Incidence and variance of knee injuries in elite college football players.

Knee injuries are among the most common musculoskeletal injuries in US football players. The literature includes little information about the role of player position and risk for knee injury. We hypothesized that the incidence of knee injury in elite collegiate US football players is high and that type of injury varies by player position. We evaluated 332 elite collegiate US football players at the 2005 National Football League Combine. All players underwent radiographic examinations, including plain x-rays and/or magnetic resonance imaging when necessary. All knee pathologic conditions and surgical procedures were recorded. Data were analyzed by player position to detect any trends. Fifty-four percent (179) of the 332 players had a history of knee injury; knee injuries totaled 233 (1.3/player injured). Eighty-six players (25.9%) had a total of 114 surgeries. The most common injuries were medial collateral ligament injury (n = 79), meniscal injury (n = 51), and anterior cruciate ligament (ACL) injury (n = 40). The most common surgeries were arthroscopic meniscectomy (n = 39), ACL reconstruction (n = 35), and arthroscopic meniscal repair (n = 13). A history of knee injury was most common in defensive linemen (68% of players), tight ends (57%), and offensive linemen (57%). Knee surgery was more commonly performed on running backs (36%) and linebackers (34%). There were no significant associations between type or frequency of specific injuries with regard to player position. Knee injuries are common injuries in elite collegiate football players, and one fourth of these players undergo surgical procedures. However, there were no statistically significant differences in type or frequency of injuries by player position.

Anteromedial portal technique for creating the anterior cruciate ligament femoral tunnel.

There has been a renewed focus on anterior cruciate ligament (ACL) insertional anatomy and its biomechanics. It has been postulated that traditional single-bundle transtibial reconstructions have placed grafts in a less anatomic location relative to the true ACL insertion site. In traditional transtibial techniques, the femoral tunnel is predetermined by the position of the tibial tunnel. It is our belief that achieving the most anatomic position for the graft requires the femoral and tibial tunnels to be drilled independently. Use of the anteromedial portal technique provides us with more flexibility in accurately placing the femoral tunnel in the true ACL insertion site as compared with the transtibial technique. Advantages include anatomic tunnel placement, easy preservation of any remaining ACL fibers when performing ACL augmentation procedures, and flexibility in performing either single- or double-bundle reconstructions in primary or revision settings. This technique is not limited by the choice of graft or fixation and offers the advantage of true parallel screw placement through the same portal as that used for tunnel drilling in the case of interference fixation.

The diagnostic and predictive value of hip anesthetic arthrograms in selected patients before total hip arthroplasty.

Concurrent osteoarthritis of the hip and lumbar spine occurs frequently. Our study tests the hypothesis that hip anesthetic arthrograms can be used as predictive diagnostic tool before total hip arthroplasty when standard evaluation techniques fail to provide convincing evidence of the source of pain. Thirty-four consecutive hip anesthetic arthrograms were reviewed retrospectively. Quantified outcome measures included Visual Analog Pain Score, Harris Hip Score, and patient satisfaction. The pain relief after hip anesthetic arthrogram accurately predicted pain relief after hip arthroplasty (positive predictive value = 95.23%, negative predictive value = 87.5%). Our study supports the selected use of hip anesthetic arthrograms in the preoperative assessment of patients with concurrent hip and lumbar spine osteoarthritis associated with nondiagnostic history and physical examinations.

Hip function in adults with severe cerebral palsy.

BACKGROUND: The reported prevalence of hip pain in patients with severe cerebral palsy has varied widely. It is unclear whether surgical treatment is indicated for progressive hip subluxation in immature patients with severe involvement. In the present study, we evaluated seventy-seven adults who were profoundly affected with cerebral palsy to determine if either spastic hip displacement (subluxation or dislocation) or osteoarthritis was associated with hip pain and/or diminished function. METHODS: Data regarding the medical history, level of function, pain, and use of analgesics were obtained from a review of medical records and from caregiver interviews. The range of motion of the hip, the degree of spasticity, the presence of pressure ulcers, and changes in vital signs as well as in the Face, Legs, Activity, Cry, and Consolability behavioral pain score were documented. Radiographs of the pelvis and spine were blindly evaluated for evidence of osteoarthritis and subluxation or dislocation. Statistical analysis was performed in order to identify associations between the medical history, the physical examination findings, and the radiographic measurements. RESULTS: The study group included seventy-seven adult subjects (thirty-eight men and thirty-nine women) with a mean age of forty years. Twenty-three (15%) of the 154 hips in these subjects were dislocated, eighteen (12%) were subluxated, and thirty-five (23%) had radiographic evidence of osteoarthritis. Twenty-eight (18%) of the 154 hips were definitely painful, and sixty-nine (45%) were definitely not painful. Increased hip pain and problems with perineal care were noted in patients with decreased hip abduction (<30 degrees ) (p = 0.01), windswept hip deformities (p = 0.02), and flexion contractures of >30 degrees (p = 0.07). Increased spasticity was associated with higher rates of osteoarthritis, dislocation, pain, and pressure ulcers. Spastic hip subluxation or dislocation was significantly associated with osteoarthritis (p = 0.0001), but not with hip pain. There was no association between radiographic evidence of osteoarthritis and hip pain. CONCLUSIONS: Neither hip displacement (i.e., subluxation or dislocation) nor osteoarthritis was found to be associated with hip pain or diminished function. Because the prevalence of hip pain is low and is not associated with hip displacement or osteoarthritis, we suggest that surgical treatment of the hip in severely affected patients be based on the presence of pain or contractures and not on radiographic signs of hip displacement or osteoarthritis. LEVEL OF EVIDENCE: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

Non-evidence-based use of Rho(D) immune globulin for threatened abortion by family practice and obstetric faculty physicians.

OBJECTIVE: To examine the practice patterns and differences between faculty members in obstetrics and gynecology (OB/G) and family practice (FP) residency programs in administering Rho(D) immune globulin (RhIG) for threatened abortion. STUDY DESIGN: A questionnaire was mailed to 50% (222) of all FP residencies and 100% (267) of OB/G programs in the United States. The obstetric curriculum coordinator at each FP residency and the director of obstetrics or maternal-fetal medicine at each OB/G residency were asked to respond. A total of 156 (70%) FP questionnaires and 186 (70%) OB/G questionnaires were returned after two mailings. RESULTS: Seventy-six percent of FP faculty and 85% of OB/G faculty reported giving RhIG in threatened abortion. Physicians with advanced training were more likely to recommend giving RhIG. CONCLUSION: Most FP and OB/G residency faculty report using RhIG in threatened abortion. The practice has become part of the medical culture despite the lack of supporting evidence and should be revaluated in that light.