Ligament Sprains Research Articles

The role of insurance data in setting priorities for netball injury prevention strategies

The aim of this study was to investigate insurance records for a one-year period to determine the injury frequencies and costs associated with different age groups in netball. The insurance records for all netball claims made during 1999 in Victoria were obtained from the insurer and entered into a database. The overall injury rate was 9.49 injuries per 1000 players, with 829 claims for injuries filed with the insurance company. Of all injuries claimed for, 85.3% were to the lower limb, 8.7% to the upper limb, 3.1% to the spine/torso and 2.9% to the head and face. Lower limb injuries accounted for 85.4% of costs, upper limb injuries 10.7% and head/neck/torso injuries 3.9% of total injury costs. Knee injuries accounted for 56.9% of total costs, with ankle and calf/Achilles injuries costing 12.7 and 11.8% of total costs, respectively. Injury prevention strategies should therefore be directed to three main injuries taking into account costs and incidence. These injuries were: ankle sprains, knee ligament sprains and Achilles tendon strains. Specifically, the prevention program for Achilles injuries should be directed to the >25 years age groups.

Functional and Release Characteristics of Alpine Ski Equipment

Abstract Releasable bindings were developed to reduce the risk of lower leg injuries. However, the relationship between the incidence of specific alpine injury groups and the function and calibration of the release system has not been well understood. Over the 32 years between December 1972 and April 2004, the authors conducted a case control study at a northern Vermont ski area involving 17 967 injuries and 3617 uninjured controls. During that time, approximately 6.4 million skier visits were recorded at the area. Injured skiers were treated at clinic in the base lodge and their injuries diagnosed by the clinic staff. Data relating to the accident, the injury, and the equipment used were recorded. The release moments of equipment associated with lower extremity injuries and uninjured controls were measured using a commercially available test device. Case studies of 43 anterior cruciate ligament (ACL) sprains, 79 lower leg injuries, and 99 uninjured controls were conducted using data collected over seven years between December 1997 and April 2004. In terms of quantitative critical defects, 17 % of the control group, 14 % of the ACL group, and 39 % of the lower leg group exhibited release levels more than 30 % above recommended. When qualitative critical defects were considered, 27 % of the control group, 25 % of the ACL group, and 54 % of the lower leg group were found to exhibit one or more defects capable of having a significant effect on equipment function. The authors concluded that sprains, fractures, strains, and contusions of the lower leg among alpine skiers were associated with measurable or observable qualities of the release system. Serious sprains of the knee were not. A substantial reduction of injuries below the knee can be expected if potentially defective equipment can be identified and repaired, or replaced.

Lisfranc Fracture Dislocation In A Fencer

HISTORY: A 21 year-old female fencer presented to the training room for a preparticipation physical exam. She grew up in Latvia, where she competed on the national team. One month prior to her arrival, she sustained an inversion injury to her right ankle while competing in a tournament. She was told she had a sprained ankle. Treatment thus far only included crutches and heat. PHYSICAL EXAM: With ambulation there was a noticeable limp when weight bearing on the right foot. The right foot and ankle were swollen, through the dorsum of her midfoot. There was tenderness to palpation of the ATFL, and CFL ankle ligaments. In addition she was tender over the dorsal surface of the forefoot and midfoot. With ankle active range of motion, plantar and dorsiflexion was approximately 5 degrees. Anterior drawer was equal to other side with firm endpoint. Talar tilt was positive for pain but negative for increased laxity. There were no sensory deficits. DIFFERENTIAL DIAGNOSIS: Ankle ligament sprain Midfoot ligament sprain Lateral malleolar fracture Metatarsal and/or tarsal fracture Soft tissue and/or bony contusion TEST AND RESULTS: Ankle anterior-posterior, lateral and mortise view radiographs -No fracture or dislocation noted. Foot anterior-posterior, lateral and oblique view radiographs -Lisfranc fracture dislocation. With a flex sign and dorsal dislocation of the second metatarsal base. FINAL WORKING DIAGNOSIS: Right foot closed displaced Lisfranc fracture dislocation TREAMENT AND OUTCOMES: Referral to orthopedic foot and ankle specialist. Open reduction internal fixation of Lisfranc fracture dislocation with external fixator. Non-weight bearing. Removal of lateral external fixator at 8 weeks post-op. Serial repeat radiographs with and post external fixator, displayed good reduction and healing. Placement in low-tide walking boot, with non-weight bearing for an additional 1–1/2 weeks and initiation of gentle range of motion of ankle and toes. Discontinued boot, weight bearing begun 12 weeks post injury and rehabilitation with athletic training staff started. Rehabilitation included foot and ankle range of motion and strengthening exercises. Along with quadriceps, hamstring and calf strengthening. Athlete returned to sport 8 months after injury. At next season's preparticipation exam athlete reported no foot pain with ambulation or fencing. Athlete was able to meet demands of sport and was cleared to compete again.

