's spine; and traumatic conditions of the upper, middle, and lower cervical spine, including ligamentous injuries and fractures, intervertebral disc injuries, and post-cervical spine fusion. Emphasized is the fact that the proposed guidelines should be used in the decision-making process in conjuction with other factors such as the age, experience, ability of the individual, level of participation, position played, as well as the attitude and desires of the athlete and his parents after an informed discussion of the problem with particular regard to potential risk.

    Title Management Guidelines for Participation in Collision Activities with Congenital, Developmental, or Post-injury Lesions Involving the Cervical Spine.
    Date August 1997
    Journal Clinics in Sports Medicine
    Excerpt

    We believe that the aforementioned management guidelines for participation in collision activities for individuals with congenital, developmental, or postinjury lesions involving the cervical spine have been formulated on the basis of the best information available to date. It is recognized that modifications may occur as more data are collected. We emphasize that these proposed guidelines should be used in the decision-making process in conjunction with such other factors as age, experience, ability of the individual, level of participation, and position played. A most important consideration is the attitude and desire of the individual and his parents following an informed discussion of the problem with particular regard to potential risks.

    Title The Pathomechanics of Chronic, Recurrent Cervical Nerve Root Neurapraxia. The Chronic Burner Syndrome.
    Date March 1997
    Journal The American Journal of Sports Medicine
    Excerpt

    This study defined chronic recurrent cervical nerve root neurapraxia, the chronic burner syndrome, characterized the clinical findings, and described the responsible pathomechanics. We studied a subset of 55 athletes (mean age, 22 years) for evaluation of recurrent burners. Eleven subjects were professional athletes. The mechanism of injury was extension combined with ipsilateral-lateral deviation in 46 patients (83%). Spurling's sign was positive in 39 patients (70%). Twenty-nine patients (53%) had developmentally narrowed cervical canals, and 48 patients (87%) had evidence of disk disease by magnetic resonance imaging. The disk disease was in the form of a disk bulge, disk protrusion, or a frank disk herniation deforming the cord. Fifty-one patients (93%) had disk disease or narrowing of the intervertebral foramina secondary to degenerative disk disease. Although burners may be the result of a brachial plexus stretch injury in high school and collegiate football players seen with acute symptoms, nerve root compression in the intervertebral foramina secondary to disk disease is a more common cause in collegiate and professional players who have recurrent or chronic burner syndromes. There is a high incidence of cervical canal stenosis in football players with recurrent burner syndrome. The combination of disk disease and cervical spinal canal stenosis may lead to an alteration in normal cervical spine mechanics that may make these athletes more prone to chronic burner syndromes.

    Title Long-term Evaluation of the Elmslie-trillat-maquet Procedure for Patellofemoral Dysfunction.
    Date February 1997
    Journal The American Journal of Sports Medicine
    Excerpt

    We evaluated 55 knees in 51 patients after Elmslie-Trillat-Maquet procedures. The procedure involves medialization of the tibial tubercle on a distal pedicle and elevating the tibial tubercle anteriorly 10 mm with a local bone graft. At a mean followup of 74.2 months (range 13 to 196), all patients completed postoperative surveys and 38 underwent postoperative examinations. Subjectively, 9 knees (16%) had excellent results, 24 knees (44%) obtained good results, and 13 knees (24%) had fair results for a total of 84% improvement overall. Using Fulkerson's functional knee score, 19 knees (35%) had excellent results, 10 knees (18%) had good results, and 11 knees (20%) had fair results for a total of 73% improvement overall. A total of 24 knees (44%) required later screw removal. The most significant findings of this study include 1) an 84% overall subjective improvement in symptoms; 2) the findings that young patients without evidence of progressive osteoarthrosis and with patella instability as a primary symptom tend to have the most favorable outcome; and 3) 24 knees (44%) required later screw removal.

    Title Analysis of Failed Surgical Management of Fractures of the Base of the Fifth Metatarsal Distal to the Tuberosity: the Jones Fracture.
    Date January 1997
    Journal Foot & Ankle International / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society
    Excerpt

    Failure of surgical management of fractures of the base of the fifth metatarsal distal to the tuberosity is uncommon. Only one such failure has been reported in the literature to date. The purpose of this article is to present the clinical course of 11 patients with failure of surgically managed jones fractures reviewed by the senior author (J.S.T.). Surgical management was complicated by delayed union in three patients, refracture in seven patients, and nonunion in one patient. The 11 procedures were divided between two established techniques: (1) intramedullary screw fixation (N = 6) and (2) inlaid corticocancellous bone graft (N = 5). In the six intramedullary fixation procedures, using other than a 4.5-mm ASIF malleolar screw for internal fixation correlated with failure. In the five inlaid bone graft procedures, undersized corticocancellous grafts and incomplete reaming of the medullary canal correlated with failure. Also, after both procedures, early return to vigorous physical activity is believed to have played a role in delayed union and refracture.

    Title The Relationship of Developmental Narrowing of the Cervical Spinal Canal to Reversible and Irreversible Injury of the Cervical Spinal Cord in Football Players.
    Date October 1996
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    An evaluation of forty-five athletes who had had an episode of transient neurapraxia of the cervical spinal cord revealed a consistent finding of developmental narrowing of the cervical spinal canal. The purpose of the present epidemiological study was to determine the relationship, if any, between a developmentally narrowed cervical canal and reversible and irreversible injury of the cervical cord with use of various cohorts of football players as well as a large control group. Cohort I comprised college football players who were asymptomatic and had no known history of transient neurapraxia of the cervical cord. Cohort II consisted of professional football players who also were asymptomatic and had no known history of transient neurapraxia of the cervical cord. Cohort III was a group of high-school, college, and professional football players who had had at least one episode of transient neurapraxia of the cervical cord. Cohort IV comprised individuals who were permanently quadriplegic as a result of an injury while playing high-school or college football. Cohort V consisted of a control group of male subjects who were non-athletes and had no history of a major injury of the cervical spine, an episode of transient neurapraxia, or neurological symptoms. The mean and standard deviation of the diameter of the spinal canal, the diameter of the vertebral body, and the ratio of the diameter of the spinal canal to that of the vertebral body were determined for the third through sixth cervical levels on the radiographs for each cohort. In addition, the sensitivity, specificity, and positive predictive value of a ratio of the diameter of the spinal canal to that of the vertebral body of 0.80 or less was evaluated. The findings of the present study demonstrated that a ratio of 0.80 or less had a high sensitivity (93 per cent) for transient neurapraxia. The findings also support the concept that symptoms may result from a transient reversible deformation of the spinal cord in a developmentally narrowed osseous canal. The low positive predictive value of the ratio (0.2 per cent) however, precludes its use as a screening mechanism for determining the suitability of an athlete for participation in contact sports. Developmental narrowing of the cervical canal in a stable spine does not appear to predispose an individual to permanent catastrophic neurological injury and therefore should not preclude an athlete from participation in contact sports.

    Title The Effect of Ambient Temperature on the Shoe-surface Interface Release Coefficient.
    Date July 1996
    Journal The American Journal of Sports Medicine
    Excerpt

    Previous studies of the shoe-surface interface correlated foot fixation with cleat length, configuration, and material composition as well as turf type and surface conditions. Our study examined the effect of temperature on the rotational torsion resistance of artificial turf football shoes. Five football shoe models, a flat-soled basketball-style turf shoe, a natural grass soccer-style shoe, and three multistudded turf shoes, were studied on dry Astro Turf at five temperatures (range, 52 degrees F to 110 degrees F). An assay device, a prosthetic foot mounted on a loaded stainless steel shaft, was used to determine the force necessary to release a shoe from the turf's surface. We used a torque wrench to apply a rotational force so that each shoe was pivoted counterclockwise through an arc of 60 degrees. Our results indicated that release coefficients differ within and among the shoe models at various turf temperatures. We also found that an increase in turf temperature, in combination with cleat characteristics, affects shoe-surface interface friction and potentially places the athlete's knee and ankle at risk of injury. Based on an established risk criterion, which correlated shoe-surface interface combinations in the laboratory with documented clinical occurrences, only the flat-soled basketball-style turf shoe could be designated "safe" or "probably safe" at all five temperatures.

    Title Magnetic Resonance Imaging of Knee Disorders. Clinical Value and Cost-effectiveness in a Sports Medicine Practice.
    Date July 1996
    Journal The American Journal of Sports Medicine
    Excerpt

    To prospectively evaluate the clinical value of magnetic resonance imaging of the knee in a referral sports medicine practice, we performed a three-part study. First, we asked 72 consecutive patients a series of clinically relevant questions regarding the ordering of their magnetic resonance imaging scans. Second, we asked the treating physicians at our center if the magnetic resonance imaging findings changed the diagnosis or treatment. Third, we compared the clinical evaluation with the findings on magnetic resonance imaging scans for 37 patients who had arthroscopic confirmation. From the physician's perspective, in only three cases would the results of the scan have changed the diagnosis. Information from the scans was judged to contribute to patient treatment in only 14 of 72 patients. Finally, comparison of clinical evaluation and magnetic resonance imaging findings with findings during arthroscopic procedures showed that clinical evaluation had a sensitivity and specificity of 100% for diagnosis of anterior cruciate ligament injuries, whereas magnetic resonance imaging was 95% sensitive and 88% specific. For isolated meniscal lesions, the clinical assessment had a sensitivity and specificity of 91% compared with 82% and 87%, respectively, for magnetic resonance imaging. For evaluation of articular surface damage, the predictive value of a positive test was 100% for clinical assessment and 33% for the magnetic resonance imaging. We conclude that magnetic resonance imaging is overused in the evaluation of knee disorders and not a cost-effective method for evaluating injuries when compared with a skilled examiner. Clinical assessment equals or surpasses the magnetic resonance imaging in accuracy.

