Home based rehabilitation for anterior cruciate ligament reconstruction.

Fifty-four patients who underwent arthroscopically assisted anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft or allograft were studied prospectively to compare a postoperative home based rehabilitation program with a clinic based program. Fifty-four patients (mean age, 30 years) were assigned randomly to the home based program (27 patients) or the clinic based program (27 patients). The home based schedule featured six physical therapy visits during a 6-month postoperative study period, whereas the clinic based schedule specified 24 physical therapy visits during those 6 months. All patients entered in the study met strict selection criteria: age older than 15 years, no previous ligament repair or reconstruction, no complicating medical conditions, no collegiate or professional athletes, reconstruction at least 6 weeks after injury, and informed consent. At the 6-month followup, no significant statistical differences were found between the two groups in range of motion, thigh atrophy, anterior drawer compliance, hopping tests, Lysholm scores, or subjective health status scores. Thus, the authors conclude that in a selected group of patients who have undergone anterior cruciate ligament reconstruction, a home based postoperative rehabilitation program is feasible, safe, and effective.

Chronically injured posterior cruciate ligament: magnetic resonance imaging.

Magnetic resonance imaging has been said to be highly reliable for diagnosis of acute posterior cruciate ligament insufficiency. In the present study, 13 patients whose posterior cruciate ligament insufficiency had been documented by magnetic resonance imaging within 10 weeks of the acute injury were recalled for a followup examination and magnetic resonance imaging. The followup interval ranged from 5 months to 4 years. In only 23% of the cases did the posterior cruciate ligament still appear discontinuous on followup magnetic resonance imaging. In the remaining 77%, the posterior cruciate ligament was continuous from tibia to femur, although it appeared abnormally arcuate or hyperbuckled. Conventional interpretation of these magnetic resonance images would suggest that the posterior cruciate ligament had healed. Nevertheless, by clinical examination results, these same patients all were judged to have posterior cruciate ligament insufficiency. Thus, it was concluded that although magnetic resonance imaging may be reliable for evaluation of acute posterior cruciate ligament injury, magnetic resonance imaging findings should not be used to infer functional status in chronic cases.

Lumbar transverse process fractures in professional football players.

In the general population, fractures of the transverse processes of lumbar vertebrae occur in cases of high-energy blunt trauma, often in motor vehicle accidents. Football players may incur the same fractures, but the circumstances and outcomes are different in this specific subgroup. A review of 29 cases among National Football League players reveals that associated visceral injuries are rare, and the time lost from sports is only an average of 3.5 weeks.

MRI findings of acute turf toe. A case report and review of anatomy.

Normal anatomy of the metatarsophalangeal joint of the hallux has been well described. However, the pathologic anatomy of turf toe, a common injury among football and rugby players, has not been documented in detail. Magnetic resonance images (MRI) of a classic case of turf toe were examined and the findings were compared with MRI of a normal specimen and correlated with known features of gross anatomy. MRI findings confirmed that turf toe involves a sprain or tear of the plantar metatarsophalangeal joint capsule.