Proximal rectus femoris avulsion in an elite, olympic-level sprinter.

Quadriceps injuries, ranging from simple strains to disabling muscle ruptures, are common athletic injuries. The rectus femoris is the most commonly injure portion of the quadriceps musculature. This article is, to our knowledge, the first report of a proximal rectus femoris avulsion in an elite, Olympic-level 100-meter sprinter, acutely managed with surgical repair. Several key factors must be considered and carefully assessed when determining the appropriate course of management (ie, deciding between operative and nonoperative treatment): amount of distal retraction of the tendon, severity of associated soft-tissue trauma, physical examination, and postoperative goals (eg, return to elite-level competitive sports involving running or kicking vs resuming basic activities of daily living). We believe that these factors in our elite, high-performance athlete dictated an operative course of management.

Chronic exertional compartment syndrome in a collegiate soccer player: a case report and literature review.

Chronic exertional compartment syndrome is a relatively rare condition among running athletes. In those who engage in repetitive activity, it can cause severe, debilitating leg pain. The diagnosis can be made with a thorough workup that includes history and physical examination, radiologic studies (x-rays, magnetic resonance imaging, bone scan), and compartment pressure monitoring. Most patients do not respond well to nonoperative intervention. Fasciotomy provides satisfactory relief of symptoms and helps patients return to their sports. We present the case of a high-level collegiate soccer player with chronic exertional compartment syndrome.

The use of hylan G-F 20 after knee arthroscopy in an active patient population with knee osteoarthritis.

PURPOSE: The purpose of this study was to evaluate the efficacy of hylan G-F 20 when used to treat an active and athletic patient population with knee osteoarthritis who had undergone knee arthroscopy for mechanical symptoms. METHODS: We performed a prospective evaluation of patients who underwent knee arthroscopy for mechanical symptoms. All patients had Outerbridge grade III or IV changes to their articular cartilage. If patients complained of residual pain or activity limitations postoperatively that was believed to be from osteoarthritis, they were treated with a series of hylan G-F 20 consisting of 3 weekly injections. International Knee Documentation Committee (IKDC) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores are reported for the time immediately before arthroscopy, at the time of the first hylan G-F 20 injection (baseline), at 3 months postoperatively, and at 6 months postoperatively. In addition, activity scores were calculated from a subset of the IKDC questionnaire before arthroscopy, at baseline, and at 3 months postoperatively. RESULTS: Fifteen patients completed 6 months' follow-up. Baseline and 3- and 6-month IKDC and WOMAC scores were significantly improved compared with before arthroscopy. There was no significant difference in 3- and 6-month scores compared with baseline. The activity scores at baseline and at 3 months showed significant improvement compared with before arthroscopy. The activity scores also showed significant improvement at 3 months compared with baseline. CONCLUSIONS: Hylan G-F 20 injections allow for improved activity levels at 3 months' follow-up. There was not a significant benefit of the injections when IKDC and WOMAC scores were evaluated. Hylan G-F 20 may be more beneficial for those patients who desire to increase their activity level rather than those who wish to decrease their pain. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Arthroscopic bursectomy with concomitant iliotibial band release for the treatment of recalcitrant trochanteric bursitis.

Trochanteric bursitis with lateral hip pain is a commonly encountered orthopaedic condition. Although most patients respond to corticosteroid injections, rest, physical therapy (PT), stretching, and anti-inflammatory medications, those with recalcitrant symptoms may require operative intervention. Studies have explored the use of the arthroscope in the treatment of these patients. However, these reports have not addressed the underlying pathology in this chronic condition. We believe that the iliotibial band must be addressed and is the main cause of pain, inflammation, and trochanteric impingement leading to the development of bursitis. We report a new technique for arthroscopic trochanteric bursectomy with iliotibial band release. Our technique involves 2 incisions--one 4 cm proximal to the greater trochanter along the anterior border of the iliotibial band, and the other 4 cm distal and along the posterior border. The 30 degrees arthroscope is introduced through the inferior portal, and a cannula is introduced through the superior portal. A 5.5-mm arthroscopic shaver is inserted through the superior cannula to clear off the surface of the iliotibial band, so that it may be adequately visualized. A hooked electrocautery probe is then used to longitudinally incise the iliotibial band until it no longer rubs, causing impingement over the greater trochanter.

