BACKGROUND:

Few studies have documented catastrophic head and neck injuries in judo, but these injuries deserve greater attention.

PURPOSE:

To determine the features of catastrophic head and neck injuries in judo.

STUDY DESIGN:

Descriptive epidemiological study.

METHODS:

This study was based on the accident reports submitted to the All Japan Judo Federation's System for Compensation for Loss or Damage. A total of 72 judo injuries (30 head, 19 neck, and 23 other injuries) were reported between 2003 and 2010. The investigated parameters were mechanism of injury, age at time of injury, length of judo experience, diagnosis, and outcome.

RESULTS:

Among head injuries, 27 of 30 (90%) occurred in players younger than 20 years of age. The relationship between age, mechanism, and location of injury was more relevant when players younger than 20 years incurred head injury while being thrown (P = .0026). Among neck injuries, 13 of 19 (68%) occurred in players with more than 36 months of experience. The relationship between experience, mechanism, and location of injury was more relevant when experienced players incurred neck injury while executing an offensive maneuver (P = .0294). Acute subdural hematoma was diagnosed in 94% of head injuries. The outcomes of head injury were as follows: 15 players died; 5 were in a persistent vegetative state; 6 required assistance because of higher brain dysfunction, hemiplegia, or aphasia; and 4 had full recovery. Among neck injuries, 18 players were diagnosed with cervical spine injury, 11 of whom had fracture-dislocation of the cervical vertebra; there was also 1 case of atlantoaxial subluxation. The outcomes of neck injury were as follows: 7 players had complete paralysis, 7 had incomplete paralysis, and 5 had full recovery.

CONCLUSION:

Neck injuries were associated with having more experience and executing offensive maneuvers, whereas head injuries were associated with age younger than 20 years and with being thrown.

BACKGROUND:

Osteochondritis dissecans (OCD) is an acquired lesion of the subchondral bone that may result in separation and instability of the overlying articular cartilage. Unstable lesions must be treated surgically to reestablish the joint surface as anatomically as possible.Hypothesis/

PURPOSE:

The aim of this study was to evaluate the potential of a biomimetic osteochondral scaffold to treat OCD by analyzing the results obtained at 2-year follow-up. The hypothesis was that this scaffold, which was developed to treat the entire osteochondral unit, might restore the articular surface and improve symptoms and function in patients affected by knee OCD.

STUDY DESIGN:

Case series; Level of evidence, 4.

METHODS:

Twenty-seven consecutive patients (19 men, 8 women; age [mean ± SD], 25.5 ± 7.7 years) who were affected by symptomatic knee OCD of the femoral condyles (average defect size 3.4 ± 2.2 cm(2)), grade 3 or 4 on the International Cartilage Repair Society (ICRS) scale, were enrolled and treated with the implantation of a 3-layer collagen-hydroxyapatite scaffold. Patients were prospectively evaluated by subjective and objective International Knee Documentation Committee (IKDC) and Tegner scores preoperatively and at 1- and 2-year follow-up. An MRI was also performed at the 2 follow-up times.

RESULTS:

A statistically significant improvement in all clinical scores was obtained at 1 year, and a further improvement was found the following year. At the 2-year follow-up, the IKDC subjective score had increased from 48.4 ± 17.8 preoperatively to 82.3 ± 12.2, the IKDC objective evaluation from 40% to 85% of normal knees, and the Tegner score from 2.4 ± 1.7 to 4.5 ± 1.6. The MRI evaluations showed good defect filling and implant integration but also inhomogeneous regenerated tissue and subchondral bone changes in most patients at both follow-up times. No correlation between the MOCART (magnetic resonance observation of cartilage repair tissue) score and clinical outcome was found.

CONCLUSION:

This biomimetic osteochondral scaffold seems to be a valid treatment option for knee OCD, showing a good clinical outcome at 2-year follow-up. Moreover, the improvement was not correlated with lesion size, so large lesions can benefit from this implant. Less favorable findings were obtained with MRI evaluation.

BACKGROUND:

In anterior cruciate ligament (ACL) reconstruction, the transtibial (TT) technique often creates a nonanatomically placed femoral tunnel, which is a frequent cause of surgical failure and postsurgical knee instability. Several studies reported that drilling the femoral tunnel through an anteromedial portal (AMP) yields a more anatomic tunnel position compared with the TT technique.

PURPOSE:

To compare the effectiveness of these two surgical techniques in restoring the intact knee joint kinematics during a physiological loading situation.

STUDY DESIGN:

Controlled laboratory study.

METHODS:

Twenty-four patients (TT, n = 12; AMP, n = 12; sex, weight, and height matched, and half with dominant leg involved) who underwent unilateral single-bundle ACL reconstruction by the same surgeon were recruited. Twenty healthy patients with no history of lower limb injuries were recruited as the control group. Tibiofemoral joint motion in 6 degrees of freedom (3 translations and 3 rotations) was determined during level walking by using a least mean square-based optimization algorithm. A redundant marker set was used to improve the accuracy of the motion analysis. Knee joint kinematics as well as spatiotemporal parameters were compared between these two techniques.