Elbow Pain - Baseball

HISTORY: A 17 year-old first baseman decided he wanted to be a pitcher and spent two long days pitching baseballs with his father. He developed left medial elbow pain in early July. He was seen by his primary care doctor who evaluated with an x-ray and recommended relative rest. A month later he continued to have medial elbow pain and stiffness that was worse with extension activities, such as bench pressing. He denied clicking, catching, numbness, or weakness. Treatment thus far had mostly consisted of stretching and icing. PHYSICAL EXAM: There was no joint effusion or soft tissue edema. He had a 5 degree extension lag, but could passively be stretched to 0 degrees. Flexion, pronation, and supination range of motion was normal. Tenderness was difficult to reproduce, but was noted along the medial epicondyle, the insertion of the ulnar collateral ligament, and the proximal flexor wad. He had a mildly positive milking maneuver. Muscle strength was normal. DIFFERENTIAL DIAGNOSIS: Ulnar collateral ligament sprain. Avulsion fracture. Medial epicondylitis. Medial epicondylar apophysitis. Olecranon bone contusion. Olecanon apophysitis. Posterior capsular pinch syndrome. Pronator teres syndrome. TESTS AND RESULTS: Xray, left elbow (July '05) - no fracture noted. Unfused olecranon process ephiphysis, all other growth plates closed. Xray, comparison right elbow (Aug '05) - unremarkable with all growth plates fused. MRI (Aug '05) - bone marrow edema adjacent to the olecranon apophysis. Xray (Sept '05) - no interval change. Xray (Oct '05) - callous formation seen in previously “open” growth plate. FINAL WORKING DIAGNOSIS: Olecranon physis stress fracture. TREATMENT AND OUTCOMES: After discussing case with an orthopedic surgeon, he was casted for 4 weeks in almost full extension. He had no clinical or radiologic improvement after 4 weeks of immobilization. Following discussion with the athlete and his parent, a trial of a bone stimulator was chosen over surgical pinning. After 4 weeks in the bone stimulator, his pain had significantly improved, his range of motion had returned to normal, and boney callous was seen on radiographs. Return to sport anticipated for spring baseball.

A 13 Year-Old Football Player with Recurrent Low Back Pain

HISTORY This subject is a 13-year-old middle school athlete who began to experience LBP while playing football in September 2005. He had played over 55 baseball games this last summer without incidence. He didn't attribute the LBP to any particular event, although he was 'sore' in his back snowboarding last winter. PHYSICAL EXAMINATION (9/26/05) PATIENT DESCRIPTION OF PAIN AND SYMPTOMS: He was having LBP and wrap around pain into the right upper thigh with running, jumping and any extension activity or lifting. He was comfortable at the time of our evaluation. Oswestry score was 20%. TESTS AND MEASUREMENTS (impairments) He has pes planus and he wears Nike shoes with coil heels that appear to have increased heel height. Active lumbar ranges of motion were grossly ½ to ¾ of normal with limitation of flexion (to ankles) with hamstring tightness. He was initially more painful in flexion, but also reported discomfort in extension. Testing of 2 legged standing extension was equally painful with 1 legged extension. Deep tendon reflexes were deferred. Manual muscle testing of his lower quarter was grossly WNL for myotomes. Trunk endurance times (without the brace): Flexion=127 secs., Extension deferred. Tension testing: His straight leg raises (SLRs) were limited at 50–55 o, with no LBP. DIFFERENTIAL DIAGNOSIS Spondylolysis Discogenic pain Lumbar paraspinal muscle strain Lumbar ligament sprain TESTS AND RESULTS Radiographs demonstrated a unilateral pars articularis fracture at L5 & disc height at L5-S1. MRI was positive for bilateral pars fractures of the L5. FINAL WORKING DIAGNOSIS diagnosis: bilateral spondylolysis. Treatment-based classification: Stabilization Treatment & Outcomes Restriction of sports activity for the Fall 2005. He was placed in a body brace for 6 weeks. Discussion with parents pros & cons of brace. Initiation of stabilization training. Rx # 1. (9/22/05) He was instructed in low level stabilization exercises in his brace and hamstring stretches. Orthotics. Rx # 2. (10/3/05) Active lumbar ROM are ½ of normal with more pain in extension. Progression of ball stability exercises. Rx #3. No complaints of LBP. Progression of ball exercises with increased intensity. Rx # 4 (10/20/05) He reports flattening his back (i.e. flexion) increased his LBP, as with riding a mountain bike with jarring. Rx: stabilization exercise, brace on with dumbbell lifting, weight bearing and non-weightbearing (ball). Oswestry score was 12% at Rx #4. Trunk endurance times (without the brace): Flexion= 148 secs, Extension=137 secs.

