Monday, October 31, 2011

NFL Patellar Tendon Ruptures new study!!

Take a look at this study that was published in the latest issue of The American Journal of Sports Medicine about Patellar Tendon Ruptures. I suspect that if the serial use of MSK ultrasound which easy to use and visualizes the Patellar tendon very well and can also be Dynamically acessed would help decrease the incident of patellar tendon ruptures. Let me know what you think!

Patellar Tendon Ruptures in National Football League Players

Background: Although knee injuries are common among professional football players, ruptures of the patellar tendon are relatively rare. Predisposing factors, mechanisms of injury, treatment guidelines, and recovery expectations are not well established in high-level athletes.
Hypothesis: Professional football players with isolated rupture of the patellar tendon treated with timely surgical repair will return to their sport.
Study Design: Case series; Level of evidence, 4.
Methods: Twenty-four ruptures of the patellar tendon in 22 National Football League (NFL) players were identified from 1994 through 2004. Team physicians retrospectively reviewed training room and clinic records, operative notes, and imaging studies for each of these players. Player game statistics and draft status were analyzed to identify return to play predictors. A successful outcome was defined as participating in 1 regular-season NFL game.
Results: Eleven of the 24 injuries had antecedent symptoms. The most common mechanism of injury was an eccentric overload to a contracting extensor mechanism. Physical examination demonstrated a palpable defect in all players. Twenty-two were complete ruptures, and 2 were partial injuries. Three of the 24 cases had a concomitant anterior cruciate ligament (ACL) injury. In 19 of the 24 injuries, the player returned to participate in at least 1 game in the NFL. Players who returned were drafted, on average, in the fourth round, while those who failed to return to play were drafted, on average, in the sixth round. Of those players who returned to play, the average number of games played was 45.4, with a range of 1 to 142 games.
Conclusion: Patellar tendon ruptures can occur in otherwise healthy professional football players without antecedent symptoms or predisposing factors. The most common mechanism of injury is eccentric overload. Close attention should be paid to stability examination of the knee given the not uncommon occurrence of concomitant ACL injury. Although this is usually a season-ending injury when it occurs in isolation, acute surgical repair generally produces good functional results and allows for return to play the following season. Players chosen earlier in the draft are more likely to return to play.


Saturday, October 29, 2011

Ultrasound-Guided Sclerosing Treatment in Patients With Patellar Tendinopathy (Jumper's Knee): 44-Month Follow-up

Ultrasound-Guided Sclerosing Treatment in Patients With Patellar Tendinopathy (Jumper's Knee): 44-Month Follow-up
by Hoksrud, A., Bahr, R. on Oct 28, 2011 8:37 PM
Background: A randomized controlled study has shown good clinical results after treatment with sclerosing injections into the area with neovessels in patients with patellar tendinopathy, but no study has investigated medium- or long-term outcomes.

Purpose: This study investigates the effect of sclerosing treatment 44 months (range, 42-47 months) after start of treatment.

Study Design: Case series; Level of evidence, 4.

Methods: Patients with a diagnosis of jumper’s knee and neovascularization corresponding to the painful area were recruited and treated with ultrasound-guided sclerosing injections using polidocanol. Primary outcome was Victorian Institute of Sport Assessment (VISA) score, which was recorded before the start of treatment, after 12 months, and 44 months after the start of the study period.

Results: Twelve of the 29 patients (14 tendons) who were followed up at 44 months had undergone arthroscopic surgery after sclerosing treatment, either to the patellar tendon (n = 6) or for other intra-articular lesions (n = 8). For patients who did not receive additional treatment after the sclerosing injections (n = 23 tendons), VISA score was 55 (range, 28-71) at baseline and 81 (range, 39-100) at 12-month follow-up (P < .001 vs baseline).Their VISA score at 44 months’ follow-up was 89 (range, 73-100; P = .047 vs 12 months). For patients who went through arthroscopic tendon surgery, VISA score was 53 (range, 39-71) at baseline and 71 before surgery (range, 48-98; P = .14 vs baseline). Their VISA score at 44 months was 91 (range, 76-100; P = .0.16 vs 12 months; P = .005 vs baseline). For patients who went through non–tendon surgery, VISA score was 45 (range, 15-69) at baseline and 57 (range, 32-95) before surgery (P = .29 vs baseline). Their VISA score at 44 months was 92 (range, 72-100; P = .006 vs before surgery; P < .001 vs baseline).

