Epidemiology and history of knee injury and its impact on activity limitation among football premier league professional referees.

BACKGROUND: The purpose of this study was to determine the epidemiology and history of knee injury and its impact on activity limitation among football premier league professional referees in Iran. METHODS: This was a descriptive study. 59 Football Premier League professional referees participated in the study. The knee injury related information such as injury history and mechanism was recorded. Injury related symptoms and their impacts on the activity limitation, ability to perform activities of daily living as well participation in sports and recreational activities was obtained through the Knee Outcome Survey (KOS). RESULTS: The results indicated that 31 out of 59 participants reported the history of knee injury. In addition, 18.6%, 22.4% and 81% of the referees reported that they had been injured during the last 6 months of the last year, and at some point in their refereeing careers, respectively. Results further indicated that 48.8% of the injuries occurred in the non-dominant leg and they occurred more frequently during training sessions (52%). Furthermore, the value of KOS was 85 ± 13 for Activities of Daily Living subscale and 90 ± 9 for Sports and Recreational Activities subscale of the KOS. CONCLUSIONS: Knee injury was quite common among the Football Premier League professional referees. It was also indicated that the injuries occurred mainly due to insufficient physical fitness. Therefore, it is suggested that football referees undergo the proper warm-up program to avoid knee injury.

The Pellegrini-Stieda Lesion Dissected Historically.

The Pellegrini-Stieda lesion is a common finding on conventional X-rays. Whether it originates in the medial collateral ligament (MCL) of the knee or the medial head of the gastrocnemius muscle or another structure remains under debate. We discuss the difference in the articles by Pellegrini and Stieda and follow the vision on the origin of the lesion through time. A systematic research in PubMed/MEDLINE was conducted, identifying all articles on the Pellegrini-Stieda lesion and analyzing them for proposed origin of the lesion. The articles with their conclusion based on either finding during surgery or magnetic resonance imaging (MRI)/computed tomography were analyzed in more detail. Our PubMed/Medline search identified 4,997 articles. After exclusion of articles that were not on the Pellegrini-Stieda lesion and of doubles, 27 articles remained. By checking the references manually, 10 more articles were identified. Proposed origins were MCL, medial gastrocnemius, adductor magnus, vastus medialis, deep MCL, and superficial MCL. Although the MCL was most often coined as origin of the lesion (54% overall, 25% on MRI, and 57% during surgery), many cases remained undecided (50% on MRI) or no specific structure was found to be the origin (29% during surgery). There are diverse proposed origins of a calcification on the medial side of the knee. The eponymous term Pellegrini-Stieda lesion seems fitting, as it comprises two different thoughts on the origin of the lesion. MRI seems to be a noninvasive and quite accurate method for future research.

[Historical Changes in Meniscus Surgery--The Changing Appreciation of Disease, Surgical Techniques and Complications]. / Geschichtlicher Wandel der Meniskuschirurgie - Veränderungen in Krankheitsverständnis, Operationstechniken und Komplikationen.

The menisci play an important role in normal function of the knee joint. Meniscal injuries are associated with pain, swelling, impairment in function and activity level as well as early arthrosis of the knee joint. Patients with meniscal tears have to undergo surgery frequently. The pathway from the beginning of meniscal surgery to the modern arthroscopic meniscal surgery was not straightforward. The clinical picture of meniscal injuries, which caused articular trouble, was controversial for a long time. Meniscal surgery developed from knee joint surgery of the loose articular bodies. The first meniscal tear was not described until 1731. More than 100 years later, in 1866 the first planned meniscal surgery was performed. The importance of surgical techniques of meniscal resection and meniscal repair was emphasised in 1885. The beginning of knee joint arthroscopy took place in the 2nd decade of the 20th century. However, arthroscopy did not start its triumphal phase not until the 1960s coursing from Japan over North America to Europe. Approximately 150 years had passed from the risky arthrotomy surgeries of the past to the modern arthroscopic meniscal surgeries with low complication rates. Today, arthroscopic knee surgeries and especially arthroscopic meniscal surgeries are one of the most frequently performed orthopaedic procedures.

[Tutankhamun: evidence-based paleopathology versus "curse of the pharaoh"]. / Tutanchamun: Evidenzbasierte Paleopathologie vs. "Fluch des Pharao".

