Previous Level Of Activity Research Articles

Anterior Cruciate Ligament Tears in Children and Adolescents

Background: Debate regarding the optimal initial treatment for anterior cruciate ligament (ACL) injuries in children and adolescents has not resulted in a clear consensus for initial nonoperative treatment or operative reconstruction. Hypothesis/Purpose: The purpose of this meta-analysis was to systematically analyze aggregated data from the literature to determine if a benefit exists for either nonoperative or early operative treatment for ACL injuries in the pediatric patient. The hypothesis was that combined results would favor early operative reconstruction with respect to posttreatment episodes of instability/pathological laxity, symptomatic meniscal tears, clinical outcome scores, and return to activity. Study Design: Meta-analysis. Methods: A literature selection process included the extraction of data on the following clinical variables: symptomatic meniscal tears, return to activities, clinical outcome scores, return to the operating room, and posttreatment instability/pathological laxity. A symptomatic meniscal tear was defined as occurring after the initial presentation, limiting activity, and requiring further treatment. Instability/pathological laxity was defined for the sake of this study as having an episode of giving way, a grade ≥2 Lachman/pivot-shift test result, or a side-to-side difference of >4 mm as measured by the KT-1000 arthrometer. All studies were evaluated using a formal study quality analysis. Meta-analysis was conducted for aggregated data in each category. Results: Six studies (217 patients) comparing operative to nonoperative treatment and 5 studies (353 patients) comparing early to delayed reconstruction were identified. Three studies reported posttreatment instability/pathological laxity; 13.6% of patients after operative treatment experienced instability/pathological laxity compared with 75% of patients after nonoperative treatment (P < .01). Two studies reported symptomatic meniscal tears; patients were over 12 times more likely to have a medial meniscal tear after nonoperative treatment than after operative treatment (35.4% vs 3.9%, respectively; P = .02). A significant difference in scores between groups was noted in 1 of 2 studies reporting International Knee Documentation Committee (IKDC) scores (P = .002) and in 1 of 2 studies reporting Tegner scores (P = .007). Two studies reported return to activity; none of the patients in the nonoperative groups returned to their previous level of play compared with 85.7% of patients in the operative groups (P < .01). Study quality analysis revealed that the majority of the studies were inconsistent in reporting outcomes. Conclusion: Meta-analysis revealed multiple trends that favor early surgical stabilization over nonoperative or delayed treatment. Patients after nonoperative and delayed treatment experienced more instability/pathological laxity and inability to return to previous activity levels than did patients treated with early surgical stabilization.

