Collateral Ligament Sprain Research Articles

Role of MRI in Evaluation of Post-Traumatic Knee Injuries: A Prospective Study

INTRODUCTIONThe knee joint is the largest and most complex joint in the human body. Therefore it is often affected by trauma. Magnetic Resonance Imaging (MRI) is a non-invasive imaging modality that provides detailed images of the soft tissue structures of the knee joint. The objective of this study was to evaluate MRI findings in patients with post-traumatic knee joint injuries. MATERIAL AND METHODSThis prospective study was carried out using a 3.0 Tesla MRI (Magnetom Lumina) scanner in the Department of Radiodiagno- sis and Medical Imaging at Universal College of Medical Sciences & Teaching Hospital, Bhairahawa, Nepal, involving 128 patients with knee injuries, from September 2023 to February 2024. Data were analyzed using SPSS version 20. RESULTSIn this study of 128 participants, 57.81% were male and 42.19% were female, with a mean age of 38.60±13.05 years. The majority of MRI findings were medial meniscus tear (51.56%), followed by anterior cruciate ligament tear (46.09%), medial collateral ligament sprain (44.53%), lateral meniscus tear (39.84%), lateral collateral ligament sprain (33.59%), and posterior cruciate ligament tear (17.97%). Our study also revealed various grades of collateral ligament injuries, including the medial and lateral ligaments. There were 59.65% of cases with a grade I medial collateral ligament sprain, followed by grade II at 33.33% and grade III at 7.02%. The grade I and grade II lateral collateral ligament sprains were 62.79% and 37.21%, respectively. CONCLUSIONMRI is a non-invasive and valuable diagnostic modality that can provide an accurate diagnosis. It is often preferred over arthroscopy.

Common sports injuries and physical treatments

Physiotherapy is a non-invasive and non-pharmaceutical application of artificial physical factors and natural physical factors to the human body through the body's neurological, humoral, endocrine, immune and other physiological regulatory mechanisms to achieve the purpose of treatment and rehabilitation. With the widespread popularity and popularity of sports, more people are participating in sports in which injuries become common at different levels of sports from daily recreation to high intensity competitive levels. Physical therapy is considered the first choice for sports people to treat sports injuries and is becoming common and mainstream in the field of sports injury treatment and rehabilitation. Physiotherapy has become critical as a primary treatment or secondary intervention after a sports injury and make sense in the rehabilitation of sports injuries. This article focuses on the physiotherapy treatment of common sports injuries in different sports. Common sports injuries in basketball include ankle sprains, meniscus tears, Achilles tendon ruptures, and patellar tendonitis. Common sports injuries in rugby include groin injuries and shoulder dislocations. Common sports injuries in baseball include ulnar collateral ligament injuries and rotator cuff injuries. Common sports injuries in tennis include epicondylitis of the elbow joint. Common injuries in soccer include medial collateral ligament sprains and calf strains. This article analyzes the anatomical structure of the above-mentioned common injury sites, the physical means of intervention and the different roles of physiotherapy in different sports injuries. The results of the article found that physiotherapy is available for all the sports mentioned above. However, depending on the injury in a sport, physiotherapy has a different proportion of the conventional treatment modalities.

Conservative Approach to Treating American Football Players With Medial Collateral Ligament Grade 2 Sprain During the Season.

The medial collateral ligament is the most commonly injured ligament in the knee. The high-speed pivoting and agility movements that are common in the sport of American Football put participants at an increased risk for a valgus force stress from contact or noncontact injuries. Positional release therapy (PRT) also considered strain/counterstrain focuses on releasing the tension in a tissue through unloading the involved body part. Two male student-athletes participating in football with a mean age of 20.5years were diagnosed by a physician with medial collateral ligament grade 2 sprain. Both patients sustained their injuries in a regular season game with a contact valgus force from an opposing player. After the initial 72hours of compression, elevation, and cryotherapy, the patients were both treated with PRT followed by progressive loading exercises. Following 4 treatment sessions of PRT over the next 6days, the patients started with quadriceps engagement exercises, single-leg squats to 60° knee flexion, side steps, triceps dips, slow controlled lunges, and toe walk. The patients progressed to full body weight squats, single-leg landing, step-up tri-extension, and sidekicks with a leg on table. Then, the patients completed function movements and sports-specific exercises. In this case series, 2 patients competing in intercollege American Football were treated with PRT and progressive loading exercises to facilitate return to unrestricted activities and improve outcome measures. Commonly, a grade 2 medial collateral ligament sprain is conservatively treated with return to sport taking 20days on average. In this type 2 case series, the clinician found success utilizing PRT early in the recovery process, which in these 2 cases lead to restoration of function, outcome measure improvement, and an expedited return to sport. The expedited return to sport occurred at an average of 18days for these patients.