    Title Cervical Spinal Stenosis with Cord Neurapraxia and Transient Quadriplegia.
    Date May 1996
    Journal Sports Medicine (auckland, N.z.)
    Excerpt

    Cervical cord neurapraxia is a transient, totally reversible phenomenon that results from compressive deformation of the spinal cord. It occurs as a result of developmental narrowing of the cervical canal, either as isolated entity or in combination with degenerative changes, instability or congenital abnormalities. Uncomplicated stenosis of the cervical canal in an individual with a stable spine does not predispose to permanent neurological injury. Our data does not indicate a correlation between developmental narrowing and permanent neurological sequelae in a spine rendered unstable by football-induced trauma. However, there are data indicating that the occurrence of an episode of cervical cord neurapraxia is not a harbinger, or an indication of susceptibility to permanent neurological sequelae. Nevertheless, we recommended that continued participation in collision activities be restricted in individuals who have a documented episode of cervical cord neurapraxia associated with (i) ligamentous instability; (ii) intervertebral disc disease with cord compression; (iii) significant degenerative changes; (iv) magnetic resonance imaging evidence of cord defect or swelling; (v) symptoms of positive neurological findings lasting more than 36 hours; and (vi) more than one recurrence.

    Title The Nicolas Andry Award. The Pathomechanics and Pathophysiology of Cervical Spinal Cord Injury.
    Date January 1996
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    Cervical cord injuries caused during American football games have resulted in reversible, incompletely reversible, and irreversible neurologic deficits. An explanation for this variable response to injury has been obtained from the study of the histochemical responses of a squid axon injury model to mechanical deformation. Data obtained indicate that recovery or lack thereof is directly proportional to the intracellular calcium concentration which in turn is directly proportional to the amount and rate of tension applied to the axon. It is concluded that in most instances of acute spinal injury, disruption of cord function is a result of the effects of local cord anoxia and the increased concentration of intracellular calcium. It is proposed that implementation of therapeutic measures that restore blood flow and reduce cytosolic calcium will increase neurologic recovery.

    Title Tibial Chondral Fissures Associated with the Lateral Meniscus.
    Date September 1995
    Journal Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
    Excerpt

    This article describes a relatively common lesion of the lateral tibial plateau that has not been reported in the literature. This lesion is a fissure of the articular cartilage parallel to the lateral meniscal rim. Sometimes asymptomatic, this articular fissure was noted in 10 of 61 consecutive patients (16%) undergoing knee arthroscopy in an outpatient surgery unit. This chondral fissure often demarcates an abrupt transition between firm and healthy articular cartilage, which is covered by the lateral meniscus, and exposed articular cartilage, which is soft and fibrillated. Progressive articular degeneration of knees with this lesion has not been documented; therefore, the clinical significance of these chondral fissure is not yet known.

    Title Symposium: Spinal Cord Resuscitation.
    Date August 1995
    Journal Contemporary Orthopaedics
    Title Arthroscopically Assisted Placement of a Supracondylar Intramedullary Nail: Operative Technique.
    Date July 1995
    Journal Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
    Excerpt

    The use of retrograde interlocking intramedullary nails has been described for the treatment of selected supracondylar fractures. A medial parapatellar incision and arthrotomy with its attendant morbidity is generally used for nail placement. Although a closed technique of nail placement has been described, the risks of damaging intra-articular structures with a blind approach have precluded the widespread use of this method. In this article, we present a simple, arthroscopically assisted method for the retrograde intramedullary nailing of supracondylar femoral fractures. This technique affords the potential benefits of intramedullary fixation of these fractures while avoiding the morbidity and complications associated with an arthrotomy. Potential benefits over the standard placement using an arthrotomy include earlier ambulation and soft tissue healing, decreased risk of damage to the knee joint, earlier convalescence with decreased hospitalization time, and better cosmesis.

    Title Atraumatic Spontaneous Hemarthrosis Associated with Lyme Arthritis. A Case Report.
    Date January 1994
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    A 20-year-old male athlete had Lyme arthritis and an associated atraumatic spontaneous hemarthrosis of the knee. Lyme arthritis is a common and well-documented manifestation of Lyme disease, but an association with an atraumatic hemarthrosis to date has not been reported. Clinical diagnosis was confirmed by serologic testing. Treatment consisted of ceftriaxone, 1-g intravenous for 14 days.

    Title Spear Tackler's Spine. An Entity Precluding Participation in Tackle Football and Collision Activities That Expose the Cervical Spine to Axial Energy Inputs.
    Date December 1993
    Journal The American Journal of Sports Medicine
    Excerpt

    We describe spear tackler's spine, a clinical entity that constitutes an absolute contraindication to participation in tackle football and other collision activities that expose the cervical spine to axial energy inputs. A subset of football players were identified who demonstrated: 1) developmental narrowing (stenosis) of the cervical canal; 2) persistent straightening or reversal of the normal cervical lordotic curve on erect lateral roentgenograms obtained in the neutral position; 3) concomitant preexisting posttraumatic roentgenographic abnormalities of the cervical spine; and 4) documentation of having employed spear tackling techniques. From data obtained by the National Football Head and Neck Injury Registry and the senior author's practice, 15 cases of spear tackler's spine were identified during 1987 to 1990. All 15 cases were evaluated because of complaints referable to the cervical spine or brachial plexus resulting from football injuries. Of these, 11 had complete neurologic recovery without permanent sequelae. Four cases resulted in permanent neurologic deficits: quadriplegia, 2; incomplete hemiplegia, 1; and residual long track signs, 1. Permanent neurologic injury occurred as the result of axial loading of a persistently straightened cervical spine from use of head-impact playing techniques. We suggest that individuals who possess the aforementioned characteristics of spear tackler's spine be precluded from participation in collision activities that expose the cervical spine to axial energy inputs.

    Title Redefining Cervical Spinal Stenosis Using Mri.
    Date December 1993
    Journal Medicine and Science in Sports and Exercise
    Title The Effect of Early Versus Late Return to Vigorous Activities on the Outcome of Anterior Cruciate Ligament Reconstruction.
    Date May 1993
    Journal The American Journal of Sports Medicine
    Excerpt

    The effect of early (mean, 5 months) versus late (mean, 9 months) return to vigorous cutting activity on the long-term outcome of anterior cruciate ligament reconstruction was evaluated retrospectively. Sixty-four reconstructions, using a distally attached medial one-third patellar tendon, were reviewed on an average of 46 months postoperatively. After surgery, the timing of return to vigorous activity was based on biologic fixation of the graft, a negative Lachman test, absence of effusion, and the patient's desire to return to previous activity. The 64 patients were retrospectively separated into two groups. The early group consisted of 31 patients who returned to activity 2 to 6 months after reconstruction, and the late group consisted of 33 patients who returned to activity 7 to 14 months after reconstruction. By clinical examination, KT-1000 arthrometer measurements, subjective evaluation, and Cybex testing, there were no differences between the early and late return groups except for reestablishment of final range of motion. At an average followup of 46 months, this study indicates that an early return to vigorous physical cutting activities after ACL reconstruction does not predispose patients to reinjury or a less satisfactory longterm result.

    Title Lachman Test Revisited.
    Date April 1993
    Journal Contemporary Orthopaedics
    Excerpt

    The Lachman test has become recognized as the most reliable noninvasive clinical method for determining the integrity of the anterior cruciate ligament. The original description provided for the test being reported as either positive or negative. The purpose of this study is to present a clinical grading system for positive examinations. The criteria are as follows: Grade I, proprioceptive appreciation of a positive test; Grade II, visible anterior translation of the tibia; Grade III, passive subluxation of the tibia with the patient supine; Grade IV, ability of the patient with a cruciate-deficient knee to actively sublux the proximal tibia. Seventy-five patients with arthroscopically-documented complete anterior cruciate ligament tears were examined clinically and graded using these criteria. In addition, all patients had arthrometric examinations to measure the amount of anterior subluxation of the tibia in millimeters. A one-way analysis of variance followed by Scheffe multiple comparisons demonstrated the mean measurements of anterior displacement of the tibia in each laxity group to be significantly different.