Factors Associated With Recurrent Fifth Metatarsal Stress Fracture

Many surgeons agree that fifth metatarsal stress fractures have a tendency toward delayed union, nonunion, and possibly refracture. Difficulty healing seems to be correlated with fracture classification. However, refracture sometimes occurs after low-grade fracture, even long after apparent resolution. The records of 168 consecutive cases of fifth metatarsal stress fracture (163 patients) treated by modified tension band wiring from March 2002 to June 2011 were evaluated retrospectively. Mean length of follow-up was 23.6 months (range, 10-112 months). Forty-nine cases classified as Torg III were bone grafted initially also. All enrolled patients were elite athletes. Eleven patients experienced nonunion and 18 refracture. The 11 nonunion cases were bone grafted. The 157 patients (excluding nonunion cases) were allocated to either a refracture group or a union group. Clinical features, such as age, weight, fracture classification, time to union, and reinjury history, were compared. Radiological parameters representing cavus deformity and fifth metatarsal head protrusion were compared to evaluate the influence of structural abnormalities. Mean group weights were significantly different (P = .041), but mean ages (P = .879), fracture grades (P = .216, P = .962), and time from surgery to rehabilitation (P = .539) were similar. No significant intergroup differences were found for talocalcaneal (TC) angle (P = .470), calcaneal pitch (CP) angle (P = .847), or talo-first metatarsal (T-MT1) angle (P = .407) on lateral radiographs; for fifth metatarsal lateral deviation (MT5-LD) angle (P = .623) on anteroposterior (AP) radiographs; or for MT5-LD angle (P = .065) on the 30-degree medial oblique radiographs. However, the mean fourth-fifth intermetatarsal (IMA4-5) angle on AP radiographs was significantly greater in the refracture group, and for Torg II cases, mean weight (P = .042), IMA4-5 angle on AP radiographs (P = .014), and MT5-LD angle (P = .043) on 30-degree medial oblique radiographs were significantly greater in the refracture group. For B2 cases (incomplete fracture and a plantar gap of 1 mm or larger), mean weight (P = .046), IMA4-5 angle on AP radiographs (P = .019), and MT5-LD angle (P = .045) on 30-degree medial oblique radiographs were significantly greater in the refracture group. All cases of refracture had a traumatic history after bone union. Refracture developed within 6 months of starting rehabilitation in 13 cases and within 3 months in 8 cases. The development of refracture after the surgical treatment of fifth metatarsal stress fractures was found to be associated with higher body mass index (BMI) and with radiological parameters (IMA4-5 on AP radiographs, MT5-LD on oblique radiographs) associated with protrusion of the fifth metatarsal head. The study indicates that patients with a protruding fifth metatarsal head and a high BMI should approach rehabilitation with care before considering a return to previous sporting activity levels. Level III, retrospective comparative series.

A new instrument to measure the activity profile of elderly shoulder pathology patients: The Senior Shoulder Activity score (SSA score)

Whether rotator cuff repair is indicated in an elderly subject depends on the patient's activity profile and functional demand. A Senior Shoulder Activity (SSA) score is described, as a support for indications and analysis of clinical results according to activity level. The SSA score, comprising 4 levels from "sedentary" to "very active", was validated by comparison against a control group of 113 asymptomatic patients. It was included in the protocol of the French Arthroscopy Society's comparative study of repair versus simple decompression in 143 rotator cuff tears. Recovery of activity was assessed according to procedure. At 1-year follow-up, suturing was associated with recovery of previous activity level in 87% of the cases and in 80% for decompression, a non-significant difference. When, however, less active patients (SSA 1 and 2) were contrasted with the more active (SSA 3 and 4), clinical results with suture versus decompression on Constant score showed a greater difference in the SSA 3-4 group. The SSA score is not the same as the activity item of the Constant score, as it assesses the patient's usual activity level, before symptom onset, whereas the Constant item assesses activity at a given moment, independently of the patient's normal activity profile. The Senior Shoulder Activity score is a simple, reproducible complement to the Constant score, revealing differences in clinical results on the latter, according to activity profile. Rotator cuff repair or simple decompression provided recovery of previous SSA activity level in more than 80% of the cases. The difference in clinical results between the two was significantly greater in more active patients. It would seem to follow that suture is more beneficial for more active subjects while simple decompression may be suitable for those with lower functional demand.

Laparoscopic removal of a bladder urolith in a standing horse

An 11-year-old Arabian gelding was evaluated for hematuria, stranguria, and pollakiuria that had been observed for 1 week. Transrectal palpation revealed a 5-cm firm round mass in the urinary bladder. Cystoscopy and transrectal ultrasonography confirmed the diagnosis of urinary bladder urolithiasis. A multiportal transparalumbar fossa laparoscopic approach was selected for cystotomy and urolith removal. Cystotomy and urolith removal was performed with sedation and local anesthesia with the horse standing. No perioperative complications were observed. Urination returned to normal 5 days after surgery. The horse returned to its previous level of activity at 3 weeks after surgery. Findings suggested that minimally invasive transparalumbar fossa laparoscopic approach can be successfully used for cystotomy and urolith extraction in standing horses; this avoids the disadvantages of conventional laparocystotomy for removal of large uroliths in male equids and the potential complications of general anesthesia and recovery. The technique provided excellent viewing and access to the bladder, permitting extraction of the urolith and secure closure of the cystotomy with minimal tension and tissue trauma to the bladder.