Poster 359: Anorexia Nervosa and Bulimia Nervosa Diagnoses Are Associated with Increased Risk of Lower Extremity Soft Tissue Injury and Orthopaedic Surgery Requirements

Objectives: An abundance of literature exists demonstrating the link between eating disorders and fracture risk. However, no studies to our knowledge have investigated the impact of an eating disorder diagnosis on risk for ligamentous injury or the need subsequent orthopedic surgery. The aim of this study was therefore to elucidate this link and determine if pre-existing eating disorder diagnoses are associated with increased incidence of lower extremity connective tissue-related orthopaedic injuries and surgeries. We hypothesized that eating disorders, specifically anorexia nervosa and bulimia nervosa, lead to an increased risk of ligamentous injuries and need for surgery on injured ligaments. Methods: Patients with a diagnosis of anorexia nervosa or bulimia nervosa were identified using International Classification of Diseases (ICD) -9 and -10 codes using the PearlDiver Mariner insurance claims data set. These patients were matched by age, gender, Charlson Comorbidity Index, record dates, and geographical region to respective control groups without anorexia nervosa or bulimia nervosa. Instances of ligamentous injuries were identified through ICD-9 and ICD-10 codes within the time period of 2010-2020 available within the Mariner dataset. Instances of ligamentous orthopaedic surgery procedures in these patients were identified through Current Procedural Terminology (CPT) codes. Rates of ligamentous injury and orthopaedic surgery among experimental and control cohorts were analyzed using chi-squared analysis. Results: The anorexia nervosa cohort and its matched control group contained a total of 2,475 patients each. Patients with a diagnosis of anorexia nervosa were significantly more likely to sustain a meniscus tear (RR=1.57, p=0.001) or deltoid ligament sprain (RR=1.83, p=0.025), and to undergo anterior cruciate ligament (ACL) reconstruction (RR=2.83, p=0.037). They were less likely to sustain a tibiofibular ligament sprain (RR=0.64, p=0.012). The bulimia nervosa cohort and its matched control group contained a total of 2,375 patients each. Patients with a diagnosis of bulimia nervosa were significantly more likely to sustain a meniscus tear (RR=1.98, p <0.001), medial collateral ligament (MCL) sprain (RR=3.07, p<0.001), any cruciate ligament tear (RR=2.14, p=0.004), unspecified ankle sprain (RR=1.56, p<0.001), and any ankle ligament sprain (RR=1.27, p=0.008), and to undergo partial meniscectomy (RR=1.80, p=0.002). Conclusions: Diagnosis of an eating disorder is associated with an increased risk of certain ankle and knee ligamentous injuries and surgeries. Orthopaedic surgeons should be aware of the effects these disorders have on soft tissue injury and surgery rates. Furthermore, patients presenting to orthopaedic surgery clinics should be informed of increased risks associated with their eating disorder diagnoses and provided with information on resources promoting recovery to help prevent further injury.

Risk of Lower Extremity Ligamentous Injury Following Concussion Diagnosis: A TriNetX Database Study.