Vertical Medial Malleolar Fracture in a Collegiate Soccer Player With Tibia Varus

HISTORY: 18 yo male collegiate soccer player with history of nondisplaced, isolated, vertical medial malleolar fracture treated conservatively with short leg nonweightbearing cast for 3 weeks followed by walking boot for 3 more weeks. 6 week radiographs showed interval healing and no change in alignment, and he returned to full activity after achieving full range of motion with physical therapy. He was asymptomatic until 7 months after initial injury when during a soccer game he felt a pop and developed medial ankle pain after landing flat on his previously injured ankle. He presented to our clinic for evaluation. PHYSICAL EXAMINATION: Mild swelling without ecchymosis over medial ankle. Small joint effusion palpable. Medial pain with attemped weight bearing. Tender to palpation 3cm above medial malleolus. No fibular or syndesmotic tenderness. Mildly tender over deltoid and posterior tibial tendon. Nontender over lateral ligaments. Negative lower extremity squeeze test. Normal Thompson's test. No pain with calcaneal squeeze or palpation over navicular, cuboid, or fifth metatarsal base. Normal neurovascular exam distally in his foot. Tibia varus alignment. DIFFERENTIAL DIAGNOSIS: Medial malleolar fracture Deltoid ligament sprain Avulsion fracture medial malleolus Posterior tibial tendon strain or subluxation Syndesmotic sprain Talar dome fracture. TEST AND RESULTS: Radiographs of ankle showed no displacement but increased lucency through callous formation from previous fracture. No widening of ankle mortise. No talar dome lesions. No other fractures. FINAL WORKING DIAGNOSIS: Nondisplaced fracture through previous fibrous union of vertical medial malleolar fracture. TREATMENT AND OUTCOMES: Patient underwent operative plate fixation with bone grafting of medial malleolar fracture. Current literature supports conservative management for isolated, nondisplaced, medial malleolar fractures (Richter, Orthopade 1999;28(6), Thordarson, Physician and Sportsmedicine 1996;24(9)). This case is very similar to that of a well known professional basketball player who underwent 4 surgeries and missed most of two seasons for a similar fracture. In these cases, it is hypothesized that the tibia varus alignment contributed to the vertical orientation of the fracture, incomplete healing, and subsequent reinjury. Anatomic alignment should be considered in management decisions for vertical medial malleolar fractures. Patients with tibia varus alignment may have a higher rate of complications and may need longer immobilization or initial operative fixation for these types of fractures.

Incidence of sports injuries in elite competitive and recreational windsurfers

Objective: To investigate the incidence of injury in windsurfing and to consider methods of prevention. Methods: A total of 107 raceboard (RB) and wave/slalom (WS) national/international competitors and recreational (REC)...

Practical Management: Nonsteroidal Antiinflammatory Drug (NSAID) Use in Athletic Injuries

Nonsteroidal antiinflammatory drugs (NSAIDs) are frequently used in the treatment of acute athletic injuries, often for analgesic purposes as the evidence to support enhanced healing is limited. However, the current evidence on NSAID use in athletic injury is slowly growing. On the basis of animal models and limited human studies, some practical management guidelines can be drawn to assist the sports physician. Specifically, NSAIDs are not recommended in the treatment of completed fractures, stress fractures at higher risk of nonunion, or in the setting of chronic muscle injury. The only exception may be very short-term use (eg, a few days) for analgesic purposes only. Judicious use of NSAIDs may be more appropriate in the management of acute ligament sprains, muscle strains, tendinitis, and eccentric muscle injury. However, length of treatment should always be kept as short as possible, with consideration of the specific type of injury, level of dysfunction, and pain.

