Comparison of posterolateral corner reconstructions using computer-assisted navigation.

PURPOSE: This study evaluated different fibular-based reconstruction techniques for grade III posterolateral corner (PLC) injuries. METHODS: Seven fresh-frozen cadaveric knees were used in this study. A surgical navigation system was used to determine varus opening and external rotation at 0 degrees , 30 degrees , and 60 degrees with a 9.8-Nm varus stress and 5-Nm external rotation stress applied to the tibia. Intact and disrupted PLC knees were used as controls. Four different fibular-based reconstruction techniques were evaluated. The femoral attachments consisted of a single- or double-tunnel technique, and the fibula attachment consisted of an anteroposterior or oblique tunnel technique. RESULTS: Sectioning of the PLC resulted in an increase in varus and external rotation at all flexion angles. All reconstruction techniques restored varus and external rotation stability compared with the PLC-deficient state, but the single-femoral tunnel reconstruction with an anteroposterior fibular tunnel did not restore varus or external rotation stability at 30 degrees and 60 degrees . No reconstruction technique overconstrained the knee at any flexion angle. CONCLUSIONS: A double femoral tunnel with an oblique fibular tunnel best restored native knee kinematics to the lateral side of the knee. CLINICAL RELEVANCE: Although there are many different techniques to reconstruct the PLC-deficient knee, this study suggests that a single-graft, fibular-based reconstruction that replicates the femoral insertions of the lateral collateral ligament and popliteus will be able to restore varus and external rotation stability to the knee.

Nonoperative Management of Complete Lateral Elbow Ligamentous Disruption in an NFL Player: A Case Report.

Disruptions of the lateral soft tissue restraints of the elbow, including the lateral ulnar collateral ligament, are a well-recognized clinical entity which may result in chronic elbow instability. When symptomatic, most authors recommend surgery to reconstruct the LUCL. We report on a case of a professional football player who sustained complete disruption of the lateral collateral ligamentous complex from the lateral humeral epicondyle with extension of his injury into his common extensor origin. He was treated conservatively and returned to play after 4 weeks. Treatment algorithm and a review of the literature are discussed.

Isometry of medial collateral ligament reconstruction.

The purpose of this study was to determine the femoral and tibial fixation sites that would result in the most isometric MCL reconstruction technique. Seven cadaveric knees were used in this study. A navigation system was utilized to determine graft isometry continuously from 0 masculine to 90 masculine. Five points on the medial side of the femur and four on the tibia were tested. A graft positioned in the center of the MCL femoral attachment (F(C)) and attached in the center of the superficial MCL attachment on the tibia led to the best isometry (2.7 +/- 1.1 mm). Movement of the origin superiorly only 4 mm (F(S)) led to graft excursion of greater than 10 mm (P < 0.01). MCL reconstruction performed with the origin of the MCL within the femoral footprint and the insertion in tibial footprint of the superficial MCL results in the least graft excursion when the knee is cycled between 0 masculine and 90 masculine. Although the MCL often heals without surgical intervention, surgical reconstruction is occasionally in Grade III MCL and combined ligamentous injuries to the knee. This study demonstrates the optimal position of the MCL reconstruction to reproduce the kinematics of the native knee.

Complications of anterior cruciate ligament reconstruction.

Anterior cruciate ligament reconstruction has become one of the most common arthroscopic knee procedures, and it has excellent success rates. Intraoperative technical complications are uncommon but can be devastating to knee function. Each of the multiple steps in the reconstruction has associated complications.

Biomechanical comparison of medial collateral ligament reconstructions using computer-assisted navigation.

