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Lyle J Micheli

Publications and source records attributed to Lyle J Micheli.

At least 19 recordsLinked to original sources
PubMed2006

Stress fractures in the spine and sacrum.

Stress fractures of the pars, pedicle, and sacrum are important considerations in the differential diagnosis of lower back pain in the child or adolescent athlete. A thorough history and physical examination as well as a high index of suspicion are essential when assessing a patient with lower back pain. Diagnostic imaging, including radiographs, bone scans, CT scans, and other imaging modalities are important for further narrowing the diagnosis. The early identification and proper management of stress fractures of the pars, pedicle, and sacrum are integral in the prevention of stress fractures in the adolescent athlete population. This article reviews current concepts in the assessment and management of stress fractures of the lumbosacral spine, particularly of the pars (spondylolysis), pedicles, and sacrum.

Adolescent↗
PubMed2006

Patellofemoral pain syndrome: evaluation of location and intensity of pain.

OBJECTIVES: To identify the sites and intensity of pain in patients with patellofemoral pain syndrome. METHOD: A prospective cohort study was conducted at an academic sports medicine practice in Boston, Massachusetts. All patients met inclusion criteria and were enrolled and evaluated during the study time frame. A single sports medicine orthopaedic surgeon examined a consecutive sample of patients with patellofemoral pain not explained by one of several well-defined anterior knee pain diagnoses. The study group consisted of 100 patients (75 females, 25 males) with median age of 14 years. Eleven discrete locations were palpated for tenderness. Hamstring tightness was evaluated by measuring the popliteal angle. Patients reported intensity of pain using a 0- to 9-point ordinal scale. Regression and nonparametric statistical methods were used. RESULTS: The most common site of pain was the patella during anterior-posterior compression (90 patients), followed by the distal pole of the patella, the medial plica, and the nonarticular medial femoral condyle. Median "worst pain" intensity was 6 out of a possible 9. The most common site of "worst pain" was also the patella in compression (63 patients). Median duration of symptoms was 10 months, with an interquartile range of 3 to 20 months. Pain intensity was inversely correlated with duration of symptoms (P < 0.01). CONCLUSIONS: In these patients with patellofemoral pain syndrome, the major source of pain was the patella subchondral bone.

Adolescent↗
PubMed2006

Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents. Surgical technique.

BACKGROUND: The management of anterior cruciate ligament injuries in skeletally immature patients is controversial. Conventional adult reconstruction techniques risk potential iatrogenic growth disturbance due to physeal damage. The purpose of this study was to evaluate the results of a physeal sparing, combined intra-articular and extra-articular reconstruction technique in prepubescent skeletally immature children. METHODS: Between 1980 and 2002, forty-four skeletally immature prepubescent children and adolescents who were in Tanner stage 1 or 2 (with a mean chronological age of 10.3 years) underwent physeal sparing, combined intra-articular and extra-articular reconstruction of the anterior cruciate ligament with use of an autogenous iliotibial band graft. Twenty-seven patients had additional meniscal surgery. Functional outcome, graft survival, radiographic outcome, and growth disturbance were evaluated at a mean of 5.3 years after surgery. RESULTS: Two patients underwent a revision reconstruction for graft failure at 4.7 and 8.3 years postoperatively. In the remaining forty-two patients, the mean International Knee Documentation subjective knee score (and standard deviation) was 96.7 +/- 6.0 points, and the mean Lysholm knee score was 95.7 +/- 6.7 points. The results of the Lachman examination for anterior cruciate ligament integrity were normal for twenty-three patients, nearly normal for eighteen patients, and abnormal for one patient. The results of the pivot-shift examination were normal for thirty-one patients and nearly normal for eleven patients. Four of the twenty-three patients who underwent concurrent meniscal repair had a repeat arthroscopic meniscal repair or partial meniscectomy. The mean growth in total height from the time of surgery to the final follow-up evaluation was 21.5 cm. No patient had an angular deformity measured radiographically or a discrepancy in the length of the lower extremities measured clinically. CONCLUSIONS: Physeal sparing, combined intra-articular and extra-articular reconstruction of the anterior cruciate ligament with use of an autogenous iliotibial band graft in skeletally immature prepubescent children and adolescents provides excellent functional outcome with a low revision rate and a minimal risk of growth disturbance.