AIMS: Several speculations exist regarding possible diseases of the juvenile Pharaoh Tutankhamun. In this review published paleopathological findings and artificial alterations as well as suggestions regarding underlying diseases were characterized. MATERIAL AND METHODS: A selective search of the literature was carried out in the PubMed data base in an arbitrary time interval from 1960 to 2013 (search terms: Tutankhamun, Pharaoh, paleopathology and mummy) and additional supplementary literature. RESULTS: Many artificial changes were a result of embalming and the examinations which have been performed since exhumation in 1922. Evidenced pathologies are craniofacial dysmorphia, bilateral alterations of the feet, malarial disease and an acute traumatic fracture of the knee. The cause of the knee fracture could no longer be reconstructed. Other trauma (e.g. skull fractures) or familial transmission of an eighteenth dynasty syndrome could not be confirmed. CONCLUSION: In addition to many artificial post-mortem alterations, chronic and acute diseases could be verified in Tutankhamun, although the underlying causes are partially unknown.

The evolution of ACL reconstruction over the last fifty years.

Anterior cruciate ligament (ACL) reconstruction has evolved considerably over the past 30 years. This has largely been due to a better understanding of ACL anatomy and in particular a precise description of the femoral and tibial insertions of its two bundles. In the 1980s, the gold standard was anteromedial bundle reconstruction using the middle third of the patellar ligament. Insufficient control of rotational laxity led to the development of double bundle ACL reconstruction. This concept, combined with a growing interest in preservation of the ACL remnant, led in turn to selective reconstruction in partial tears, and more recently to biological reconstruction with ACL remnant conservation. Current ACL reconstruction techniques are not uniform, depending on precise analysis of the type of lesion and the aspect of the ACL remnant in the intercondylar notch.

Surgery for anterior cruciate ligament deficiency: a historical perspective.

The anterior cruciate ligament (ACL) has entertained scientific minds since the Weber brothers provided biomechanical insight into the importance of the ACL in maintaining normal knee kinematics. Robert Adams described the first clinical case of ACL rupture in 1837 some 175 years to date, followed by Mayo-Robson of Leeds who performed the first ACL repair in 1895. At that time, most patients presented late and clinicians started to appreciate signs and symptoms and disabilities associated with such injuries. Hey Groves of Bristol provided the initial description of an ACL reconstruction with autologous tissue graft in 1917, almost as we know it today. His knowledge and achievements were, however, not uniformly appreciated during his life time. What followed was a period of startling ingenuity which created an amazing variety of different surgical procedures often based more on surgical fashion and the absence of a satisfactory alternative than any indication that continued refinements were leading to improved results. It is hence not surprising that real inventors were forgotten, good ideas discarded and untried surgical methods adopted with uncritical enthusiasm only to be set aside without further explanation. Over the past 100 years, surgeons have experimented with a variety of different graft sources including xenograft, and allografts, whilst autologous tissue has remained the most popular choice. Synthetic graft materials enjoyed temporary popularity in the 1980 and 1990s, in the misguided belief that artificial ligaments may be more durable and better equipped to withstand stresses and strains. Until the 1970s, ACL reconstructions were considered formidable procedures, often so complex and fraught with peril that they remained reserved for a chosen few, never gaining the level of popularity they are enjoying today. The increasing familiarity with arthroscopy, popularised through Jackson and Dandy, and enhancements in surgical technology firmly established ACL reconstruction as a common procedure within the realm of most surgeons' ability. More recently, the principle of anatomic ACL reconstruction, aiming at the functional restoration of native ACL dimensions and insertion sites, has been introduced, superseding the somewhat ill-advised concept of isometric graft placement. Double-bundle reconstruction is gaining in popularity, and combined extra- and intra-articular procedures are seeing a revival, but more accurate and reliable pre- and post-operative assessment tools are required to provide customised treatment options and appropriate evaluation and comparability of long-term results. Modern ACL surgery is united in the common goal of re-establishing joint homoeostasis with normal knee kinematics and function which may ultimately assist in reducing the prevalence of post-operative joint degeneration. This review hopes to provide an insight into the historical developments of ACL surgery and the various controversies surrounding its progress. Level of evidence V.

[History of implant-free anterior cruciate ligament reconstruction]. / Geschichte des implantatfreien Kreuzbandersatzes.

Most recent articles on anterior cruciate ligament (ACL) reconstruction focus on anatomic tunnel placement, but reviewing the early history of ACL reconstruction it can be seen that at the beginning of the 20th century Ernest Hey-Groves had already pointed out the importance of anatomic placement of the tunnels. Palmer even developed a femoral drill guide for precise anatomic placing of the tunnel before World War II. The possibility of graft fixation without any fixation material is also not new and was described as early as 1967 by Brückner from Rostock. Many techniques in ACL reconstruction with non-anatomic placement and high failure rates could have been avoided if surgeons had been aware of what the early pioneers in this important field of orthopedic surgery had already described.

