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L J Micheli

Publications and source records attributed to L J Micheli.

At least 19 recordsLinked to original sources
PubMed2001

Elbow arthroscopy in the pediatric and adolescent population.

PURPOSE: The purpose of this study was to show the diagnostic and therapeutic benefits of elbow arthroscopy in athletically active pediatric patients. We describe our techniques for elbow arthroscopy in young patients. TYPE OF STUDY: Case series of 47 patients. METHODS: We reviewed 49 cases of elbow arthroscopies performed in 47 pediatric and adolescent patients retrospectively over a 16-year period. Charts were reviewed to identify the age of patients at the time of surgery, side involved, hand dominance, diagnosis, complications, the primary sport involved, and the average volume of loose bodies if surgical removal was performed. Each patient was contacted after a minimum of 2 years after surgery and a modified Andrews elbow scoring system was used to rate elbow function. RESULTS: The average age of this group was 14.0 years (range, 3.5 to 17.0 years) with an average follow-up of 4.7 years. Elbow arthroscopy was performed for osteochondritis dissecans (58%), arthrofibrosis and joint contracture (20%), synovitis (10%), acute trauma (10%), and posterior olecranon impingement syndrome (5%). Based on a modified Andrews elbow scoring system, 85% of patients had good or excellent result with 90% of the children returning to sports without limitation. No patient experienced nerve injury, infection, or loss of elbow motion as a postoperative complication. CONCLUSIONS: This series shows that elbow arthroscopy has a safe and effective role in the treatment of selective elbow pathologies in the pediatric and adolescent population when performed by experienced small joint arthroscopists.

Adolescent↗
PubMed2001

Common athletic injuries in adolescent girls.

Teenaged girls constitute the fastest growing segment of children and adolescents participating in organized athletics. Adolescent girls appear to have similar injury rates as boys in comparable activities but different injury patterns. To properly diagnose and manage athletic injuries in adolescent girls, pediatric health care providers must be aware of these differences, especially as the literature and their knowledge base may be skewed to the traditional predominance of males in sport. This review identifies athletic injuries that are unique to or especially common in adolescent girls, including apophyseal injuries; breast and pelvic injuries; scoliosis and spondylolysis; multidirectional shoulder instability and "gymnast's wrist"; anterior cruciate ligament injuries and patellofemoral pain syndrome; chronic exertional lower-leg compartment syndrome, ankle sprains, and reflex sympathetic dystrophy; and stress fractures. It also briefly discusses possible risk factors for these injuries, emphasizing the female athlete triad.

Adolescent↗
PubMed2001

Autologous chondrocyte implantation of the knee: multicenter experience and minimum 3-year follow-up.

OBJECTIVE: To determine clinical outcome and graft survivorship in patients undergoing autologous chondrocyte implantation (ACI) for the repair of chondral defects of the knee. DESIGN: Prospective cohort study. SETTING: 19 centers in the United States. PATIENTS: 50 patients (37 males, 13 females). Mean age was 36 years (range: 19-53). Defects were grade III or IV with a mean size of 4.2 cm 2. All patients had a minimum of 36 months postoperative follow-up. MAIN OUTCOME MEASUREMENTS: Clinician and patient evaluation based on the modified Cincinnati Knee Rating System. Graft failure was defined as replacement or removal of the graft due to mechanical symptoms or pain. RESULTS: Clinician and patient evaluation indicated median improvements of 4 and 5 points, respectively, at 36 months following ACI (p < 0.001). Previous treatment with marrow stimulation techniques and size of defect did not impact the results with ACI. The most common adverse events reported were adhesions and arthrofibrosis and hypertrophic changes. Three patients had graft failure and required reimplantation or treatment with alternative cartilage repair techniques. Kaplan-Meier estimated freedom from graft failure was 94% at 36 months postoperatively (95% CI = 88-100%). CONCLUSIONS: These results of this study indicate excellent graft survivorship using ACI as well as substantial improvement in functional outcome.

Adult↗
PubMed2000

Karate injuries in children and adolescents.