Background Concussion is one of the most frequently reportedsports-related injuries in the United States; there is evidence that residual deficits in neurocognition may increase the risk of lower extremity musculoskeletal injury after concussion in high school, college, and professional athletes. The purpose of this study is to identify whether similar trends are identified in community-based populations. Methods The TriNetX Research Network database was queried for patients 10-60 years old who experienced an ambulatory or emergency visit from 2018-2020. Cohorts were defined by patients seen for concussion and patients seen for other reasons. These cohorts were then propensity score matched based on significant differences in demographics; after matching, each cohort included 97,708 patients. The propensity score-matched cohorts were then evaluated to identify patients who experienced subsequent lower extremity ligamentous injury within 12 months. Results Patients with a history of concussion were more likely to experience posterior cruciate ligament (PCL) sprain (0.04% vs. 0.02%, risk ratio (RR)=1.79, p=.039), medial collateral ligament (MCL) sprain (0.18% vs. 0.08%, RR=2.355, p<.001), lateral collateral ligament (LCL) sprain (0.05% vs. 0.02%, RR=2.202, p=.003) and ankle sprain (1.05% vs. 0.47%, RR=2.265, p<.001). Conclusion Patients diagnosed with concussion were more likely to experience a lower extremity ligamentous injury when compared with patients who did not have concussion. Patients should be counseled regarding this increased risk and additional neuromuscular evaluation and injury prevention education may be indicated following concussion diagnosis.

Validation of the spontaneous lateral laxity sign for radial collateral ligament sprain of the metacarpophalangeal joint of the fingers: Anatomical study

Severe collateral ligament sprain of the metacarpophalangeal joint (MCP) of the fingers is rare. Clinical examination is mandatory to diagnose severity. The purpose of our study was to validate a clinical sign for MCP joint laxity: the spontaneous lateral laxity sign (SLLS), recently described by Meyer et al. to diagnose severe MCP radial collateral ligament (RCL) sprain, with a comparison with the already validated rotational laxity test (RLT). SLLS and RLT were assessed before RCL transection, after RCL transection and after RCL repair on 40 long fingers in 10 fresh thawed cadavers. SLLS was performed with the elbow on the table, wrist in 70° flexion, in neutral pronation-supination, hands drooping passively with the dorsal side toward the examiner and the ulnar side toward the table. The MCP joints were at rest, in passive slight extension. Positive results were defined as an overlap of the damaged finger on the next, or as an increased abduction of the little finger. Correlation between the two tests was calculated. SLLS was positive in 0% of cases before RCL transection, 100% after transection and 0% after repair. Mean arcs of pronation and supination on RLT were 16 and 19.5 mm before section, 24 and 33 mm after section (52% and 69% increase compared to preoperative data), and 17 and 21 mm after repair (7% and 8% increase). Correlation between the two tests was 100%. The spontaneous lateral laxity sign is a simple and reliable clinical sign for diagnosing complete long-finger MCP RCL tears requiring surgery. Level of evidence: III, case-control study.

Calcaneal Intraosseous Lipoma: A Case Report

Background: This case report is presented to increase awareness among clinicians about the existence of this rare cause of calcaneal pain. Intraosseous lipoma is a rare, benign primary tumour occurring in the bone We report a 40-year-old lady who presented with the history of one week old trauma with pain in the lateral aspect of right ankle which was clinically diagnosed to be right lateral collateral ligament sprain. The radiographs of the right ankle and heel incidentally revealed a lytic lesion. The patient had no symptoms persisting to foot and heel. MRI of right foot was suggestive of calcaneal stage 2 intra osseous lipoma. In view of the subchondral location of the lesion, prophylactically the lesion was treated with curettage and bone grafting to prevent the pathological fracture. The post-operative radiographs demonstrated continued remodelling and healing of the graft site. The patient was followed up on an OPD basis and made a full recovery with good patient compliance. Even though this tumour is rare, there is a need for physicians to recognize its radiological findings and offer the appropriate treatment options. It is also important for primary care physicians to be aware that there are other causes of heel pain than the common suspects. Keywords: Intraosseous lipoma, Heel pain, Lytic lesion, Benign primary tumour

