Gohil S, Annear PO, Breidahl W. Anterior cruciate ligament reconstruction using autologous double hamstrings: a comparison of standard versus minimal debridement techniques using MRI to assess revascularisation. A randomised prospective study with a one-year follow-up. J Bone Joint Surg Br. 2007;89:1165-71.
Patients were randomized to minimal débridement of the intercondylar notch or conventional clearance of the notch for autologous hamstring anterior cruciate ligament reconstruction. All patients underwent magnetic resonance imaging postoperatively at two, six, and twelve months to evaluate revascularization of the implanted autografts. Results showed earlier revascularization of the midsubstance of the anterior cruciate ligament graft at two months in association with the minimal débridement technique. The clinical importance of this finding, however, is unclear, as no differences in clinical outcomes or examination findings were demonstrated between the groups.
Hantes ME, Basdekis GK, Varitimidis SE, Giotikas D, Petinaki E, Malizos KN. Autograft contamination during preparation for anterior cruciate ligament reconstruction. J Bone Joint Surg Am. 2008;90:760-4.
The contamination rates of bone-patellar tendon-bone and hamstring autografts were evaluated with graft-tissue culture samples at different time intervals during preparation. The contamination rate before implantation was 12% overall, with no difference between the bone-patellar tendon-bone and hamstring groups, and no postoperative infections were reported. Also, no changes in the postoperative erythrocyte sedimentation rate or C-reactive protein level were demonstrated between patients with a contaminated graft and those with an uncontaminated graft. These findings suggest that in a patient with a contaminated graft, no additional treatment is necessary in the absence of clinical signs of infection.
Bottoni CR, Liddell TR, Trainor TJ, Freccero DM, Lindell KK. Postoperative range of motion following anterior cruciate ligament reconstruction using autograft hamstrings: a prospective, randomized clinical trial of early versus delayed reconstructions. Am J Sports Med. 2008;36:656-62.
This randomized, prospective controlled trial evaluated the effect of early as opposed to delayed anterior cruciate ligament reconstruction with hamstring autograft on postoperative range of motion and stability in young, active patients. Seventy patients were randomized into two groups, with one group undergoing surgery within three weeks after the injury and a second group undergoing reconstruction at a minimum of six weeks after the injury. The average duration of follow-up after surgery was one year. No significant difference in postoperative range of motion was found between the two groups. There also were no differences between the groups in terms of operative time, KT-1000 measurements, or subjective knee outcome measures. This study demonstrates that anterior cruciate ligament reconstruction does not need to be delayed to achieve optimal results. The authors advocate the use of a rehabilitation program that emphasizes early mobilization and maintenance of extension.
Beck BR, Matheson GO, Bergman G, Norling T, Fredericson M, Hoffman AR, Marcus R. Do capacitively coupled electric fields accelerate tibial stress fracture healing? A randomized controlled trial. Am J Sports Med. 2008;36:545-53.
Twenty men and twenty-four women with acute posteromedial tibial stress fractures were randomly assigned to treatment with active or placebo capacitively coupled electric field stimulation devices for fifteen hours a day until the fractures healed. Patients also received supplemental calcium and were instructed to refrain from provocative training. The active and placebo groups showed no difference in terms of the time to healing. Women healed more slowly than men did. Noncompliance with rest instructions led to an increased time to healing, with optimal compliance leading to a reduced healing time. Severe stress fractures showed shortened healing time in association with active capacitively coupled electric field device use. This study shows that capacitively coupled electric field stimulation may be most efficacious for patients with a higher incentive to return to play, assuming that this patient population will be motivated to be more compliant with device use and weight-bearing restrictions during healing.
Henn RF 3rd, Kang L, Tashjian RZ, Green A. Patients' preoperative expectations predict the outcome of rotator cuff repair. J Bone Joint Surg Am. 2007;89:1913-9.
This observational study evaluated the relationship between preoperative expectation and postoperative outcome following unilateral primary repair of chronic rotator cuff tears for 125 patients. Each patient prospectively completed several limb-specific outcome instruments and SF-36 (Short Form-36) forms preoperatively and again at one year postoperatively. The results showed that greater preoperative expectations were correlated with better postoperative performance on self-assessed outcome measures. The authors noted that, unlike in previous studies, higher preoperative expectations were associated with better postoperative function and pain. This study highlights the importance of preoperative expectations on outcomes following rotator cuff repair, and it also reiterates the importance of preoperative patient counseling.