Conclusion: Sclerosing treatment with polidocanol was effective for the majority of the patients. Nevertheless, one-third elected to seek additional treatment through arthroscopic surgery during the 44-month follow-up period.

Friday, October 28, 2011

When do Rotator Cuff Repairs Fail? New study

When Do Rotator Cuff Repairs Fail? Serial Ultrasound Examination After Arthroscopic Repair of Large and Massive Rotator Cuff Tears

by Miller, B. S., Downie, B. K., Kohen, R. B., Kijek, T., Lesniak, B., Jacobson, J. A., Hughes, R. E., Carpenter, J. E. on Oct 8, 2011 2:36 AM

Background: Despite advances in arthroscopic repair of rotator cuff tears, recurrent tears after repair of large and massive tears remain a significant clinical problem. The primary objective of this study was to define the timing of structural failure of surgically repaired large and massive rotator cuff tears by serial imaging with ultrasound. The secondary objective of this study was to investigate the association between recurrent tears and clinical outcome after rotator cuff repair.

Hypothesis: Recurrent tear after arthroscopic repair of large rotator cuff tears is more likely to occur late (>3 months) in the postoperative period and will be associated with inferior clinical outcome scores.

Study Design: Cohort study; Level of evidence, 3.

Methods: Twenty-two consecutive patients with large (>3 cm) rotator cuff tears underwent arthroscopic repair with a standardized technique. Serial ultrasound examinations were performed at 2 days, 2 weeks, 6 weeks, 3 months, 6 months, 12 months, and 24 months after surgery. Western Ontario Rotator Cuff (WORC) Index scores were also collected at these time points.

Results: Nine (41%) of the 22 arthroscopically repaired rotator cuff tears demonstrated recurrent tears. Seven of the 9 retears occurred within 3 months of surgery, and the other 2 occurred between 3 and 6 months. No retears occurred after 6 months. At 24-month follow-up, WORC scores favoring intact rotator cuffs over retears approached statistical significance (mean WORC intact 123.9 vs retear 659.8; P = .07).

Conclusion: Recurrent rotator cuff tears are not uncommon after arthroscopic repair of large and massive tears. These recurrent tears appear to occur more frequently in the early postoperative period (within the first 3 months) and are associated with inferior clinical outcomes.

Wednesday, October 26, 2011

Cold water immersion, Contrast baths, and Recovery between workouts shows some Promise.

Sprint Cycling Performance Is Maintained with Short-Term Contrast Water Immersion


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Purpose: Given the widespread use of water immersion during recovery from exercise, we aimed to investigate the effect of contrast water immersion on recovery of sprint cycling performance, HR and, blood lactate.
Methods: Two groups completed high-intensity sprint exercise before and after a 30-min randomized recovery. The Wingate group (n = 8) performed 3 × 30-s Wingate tests (4-min rest periods). The repeated intermittent sprint group (n = 8) cycled for alternating 30-s periods at 40% of predetermined maximum power and 120% maximum power, until exhaustion. Both groups completed three trials using a different recovery treatment for each trial (balanced randomized application). Recovery treatments were passive rest, 1:1 contrast water immersion (2.5 min of cold (8°C) to 2.5 min of hot (40°C)), and 1:4 contrast water immersion (1 min of cold to 4 min of hot). Blood lactate and HR were recorded throughout, and peak power and total work for pre- and postrecovery Wingate performance and exercise time and total work for repeated sprinting were recorded.
Results: Recovery of Wingate peak power was 8% greater after 1:4 contrast water immersion than after passive rest, whereas both contrast water immersion ratios provided a greater recovery of exercise time (∼10%) and total work (∼14%) for repeated sprinting than for passive rest. Blood lactate was similar between trials. Compared with passive rest, HR initially declined more slowly during contrast water immersion but increased with each transition to a cold immersion phase.
Conclusions: These data support contrast water immersion being effective in maintaining performance during a short-term recovery from sprint exercise. This effect needs further investigation but is likely explained by cardiovascular mechanisms, shown here by an elevation in HR upon each cold immersion.

Medicine & Science in Sports & Exercise:
November 2011 - Volume 43 - Issue 11 - pp 2180-2188
doi: 10.1249/MSS.0b013e31821d06d9

Tuesday, October 25, 2011

Do Lace-up Ankle Braces on Basketball Players Work?