Knee pain: Ultrasound and MRI correlation

Abstract Background Knee pain incidence is increasing among the community which has different multiple pathologies. Magnetic Resonance Imaging (MRI) is considered the gold standard imaging modality in diagnosing knee soft tissue injury. Ultrasound (US) is another modality which can be used in diagnosing soft tissue injury. Aim of the Work is to detect the reliability of US in diagnosing cases with knee pain as compared to MRI. Patients and Methods A prospective study was conducted on 20 patients with knee pain. They were referred from the Orthopedic and/or Rheumatology Department to Radiology department at Ain Shams University hospitals for MRI and US examination of the knee.The age group were from 19 to 59 years. Results In this study, 20 patients were examined with majority being males (75%). US was tested against MRI for different soft tissue pathologies.including knee effusion, meniscal pathology (tear, degeneration and extrusion), medial collateral ligament sprain, lateral collateral ligament sprain and Baker’s cyst. There was good agreement between US and MRI in most of these pathologies. US showed an overall sensitivity of 61.7% and specificity of 92.7% with accuracy of 86.9%. The overall PPV and NPV were 66.1% and 91.3% respectively. Conclusion Ultrasound can be considered a reliable screening imaging modality in cases of knee pain.

Traumatic Hip Dislocation in an NCAA DI Football Player with Occult Sequelae: A Case Report.

Background and PurposeAmerican football generates the most sports-related injuries in the United States, with tackling as the leading injury mechanism. Overall injury rate at the collegiate level has been reported as 8.61 per 1,000 athlete exposures (AEs) – twice the rate of high school levels; competition injury rates are reported as high as 36.94/1000 AEs. Traumatic hip dislocation is an uncommon injury typically arising from high-energy axial impact with only 2-5.5% occurring during sports activities.Case DescriptionA 22-year-old NCAA Division I football defensive back who experienced extreme left hip pain following contact with another player with his hip flexed during a game was diagnosed with a type 1 posterior hip dislocation, a grade 1 medial collateral ligament sprain with concomitant posterior thigh and hip muscle strains. Key impairments were limited left lower extremity motor performance, range of motion deficits, left hip pain, and diminished function and weight-bearing ability.OutcomesThe athlete reintegrated into typical defensive back off-season training approximately four to five months post injury without restrictions, however presented with new anterior hip pain seven months post injury revealing occult sequelae requiring surgical intervention. He was able to return to full play the following football season.DiscussionThis case report describes the successful return to sport of a Division I football player who sustained a traumatic posterior hip dislocation and complicated course including surgical intervention secondary to associated sequelae.Level of Evidence5

Collateral ligament sprains of the metacarpophalangeal joint of the long fingers: Results of a surgical series of 15 patients

IntroductionCollateral ligament sprains of the metacarpophalangeal joint (MP) of the long fingers are rare and mostly treated conservatively. Clinical examination to diagnose the severity of these injuries is mandatory. The purpose of our study is to report the results of 15 patients treated surgically. MethodsTwenty-three patients, mean age 48, underwent surgery for Stage 3 radial collateral ligament (RCL) injuries of the middle finger (12), the ring finger (4) and the little finger (7). The mean time from trauma to surgery was 53 days. The clinical evaluation consisted of measuring active joint motion, performing laxity tests at 0°, 30° and 90° of MP flexion, testing for laxity and rotation, looking for a spontaneous overlapping finger (or hyperabducted little finger) in relaxed position and measuring the strength (Jamar). ResultsAmong the 23 operated patients, RCL lesions were distal in 8 cases, proximal in 9, and mid-substance in 6. There were 2 Stener-like lesions.Preoperatively, 16 patients presented an overlapping finger over the next one and 7 had spontaneous hyperabduction of the fifth finger.Mean follow-up of the 15 patients reviewed was 24 months (8–56).Mean MP flexion-extension range of motion was 86°/11° (71–99/0–29).Mean MP ulnar laxity of the injured finger was 18°, 14° and 11° respectively at 0°, 30° and 90° and 19°, 16°and 13°on comparison to the same digit on the opposite side.Mean MP radial laxity of the injured finger was 28°, 22° and 10° respectively at 0°, 30°, 90°, same digit on opposite side was 29°, 21°, 11°.There were no postoperative overlapped or hyperabducted fingers concerning spontaneous lateral laxity in extension.The postoperative rotational laxity test showed differences of arc in supination and pronation between operated finger and healthy side of respectively −12% and +8%. ConclusionThe postoperative results of RCL repair of the MP in the long fingers are good in spite of some residual ligamentous distension, revealed by the laxity tests. The lateral laxity sign as a simple painless clinical sign for diagnosing complete RCL tears requiring surgery needs a validating study in order to spread its use. Level of evidenceIV; retrospective study.

