Current Sports-medicine News Results

PLIF in thoracolumbar trauma: technique and radiological results.

Eur Spine J. 2010 Mar 9;
Rene S, Dietmar K, Peter S, Michael B, Anton K

Patients with fractures from the 11th thoracic to the 5th lumbar vertebra had a reconstruction of the anterior column with monocortical iliac crest autograft by using a single dorsal approach. The loss of correction was observed using X-rays pre- and post-operatively, at 3 months and after implant removal (IR). Successful fusion was assessed using computed tomography after the implant removal. To assess the loss of correction and intervertebral fusion rate of this technique. There are still controversial discussions about the treatment modalities of spine lesions, especially in cases of burst fractures. Dorsal, combined and ventral procedures are reported with different assets and drawbacks. We want to present a method to restore the weight-bearing capability of the anterior column using a single dorsal approach. From 2001 to 2005, a total of 100 patients was treated with this technique at our department. Follow-up examination was possible in 82 patients. The X-rays and CT scans were proofed for loss of correction and fusion rate. The anterior column has been restored using a monocortical strut graft via a partial resection of the lamina and the apophyseal joint on one side to access the disc space. The dorsal reduction has been achieved using an angular stable pedicle screw system. The mean follow-up time was 15 months (range 8-39); 67 patients had a CT scan at follow-up and 83% showed a 360 degrees fusion. The average post-operative loss of correction was 3.3 degrees (range 0-21). The average duration of operation was 192 min (range 120-360) and the mean blood loss was 790 ml (range 300-3,400 ml). Regarding the complications we did not have any deep wound infections. We had two epidural haematomas postoperatively with a neurological deterioration that had to be revised. We were able to decompress the neurological structures and restore the weight-bearing capability of the anterior column in a one-stage procedure. So we think that this technique can be an alternative procedure to combined operations regarding the presented radiological results of successful fusion and loss of correction.

Prevalence of Chondral Defects in Athletes' Knees - A Systematic Review.

Med Sci Sports Exerc. 2010 Mar 8;
Flanigan DC, Harris JD, Trinh TQ, Siston RA, Brophy RH

PURPOSE:: To determine the prevalence of full-thickness, focal chondral defects in the athlete's knee. METHODS:: We conducted a systematic review of multiple databases, evaluating studies of the prevalence of articular cartilage defects in athletes. Due to heterogeneity of data, a meta-analysis could not be performed. RESULTS:: Eleven studies were identified for inclusion (931 subjects). All studies were Level IV evidence. Defects were diagnosed via MRI, arthroscopy, or both. Forty percent of athletes were professional (NBA, NFL). The overall prevalence of full-thickness, focal chondral defects in athletes was 36% (2.4% - 75% between all studies). Fourteen percent of athletes were asymptomatic at the time of diagnosis. Patellofemoral defects (37%) were more common than femoral condyle (35%) and tibial plateau defects (25%). Medial condyle defects were more common than lateral (68% versus 32%) and patella defects more common than trochlea (64% versus 36%). Meniscal tear (47%) was the most common concomitant knee pathology, followed by ACL tear (30%), then MCL or LCL tear (14%). CONCLUSION:: Full-thickness, focal chondral defects in the knee are more common in athletes than among the general population. Over one-half of asymptomatic athletes have a full-thickness defect. Further study is needed to more precisely define the prevalence of these lesions in this population. LEVEL OF EVIDENCE:: IV.

Effect of Sodium Cromoglycate on Mast Cell Mediators during Hyperpnea in Athletes.

Med Sci Sports Exerc. 2010 Mar 8;
Kippelen P, Larsson J, Anderson SD, Brannan JD, Dahlén B, Dahlén SE