    Title Epidemiology, Pathomechanics, and Prevention of Football-induced Cervical Spinal Cord Trauma.
    Date August 1992
    Journal Exercise and Sport Sciences Reviews
    Title Arthroscopic Resection of Glenoid Labral Tears in the Athlete: a Report of 29 Cases.
    Date April 1992
    Journal Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
    Excerpt

    This article is a retrospective review of 28 overhead-throwing and striking athletes who underwent 29 arthroscopic partial glenoid labral resections. Indications for the procedure were a sudden inability to perform because of pain and the presence of a palpable "click" on clinical examination. At a minimum of 2 years follow-up, there was a statistically significant difference in the functional outcome between patients with stable and those with unstable glenohumral joints. In those with stable joints, there was a 91% good or excellent functional outcome. In those with unstable joints, there was a 25% good functional outcome and a 75% fair or poor functional outcome. We also noted a statistically significant difference in labral tear location between the stable and unstable glenohumeral joints. Seven of eight superior labral tears were in stable shoulders. Fourteen of 19 anterior labral tears were in stable shoulders. Both posterior labral tears were in unstable glenohumeral joints. Injury of the glenoid labrum without anatomic instability was observed in 72% of patients. Arthroscopic resection of a longitudinal labral tear in a stable shoulder can relieve the patient's discomfort and allow him or her to return to athletic competition. No patient developed clinical subluxation as a result of labral debridement, nor did any patient convert from a subluxing shoulder to a dislocating shoulder following surgery. In patients with anterior instability and labral tears, labral debridement was not a successful alternative to formal stabilization.

    Title The Axial Load Teardrop Fracture. A Biomechanical, Clinical and Roentgenographic Analysis.
    Date October 1991
    Journal The American Journal of Sports Medicine
    Excerpt

    The anteroinferior cervical vertebral body corner fracture was originally described by Schneider and Cann as the "teardrop" fracture. This report analyzes the biomechanical, clinical, and roentgenographic features of 55 such fractures obtained from the National Football Head and Neck Injury Registry. Teardrop fractures resulting from tackle football characteristically occurred in players attempting to make a tackle in which initial contact was made with the top or crown of the helmet. There were two fracture patterns associated with the anteroinferior corner (teardrop) fracture fragment: 1) the isolated fracture, which is usually not associated with permanent neurologic sequelae; and 2) the three-part, two-plane fracture in which there is an associated sagittal vertebral body fracture as well as fracture of the posterior neural arch. This latter pattern was almost always associated with permanent neurologic sequelae, specifically quadriplegia. Axial loading of the cervical spine was clearly identified as a mechanism of injury for both fracture patterns. Roentgenographic examination must include both anteroposterior and lateral views with computed tomography or tomography as necessary to determine the presence of the sagittal vertebral body fracture and the integrity of the posterior neural arch.

    Title Axial Loading Injuries to the Middle Cervical Spine Segment. An Analysis and Classification of Twenty-five Cases.
    Date April 1991
    Journal The American Journal of Sports Medicine
    Excerpt

    Injuries to the cervical spine at the C3-C4 level involving the bony elements, intervertebral disks, and ligamentous structures are rare. We present 25 cases of traumatic C3-C4 injuries sustained by young athletes and documented by the National Football Head and Neck Injury Registry. Review of the cases reveals that the response of energy inputs at the C3-C4 level differ from those involving the upper (C1-C2) and lower (C4-C5-C6-C7) cervical segments. Specifically, the C3-C4 lesions appear to be unique with regard to the infrequency of bony fracture, difficulty in effecting and maintaining reduction, and a more favorable recovery following early, aggressive treatment. In the majority of instances, injury at this level results from axial loading of the cervical spine. Lesions were distributed into specific categories: 1) acute intervertebral disc herniation (N = 4), 2) anterior subluxation of C3 on C4 (N = 4), 3) unilateral facet dislocation (N = 6), 4) bilateral facet dislocation (N = 7), and 5) fracture of vertebral body C4 (N = 4). Analysis of these 25 cases suggests that traumatic lesions of the cervical spine in general can be classified as involving the upper (C1-C2), middle (C3-C4), or lower (C4-C7) segments. This is based on our observations from this series that C3-C4 lesions 1) generally do not involve fracture of the bony elements; 2) acute intervertebral disc herniations are frequently associated with transient quadriplegia; 3) reduction of anterior subluxation of C3 on C4 is difficult to maintain; 4) reduction of unilateral facet dislocation is difficult to obtain by skeletal traction and is best managed by closed manipulation and reduction under general anesthesia; and 5) reduction of bilateral facet dislocation is difficult to obtain by skeletal traction and is best managed by open methods. The more favorable results observed in this series of immediate reduction of both unilateral and bilateral facet dislocations deserves emphasis. In two cases of unilateral facet dislocation reduced within 3 hours of injury and subsequently fused anteriorly, significant neurologic recovery occurred. The other four patients, two who underwent an open reduction and laminectomy and two treated closed with skeletal traction, remained quadriplegic. In the four instances of bilateral facet dislocation where reduction was achieved by either closed or open methods, although there was no neurologic recovery, all four patients survived their injuries. However, the three patients who were not successfully reduced died.

    Title Arthroscopic Surgery of the Knee Under Local Anesthesia.
    Date February 1991
    Journal Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
    Excerpt

    This report delineates the efficacy of local anesthesia in the performance of arthroscopic surgery of the knee. A retrospective review of 500 cases revealed that only three required administration of general anesthesia to successfully complete the procedure. A prospective study comparing fentanyl, midazolam, and fentanyl/midazolam combinations as intravenous supplements was performed. Meticulous surgical technique combined with local anesthesia and some form of intravenous sedation in minimal therapeutic dosage will provide satisfactory conditions to perform surgical arthroscopy of the knee.

    Title Fractures of the Base of the Fifth Metatarsal Distal to the Tuberosity.
    Date August 1990
    Journal Orthopedics
    Title Cervical Spinal Stenosis with Cord Neurapraxia and Transient Quadriplegia.
    Date May 1990
    Journal Clinics in Sports Medicine
    Excerpt

    The purpose of this article is to define as a distinct clinical entity, the syndrome of cervical spinal cord neurapraxia with transient quadriplegia. Sensory changes include burning pain, numbness, tingling, or loss of sensation, whereas motor changes consist of weakness or complete paralysis. The phenomenon of cervical spinal cord neurapraxia occurs in individuals with (1) developmental cervical spinal stenosis, (2) congenital fusions, (3) cervical instability, or (4) intervertebral disc protrusions when associated with a decrease in the anteroposterior diameter of the spinal canal. There is no evidence that the occurrence of cervical spinal cord neurapraxia predisposes an individual to permanent neurologic injury. However, patients with this syndrome and associated with cervical spine instability or acute or chronic degenerative changes should be precluded from further participation in contact sports. Those with developmental spinal stenosis or spinal stenosis associated with congenital abnormalities should be treated on an individual basis.

    Title Clinical Prognosticators for the Efficacy of Retinacular Release Surgery to Treat Patellofemoral Pain.
    Date May 1990
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    The purpose of this prospective study was to identify clinical, pathologic, and roentgenographic factors that might serve as prognosticators for acceptable results after a lateral retinacular release for treatment of patellofemoral pain unresponsive to conservative measures. Fifty-two knees in 45 patients were studied. The data indicated that acceptable results can be expected in patients who have a negative mal-loose sign (no evidence of patellar malalignment or hyperlaxity) or a positive Sage sign (tight lateral parapatellar soft-tissue structures). Poorer results are predictable in patients with patellar hypermobility.

    Title The Epidemiologic, Pathologic, Biomechanical, and Cinematographic Analysis of Football-induced Cervical Spine Trauma.
    Date March 1990
    Journal The American Journal of Sports Medicine
    Excerpt

    Epidemiologic, pathologic, biomechanical, and cinematographic data on head and neck injuries occurring in tackle football have been compiled since 1971 by the National Football Head and Neck Injury Registry. Preliminary analysis performed in 1975 indicated that the majority of serious cervical spine football injuries were caused by axial loading. Based on this observation, the National Collegiate Athletic Association (NCAA) and National Federation of High School Athletic Associations (NFHSAA) implemented rule changes banning "spearing" and the use of the top of the helmet as the initial point of contact in striking an opponent during a tackle or block. Between 1976 and 1987, as a result of these rule changes, the Registry has documented a dramatic decrease in both the total number of cervical spine injuries and those resulting in quadriplegia at both the high school and college level. It is suggested that development and implementation of similar preventative measures based on clearly defined injury mechanisms would decrease injury rates in diving, rugby, ice hockey, trampolining, wrestling, and other high-risk sports as well.

