Does decrease in hip range of motion interfere in frontal plane leg alignment in teenage soccer players?

INTRODUCTION: This study determines cross-sectional changes in transverse plane hip range of motion (ROM) in teenager soccer athletes and non-athletes and correlates these measures with changes in frontal plane leg alignment (varus-valgus alignment). EVIDENCE ACQUISITION: This was a comparative cross-sectional study with non-random convenience sampling. EVIDENCE SYNTHESIS: Participants were recruited from a major professional soccer club and two local state-run schools in southern Brazil. A total of 396 male participants aged 9-18 years were assessed, 183 soccer players (athlete group; mean age, 13.3 ± 2.7 years) and 213 students (non-athlete group; mean age 14.4 ± 2.5 years). Hip internal rotation (IR) and external rotation (ER) and frontal plane leg alignment were measured in all participants. Changes in transverse plane hip ROM and frontal plane leg alignment were determined. Mean IR was 20.7° ± 5.8° in athletes versus 32.8° ± 2.9° in non-athletes, and mean ER was 36.5° ± 7.4° in athletes versus 46.7° ± 4.8° in non-athletes. Overall, IR was decreased in the athlete group compared to the non-athlete group (P < 0.001). Mean IR and ER were significantly lower in older athletes (P < 0.001), while only ER was significantly lower in older non-athletes (P < 0.001). Varus leg alignment was prevalent at all ages in the athlete group (71.0%, P = 0.153). In the non-athlete group, the occurrence of varus leg alignment was higher in older participants (P = 0.001). Lower mean IR was correlated with more severe varus leg alignment in the athlete group (rs = 0.19; P = 0.009). CONCLUSIONS: We found a lower hip ROM, particularly in IR, in teenager soccer players according to the enhancement age group from the sample. But varus alignment of the leg was also prevalent in this group and comes before hip abnormalities started to be detected.

The External Rotation Radiographic Technique for Posterolateral Injury.

Posterolateral corner injuries are a severe and often unrecognized pathology. Injuries to these structures are difficult to identify using magnetic resonance images. Physical examination tests including the dial test, frog-leg test, and varus stress test can be difficult to perform. In addition it is difficult to correctly evaluate the results in a multiligament injury setting. The correct diagnosis of this pathology is essential to determine the proper treatment and improve outcomes. Furthermore, failure to recognize this pathology is associated with a high risk of failure following isolated anterior cruciate ligament reconstructions. The purpose of this Technical Note is to present an alternative method for the evaluation of posterolateral corner injuries using radiographic images.

Simultaneous Radiographic Technique to Evaluate Ankle Instability.

The use of ankle stress radiographs is common to evaluate ankle instability. However, the majority of the studies report the use of a manual method to apply the stress, increasing radiation exposure to the physician. Furthermore, as reported in other studies, the force applied during the stress may vary between examiners according the strength and experience. In this Technical Note, we describe our preferred method to evaluate ankle instability, either using an inversion or eversion stress, avoiding the necessity of a physician in the radiographic room.

Medial patellofemoral ligament reconstruction with semitendinosus autograft for chronic patellar instability: a follow-up study.

PURPOSE: The purpose of this study was to describe the long-term results of medial patellofemoral ligament reconstruction with a free semitendinosus graft. TYPE OF STUDY: Prospective nonrandomized study. METHODS: We assessed 15 patients (16 knees) treated between 1992 and 1996 (follow-up > 5 years). Diagnosis of patellofemoral dislocation or subluxation was based on the patient's report plus reproduction of subjective complaints of instability on physical examination. All patients were treated by the same surgeon. Assessment was performed by a different surgeon based on Crosby-Insall and Aglietti criteria. RESULTS: According to Crosby-Insall criteria, 11 knees were rated as excellent, 4 good, and 1 poor. According to Aglietti criteria, 11 knees were rated as excellent, 3 good, 1 fair, and 1 poor. According to both protocols, 15 knees showed negative apprehension test, absence of patellofemoral pain, and normal patellar tracking. In one knee, the apprehension test was positive, patellofemoral pain was present, and patellar tracking was abnormal. Patellofemoral crepitus was detected in 10 knees (attenuated in 6). Thirteen patients (14 knees) were satisfied with the results. One patient considered the result acceptable, but below expectations. The final patient underwent an additional procedure. No cases of infection and no vascular problems were seen. CONCLUSIONS: Medial patellofemoral ligament reconstruction proves to be useful in improving unstable extension mechanisms and in preventing insecurity, gradual joint deterioration, and disabling pain during dislocation episodes, in a minimal 5-year follow-up study. LEVEL OF EVIDENCE: Level IV.