INTRODUCTION:: The role of mast cells in the airway response to exercise and the benefit of sodium cromoglycate (SCG) in athletes is unclear. PURPOSE:: To clarify the role of mast cell mediators in the airway response to exercise in athletes and to investigate the effect of SCG. METHODS:: Eleven athletes with exercise-induced bronchoconstriction (EIB) and eleven without (EIB) performed an eucapnic voluntary hyperpnea (EVH) test (a surrogate for exercise) 10 min after inhalation of a placebo or 40 mg of the mast cell stabilizing agent sodium cromoglycate (SCG). The urinary concentrations of 9a,11beta-PGF2 (a metabolite of PGD2 and marker of mast cell activation) and LTE4 were measured by enzyme immunoassay 60 min before and for 90 min after challenge. RESULTS:: In the EIB group, the maximum fall in forced expiratory volume in 1 s (FEV1) of 20.3 +/- 3% on placebo was reduced to 11.5 +/- 1.9% following SCG (P = 0.003). There was an increase in the urinary excretion of 9alpha,11beta-PGF2 on the placebo day after EVH in both groups (P < 0.05) that was abolished by SCG. In the EIB group, there was also an increase of urinary LTE4 on the placebo day that was abolished by SCG, whereas the urinary excretion of LTE4 was inconsistent in the EIB group. CONCLUSION:: The results support mast cell activation with release of bronchoconstrictive mediators following hyperpnea in athletes, with and without EIB and inhibition by SCG. The degree of airway responsiveness to the specific mediator released is likely to determine whether or not bronchoconstriction will occur after EVH.

Performance-Based Outcomes Following Lumbar Discectomy in Professional Athletes in the National Football League.

Spine (Phila Pa 1976). 2010 Mar 5;
Hsu WK

STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To determine the performance-based outcomes in National Football League (NFL) athletes after discectomy for a lumbar disc herniation (LDH). SUMMARY OF BACKGROUND DATA.: Long-term outcomes following surgical treatment in elite athletes in the NFL are unknown. Postoperative outcomes may be significantly different from the general population due to the exceptional physical demands imposed by the sport. METHODS.: National Football League players diagnosed with a lumbar disc herniation were identified using information from press releases, team injury reports, and newspaper archives. Demographic, treatment, and performance data based on vital statistics to each position were recorded for each player over the length of his career. Using a modification of a previously published scoring system (Carey et al, Am J Sports Med 2006;34:1911-7) based on game statistics, a "Performance Score" was calculated for each player both before and after diagnosis of LDH. RESULTS.: A total of 137 National Football League players were identified as having an LDH necessitating treatment. Ninety-six players underwent surgical treatment with a lumbar discectomy, and 34 athletes were treated nonoperatively. Seventy-eight percent of athletes treated surgically for an LDH returned to play in at least 1 NFL game. Players treated surgically played in statistically more games post-treatment (36) than those treated nonoperatively (20) (P < 0.002). There was no significant difference between the Performance Score preoperatively and postoperatively over the length of the players' careers. Age at diagnosis, body mass index, Pro Bowl appearances, and position played did not significantly affect outcome. CONCLUSION.: The data in this study suggests that even though a lumbar discectomy has career-threatening implications, a large percentage of NFL athletes return to play at competitive levels. Despite the general opinion of many NFL general managers, players who are able to complete the rigorous rehabilitation required to return to play after lumbar discectomy can expect excellent performance-based outcomes after surgery.

Addition of the Electrocardiogram to the Preparticipation Examination of College Athletes.

Clin J Sport Med. 2010 Mar; 20(2): 98-105
Le VV, Wheeler MT, Mandic S, Dewey F, Fonda H, Perez M, Sungar G, Garza D, Ashley EA, Matheson G, Froelicher V