Fredberg U, Bolvig L, Andersen NT. Prophylactic training in asymptomatic soccer players with ultrasonographic abnormalities in Achilles and patellar tendons: the Danish Super League Study. Am J Sports Med. 2008;36:451-60.
This randomized controlled trial evaluated the effect of a prophylactic eccentric training and stretching program for professional soccer players with ultrasonographic intratendinous changes of the Achilles and patellar tendons. Two hundred and nine Danish professional soccer players from twelve teams were followed over a twelve-month period. Half of the teams were randomized to a treatment group and underwent prophylactic eccentric training and stretching of the Achilles and patellar tendons during the season. The training and stretching program for patients with normal patellar tendons led to a significant reduction in the proportion of players with ultrasonographic patellar tendon changes by the end of the season. The program had no effect on normal Achilles tendons. Preseason intratendinous changes on ultrasound significantly increased the risk of tendon problems during the season. Thus, ultrasound can be used in the preseason to identify players in whom symptomatic Achilles or patellar tendon problems may develop during the season. Unfortunately, the preseason eccentric training program aimed at reducing intraseason injuries in patients with ultrasonographic changes actually was associated with an increased injury risk.
Hiemstra LA, Sasyniuk TM, Mohtadi NG, Fick GH. Shoulder strength after open versus arthroscopic stabilization. Am J Sports Med. 2008;36:861-7.
This piggyback randomized controlled trial assessed shoulder strength following open as opposed to arthroscopic stabilization for the treatment of traumatic anterior instability. The hypothesis was that patients undergoing open stabilization would have internal rotation deficits when compared with those undergoing arthroscopic repair. Forty-eight patients were randomized to either open stabilization (with a subscapularis splitting approach) or arthroscopic stabilization. All patients underwent isokinetic strength testing at one year after surgery. No significant difference in internal concentric strength at 60°/sec (the primary outcome measure) was found between the groups. Both groups had strength deficits in the treated limb as compared with the contralateral limb. This study demonstrated that internal and external rotation deficits exist following both open and arthroscopic anterior stabilization procedures. Further study is needed to determine if subscapularis tendon detachment procedures for anterior stabilization lead to increased internal rotation deficits.
Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R. Prevention of injuries among male soccer players: a prospective, randomized intervention study targeting players with previous injuries or reduced function. Am J Sports Med. 2008;36:1052-60.
The authors of this randomized controlled trial sought to determine whether the most common injuries in high-risk soccer players could be identified and subsequently prevented through the implementation of a preventive training program. Five hundred and eight players completed a questionnaire evaluating previous injury and/or limited function. From this, high-risk and low-risk groups were created. The high-risk group was randomized into an intervention group (managed with a preventive training program) and a control group. High-risk players were successfully identified with the questionnaire. There was no difference in the risk of injury between the high-risk intervention and control groups. This finding was thought to be due in large part to poor compliance with the training program by those in the intervention group.
Tagesson S, Oberg B, Good L, Kvist J. A comprehensive rehabilitation program with quadriceps strengthening in closed versus open kinetic chain exercise in patients with anterior cruciate ligament deficiency: a randomized clinical trial evaluating dynamic tibial translation and muscle function. Am J Sports Med. 2008;36:298-307.
The authors of this randomized controlled trial sought to compare closed and open kinetic chain quadriceps-strengthening programs for patients with anterior cruciate ligament deficiency. Forty-two patients were randomized into a closed kinetic chain or an open kinetic chain quadriceps-strengthening rehabilitation program. Patients were evaluated after the completion of four months of rehabilitation. Several assessment tools were used, with no difference being noted between the groups, with the exception that the open kinetic chain group had significantly greater quadriceps strength in comparison with the closed kinetic chain group. This study suggests that open kinetic chain quadriceps-strengthening rehabilitation programs may be effective for patients with anterior cruciate ligament deficiency.
Stergioulas A, Stergioula M, Aarskog R, Lopes-Martins RA, Bjordal JM. Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic Achilles tendinopathy. Am J Sports Med. 2008;36:881-7.
The purpose of this study was to investigate the use of low-level laser irradiation combined with an eccentric exercise program for recreational athletes with chronic Achilles tendinopathy. Fifty-two recreational athletes with chronic Achilles tendinopathy were randomized into two groups. One group was treated with an eccentric exercise program and low-level laser therapy, while another group underwent eccentric exercise combined with placebo low-level laser therapy. Patients in the eccentric exercise program and low-level laser therapy group experienced faster recovery from the Achilles tendinopathy in comparison with those in the eccentric exercise combined with placebo low-level laser therapy group.