    Title Natural History of the Posterior Cruciate Ligament-deficient Knee.
    Date October 1989
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    This paper documents the clinical course of the posterior cruciate ligament-deficient knee. By obtaining an understanding of the natural history of this lesion, the indications for surgical repair, reconstruction, and conservative treatment will be more clearly defined, and the clinician will be able to more critically evaluate the results of both acute repair and reconstruction of this ligament. Forty-three patients with an average interval of 6.3 years (range, one to 37 years) between injury and evaluation were included in this study. Fourteen patients had a straight unidirectional posterior instability and 29 had a combined multidirectional instability. The follow-up evaluation included functional assessment, physical and roentgenographic evaluation, arthrometric laxity measurement, and isokinetic dynametric testing of quadriceps function. Statistical treatment of the data, utilizing both nonparametric methods and logistic modeling, clearly delineated the natural history of the injury to the posterior cruciate ligament (PCL). It was established that the functional outcome can be predicted on the basis of the instability type. Specifically, those knees with PCL disruption without associated ligamentous laxity will probably remain symptom-free. However, when PCL disruption is associated with combined instabilities, a less than desirable functional result will probably occur. Application of logistic modeling to the data demonstrated that the functional result was not due to the type of instability per se, but rather to associated factors, i.e., chondromalacia of the patella, meniscal derangement, quadriceps atrophy, or degenerative changes. A direct correlation has been established between combined multidirectional instability and the occurrence of those associated secondary problems resulting in the patient's complaints and functional disability.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title Cervical Spinal Stenosis with Cord Neurapraxia and Transient Quadriplegia.
    Date May 1989
    Journal Clinics in Sports Medicine
    Excerpt

    Cervical spinal cord neurapraxia with transient quadriplegia is defined as a distinct clinical entity. The authors identify diminution of the anteroposterior diameter of the spinal canal as the factor that explains the described neurologic picture of the injury. Based on the result of a study of 39,377 athletes, the authors conclude that the prevalence of the injury is high and warrants attention. Given that of the patients interviewed, none recalled prodromal experience of transient motor paresis and none sustained further injury, this injury does not predispose individuals to permanent neurologic injury. No definite recurrence patterns have been established that would warrant the restriction of individuals from further activity. Activity restrictions are called for in the case of individuals with stability or chronic degenerative changes. Individuals with developmental spinal stenosis or spinal stenosis should be treated on an individual basis.

    Title Trampoline-induced Quadriplegia.
    Date May 1989
    Journal Clinics in Sports Medicine
    Excerpt

    This review of the world's literature documenting cervical spine injuries attempts to determine common factors regarding patient characteristics, environment, injury mechanisms, and pathology. The policy statements and safety guidelines of both the American Academy of Pediatrics and athletic administrative bodies are reviewed in order to evaluate what effect, if any, these policies and guidelines have had on documented injuries. On the basis of this review, it is believed that the AAP was ill-advised in altering its position on the use of trampolines. The opinion is presented that both the trampoline and minitrampoline are dangerous devices when used in the best of circumstances, and their use has no place in recreational, educational, or competitive gymnastics.

    Title Rehabilitation of Cervical Spine, Brachial Plexus, and Peripheral Nerve Injuries.
    Date May 1989
    Journal Clinics in Sports Medicine
    Excerpt

    The cervical spine is placed at risk of injury in a number of athletic activities. It is important to understand the principles and methods of therapeutic and rehabilitative exercises both to prepare the athlete for the demands each sport will place on his or her body and to return the injured athlete to activity safely. General principles of rehabilitation are reviewed, followed by a discussion of the clinical entities of concern and descriptions of specific rehabilitation exercises for each injury.

    Title Spinal Injury at the Level of the Third and Fourth Cervical Vertebrae Resulting from the Axial Loading Mechanism: an Analysis and Classification.
    Date May 1989
    Journal Clinics in Sports Medicine
    Excerpt

    The traumatic C3-C4 level injuries sustained by young athletes and documented by the National Football Head and Neck Injury Registry are discussed. Twenty-eight of 885 (2.8 per cent) injuries involved the C3-C4 vertebrae. Review of these cases reveals that the response to energy inputs at the C3-C4 level differ from that of those involving the upper (C1-C2) and lower (C5-C6) cervical segments. Specifically, these lesions appear unique with regard to infrequency of bony fracture, difficulty in effecting and maintaining reduction, and their more favorable response to early aggressive treatment. It is the authors' belief that these lesions resulting from athletic activity are due to axial loading.

    Title Management Guidelines for Head Injuries in Athletics.
    Date May 1989
    Journal Clinics in Sports Medicine
    Excerpt

    The spectrum of athletic head injuries is presented with discussion of on-site recognition, definite diagnosis, and specific treatment. Emphasis is placed on the proper medical evaluation of athletes to ensure recovery and prevent serious consequences of repeated injury.

    Title Management Guidelines for Athletic Injuries to the Cervical Spine.
    Date May 1989
    Journal Clinics in Sports Medicine
    Excerpt

    The potential or actual involvement of the nervous system in injuries to the cervical spine requires that management must proceed with particular care. Prevention of further injury is the main objective. Proper management must begin with the removal of the athlete from the field, and the correct procedures for doing this are reviewed. Treatment procedures for the following injuries are discussed: (1) nerve root and brachial plexus neurapraxia; (2) acute cervical sprain syndrome; (3) cervical vertebral subluxation without fracture; (4) cervical fractures and dislocations; (5) cervical spinal cord neurapraxia with transient quadriplegia; and (6) cervical spinal instability. Also, guidelines for activity restrictions are presented.

    Title The National Football Head and Neck Injury Registry: 14-year Report on Cervical Quadriplegia (1971-1984).
    Date May 1989
    Journal Clinics in Sports Medicine
    Excerpt

    The specter of catastrophic cervical neurotrauma resulting from athletic participation, although infrequent, has been consistently associated with football, water sports, gymnastics, rugby, and ice hockey. Injury involving intracranial hemorrhage can result in death or permanent neurologic impairment, whereas certain fractures and dislocations of the cervical spine are associated with quadriplegia. Athletic injuries to both the central nervous system and spinal cord demand our attention as an active area of clinical and basic injury. A review of the available literature reveals changing injury patterns as well as current concepts regarding the mechanism responsible for most athletic injuries to these structures. Accurate descriptions of the mechanism(s) responsible for a particular injury transcend simple academic interest. In order that preventive measures be implemented, the manner in which injury occurs must be accurately defined. The purpose of this article is to describe how the application of this principle resulted in the significant reduction of cervical spine injuries associated with quadriplegia that have occurred in tackle football since 1976.

    Title Roentgen Examination of Cervical Spine Injuries in the Athlete.
    Date May 1989
    Journal Clinics in Sports Medicine
    Excerpt

    The roentgen evaluation of the cervical spine must be performed immediately following the possibility of injury and in such a manner as not to compromise the neurologic status of the patient. Subtle roentgen findings indicating ligamentous injuries must be recognized so that they can be treated prior to developing cervical spine instability. Occult fractures, which may be difficult to diagnose on plain films and require multiple radiographic modalities, must be diagnosed so as to prevent prolonged intractable neck pain. Most importantly, recognizing the mechanism of injury and prevention of cervical spine injuries are critical to prevent catastrophic cervical spine injuries secondary to athletic participation.

    Title Overuse Injuries in Sport: the Foot.
    Date January 1988
    Journal Clinics in Sports Medicine
    Excerpt

    The authors discuss the clinical characteristics and treatment of such overuse injuries of the foot as plantar fasciitis, Haglund's syndrome, Jones' fracture, and tarsal navicular stress fractures. A consideration of orthotic devices is also provided.

    Title Management and Rehabilitation of Ligamentous Injuries to the Ankle.
    Date November 1987
    Journal Sports Medicine (auckland, N.z.)
    Excerpt

    The management of ligamentous injuries to the ankle is controversial. Neither the methods for classification and diagnosis, or the procedures for treatment are clear cut. Ankle sprains are a common occurrence, with the majority involving the lateral ligament complex. Within this complex, the anterior talofibular ligament is injured most frequently, usually while the foot is in the plantar flexed position. Ankle injuries can be diagnosed through physical exam, including the anterior drawer test and/or a stress exam, or through roentgenographic evaluation. The purpose of the stress roentgenogram is to measure the degree of talar tilt. However, it does not always yield consistent, reliable results. This inconsistency has led to the use of arthrography. There is debate over its use as well, however, Ankle sprains can be classified into three groups, according to functional loss. Treatment for first and second degree sprains is usually non-operative. The best approach to Grade III sprains is debatable. The issues in the treatment of Grade III sprains are first, whether treatment should be operative or non-operative, and second, whether non-operative treatment should emphasise immobilisation or mobilisation. Brostrom's work is cited as noteworthy. He recommended adhesive strapping followed by mobilisation as the treatment of choice, and reserves surgery for cases of chronic instability. Results demonstrated that strapping yielded shorter disability periods, while surgery produced less instability. The prevention of functional instability is a major concern in the treatment of ankle injuries. There is no consensus for treating a lateral ligament rupture. The authors suggest immobilisation followed by a rehabilitative programme. Three methods of immobilisation are plaster casting, adhesive strapping, and the air-stirrup. The physiological mechanism of cryotherapy and thermotherapy are discussed briefly and recommendations for their use are provided. Aspiration is also discussed. Loss of motion is designated as a primary cause of chronic pain and reinjury, and exercises intended to restore range of motion are provided. Exercises aimed at restoring strength and proprioception are also presented. This allows for return to activity and serves to prevent reinjury.

    Title Mr Imaging of Osteoid Osteoma of the Talus.
    Date November 1987
    Journal Journal of Computer Assisted Tomography
    Excerpt

    Magnetic resonance (MR) imaging of the painful ankle of a 15-year-old boy revealed the nidus of a subarticular osteoid osteoma of the talus along with markedly abnormal signal intensity in the neighboring bone marrow. This MR appearance correlated with alterations in the neighboring bone marrow documented by histopathologic examination.