OBJECTIVE:: Although the use of standardized cardiovascular (CV) system-focused history and physical examination is recommended for the preparticipation examination (PPE) of athletes, the addition of the electrocardiogram (ECG) has been controversial. Because the impact of ECG screening on college athletes has rarely been reported, we analyzed the findings of adding the ECG to the PPE of Stanford athletes. DESIGN:: For the past 15 years, the Stanford Sports Medicine program has mandated a PPE questionnaire and physical examination by Stanford physicians for participation in intercollegiate athletics. In 2007, computerized ECGs with digital measurements were recorded on athletes and entered into a database. SETTING:: Although the use of standardized CV-focused history and physical examination are recommended for the PPE of athletes, the addition of the ECG has been controversial. Because the feasibility and outcomes of ECG screening on college athletes have rarely been reported, we present findings derived from the addition of the ECG to the PPE of Stanford athletes. For the past 15 years, the Stanford Sports Medicine program has mandated a PPE questionnaire and physical examination by Stanford physicians for participation in intercollegiate athletics. In 2007, computerized ECGs with digital measurements were recorded on athletes and entered into a database. MAIN OUTCOME MEASURES:: Six hundred fifty-eight recordings were obtained (54% men, 10% African-American, mean age 20 years) representing 24 sports. Although 68% of the women had normal ECGs, only 38% of the men did so. Incomplete right bundle branch block (RBBB) (13%), right axis deviation (RAD) (10%), and atrial abnormalities (3%) were the 3 most common minor abnormalities. Sokolow-Lyon criteria for left ventricular hypertrophy (LVH) were found in 49%; however, only 27% had a Romhilt-Estes score of >/=4. T-wave inversion in V2 to V3 occurred in 7%, and only 5 men had abnormal Q-waves. Sixty-three athletes (10%) were judged to have distinctly abnormal ECG findings possibly associated with conditions including hypertrophic cardiomyopathy or arrhythmogenic right ventricular dysplasia/cardiomyopathy. These athletes were offered further testing but this was not mandated according to the research protocol. RESULTS:: Six hundred fifty-three recordings were obtained (54% men, 7% African American, mean age 20 years), representing 24 sports. Although 68% of the women had normal ECGs, only 38% of the men did so. Incomplete RBBB (13%), RAD (10%), and atrial abnormalities (3%) were the 3 most common minor abnormalities. Sokolow-Lyon criteria for LVH were found in 49%; however, only 27% had a Romhilt-Estes score of >/=4. T-wave inversion in V2 to V3 occurred in 7% and only 5 men had abnormal Q-waves. Sixty-five athletes (10%) were judged to have distinctly abnormal ECG findings suggestive of arrhythmogenic right ventricular dysplasia, hypertrophic cardiomyopathy, and/or biventricular hypertrophy. These athletes will be submitted to further testing. CONCLUSIONS:: Mass ECG screening is achievable within the collegiate setting by using volunteers when the appropriate equipment is available. However, the rate of secondary testing suggests the need for an evaluation of cost-effectiveness for mass screening and the development of new athlete-specific ECG interpretation algorithms.

Impact of prior concussions on health-related quality of life in collegiate athletes.

Clin J Sport Med. 2010 Mar; 20(2): 86-91
Kuehl MD, Snyder AR, Erickson SE, Valovich McLeod TC

OBJECTIVE:: To investigate how self-reported sport-related concussion history affects health-related quality of life in collegiate athletes. DESIGN:: Cross sectional. SETTING:: Division I university, Division II university, and a junior college. PARTICIPANTS:: Three hundred two collegiate athletes (210 men, 92 women). ASSESSMENT OF RISK FACTORS:: Participants completed a demographic information sheet and concussion history form; they were then grouped by number of previous self-reported concussions, designated as 0, 1-2, or 3+. MAIN OUTCOME MEASURES:: The Medical Outcomes Short Form (SF-36) and the Headache Impact Test (HIT-6). RESULTS:: Significant differences between groups were found for the bodily pain, vitality, and social functioning subscales of the SF-36. The 3+ group had significantly lower scores for bodily pain (48.1 +/- 8.9) compared with the 1-2 group (P = 0.028, 52.1 +/- 7.7) and 0 group (P < 0.01, 53.5 +/- 8.3), for vitality (52.4 +/- 8.4) compared with the 0 group (P = 0.011, 55.9 +/- 8.6), and for social functioning (48.5 +/- 9.4) compared with the 1-2 group (P = 0.028, 51.6 +/- 7.3) and 0 group (P = 0.003, 51.9 +/- 8.1). Significant differences were noted on the HIT-6 total score. The 3+ group reported greater impact of headache (46.7 +/- 6.4) than the 1-2 group (P = 0.05, 44.6 +/- 6.4) and 0 group (P < 0.001, 42.9 +/- 5.8). The 1-2 group also had higher HIT-6 scores than the 0 group (P = 0.033). CONCLUSIONS:: Results suggest that a collegiate athlete's perception of bodily pain, vitality, social functioning, and headache is adversely affected by previous sport-related concussions. However, by incorporating general and specific outcome measures into the standard evaluation of sport-related concussion, the clinician can better determine how the athlete is responding to treatment and recovery.