MRI-Detected Knee Ligament Sprains and Associated Internal Derangement in Athletes Competing at the Rio de Janeiro 2016 Summer Olympics.

PurposeDescribe the frequency and severity of knee ligament sprains diagnosed by MRI in athletes participating at the 2016 Summer Olympic Games, their association with certain sports and assess correlations with additional knee structural injury.Patients and MethodsAll knee MRIs performed in the Olympic Village and polyclinics during the 2016 Olympics were retrospectively, blindly reviewed for ligament sprains and associated knee injuries. In addition to the absence or presence of these abnormalities, athletes were stratified by age, gender and sport.Results11,274 athletes participated in the 2016 Olympic Games: 113 athletes received at least one knee MRI with some having bilateral or repeat MRI on the same knee. Anterior cruciate and medial collateral ligament (ACL/MCL) sprains were most common, accounting for 32 of the 43 sprains (74.4%). Wrestling (10), hockey (7), athletics (7), and judo (5) accounted for over half of ligament sprains. ACL sprains showed a significant positive correlation with medial, lateral meniscal tears and bone contusions. The positive correlation between posterior cruciate ligament (PCL) sprains with MCL/lateral collateral ligament sprain, and popliteus tendon tear was statistically significant with 50% of total PCL sprains occurring in hockey. When athletes were stratified by gender, ligament sprains had a similar occurrence and distribution between men and women.ConclusionKnee ligament sprains, at the Rio 2016 Games, were most common in wrestling, hockey, athletics and judo with ACL and MCL sprains most frequent. Meniscal tears and bone contusions occurred often with ACL sprains. PCL sprains tended to be multi-ligamentous injuries. Sustained ligament sprains had similar occurrence between genders, while men had a peak incidence of sprains at a younger age and women at an older age.

Chronic Medial Collateral Ligament Sprain Treated With Percutaneous Ultrasonic Debridement: A Case Report

The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. Most grade I and II injuries respond to conservative management, but symptoms persist in some patients. In these cases, treatment options are limited. Percutaneous ultrasonic debridement is increasingly being used for tendinopathy and fasciopathy refractory to conservative management, but this has not been reported as a treatment for ligament injury. Here, we present a case of a chronic grade II MCL sprain successfully treated with percutaneous ultrasonic debridement.

Cost and Treatment Characteristics of Sport-Related Knee Injuries Managed by Athletic Trainers: A Report From the Athletic Training Practice-Based Research Network.

Knee injuries are common during sport participation. However, little is known about the overall management and estimated direct costs of care associated with these injuries when under the care of athletic trainers. To describe the treatment characteristics and direct costs of care for athletic training services provided for patients with knee injuries. Descriptive study. Ninety-five athletic training facilities across 24 states. A total of 117 athletic trainers (females = 56.4%, age = 29.4 ± 8.7 years, years certified = 4.7 ± 6.0, years employed at site = 1.6 ± 4.1). Complete patient cases were identified using International Classification of Disease-10 diagnostic codes between 2009 and 2020. Summary statistics were calculated for patient demographics, treatment characteristics, and direct costs of care. Treatment characteristics included the type of athletic training service, duration, amount (eg, number of visits), and direct costs of care. A total of 441 patient cases were included. The most common injuries reported were cruciate ligament sprain (18.1%, n = 80), medial collateral ligament sprain (15.4%, n = 68), and knee pain (14.1%, n = 62). Injuries occurred most frequently during football (35.4%, n = 156), basketball (14.7%, n = 65), and soccer (12.7%, n = 56). A total of 8484 athletic training services were recorded over 4254 visits, with therapeutic exercise (29.8%, n = 2530), hot or cold pack (25.8%, n = 2189), and therapeutic activities (11.2%, n = 954) being the most frequently reported services. The median duration of care was 23 days and number of visits was 8. The median total cost of care was $564 per injury and $73 per visit. Patients with knee injuries demonstrated greater time loss than those with other lower extremity injuries. Thus, it is unsurprising that knee injuries were associated with a longer duration and higher cost of care than other lower extremity injuries such as ankle sprains. Future researchers should examine the effectiveness of common treatment strategies and aim to identify treatments that can reduce costs and improve patient outcomes.

