The effect of foot structure and range of motion on musculoskeletal overuse injuries.

The purpose of this prospective study was to determine whether an association exists between foot structure and the development of musculoskeletal overuse injuries. The study group was a well-defined cohort of 449 trainees at the Naval Special Warfare Training Center in Coronado, California. Before beginning training, measurements were made of ankle motion, subtalar motion, and the static (standing) and dynamic (walking) characteristics of the foot arch. The subjects were tracked prospectively for injuries throughout training. We identified risk factors that predispose people to lower extremity overuse injuries. These risk factors include dynamic pes planus, pes cavus, restricted ankle dorsiflexion, and increased hindfoot inversion, all of which are subject to intervention and possible correction.

Anterior cruciate ligament reconstruction in the military patient.

This study prospectively evaluates the likelihood of a return of military personnel to full duty after anterior cruciate ligament reconstruction. We report the results of 120 active duty military patients who underwent anterior cruciate ligament reconstruction with autogenous patella tendon. Mean follow-up was 29 months (range, 24-65 months). Time from injury to reconstruction was > 6 months in 90% of patients. Final Lysholm scores averaged 89 (range, 29-100). We found that 77% of patients returned to full duty, whereas 23% of patients were medically discharged from military service. The patient age, military rank, time from injury to surgery, and KT-1000 measurements did not correlate with either the Lysholm score or return to duty (p = 0.05). Severe chondromalacia (Outerbridge III or IV) did correlate with poor result (p = 0.043), and Lysholm score did correlate with return to duty (p = 0.003). Anterior cruciate ligament reconstruction offers a higher likelihood of return to full military duty than nonoperative treatment in a similar study.

The incidence of deep venous thrombosis in anterior cruciate ligament reconstruction.

We prospectively studied the incidence of deep venous thrombosis (DVT) in anterior cruciate ligament reconstruction. A total of 67 male patients (aged 19 to 39 years) were examined by compression ultrasonography to determine the presence of DVT in the operated extremity. All patients were studied preoperatively and 2 to 3 days postoperatively. The area of examination was from popliteal vein to inguinal ligament; no DVT prophylaxis was used. No patient had clotting preoperatively. The incidence of DVT was 1 in 67. One patient had an asymptomatic noncompressible lesion in the proximal femoral vein on postoperative day 3; repeat examination at day 10 was normal. Unless other risk factors are present, we do not recommend routine prophylaxis for male patients younger than 40 years of age who are undergoing anterior cruciate ligament reconstruction.

Patella infera following arthroscopic anterior cruciate ligament reconstruction.

Fifty patients who had an arthroscopic anterior cruciate ligament reconstruction for chronic insufficiency were reviewed at an average of 13.6 months following surgery. Among these patients, 32% complained of anterior knee pain that interfered with daily activities. Radiographic patella infera was present in 12% of patients using the Insall-Salvati ratio and in 16% using the Blackburne-Peel ratio. Radiographic patella infera did not correlate with the clinical problem of postoperative anterior knee pain. However, loss of knee extension of greater than 5 degrees correlated highly with pain (p=0.002).