Repetitive load on the spine increases the risk of back pain and spondylolysis. “High-risk” sports include ballet, diving, figure skating, football, gymnastics, rowing, weight lifting, and wrestling. Rates of spondylolysis in sports have been reported from 17 to 43%. Electrical stimulation (e-stim) is typically used to heal recalcitrant cases of non-union. Retrospective studies suggest that e-stim may improve healing rates of spondylolysis. PURPOSE: To determine if patients with spondylolysis fractures have a higher rate of healing with the Boston Overlapping Brace (BOB) and e-stim versus those who use BOB alone. METHODS: In this prospective case control study, 56 athletes ages 12–22 (mean= 16) with extension-based back pain were enrolled after being diagnosed with spondylolysis by either positive SPECT bone scan and CT scan, or positive MRI and CT scan. Patients were randomly assigned to standard treatment or experimental treatment. The standard arm (BOB group) consisted of activity restriction, antilordotic bracing 23 hours/day, and physical therapy (PT). The experimental arm (e-stim group) involved standard therapy plus an external electrical bone stimulator, worn outside the brace over the spondylolysis site 3 hours/day. At 4 months, repeat CT exams were obtained. Patients in the standard group who were still experiencing back pain and had radiographic evidence of non-union of the fracture were then crossed-over to begin e-stim therapy (CO group). Patients were followed for one year with physical exams, compliance and pain surveys, and CT scans until bony/fibrous union was noted. RESULTS: 30 patients were randomized to e-stim, 26 patients to BOB, and 7 of the BOB patients became CO patients. Bony or fibrous union was noted on CT in 20/50 of the e-stim group, 13/32 in the BOB group, and 6/7 of the CO group. When radiographic results of e-stim and CO were combined and compared with BOB using chi square testing, there was no significant difference in the frequency of bony/fibrous union between the two groups (p ≤ 1.0). CONCLUSIONS: The preliminary data of this study suggest that adding e-stim to BOB and PT in the treatment of spondylolysis does not improve the rate of bony/ fibrous union compared to BOB and PT alone. However, more patients are being recruited to enhance future subgroup analysis.
The Guardian Angels represent a form of citizen crime prevention that has fostered interest and concern regarding the group's impact, motives, leadership, and organizational structure. Led by their founder, Curtis Sliwa, these volunteers patrol the streets and subways in over 50 cities. The purpose of this exploratory study was to document the activities of the Angels, assess their impact on crime and citizen fear of crime, and describe features of the group that differentiate it from other citizen patrols. Recent research suggests that citizen patrols may reduce crime and make citizens feel safe by imposing social order. Study findings suggest that Angels may not reduce the violent offenses they seek to prevent, although they may have limited impact on property crimes. Segments of the population feel safe when Angels patrol, which may be associated with the Angels performing an order-maintenance role. Sliwa's efforts to mobilize minority youth to be positive role models is a unique feature of the Angels. Ultimately, the effectiveness of the Angels may depend on the extent to which Sliwa can seek rapprochement with law enforcement and community leaders.
To establish injury profile of collegiate rugby union in the USA. DESIGN/ SETTING: 31 men's and 38 women's collegiate rugby union teams prospectively recorded injuries during games and practice during the 2005-06 season. Three teams withdrew before data collection. An injury was defined as one: (1) occurring in an organised intercollegiate game or practice; and (2) requiring medical attention during or after the game or practice, or (3) resulting in any restriction of the athletes' participation for >or=1 day(s) beyond the day of injury, or in a dental injury.In total, 847 injuries (447 in men; 400 in women) during 48,026 practice (24,280 in men; 23,746 in women) and 25,808 game (13,943 in men; 11,865 in women) exposures were recorded.During games, injury rates of 22.5 (95% CI 20.2 to 25.0) and 22.7 (20.2 to 25.5) per 1000 game athletic exposures or 16.9 (15.1 to 18.9) and 17.1 (15.1 to 19.1) per 1000 player game hours were recorded for men and women, respectively. Over half of all match injuries were of major severity (>7 days' absence) (men 56%; women 51%) and the tackle was the game event most often associated with injury (men 48%; women 53%).Collegiate game injury rates for rugby were lower than rates recorded previously in men's professional club and international rugby and lower than reported by the National Collegiate Athletic Association Injury Surveillance System for American football, but similar to rates reported for men's and women's soccer in 2005-06.
