Peroneal Tendon Subluxation in Athletes: Fibular Groove Deepening and Retinacular Reconstruction

2005 ◽  
Vol 26 (6) ◽  
pp. 436-441 ◽  
Author(s):  
David Porter ◽  
John McCarroll ◽  
Erin Knapp ◽  
Jennifer Torma

Background: The purpose of this study was to evaluate the results of operative treatment of recurrent peroneal tendon dislocations followed by accelerated rehabilitation incorporating early range of motion and intermittent immobilization. Methods: Four female and nine male athletes with an average age of 24 years had objective clinical evidence of peroneal tendon dislocation (14 ankles). Operative treatment involved removing a bone flap from the distal posterior fibula, deepening the posterior fibular groove, and reattaching the bone flap within the deepened groove. The superior peroneal retinaculum also was reconstructed. Postoperatively, a removable boot was worn for approximately 4 weeks, when it was replaced with a stirrup brace. Results: At an average followup of 35 months, no recurrent subluxation or dislocation of the peroneal tendons had occurred. All patients were able to return to sports by 3 months after surgery. Nine of the 14 ankles regained normal range of motion, and the remaining five were within 5 degrees of the opposite side. Four patients were completely pain free, and nine patients had mild occasional pain that did not limit their activities. Eight patients returned to preinjury sports participation, and five patients elected to participate in sports at a level lower than they had before surgery for reasons not related to their ankle injury. Conclusions: This procedure was reliable for preventing recurrent peroneal tendon instability. Range of motion was nearly normal, immobilization time was minimal, and all patients returned to daily activities and sports within 3 months of surgery.

Trauma ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 142-145
Author(s):  
Michael W Sybert ◽  
William L Hennrikus

To date, only two cases of bilateral elbow dislocations with medial epicondyle fractures have been reported. The current case is an 11-year-old girl who sustained bilateral elbow dislocations with medial epicondyle fractures by landing on extended elbows while performing a back handspring on a trampoline. Closed reduction and splinting were performed in the emergency room. Open reduction with screw fixation of the medial epicondyle fractures was performed in the operating room. Post-operatively, the patient was splinted for eight days followed by range of motion exercises. She returned to full sports participation at 15 weeks. On final follow-up 24 months later, the patient had full range of motion, normal strength, and normal neurovascular examination. Compared to the two previous case reports in the literature, this is the only case report demonstrating full range of motion, full strength, and full return to sports after bilateral elbow dislocation with medial epicondyle fractures. Keys to complete recovery included internal fixation with a screw and washer followed by early range of motion.


2007 ◽  
Vol 28 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Maxwell W. Steel ◽  
James K. DeOrio

2007 ◽  
Vol 35 (9) ◽  
pp. 1477-1483 ◽  
Author(s):  
Shane Seroyer ◽  
Samir G. Tejwani ◽  
James P. Bradley

Background A type VIII superior labrum anterior posterior lesion represents pathologic posteroinferior extension of a type II superior labrum anterior posterior lesion with injury to the insertion of the posterior band of the inferior glenohumeral ligament. No reports in the literature describe arthroscopic treatment of a type VIII superior labrum anterior posterior lesion and its associated glenohumeral instability. Hypothesis Arthroscopic capsulolabral reconstruction is effective in alleviating pain and restoring stability and function in athletes with glenohumeral instability due to the type VIII superior labrum anterior posterior lesion. Study Design Case series; Level of evidence, 4. Methods From 2003 to 2006, 23 shoulders in 23 athletes were diagnosed with a type VIII superior labrum anterior posterior lesion by physical examination, magnetic resonance arthrography, and arthroscopy. All were treated with an arthroscopic capsulolabral reconstruction. Ten patients were involved in rehabilitation less than 9 months after surgery and were not included in this study. Thirteen remaining shoulders in 13 athletes with a mean age of 27.8 ± 10.9 years were analyzed at a mean follow-up of 24 months. Shoulders were evaluated preoperatively and postoperatively using the American Shoulder and Elbow Surgeons scoring system and standard subjective scales for stability, strength, function, and range of motion. Results Athletes most commonly participated in sport at the recreational level (n = 8), followed by collegiate (n = 3) and high school (n = 2). The most common activity was weight lifting (n = 4). Eight athletes (62%) participated in contact sports, most commonly football and wrestling. Two patients (15%) had a partial-thickness articular-sided supraspinatus tendon tear that was debrided at the time of surgery. Mean American Shoulder and Elbow Surgeons score improved from 51.4 to 90.0 (P < .001). There were significant improvements in stability, pain, function, and range of motion based on standardized subjective scales (P < .001). No shoulder required revision surgery for recurrent instability. All patients were able to return to sports, with 9 (69%) able to return to their highest level before surgery. Conclusion Arthroscopic capsulolabral reconstruction is an effective and reliable treatment for glenohumeral instability due to a type VIII superior labrum anterior posterior lesion in the contact, noncontact, and throwing athlete. Successful postoperative return to sport is a reasonable expectation.