Adolescent↗
PubMed2005

Autologous chondrocyte implantation versus debridement for treatment of full-thickness chondral defects of the knee: an observational cohort study with 3-year follow-up.

BACKGROUND: Studies that compare the effectiveness of different cartilage repair treatments are needed to update treatment algorithms. HYPOTHESIS: Autologous chondrocyte implantation provides greater improvement in overall condition score than does debridement at a minimum of 3 years' follow-up. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Cohorts for debridement and autologous chondrocyte implantation each included 58 Cartilage Repair Registry patients who met study criteria. A retrospective analysis was performed on prospectively collected baseline and follow-up data. RESULTS: Patients in the autologous chondrocyte implantation and debridement groups had similar demographics and chondral lesions at baseline. However, more autologous chondrocyte implantation patients failed a previous debridement or marrow stimulation procedure than did debridement patients. Follow-up outcome assessments were completed by 54 autologous chondrocyte implantation patients and 42 debridement patients. Eighty-one percent of the autologous chondrocyte implantation patients and 60% of the debridement patients reported median improvements of 5 points and 2 points, respectively, in the overall condition score. Autologous chondrocyte implantation patients also reported greater improvements in the median pain and swelling scores than did debridement patients. The treatment failure rate was the same for both autologous chondrocyte implantation and debridement patients. Eighteen autologous chondrocyte implantation patients and 1 debridement patient had at least 1 subsequent operation. CONCLUSION: Although patients treated with debridement for symptomatic, large, focal, chondral defects of the distal femur had some functional improvement at follow-up, patients who received autologous chondrocyte implantations obtained higher levels of knee function and had greater relief from pain and swelling at 3 years.

Adult↗
PubMed2005

Functional outcome of knee articular cartilage repair in adolescent athletes.

BACKGROUND: Limited information exists about the treatment of full-thickness articular cartilage lesions of the knee in adolescent athletes. PURPOSE: To evaluate the functional outcome and athletic activity after articular cartilage repair in the knees of adolescent athletes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twenty adolescent athletes with full-thickness articular cartilage lesions of the knee were treated with autologous chondrocyte transplantation. Functional outcome was evaluated by subjective patient outcome rating, knee activity scores, and level of athletic participation. RESULTS: At a mean of 47 months after autologous chondrocyte transplantation, 96% of adolescents reported good or excellent results with significant increases in postoperative Tegner activity scores and Lysholm scores. Ninety-six percent returned to high-impact sports and 60% to an athletic level equal or higher than that before knee injury. Return to preinjury sports correlated with shorter preoperative symptoms and a lower number of prior operations. All adolescents with preoperative symptoms < or =12 months returned to preinjury-level athletics, compared to 33% with preoperative intervals longer than 12 months. CONCLUSION: Treatment of full-thickness articular injuries of the knee in adolescent athletes with autologous chondrocyte transplantation yields a high rate of functional success at a mean follow-up of 47 months. The rate of return to demanding athletic activities is higher in cases in which the preoperative duration of symptoms is 12 months or less.

Adolescent↗
PubMed2005

Clinical outcome of autologous chondrocyte implantation at 5 years in US subjects.