Croisier JL, Ganteaume S, Binet J, Genty M, Ferret JM. Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. Am J Sports Med. 2008;36:1469-75.
In this cohort study, a standard concentric and eccentric isokinetic assessment program was used during the preseason to identify and treat professional soccer players who had hamstring strength imbalances that may predispose them to injury. Six hundred and eighty-seven players were enrolled during the preseason, and 462 were available for follow-up. The study found that the risk of injury was, in fact, high for those individuals. Furthermore, restoring the strength profile, thus eliminating the imbalance, decreased the incidence of injury.
Blaine T, Moskowitz R, Udell J, Skyhar M, Levin R, Friedlander J, Daley M, Altman R. Treatment of persistent shoulder pain with sodium hyaluronate: a randomized, controlled trial. A multicenter study. J Bone Joint Surg Am. 2008;90:970-9.
The purpose of this double-blind, randomized, phosphate-buffered saline solution-controlled study was to evaluate the use of three and five-injection regimens of intra-articular sodium hyaluronate for the treatment of shoulder pain. Six hundred and sixty patients with shoulder pain secondary to a variety of etiologies were enrolled, and 456 were available for follow-up at twenty-six weeks. The primary end point of the study was to achieve improvement in terms of shoulder pain at thirteen weeks. Unfortunately, this was not achieved overall. However, the authors found that both the three and five-injection regimens were successful for the treatment of persistent shoulder pain in patients with osteoarthritis. Therefore, patients with osteoarthritis who fail to respond to other conservative measures and who also are poor surgical candidates may benefit from an intra-articular sodium hyaluronan treatment regimen.
Tanner SM, Dainty KN, Marx RG, Kirkley A. Knee-specific quality-of-life instruments: which ones measure symptoms and disabilities most important to patients? Am J Sports Med. 2007;35:1450-8.
The authors of this cohort study sought to identify the knee-specific quality-of-life instruments that best detect symptoms and disabilities of the most importance to patients. One hundred and fifty-three patients with anterior cruciate ligament ruptures, isolated meniscus tears, or osteoarthritis completed the subjective portions of eleven knee-specific instruments. The Mohtadi quality-of-life instrument scored best for anterior cruciate ligament tears, with the Western Ontario Meniscal Evaluation Tool (WOMET) scoring best for meniscal tears. For osteoarthritis, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) faired best. For general knee instruments, the International Knee Documentation Committee Standard Evaluation Form and the Knee Injury and Osteoarthritis Outcome Score were both thought to contain the most items of importance to patients. This study is of great clinical research importance as its results may be used to guide clinical outcomes research for knee disorders.
Buist I, Bredeweg SW, van Mechelen W, Lemmink KA, Pepping GJ, Diercks RL. No effect of a graded training program on the number of running-related injuries in novice runners: a randomized controlled trial. Am J Sports Med. 2008;36:33-9.
In this randomized controlled trial, participants who were preparing for a recreational 4-mi (6.4-km) running event were randomized into either a control group (managed with an eight-week graded training program) or an intervention group (managed with a thirteen-week graded training program). The purpose of the study was to compare the results of either program on the incidence of running-related injury (defined as any lower extremity or back musculoskeletal complaint that would restrict running for at least one week). The thirteen-week graded program was accelerated on the basis of the 10% training rule. The study demonstrated no difference in the incidence of running-related injuries between the groups.
Webb D, Guttmann D, Cawley P, Lubowitz JH. Continuous infusion of a local anesthetic versus interscalene block for postoperative pain control after arthroscopic shoulder surgery. Arthroscopy. 2007;23:1006-11.
The purpose of this randomized trial was to evaluate and compare a one-time interscalene block with a continuous catheter infusion of local anesthetic for pain control following arthroscopic surgery of the shoulder. Fifty-six patients were randomized into either a preoperative interscalene block group or a subacromial continuous infusion group. Pain was evaluated at various stages through the seventh postoperative day. Primary outcomes included pain scores, the complication rate, cost, and rescue medication intake. No difference was found between the groups in terms of any primary outcome. The authors concluded that more research could be done in this area.
Lubowitz JH, Appleby D, Centeno JM, Woolf SK, Ried JB 3rd. The relationship between the outcome of studies of autologous chondrocyte implantation and the presence of commercial funding. Am J Sports Med. 2007;35:1809-16. Erratum in: Am J Sports Med. 2008;36:193.