Magnetic resonance imaging of the knee in asymptomatic professional basketball players.

PURPOSE: The purpose of this study was to evaluate the prevalence of articular cartilage lesions and meniscal tears on magnetic resonance imaging (MRI) scans in the knees of asymptomatic male professional basketball players. TYPE OF STUDY: A retrospective review. METHODS: Twenty players (40 knees) met the inclusion criteria of being signed by a National Basketball Association team and passing their preseason physical examination. All included athletes were assessed for the presence of articular cartilage lesions, meniscal pathology, and the presence of effusions. RESULTS: The overall prevalence of articular cartilage lesions on MRI was 47.5% in our study group. There were trochlear groove articular lesions in 25%. The lateral femoral condyle was involved in 2.5% of all knees. The medial femoral condyle was affected in 10% of all knees. The lateral tibial plateau showed articular cartilage lesions in 5%. The patella had articular cartilage lesions in 35%. The overall prevalence of various grade meniscal lesions was 20% on MRI. Medial intra-meniscal signals accounted for 87.5% and 12.5% on the lateral side. CONCLUSIONS: The results of our study show an equal to or higher prevalence of meniscal lesions in male professional basketball players than previously reported in the literature. We found a large number of patella-femoral articular cartilage lesions in our study population of male professional basketball players. These athletes perform at the highest demand level, which indicates that the presence of these lesions did not cause any symptoms. LEVEL OF EVIDENCE: Level IV, case series.

Arthroscopic meniscus repair with bioabsorbable arrows.

PURPOSE: The clinical results of a single surgeon's experience with Meniscus Arrows (Bionx, Blue Bell, PA) for meniscal repair are reviewed and reported to determine the safety and efficacy of this device. TYPE OF STUDY: Consecutive sample. METHODS: Over a 3-year period, the senior author has used only Meniscus Arrows for all meniscal repairs. All patients who underwent meniscal repair with at least 12 months of follow-up were evaluated for this study. Thirty patients had a meniscal repair, and 29 were available for follow-up. The average age at surgery was 29 years (range, 15 to 45 years) and there were 24 male and 5 female patients; 25 patients had an anterior cruciate ligament (ACL) reconstruction with the meniscal repair, 2 repairs were performed in ACL-deficient knees, and 2 repairs were performed in ACL stable knees. The average follow-up was 24 months (range, 12 to 42 months). RESULTS: The average Lysholm knee scores for ACL reconstruction, ACL-intact, and ACL-deficient knees improved from 47, 6, and 35, respectively, to 91, 96, and 81 postoperatively. Tegner activity scores improved from 2.7, 0, and 1.5, respectively, to 7.4, 6.5, and 4.5 after surgery. There were no surgical complications, no infections, and no neurovascular injuries. Five patients had mild subcutaneous irritation caused by the Arrow tips, but in each case this resolved within 3 to 7 months. There were 2 failures (7%) that required later arthroscopy and partial meniscectomy. One failure was in an ACL-deficient knee, and the other was in an ACL-reconstructed knee. CONCLUSIONS: Although the data presented in this report are based on short-term clinical follow-up, the preliminary results of the Meniscal Arrow repair are encouraging.

A More Comfortable Cast?

In brief This prospective study of 140 consecutive patients who needed cast immobilization tested the comfort, practicality, and possible cutaneous side effects of a waterproof cast liner that allows swimming, bathing, and hydrotherapy without special drying procedures. Minor cutaneous complications were observed in 4.3% of patients; none required medical care. Odor, itching, and difficulties with drying after wetting were minimal. Physician and patient satisfaction levels with the cast were high.