Plasma amino acids and sports injuries.

The aim of this study was to explore the relationship between changes in plasma amino acids and the incidence of sports injuries during a soccer season. Fourteen plasma amino acids were assayed at monthly intervals in 12 young soccer players during a whole soccer season. Based on the number and severity of injuries the soccer players were divided into an injury-prone and a non-injury-prone group. The mean plasma level of the amino acid glycine was significantly lower ( P=0.009) in the injury-prone group than the other group, while the mean plasma levels of tyrosine, tryptophan and lysine were higher in the injury-prone group during this period ( P<0.05). However there were no significant differences in the calculated plasma tryptophan and tyrosine/large neutral amino acids ratios. Significant linear time trends were observed for taurine, ornithine, lysine and the tryptophan/large neutral amino acids ratio.These results indicate that the plasma concentrations of glycine and to a lesser extent those of tyrosine, tryptophan and lysine may be promising peripheral markers for injury-proneness in young soccer players. Whether a role for glycine substitution will be indicative to reduce the occurrence of sports injuries will need to be investigated in future studies.

Dome fracture of the talus.

Three cases of transchondral fracture of the dome of the talus are reported. Two were treated surgically, one conservatively. A review of the literature is presented and the relative values of surgical intervention and conservative therapy are discussed.

Clinical diagnosis, arthrography, stress examination and surgical findings after inversion trauma of the ankle.

In a series of 921 patients with acute inversion trauma of the ankle joint, the diagnostic features of lateral ligamentous ruptures were evaluated. Patients with proven lateral ligamentous rupture (150 patients in this series) were submitted to a prospective trial to compare three methods of treatment. In the 50 patients operated upon, the results of clinical diagnosis, stress radiography, and ankle arthrography were compared with surgical findings. Clinical diagnosis proved to be of very little value. The positive signs of ankle arthrography showed a reliability of 96% in predicting ligamentous rupture. Inversion stress radiography under full anesthesia showed a reliability of 92%, but the same investigation under local anesthesia, however, was only 68%.

Arthrography, talar tilt and surgical findings after inversion trauma of the ankle.

Both inversion stress examination under general anesthesia and arthrography are sensitive indicators of lateral ankle ligament pathology (91%, 96% resp.). Arthrography is significantly superior to inversion stress examination done under local anesthesia (96%, 70% resp.). Peroneus tendon sheath filling is always pathological, but although this does not always indicate calcaneo-fibular ligament rupture, such rupture cannot be excluded in its absence. Talar tilt difference cannot be correlated with the extent of ligamentous rupture and therefore inversion stress examination, while providing valuable additional information, must be regarded as a secondary technique to ankle arthrography.

Arthrographic differential diagnosis between ruptures of the anterior talofibular ligament, the joint capsule and the anterior tibiofibular ligament.

From literature study, surgical findings and cadaver experiments, it is unlikely that, in an inversion type ankle sprain, rupture of the anterior tibiofibular ligament frequently accompanies rupture of the capsule and the lateral ligaments. Contrary to the experience of other authors, we found the presence or absence of a) a contrast-free zone, b) the tibiofibular recess, or c) both together, on ankle arthrography in no way indicative of a rupture of the anterior tibiofibular ligament. Contrast leakage out of the joint into the soft tissues without leakage below and lateral to the lateral malleolus indicates rupture of the joint capsule. Leakage below and lateral to the lateral malleolus indicates rupture of the anterior talofibular ligament. The anatomic relationships between the syndesmosis, the joint capsule, the tibiofibular recess and the anterior talofibular recess and the anterior talofibular ligament were studied on cadavers and during surgery. Contrast spread in the soft tissues is probably determined by the arrangement of and damage to the soft tissues and by the size of the haematoma and follows the path of least resistance.

The significance of the peroneus tendon sheath in ankle arthrography.

Bilateral distension arthrography was performed in 40 non traumatized cadavers and the ratio of peroneus tendon sheath filling, and filling of the subtalar joints and medial tendon sheaths were compared with data from groups of normal and pathological arthrograms in patients who had sustained inversion trauma. The investigation confirms that filling of the peroneus tendon sheath is always of pathological significance, and is independent of age. The different mechanisms which may produce filling of the peroneus tendon sheath are discussed. Filling of the medial tendon sheaths and subtalar joints are normal arthrographic findings, not related to trauma or age.

Filling of lymphatic vessels in ankle arthrography.

3 patients are described in whom lymphatic filling occurred in ankle arthrography. There were no clinical and arthrographic features of rheumatoid arthritis. It is therefore concluded that these occurrences are due to a pressure phenomenon.

Adhesive capsulitis of the ankle (frozen ankle).

Adhesive capsulitis or "frozen ankle" is a syndrome resulting from repeated ankle sprains, or perhaps following immobilization after trauma. Ankle arthrography is a useful and safe diagnostic procedure in this syndrome. Typical arthrographic features are described together with case histories of two patients with frozen ankle. We suggest that early mobilization of the patient following trauma is particularly important in preventing the development of a forzen ankle syndrome.