Arthroscopic treatment of osteochondral lesion of olecranon

Osteochondral lesions (OCLs) are rarely seen in the elbow joint. These lesions are most commonly seen in the capitellum and radial head [5]. Although their exact mechanism is not very well understood, repetitive microtrauma and ischaemia are accepted as the two main aetiological factors [1, 5]. The term ‘‘osteochondral lesion’’ was used in this text, because it seems recently to cover all the definitions used for osteochondral abnormalities. Generally, the treatment aims for the pain relief and the return of the patient to the previous level of activities. Conservative follow-up and different surgical methods are possible for the treatment. The surgical treatment options include arthroscopic debridement, drilling, fragment excision or fixation, and osteochondral autografting. Among surgical modalities, arthroscopic excision of the fragments and subchondral abrasion or drilling of the lesion resulted in satisfactory short-term clinical outcomes [1, 2]. Case report

Superficial digital flexor tendonitis in cutting horses: 19 cases (2007–2011)

To characterize superficial digital flexor (SDF) tendon lesions in the forelimbs of cutting horses and determine recurrence rate and prognosis for this condition. Retrospective case series. 19 cutting horses with SDF tendonitis. Medical records for horses evaluated for SDF tendonitis in 2007 through 2011 were reviewed. Data regarding age, sex, lameness grade, affected limb, and treatment were collected. Ultrasonographic images were reviewed, and lesion characteristics were recorded. Follow-up telephone interviews with owners or trainers were conducted to determine recurrence of SDF tendonitis, return of horse to its previous level of activity, and duration of the convalescent period. All 19 horses initially evaluated for SDF tendonitis had similar lesions in the lateral aspect of the tendon. The right forelimb was affected in 11 horses, and the left forelimb was affected in 7 horses; 1 horse was affected in both forelimbs. Mean lameness grade was 1.26 (range, 0 to 3). Of 17 horses for which follow-up information was available, 3 had recurrence of tendon lesions and 1 developed a lesion in the contralateral forelimb SDF tendon; 16 horses returned to their previous level of activity. The location of SDF tendonitis in cutting horses appeared to be unique in that no central core lesions were detected ultrasonographically. Lesions at the periphery of the tendon may have an increased ability to heal, compared with lesions at the central core. Results suggested that cutting horses with SDF tendonitis have a better prognosis than that reported for affected racehorses.

Neuromuscular Training to Target Deficits Associated With Second Anterior Cruciate Ligament Injury

Successful return to previous level of activity following anterior cruciate ligament (ACL) reconstruction is not guaranteed, and the prevalence of second ACL injury may be as high as 30%. In particular, younger athletes who return to sports activities within the first several months after ACL reconstruction may be at significantly greater risk of a second ACL rupture compared to older, less active individuals. Significant neuromuscular deficits and functional limitations are commonly identified in athletes following ACL reconstruction, and these abnormal movement and neuromuscular control profiles may be both residual of deficits existing prior to the initial injury and exacerbated by the injury and subsequent ACL reconstruction surgery. Following ACL reconstruction, neuromuscular deficits are present in both the surgical and nonsurgical limbs, and accurately predict second-ACL injury risk in adolescent athletes. While second ACL injury in highly active individuals may be predicated on a number of modifiable and nonmodifiable factors, clinicians have the greatest potential to address the modifiable postsurgical risk factors through targeted neuromuscular interventions. This manuscript will (1) summarize the neuromuscular deficits commonly identified at medical discharge to return to sport, (2) provide the evidence underlying second-ACL injury risk factors, (3) propose a method to assess the modifiable deficits related to second-ACL injury risk, and (4) outline a method of intervention to prevent second ACL injury. The program described in this clinical commentary was developed with consideration for the modifiable factors related to second-injury risk, the principles of motor learning, and careful selection of the exercises that may most effectively modify aberrant neuromuscular patterns. Future validation of this evidence-based, late-phase rehabilitation program may be a critical factor in maximizing return-to-activity success and reduction of second-injury risk in highly active individuals. Therapy, level 5.