Accuracy and Reliability of Anterior Cruciate Ligament Clinical Examination in a Multidisciplinary Sports Medicine Setting.

Clin J Sport Med. 2010 Mar; 20(2): 80-85
Peeler J, Leiter J, Macdonald P

OBJECTIVE:: To investigate the accuracy and reliability of anterior cruciate ligament (ACL) clinical examination in a multidisciplinary sports medicine setting. DESIGN:: Retrospective review of patient charting. SETTING:: Community-based multidisciplinary sports medicine clinic. PATIENTS:: One hundred twelve patients with surgically confirmed ACL tear. INTERVENTIONS:: Review of therapist, physician, and orthopedic surgeon charting. MAIN OUTCOME MEASURES:: Scoring for the anterior drawer, Lachman, and pivot shift tests completed during clinical examination. Coefficient of agreement (Po) was calculated for each assessment technique to determine the interrater reliability. Sensitivity of assessment was determined by comparing patient's arthroscopic surgical results against clinician's scoring. RESULTS:: On average, Po values indicated only moderate levels of interrater reliability (anterior drawer, &OV0335; = 0.57; Lachman, &OV0335; = 0.45; pivot shift, &OV0335; = 0.53), with great variation observed between clinician's scoring for each assessment technique. Accuracy testing demonstrated that the Lachman test had the highest level of sensitivity when administered by orthopedic surgeons (&OV0335; = 86%) and that sensitivity varied greatly among clinician groups and by assessment technique (range, 15%-87%). CONCLUSIONS:: In sports medicine, unreliable or inaccurate clinical examination confounds the clinician's ability to make informed decisions regarding appropriate patient referral and treatment interventions. Our results indicate that levels of accuracy and reliability for clinical examination of the ACL within a multidisciplinary sports medicine setting may be much lower than previously reported within the literature. Further research is needed to clarify whether a standardized approach to ACL clinical examination could enhance levels of accuracy and reliability among clinicians working in a multidisciplinary setting.

Ex Australis semper aliquid novi*.

Clin J Sport Med. 2010 Mar; 20(2): 77-9
Humphries D, Garnham A, McCrory P

Lower extremity kinetics in tap dance.

J Dance Med Sci. 2010; 14(1): 3-10
Mayers L, Bronner S, Agraharasamakulam S, Ojofeitimi S

Tap dance is a unique performing art utilizing the lower extremities as percussion instruments. In a previous study these authors reported decreased injury prevalence among tap dancers compared to other dance and sports participants. No biomechanical analyses of tap dance exist to explain this finding. The purpose of the current pilot study was to provide a preliminary overview of normative peak kinetic and kinematic data, based on the hypothesis that tap dance generates relatively low ground reaction forces and joint forces and moments. Six professional tap dancers performed four common tap dance sequences that produced data captured by the use of a force platform and a five-camera motion analysis system. The mean vertical ground reaction force for all sequences was found to be 2.06 +/- 0.55 BW. Mean peak sagittal, frontal, and transverse plane joint moments (hip, knee, and ankle) ranged from 0.07 to 2.62 N.m/kg. These small ground reaction forces and joint forces and moments support our hypothesis, and may explain the relatively low injury incidence in tap dancers. Nevertheless, the analysis is highly complex, and other factors remain to be studied and clarified.

An in vitro model of biomaterial-augmented microfracture including chondrocyte-progenitor cell interaction.