OBJECTIVES: To identify risk factors for injury and to establish safety guidelines for children in Uechi-Ryu karate. DESIGN: A 1-year retrospective survey of injuries. SETTING: A private karate school (Uechi-Ryu style) in Plymouth, MA. PATIENTS: A total of 68 athletes (age 6-16 years; mean age 10 years) who participated in karate during the 1995-1996 season. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The presence or absence of injury, with grading of injuries as major, moderate or minor. The types of injuries and body region involved were also analyzed. RESULTS: Twenty eight percent of athletes sustained at least one injury. All injuries were minor, with no time off from training required. The injuries consisted primarily of bruises (11 of 19). Other injuries included mild sprains or strains (5 of 19) and having their 'wind knocked out' (3 of 19). Most injuries were localized to the extremities. Logistic regression analysis identified risk factors for injury. Risk of injury increased with number of years of training (odds ratio 2.95; 95% confidence interval 1.81-4.82; P<0.0001), number of hours per week (odds ratio 2.12; CI 1.15-4.21; P = 0.016) and rank, specifically brown belt versus lower belts (odds ratio 6.56; CI 2.02-21.26; P = 0.006). CONCLUSIONS: Karate is a relatively safe sport for children and adolescents when properly taught. Risk of injury increases with experience; therefore, greater supervision is required of higher ranks. Injury increases with weekly training; however, 3 h a week or less appears to be associated with a low risk of significant injury in this age group.

Adolescent↗
PubMed2000

Back injuries in the young athlete.

The diagnosis of back pain in the young athlete should be specific and not attributed to nonspecific, mechanical causes. Risk factor identification and intervention are required. Treatment is then initiated in a specific pattern, addressing flexibility and muscular imbalances. Bracing is often used to allow healing of growth tissue. The lumbosacral orthosis may be molded in a lordotic posture to unload the disc or antilordotic posture to relieve the posterior column; however, customizing the lordosis to the individual biomechanics may be required. Spinal stabilization is initiated with therapy for strengthening isolated weaknesses and progressing to coactivation and proprioceptive techniques, such as the balance ball. Returning to competition is preceded with sport-specific training.

Acute Disease↗
PubMed2000

The young dancer.

The injuries that are prevalent in and unique to dancers have their origins inextricably linked to faulty technique or poor biomechanics, combined with other risk factors. It is this combination of factors that must be addressed when considering diagnosis, treatment, and rehabilitation. For the dancer to return to full activity with minimal risk of recurrent injury, neuromuscular re-education is mandatory. This process best entails using a team approach, accessing the resources of healthcare professionals and those who train the dancer on a daily basis. In some cases, parents also may need to be involved. Communication, interaction, and mutual understanding among these groups will assist the dancer in regaining and maintaining health.

Adolescent↗
PubMed2000

The prevention of sports injuries in children.

With the explosion of the number of youth participating in sports activities has come an epidemic of injuries. Myriad factors make their prevention a great challenge for society. This article presents an overview of statistics, factors contributing to sports injuries, a review of significant prevention efforts, barriers to prevention, and recommendations for the future.

Adolescent↗
PubMed2000

Idiopathic scoliosis and spondylolysis in the female athlete. Tips for treatment.

Idiopathic scoliosis and spondylolysis can be common back problems in female athletes. Diagnosis and treatment can be difficult. With the notable trend toward increasing participation of women and girls in organized sports, it is necessary to know which sports carry additional risks for participants to have these two conditions develop and to determine treatment modalities. In general, idiopathic scoliosis is more prevalent in females and even may be higher in the athletes. Treatment options may include observation, the use of a brace, and surgery. In determining treatment, the type of sport and caliber of athlete must be considered in conjunction with the severity of the curve. Spondylolysis or a stress fracture of the posterior vertebral elements can be a common cause of back pain in an athlete. In many sports that are dominated by females (gymnastics, dancing, figure skating), the athletes carry a high risk of having spondylolysis or a stress fracture. Knowing the risk factors permits precise diagnosis and appropriate treatment. Treatment options include the use of a brace and surgery. In the current study, an extensive review of the literature in conjunction with the extensive experience of a well-established sports medicine clinic at the authors' institution is presented.

Athletic Injuries↗
PubMed2000

Safety recommendations in Shotokan karate.

OBJECTIVE: To study risk factors for injury in karate and to establish safety recommendations. DESIGN: Cross-sectional survey of karate injuries. SETTING: Shotokan karate clubs in Boston, Massachusetts, Dallas, Texas, and Winnipeg, Manitoba, Canada. PARTICIPANTS: All athletes training at each club received surveys. A total of 114 surveys were analyzed (74% response rate). MAIN OUTCOME MEASURES: Presence of injuries (requiring any time off from practice), major injuries (requiring at least 7 days off), and multiple injuries (3 or more injuries). RESULTS: No statistically significant differences were found with respect to sex. For all outcomes, karateka younger than 18 years of age had fewer injuries. The number of karateka with injuries and with multiple injuries increased with belt rank until brown belt, then reached a plateau. Brown and black belts had a greater frequency of major injuries than the lower ranks. Training more than 3 hours per week correlated with an increase in injuries, major injuries, and multiple injuries. CONCLUSION: Shotokan karate appears to be a safe sport, especially for those younger than 18 years of age. Risk of injury increases significantly when younger karateka of any rank or older karateka of lower ranks train more than 3 hours per week; therefore, to reduce the risk of injury to less than 50%, weekly training should be limited to a maximum of 3 hours in these groups.