Promising Short-Term Results Following Selective Bundle Reconstruction In Partial Anterior Cruciate Ligament Tears

Promising Short-Term Results Following Selective Bundle Reconstruction In Partial Anterior Cruciate Ligament Tears

Functional performance tests as indicators of returning to sports after anterior cruciate ligament reconstruction

BackgroundThere is a lack of standardized objective criteria to accurately assess the ability of a patient to progress through the end stages of rehabilitation and safely return to their previous level of athletic activity after anterior cruciate ligament (ACL) reconstruction. PurposeTo determine objective factors involved in returning to sports following ACL reconstruction. MethodsBased on our inclusion criteria of a minimum 2-year follow-up, pre-injury sports activity level of Tegner 5 or greater, we retrospectively evaluated 67 patients who underwent ACL reconstruction. The patients were divided into “return-to-sports” (n=51) and “non-return” groups (n=16) by surveying participants using a questionnaire. Comparisons between the two groups were made using pre-operative and post-operative International Knee Documentation Committee questionnaires (IKDC), Lysholm score, and KT-2000 arthrometer. Flexor and extensor muscle strength, and functional performance tests (one-leg-hop test, co-contraction, shuttle run, and carioca tests) were used for assessment. ResultsOverall clinical results, including IKDC score, Lysholm score, and KT-2000 arthrometer, improved in all patients post-operatively and no significant difference was seen between the two groups (P>0.05). Although there was no significant difference in flexor or extensor deficits, one-leg-hop test, or shuttle run test, “return-to-sports” group obtained significantly better scores in the co-contraction and carioca tests (P<0.05). ConclusionsTests that assess rotational stability showed statistically significant differences between the two groups. Further prospective studies with larger cohort are needed to determine the factors associated with returning to sports after ACL reconstruction. Level of evidenceRetrospective comparative study, Level III.

Influence of knee flexion and atraumatic mobilisation of infrapatellar fat pad on incidence and severity of anterior knee pain after tibial nailing

We evaluated the incidence and aetiology of anterior knee pain (AKP) in a series of patients that underwent intramedullary nailing for stabilisation of tibial fractures. During the preparation of the entry site no excision of the infrapatellar fat was allowed and electrical haemostasis was kept at the lowest level. Medullary canal was reamed and the nails inserted in position of knee flexion over 100 degrees. All fractures were fixed using medial paratendinous approach. Functional outcome was measured using Lysholm knee score. The knee range of movement and return to previous level of activity were also documented and analysed. Mean follow up was 38.9 months (range 12-84 months). In total 60 patients with 62 tibial shaft fractures were analysed. The mean age at the time of final follow up was 49.4 years (range 20-87). In 22 (35.5%) a newly developed and persisting pain in the anterior region of the operated knee was reported. According to VAP scale, the pain was mild (VAS 1-3) in 12 cases (19.4%) and moderate (VAS 4-6) in 10 (16.1%). In 16 cases (73%) the pain was noticed 6-12 months after injury and subjectively related to return to full range of working and recreational activities. The mean Lysholm knee score in the group without AKP was 90.8. In the AKP group with mild pain it was 88.4 and in the group with moderate AKP it was 79.9. Complete return to previous professional and recreational activities occurred in 49/60 patients (81.7%). Content with the treatment regarding expectations in recovery dynamics and return to desired level of activity was present in 98.3% of patients; one patient was unsatisfied with the treatment.Our results indicate that respecting the physiological motion of Hoffa pad and menisci during knee flexion, accompanied with atraumatic mobilisation of retrotendinous fat, reduces incidence and severity of anterior knee pain following intramedullary fixation of tibial shaft fractures.