UNLABELLED: Peterson's pioneering experience with the first clinical application of autologous chondrocyte implantation showed improvement in clinical outcomes, durable as much as 11 years, for a difficult patient population. An assessment of the general applicability of this technology in the United States requires long-term, multicenter followup. The purpose of this multicenter cohort study was to assess the clinical outcomes of patients treated with autologous chondrocyte implantation for lesions of the distal femur. Modified 10-point scales of the Cincinnati knee rating system were used to measure outcomes assessments at baseline and at 5 years. Eighty-seven percent (87 of 100) of patients completed 5-year followup assessments. Patients were an average 37 years of age, had a mean total defect size of 4.9 cm2, and had low baseline overall condition scores. At least one prior cartilage repair procedure had failed in 70% of the patients. At followup, 87 patients reported a mean improvement of 2.6 points in the overall condition score, including 62 with improved conditions, six with no change in condition, and 19 with worsened conditions. Of the 62 patients who improved, the mean overall condition score improved 4.1 points at followup. Patients treated with autologous chondrocyte implantation for large cartilage defects in the distal femur reported improvement in outcome scores at 5 years followup. LEVEL OF EVIDENCE: Therapeutic study, Level II-1 (prospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2005

Soccer injuries.

OBJECTIVE: This chapter reviews the existing epidemiological studies on pediatric soccer injuries and discusses possibilities for future research. DATA SOURCES: A comprehensive, web-based search of existing soccer injury literature was performed with an emphasis on the pediatric population. The search encompassed all available studies, including European journals and texts, and initial investigations from the 1970s which serve as a basis of comparison to more recent work. MAIN RESULTS: Youth soccer is a relatively safe sport with an injury incidence ranging from 2.3 per 1,000 practice hours to 14.8 per 1,000 game hours. Similar to adults, youth soccer injuries occur mostly in the lower extremities, specifically the knee and ankle. Contusions are the most common injury, and minor/moderate injuries predominate. Extrinsic risk factors for youth soccer include: dangerous play, play on small fields, and inclusion of youth players on adult teams. The most important intrinsic risk factor is the relation of knee injury and female gender. CONCLUSIONS: Adolescent females suffer a disproportionate number of knee and anterior cruciate ligament injuries compared to adolescent males, but recent injury prevention studies yielded encouraging results. Head injuries in youth soccer are low, and rarely, if ever, occur from head to ball contact. Adherence to the rules of the game, proper coaching, and adequate refereeing are important factors in youth soccer injury prevention.

Adolescent↗
PubMed2005

Correlates of stress fractures among preadolescent and adolescent girls.

OBJECTIVE: Although stress fractures are a source of significant morbidity in active populations, particularly among young female athletes, the causes of stress fractures have not been explored among females <17 years of age or in the general population. The purpose of this study was to examine correlates of stress fractures in a large, population-based, national, cohort study of preadolescent and adolescent girls. METHODS: A cross-sectional analysis of data from 5461 girls, 11 to 17 years of age, in the Growing Up Today Study, an ongoing longitudinal study of the children of registered female nurses participating in Nurses' Health Study II, was performed. Mothers self-reported information regarding their children's histories of stress fractures on their 1998 annual questionnaire. Growing Up Today Study participants self-reported their weight and height, menarcheal status, physical activity, dietary intake, and disordered eating habits on annual surveys. RESULTS: In 1998, the mean age of the participants was 13.9 years. Approximately 2.7% of the girls had a history of stress fracture, 3% engaged in disordered eating (using fasting, diet pills, laxatives, or vomiting to control weight), and 16% participated in > or =16 hours per week of moderate to vigorous activity. Age at menarche, z score of BMI in 1998, calcium intake, vitamin D intake, and daily dairy intake were all unrelated to stress fractures after controlling for age. Independent of age and BMI, girls who participated in > or =16 hours per week of activity in 1998 had 1.88 greater odds of a history of stress fracture than did girls who participated in <4 hours per week (95% confidence interval [CI]: 1.18-3.30). Girls who participated in > or =16 hours per week of activity were also more likely than their peers to engage in disordered eating (4.6% vs 2.8%); however, disordered eating did not have an independent association with stress fractures (odds ratio [OR]: 1.33; 95% CI: 0.61-2.89). Independent of age and BMI, each hour per week of high-impact activity significantly increased the risk of stress fracture (OR: 1.05; 95% CI: 1.02-1.09). Among the high-impact physical activities, only running (OR: 1.13; 95% CI: 1.05-1.22) and cheerleading/gymnastics (OR: 1.10; 95% CI: 1.01-1.21) were independently associated with greater odds of stress fracture. CONCLUSIONS: These findings suggest that, although activity can be beneficial for bone health, there is a threshold over which the risk of stress fracture increases significantly among adolescent girls. High-impact activities, particularly running, cheerleading, and gymnastics, appear to be higher risk than other activities. Prospective studies are needed to explore the directionality of these relationships, as well as the role of menstrual history. In the meantime, clinicians should remain vigilant in identifying and treating disordered eating and menstrual irregularities among their highly active, young, female patients.