This comparative meta-analysis evaluated and compared the outcomes and levels of evidence of commercially-funded studies of autologous chondrocyte implantation with those of non-commercially-funded studies. Twenty-three studies were included. No difference in clinical outcome data was found. However, it was found that commercially-funded studies had a significantly lower level of evidence in comparison with non-commercially-funded studies. These results are reassuring in that no evidence of bias between commercially-funded and non-commercially-funded studies was found. However, as a result of these findings, commercial-funding entities may seek to fund studies with potentially higher levels of evidence in the future.
Taverna E, Battistella F, Sansone V, Perfetti C, Tasto JP. Radiofrequency-based plasma microtenotomy compared with arthroscopic subacromial decompression yields equivalent outcomes for rotator cuff tendinosis. Arthroscopy. 2007;23:1042-51.
This randomized trial aimed to determine whether radiofrequency-based plasma microtenotomy (microdébridement) was effective for the treatment of chronic supraspinatus tendinosis. Sixty patients were randomized to undergo either radiofrequency-based microtenotomy (with use of a bipolar radiofrequency-based probe) of the supraspinatus tendon without subacromial decompression or subacromial decompression alone. Pain and functional assessments were performed. Both approaches resulted in significant pain improvement for patients at one year after surgery. This study raises the question of whether this patient population requires such an extensive procedure as a subacromial decompression.
Fanton GS, Dillingham MF, Wall MS, Gillenwater GE, Khan AM, Carver TJ, Perkins JG, Demopulos GA. Novel drug product to improve joint motion and function and reduce pain after arthroscopic anterior cruciate ligament reconstruction. Arthroscopy. 2008;24:625-36.
This prospective, double-blind, vehicle-controlled, parallel-group, randomized study evaluated the use of an investigational drug, OMS103HP, in patients undergoing arthroscopic anterior cruciate ligament reconstruction. This investigational drug product contains ketoprofen, amitriptyline, and oxymetazoline. Study outcome measures included drug safety and the ability to improve postoperative knee function and motion, to reduce postoperative pain, and to allow earlier return to work over a thirty-day period postoperatively. The drug was well tolerated, and the OMS103HP group outperformed the vehicle-treated group in all three categories.
Hart R, Krejzla J, Sváb P, Kocis J, Stipcák V. Outcomes after conventional versus computer-navigated anterior cruciate ligament reconstruction. Arthroscopy. 2008;24:569-78.
The goal of this prospective randomized study was to assess the biomechanical, radiographic, and functional outcome of computer-navigated single-bundle anterior cruciate ligament reconstruction. Forty patients underwent anterior cruciate ligament reconstruction utilizing the OrthoPilot navigation system (B. Braun Aesculap, Tuttlingen, Germany), and another forty underwent reconstruction with use of a standard manual targeting technique. Assessment of the reconstruction was done with use of the KT-1000, radiographs, and the questionnaire-based Lysholm and International Knee Documentation Committee scales. The only significant difference found was more accurate femoral tunnel placement in association with the use of the navigation system.
Hägglund M, Waldén M, Ekstrand J. Lower reinjury rate with a coach-controlled rehabilitation program in amateur male soccer: a randomized controlled trial. Am J Sports Med. 2007;35:1433-42.
In this randomized controlled trial, twenty-four male amateur soccer teams were randomized into an intervention group (managed with a coach-controlled rehabilitation program) and a control group. The purpose of the study was to evaluate the effect of the intervention on reducing the rate of reinjury. Analysis showed a significant reduction in injury in the intervention group for all injury locations. The greatest preventive effect was recognized during the first week of return to play, and the authors concluded that a coach-controlled rehabilitation program can lead to a reduction in reinjury for this athletic population.
Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy. 2007;23:1320-5.e6.
The purpose of this meta-analysis was to generate estimates of the true incidence of anterior cruciate ligament tears as a function of sex, sports activity, and injury-reduction training. Females had a three times greater incidence of anterior cruciate ligament tears in soccer and basketball as compared with males. Injury-reduction programs were effective in soccer but not in basketball. The highest incidence of anterior cruciate ligament tears was seen in recreational Alpine skiers, but no variance by sex was found for Alpine skiers. No variance by sex was found for lacrosse players. Those at greatest risk for anterior cruciate ligament tear were found to be year-round female athletes who play both soccer and basketball, with a 5% rate of anterior cruciate ligament tears.