Quantifying the functional rehabilitation of injured football players

Objective: To determine whether quantified, auditable records of functional rehabilitation can be generated using subjective assessments of players’ performance in fitness tests routinely used in professional football. Method: Ten sequential...

First-Time Inversion Ankle Ligament Trauma

Background Inversion ankle trauma is disabling, yet little is known regarding the incidence rate of first-time ankle sprains and how it is influenced by factors including sex, level of competition, and sport. Hypothesis The incidence rates of first-time ankle ligament sprains are influenced by sex, level of competition (high school vs college), and type of sports participation (basketball, soccer, lacrosse, and field hockey). Study Design Cohort study; Level of evidence, 2. Methods Between 1999 and 2003, high school and college athletes were evaluated before participation in their sports. Subjects were included in the study if they had not experienced a prior ankle or lower extremity injury and were then followed during participation in soccer, basketball, lacrosse, or field hockey to document their days of exposure to sport and injuries sustained. The relative risk associated with sex, level of competition, and sport was estimated by Cox regression. Results A total of 901 athletes had 50 680 person-days of exposure to sports, and 43 (4.8%) had an inversion injury that produced an ankle ligament sprain. Overall, the injury incidence rate was 0.85 sprains per 1000 person-days of exposure to sport. There were 0.68 and 0.97 ankle sprains per 1000 person-days of exposure to sport for the men and women, respectively. Although the risk of suffering an ankle sprain was higher for women than for men (relative risk, 1.51), the difference was not statistically significant (P=. 21) and was owing to the increased risk in female basketball athletes compared to male basketball athletes (relative risk, 4.11; P=. 045). Risk of injury was similar for the high school athletes in comparison to the college athletes (relative risk, 1.16). For the men, there was no difference in the risk of suffering an ankle sprain between the sports of basketball, soccer, and lacrosse, whereas for the women, the risk of suffering an ankle sprain was significantly greater during participation in basketball compared to lacrosse. Conclusion In this study of first-time ankle sprains, for most sports, the incidence rate of inversion injury is less than 1 per 1000 days of exposure to sport, a value lower than previously reported. Among female athletes, ankle injury is associated with type of sport. Risk is highest for female basketball athletes, who are at significantly greater risk than male basketball athletes and female lacrosse athletes. The risk of first-time ankle injury is similar for high school and college-level athletes.

Score-Celebration Injuries among Soccer Players

Background Professional and amateur soccer players often perform dramatic on-field feats of celebration after scoring a goal. Injuries may occur during these activities. Purpose With the aim of preventing such “score-celebration injuries” in the future, the authors examine these events in professional soccer players and discuss potential avenues for prevention. Study Design Case series; Level of evidence, 4. Methods Over the course of 2 seasons (1996-1998), 152 soccer players were evaluated at an orthopaedic clinic for injuries incurred during matches. Nine players (6%) had injured themselves while celebrating after scoring goals in a match. The type of celebration, injury type, treatment, and mean duration of recovery were noted. Results Seven of the 9 patients were male professional soccer players with ages ranging between 17 and 29 years (mean age, 24 years). The injuries occurred when the playing ground was natural turf in 8 cases; most injuries occurred in the second half of the game. The types of celebration maneuvers were sliding (prone or supine) and sliding while kneeling in 5 cases, piling up on jubilant teammates in 3 cases, and being tackled while racing away in 1 case. Injuries included ankle, clavicle, and rib fractures; medial collateral ligament sprain; low back strain; hamstring and adductor muscle strain; quadriceps muscle sprain; and coccyx contusion. The mean duration for recovery was 6.2 weeks. Rival team players were usually not responsible for such trauma. Conclusion Exaggerated celebrations after making a goal, such as sliding, piling up, and tackling a teammate when racing away, can result in serious injury. In addition to general measures for preventing soccer injuries, coaches and team physicians should teach self-control and behavior modification to minimize the risk of such injuries. More restrictive rules, which penalize such behavior, may assist in the prevention of score-celebration injuries.