Adolescent↗
PubMed2005

Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents.

BACKGROUND: The management of anterior cruciate ligament injuries in skeletally immature patients is controversial. Conventional adult reconstruction techniques risk potential iatrogenic growth disturbance due to physeal damage. The purpose of this study was to evaluate the results of a physeal sparing, combined intra-articular and extra-articular reconstruction technique in prepubescent skeletally immature children. METHODS: Between 1980 and 2002, forty-four skeletally immature prepubescent children and adolescents who were in Tanner stage 1 or 2 (with a mean chronological age of 10.3 years) underwent physeal sparing, combined intraarticular and extra-articular reconstruction of the anterior cruciate ligament with use of an autogenous iliotibial band graft. Twenty-seven patients had additional meniscal surgery. Functional outcome, graft survival, radiographic outcome, and growth disturbance were evaluated at a mean of 5.3 years after surgery. RESULTS: Two patients underwent a revision reconstruction for graft failure at 4.7 and 8.3 years postoperatively. In the remaining forty-two patients, the mean International Knee Documentation subjective knee score (and standard deviation) was 96.7 +/- 6.0 points, and the mean Lysholm knee score was 95.7 +/- 6.7 points. The results of the Lachman examination for anterior cruciate ligament integrity was normal for twenty-three patients, nearly normal for eighteen patients, and abnormal for one patient. The results of the pivot-shift examination were normal for thirty-one patients and nearly normal for eleven patients. Four of the twenty-three patients who underwent concurrent meniscal repair had a repeat arthroscopic meniscal repair or partial meniscectomy. The mean growth in total height from the time of surgery to the final follow-up evaluation was 21.5 cm. No patient had an angular deformity measured radiographically or a discrepancy in the length of the lower extremities measured clinically. CONCLUSIONS: Physeal sparing, combined intra-articular and extra-articular reconstruction of the anterior cruciate ligament with use of an autogenous iliotibial band graft in skeletally immature prepubescent children and adolescents provides excellent functional outcome with a low revision rate and a minimal risk of growth disturbance.

Adolescent↗
PubMed2004

Foot and ankle injuries in dance.

This review focuses on many of the foot and ankle injuries commonly seen among dancers. These unique athletes place extreme demands on their musculoskeletal system and thereby face a variety of acute and overuse injuries. Conservative treatment is successful in the majority of cases, but these patients often continue to dance while healing--commonly prolonging and at times complicating treatment. When surgery is being contemplated, the dancer's performance level and expectations about returning to dance after surgery should be thoroughly explored. Foot and ankle surgeries that routinely yield good to excellent results in the general population can prematurely end a dancer's otherwise promising career. The physician must consider all these factors when designing an appropriate treatment plan for a dancer.

Ankle Injuries↗
PubMed2003

Laxity and functional outcome after arthroscopic reduction and internal fixation of displaced tibial spine fractures in children.