Objective: To determine the evidence base for recommendations regarding autologous chondryocyte implantation in adolescent athletes. Materials and Methods: All literature on articular cartilage repair from MEDLINE search dated 1990 to 2006 was reviewed. The majority of articles describe surgical technique and indications. Three techniques for secondary articular cartilage repair have been identified: autologous chondrocyte implantation, autologous osteochondral implants, and marrow stimulation techniques. The initial literature search identified 4 studies that reported the effectiveness and durability of autologous chondrocyte implantation in adults and 2 studies that reported the outcomes of autologous chondrocyte implantation in adolescent athletes. No results of osteochondral implantation or marrow stimulation techniques in adolescent athletes have been published. Results: Acceptable repair rates with all 3 techniques have been reported in adult athletes. Two studies reported high success using autolgous chondrocyte implantation (ACI) in children. Conclusions: Articular cartilage injury in young athletes remains a difficult problem. The ideal situation is early diagnosis and primary repair, particularly with lesions of the knee, elbow, and ankle. In cases where primary repair is not possible or has been unsuccessful and the lesion is large or symptomatic, secondary repair with either marrow stimulation, microfracture, autologous chondrocyte implantation, or autologous osteochondral grafting may be used. However, at present only the results of ACI repair have been reported for adolescent athletes.
There is no consensus regarding optimum surgical treatment for chronic ankle instability. The purpose of this study is to describe a variation of the Chrisman-Snook lateral ligament reconstruction that the senior author uses in patients with chronic ankle instability recalcitrant to conservative management. All patients who underwent reconstruction from 1997 to 2006 were identified, and those with a minimum 2-year follow-up were included, representing a total of 44 ankles in 43 patients. All underwent clinical evaluation and completion of the Foot and Ankle Outcome Survey and the Kaikkonen Scale. At mean follow-up of 4.4 years, mean dorsiflexion loss was 2° compared with the nonoperative side. The postoperative mean Foot and Ankle Outcome Survey score was 74 ± 16 (range, 36-98), while the mean Kaikkonen total score was 77 ± 14 (range, 40-95). Thirty-eight patients (84.6%) were satisfied with their result. Six patients (13.6%) underwent reoperation, including 4 with peroneal tendon scarring requiring tenolysis. Return to sport was achieved in 28 of 35 patients (80%) at a median of 6 months postoperatively. It is concluded that dorsiflexion loss can be minimized and return to sport expected in most patients following this variation of the Chrisman-Snook reconstruction.
Now from the AAP! Adolescent Medicine: State of the Art Reviews(formerly Adolescent Medicine Clinics) is the official publication of the AAP Section on Adolescent Health. This widely respected resource continues to deliver practice-focused, useful information you won't see anywhere else.Topics in Musculoskeletal Disorders include:Musculoskeletal Diagnosis in AdolescentsAn Introduction to Physical Therapy ModalitiesMetabolic Bone Disease in Adolescents: Recognition, Evaluation, Treatment, and PreventionChronic Arthritis in AdolescenceDiagnosis and Management of Bone Malignancy in AdolescenceOsteomyelitis in AdolescentsOveruse Injuries in AdolescentsScoliosis and Kyphosis: Diagnosis and ManagementDiagnosis and Management of Back Pain in AdolescentsHip Disorders in the AdolescentFoot Problems in the AdolescentAnterior Knee Pain in Adolescents and Young AdultsReflex Sympathetic DystrophyAnd more!May 2007Softcover - Volume 18, Number 1
Pediatric intramedullary spinal cord tumors are rare and account for 3% to 6% of all central nervous system tumors. Astrocytomas are infiltrating neoplasms, and they predominate in the pediatric population. We report a case of an intramedullary spinal cord astrocytoma in a 5-year-old boy with nonspecific mid-back pain for 3 months. Physical examination revealed clonus, thoracolumbar tenderness, and pain with sitting straight leg raises. An urgent magnetic resonance imaging showed an intramedullary tumor in the mid-thoracic cord, confirmed by surgical excision. The physician should maintain a high index of suspicion when evaluating the pediatric patient who presents with unexplained and persistent back pain. Associated findings, including nocturnal pain and neurological symptoms may indicate a more serious underlying pathology such as a tumor. Early detection, prompt treatment, and proper post surgical management will often lead to improved outcomes in patients.
Anterior cruciate ligament (ACL) reconstruction is quite commonly used to treat anterior knee instability. Surgeon preference and patient functional goals determine graft selection and graft fixation techniques. Interference screws are considered a safe and effective device for graft fixation in surgical ACL reconstruction. Poly-L-lactide acid (PLLA) bioabsorbable interference screws are becoming increasingly popular in ACL reconstruction surgery. There are several reasons why they may be more advantageous than metallic screws, including reduced graft laceration during insertion, ease of performance of revision procedures, avoidance of graft injury encountered with aperture fixation using metallic screws, and fewer artifacts on magnetic resonance images (MRI). Few studies describe complications associated with PLLA bioabsorbable screws, particularly extra-articular screw migration. This article presents a case of an extra-articular extraosseous migration of the femoral bioabsorbable interference screw. This case further demonstrates the problem of the femoral bioabsorbable interference screw.