    Title Cervical Spinal Stenosis: Determination with Vertebral Body Ratio Method.
    Date September 1987
    Journal Radiology
    Excerpt

    Transient bilateral sensory and motor symptoms after trauma, including complete paralysis, have been identified in patients with cervical spinal stenosis. Radiographs of 23 patient athletes with cervical spinal neurapraxia were used for measurement of the cervical spinal canal. Two methods of measurement were used. In the conventional method, sagittal diameter is measured from the posterior surface of the vertebral body to the nearest point of the corresponding laminar line. In the ratio method, the sagittal diameter of the spinal canal is divided by the sagittal diameter of the corresponding vertebral body. Results indicate the ratio method is reliable for determining cervical spinal stenosis and is independent of technical factor variables.

    Title A Modified Bristow-helfet-may Procedure for Recurrent Dislocation and Subluxation of the Shoulder. Report of Two Hundred and Twelve Cases.
    Date August 1987
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    A modified Bristow-Helfet-May procedure was performed for recurrent dislocation or subluxation of the glenohumeral joint in 207 patients (212 shoulders), whose average age at the time of surgery was 20.3 years (range, fourteen to forty-seven years). The procedure was modified by directing the coracoid segment and conjoined tendon over the superior border rather than through the substance of the subscapularis tendon and muscle. The indications were either documented recurrent anterior dislocation of the glenohumeral joint or subluxation with instability as demonstrated on examination with the patient under anesthesia. The procedure was evaluated on the basis of the rate of recurrence of dislocation and subluxation, postoperative complications, the patients' subjective evaluation, and the effect of the procedure on the motion of the glenohumeral joint and the strength of the muscles of the shoulder as related to overhead throwing. Eight (3.8 per cent) of the shoulders redislocated and ten (4.7 per cent) had one or more subjective episodes of subluxation after the procedure. Complications included postoperative infection in two patients and problems with the screw that required its removal in ten. One hundred and thirty-one (62 per cent) of the patients responded to a questionnaire regarding their subjective evaluation of the results of surgery. Eleven (8 per cent) were unable to perform daily activities that involved overhead work, and forty-five (34 per cent) stated that they still had some degree of discomfort or pain in the shoulder. One hundred and twenty-six patients (96.2 per cent) stated that they were happy with the results of the surgery and would have the procedure again. Thirty patients had Cybex testing of the muscles of the shoulder. Only three (16 per cent) of the nineteen athletes whose dominant arm had been operated on returned to their pre-injury level of throwing. Data obtained with regard to changes in the range of motion and strength of the glenohumeral joint indicate that this loss of throwing ability was not due solely to a loss of glenohumeral motion. It appeared to be also related to a concomitant loss of strength at the extreme of external rotation of the humerus and the initiation of internal rotation of the humerus.

    Title Isokinetic and Isometric Testing of Knee Musculature in Patients with Rheumatoid Arthritis with Mild Knee Involvement.
    Date June 1987
    Journal Archives of Physical Medicine and Rehabilitation
    Excerpt

    This study sought to determine if weakness and poor endurance of quadriceps and hamstring muscles are present in rheumatoid arthritis (RA) patients with minimally involved knees; determine if there is an abnormal hamstring/quadriceps ratio or abnormal torque curves in RA patients; and begin to evaluate the feasibility of isokinetic (IK) exercise in RA patients. Sixteen RA patients with minimally involved knees and 16 matched control subjects were tested bilaterally with a Cybex II dynamometer. Torque values in the RA group were significantly less (78% for isokinetic and 81% for isometric). The hamstring/quadriceps torque ratio was significantly higher in the RA patients than in the controls: 66.8% vs 61.7%. There was no significant difference in endurance between the two groups. In the RA patients the angle at which peak torque occurred shifted later in the range of motion (37.4 degrees) compared with the control subjects (28.7 degrees). Except for IK torque of hamstring muscles in the control group, there was no significant difference in the torque values between the right and left sides in RA patients or control subjects. The findings suggested that even in RA patients with minimally involved joints, muscle weakness was present; exercise of quadriceps should be emphasized since in RA patients quadriceps were weaker than hamstrings; and isokinetic testing is feasible in selected patients with RA.

    Title Fractures of the Base of the Fifth Metatarsal Distal to the Tuberosity: a Review.
    Date April 1987
    Journal Foot & Ankle
    Excerpt

    Fractures of the proximal part of the fifth metatarsal can be separated into two types: those involving the tuberosity, and those involving the proximal part of the diaphysis distal to the tuberosity. Recently it has been recognized that the latter group, Jones' fractures, may be difficult to treat. Although reports in the literature have indicated the potential difficulties in the treatment of Jones' fractures, prevailing guidelines for their management are ambiguous. Apparently the varied clinical and roentgenographic manifestations of these fractures have not been correlated with their response to treatment. In this paper we describe a classification of these fractures and a plan of treatment based on clinical and roentgenographic criteria that were developed to define acute fractures, delayed unions, and nonunions. The treatment of choice for acute fractures is immobilization of the limb in a toe to knee cast with nonweight-bearing. Fractures with delayed union may eventually heal if they are treated conservatively, but an active athlete with delayed union or an established nonunion will benefit from operative intervention. The procedures of choice are medullary curettage and bone grafting, and closed axial intramedullary screw fixation using a 4.0-mm ASIF malleolar screw.

    Title Lachman Test Evaluated. Quantification of a Clinical Observation.
    Date April 1987
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    The Lachman test has become recognized as the most reliable noninvasive clinical method for determining the integrity of the anterior cruciate ligament. The original description provided for the test is reported as either positive or negative. The purpose of this study is to present a clinical grading system for positive examinations. The criteria are as follows: Grade I, proprioceptive appreciation of a positive test; Grade II, visible anterior translation of the tibia; Grade III, passive subluxation of the tibia with the patient supine; and Grade IV, ability of the patient with a cruciate-deficient knee to actively sublux the proximal tibia. Seventy-five patients with arthroscopically documented complete anterior cruciate ligament tears were examined clinically and graded using the above criteria. In addition, all patients had arthrometric examinations to measure the amount of anterior subluxation of the tibia in millimeters. A one-way analysis of variance followed by Scheffe multiple comparisons demonstrated the mean measurements of anterior displacement of the tibia in each laxity group to be significantly different.

    Title Neurapraxia of the Cervical Spinal Cord with Transient Quadriplegia.
    Date January 1987
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    The purpose of this study was to define as a distinct clinical entity the syndrome of neurapraxia of the cervical spinal cord with transient quadriplegia. The sensory changes include burning pain, numbness, tingling, and loss of sensation, while the motor changes range from weakness to complete paralysis. The episodes are transient and complete recovery usually occurs in ten to fifteen minutes, although in some patients gradual resolution occurs over a period of thirty-six to forty-eight hours. Except for burning paresthesia, pain in the neck is not present at the time of injury and there is complete return of motor function and full, pain-free motion of the cervical spine. In our series, routine roentgenograms of the cervical spine were negative for fractures or dislocations in all patients. However, the roentgenographic findings did include developmental spinal stenosis in seventeen patients, congenital fusion in five patients, cervical instability in four patients, and intervertebral disc disease in six patients. Spinal stenosis was determined by two different roentgenographic methods. The first was the standard method, and the second was a ratio method devised by us. Both measurements were made at the level of the third through the sixth vertebral body on a routine lateral roentgenogram of the cervical spine that was available for twenty-four of the thirty-two patients and for a control group of forty-nine male subjects of similar age who did not have any neurological complaints. Using the ratio method, a measurement of less than 0.80 indicated significant spinal stenosis in the group of twenty-four patients for whom roentgenograms were available, as compared with a ratio of approximately 1.00 or more in the control group. There was statistically significant spinal stenosis (p less than 0.0001) in all of the patients as compared with the control subjects by both methods of determining spinal stenosis. A survey of 503 schools participating in National Collegiate Athletic Association (NCAA) football in the 1984 season found that 1.3 per 10,000 athletes had a history that was suggestive of neurapraxia of the cervical spinal cord. The phenomenon of neurapraxia of the cervical spinal cord occurs in individuals with developmental stenosis of the cervical spine, congenital fusion, cervical instability, or protrusion of an intervertebral disc in association with a decrease in the anteroposterior diameter of the spinal canal. We postulate that in athletes with diminution of the anteroposterior diameter of the spinal canal the spinal cord can, on forced hyperextension or hyperflexion, be compressed, causing transitory motor and sensory manifestations.(ABSTRACT TRUNCATED AT 400 WORDS)

    Title A Preliminary Study on the Measurement of Static and Dynamic Motion at the Glenohumeral Joint.
    Date September 1986
    Journal The American Journal of Sports Medicine
    Excerpt

