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PubMed1979

Knee ligament injuries in children.

Nine children who were less than fourteen years old and had open physes and ligament injuries of the knee were studied. Despite an initial thorough physical and roentgenographic evaluation, the full extent of the lesion was determined only at operation in seven of the nine patients. The intercondylar eminence of the tibia was avulsed in five patients, four of whom had associated collateral ligament injuries and a positive anterior drawer sign. Despite surgical repair, all nine patients demonstrated some degree of postoperative ligament instability. This was increased in those patients in whom menisectomy had been performed concomitantly with ligament repair. Although none of the children were symptomatic at the time of writing, development of degenerative arthritis in the future must be considered. Ligament injury must be considered in the differential diagnosis of the child suffering from knee trauma. The association of avulsion of the tibial spine and collateral ligament injury is emphasized.

Adolescent↗

PubMedDate not supplied

Hamstring strains in athletes: diagnosis and treatment.

Hamstring strains are among the most common injuries (and reinjuries) in athletes. Studies combining electromyography with gait analysis have elucidated the timing of activity of the three muscles of the hamstring group; they function during the early-stance phase for knee support, during the late-stance phase for propulsion, and during midswing to control the momentum of the leg. Muscle injury, whether partial or complete, occurs at the myotendinous junction, where force is concentrated. The healing response begins with inflammation, associated edema, and localized hemorrhage. After an initial period of reduced tension, the healing muscle regains strength rapidly as long as reinjury does not occur. Although the use of anti-inflammatory medication is a keystone of treatment, a certain degree of inflammation is necessary for removing necrotic muscle fibers and rescaffolding to allow optimal recovery. The protocol of rest, ice, compression, and elevation is still the preferred first-aid approach. After a brief period of immobilization (usually less than 1 week for even the most severe strain), mobilization is begun to properly align the regenerating muscle fibers and limit the extent of connective tissue fibrosis. Concurrent pain-free stretching and strengthening exercises (beginning with isometrics and progressing to isotonics and isokinetics) are essential to regain flexibility and prevent further injury and inflammation. Readiness for return to competition can be assessed by isokinetic testing to confirm that muscle-strength imbalances have been corrected, the hamstring-quadriceps ratio is 50% to 60%, and the strength of the injured leg has been restored to within 10% of that of the unaffected leg. The only indication for surgery is a complete rupture at or near the origin from the ischial tuberosity or distally at its insertion (either soft-tissue avulsion with a large defect or bone avulsion with displacement by 2 cm).

Athletic Injuries↗