Chronic Medial Collateral Ligament Sprain and Medial Collateral Ligament Bursitis of the Knee in a Female Soccer Player: A Case Report

Chronic Medial Collateral Ligament Sprain and Medial Collateral Ligament Bursitis of the Knee in a Female Soccer Player: A Case Report

Left Knee, Leg Pain After A Hand Cycling Accident

HISTORY: A 56 year old female with past medical history of Ehlers-Danlos Syndrome and stroke with residual left hemiparesis sustained a left knee and leg injury while hand cycling. Patient was on a ride when she collided with another cyclist, causing her to fall onto her left leg and thigh. She reported immediate pain, swelling and bruising of her left knee and leg. She presented to her primary care physician a few days later due to persistent pain. X-rays were negative for fracture. Patient had no new numbness or tingling. Her strength in her left lower extremity is minimal due to her stroke but she had noticed more difficulty with transfers due to pain PHYSICAL EXAMINATION: There was a large area of swelling on the lateral aspect of the distal left thigh that was firm and tender to palpation. Left knee showed no obvious deformity. There was diffuse tenderness to palpation over the medial and lateral knee and proximal tibia. There was no erythema or effusion. She had full knee range of motion in flexion/extension without pain. There was no ligamentous laxity in varus/valgus testing. Anterior and posterior drawer, Lachman’s/McMurry’s tests were negative. Strength was 1/5 in hip flexion, 0/5 in knee flexion/extension which, per patient report, was baseline. Sensation was intact to light touch. DIFFERENTIAL DIAGNOSIS: Femoral/tibial fracture, bone contusion, medial/lateral collateral ligament sprain, meniscus injury TEST AND RESULTS: MRI KNEE LT WO CONTRAST There is a T2 hyperintense 1.8 x 8.1 cm (transverse by AP) fluid collection layering over the iliotibial band and superficial fascial biceps femoris, with free floating internal fat lobules. Favored to represent a Morel-Lavallee lesion. The menisci, cruciate and medial collateral ligaments, lateral collateral ligamentous complex and extensor mechanism are intact. FINAL WORKING DIAGNOSIS: Morel-Lavallee lesion of left thigh TREATMENT AND OUTCOMES: Patient referred to plastic surgery who recommended percutaneous drainage. She underwent ultrasound guided drainage of 25 ml of serosanguinous fluid. At follow up no further fluid collection seen on ultrasound. Pain was resolving. Patient advised to wear compression garment to assist with healing. Cleared to return to activity as tolerated. Patient seen one year later with resolved symptoms and physical exam findings.

Left Elbow Pain In An Elite Basketball Player

HISTORY: A 32 year old, right handed, female professional basketball player presented two weeks following injury to the left elbow. Her history is significant for various lower extremity musculoskeletal injuries but no previous elbow or shoulder complaints. She presented two weeks following an in-game injury, in which she was “tied up” with another player and felt a hyperextension and valgus movement at the elbow. She felt immediate pain at the medial elbow. Initially there were paresthesias in the ulnar distribution but these resolved shortly. She continued playing through the discomfort for two weeks. PHYSICAL EXAMINATION: On inspection, there was a trace effusion about the left elbow. There was tenderness to palpation over the flexor pronator mass, medial epicondyle, and sublime tubercle. Extension lacked 5 degrees of range of motion. Flexion was normal at 130 degrees. Strength testing was normal, although there was pain with resisted wrist flexion and pronation. There was no pain with wrist or finger extension or elbow supination. A moving valgus stress test reproduced pain. There was no obvious laxity. Tinel’s test over the ulnar nerve was negative. DIFFERENTIAL DIAGNOSIS: 1. Medial epicondylosis 2. Ulnar collateral ligament sprain or tear 3. Ulnar neuropathy 4. Valgus extension overload syndrome TEST AND RESULTS: Left elbow X-ray: Unremarkable; Left elbow ultrasound: Full-thickness proximal UCL tear with significant (2.7mm) humeroulnar joint space opening with valgus stress test; Left elbow MRI: Full-thickness tear of the UCL at its humeral attachment with associated edema and inflammation extending into the adjacent flexor digitorum superficialis muscle and partially encasing the ulnar nerve within the cubital tunnel FINAL WORKING DIAGNOSIS: Left ulnar collateral ligament full thickness tear TREATMENT AND OUTCOMES: 1. The patient underwent PRP to the UCL tear 2. Post injection rehabilitation started with 6 weeks of rest, protection and range of motion. Pain resolved. 3. Follow up ultrasound at 6 weeks demonstrated interval healing of the full-thickness proximal UCL tear with no significant humeroulnar joint opening on valgus stress testing (0.7mm). 4. Continued PT through 16 weeks post injection and remained pain free with a normal elbow examination throughout the following season without limitation.

