The safety of sportive chokes: a cross-sectional survey-based study.

Objectives: Sportive choking or strangling, known as a 'choke' in the combat sports community, is the practice of compressing the jugular veins and carotid arteries to threaten unconsciousness by lowering cerebral perfusion pressure. This is commonly practiced within combat sports and police/military combatives. The safety profile of sportive choking is underrepresented in the literature. The authors sought to explore the safety of sportive chokes. Methods: A convenience sample of visitors to two combat sports internet forums completed an anonymous web-based survey on choking experience and related symptoms. Descriptive statistics were used to describe the obtained data. Bivariate analysis was performed to elaborate on relationships between grappling experience and the number of times choked, between the number of times choked with pre-syncope/syncope, and between the duration of symptoms and the number of times choked with pre-syncope/syncope. Results: Overall, 4421 individuals completed the survey. One hundred and fourteen were excluded, leaving 4307 analyzed respondents. Ninety-four percent were male, 89.2% were ages 18-44 years. Seventy-nine percent had >1 year of grappling experience and 30% had >5 years. Of the 4307, 1443 (33.5%) reported being choked >500 times, 3257 (75.7%) have been choked to near-syncope, and 1198 (27.8%) have been choked unconscious. Two of the 4307 (0.05%) reported ongoing symptoms from chokes. Of the respondents, 94.3% felt applying a choke would be a safe and effective way to control a street fight; 83.6% felt that vascular neck restraint, the police combative equivalent of sportive choking, would be appropriate as an alternative escalation of force option. Conclusion: Based on a convenience sample of 4307 respondents' self-reported data, sportive choking appears to be safe. Only 0.05% experienced ongoing symptoms, which were likely not related to brain ischemia.

Comparison of Radiographs and Computed Tomography for the Screening of Anterior Inferior Iliac Spine Impingement.

PURPOSE: To compare radiographic and 3-dimensional (3D) computed tomography (CT) imaging modalities for the screening of anterior inferior iliac spine (AIIS) impingement by establishing imaging measurement related to the AIIS. METHODS: Anteroposterior and false-profile radiographs and 3D CT scans were obtained on 10 human cadaveric pelvises. On the anteroposterior view for each methodology, 2 measurements were calculated: distance to the most lateral AIIS from the 12 o'clock position on the acetabular rim, and the angle between the lateral AIIS and the sagittal plane. On the false-profile view for each methodology, 2 measurements were calculated: distance to the anterior AIIS from the 12 o'clock position on the acetabular rim, and the angle between the anterior AIIS and the sagittal plane. Inter-rater and intrarater reliability analyses were performed for both methods in addition to an intermethod analysis. RESULTS: The radiographic false-profile view was the most repeatable orientation, with intraclass correlation coefficients showing excellent reproducibility in both inter-rater (angle: 0.980, distance: 0.883) and intrarater (angle: 0.995, distance: 0.995) analyses. The mean distance from the 12 o'clock position of the acetabular rim to the most anterior/lateral aspect of the AIIS was 41.4 mm and 16.0 mm on the radiographic false-profile and anteroposterior views, respectively. Intermethod analysis showed a systematic, quantitative bias between modalities (anteroposterior view: -4.1 mm, 6.7°; false-profile view: -0.1 mm, 8.3°), which will remain relatively consistent as evidenced by the strong individual reproducibility of each measurement. CONCLUSIONS: AIIS morphology in relation to the acetabular rim 12 o'clock position and its angle relative to the sagittal plane can be quantitatively determined using either radiographic or 3D CT imaging modalities. CLINICAL RELEVANCE: Radiographic evaluation may be a valuable tool in the screening of AIIS impingement.

Radiographic Identification of Arthroscopically Relevant Acetabular Structures.

BACKGROUND: The anatomy of the acetabulum has been described extensively in the literature, but radiographic acetabular guidelines have not been well established. This study provides a radiographic map of acetabular landmarks in the hip. PURPOSE/HYPOTHESIS: The purpose of this study was to quantify the precise radiographic location of arthroscopic landmarks around the acetabulum. The hypothesis was that their locations were reproducible despite variability in the anatomy and positioning of pelvic specimens. STUDY DESIGN: Descriptive laboratory study. METHODS: Ten fresh-frozen cadaveric specimens were dissected, and radio-opaque hardware was placed for each landmark of interest. Anteroposterior (AP) and false-profile radiographs were obtained, and measurements were taken using a digital picture archiving and communication system. RESULTS: On AP radiographs, the direct and indirect heads of the rectus femoris were a mean 48.2 ± 4.6 mm and 44.7 ± 4.3 mm proximal to the teardrop line, respectively. The mean radiographic distance between their insertions was 5.0 ± 3.4 mm. Moreover, the anterior inferior iliac spine was a mean 11.5 ± 3.8 mm from the acetabular rim. On false-profile radiographs, the mean distance between the direct and indirect heads of the rectus femoris was 31.4 ± 6.2 mm. The mean distance between the superior margin of the anterior labral sulcus (the psoas-u) and the midpoint of the transverse acetabular ligament was 41.0 ± 5.7 mm. Additionally, the direct and indirect heads of the rectus femoris corresponded to the 2:30 and 1:30 locations on the acetabular clockface, respectively. The midpoint of the transverse acetabular ligament was located at 7 o'clock on the clockface. CONCLUSION: The most important finding of this study, determined by quantitative measurements, was that the described surgical landmarks had reliable locations on radiographs. Distances between landmarks as well as distances between landmarks and reference lines were reproducible in both AP and false-profile views. CLINICAL RELEVANCE: An understanding of how acetabular structures present on radiographs could lead to more accurate portal and hardware placement intraoperatively during arthroscopic surgery as well as better preoperative and postoperative assessments.

Radiographic Identification of Arthroscopically Relevant Proximal Femoral Structures.

BACKGROUND: Anatomic landmarks located on the proximal femur have only recently been defined, and there is a lack of radiographic guidelines for their locations presented in the literature. With the confident identification of these landmarks, radiographs could provide more assistance in preoperative evaluations, intraoperative guidance, and postoperative assessments. PURPOSE: To quantify the radiographic locations of endoscopic landmarks of the proximal femur. STUDY DESIGN: Descriptive laboratory study. METHODS: Ten cadaveric specimens were dissected, and radio-opaque hardware was placed for each landmark of interest. Radiographs were obtained and measurements recorded in anteroposterior (AP) and Dunn 45° views. RESULTS: In the AP view, the gluteus medius insertion was located a mean 12.9 ± 2.4 mm and 34.7 ± 5.1 mm from the piriformis fossa and vastus tubercle, respectively. The piriformis fossa was a mean 14.8 ± 5.9 mm and 4.9 ± 1.9 mm from the anterior and posterior tips of the greater trochanter, respectively. The anterior and posterior tips of the greater trochanter were a mean 14.8 ± 5.1 mm from each other. In the Dunn 45° view, the piriformis fossa was a mean 13.3 ± 2.0 mm, and the vastus tubercle was a mean 21.5 ± 6.0 mm, from the gluteus medius insertion. Moreover, the vastus tubercle was a mean 33.5 ± 6.4 mm from the anterior tip of the greater trochanter and 31.6 ± 8.5 mm from the posterior tip of the greater trochanter. CONCLUSION: In spite of the variation in cadaveric sizes, quantitative descriptions of endoscopic landmarks were reproducible in clinical views. CLINICAL RELEVANCE: A detailed understanding of how the described landmarks present radiographically is relevant to preoperative planning, intraoperative evaluations, and postoperative assessments.