2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0047
Author(s):  
Fahroni Cahyono Winata

Introduction: Peroneal longus dislocation is an uncommon sports injury and commonly misdiagnosed. Imaging measure includes plain radiography, ultrasonography, and MRI examination. Treatment strategies include controversial nonoperative treatment with a significant failure rate and several surgical procedures were reported. We reporting a chronic peroneal longus dislocation case in our hospital. Material and methods: Twenty-two years old male presented with a painful snapping lateral ankle suffered 3-month prior surgery. He played futsal and suddenly he felt popped on his ankle followed by pain and swelling. Dynamic ultrasound examination shows dislocation of peroneal longus tendon and convex shape of the retromalleolar groove. A five-centimeter long incision is made posterior to the lateral malleolus and during exploration we confirmed the ultrasound findings. We perform retromalleolar groove deepening by making bone flap medially, curette the cancellous bone and tamper back the bone flap, followed by superior peroneal retinaculum (SPR) reconstruction to the medial aspect of lateral cortex of the lateral malleolus to provide smooth gliding surface. We immobilize the ankle with a cast for six weeks for soft tissue healing. Result: After six weeks he can perform the almost full range of motion of the ankle without pain. Followed by further physiotherapy to regain full range of motion of the ankle. He returns to sport six months after surgery. Ultrasound examination shows the stability of the peroneal longus tendon. Conclusion: Dynamic ultrasound examination and retromalleolar groove deepening with SPR reconstruction are simple and inexpensive management for peroneal longus dislocation


2020 ◽  
Vol 18 ◽  
pp. 255-260
Author(s):  
Daniel Bakker ◽  
Jan B. Schulte ◽  
Duncan E. Meuffels ◽  
Tom M. Piscaer

2019 ◽  
Vol 7 (7) ◽  
pp. 232596711986181
Author(s):  
Meagan M. McCarthy ◽  
Jonathan H. Bihl ◽  
Rachel M. Frank ◽  
Hytham S. Salem ◽  
Eric C. McCarty ◽  
...  

Background: Little is known about the epidemiology of clavicle fractures in United States (US) high school athletes. Sports participation among high school students has increased steadily, placing increased numbers at risk of sports-related injury. Purpose: To describe the epidemiology of clavicle fractures among high school athletes, including injury rates by sex, sport, and type of play and trends in operative versus nonoperative treatment. Study Design: Descriptive epidemiology study. Methods: The study data set included all athlete-exposure (AE) and clavicle fracture data collected from 2008-2009 through 2016-2017 from a large sample of US high schools as part of the National High School Sports-Related Injury Surveillance Study for students participating in boys’ football, boys’/girls’ soccer, boys’/girls’ basketball, boys’/girls’ volleyball, boys’ wrestling, boys’ baseball, girls’ softball, girls’ field hockey, boys’ ice hockey, boys’/girls’ lacrosse, boys’/girls’ swimming and diving, boys’/girls’ track and field, girls’ gymnastics, girls’ cheerleading, boys’/girls’ tennis, and boys’/girls’ cross-country. Results: Overall, 567 clavicle fractures were reported during 31,520,765 AEs, an injury rate of 1.80 per 100,000 AEs. Injury rates varied by sport, with the highest rates in the boys’ full-contact sports of ice hockey (5.27), lacrosse (5.26), football (4.98), and wrestling (2.21). Among girls’ sports, the highest rates were in soccer (0.92), lacrosse (0.26), and basketball (0.25). In sex-comparable sports, injury rates were still significantly higher among boys (1.03) than girls (0.35) (rate ratio, 2.91; 95% CI, 1.97-4.30). Injury rates were significantly higher in competition (4.58) as compared with practice (0.87) (rate ratio, 5.27; 95% CI, 4.44-6.26). Most injuries were treated conservatively (82.7%) rather than operatively (17.3%). Time to return to sports varied, with a greater proportion of medical disqualifications among those treated operatively (40.0%) as compared with those treated conservatively (22.6%) (injury proportion ratio, 1.77; 95% CI, 1.31-2.39). Conclusion: Although clavicle fracture rates are relatively low, they vary by sport, sex, and activity. Understanding such differences should drive more effective, targeted injury prevention efforts. Increased time loss from sports with surgical versus conservative treatment may have been influenced by factors including injury severity and its timing relative to the season’s progress.