Papineau debridement, Ilizarov bone transport, and negative-pressure wound closure for septic bone defects of the tibia

Ilizarov pioneered bone transport using a circular external fixator. Papineau described a staged technique for the treatment for infected pseudarthrosis of the long bones. This article presents a single-stage Papineau technique and Ilizarov bone transport, and postoperative negative-pressure wound dressing changes for septic bone defects of the tibia. We studied the files of seven patients (mean age, 32 years) with septic bone defects of the tibia treated with a Papineau technique and Ilizarov bone transport in a single stage, followed by postoperative negative-pressure wound dressing changes. All patients had septic pseudarthrosis and skin necrosis of the tibia. The technique included a single-stage extensive surgical debridement of necrotic bone, open bone grafting with cancellous bone autograft and bone transport, and postoperative negative-pressure wound dressing changes for wound closure. The mean time from the initial injury was 6 months (range, 4-8 months). The mean follow-up was 14 months (range, 10-17 months). All patients experienced successful wound healing at a mean of 29 days. Six patients experienced successful bone regeneration and union at the docking side at a mean of 6 months. One patient experienced delayed union at the docking site, which was treated with autologous cancellous bone grafting. Two patients experienced pin track infection, which was successfully treated with antibiotics and pin site dressing changes. All patients were able to return to their work and previous levels of activity, except one patient who had a stiff ankle joint and had to change his job. No patient experienced recurrence of infection, or fracture of the regenerated or transported bone segment until the period of this study. The combined Papineau and Ilizarov bone transport technique with negative-pressure wound closure provides for successful eradication of the infection, reconstruction of the bone defect, and soft-tissue closure. A single-stage surgical treatment is feasible, without any complications.

Deep digital flexor tendon injury within the hoof capsule; does lesion type or location predict prognosis?

The type and location of deep digital flexor tendon (DDFT) lesions may be important in predicting outcome. The objectives of this study were to determine the frequency of different types of DDFT lesions within the hoof capsule and to determine whether lesion type predicts return to athletic activity. Lesions of the DDFT were divided into: core lesions, dorsal border lesions and parasagittal splits. Lesion location was documented, and follow-up information was obtained by telephone survey at least 18 months after diagnosis. Of 168 horses with primary DDFT injury, 54 horses had dorsal border lesions, 59 had parasagittal splits and 55had core lesions. Twenty-five per cent of all horses returned to previous levels of athletic activity within 18 months of MRI evaluation. Horses with complete splits or core lesions of the DDFT were significantly less likely to return to some level of athletic activity than horses with dorsal border lesions P<0.001. Dorsal border lesions of the DDFT appear to have a better prognosis than core lesions or parasagittal splits. This study provides additional information that may help clinicians predict the prognosis for different types of DDFT injury.

‘It’s all about modifying your expectations’: women’s experiences with physical activity during pregnancy

The purpose of this study was to qualitatively examine women’s experiences with physical activity throughout the course of pregnancy. Nine pregnant women participated in two semi-structured interviews (total of 18 interviews) – between one and five months apart. The data were analysed using interpretative phenomenological analysis. Results revealed that participants felt the need to ‘slow down’ from their previous physical activity levels due to physical changes brought on by pregnancy such as fatigue, nausea and/or vomiting and injury potential. The women negotiated underlying tensions associated with the experience of being physically active while pregnant by changing their activities and also by changing their activity-related attitudes as pregnancy progressed. Despite these changes, activity remained important for the women as they persisted with physical activity throughout the course of pregnancy to maintain physical fitness, their health and the health of the baby, to socialise and to relieve stress. These behaviours were partially supported by the participants’ partners, family and friends; however, the women did not perceive this partial support to be constraining and sought out prenatal exercise classes to create a social network with other expecting mothers. Findings highlight the importance of considering women’s experiences when devising health-promotion interventions focused on increasing and improving women’s physical activity behaviours during pregnancy. Participants were heterosexual, highly educated, predominantly white and English speaking; thus, future studies should examine the experience of physical activity during pregnancy in more diverse populations.