PURPOSE: The purpose of this study was to evaluate laxity and functional outcome of displaced tibial spine fractures in skeletally immature patients treated with arthroscopic reduction and internal fixation. TYPE OF STUDY: Retrospective case series. METHODS: Six patients (mean age, 12.0 years old) underwent subjective, objective, and instrumented knee laxity assessment at minimum 2 years (mean, 3.2 years) of follow-up time after arthroscopic reduction and 3.5-mm cannulated screw fixation of (Meyers and McKeever type III) tibial spine fractures. RESULTS: Physical examination showed persistent laxity, with an abnormal Lachman examination in 5 of 6 patients and an abnormal pivot-shift examination in 2 of 6 patients. Instrumented knee laxity (KT-1000) showed greater than 3-mm manual-maximum side-to-side difference in 4 of 6 patients. Functional assessment revealed excellent function, with a mean Lysholm score of 99.5 (range, 98-100), mean Marshall score of 49.0 (range, 47-50), and mean Tegner score of 8.7 (range, 7-9). CONCLUSIONS: Arthroscopic reduction and internal fixation of type III tibial spine fractures in skeletally immature patients results in persistent laxity but excellent functional outcome.

Adolescent↗
PubMed2003

Current evaluation and management of spondylolysis and spondylolisthesis.

Spondylolysis occurs with a prevalence of 4% to 6% in the general population. Although the etiology of this lesion is still unclear, it has been shown to have both hereditary and acquired risk factors, with an increased prevalence in men and athletes participating in certain high-risk sports. Spondylolisthesis occurs in a significant proportion of individuals with bilateral spondylolysis. Predicting risk factors for progression of the slip in spondylolisthesis has proven difficult. Multiple imaging techniques are helpful in the diagnosis of spondylolysis and spondylolisthesis, with recent research addressing the utility of magnetic resonance imaging in the diagnosis and management of pars lesions. The management guidelines have remained largely unchanged since early recommendations. Recently, the addition of a bone growth stimulator to the management of difficult cases has shown promise.

Adult↗
PubMed2003

Meniscal and articular cartilage injury in the skeletally immature knee.

Meniscal and articular cartilage injuries in skeletally immature patients appear to be occurring with increased frequency, particularly in athletically active children. The orthopaedic surgeon should understand the principles of diagnosis and management, as well as be aware of current surgical treatment options available.

Adolescent↗
PubMed2003

Skeletal scintigraphy of young patients with low-back pain and a lumbosacral transitional vertebra.

UNLABELLED: Lumbosacral transitional vertebrae can alter the biomechanics of weight transfer at the affected spinal segment. Low-back pain may result. This study assessed what skeletal scintigraphy reveals about stress associated with a lumbosacral transitional vertebra in young patients with low-back pain. METHODS: The study population included 48 patients (30 male, 18 female; age range, 6-19 y; mean age, 15.7 y) with low-back pain and a lumbosacral transitional vertebra. Skeletal scintigraphy was correlated with plain radiographs in all, CT in 12, and MRI in 11. RESULTS: High uptake was shown at the articulation between the transverse process of a lumbosacral transitional vertebra and the sacrum in 39 (81%) of the patients. In 23 (59%) of the 39 patients with high uptake, this finding was shown only by SPECT. In 13 (81%) of the 16 for which the high uptake was shown by planar imaging, the anterior projection was more valuable than the posterior projection. In 9 (23%) of the 39 patients with high uptake at the transverse-sacral articulation, the lumbosacral transitional vertebra had not been noted in a radiographic report before skeletal scintigraphy but was identified through reevaluation or repetition of radiographs after skeletal scintigraphy. Radiographs showed sclerosis along the transverse-sacral articulation in only 8 (21%) of the 39 patients with high uptake. Findings indicating stress or motion at the joint were shown by CT in 6 (55%) of 11 and by MRI in 5 (63%) of 8 patients with high uptake at the transverse-sacral articulation who underwent these examinations. CONCLUSION: Skeletal scintigraphy often indicates stress at the transverse-sacral articulation of young patients with low-back pain and a lumbosacral transitional vertebra. Showing evidence of stress is best accomplished using SPECT. Changes are usually not radiographically evident, but there is a trend for MRI and CT to show findings that imply stress or motion at the articulation. The unique ability of skeletal scintigraphy to provide this physiologic information supports its use in these patients.

Adolescent↗
PubMed2002

Spondylolysis: returning the athlete to sports participation with brace treatment.

