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Archive for July, 2010

Thumb Injuries in Intercollegiate Men’s Lacrosse

Thursday, July 1st, 2010

Abstract

Background Men’s intercollegiate lacrosse is played at a fast pace and with significant force. Glove protection is required. However, the thumb is at risk because of contact with opponents’ sticks, the ball, other players, and the ground or artificial surface.

Purpose To characterize patterns of hand injuries in men’s intercollegiate lacrosse and to compare them with those in similar intercollegiate stick-handling sports that require gloves.

Study Design Descriptive epidemiology study.

Methods The National Collegiate Athletic Association (NCAA) Injury Surveillance System was utilized to evaluate thumb injuries in intercollegiate stick-handling sports (men’s lacrosse, women’s lacrosse, and men’s ice hockey) during 16 intercollegiate seasons. Injuries were defined as events requiring an athlete to seek medical treatment and miss competition. Data were collected for injuries to the thumb, phalanges, and hand. Descriptive statistics were performed to calculate rates of injury per 1000 athlete-exposures and the relative exposure of the thumb with respect to total hand injuries. χ2 testing with the Yates correction for continuity was performed to determine differences in proportions of injury among the 3 sports studied.

Results During 16 intercollegiate seasons, there were 692 thumb, finger, and hand injuries in 3 038 255 athlete-exposures. Total thumb injuries were significantly higher in men’s lacrosse, accounting for 59.4% of total hand injuries, when compared with women’s lacrosse (42%) and men’s ice hockey (35.8%) (P <.001). Thumb fractures and contusions were each also found to be significantly more prevalent (P <.001) when compared with women’s lacrosse and men’s ice hockey.

Conclusion Men’s intercollegiate lacrosse requires the use of gloves; nonetheless, injury rates of the thumb are significantly elevated in this sport compared with other gloved, stick-handling sports. Recommendations include the development of gloves with improved thumb protection.

  1. Andrea L. Bowers, MD,
  2. John G. Horneff,
  3. Keith D. Baldwin, MD, MPH, MSPT,
  4. G. Russell Huffman, MD, MPH and
  5. Brian J. Sennett, MD*

Posted in General | Email Us

Factors Involved in the Development of Osteoarthritis After Anterior Cruciate Ligament Surgery

Thursday, July 1st, 2010

Abstract

Background The incidence of osteoarthritis after anterior cruciate ligament reconstruction is disturbingly high, with reports of nearly 50% of patients developing mild to moderate osteoarthritis 6 years after surgery. Few studies have assessed the factors involved in the development of osteoarthritis.

Hypothesis The following 10 factors will be found to be predictive of osteoarthritis: meniscectomy, chondral damage, patellar tendon grafting, age at surgery, time delay between injury and surgery, type and intensity of postsurgery sport, quadriceps strength, hamstring strength, quadriceps-to-hamstring strength ratio, and residual joint laxity.

Study Design Cohort study (prognosis); Level of evidence, 1.

Methods Fifty-six subjects with anterior cruciate ligament reconstruction were followed for 6 years after surgery. Assessment included KT-1000 arthrometer testing, isokinetic strength testing, a return-to-sport questionnaire, and a radiograph assessment. A discriminant analysis was performed to assess which of the 10 factors could discriminate between those patients who developed tibiofemoral and patellofemoral osteoarthritis and those who did not.

Results Five factors were found to be predictive of tibiofemoral osteoarthritis. Meniscectomy (r = .72) and chondral damage (r = .41) were the strongest discriminators, followed by patellar tendon grafting (r = .37) (χ2 [7, n = 56] = 25.48; P = .001). Weak quadriceps (r = .39) and low quadriceps-to-hamstring strength ratios (r = .6) were very close discriminators (χ2 [8, n = 42] = 15.02; P = .059). For patellofemoral osteoarthritis, meniscectomy (r = .45), chondral damage (r = .75), and age at surgery (r = .65) were predictors or close predictors (χ2 [7, n = 54] = 13.30; P = .065).

Conclusion As not all 10 factors studied were predictive of osteoarthritis, the hypothesis was only partially proven. Preventing further meniscal and chondral damage in patients with anterior cruciate ligament deficiency is critical. Grafting using the hamstring tendons and restoration of quadriceps-to-hamstring strength balance are associated with less osteoarthritis.

  1. Susan L. Keays, PT, PhD†‡*,
  2. Peter A. Newcombe, PhD§,
  3. Joanne E. Bullock-Saxton, PT, PhD||,
  4. Margaret I. Bullock, PT, PhD, AM, FTSE|| and
  5. Anthony C. Keays, MD‡

Posted in Clinical Research | Email Us

Accuracy of the Anterior Apprehension Test as a Predictor of Risk for Redislocation After a First Traumatic Shoulder Dislocation

Thursday, July 1st, 2010

Abstract

Background The treatment options for a first traumatic shoulder dislocation in a young patient are either nonoperative care or primary surgery. It would be valuable to find patient-specific assessments that could predict the risk for redislocation in these patients and thereby identify those who would benefit from primary surgery.

Hypothesis The supine apprehension test, performed after completion of physical therapy in first traumatic shoulder dislocators, can predict risk for redislocation. Patients with a positive test would be at very high risk for redislocation and therefore would be candidates for primary surgery.

Study Design Cohort study (prognosis); Level of evidence, 2.

Methods Men aged 17 to 27 years who sustained first traumatic shoulder dislocations were treated in a shoulder immobilizer for 4 weeks and then treated according to a physical therapy protocol. At the 6-week follow-up, an anterior apprehension test was performed to assess risk of redislocation. Follow-up of patients was done at 3 months, 6 months, 1 year, and 2 years. Follow-up continued yearly for up to another 2 years.

Results Fifty-two men with a mean age of 20.3 years (standard deviation, 2.5) participated. Seventy-nine percent were combat soldiers. Twenty-four participants (46.2%) sustained redislocation. The minimum follow-up period was 24 months (range, 24–48 months; mean, 39.6 months). Redislocations were sustained in 36.8% of participants with negative apprehension tests and 71.4% with positive tests (P = .03). The odds ratio was 4.285 (95% confidence interval, 1.129–16.266). The sensitivity of the apprehension test was 41.7% and the specificity was 85.7%.

Conclusion The anterior apprehension test performed 6 to 9 weeks after a first traumatic dislocation is not a definitive tool to predict risk for recurrent dislocation. It can, however, categorize patients into groups at higher and lower risk for recurrence. The redislocation rate found in this study is less than that of previous reports.

Ori Safran, MD*, Charles Milgrom, MD*†, Denitsa R. Radeva-Petrova, MPH*, Saleh Jaber* and  Aharon Finestone, MD

Posted in Injury Prevention | Email Us