RESULTS:

The AMP technique restored the anterior-posterior translation of the knee joint, while the TT technique resulted in significantly greater (TT, 22.2 mm vs controls, 13.2 mm; P < .01) anterior femoral translations than in the healthy controls during the swing phase. Excessive femoral external (tibial internal) rotation (3.8°; P < .05) was found at midstance in the knees that were reconstructed using the TT technique; using the AMP technique, the external rotation offset was greatly reduced during the stance phase. However, knees repaired using the AMP technique were significantly less extended (5°; P < .05) compared with the knees of the controls during the late stance phase. Neither surgical technique restored the superior-inferior femoral translation to the intact level during the swing phase.

CONCLUSION:

The AMP technique better restores the anterior-posterior translation during the swing phase and femoral external rotation at midstance than the TT technique does. However, the AMP technique is also correlated with an extension loss during the late stance phase.

CLINICAL RELEVANCE:

The AMP femoral tunnel drilling technique can improve overall knee joint stability, but the increased difficulty with full extension may need to be considered.

BACKGROUND:

Infections after anterior cruciate ligament reconstruction (ACLR) can be devastating. Hamstring tendon autografts may be more susceptible to infections than other graft types.

PURPOSE:

To determine the incidence of surgical site infections (SSIs) in a large sample of patients who underwent ACLR and to evaluate the risk of superficial and deep SSIs associated with grafts used for ACLR.

STUDY DESIGN:

Cohort study; Level of evidence, 2.

METHODS:

All primary ACLRs performed between February 2005 and September 2010 registered in the Kaiser Permanente ACLR registry were included in the study. The graft types evaluated included the bone-patellar tendon-bone (BPTB) autograft, hamstring tendon autograft, and allograft (all types). The main end point of the study, SSIs (deep and superficial), was prospectively ascertained using an electronic screening algorithm and adjudicated by the principal investigator. Descriptive statistics were used to describe the cohort, and logistic regression models were used to evaluate the likelihood of an infection.

RESULTS:

There were 10,626 cases that fit the study criteria. The overall cohort was 64% male, mean age was 29 ± 11 years, and mean body mass index (BMI) was 27 ± 5 kg/m(2). The overall incidence of SSIs was 0.48% (n = 51), with 17 (0.16%) superficial infections and 34 (0.32%) deep infections. Hamstring tendon autografts (n = 20; 0.61%) had the highest incidence of deep SSIs of the graft types (BPTB autograft, n = 2 [0.07%]; allograft, n = 12 [0.27%]; P < .001). After adjusting for age, sex, and BMI, the likelihood of a patient with a hamstring autograft having a deep SSI was 8.24 times higher (95% CI, 1.91-35.55; P = .005) than someone receiving a BPTB autograft. The risk of infections in allografts was not statistically significantly higher than BPTB autografts.

CONCLUSION:

The overall SSI rate after ACLR was 0.48%. Deep SSIs were identified in 0.32% of the ACLR cases and superficial SSIs in 0.16%. An 8.2-times higher risk of SSIs was observed in hamstring tendon autografts compared with BPTB autografts. No difference in SSI incidence was identified between allografts and BPTB autografts. Surgeons should bear in mind that although the overall infection rates after ACLR are low, there is an increased risk of deep infections with hamstring tendon autografts.

BACKGROUND:

The repetitive, excessive compression forces in the radiocapitellar joint caused by elbow valgus stresses during throwing motions can result in osteochondritis dissecans (OCD) of the humeral capitellum in adolescent athletes.

PURPOSE:

To assess the effect of elbow valgus torque on contact pressure in the radiocapitellar joint and that of central and lateral capitellar osteochondral defects on radiocapitellar joint contact pressure, elbow valgus laxity, and ulnar collateral ligament (UCL) strain.

STUDY DESIGN:

Controlled laboratory study.

METHODS:

In 8 matched pairs of fresh-frozen cadaveric upper limbs, lateral osteochondral defects of the humeral capitellum (5-, 10-, 15-, and 20-mm diameters) were evaluated in one side, and central defects were evaluated in the contralateral side. Radiocapitellar joint contact pressure, elbow valgus laxity, and UCL strain were all measured with and without 2 N·m of valgus torque at 30°, 60°, and 90° of elbow flexion in neutral forearm rotation.

RESULTS:

Applying valgus torque increased contact pressure in radiocapitellar joints with intact or damaged capitula. Contact pressure in joints with 15-mm (90° of elbow flexion) and 20-mm (60° and 90° of elbow flexion) lateral capitellar defects was greater than that in joints with intact capitula. Radiocapitellar contact pressure was greater with a 20-mm lateral capitellar defect than in the same-sized central defect at 60° and 90° of elbow flexion. In both central and lateral defect groups, elbow valgus laxity increased as the size of the capitellar defect increased, and UCL strain remained unchanged regardless of the size of the capitellar defect.

CONCLUSION:

Elbow valgus torque increases contact pressure in the radiocapitellar joint. Capitellar osteochondral defects increase elbow valgus laxity and contact pressure without increasing UCL strain. When valgus torque is applied, contact pressure in the radiocapitellar joint is greater with a lateral defect than with a central defect.