Ultrasound therapy in the management of acute lateral ligament sprains of the ankle joint

Objectives To determine the efficacy of ultrasound treatment in the management of acute lateral ligament sprains of the ankle joint. Design Single-blind randomized controlled trial. Setting Physiotherapy Department of St Luke's Hospital, Malta. Participants Thirty-four patients with acute lateral ligament sprains of the ankle joint presenting to the Accident and Emergency Department of St Luke's Hospital, Malta were randomly assigned to one of three treatment groups: active ultrasound treatment group ( n=12); placebo ultrasound treatment group ( n=10); no ultrasound treatment group ( n=12). Main outcome measures Pain (visual analogue scale), swelling (tape measure), range of motion during dorsiflexion and plantarflexion (universal 360° goniometer), and postural stability (balance error scoring system) were measured on days 1 (baseline), 8, 15 and 22. Results No statistically significant differences ( α=0.05) between treatment groups were detected in any outcome measure. Within treatment groups, statistically significant differences ( α=0.05) were detected in pain, swelling, range of motion during dorsiflexion and plantarflexion, and postural stability. Conclusions At the dose and duration used, ultrasound treatment does not increase the effectiveness of management of acute lateral ligament sprains of the ankle joint, with respect to the following outcomes: pain, swelling, range of motion during dorsiflexion and plantarflexion, and postural stability.

Ultrasound And Cryotherapy Combined Therapy To Control Delayed Onset Muscle Soreness

Muscle injuries are, after the ligament sprains, the most frequent injury of soft tissues in athletes. The study of the Delayed Onset Muscle Soreness (DOMS) from an Eccentric Exercise Protocol (EEP) has been proved as a valuable experimental model, where the muscular damage is comparable to a clinical muscular injury. The main characteristics of DOMS are soreness, muscle injury and functional impairment, where the effects of therapeutic Ultrasound (US) and cryotherapy (CRY) are normally oriented. PURPOSE To determine if the combined therapy of US and CRY, after an EEP, is able to control the DOMS. METHODS Thirty seven healthy men and women were recruited for a simple-blind, placebo-controlled trial. Parameters as difference with the baseline Pain (dVAS) with a 20 grs/mm compression, mid arm relaxed girth (dMAG), maximal isometric voluntary contraction (dMIVC), and rest elbow angle (dREA) and Total Plasma Creatine Kinase activity (CK) were measured 72 hours before, immediately after, and 24, 48, 72, 96 and 168 hours after a 80% MIVC nondominant elbow flexors eccentric-exercise protocol. Subjects were randomly assigned in one of the follow groups: Control-Control (CON-CON) without EEP and any treatment (n=8), Control-Exercise (CON-EXC) with EEP and no kind of treatment (n=10), US sham+CRY (USC-S) with EEP and placebo US treatment plus CRY (n=10) and US+CRY (USC) with EEP and US treatment plus CRY. The CRY was a 20 minutes cold pack protocol applied immediately after, 12, 24, 36, 60, 84 and 108 hours after the EEP; while the US was applied by 10 minutes, 36, 60, 84 and 108 hours after the EEP, with a 0,04–0.16 W/cm2 variable SATA. RESULTS: No statistical differences (p > 0.05) were observed for any studied parameter at the within group CON-CON analysis, confirming the statistical baseline. CK levels were lower in USC group compared to CON-EXC group at 48 hours after EEP (356.73 ± 436.93 v/s 1402.80 ± 1491.81 U/L, p < 0.05) and higher in USC-S group compared to CON-CON group at 96 and 168 hours after EEP (1801.88 ± 1316.70 v/s 185.71 ±132.78 U/L, and 1449.88 ±1038.73 v/s 131.63 ± 57.22 U/L, p < 0.05, respectively), without statistical significances between USC and CON-CON groups at any time. At the dMAG, USC-S group were lower than USC group at 24 and 48 hours after EEP (−0.08 ± 0.39 v/s 0.54 ± 0.76 cms, and 0.00 ± 0.44 v/s 0.62 ± 0.72 cms, p < 0.05, respectively). At the dREA, USC group were lower than USC-S group at 48 hours after EEP (−25.00 ± 9.79 v/s −43.38 ± 10.65, p < 0.05). CONCLUSIONS These results showed that the therapeutic US itself and combined with CRY may be considered as one answer for the treatment for acute muscle injuries, but more studies must be done to determine the exact US and CRY doses.