Drive for Thinness Predicts Musculoskeletal Injuries in Division II NCAA Female Athletes.

The female athlete triad is the interrelation of low energy availability, menstrual dysfunction, and low bone mineral density. Previously, the components of the female athlete triad have been linked to bone stress injuries. The objective of this study was to explore the relationship between drive for thinness, a proxy indicator of low energy availability, and musculoskeletal injuries. Fifty-seven female athletes, from an NCAA Division II college, were followed throughout their respective sport season for musculoskeletal injuries. Women were grouped based on a median split of the drive for thinness score (high drive for thinness (DT) vs. low DT). At the end of each sport season, injury data were compiled using an electronic medical record database. Forty-seven of the 57 women (82%) incurred 90 musculoskeletal injuries. The most prevalent injuries included: Low back pain/spasm/strain (n = 12), followed by shin splints/medial tibial stress syndrome (n = 9), general knee pain (n = 7), quadriceps strain (n = 6), and knee sprain (anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament sprains; n = 5). The number of in-season injuries in the High DT group (2.0 ± 0.3) was significantly higher than the Low DT group (1.2 ± 0.2, p = 0.026). A high drive for thinness is associated with an increased number of injuries during the competitive season.

Determination of Effect of Platelet Rich Plasma Injection on Improving Pain and Function in Young Healthy Athletes with Isolated Grade 2 or 3 Knee Medial Collateral Ligament Sprains

Background: Knee medial collateral ligament (MCL) sprain is common in athletes, which keeps them away from trainings. Platelet-rich plasma (PRP) injection is used as an adjunct for treatment of musculoskeletal injuries. This study was supposed to define effect of PRP injection on high-grade MCL sprain healing, in comparison to rehabilitation alone. M aterials and Methods: This study was performed on 46 healthy athletes with high-grade MCL sprains who came to sports medicine clinic of Taleghani Hospital, Tehran over a one-year period (2017-2018). In first visit injury grade, its location, baseline pain, Lysholm score and joint stability was determined. Participants randomly allocated to 2 groups (n=23), “group A” had 12-week functional rehabilitation and “group B” had the same rehabilitation plus a single PRP injection. At 4-week intervals valgus stress testing, pain and Lysholm scores was reassessed. The scores of 4 th , 8 th and 12 th weeks was compared to the baseline scores. R es ults: Mean baseline pain score in control and intervention group was 5.09±0.949 and 5.26±0.810 respectively that in the fourth week of study reduced to 1.30±0.765 and 2.43±0.507 (p<0.001). In intervention group, fourth week pain was significantly reduced while stability and Lysholm scores of the groups had no significant difference. C onclusion: PRP injection had a short-term statistically significant pain reduction effect that may assist in faster rehabilitation progress, shorter return to play and less detraining which is crucial to professional athletes.