CLINICAL RELEVANCE:

Adolescent baseball players with capitellar OCD should stop throwing, even if the UCL is intact, to prevent exacerbating the osteochondral defect. Lateral capitellar OCD is more severe than central capitellar OCD.

BACKGROUND:

Although many authors report on acute injuries and chronic injuries in the orthopaedic literature, the actual terms are seldom explicitly defined.

HYPOTHESIS:

Much of the literature pertaining to sports injuries that are acute or chronic does not define these terms. It is believed that definitions will provide clarity and specificity in future literature.

STUDY DESIGN:

Systematic review.

METHODS:

A systematic review of 116 articles was conducted to determine whether and how the terms acute and chronic were defined as they pertain to several commonly treated conditions: Achilles tendon rupture, distal biceps tendon rupture, pectoralis major tendon rupture, anterior cruciate ligament (ACL) tear, anterior shoulder instability, and acromioclavicular (AC) joint dislocation. Articles were isolated from various databases and search engines by use of keywords to identify relevant literature.

RESULTS:

This study determined that the terms acute and chronic for each injury are defined, respectively, as follows: Achilles tendon rupture: <1 week, >4 weeks; distal biceps tendon rupture: <6 weeks, >12 weeks; pectoralis major tendon rupture: <6 weeks, >6 weeks; ACL tear: <6 weeks, >6 months; anterior shoulder instability: <2 weeks, >6 months; AC joint dislocation, <3 weeks, >6 weeks.

CONCLUSION:

The current literature varies greatly in defining the terms acute and chronic in common sports injuries. The vast majority of authors imply these terms, based on the method of their studies, rather than define them explicitly. Injuries involving tendons showed greater consistency among authors, thus making a definition based on consensus easier to derive. The literature on ACL and shoulder instability in particular showed great variability in defining these terms, likely representing the more complex nature of these injuries and the fact that timing of surgery in the majority of patients does not particularly affect the complexity of the surgical approach and treatment.

CLINICAL RELEVANCE:

Defining injuries as acute or chronic is clinically relevant in many cases, particularly concerning tendon injuries, where these terms have implications regarding the anatomic pathologic changes and tissue quality, which may necessitate augmentation and alter the initial surgical plan. In cases where these terms are less pertinent to operative treatment considerations, they bring clarity to the discussion of the acuity of the injury (as it pertains to time from insult).

BACKGROUND:

Bone bruising, commonly found on magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) injury, may be associated with intra-articular injuries, but little is known about this association.

PURPOSE:

To examine demographic factors and intra-articular injuries associated with bone bruising in patients undergoing ACL reconstruction.

STUDY DESIGN:

Case-control study; Level of evidence, 3.

METHODS:

Patients with ACL injury who had an MRI within 6 weeks and arthroscopy within 3 months of injury were included in this prospective study (N = 171). Presence and severity of bone bruising were determined from preoperative MRIs for each anatomic site: lateral femoral condyle (LFC), lateral tibial plateau (LTP), medial femoral condyle (MFC), and medial tibial plateau (MTP). Multiple logistic regression was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for predictors of bruising and associations between bruising and intra-articular injuries found during arthroscopy. Outcomes included the presence of bruising and severity of lateral bruising (mild, moderate, severe vs none/minimal bruising).

RESULTS:

Frequencies of bone bruising were as follows: 85% LTP, 77% LFC, 26% MTP, and 6% MFC. Patient age between 18 and 28 years (OR, 0.27; 95% CI, 0.09-0.82) and 29 years and older (OR, 0.18; 95% CI, 0.05-0.61) predicted less LFC bruising compared with patients aged 17 years and younger. Age (18-28 years: OR, 0.15; 95% CI, 0.03-0.66; ≥29 years: OR, 0.10; 95% CI, 0.02-0.68) and contact injuries (OR, 0.17; 95% CI, 0.04-0.78) predicted less moderate LFC bruising. Male sex predicted mild (OR, 6.16; 95% CI, 1.44-26.43), moderate (OR, 8.98; 95% CI, 1.96-41.19), and severe (OR, 15.66; 95% CI, 3.19-76.92) LFC bruising. Male sex also predicted mild LTP bruising (OR, 0.19; 95% CI, 0.05-0.83), and contact injuries predicted severe LTP bruising (OR, 5.01; 95% CI, 1.21-20.67). LFC bruising (OR, 2.57; 95% CI, 1.04-6.32) and LTP bruising (OR, 3.13; 95% CI, 1.06-9.23) were associated with lateral meniscal tears. Moderate (OR, 8.14; 95% CI, 1.93-34.27) and severe (OR, 15.30; 95% CI, 2.34-100.10) LTP bruising was associated with medial meniscal tears. MFC bruising and MTP bruising were not associated with any predictors or intra-articular injuries.

CONCLUSION:

Bone bruising is more common and severe in young men, and lateral bone bruising is associated with lateral meniscal tears. Medial meniscal tears are associated with increased severity of LTP bruising.