Biomedical subjects
Publications and source records attributed to J R McCarroll.
Golfers are athletes, for golf is a sport. To play it well, one must have athletic ability, strength, agility, coordination, and endurance. The golf swing is physically demanding and has contributed to overuse injuries in the upper extremity. The wrist, elbow, and shoulder are the most frequently injured joints.
Anterior cruciate ligament (ACL) injuries in skeletally immature adolescents are being diagnosed and reported with increasing frequency. Nonoperative management of mid-substance ACL injuries in adolescent athletes frequently results in a high incidence of giving-way episodes, recurrent meniscal tears, and early onset of osteoarthritis. An intraarticular ACL reconstruction (using the central 10-mm patellar tendon graft) in young athletes approaching skeletal maturity provides predictable excellent knee stability, and the athletes are able to return to competitive sports with a decreased risk of recurrent meniscal and/or chondral injury. Guidelines for the management of ACL injuries in skeletally immature adolescents are presented.
We report a series of 20 athletes with an ossicle associated with Osgood-Schlatter's disease (OSD) who underwent anterior cruciate ligament (ACL) reconstruction using autogenous, central-10-mm patellar-tendon graft. All patients had an Osgood Schlatter's lesion with an ossicle as seen on a plain radiograph. The patients were reviewed at an average follow-up of 44 months (range, 24 to 108 months). The postoperative assessment included clinical examination, KT-1000 testing, isokinetic testing, and subjective score (using the modified Noyes' questionnaire). At the time of latest review, all 20 patients had a stable knee. The average side-to-side difference on manual maximum KT-1000 assessment was 1.9 mm (range, 0 to 5 mm). Average time to return to full sporting activities was 5.2 months (range, 2.6 to 8.9 months). All patients returned to their previous level of activity. The mean modified Noyes' knee score was 96 (range, 89 to 100). To date, no graft failure has occurred. Based on the results of this study, we believe that ACL reconstruction using the autogenous bone-patellar tendon-bone graft can be safely undertaken in athletes with an ossicle associated with OSD without compromising the final knee function.
Although golf has not been recognized as a sport associated with injuries, epidemiologic studies document that back and elbow injuries are most common in male amateur golfers. Lower back and wrist injuries occur in the male golf professional while female professional golfers are more likely to suffer injuries to the wrist and lower back, respectively. The elbow, followed by the lower back, is the most likely area of injury associated with female amateur golfers. These injuries are related to overuse, poor conditioning, and improper swing mechanics. It is the hope of this author that more studies regarding the mechanics, prevention, and treatment of these injuries will be stimulated by this journal and others.
Complete midsubstance tears of the anterior cruciate ligament (ACL) in skeletally-immature adolescents are being diagnosed and reported with increasing frequency. Conservative treatment of such ACL tears in junior high schools, subsequent meniscal tears, and very early osteoarthritis. Results of primary repair of the torn ACL and extra-articular reconstructive procedures have been disappointing. Intra-articular ACL reconstruction in young athletes approaching skeletal maturity using the autogenous patellar tendon graft gives excellent knee stability, and decreases the risk of meniscal tears. Athletes are able to return to competitive sports at their preinjury level. Here, the existing literature on the subject of midsubstance ACL tears in young athletes is reviewed, and guidelines for the management of ACL-deficient knee in this population are provided.
Complete knee dislocations are infrequent but serious injuries resulting from a wide spectrum of traumatic events. Significant soft tissue and ligamentous damage usually result. Previous experience and several reports in the literature had led us to believe that complete dislocations were associated with both ACL and PCL rupture. Three cases of documented complete knee dislocation in which the PCL is preserved intact are presented.
Complete knee dislocation is an uncommon but potentially devastating injury with a reported high rate of neurovascular injury. Treatment of this ligamentous injury is controversial. The operative (repair of all ligaments) and nonoperative management of ligament injuries appears to result in a stiff knee (decreased range of motion [ROM]), and/or a significant incidence of clinical instability and pain. We report our data on low-velocity knee dislocations and present a treatment plan of noninvasive assessment of the vascular status, a stabilizing procedure centered on posterior cruciate ligament reconstruction (PCL) and an aggressive rehabilitation program that can result in improved ROM, acceptable stability, and a more optimal functional outcome.
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Health effects associated with electricity production, especially air pollution from fossil fuel combustion, have received much attention in the past 30 years. Virtually no attention has been paid to the health costs of a reduced or overpriced energy supply although these are real and formidable. Stringent regulations mandating control technology on stack emissions and/or burning of low sulfur fuels have been promulgated which cost the American public billions of dollars. These have indeed alleviated some health problems, but pressures to further tighten regulations offer little chance of further health benefits commensurate with their cost and are most likely to produce a new series of problems.
In a retrospective review of 184 knees treated for surgically diagnosed chondromalacia of the patella, the average follow-up period was 3.9 years. The treatment rendered included trephine and drilling in 71 knees, facetectomy in 57 knees, shaving in 35 knees, and a combination procedure in 21 knees. Knees were graded as 2, 3, or 4, depending on the depth and severity of the lesion. The best results were in Grades 2 and 3 disease treated by trephine and drilling or facetectomy. Six patients required further patellar surgery during the follow-up period. The purpose of surgical treatment of the patellar articular surface is to relieve pain and preserve the mechanical advantage of the patella for normal knee function.
A 20-year-old male athlete had painful triggering and occasional locking of the great toe caused by entrapment of the flexor hallucis longus tendon within the flexor tendon sheath posterior to the left medial malleolus. No rupture of the tendon fibers, tendonitis, or supernumerary muscle was found. At open operation an elongated flexor hallucis longus was found entrapped under the tendon sheath in the ankle. After other therapy methods failed, the condition was relieved by a surgical procedure that released the flexor hallucis longus muscle from the tendon sheath.
An acute monoarticular infection of the sternoclavicular joint due to coagulase-positive Staphylococcus aureus occurred without predisposing factors in a 48-year-old man. Pyogenic infection must be considered as a cause of pain and swelling of the sternoclavicular joint. Correctly diagnosed and promptly treated, the end results of sternoclavicular joint infection can be excellent.
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