Medial Elbow Pain - Recreational Athlete

HISTORY: 22-year female recreational athlete with history of left elbow pain following a fall on outstretched arm during a running/cutting activity. She noted immediate local pain of 7/10 on VAS and swelling of the medial elbow and forearm. She was unable to fully extend the elbow. PHYSICAL EXAMINATION: Edema was noted at the medial elbow, extending into the medial forearm. Palpation of soft tissues, tendon and bony structures revealed significant point tenderness at the medial joint space and at the medial epicondyle. Limited active ROM with extension was noted due to pain. Valgus stress test was positive, with significant discomfort upon moderate loading. Due to significant pain complaints, further physical examination was suspended and clinician progressed to point-of-care ultrasound imaging of the medial elbow complex DIFFERENTIAL DIAGNOSIS: 1. Medical Collateral ligament sprain 2. Medial Collateral ligament disruption 3. Common Flexor Tendon Pathology 4. Pronator Teres Strain 5. Medial epicondyle avulsion fracture 6. Biceps tendon pathology TESTS AND RESULTS: Bilateral ultrasound Imaging of the medial elbow complex revealed disruption of the ligamentous fibers of the UCL anterior band at the joint line. A large hypoechoic gap in the UCL is present, denoting the presence of significant fluid. Gravity valgus stress loading revealed a joint gap of 0.76cm compared to 0.38cm of the uninvolved side. FINAL WORKING DIAGNOSIS: Full thickness tear of the anterior bundle of the medial collateral ligament TREATMENT AND OUTCOMES: Since the athlete did not participate in overhead throwing activities, conservative management approach was selected. ROM was limited 0-100 degrees initially to full ROM at 4 weeks post injury. Strengthening was initiated with initial emphasis on core and shoulder musculature, progressed to elbow and forearm musculature, including the flexor/pronator group as an active stabilizer against valgus forces. Patient was symptom-free at 4 months following injury, and ultrasound imaging revealed reduced valgus joint gapping. This case presentation illustrates the utility of ultrasound imaging in diagnosing MCL pathology, especially when physical examination is limited due to patient discomfort, and further illustrates the successful conservative management of a full thickness MCL tear.

Knee Pain in a 7th Grade Runningback

AUTHORS: Michael J. Bradburn, E. Ray Stewart, E. Lyle Cain AFFILIATION: The University of Alabama, Tuscaloosa, AL, Andrews Sports Medicine and Orthopaedic Center, Birmingham, AL TITLE: Knee pain in a 7th Grade Runningback CASE HISTORY: Patient is a 13-year-old male 7th grade runningback who sustained a left knee injury at practice. He reported running the football and dragging a defender who was holding onto the patients left leg. He felt a pop in his knee and reported immediate swelling. He was evaluated later that night at the Varsity football game and was referred to the sports medicine office in Tuscaloosa for evaluation. PHYSICAL EXAM: Inspection: non-weight bearing left lower extremity, assistance with crutches Mild ecchymosis, severe effusion, maximal tenderness: lateral joint line, medial patellar, moderate swelling Tests: left knee: negative Lachman’s, guarded medial and lateral McMurray’s. Negative valgus and varus stress, negative anterior and posterior drawer Range of motion left knee: painful active and passive range of motion, 45 degrees of flexion active and passive, 0 degrees extension active and passive Positive patellar apprehension on left Lower extremity strength is normal Lower extremity neurovascular exam is normal DIFFERENTIAL DIAGNOSIS #1: patellar subluxation #2: femoral condyle fracture #3: lateral collateral ligament sprain #4: lateral meniscus tear #5: femoral / tibial bone contusion TESTS AND RESULTS: X-ray Knee 4 views Left: avulsion fracture of lateral femoral condyle – minimally displaced MRI Left knee without contrast: popliteus tendon rupture with retraction. Edema surrounding ACL FINAL / WORKING DIAGNOSIS: Left popliteus tendon femoral avulsion DISCUSSION: Isolated popliteus tendon rupture is a rarely reported finding in the literature. The vast majority of popliteus tendon ruptures occur in combination with other ligamentous injuries specifically in the posterolateral structures of the knee. Generally, reported cases are treated non-operatively with a high rate of return to play at previous level. OUTCOME: Patient was evaluated by an orthopedic surgeon at Andrews Sports Medicine and Orthopaedic Center in Birmingham, AL and underwent arthroscopic left popliteus tendon repair RETURN TO ACTIVITY AND FOLLOW UP: After surgery the patient followed an ACL rehabilitation protocol, weight bearing as tolerated in a controlled motion brace, locked in extension for two weeks and began physical therapy after his initial post-operative appointment two weeks after surgery. At his 2-week post-operative appointment he could wean off crutches and weight bear as tolerated with his knee brace locked in extension. Physical therapy following ACL rehab protocol was initiated for the next 4 weeks, allowing for range of motion exercises out of the brace. After six weeks total he was released to return to full activities.