2020 ◽  
Vol 48 (3) ◽  
pp. 715-722 ◽  
Author(s):  
Travis J. Dekker ◽  
Lucca Lacheta ◽  
Brandon T. Goldenberg ◽  
Marilee P. Horan ◽  
Jonas Pogorzelski ◽  
...  

Background: Osteoarthritis of the sternoclavicular (SC) joint is a rare condition that leads to decreased function and persistent pain, ultimately altering the function of the shoulder and keeping individuals from their desired activities. SC resection in the setting of primary and posttraumatic osteoarthritis is the most common surgical treatment for these patients, but midterm results are lacking. Purpose/Hypothesis: The purpose was to assess the clinical outcomes, pain levels, return to sports rate, and survivorship after open SC joint resection in the setting of painful primary SC joint osteoarthritis. We hypothesized that an SC joint resection of maximum 10 mm would result in a significant improvement in clinical outcomes, decreased pain levels, a high rate of return to sports, and a high survivorship. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent SC joint resection (maximum 10 mm) by a single surgeon between the years 2006 and 2013 with minimum 5-year follow-up were reviewed. The following clinical outcomes were collected prospectively during this time period: 12-Item Short Form Health Survey Physical Component Score (SF-12 PCS), American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numerical Evaluation (SANE) score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and patient satisfaction. Return to sports and pain were assessed through use of a customized questionnaire. Survivorship of SC joint resection was defined as not requiring further surgery on the affected joint. Results: A total of 21 SC joints were treated with resection of the medial clavicle and intra-articular disk and capsulorrhaphy for SC joint osteoarthritis in 19 patients with a mean age of 39.4 years (range, 12.5-66.7 years). At minimum 5-year follow-up, 19 SC joint resections were assessed in 16 of 19 patients (84%) with a mean follow-up of 6.7 years (range, 5.0-10.4 years). All outcome scores improved significantly from pre- to postoperative assessments: ASES (from 54 to 90.5; P = .003), SANE (from 61.8 to 90.4; P = .004), QuickDASH (from 43.1 to 13.8; P = .004), and SF-12 PCS (from 39.8 to 51.3; P = .004). Median satisfaction with surgical outcomes was 9 (range, 2-10), and pain levels improved from a score of 8 out of 10 to 3 out of 10 (scale of 0 to 10 with 0 being pain free and 10 worst possible pain). Of the 13 patients who answered the optional sports participation question, 13 (100%) patients had participated in sports before their injury. A total of 14 patients answered the question on sports participation after injury, with 12 (86%) indicating successful return to sports. Pain at its worst ( P = .003) and pain with competition ( P = .017) significantly decreased pre- to postoperatively. Resection survivorship at final follow-up was 84.2% at 5 years. We found that 3 patients (15%) had recurrent SC joint pain and were treated with revision surgery. Conclusion: Open SC resection arthroplasty with capsulorrhaphy in the setting of pain for SC osteoarthritis results in significant improvement in clinical outcomes, patient satisfaction, return to sports, and pain reduction at minimum 5-year follow-up.