BACKGROUND: The medial collateral ligament is a broad ligament that functions as the primary stabilizer against valgus knee stress, particularly at 30 degrees of flexion. HYPOTHESIS: A double-bundle reconstruction technique that better restores the native medial collateral ligament anatomy will restore valgus and external rotation stability to a medial collateral ligament-deficient knee. STUDY DESIGN: Controlled laboratory study. METHODS: Seven fresh-frozen cadaveric knees were studied. A surgical navigation system was used to determine valgus opening and external rotation at 0 degrees and 30 degrees with a 9.8-N.m valgus stress applied to the tibia graft isometry at multiple points on the tibia and femur. Intact and disrupted medial collateral ligament knees were used as controls. Four repair techniques were tested: Bosworth, modified Bosworth, anatomical single bundle, and anatomical double bundle. RESULTS: Complete sectioning of the medial collateral ligament resulted in an increase in valgus opening of 5 degrees at 0 degrees and 7.7 degrees at 30 degrees . External rotation increased 4.6 degrees at 0 degrees and 9.7 degrees at 30 degrees . Single-bundle techniques (Bosworth, anatomical single bundle) did not restore valgus laxity at 0 degrees or 30 degrees ; the anatomical single bundle did not restore external rotation at 0 degrees . Double-bundle techniques (modified Bosworth, anatomical double bundle) restored valgus laxity and external rotation to the native knee conditions at 0 degrees and 30 degrees . At 30 degrees , the modified Bosworth was 0.3 degrees tighter and the anatomical double bundle 0.2 degrees tighter than was the intact knee. The center of the medial collateral ligament origin on the femur to the proximal insertion of the superficial medial collateral ligament resulted in the most isometric graft position. CONCLUSION: Medial collateral ligament reconstruction configurations that use a double-bundle reconstruction better resist valgus and external rotations in response to valgus stress than do single-bundle techniques. CLINICAL RELEVANCE: Although the medial collateral ligament often heals without surgical intervention, surgical reconstruction is occasionally necessary in grade III medial collateral ligament and combined ligamentous injuries to the knee. Double-bundle reconstruction of the medial collateral ligament better resists valgus forces across the knee and may allow for better surgical outcome after medial collateral ligament reconstruction.

Hip injuries and labral tears in the national football league.

BACKGROUND: Injuries to the hip account for approximately 10% of all injuries in football, but definitive diagnosis is often challenging. Although these injuries are often uncomplicated contusions or strains, intra-articular lesions are increasingly found to be sources of hip pain. PURPOSE: The objective was to define the incidence and etiologic factors of intra- and extra-articular hip injuries in the National Football League (NFL). STUDY DESIGN: Descriptive epidemiology study. METHODS: The NFL Injury Surveillance System was used to define all hip-related injuries from 1997 to 2006. Injuries were included if the athlete missed more than 2 days. All hip and groin injuries were included for evaluation. The authors also report on NFL players with intra-articular injuries seen at their institution outside of the NFL Injury Surveillance System. RESULTS: There were a total of 23 806 injuries from 1997 to 2006, of which 738 were hip injuries (3.1%) with an average of 12.3 days lost per injury. Muscle strains were the most common injury. Intra-articular injuries resulted in the most time lost. Contact injuries most likely resulted in a contusion, and noncontact injuries most often resulted in a muscle strain. In the authors' institutional experience, many of the athletes with labral tears have persistent adductor strains that do not improve despite adequate therapy. CONCLUSION: Hip injuries represent a small but substantial percentage of injuries that occur in the NFL. A majority of these injuries are minor, with a return to play within 2 weeks. Intra-articular injuries are more serious and result in a significant loss of playing time. The "sports hip triad" (labral tear, adductor strain, and rectus strain) is described as a common injury pattern in the elite athlete.

Epidemiology of National Football League training camp injuries from 1998 to 2007.

BACKGROUND: Football is one of the leading causes of athletic-related injuries. Injury rates and patterns of the training camp period of the National Football League are unknown. HYPOTHESIS: Injury rates will vary with time, and injury patterns will differ between training camp practices and preseason games. STUDY DESIGN: Descriptive epidemiology study. METHODS: From 1998 to 2007, injury data were collected from 1 National Football League team during its training camp period. Injuries were recorded as a strain, sprain, concussion, contusion, fracture/dislocation, or other injury. The injury was further categorized by location on the body. Injury rates were determined based on the exposure of an athlete to a game or practice event. An athlete exposure was defined as 1 athlete participating in 1 practice or game. The injury rate was calculated as the ratio of injuries per 1000 athlete exposures. RESULTS: There were 72.8 (range, 58-109) injuries per year during training camp. Injuries were more common during weeks 1 and 2 than during weeks 3 to 5. The rate of injury was significantly higher during games (64.7/1000 athlete exposures) than practices (12.7/1000 athlete exposures, P < .01). The rate of season-ending injuries was also much higher in games (5.4/1000 athlete exposures) than practices (0.4/1000 athlete exposures). The most common injury during the training camp period was a knee sprain, followed by hamstring strains and contusions. CONCLUSION: Muscle strains are the most common injury type in practices. Contact type injuries are most common during pre-season games, and the number of significant injuries that occur during preseason games is high.