Arch Orthop Trauma Surg. 2010 Mar 6;
Vavken P, Arrich F, Pilz M, Dorotka R

BACKGROUND: Biomaterials, acting as scaffolds for cell migration and differentiation, may be used to improve outcomes after microfracture. Three mechanisms determine the success of such procedures and are tested herein: the general capacity of adult femoral mesenchymal progenitor cells (MPC) to differentiate into cartilage, their capacity to do so in a biomaterial, and finally potential interactions between MPC and autologous chondrocytes. METHODS: Human adult chondrocytes and MPC were obtained with informed consent and cultured individually or in co-culture on a collagenous biomaterial. Differentiation potential of MPC was assessed using PCR and proliferation and biosynthesis were compared to test for differences between individual cultures and co-cultures. Finally, potential interaction between chondrocytes and MPC was assessed by comparing the observed levels of proliferation and biosynthesis with those expected in independent growth. RESULTS: We found that adult femoral marrow-derived MPC have the potential to differentiate into multiple lineages, and, seeded in a biomaterial, show similar differentiation when compared with autologous chondrocytes. Finally, there was a strong indication for an interaction between MPC and chondrocytes in biosynthetic activity, which was twice as high as would be expected in independent cell activity. Proliferation rates were unaffected. CONCLUSION: Our study showed that biomaterial-augmented microfracture is a viable option in cartilage repair from a biological perspective because adult femoral MPC have a strong capacity to differentiate into chondrocytes, which is further enhanced by the surrounding cartilage. Failure in in vivo studies must be explained by other factors of the intra-articular environment, such as cytokines or biomechanics.

Juridical and ethical peculiarities in doping policy.

J Med Ethics. 2010 Mar; 36(3): 165-9
McNamee MJ, Tarasti L

Criticisms of the ethical justification of antidoping legislation are not uncommon in the literatures of medical ethics, sports ethics and sports medicine. Critics of antidoping point to inconsistencies of principle in the application of legislation and the unjustifiability of ethical postures enshrined in the World Anti-Doping Code, a new version of which came into effect in January 2009. This article explores the arguments concerning the apparent legal peculiarities of antidoping legislation and their ethically salient features in terms of: notions of culpability, liability and guilt; aspects of potential duplication of punishments and the limitations of athlete privacy in antidoping practice and policy. It is noted that tensions still exist between legal and ethical principles and norms that require further critical attention.

Executive summary: The health and fitness benefits of regular participation in small-sided football games.

Scand J Med Sci Sports. 2010 Mar 4;
Krustrup P, Dvorak J, Junge A, Bangsbo J

The present special issue of Scandinavian Journal of Medicine & Science in Sports deals with health and fitness benefits of regular participation in small-sided football games. One review article and 13 original articles were the result of a 2-year multi-center study in Copenhagen and Zurich and include studies of different age groups analyzed from a physiological, medical, social and psychological perspective. The main groups investigated were middle-aged, former untrained, healthy men and women who were followed for up to 16 months. In addition, elderly, children and hypertensive patients were studied. A summary and interpretations of the main findings divided into an analysis of the physical demands during training of various groups and the effect of a period of training on performance, muscle adaptations and health profile follow. In addition, social and psychological effects on participation in recreational football are considered, the comparison of football training and endurance running is summarized and the effects of football practice on the elderly and children and youngsters are presented.

Arthroscopic suprascapular nerve decompression: indications and surgical technique.

J Shoulder Elbow Surg. 2010 Mar; 19(2 Suppl): 118-23
Romeo AA, Ghodadra NS, Salata MJ, Provencher MT

BACKGROUND: Although entrapment of the suprascapular nerve (SSN) is an infrequent presentation of shoulder pain, proper diagnosis and treatment are critical to prevent chronic supraspinatus and infraspinatus atrophy. MATERIALS AND METHODS: We present a technique that allows SSN decompression at the spinoglenoid notch or suprascapular notch through the subacromial space. RESULTS AND CONCLUSIONS: This method allows for facile decompression of the SSN after repair of concomitant shoulder pathology and allows direct visualization of the medial neck of the glenoid to avoid complications of iatrogenic SSN nerve injury from aggressive medial capsule dissection. The purpose of this article is to provide surgeons with a safe, reliable method to decompress the SSN at the suprascapular or spinoglenoid notch.

Elbow medial ulnar collateral ligament reconstruction: clinical relevance and the docking technique.

