Surgeon-Administered Anterolateral Geniculate Nerve Block as an Adjunct to Regional Anesthetic for Pain Management Following Anterior Cruciate Ligament Reconstruction.

Regional anesthetic blockade of the adductor canal following anterior cruciate ligament reconstruction has gained popularity due to theoretical benefit of improved patient experience, decreased requirement for pain medication and maintained motor function. However, this block does not cover the anterior and lateral genicular innervation to the knee, which may lead to persistent pain postoperatively. The following Technical Note details the genicular nervous system and provides rationale and technique for performing a simple surgeon-administered regional anesthetic at the completion of anterior cruciate ligament reconstruction to address the anterior and lateral genicular nervous system.

Stability of mid-shaft clavicle fractures after plate fixation versus intramedullary repair and after hardware removal.

PURPOSE: Operative treatment for middle-third clavicle fractures has been increasing as recent data has demonstrated growing patient dissatisfaction and functional deficits after non-operative management. A controlled biomechanical comparison of the characteristics of locked intramedullary (IM) fixation versus superior pre-contoured plating for fracture repair and hardware removal is warranted. Therefore, the purpose of the present study was to investigate potential differences between these devices in a biomechanical model. METHODS: Thirty fourth-generation composite clavicles were randomized to one of five groups with 6 specimens each and tested in a random order. The groups tested were intact, repair with plate, repair with IM device, plate removal, and IM device removal. The lateral end of the clavicles was loaded to failure at a rate of 60 mm/min in a cantilever bending setup. Failure mechanism, energy (J), and torque (Nm) at the site of failure were recorded. RESULTS: Failure torque of the intact clavicle (mean ± standard deviation) was 36.5 ± 7.3 Nm. Failure torques of the IM repair (21.5 ± 9.0 Nm) and plate repair (18.2 ± 1.6 Nm) were not significantly different (n.s.) but were significantly less than the intact group (P < 0.05). Failure torque following IM device removal (30.2 ± 6.5 Nm) was significantly greater than plate removal (12.9 ± 2.0 Nm) (P < 0.05). No significant differences were observed between the intact and IM device removal groups (n.s.). CONCLUSION: The results of the current study demonstrate that IM and plate devices provide similar repair strength for middle-third clavicle fractures. However, testing of the hardware removal groups found the IM device removal group to be significantly stronger than the plate removal group.

Injuries in elite and recreational snowboarders.

BACKGROUND: The relatively young sport of snowboarding exhibits high injury rates. The current efforts to characterise the injury pattern of snowboarders focus largely on the general snowboard population and upper extremity injuries, the most common injury site in snowboarders as a whole. METHODS: In an effort to describe the current published information available on snowboarding injuries in the elite-level population, a literature search was performed and the articles related to snowboarding injuries were analysed. Additionally, the literature pertaining to biomechanical analyses of injury and injury prevention was included. RESULTS: Studies rarely stratify the snowboarders by skill level, a classification which has a profound effect on the riding activities of snowboarders and the resultant injury patterns. Elite-level snowboarders are often injured when performing difficult manoeuvres at high velocities and with amplified levels of force to the lower limbs. Consequently, elite-level snowboarders suffer from injuries that are of higher severity and have decidedly greater lower extremity injury rates. Conversely, injuries to the upper extremities are decreased in the elite snowboarders. Furthermore, little has been published regarding the biomechanical analyses and injury prevention for the protection of the lower extremities in snowboarding. CONCLUSIONS: Snowboarding continues to evolve as a sport. This includes a steady progression in the degree of difficulty of the manoeuvres conducted by athletes and an increase in the number of snowboarders attempting such manoeuvres. The injury patterns across the skill levels are markedly different, and it is imperative that the research directed towards understanding the disparate lower extremity injury pattern of elite-level snowboarders is increased.

Anterior shoulder forces in professional and Little League pitchers.

BACKGROUND: The developing musculoskeletal system of a youth pitcher is substantially different from that of the adult professional pitcher, predisposing the younger players to a different set of injuries. METHODS: High-speed videography of 39 professional and 13 youth pitchers were obtained. High-speed motion analysis was performed to calculate average anterior forces and arm positions at maximal force generation. RESULTS: Professional players generated an average of 33.8+/-14.4 N/kg maximal anterior force, corresponding to 151.9+/-17.0 degrees of external rotation. Youth pitchers generated 16.2+/-3.8 N/kg of anterior forces, corresponding to 118.0+/-23.4 degrees of external rotation. The degree of coronal abduction and horizontal abduction between the 2 groups were not significantly different-92.4+/-9.0 degrees in professionals versus 91.7+/-7.9 degrees in the youth and 11.1+/-11.1 degrees of horizontal abduction in professionals versus 7.8+/-14.1 degrees in the younger throwers. Professional pitchers exerted higher internal rotation torque at 19.4+/-4.1 Nm/kg versus 5.6+/-1.0 Nm/kg in youth, and compressive forces were found to be 121.7+/-21.7 N/kg in professional pitchers compared with 47.5+/-7.6 N/kg in the youth pitchers. CONCLUSIONS: Youth pitchers experience significant anterior shoulder forces and internal rotation torques, although these are lower than professional pitchers. CLINICAL RELEVANCE: Overhead throwing as a youth can lead to shoulder injuries and can predispose the shoulder to more significant injuries as an adult pitcher.