Severe Bilateral Foot Pain In A High School Football Player

HISTORY We present a high school football player with bilateral forefoot pain. During the first week of the season, he trained once a day without pain. There was no acute injury. He then began practicing three times a day and developed gradually worsening bilateral foot pain. The pain was initially present only with activity. However, after one week of the intense training schedule, it became constant. PHYSICAL EXAMINATION The patient was a well-built football player (200 lbs. 6 ft. 3 in.) with bilateral limping. He had normal hip and leg strength and range of motion. The arches were also normal. His feet had no swelling, edema, ecchymosis, or deformities. His right forefoot was diffusely tender to palpation and the pain was greatest along the first and third metatarsals. His left forefoot was also diffusely tender to palpation, with the greatest pain along the second metatarsal shaft. DIFFERENTIAL DIAGNOSIS Metatarsal fractures, metatarsalgia, Freiberg's infraction, myofascial strain of the interossei, sprain of the transverse ligament, extensor digitorum tendonitis, Lis Franc Ligament sprain, Morton's neuromas, or metatarsal stress fractures. TEST AND RESULTS To distinguish between the above etiologies of foot pain, MRI of the feet was performed. T2 weighted images demonstrated significantly increased signal within the shafts of the right first and third metatarsals, as well as the left second metatarsal. The remainder of the metatarsals also showed mild T2 signal abnormality. There were no fracture lines seen on either T1 or T2 images. FINAL WORKING DIAGNOSIS Grade II stress fractures of the right first and third metatarsals and left second metatarsal with diffuse stress reaction throughout both feet. TREATMENT AND OUTCOMES The patient was held from athletic participation and was weight bearing as tolerated for 3 weeks, but had little improvement. He was then given crutches for 2 weeks and his symptoms improved significantly. Dietary counseling was provided and he was educated on proper footwear and training regimens. Gait analysis is planned after the symptoms are fully resolved.

Knee Pain - Martial Arts

HISTORY A 21-year-old man initially presented to an outside orthopedic clinic complaining of 5–6 weeks of left knee pain. At the time of onset he recalls slipping and twisting his knee while playing basketball. He did not hear or feel a pop and was able to continue playing. He was initially diagnosed with a lateral collateral ligament sprain, but did not respond to conservative treatment. After three months of symptoms, he underwent an arthroscopy which revealed diffuse synovitis, which was treated with a partial synovectomy. Post-operatively, he continued to have diffuse knee pain prompting further work-up. During this time he traveled to Guatemala where his symptoms worsened. Upon follow-up in the United States, serologic and knee aspirate evaluation suggested a rheumatologic etiology, possibly consistent with a seronegative arthropathy. He was treated with NSAIDs, sulfsalazine and eventually methotrexate over a four month period without significant improvement in his symptoms. With continued lateral knee pain and intermittent swelling, he presented for further evaluation. PHYSICAL EXAMINATION He was a well developed male in no acute distress. There was no obvious rash or atrophy, though he had a mild effusion. Left knee range of motion was 0/3/130 degrees. He was diffusely tender with palpation, though mainly along the lateral joint line. There was no instability with Lachman's testing, anterior and posterior drawer testing and varus/valgus stress at 0 and 30 degrees. McMurray's test was negative. DIFFERENTIAL DIAGNOSIS Pigmented Villonodulous Synovitis Tuberculous arthritis Mycotic arthritis Monoarthritis secondary to Lyme Disease Gout/Pseudogout arthiritis TEST AND RESULTS Plain radiographs (AP, lateral and sunrise views of the knee): normal. MRI knee: Moderate effusion and chronic proliferate synovitis. Laboratory: HLA-B27, negative; RF positive; ANA with low titer of 1:40; ESR 93, CRP 4.4. CBC, chemistry, and LFT's were normal. Lyme serologies were positive. FINAL WORKING DIAGNOSIS Monoarthritis of the knee secondary to Lyme disease. TREATMENT AND OUTCOMES Doxycycline 100mg BID for 21 days. Continued home exercise program for quadriceps and hamstring strengthening. Complete resolution of pain, but some residual mild crepitus. Return to full activity by a four weeks.