Gait Asymmetries Persist 1 Year After Anterior Cruciate Ligament Reconstruction.

Background:After anterior cruciate ligament reconstruction (ACLR), motivation to return to previous levels of activity is high. Very few studies have used return-to-activity criteria to determine when to permit athletic play. Return-to-activity measures objectively evaluate functional limb symmetry; however, previous biomechanical studies have found gait deviations in these individuals that persist up to 2 years after surgery.Purpose:To evaluate gait biomechanics in a specific cohort of ACL patients 1 year after surgery and retrospectively compare individuals who pass return-to-activity criteria 6 months after surgery with those who fail.Study Design:Prospective analysis.Methods:A total of 40 athletes who participated regularly (>50 h/y) in cutting, jumping, and pivoting activities and who sustained an isolated, unilateral ACL rupture were included in this study. All participants underwent reconstruction by the same surgeon and received individualized postoperative rehabilitation. Performance-based and self-report data were measured 6 months after surgery to assess readiness to return to activity (90% outcome required to pass); 20 subjects passed return-to-activity criteria and 20 subjects did not. Motion analysis was performed 1 year after surgery, and knee flexion angles, moments, and excursions were measured during gait and evaluated for all subjects.Results:There was no limb × group interaction or effect of group for all measures. Decreased knee measures were seen on the involved limb compared with the uninvolved limb for all subjects, and failed subjects demonstrated larger differences between limbs.Conclusion:Patients continued to demonstrate biomechanical limb asymmetries 1 year after ACLR, regardless of performance-based measures at 6 months. Early return to activity did not ensure limb symmetry at 1 year.Clinical Relevance:Gait asymmetries were seen in all subjects 1 year after surgery regardless of status at 6 months. Potentially prolonging athlete’s timelines for returning to activity may prove beneficial for a successful return to activity as well as for long-term knee function.

Long-Term Gait Deviations in Anterior Cruciate Ligament–Reconstructed Females

Little is known of the potential long-term gait alterations that occur after an anterior cruciate ligament (ACL) reconstruction. In particular, variables, such as impact loading, which have been previously associated with joint deterioration, have not been studied in walking and running after an ACL reconstruction. The purpose of this study was to define the alterations in impact forces, loading rates, and the accompanying sagittal plane kinematic and kinetic mechanics at the time of impact between the ACL-reconstructed group and a healthy control group. Forty females (20 with ACL reconstruction and 20 controls) participated in the study. An instrumented gait analysis was performed on all subjects. Between-group and between-limb comparisons were made for the initial vertical impact force, loading rate, and sagittal plane knee and hip angles as well as moments. During walking and running, the ACL cohort had significantly greater initial vertical impact force (P = 0.002 and P = 0.001, respectively) and loading rates (P = 0.03 and P = 0.01, respectively), as well as a smaller knee extensor moment and hip angle during walking (P = 0.000 and P = 0.01, respectively). There was a trend toward a smaller knee moment and hip angle during running (P = 0.08 and P = 0.06, respectively) as well as a larger hip extensor moment during walking (P = 0.06) in the ACL group. No differences were found for hip extensor moment during running and for knee angles between groups during walking or running. Lastly, no between-limb differences were found for any variable. Gait deviations such as elevated impact loading and loading rates do not resolve long term after an individual has resumed previous activity levels and these may contribute to the greater risk of early joint degeneration in this population.