Between 1988 and 1995, 73 adolescent athletes treated with the Boston Overlap Brace for spondylolysis were reviewed to evaluate improvement in pain score and activity level. A favorable clinical outcome was achieved in 80%. Girls and boys who participated in high-risk sports were five times more likely to have an unfavorable clinical outcome than those who participated in low-risk sports (odds ratio = 5, 95% confidence interval = 2.4-7.5, P = .003). In addition, acute onset of pain and hamstring tightness were associated with a worse outcome. Athletes with symptomatic spondylolysis treated with an antilordotic brace can expect improvement in their clinical course and return to sports participation in 4-6 weeks.

Adolescent↗
PubMedDate not supplied

Discoid lateral meniscus: prevalence of peripheral rim instability.

The purpose of this study was to determine the prevalence of peripheral rim instability in discoid lateral meniscus. A consecutive series of 112 patients (128 knees) (mean age 10.0 years [range 1 month to 22 years]) who underwent arthroscopic evaluation and treatment of a discoid lateral meniscus between 1993 and 2001 was reviewed. Of those discoid menisci classified intraoperatively (n = 87), 62.1% (n = 54) were complete discoid lateral menisci and 37.9% (n = 33) were incomplete discoid lateral menisci. An associated meniscal tear was present in 69.5% (n = 89) of all knees studied. Overall, 28.1% (n = 36) of discoid lateral menisci had peripheral rim instability: 47.2% (n = 17) were unstable at the anterior-third peripheral attachment, 11.1% (n = 4) at the middle-third peripheral attachment, and 38.9% (n = 14) at the posterior-third peripheral attachment. Thirty-one of the 36 unstable discoid menisci underwent repair of the peripheral meniscal rim attachment. One patient underwent a complete, open meniscectomy. Peripheral rim instability was significantly more common in complete discoid lateral menisci (38.9% vs. 18.2%; P = 0.043) and in younger patients (8.2 vs. 10.7 years; P = 0.002). The frequency of peripheral instability mandates a thorough assessment of meniscal stability at all peripheral attachments during the arthroscopic evaluation and treatment of discoid lateral meniscus, particularly in complete variants and in younger children.

Adolescent↗
PubMedDate not supplied

Hip arthroscopy in children and adolescents.

Hip arthroscopy has become an established procedure for certain indications in adults, but experience in children and adolescents has been more limited. The purpose of this study is to report the early-term results of hip arthroscopy in children and adolescents. A consecutive case series of 54 hip arthroscopies in 42 patients 18 years old and younger over a 3-year period at a tertiary-care children's hospital with a minimum of 1 year of follow-up was reviewed. Patients were assessed with the modified Harris hip score (HHS) before and after surgery. Overall results and results by common diagnoses were analyzed. Indications for surgery included isolated labral tear (n = 30), Perthes disease (n = 8), hip dysplasia with labral tear after prior periacetabular osteotomy (n = 8), inflammatory arthritis (n = 3), spondyloepiphyseal dysplasia (n = 2), avascular necrosis (n = 1), slipped capital femoral epiphysis (n = 1), and osteochondral fracture (n = 1). Overall, there was a significant improvement in HHS from 53.1 to 82.9 (P < 0.001), with 83% of patients improved. By diagnosis, significant improvement in HHS was seen for patients with isolated labral tears undergoing labral debridement (before surgery 57.6; after surgery 89.2; P < 0.001), for patients with Perthes disease undergoing chondroplasty and loose body excision (before surgery 49.5; after surgery 80.1; P < 0.001), and for patients with hip dysplasia after prior periacetabular osteotomy undergoing labral debridement (before surgery 51.8; after surgery 79.8; P < 0.001). Complications included transient pudendal nerve palsy (n = 3), instrument breakage (n = 1), and recurrent labral tear (n = 3). Hip arthroscopy in children and adolescents appears to be safe and efficacious for certain indications in the short term.

Adolescent↗