Adolescent↗
PubMed2000

Chronic recurrent subluxation of the peroneal tendons in a pediatric patient. Surgical recommendations.

Numerous surgical and non-operative approaches have been used to treat chronic recurrent subluxation of the peroneal tendons in adult athletes. There have been no published reports of surgical repair in children. In this report on a skeletally immature patient a modification of the Chrisman-Snook procedure (previously described for lateral ligament reconstruction) is described to correct recurrent subluxation of the peroneal tendons, child.

Ankle↗
PubMed2000

Upper extremity injuries in the paediatric athlete.

Injuries to the upper extremity in paediatric and adolescent athletes are increasingly being seen with expanded participation and higher competitive levels of youth sports. Injury patterns are unique to the growing musculoskeletal system and specific to the demands of the involved sport. Shoulder injuries include sternoclavicular joint injury, clavicle fracture, acromioclavicular joint injury, osteolysis of the distal clavicle, little league shoulder, proximal humerus fracture, glenohumeral instability and rotator cuff injury. Elbow injuries include supracondylar fracture, lateral condyle fracture, radial head/neck fracture, medial epicondyle avulsion, elbow dislocation and little league elbow. Wrist and hand injuries include distal radius fracture, distal radial physeal injury, triangular fibrocartilage tear, scaphoid fracture, wrist ligamentous injury thumb metacarpalphalangeal ulnar collateral ligament injury, proximal and distal interphalangeal joint injuries and finger fractures. Recognition of injury patterns with early activity modification and the initiation of efficacious treatment can prevent deformity/disability and return the youth athlete to sport.

Adolescent↗
PubMed2000

[Autologous chondrocyte transplantation for treatment of cartilage defects of the knee joint. Clinical results].

Cartilage defects in the knee joint are common and have a bad tendency for healing due to the limited regeneration of hyaline cartilage. Surgeons have an ample choice of various operative treatment measures. Especially for the treatment of larger lesions first results of autologous chondrocyte transplantation (ACT) were published in 1994 [3]. Autologous chondrocytes are isolated from an arthoscopically harvested cartilage biopsy, cultured in vitro and implanted in the defect under a periostal flap in a second procedure. In an international multicenter study 1,051 patients treated with ACT between 6/95 and 12/98 were documented with follow-up examinations after 12 months (588 patients), 24 months (220 patients) and 36 months (40 patients). The majority of the defects (61.2%) were localized on the medial femoral condyle, measuring 4.6 cm2 and mostly described as grade III/IV lesions. The clinical evaluation was performed using a modified Cincinnati knee rating system independently for clinician and patient. Evaluations showed an increase from 3.35 to 6.25 after 24 months and from 3.10 to 6.77 in a scale from 1 (bad) to 10 (excellent). ACT favours defects of the femur with an improvement rate of 85%. Adverse events possibly related to ACT were described in 4.8% of the patients. Diagnostic second-look arthroscopies are included in the reoperation rate of 5.1%. The presented data indicate autologous chondrocyte transplantation as an effective and safe option for the treatment of large full thickness cartilage defects in the knee joint.

Adolescent↗
PubMed1999

Anterior cruciate ligament reconstruction in patients who are prepubescent.

Between 1980 and 1996, 17 children who were prepubescent have had a combined intraarticular and extraarticular reconstruction of the anterior cruciate ligament using the iliotibial band that does not violate the physes. The average chronological age of the patients was 11 years (range, 2-14 years) and the average skeletal age of the patients was 10 years (range, 2-13 years). Eight of the 10 patients who had attained skeletal maturity were evaluated at an average of 66.5 months postoperatively (range, 25-168 months). All knees were stable subjectively by history and objectively by KT1000 testing. The average Lysholm score at assessment was 97.4. No child with a traumatic disruption had leg length discrepancy develop.

Adolescent↗
PubMed1999

Foot and ankle problems in the young athlete.