American Collegiate Men's Ice Hockey

Background Reported rates and types of ice hockey injuries have been variable. Ice hockey combines tremendous speeds with aggressive physical play and therefore has great inherent potential for injury. Purpose To identify rates and determinants of injury in American men's collegiate ice hockey. Study Design Prospective cohort study. Methods Data were collected from 8 teams in a Division I athletic conference for 1 season using an injury reporting form specific for ice hockey. Results There were a total of 113 injuries in 23 096 athlete exposures. Sixty-five percent of injuries occurred during games, although games accounted for only 23% of all exposures. The overall injury rate was 4.9 per 1000 athlete exposures (13.8 per 1000 game athlete exposures and 2.2 per 1000 practice athlete exposures). Collision with an opponent (32.8%) or the boards (18.6%) caused more than half of all injuries. Concussion (18.6%) was the most common injury, followed by knee medial collateral ligament sprains, acromioclavicular joint injuries, and ankle sprains. Conclusions The risk of injury in men's collegiate ice hockey is much greater during games than during practices. Concussions are a main cause for time lost and remain an area of major concern.

Ankle joint evertor–invertor muscle torque ratio decrease due to recurrent lateral ligament sprains

Objective. To determine an ankle inversion–eversion movement range part where evertor/invertor muscles torque ratio is altered after recurrent ankle lateral ligament sprains. Design. The ankle evertor/invertor muscles torque ratios were determined in the different range parts of angular positions by the muscle isokinetic movements. Background. It is important to determine the movement range part where the evertor muscle weakness after the ankle lateral ligament sprains is more expressed and a repeated trauma of the lateral ligaments is more probable. Methods. Twenty-eight male handball players participated in the tests using an ankle isokinetic inversion–eversion movement investigation dynamometer system. Thirty-three ankle joints were uninjured, but 23 underwent recurrent lateral ligament sprains. Results. The ankle evertor/invertor muscles torque ratio for the sprained ankles was significantly lower in comparison with the uninjured joints in inversion positions at 50° and 60° of the range of movements in all applied velocities, except the slowest movement (30°/s). Conclusions. The recurrent ankle lateral ligament sprains reduced the evertor/invertor muscles torque ratio in the inversion positions of the range of movements and therefore the evertor muscle weakness was more expressed in the beginning of the eversion movement. Relevance An isokinetic dynamometry allows determining the ankle evertor/invertor muscles torque ratio alteration in the different positions of the range of movements and detecting the sprained ankle evertor muscle movement range risky parts. As a result one could elaborate special training programs for the evertor muscles rehabilitation.

Knee Injury - Soccer

0627 HISTORY: 18 year old male freshman collegiate soccer player sustained a left knee injury during a game. The mechanism of injury was felt to be a hyperextension of the knee with a varus load. He continued to play in the game. He noted worsening pain throughout the next day and was seen in the training room. He complained of a giving out sensation in extension. He denied any locking or clicking. PHYSICAL EXAMINATION: Initial examination revealed no effusion, full active range of motion, no laxity to varus or valgus testing at 0 or 30 degrees, normal anterior drawer at 90, apparent increased anterior translation with a firm end point at 30 degrees, positive posterior drawer at 30 degrees, negative posterior drawer at 90 degrees, positive posterolateral joint line tenderness, negative McMurray's, positive recurvatum when toes are elevated off the table, positive recurvatum when standing, no tenderness over the fibular head, no tenderness over the femoral condyles or tibial plateau, and normal neurovascular exam. DIFFERENTIAL DIAGNOSIS: Posterior cruciate ligament injury Lateral meniscus injury Lateral collateral ligament sprain Hamstring strain Posterior lateral corner injury Anterior cruciate ligament injury Bone contusion TEST AND RESULTS: None Indicated FINAL/WORKING DIAGNOSIS: Isolated posterolateral corner injury TREATMENT AND OUTCOMES: Allowed to return to play as tolerated by pain Offered knee brace versus hyperextension taping and he elected to use taping as this felt more comfortable and allowed him a closer to normal activity level. His pain was tolerable for the remainder of the soccer season and he did not miss any games because of this injury.