    Measurement of glenohumeral joint motion has, for the most part, been performed with the simple goniometer. The purpose of this paper is to describe a method for measuring and recording static and dynamic external rotation of the glenohumeral joint using the Cybex II Isokinetic Dynamometer and an MFE model 815 X-Y plotter. Static range of motion was assessed at 60 deg/sec using a slow arm action externally from a 90 degree abduction position. Dynamic motion was recorded at 300 deg/sec using a rapid rotational whipping action from a 90 degree abducted position. Measurements were recorded on three groups of athletes, and the influences of sex, hand dominance, overarm activity, and surgery were analyzed. The subjects in the first two groups were divided according to sex and their participation in overarm versus nonoverarm (control) activities. Static and dynamic motion in both groups was significantly influenced by sex and hand dominance (P less than 0.05). Although there was no overall difference in the motion measurements between the control and overarm groups, the interaction of this factor with sex and type of measurement was significant. Males who participated in overarm activities had, on the average, more static range of motion than males in the control group. A third group that had undergone a modified Bristow procedure for recurrent dislocation/subluxation of the shoulder demonstrated that static and dynamic range of motion were significantly reduced by the surgery (P less than 0.05). The average differences in static and dynamic motion between the surgical arm and its nonsurgical counterpart were 17.5 degrees and 21 degrees, respectively, resulting in an overall range of motion difference of 19 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title Application of Electrothermal Energy in Arthroscopy.
    Date April 1986
    Journal Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
    Excerpt

    Bovine stifle joints were utilized for the application of electrothermal energy in arthroscopic surgical procedures. The anatomy of the bovine stifle joint was comparable to that of the human knee and proved to be a suitable model for arthroscopic surgery. Partial and total meniscectomies were performed in vitro and in situ on cadaveric stifle joints using 1.5% glycine as a liquid medium. Histologic preparations revealed no adverse effects associated with the use of glycine, and coagulation necrosis never extended more than 0.1 mm into the meniscal substance. Instrumentation designed specifically for the intraarticular application of electrothermal energy facilitated arthroscopic meniscectomy with minimal effect on adjacent tissue.

    Title The National Football Head and Neck Injury Registry. 14-year Report on Cervical Quadriplegia, 1971 Through 1984.
    Date January 1986
    Journal Jama : the Journal of the American Medical Association
    Excerpt

    Data on cervical spine injuries resulting from participation in football have been compiled by a national registry. Analysis of epidemiologic data and cinematographic documentation clearly demonstrated that the majority of cervical fractures and dislocations were due to axial loading. On the basis of this observation, rule changes banning both deliberate "spearing" and the use of the top of the helmet as the initial point of contact in making a tackle were implemented at the high school and college level. Subsequently, a marked decrease in cervical spine injury rates has occurred. The occurrence of permanent cervical quadriplegia decreased from 34 in 1976 to five in the 1984 season. It is suggested that axial loading of the cervical spine is also responsible for the catastrophic injuries in diving, rugby, ice hockey, and gymnastics. Implementation of appropriate changes in playing techniques and/or equipment modifications could possibly reduce the incidence of cervical spine injuries in these activities.

    Title Fibular Head Transposition for Repair of Cruciate-deficient Stifle in the Dog.
    Date October 1985
    Journal Journal of the American Veterinary Medical Association
    Excerpt

    Fibular head transposition (FHT) was introduced as a surgical technique to reconstruct the cruciate-deficient stifle in the dog. Surgically moving the fibular head into a cranial position alters the orientation of the lateral collateral ligament, thereby preventing cranial drawer motion and minimizing internal rotation of the tibia. The technique was found to be safe, mechanically sound, and clinically effective. Comparison of clinical results for this technique with those for the fascial strip technique (using a uniform grading system) demonstrated an overall superior performance of FHT. Factors found to adversely influence clinical results were heavy body weight and meniscal damage. The interval between stifle injury and reconstructive surgery or the presence of associated osteoarthritic disease bore no relationship to clinical outcome. It was concluded that the clinical performance after FHT was equal or superior to other surgical methods for reconstructing the cruciate-deficient stifle in the dog.

    Title Maintenance of Hamstring Strength Following Knee Surgery.
    Date September 1985
    Journal Medicine and Science in Sports and Exercise
    Excerpt

    Following a variety of surgical procedures on the knee, routine clinical Cybex testing demonstrated that the hamstring muscle group loses less strength than the quadriceps group, regardless of whether the hamstrings were exercised during the rehabilitation. Two groups of postsurgical patients were randomly selected to evaluate the effects of surgery on the muscle strength of the quadriceps and hamstrings. Group I (N = 15) underwent arthrotomy and medial meniscectomy. Group II (N = 20) underwent an extraarticular substitution of the anterior cruciate ligament. All subjects were tested on a Cybex II at 60 degrees/s: Group I at 5-10 wk (mean, 7.0), and Group II at 15-22 wk (mean, 18.6). Peak torque for the quadriceps and hamstrings was measured at 30, 60, and 90 degrees. The percent deficits of the quadriceps and hamstrings were analyzed by a three-way ANOVA. The hamstring deficit was significantly less (P = 0.041) than the quadriceps deficit. A significant difference (P less than 0.001) was found between the two surgery groups. No significant difference in percent strength deficit was found at the various joint angles (30, 60, and 90 degrees). Lastly, the factors examined in the ANOVA did not contribute to a significant first or second order interaction. The authors conclude that specific hamstring strengthening postsurgically is not always indicated.

    Title Epidemiology, Pathomechanics, and Prevention of Athletic Injuries to the Cervical Spine.
    Date September 1985
    Journal Medicine and Science in Sports and Exercise
    Excerpt

    Athletic injuries to the cervical spine associated with quadriplegia most commonly occur as a result of axial loading. Whether it be a football player striking an opponent with the top or crown of his helmet, a poorly executed dive into a shallow body of water where the subject strikes his head on the bottom, or a hockey player pushed into the boards head first, the fragile cervical spine is compressed between the rapidly decelerated head and the continued momentum of the body. Appropriate rule changes recognizing this mechanism have resulted in a reduction of football quadriplegia by two-thirds. Presumably, educational efforts designed to inform the public of the dangers of diving would have a similar effect. The predominance of the axial loading mechanism is not as clearly defined in trampoline and minitrampoline injuries. However, both of these devices are dangerous when used in the best of circumstances, and their use has no place in recreational, educational, or competitive gymnastics. The emergence of severe cervical spine injuries resulting from ice hockey is recognized. Methods, based on sound scientific evidence, to modify the games so as to prevent these injuries are lacking.

    Title Osteoid Osteoma. Distant, Periarticular, and Subarticular Lesions As a Cause of Knee Pain.
    Date August 1985
    Journal Sports Medicine (auckland, N.z.)
    Excerpt

    Osteoid osteoma, a benign osteoblastic tumour comprised of osteoid and atypical bone, is a well-known entity. However, clinical diagnosis may be delayed, especially when the pain is referred to a nearby joint. This paper reports a series of 11 cases occurring in physically active patients in whom the diagnosis was delayed because of pain referral to the knee. The mean duration from the onset of symptoms to diagnosis of osteoid osteoma was 20 months (range 3 to 48 months). Review of these 11 lesions indicates that they can be classified on the basis of their anatomical location: (a) distant to the knee; (b) periarticular; or (c) subarticular (intraarticular). It should be noted that initially only 5 of the 11 cases displayed characteristic x-ray findings; in the remaining 6 cases, diagnosis was dependent on positive 99mTc radionuclide bone scans, tomograms, and computerised tomography scans. Of the 9 patients who underwent surgical resection of their lesions, all had complete relief of symptoms and all continued to be asymptomatic at follow-up evaluations.

    Title Stress Fracture of the Ipsilateral First Rib in a Pitcher.
    Date August 1985
    Journal The American Journal of Sports Medicine
    Excerpt

    This stress fracture of the left first rib in a 17-year-old, left-handed high school baseball pitcher represents the first of its type reported in the literature. Two similar cases have been reported in pitchers, but the fracture was on the nondominant side in both cases. In contrast to most cases of this rare lesion, the stress fracture we report occurred acutely and was documented roentgenographically from onset to complete healing 9 months later.

    Title Trampoline and Minitrampoline Injuries to the Cervical Spine.
    Date March 1985
    Journal Clinics in Sports Medicine
    Excerpt

    The purpose of this paper is to (1) examine the world's literature documenting cervical spine injuries; (2) attempt to identify common factors regarding patient characteristics, environment, injury mechanisms, and pathology; (3) review policy statements and safety guidelines of various medical and athletic administrative bodies; and (4) evaluate what effect, if any, these policies and guidelines have had on documented injuries. On the basis of this review, we believe that the American Academy of Pediatrics was ill-advised in altering its position on the use of trampolines. It is our opinion that both the trampoline and the minitrampoline are dangerous devices when used in the best of circumstances, and their use has no place in recreational, educational, or competitive gymnastics.