Historia natural de las roturas del ligamento cruzado anterior / The natural history of anterior cruciate ligament rupture

Existe cierto grado de incertidumbre en la historia natural de las roturas del ligamento cruzado anterior (LCA) tratadas conservadoramente. Esta revisión de la literatura demuestra que un paciente activo, con un LCA no funcionante, es susceptible de sufrir una lesión meniscal y de desarrollar cambios degenerativos en su rodilla. La reconstrucción del LCA con las técnicas actuales no previene el desarrollo de artrosis en la rodilla, probablemente, porque dichas técnicas son incapaces de restaurar la cinemática normal de la rodilla particularmente el control del desplazamiento medio-lateral y en rotación de la tibia respecto al fémur (AU)

A measure of uncertainty exists regarding the natural history of anterior cruciate ligament (ACL) rupture subjected to conservative management. This literature review shows that an active patient with a non-functioning ACL is susceptible to meniscal injury and the development of degenerative knee problems. Reconstruction of the ACL with the current techniques does not avoid the development of knee osteoarthritis, probably because they are unable to restore normal knee kinematics, particularly as refers to the control of mediolateral displacement with rotation of the tibia with respect to the femur (AU)

[History of surgery of the anterior cruciate ligament]. / Geschichte der Chirurgie des vorderen Kreuzbandes.

Early comments on the anterior cruciate ligament were found in ancient literature, and the first scientific reports were published in the nineteenth century. The first surgical treatment of a ruptured anterior cruciate ligament was carried out in 1895 by Robson performing a primary suture of the torn ligament. In 1903 F. Lange suggested a complete replacement of the injured ligament using silk ligaments and in 1914 Grekow was probably the first who recommended autogenous transplants by using a fascia lata strip. In 1917 Hey-Groves presented his surgical technique that was the fundament for reconstruction surgery in the following years. Today, the autogenous transplant is accepted to be the golden standard for replacement of the injured anterior cruciate ligament. The bone-tendon-bone transplant of the patellar ligament and the semitendinosus or gracilis tendon are recommended by most surgeons. In the history of anterior cruciate ligament surgery, the surgical technique of the operative procedures has also changed. The evolution started with open arthrotomy followed by mini-arthrotomy and led to arthroscopically assisted replacement of the anterior cruciate ligament.

[Historical development of sports orthopedics]. / Geschichtliche Entwicklung der Sportorthopädie.

The history of German sports medicine was decisively influenced by the surgeon August Bier at the beginning of the twentieth century. Initially, general medical and physiological problems were emphasized. Individual treatment of injured athletes played an increasing role at the end of last century. Operative treatment of injured athletes and earlier rehabilitation has changed therapeutic standards of orthopedic treatment. During critical discussion of the historical development of the treatment of ruptured anterior cruciate ligaments and meniscal tears, it becomes evident that treatment methods once rejected may now prove to be useful and correct.

Historic perspectives of treatment algorithms in knee dislocation.

Knee dislocation remains a devastating injury with many complications. It necessitates prompt diagnosis, reduction if needed, and emergent repair of any vascular injury. Serial physical examinations and frequent use of arteriograms are necessary to avoid late vascular complications. Many authors are concerned that normal pulses, normal Doppler signals, and normal ABIs have preceded late ischemia and documented intimal tear, demonstrated by arteriography. More recently, other authors have challenged the gold standard of mandatory arteriography by describing studies in which physical examination was 100% accurate in diagnosing patients without operative vascular injury. If pedal pulses, Doppler signals, or ABIs are asymmetric before or after reduction then either immediate operative exploration or arteriography should be performed. If the initial physical examination is normal, serial examinations are used in the hospital to check for late artery thrombosis. Opponents of mandatory arteriography point to a 5% false-negative rate, high cost, and an 8% complication rate, such as contrast allergy, pseudoaneurysm, local hematoma, and arteriovenous fistula. Today a consensus is that repair and reconstruction of the PCL and posterolateral corner injuries are the primary concerns in the multiple-ligament injured knee after dislocation. The ACL may be repaired later if instability persists, but some investigators believe it should not be repaired acutely, thereby avoiding increased surgical trauma and possible stiffness. Recently one of the goals of ligamentous repair and reconstruction has been to provide stability with the least invasive surgical technique to avoid postoperative stiffness. Recent treatments have focused on early arthroscopic-assisted allograft reconstruction of the ACL and PCL. Allograft provides a less invasive means of graft support than autograft. Early, limited range of motion in a brace helps to maintain flexion and extension.