The Effect of Lace-up Ankle Braces on Injury Rates in High School Basketball Players

  1. Timothy A. McGuine, PhD, ATC*
  2. Alison Brooks, MD and 
  3. Scott Hetzel, MS
+Author Affiliations
  1. University of Wisconsin-Madison, Madison, Wisconsin
  2. Investigation performed at the University of Wisconsin, Madison, Wisconsin
  1. * Timothy A. McGuine, PhD, ATC, UW Health Sports Medicine Center, 621 Science Drive, Madison, WI 53711 (e-mail:
  1. Presented at the 37th annual meeting of the AOSSM, San Diego, California, July 2011.


Background: Ankle injuries are the most common injury in basketball players. However, no prospective studies have been performed to determine if wearing lace-up ankle braces will reduce the incidence of ankle injuries in high school athletes.
Purpose: This trial was undertaken to determine if lace-up ankle braces reduce the incidence and severity of acute first-time and recurrent ankle injuries sustained by high school basketball players.
Design: Randomized controlled trial; Level of evidence, 1.
Methods: A total of 1460 male and female basketball players from 46 high schools were randomly assigned to a braced or control group. The braced group players wore lace-up ankle braces during the 2009-2010 basketball season. Athletic trainers recorded brace compliance, athlete exposures, and injuries. Cox proportional hazards models (adjusted for demographic covariates), accounting for intracluster correlation, were utilized to compare time to first acute ankle injury between groups. Injury severity (days lost) was tested with the Wilcoxon rank-sum test.
Results: The rate of acute ankle injury (per 1000 exposures) was 0.47 in the braced group and 1.41 in the control group (Cox hazard ratio [HR] 0.32; 95% confidence interval [CI] 0.20, 0.52; P < .001). The median severity of acute ankle injuries was similar (P = .23) in the braced (6 days) and control group (7 days). For players with a previous ankle injury, the incidence of acute ankle injury was 0.83 in the braced group and 1.79 in the control group (Cox HR 0.39; 95% CI 0.17, 0.90; P = .028). For players who did not report a previous ankle injury, the incidence of acute ankle injury was 0.40 in the braced group and 1.35 in the control group (Cox HR 0.30; 95% CI 0.17, 0.52, P < .001).
Conclusion: Use of lace-up ankle braces reduced the incidence but not the severity of acute ankle injuries in male and female high school basketball athletes both with and without a previous history of an ankle injury.



Sunday, October 23, 2011

Recovery and Sports

Great turnout for my lecture in recovery in NY. Looking forward to the next one in the DC, MD, VA area.

Friday, October 21, 2011

Is Hip Muscle Weakness a Predisposing Factor for Patellofemoral Pain in Female Novice Runners? A Prospective Study

Is Hip Muscle Weakness a Predisposing Factor for Patellofemoral Pain in Female Novice Runners? A Prospective Study

  1. Youri Thijs, PT, PhD*
  2. Els Pattyn, PT
  3. Damien Van Tiggelen, PT, PhD
  4. Lies Rombaut, PT§ and 
  5. Erik Witvrouw, PT, PhD
+Author Affiliations
  1. Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
  2. Military Hospital of Base Queen Astrid, Department of Physical Medicine and Rehabilitation, Brussels, Belgium
  3. §Department of Rehabilitation Sciences and Physiotherapy, Ghent University–Artevelde University College, Ghent, Belgium
  4. Investigation performed at Ghent University, Ghent, Belgium
  1. * Youri Thijs, PT, PhD, Ghent University, Faculty of Medicine, Ghent University Hospital (3B3) (REVAKI), De Pintelaan 185, 9000 Gent, Belgium (


Background: Hip muscle weakness has been proposed to contribute to patellofemoral malalignment and the development of the patellofemoral dysfunction syndrome (PFDS). However, from the retrospective studies that have addressed this issue, it is still unclear if hip muscle weakness is a cause or a consequence of PFDS.
Purpose: This study was undertaken to investigate if hip muscle weakness is a predisposing factor for the development of PFDS.
Study Design: Cohort study (prognosis); Level of evidence, 2.
Methods: Before the start of a 10-week “start to run” program, the isometric strength of the hip flexor, extensor, abductor, adductor, and external and internal rotator muscles was measured in 77 healthy female novice runners. During the 10-week training period, patellofemoral pain was diagnosed and registered by an orthopaedic surgeon.
Results: Statistical analysis revealed that there was no significant difference in strength of any of the assessed hip muscle groups between the runners who did and did not develop PFDS. Logistic regression analysis did not identify a deviation in strength of any of the assessed hip muscle groups as a risk factor for PFDS.
Conclusion: The findings of this study suggest that isometric hip muscle strength might not be a predisposing factor for the development of PFDS.