A Six Months Exercise Intervention Influences the Genome-wide DNA Methylation Pattern in Human Adipose Tissue

Epigenetic mechanisms are implicated in gene regulation and the development of different diseases. The epigenome differs between cell types and has until now only been characterized for a few human tissues. Environmental factors potentially alter the epigenome. Here we describe the genome-wide pattern of DNA methylation in human adipose tissue from 23 healthy men, with a previous low level of physical activity, before and after a six months exercise intervention. We also investigate the differences in adipose tissue DNA methylation between 31 individuals with or without a family history of type 2 diabetes. DNA methylation was analyzed using Infinium HumanMethylation450 BeadChip, an array containing 485,577 probes covering 99% RefSeq genes. Global DNA methylation changed and 17,975 individual CpG sites in 7,663 unique genes showed altered levels of DNA methylation after the exercise intervention (q<0.05). Differential mRNA expression was present in 1/3 of gene regions with altered DNA methylation, including RALBP1, HDAC4 and NCOR2 (q<0.05). Using a luciferase assay, we could show that increased DNA methylation in vitro of the RALBP1 promoter suppressed the transcriptional activity (p = 0.03). Moreover, 18 obesity and 21 type 2 diabetes candidate genes had CpG sites with differences in adipose tissue DNA methylation in response to exercise (q<0.05), including TCF7L2 (6 CpG sites) and KCNQ1 (10 CpG sites). A simultaneous change in mRNA expression was seen for 6 of those genes. To understand if genes that exhibit differential DNA methylation and mRNA expression in human adipose tissue in vivo affect adipocyte metabolism, we silenced Hdac4 and Ncor2 respectively in 3T3-L1 adipocytes, which resulted in increased lipogenesis both in the basal and insulin stimulated state. In conclusion, exercise induces genome-wide changes in DNA methylation in human adipose tissue, potentially affecting adipocyte metabolism.

Exercise prescription in oncology patients: General principles

ObjectiveThe incidence of oncological diseases as well as the survival rates of cancer patients has risen in recent years. Cancer-related research has also increased, particularly with respect to the role of exercise. We performed a review of the literature on exercise prescription in oncology patients. Materials and methodsA search was conducted in reference textbooks and electronic databases. ResultsExercise bestows benefits to oncology patients with respect to fatigue, functional and physical performance. In addition, exercise exhibits promising effects in the maintenance of the body composition, metabolism, immune and psychological functioning. International Societies recommend 30min of moderate aerobic physical activity at least five times per week, strength training three times per week, and flexibility exercises. Exercise must be prescribed on an individual basis, taking age, previous activity level, tolerance to exertion, diagnosis, disease stage, therapeutic approach, and the patients’ comorbidities into account. ConclusionsExercise plays an important role as an adjuvant of oncological treatment.

Promising short-term results following selective bundle reconstruction in partial anterior cruciate ligament tears

BackgroundThe different functions of the two anterior cruciate ligament (ACL) bundles have increased interest in tears of only one of these two bundles. The purpose of this study was to assess the outcome of selective reconstruction of an injured bundle of isolated anteromedial bundle (AMB) or posterolateral bundle (PLB) tears. MethodsConsecutive series of 147 ACL reconstructions was prospectively analyzed. Patients with partial ACL tears who underwent selective bundle reconstructions were studied. Stability was assessed with the Lachman, anterior-drawer and pivot-shift tests and KT-1000. Functional assessment was performed with Lysholm and Tegner questionnaires. The preoperative MRI was analyzed to detect differences from arthroscopic findings. ResultsTwenty-eight patients (19%) were included. The minimum follow-up period was 30months. Eighteen had AMB and 10 PLB tears. Only 19% of their MRI's were categorized as partial ACL tears.The Lysholm score improved from 66.1/65.5 to 96.6/95.2 in the AMB/PLB groups, respectively (p<0.001). The same or no more than one level lower Tegner score was restored. The pivot-shift, Lachman and anterior-drawer tests were negative in all cases (p<0.001). Two reconstructed AMBs developed extension loss due to Cyclops lesions and were resolved surgically. ConclusionsThe technique provided excellent functional scores with normalized stability and a return to previous level of activity with a low rate of minor complications at a minimum 2.5years' follow-up. Arthroscopic examination was the most reliable tool for properly diagnosing and treating a condition observed in almost one out of every five ACL reconstructed knee in this series. Level of evidenceTherapeutic case series; level 4.