Musculoskeletal-Chronic Left Knee Pain in a High School Athlete Competing in Football and Basketball

0109 HISTORY: A 15 year-old high school basketball and football player presents with complaint of intermittent left knee pain for 3 months. One week prior to presentation, the athlete notes that while running and cutting in football practice he “felt something pop in his left knee during contact drills.” After this episode, the patient describes acute swelling over his left knee, occasional “locking” of the knee, and has had to reduce his activities to non-contact drills due to the increased pain with his left knee. The pain presently is located over “the front, inside part of my knee.” Denies any 'giving out' of the knee when ambulating, and has no difficulty ascending or descending stairs. PHYSICAL EXAM: On examination, atrophy of the left thigh over vastus medialis (left thigh girth 2 cm smaller in diameter). Tenderness over medial femoral condyle and anteromedial aspect of knee. Small joint effusion was noted over the left knee. Normal range of motion, no other areas of point tenderness over patella, patellar tendon, or tibial tubercle, and normal patellar tracking with negative apprehension test. No point tenderness over medial or lateral joint lines. Negative Lachman's, posterior drawer, valgus and varus stress testing. Negative McMurray's test. Wilson's test negative. Tanner stage 4. DIFFERENTIAL DIAGNOSIS: Osteochondritis Dissecans of the Knee Stress Fracture of the Knee Medial Meniscal injury Medial Collateral Ligament Sprain Patellar subluxation Tibial Plateau fracture Idiopathic Anterior Knee pain (patellofemoral knee syndrome) TESTS AND RESULTS: Left Knee plain radiographs – Partial loose body defect of lateral part of medial femoral. FINAL/WORKING DIAGNOSIS: Osteochondritis Dissecans of the Left Knee TREATMENT AND OUTCOMES: Restriction of all athletic competition and placed on non-weight bearing status via crutches. Two fragments were fixed into position using Acutrak screws followed by chondroplasty. Athlete was placed into immobilizing brace and advised to follow up on a monthly basis to determine weight bearing status via physical examination and follow up radiographs. Follow up radiographs from his first visit showed good approximation of osteochondral body in situ by Acutrak screws. Due to the osteochondral body in situ, patient will likely be non-weight bearing for 8–12 weeks with avoidance of pivoting. For the first 4 weeks, the patient was advised to start range-of-motion exercises with extension and flexion only. Following this, he will start quadriceps strengthening and rehabilitation of left knee. The athlete will likely return to sports in 3–4 months from surgery with graded progression of activity.

Musculoskeletal-Chronic Left Knee Pain in a High School Athlete Competing in Football and Basketball

0109 HISTORY: A 15 year-old high school basketball and football player presents with complaint of intermittent left knee pain for 3 months. One week prior to presentation, the athlete notes that while running and cutting in football practice he “felt something pop in his left knee during contact drills.” After this episode, the patient describes acute swelling over his left knee, occasional “locking” of the knee, and has had to reduce his activities to non-contact drills due to the increased pain with his left knee. The pain presently is located over “the front, inside part of my knee.” Denies any 'giving out' of the knee when ambulating, and has no difficulty ascending or descending stairs. PHYSICAL EXAM: On examination, atrophy of the left thigh over vastus medialis (left thigh girth 2 cm smaller in diameter). Tenderness over medial femoral condyle and anteromedial aspect of knee. Small joint effusion was noted over the left knee. Normal range of motion, no other areas of point tenderness over patella, patellar tendon, or tibial tubercle, and normal patellar tracking with negative apprehension test. No point tenderness over medial or lateral joint lines. Negative Lachman's, posterior drawer, valgus and varus stress testing. Negative McMurray's test. Wilson's test negative. Tanner stage 4. DIFFERENTIAL DIAGNOSIS: Osteochondritis Dissecans of the Knee Stress Fracture of the Knee Medial Meniscal injury Medial Collateral Ligament Sprain Patellar subluxation Tibial Plateau fracture Idiopathic Anterior Knee pain (patellofemoral knee syndrome) TESTS AND RESULTS: Left Knee plain radiographs – Partial loose body defect of lateral part of medial femoral. FINAL/WORKING DIAGNOSIS: Osteochondritis Dissecans of the Left Knee TREATMENT AND OUTCOMES: Restriction of all athletic competition and placed on non-weight bearing status via crutches. Two fragments were fixed into position using Acutrak screws followed by chondroplasty. Athlete was placed into immobilizing brace and advised to follow up on a monthly basis to determine weight bearing status via physical examination and follow up radiographs. Follow up radiographs from his first visit showed good approximation of osteochondral body in situ by Acutrak screws. Due to the osteochondral body in situ, patient will likely be non-weight bearing for 8–12 weeks with avoidance of pivoting. For the first 4 weeks, the patient was advised to start range-of-motion exercises with extension and flexion only. Following this, he will start quadriceps strengthening and rehabilitation of left knee. The athlete will likely return to sports in 3–4 months from surgery with graded progression of activity.