Wednesday, October 19, 2011

Cycling and Saddle Sores How to Prevent them

Preventing Saddle Sores

SaddleSoresWearing cycling shorts, as opposed to regular shorts over cotton underwear, will help cut down on friction that leads to saddle sores.
For many recreational cyclists, the worst part about getting back on a bike is the inevitable saddle soreness. Depending on how long you've been away, it may only take a few minutes before pain in the rear starts taking the joy out of your ride. Fortunately, it willget better with time. The more you ride, regardless of physical exertion, the longer you'll be able to sit as your tissues adapt to the added stress.

A Short Order

One way to reduce saddle soreness is by wearing cycling shorts. You will notice a huge difference when you stop using shorts over cotton underwear. Cotton absorbs and holds sweat, leading to a very chafed bottom.
I recommend using bib-shorts. This style, which has built-in suspenders, usually fits better than traditional shorts and does not shift while riding. When the chamois moves, it causes friction. Friction can cause irritation, chafing and eventually saddle sores.
It's important to clean yourself right after a ride so organisms don't start to grow and multiply. Make sure your bottom and crotch are as clean as possible before a ride to help prevent organisms from growing in the first place. For long-distance rides, cyclists might consider changing shorts at various points to help cut down on possible infections and chaffing.
It's important to remember that when you stop riding your sweat starts to dry. Because it contains salt, sweat will turn into solid crystals that start to sand the skin. The longer you're on the bike, the more you will need to apply chamois crème. Reapply when you stop to help decrease friction and keep a barrier from the potential salt crystals. Most crèmes on the market work pretty well, but try a few and see what works best for you. I do not recommend Vaseline. It is hard to get out of clothes, clogs pores, and stays on the hands, which can get into your gloves and cause a big mess.

The Right Saddle for Your Ride

Research has shown that traditional saddles compress various nerves and blood vessels. Over the past few years, saddle manufactures have been trying to decrease the pressure to these areas, and many companies now sell saddles with an open channel down the center.
Riders should also pay attention to saddle size and cushioning. There is a reason other than weight that you don't see huge saddles on the pro tour. Having a large area of contact with the bike increases the potential for pressure, which in turn causes nerve and blood-vessel issues. You want your sit bones and some buttock tissue to receive most of the pressure from the seat, not the area were most of the blood vessels and nerves connected to your genitals are located. 
Serious amateur riders and enthusiasts who spend long hours on their bikes need a comfortable, light saddle that eliminates all numbness. This cuts down the risk of damage due to repetitive micro-trauma.
I sometimes hear or read advice telling people to lower the tip of their saddle. This may help, but it creates an entirely different health issue. This adjustment changes the biomechanics of the bike. Riders can develop knee pain or other issues, which often leads to more bike adjustments and so on and so forth. The end result is an ill-fitting bike that causes more harm than good. The saddle should remain level, allowing the rider to slide a bit back on long climbs and allow the body to utilize fresh muscle fibers.
So what saddles are best for you? Experiment before choosing one. See if you can get a loaner saddle from your local bike shop. I use two different versions of the Selle SMP, a minimalist Stratos for my racing bike and a Glider, which has a bit more padding and is wider, for my touring bike. This saddle has a huge gap in the middle of the seat as well as a curved overall shape to help eliminate the pressure of the nerves and blood vessels. Its front is bent forward for added control when climbing or descending. In addition, the back portion of the saddle has a drop-out to prevent the tailbone from hitting the seat on uneven surfaces or hard bumps.
I just finished the 1200-kilometer Paris-Brest-Paris ride without any numbness whatsoever. Selle Italia also makes a few models I think are good alternatives for riders that experience numbness. In addition, Specialized has a broad range of sizes and gender-specific saddles developed by Dr. Andy Pruitt, one of the most knowledgeable professionals in cycling on body position and injury.
The best way to deal with chafing and saddle sores is to treat your bottom like a baby's. Use Destin, Balmex or any ointment with zinc oxide. In addition, using triple antibiotic plus a pain reliever on long rides is helpful. Remember, be picky when choosing your saddles, shorts, and creams; keep that area clean and you will find your rides to be much less of a pain in the butt.