    Title Posterior Cruciate Ligament Insufficiency. A Review of the Literature.
    Date January 1985
    Journal Sports Medicine (auckland, N.z.)
    Excerpt

    A review of the English language literature establishes athletic mishaps as a major cause of posterior cruciate ligament injury. However, diversity of opinion exists regarding the functional significance of the lesion, its occurrence as an isolated entity, and the roles of conservative and surgical management. The posterior cruciate ligament is a composite structure, consisting of a superficial tibiofemoral and meniscofemoral portion and a deep tibiofemoral portion. The structure is intra-articular but extrasynovial, coursing from its attachment to the lateral surface of the medial femoral condyle posteriorly and inferiorly to its distal attachment into the posterior rim of the tibia, blending with the capsule and periosteum. Mechanical studies have demonstrated that abnormal posterior tibial displacement can occur only with posterior cruciate ligament laxity. The most prevalent mechanism resulting in injury to the posterior cruciate results from a blow on the anterior aspect of the flexed knee. However, both hyperflexion and hyperextension as well as deceleration and rotation have been described. Posterior cruciate ligament insufficiency may result from an avulsion fracture involving the ligament-bone insertion of the ligament, usually from the posterior aspect of the proximal tibia. Also, disruption may occur as an intersubstance tear of the ligament, either as an isolated phenomenon or in combination with multiple ligamentous injuries. The importance of distinguishing between combined injuries associated with significant collateral and/or anterior cruciate ligament injuries from the 'isolated' type lies in the fact that the prognosis for the 'isolated' injuries is much better. Careful clinical evaluation of the knee with an acute posterior cruciate ligament injury will reveal subtle, but definite, findings peculiar to the lesion. These include the posterior sag sign, the posterior drawer sign, reverse pivot shift, Godfrey's test, and the presence of varus or valgus instability with the joint in full extension. In patients with chronic posterior cruciate ligament laxity, the presenting symptom is often that of patellar pain. It is generally agreed that avulsion fractures involving the ligament-bone insertion of the posterior cruciate ligament should be treated by open reduction and internal fixation. Surgical treatment of this lesion will result in excellent functional recovery. A variety of procedures have been reported for the management of acute disruption of the posterior cruciate ligament.(ABSTRACT TRUNCATED AT 400 WORDS)

    Title Trampoline-related Quadriplegia: Review of the Literature and Reflections on the American Academy of Pediatrics' Position Statement.
    Date December 1984
    Journal Pediatrics
    Excerpt

    A review of the world's literature documenting cervical spine injuries has been made in an attempt to determine common factors regarding patient characteristics, environment, injury mechanisms, and pathology. The policy statements and safety guidelines of both the American Academy of Pediatrics and athletic administrative bodies have been reviewed in order to evaluate what effect, if any, these policies and guidelines have had on documented injuries. On the basis of this review, it is believed that the AAP was ill-advised in altering its position on the use of trampolines. The opinion is presented that both the trampoline and minitrampoline are dangerous devices when used in the best of circumstances, and their use has no place in recreational, educational, or competitive gymnastics.

    Title Fractures of the Base of the Fifth Metatarsal Distal to the Tuberosity. Classification and Guidelines for Non-surgical and Surgical Management.
    Date March 1984
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    Between 1973 and 1982 forty-six fractures of the base of the fifth metatarsal, distal to the tuberosity, were treated and followed for a mean of forty months (range, six to 108 months). Roentgenographic criteria were used to define three types of fractures: acute fractures characterized by a narrow fracture line and absence of intramedullary sclerosis; those with delayed union, with widening of the fracture line and evidence of intramedullary sclerosis; and those with non-union and complete obliteration of the medullary canal by sclerotic bone. Of the twenty-five acute fractures in this series, fifteen were treated with a non-weight-bearing toe-to-knee cast, and fourteen of them healed in a mean of seven weeks. Only four of the other ten, which were treated with various weight-bearing methods, progressed to union. Of the twelve patients with delayed union, one refused treatment, one was treated with a bone graft, and ten were treated initially by immobilization of the limb in a plaster cast and weight-bearing. Of these ten fractures, seven healed in a mean of 15.1 months and three eventually required grafting for non-union. Of the nine non-unions in the series, which were treated primarily with medullary curettage and bone-grafting, eight healed in a mean of three months. In all, twenty fractures were treated surgically with an autogenous corticocancellous graft that was inlaid after thorough curettage and drilling of the sclerotic bone that obliterated the intramedullary cavity. Of these twenty fractures, nineteen progressed to complete healing and one, to asymptomatic non-union.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title Athletic Footwear and Orthotic Appliances.
    Date December 1983
    Journal Clinics in Sports Medicine
    Title Bilateral Patellar Fractures from Indirect Trauma. A Case Report.
    Date October 1983
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    Bilateral simultaneous fractures of the patella occurred in a 17-year-old basketball player. This rare occurrence is, for the first time, linked to apparent stress reactions in each patella.

    Title Tarsal Navicular Stress Fractures: Radiographic Evaluation.
    Date September 1983
    Journal Radiology
    Excerpt

    Tarsal navicular stress fractures are a potential source of disabling foot pain in physically active individuals. The diagnosis of tarsal navicular stress fracture requires a high index of clinical and radiographic suspicion because the fracture is only rarely evident on routine radiographs or standard tomograms. The radiographic diagnosis of a tarsal navicular stress fracture may require anatomic anteroposterior tomograms or a radionuclide bone scan with plantar views. Radiographic examinations of 23 fractures in 21 patients are evaluated.

    Title Stress Fractures of the Pubic Ramus. A Report of Twelve Cases.
    Date December 1982
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    Twelve stress fractures of the pubic arch were seen in eleven patients who were joggers, long-distance runners, or marathoners. In two of the fractures there were complications of healing; that is, delayed union or refracture. With two exceptions, the lesions occurred in women between the ages of nineteen and forty-eight. In all of the patients the fracture was in the inferior pubic ramus near the symphysis pubis, and caused pain in the groin, buttock, or thigh. All fractures were non-displaced and easy to overlook on the initial radiographic examination; when a fracture of the pubic arch was clinically suspected but the radiographs were normal, a radionuclide bone scan was diagnostic. After identification of the fracture, running had to be curtailed until the symptoms disappeared in order for healing to occur.

    Title Stress Fractures of the Tarsal Navicular. A Retrospective Review of Twenty-one Cases.
    Date August 1982
    Journal The Journal of Bone and Joint Surgery. American Volume
    Title Interscalene Brachial Plexus Block Anesthesia for the Modified Bristow Procedure.
    Date July 1982
    Journal The American Journal of Sports Medicine
    Title "pseudowinging" of the Scapula Secondary to Subscapular Osteochondroma.
    Date June 1982
    Journal Clinical Orthopaedics and Related Research
    Title Nonunion of Olecranon Epiphysis: Two Cases in Adolescent Baseball Pitchers.
    Date June 1981
    Journal Ajr. American Journal of Roentgenology
    Title Salter-harris Type-iii Fracture of the Medial Femoral Condyle Occurring in the Adolescent Athlete.
    Date June 1981
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    This report adds six Salter-Harris type-III fractures of the medial femoral condyle to the fourteen such fractures that have been previously reported in the English literature. The injury results from a valgus force applied to the knee. As the fracture may reduce spontaneously, radiographs may not be diagnostic and the fracture may be unrecognized or be mistaken for disruption of the medial collateral ligament. If a fracture is suspected, a cross-table lateral radiograph should be made in an attempt to detect fat within the joint fluid and confirm the existence of an intra-articular fracture. An oblique, tunnel (notch), or over-penetrated radiograph may demonstrate the fracture. However, if it fails to do so, radiographs made with valgus stress applied to the knee while the patient is under general anesthesia may be necessary. In our six patients, satisfactory healing of the fracture occurred after either spontaneous or manipulative reduction and subsequent non-weight-bearing immobilization in cylinder cast. Minimum femoral shortening developed in two patients, late anterior cruciate laxity was demonstrable in two patients, and one patient required arthrotomy for removal of an osteochondral fracture fragment.

    Title Computed Tomography of the Cruciate Ligaments.
    Date September 1979
    Journal Radiology
    Excerpt

    Computed tomography was used to delineate the cruciate ligaments of the knee joint in 31 patients. Optimal positioning for demonstrating the length and body of the anterior and posterior cruciate ligaments is described and the CT, arthrographic, surgical, and clinical findings are correlated. The potential and limitations of CT and its role in combination with double-contrast arthrography in the clinical setting are discussed.

    Title The National Football Head and Neck Injury Registry. Report and Conclusions 1978.
    Date June 1979
    Journal Jama : the Journal of the American Medical Association
    Excerpt

    The National Football Head and Neck Injury Registry has documented 1,129 injuries since 1971 that involved hospitalization for more than 72 hours, surgical intervention, fracture-dislocation, permanent paralysis, or death. Of this group of injuries, 550 were fracture-dislocations of the cervical spine, of which 176 were associated with permanent quadriplegia. It appears that during the last two decades, there has been a decrease in the incidence of direct fatalities, head injuries associated with intracranial hemorrhage, and injuries associated with death. Conversely, cervical spine injuries with fracture-dislocation and with permanent quadriplegia have increased. We believe that these observations are the result of the development of a protective helmet-face mask system that has effectively protected the head, and by so doing has allowed it to be used as a battering ram in tackling and blocking techniques, thus placing the cervical spine at risk of injury.