2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0012 ◽  
Author(s):  
Matthew D. Milewski ◽  
Caitlin M. McCracken ◽  
Bill Meehan ◽  
Andrea Stracciolini

BACKGROUND Sleep duration and sport specialization have been shown to affect injury profile in young athletes. The interplay between training hours per week, and, multiple versus single sports participation on sleep hours in young athletes is unknown. Purpose/Objective To investigate associations between single sport participation and training volume, with sleep hours, in pediatric and adolescent athletes. METHODS Study design: Cross-sectional epidemiological study was conducted using electronic questionnaire data from an injury prevention evaluation (IPE) at a sports injury prevention center affiliated with a tertiary level pediatric medical center between April 2013 and February 2018. Data analysis included sports participation, previous injury history, training regimen, and sleeping habits. For each sport selected, athletes were asked about average number of practice hours for each sport and number of seasons training for the sport during the year. All athletes aged 11-18 years were included in the study. Main outcome measures include sleep duration, single sport, and training hours/seasons. Single sport athletes were defined as those athletes who listed participation in only one sport year-round. Binary measures were created to indicate 1)any participant that listed practicing > 10 hour/week for any sport during a season and 2) any participant that trains three or more seasons for any sport in which they participate. Multivariate regression models (M1, M2, M3) were created for soccer athletes to control for sport training differences while testing the independent effect of gender, age and sport training. Based on the results univariate linear regression of hours of sleep was stratified by age and gender and regressed by self-reported hours of practice per week, identification as single sport athlete, training three or more seasons for soccer. RESULTS There were 756 athletes, 11-18 years old, included (mean age 13.5±2.5 years; 56% female (N=426)). For female athletes, figure skating (46%, 11/24), dance (42%, 28/67), and gymnastics (25%, 12/47) lead the list for single sport athletes. In comparison, for male athletes, swimming (26%, 5/19), tennis (19%, 5/26) and soccer (13%, 16/120) lead the list. The overwhelming majority of gymnasts, dancers, and figure skaters (88% (38/43), 83% (54/66) and 83%, (20/24)) train = 3 seasons of the year. In comparison, for male athletes, tennis athletes (62%, 16/25) seem to train = 3 seasons of the year followed by soccer (41%, 49/119) and swimming (39%, 7/18). (Tables 1 and 2) Table 3 presents multivariate linear regression coefficient of weeknight hours slept by practice hours, gender, age and sport characteristics for soccer participants using three different models (M1, M2, M3). Younger athletes, ages 11-14 years, slept nearly an hour more than participants aged 15-18 years across all training types. Only female soccer athletes training = 3 seasons slept significantly less (ß -0.24, SE 0.12, 95%) than their male counterparts. Participants that practiced soccer > 10 hours/week slept significantly, and substantively, less than their peers practicing =3 or less hours/week (ß -0.61, SE 0.17, 95%). Table 4 presents all participants and sport type stratified by age and sex. Practicing more than 10 hours/week was significant in males ages 11-14 years. Middle school aged males, practicing > 10 hours/week for any sport in which they participate over the course of the year, slept over half an hour less than their peers that practiced fewer hours (ß -0.65, SE 0.2, 95%). CONCLUSIONS/SIGNIFICANCE Training volume appears to affect sleep in young athletes. Middle school male athletes practicing greater than 10 hours/week appear to sleep less than their peers. Anticipatory guidance surrounding training may help to improve sleep hygiene in pediatric and adolescent athletes. [Table: see text][Table: see text][Table: see text][Table: see text]


2018 ◽  
Vol 3 (6) ◽  
pp. 374-380 ◽  
Author(s):  
Paul Hoogervorst ◽  
Peter van Schie ◽  
Michel PJ van den Bekerom

Clavicle fractures are common fractures and the optimal treatment strategy remains debatable. The present paper reviews the available literature and current concepts in the management of displaced and/or shortened midshaft clavicle fractures. Operative treatment leads to improved short-term functional outcomes, increased patient satisfaction, an earlier return to sports and lower rates of non-union compared with conservative treatment. In terms of cost-effectiveness, operative treatment also seems to be advantageous. However, operative treatment is associated with an increased risk of complications and re-operations, while long-term shoulder functional outcomes are similar. The optimal treatment strategy should be one tailor-made to the patient and his/her specific needs and expectations by utilizing a shared decision-making model. Cite this article: EFORT Open Rev 2018;3:374-380. DOI: 10.1302/2058-5241.3.170033


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