Hindfoot Arthroscopy: A Systematic Surgical Approach for Identifying Anatomy and Hindfoot Pathology (SS-47)

Hindfoot arthroscopy has been recognized as a safe and valid technique for treating hindfoot pathology, while also facilitating an earlier return to sporting activities when compared to the traditional open approach. Standardized examinations for anterior ankle arthroscopy, such as Ferkel’s 21 point evaluation, have been described in the literature, however a systematic surgical approach for performing hindfoot arthroscopy has not yet been described. The objective of this study is to present a structured systematic surgical approach for identifying relevant anatomical structures and pathology during hindfoot arthroscopy. In addition, we report the clinical results of a case series of 22 patients whom had hindfoot arthroscopy performed for posterior ankle impingment. The systematic surgical approach divides the extra-articular structures of the hindfoot into quadrants as defined by the intermalleolar ligament. Twenty-two patients underwent hindfoot arthroscopy for the treatment of posterior ankle impingement syndrome. The mean follow-up time was 20 months (range, 7 – 35 months). Standard patient reported outcome questionnaires in the Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) general health survey were administered at standard time points after surgery. Return to sporting activities was also calculated as the time period from the date of surgery until the patient was able to participate at their previous level of activity. The mean FAOS score improved from 58.17 points (range 22.22 – 94.45) preoperatively to 86.06 points (range 47.22 – 100) postoperatively (p < 0.0001). The mean SF-12 scores showed similar improvement with a mean of 65.62 points (range 41.88 – 95.30) preoperatively to 86.88 points (range 55.94 – 95.55) postoperatively (p < 0.0001). 19 patients reported competing at some level of athletic sport prior to surgery. All patients returned to their previous level of competition after surgery. The mean time to return to sporting activities was 12 weeks (range 6 – 16 months). Two complications were reported post-operatively; one wound infection and one case of dysthesia of the deep peroneal nerve. Hindfoot arthroscopy is a safe and effective treatment strategy for posterior ankle impingement syndrome. In addition, it allows the patients a rapid return to sporting activities.

Hindfoot Arthroscopic Surgery for Posterior Ankle Impingement

Background: Hindfoot arthroscopic surgery has been described as a minimally invasive surgical treatment for posterior ankle impingement syndrome. The current article describes a systematic approach for identifying relevant hindfoot structures as well as the clinical results of a case series. Purpose: To present a structured systematic surgical approach for identifying relevant anatomic structures and abnormalities during hindfoot arthroscopic surgery. In addition, we report the clinical results of a case series. Study Design: Case series; Level of evidence, 4. Methods: The systematic surgical approach divides the extra-articular structures of the hindfoot into quadrants as defined by the intermalleolar ligament. Twenty-two patients underwent hindfoot arthroscopic surgery for the treatment of posterior ankle impingement syndrome. The mean follow-up time was 25 months (range, 14-35 months). Standard patient-reported outcome questionnaires of the Foot and Ankle Outcome Score (FAOS) and Short Form–12 (SF-12) general health survey were administered at standard time points after surgery. Return to sporting activities was also calculated as the time period from the date of surgery until the patient was able to participate at their previous level of activity. Results: The mean FAOS score improved from 59 (range, 22-94) preoperatively to 86 (range, 47-100) postoperatively (P < .01). The mean SF-12 score showed similar improvement with a mean of 66 (range, 42-96) preoperatively to 86 (range, 56-98) postoperatively (P < .01). Nineteen patients reported competing at some level of athletic sport before surgery. All patients returned to their previous level of competition after surgery. The mean time to return to sporting activities was 12 weeks (range, 6-16 weeks). Two complications were reported postoperatively: 1 wound infection and 1 case of dysesthesia of the deep peroneal nerve. Conclusion: Hindfoot arthroscopic surgery is a safe and effective treatment strategy for posterior ankle impingement syndrome. In addition, it allows the patients a rapid return to sporting activities.