    Title National Football Head and Neck Injury Registry: Report on Cervical Quadriplegia, 1971 to 1975.
    Date June 1979
    Journal The American Journal of Sports Medicine
    Excerpt

    Data on cervical spine injuries resulting from participation in football have been compiled by a national registry established in 1975. Information has been collected retrospectively by defined criteria since 1971. Efforts have been made to establish the mechanism of injury responsible in the majority of instances on the basis of epidemiologic evidence and recognized biomechanical principles. During the 5-year period, 77 deaths resulted from severe neck injuries. During this period, 1,275,000 players were exposed. Ninety-nine cervical fracture-dislocations resulting in permanent quadriplegia and 259 cervical fractures-dislocations occurred. There may be a "trend" towards an increase in permanent quadriplegia resulting from serious cervical spine injuries sustained while playing football. Apparently, the cause can be attributed to the helmet-face mask that has encouraged the use of the head as the primary point of contact in blocking, tackling, and head butting. The figures clearly identify defensive backs, linebackers, or specialty team members making tackles by using the head as the initial point of contact, as the individuals at greatest risk to sustain cervical spine injuries resulting in permanent quadriplegia.

    Title Proximal Diaphyseal Fractures of the Fifth Metatarsal--treatment of the Fractures and Their Complications in Athletes.
    Date June 1979
    Journal The American Journal of Sports Medicine
    Excerpt

    Twenty-one patients (age range, 15 to 26; 18 patients 15 to 20 years old) had proximal diaphyseal fractures of the fifth metatarsal. Clinical records and radiographs for all patients were available for review. Patient treatment had been individualized and included several methods, including rest, plaster immobilization, and bone grafting. Twenty of the 21 patients were boys or men participating in athletics. Nine of the 21 fractures and 8 of the reinjuries were sustained while playing basketball. Healing required a minimum of 3 months (with bone graft) and some fractures were not radiographically healed at 20 months, although the patients were clinically asymptomatic. The fracture of the proximal shaft of the fifth metatarsal, particularly the 1.5-cm segment distal to the tuberosity, is a troublesome injury in the active athlete. The clinical course does not appear to be influenced by the usual initial conservative treatment modalities, although many of these fractures will heal if the athlete is willing to restrict activities for a prolonged period of time. In this series, bone grafting with a tibial corticocancellous graft after thorough curettage of sclerotic bone obliterating the medullary canal was the most effective treatment modality for delayed union.

    Title Double Contrast Arthrographic Evaluation of the Anterior Cruciate Ligament.
    Date April 1978
    Journal Radiology
    Excerpt

    A review of 100 surgically confirmed cases indicates that double contrast arthrography, performed and interpreted with the described criteria, can accurately demonstrate the status of the anterior cruciate ligament. Visualization of the posterior cruciate ligament, which is less commonly injured, assures that proper radiologic positioning has been attained. Joint distraction is used to increase the visualized length of the anterior cruciate ligament coated by contrast agent. Various types of anterior cruciate ligament abnormalities as well as the high incidence of anterior cruciate ligament in young athletes are emphasized.

    Title Spinal Injury at the Level of the Third and Fourth Cervical Vertebrae from Football.
    Date February 1978
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    Acute traumatic lesions of the spine at the third and fourth cervical levels without associated fracture are not common. The eight lesions in this report occurred as a result of injuries sustained during tackle football. They included acute intervertebral disc herniation, anterior subluxation of the third cervical vertebra on the fourth, unilateral dislocation of the joint between the articular processes, and bilateral dislocation of the joints between the articular processes. The mechanism of injury was the use of the top or crown of the helmet as the primary point of contact in a high-impact collision when blocking, tackling, or head-butting. To avoid a seemingly inevitable increase in the incidence of these lesions occurring from tackle football, coaches and officials will have to modify the current techniques of blocking tackling, and head-butting.

    Title Severe and Catastrophic Neck Injuries Resulting from Tackle Football.
    Date August 1977
    Journal Journal of the American College Health Association
    Title Severe and Catastrophic Neck Injuries Resulting from Tackle Football.
    Date July 1977
    Journal Delaware Medical Journal
    Title Non-union of a Stress Fracture Through the Olecranon Epiphyseal Plate Observed in an Adolescent Baseball Pitcher. A Case Report.
    Date May 1977
    Journal The Journal of Bone and Joint Surgery. American Volume
    Title Collision with Spring-loaded Football Tackling and Blocking Dummies. Report of Near-fetal and Fatal Injuries.
    Date October 1976
    Journal Jama : the Journal of the American Medical Association
    Title Clinical Diagnosis of Anterior Cruciate Ligament Instability in the Athlete.
    Date October 1976
    Journal The American Journal of Sports Medicine
    Title The Shoe-surface Interface and Its Relationship to Football Knee Injuries.
    Date January 1976
    Journal The Journal of Sports Medicine
    Title Comminuted Epiphyseal Fracture of the Distal Tibia. A Case Report and Review of the Literature.
    Date November 1975
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    Classification of epiphyseal injuries include only simple fractures and few cases of comminuted fracture of the distal tibial epiphysis, epiphyseal plate and adjacent metaphysis. On the basis of a review of the literature, as well as our own experience, it appears that that fracture is unstable and requires open reduction and internal fixation.

    Title Manifestations of the Battered-child Syndrome.
    Date March 1975
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    Between 1965 and 1972, 231 patients were admitted to St. Christopher's Hospital for Children in Philadelphia with the battered-child syndrome. The case records and reontgenograms of 217 patients were reviewed. About one-third of the patients repuired orthopaedic treatment. The purpose of this paper is to alert the orthopaedist to the existence and prevalence of the battered-child syndrome, to describe both the non-orthopaedic and the orthopaedic manifestations of this problem, and to delineate the orthopaedist's responsibility to the battered child and the child's family.

    Title Letter: Women in Sports.
    Date September 1974
    Journal Jama : the Journal of the American Medical Association
    Title The Use of Thermography in the Early Diagnosis of Neuropathic Arthropathy in the Feet of Diabetics.
    Date January 1973
    Journal Clinical Orthopaedics and Related Research
    Title The Little League Pitcher.
    Date October 1972
    Journal American Family Physician
    Title Opening of the Season: Little League Baseball Pro and Con.
    Date September 1972
    Journal Pediatrics
    Title The Effect of Competitive Pitching on the Shoulders and Elbows of Preadolescent Baseball Players.
    Date April 1972
    Journal Pediatrics
    Title Effect of Shoe Type and Cleat Length on Incidence and Severity of Knee Injuries Among High School Football Players.
    Date August 1971
    Journal Research Quarterly
    Title Malignant Hemangioendothelioma of the Cervical Spine. A Case Report.
    Date January 1971
    Journal The Journal of Bone and Joint Surgery. American Volume
    Title An Unusual Hereditary Osteomalacic Disease--pseudo-vitamin-d Deficiency.
    Date October 1970
    Journal The Journal of Bone and Joint Surgery. American Volume
    Title Sequential Roentgenographic Changes Occurring in Massive Osteolysis.
    Date January 1970
    Journal The Journal of Bone and Joint Surgery. American Volume
    Title Entrapment of a Sesamoid in the Index Metacarpophalangeal Joint. Report of Two Cases.
    Date September 1969
    Journal The Journal of Bone and Joint Surgery. American Volume
    Title Hereditary Multicentric Osteolysis with Recessive Transmission: a New Syndrome.
    Date September 1969
    Journal The Journal of Pediatrics
    Title Infection of the Cervical Spine Associated with a Fracture of the Mandible.
    Date March 1969
    Journal Journal of Oral Surgery (american Dental Association : 1965)
    Title Essential Osteolysis with Nephropathy. A Review of the Literature and Case Report of an Unusual Syndrome.
    Date January 1969
    Journal The Journal of Bone and Joint Surgery. American Volume
    Title Septic Arthritis of the Knee Due to Clostridium Welchii. Report of Two Cases.
    Date October 1968
    Journal The Journal of Bone and Joint Surgery. American Volume
    Title Catastrophic Head and Neck Injuries.
    Date
    Journal Adolescent Medicine (philadelphia, Pa.)
    Excerpt

    Although all athletic injuries require careful attention, the evaluation and management of injuries to the head and neck should proceed with particular consideration. The actual or potential involvement of the nervous system creates a high-risk situation in which the margin for error is low. This chapter presents guidelines for classification, evaluation, and emergency management of catastrophic injuries that occur to the head and neck as a result of participation in competitive and recreational activities.

    Title National Athletic Trainers' Association Position Statement: Head-down Contact and Spearing in Tackle Football.
    Date
    Journal Journal of Athletic Training
    Excerpt

    OBJECTIVE: To present recommendations that decrease the risk of cervical spine fractures and dislocations in football players. BACKGROUND: Axial loading of the cervical spine resulting from head-down contact is the primary cause of spinal cord injuries. Keeping the head up and initiating contact with the shoulder or chest decreases the risk of these injuries. The 1976 rule changes resulted in a dramatic decrease in catastrophic cervical spine injuries. However, the helmet-contact rules are rarely enforced and head-down contact still occurs frequently. Our recommendations are directed toward decreasing the incidence of head-down contact. RECOMMENDATIONS: Educate players, coaches, and officials that unintentional and intentional head-down contact can result in catastrophic injuries. Increase the time tacklers, ball carriers, and blockers spend practicing correct contact techniques. Improve the enforcement and understanding of the existing helmet-contact penalties.


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