Quadriceps contusions: clinical results of immediate immobilization in 120 degrees of knee flexion.

OBJECTIVE: Quadriceps contusions often result in significant time loss and the possibility of myositis ossificans. The objective of this descriptive case series was to document the results of an initial treatment regimen instituted within 10 minutes from the time of the injury. DESIGN: This study was a prospective case series of 47 midshipmen who sustained quadriceps contusions between August 1987 and December 2005 and who were treated identically and followed by serial examinations until the return to unrestricted full athletic activities. SETTING: United States Naval Academy (USNA), Annapolis, Maryland. PARTICIPANTS: USNA midshipmen who sustained quadriceps contusions while participating in sports activities. Inclusion criteria were (1) stated inability at the time of the injury to continue participation and (2) the inability to perform a pain-free, isometric quadriceps contraction and maintain the knee in full extension with a straight leg lift. INTERVENTIONS: On diagnosis the knee was passively flexed painlessly to 120 degrees and held continuously in that position for 24 hours. Use of the brace was discontinued at 24 hours and the midshipman was instructed to perform active, pain-free quadriceps stretching several times a day and to perform pain-free isometric quadriceps strengthening exercises as soon as possible. Goals included pain-free knee flexion and quadriceps size and firmness equal to the uninjured side. MAIN OUTCOME MEASUREMENTS: Average time from the day of the injury to return to unrestricted full athletic activities with no disability. RESULTS: The average time to return to unrestricted full athletic activities with no disability was 3.5 days (range of 2 to 5 days). Radiographic examination of the first 23 midshipmen at 3 and 6 months following the injury revealed 1 case of myositis ossificans. CONCLUSIONS: Placing and holding the knee in 120 degrees of flexion immediately following a quadriceps contusion appears to shorten the time to return to unrestricted full athletic activities compared with reports in other studies.

Functional bracing after anterior cruciate ligament reconstruction: a prospective, randomized, multicenter study.

BACKGROUND: Bracing after anterior cruciate ligament reconstruction is expensive and is not proven to prevent injuries or influence outcomes. PURPOSE: To determine whether postoperative functional knee bracing influences outcomes. STUDY DESIGN: Prospective, randomized, multicenter clinical trial. METHODS: One hundred volunteers from the 3 US service academies with acute anterior cruciate ligament tears were randomized into braced or nonbraced groups. Only those subjects with anterior cruciate ligament tears treated surgically within the first 8 weeks of injury were included. Patients with chondral injuries, significant meniscal tears, or multiple knee ligament injuries were excluded. Surgical procedures and the postoperative physical therapy protocols were identical for both groups. The braced group was instructed to wear an off-the-shelf functional knee brace for all cutting, pivoting, or jumping activities for the first year after surgery. RESULTS: Ninety-five subjects were available with a minimum 2-year follow-up. There were no statistically significant differences between groups in knee stability, functional testing with the single-legged hop test, International Knee Documentation Committee scores, Lysholm scores, knee range of motion, or isokinetic strength testing. Two braced subjects had reinjuries, and 3 nonbraced subjects had reinjuries. CONCLUSIONS: In this young, active population, postoperative bracing does not appear to change the clinical outcomes after anterior cruciate ligament reconstruction.

Arthroscopic posterior cruciate ligament repair for acute femoral "peel off" tears.

Posterior cruciate ligament (PCL) injuries can be associated with acute and chronic morbidity. Treatment of PCL disruption is typically either nonoperative or reconstructive, using a graft substitute. We describe a minimally invasive arthroscopic technique for repair of acute PCL tears of the femoral origin. This has been referred to as the femoral "peel off" injury. The procedure makes use of arthroscopic instrumentation to provide a direct repair of the ligament back to the femoral origin. This is a very specific injury often diagnosed with magnetic resonance imaging. This technique is not applicable to interstitial or tibial insertion tears. Operative repair is achieved using accessory portals, and instrumentation to place sutures in the PCL, which are then secured via an accessory incision for fixation. The procedure and clinical experience are discussed in detail, and a case report is included. In this very select and specific type of PCL injury, repair may provide a clinically useful alternative to full PCL reconstruction.