In the U.S., greater than half of boys and one quarter of girls in the 8- to 16-yr-old age range are engaged in some type of competitive, scholastic, organized sport during the school year. Children and adolescents are becoming more involved in sports at earlier ages and with higher levels of intensity. Foot and ankle problems, in particular, are the second most common musculoskeletal problem facing primary care physicians in children under 10 yr of age next to acute injury. This report focuses on foot and ankle problems, trauma, and overuse in the young athletic population. Guidelines are given for both conservative and surgical management. Specific problems addressed include pes planus, tarsal coalition, adolescent bunion, os trigonum, accessory navicular, physeal fractures, sprains, peroneal tendon subluxation, metatarsal fractures, sesamoid fractures, turf toe, stress fractures, tendonitis, osteochondritis dissecans, ankle impingement, bursitis, Haglund's deformity, sesamoiditis, plantar fasciitis, apophysitis, osteochondroses, cuboid syndrome, and reflex sympathetic dystrophy. An extensive review of the literature is performed and presented in combination with the extensive experience of a well-established sports medicine clinic at the Boston Children's Hospital.

Adolescent↗
PubMed1999

Anterior cruciate ligament reconstructive surgery in adolescent soccer and basketball players.

OBJECTIVE: To evaluate trends in the frequency of anterior cruciate ligament (ACL) tears among adolescent soccer and basketball players resulting in reconstructive surgery, and to assess differences between female and male adolescent athletes. DESIGN: A retrospective review of ACL reconstructive surgeries performed from 1992 through 1997 and annual statewide participation rates obtained from the National Federation of State High School Associations. SETTING: Children's Hospital, Boston, Massachusetts, U.S.A. PATIENTS: Adolescent athletes 13 to 19 years of age (78 girls, 31 boys) admitted for ACL reconstruction due to soccer or basketball injuries. MAIN OUTCOME MEASURES: Number of ACL reconstructive surgeries and number of Massachusetts participants in high school soccer and basketball. RESULTS: A total of 69 soccer (49 girls, 20 males) and 40 basketball (29 girls, 11 males) players underwent ACL reconstruction. A greater proportion of girls underwent ACL surgery in both sports. The frequency increased over time for both sexes in both sports. Soccer-related surgeries increased at a faster rate among girls than boys. Basketball-related surgeries increased at a similar rate for both sexes, although in any given year more surgeries were performed on girls. CONCLUSION: The frequency of ACL surgery at our institution has increased among high school soccer and basketball players in a manner consistent with trends in sports participation. In our study, ACL surgery was more common among girls than boys.

Adolescent↗
PubMed1998

Youth soccer: an epidemiologic perspective.

The youth soccer movement in the United States is developing at a tremendous rate. This article explores the epidemiology of youth soccer including trends in participation, injury data, and injury categories that are of specific concern to the young athlete. Finally, recommendations are made regarding possible future areas of study and research on youth soccer.

Adult↗
PubMed1998

Electromyographic analysis of grand-plié in ballet and modern dancers.

PURPOSE: The purpose of this report is to describe lower extremity muscle activity in grand-plié, as determined by EMG analysis; to compare and contrast muscle function in grand-plié and demi-plié to support the hypothesis that grand-plié is not simply a deeper demi-plié, but rather a fundamentally different movement in terms of muscle use; and to present further evidence in support of the hypothesis that ballet dancers use muscles differently than modern dancers in dance movement. METHODS: Surface electromyography was used to analyze lower extremity muscle activity during grand-plié in first position with lower extremities turned out in five ballet and seven modern female professional dancers. RESULTS: Electromyographic (EMG) activity of tibialis anterior included continuous activity from heel-off during the lowering phase, through midcycle, and ending at heel-on during the rising phase in all grand-pliés; the majority of tibialis anterior EMG tracings in ballet dancers had additional activity at the end of the rising phase. All EMG tracings for vastus lateralis and medialis included a peak of activity during the lowering phase, a decrease (valley) at midcycle, followed by another peak during the rising phase; increased activity at the end of the rising phase was observed in most grand-plié in ballet, and not modern, dancers. Adductor EMG activity was also observed in all tracings with a peak during the lowering phase from heel-off to midcycle, a valley at midcycle, followed by a peak of activity in early rising phase; the midcycle valley was of lower, and the rising phase peak of higher, activity in ballet compared with modern dancers. Variation of EMG patterns was observed for lateral and medial gastrocnemius, gluteus maximus, and hamstrings. CONCLUSIONS: The data support the concept that lower extremity muscle activity in dance movement is comprised of three major types: (a) unique, characteristic activity required for the execution of the movement; (b) varied activity which is characteristic of dancers of different dance idioms; and (c) varied activity which may depend on factors such as balance, personal habit, and individual training background. Furthermore, EMG activity of vastus lateralis and medialis at the midcycle valley in grand-plié was significantly less in ballet dancers than in modern dancers despite similar degree of knee flexion, suggesting that ballet dancers may have lower patellofemoral joint reaction force at midcycle than modern dancers.

Analysis of Variance↗