J Shoulder Elbow Surg. 2010 Mar; 19(2 Suppl): 110-7
Bowers AL, Dines JS, Dines DM, Altchek DW

INTRODUCTION: Elbow ulnar collateral ligament (UCL) reconstruction has become the standard of care for the throwing athlete with a symptomatic ruptured or insufficient ligament and the desire to resume competitive play. Since Jobe's initial description of UCL reconstruction, the technique has evolved. A novel modification was the "docking" technique developed by Altchek. Subsequently, the docking technique as originally described was slightly modified. Arthroscopy is no longer routinely performed, and in some cases, a 3-strand graft is used. MATERIALS AND METHODS: We treated 21 overhand athletes with clinical and radiographic evidence of UCL insufficiency with ligament reconstruction using a modified version of the docking technique using a 3-strand graft. There were 5 professional, 11 college, and 5 high school baseball players in the reconstructed group. Athletes were evaluated postoperatively by use of the Conway Scale. RESULTS: Of the 21 patients who underwent the modified docking technique with a three-strand graft, 19 (90%) had excellent results. There were 2 good results and no complications. DISCUSSION: UCL reconstruction can successfully treat athletes with UCL insufficiency. Several different reconstruction techniques have been described. By use of the docking and modified docking techniques, good to excellent results can be achieved in the majority of cases with a low complication rate.

Arthroscopic tennis elbow release.

J Shoulder Elbow Surg. 2010 Mar; 19(2 Suppl): 31-6
Savoie FH, VanSice W, O'Brien MJ

Lateral epicondylitis, originally referred to as "tennis elbow," affects between 1% and 3% of the population and is usually noted in patients aged between 35 and 50 years old. Although it was first thought lateral epicondylitis was caused by an inflammatory process, most microscopic studies of excised tissue demonstrate a failure of reparative response in the extensor carpi radialis brevis tendon in any of these associated structures. Most cases of lateral epicondylitis respond to appropriate nonoperative treatment protocols. Nonoperative management includes medication, bracing, physical therapy, corticosteroid injections, shock wave therapy, platelet-rich plasma, and low-dose thermal ablation devices. When these are unsuccessful, however, surgical measures may be performed with a high rate of success. Satisfactory results of the arthroscopic surgical procedures have been documented, with reported improvement rates of 91% to 97.7%. The recent advances in arthroscopic repair and plication of these lesions, along with the recognition of the presence and repair of coexisting lesions, have allowed arthroscopic techniques to provide results superior to other measures.

Can shoulder arthroplasty restore the range of motion in activities of daily living? A prospective 3D video motion analysis study.

J Shoulder Elbow Surg. 2010 Mar; 19(2 Suppl): 59-65
Kasten P, Maier M, Wendy P, Rettig O, Raiss P, Wolf S, Loew M

HYPOTHESIS: There are limited data how total shoulder arthroplasty (TSA) improves shoulder function during activities of daily living (ADL). The hypothesis of this study was that the range of motion (ROM) in ADL gets back to normal after TSA. MATERIALS AND METHOD: We examined 13 patients before they received TSA for osteoarthritis and 6 months postoperatively with a 3D motion video analysis during 3 ADL and compared them with a control group without any shoulder pathology. RESULT: Comparing the TSA status preoperatively and postoperatively resulted in a significant increase of the mean values of the ROMs in the ADL in all planes (P < .05). When the postoperative ROM was compared with the controls, TSA was able to restore the ROM in all planes except for abduction in 2 of 3 ADL. The patients were not able to use their maximum active abduction during the course of the ADL. DISCUSSION: TSA improves the ROM in ADL, but it cannot return completely to normal in abduction after 6 months. CONCLUSION: This is not related to limitations of active or passive ROM but may be due to impaired proprioception or pathologic movement patterns, or both.

Hyaluronan Inhibits Prostaglandin E(2) Production via CD44 in U937 Human Macrophages.

Tohoku J Exp Med. 2010; 220(3): 229-35
Yasuda T

Prostaglandin E(2) (PGE(2)) is one of the key mediators of inflammation in affected joints of rheumatoid arthritis (RA). Intra-articular injection of high molecular weight hyaluronan (HA) into RA knee joints relieves arthritic pain. Although HA has been shown to inhibit PGE(2) production in cytokine-stimulated synovial fibroblasts, it remains unclear how HA suppresses PGE(2) production in activated cells. Furthermore, HA effect on macrophages has rarely been investigated in spite of their contribution to RA joint pathology. This study was aimed to investigate the inhibitory mechanism of HA on lipopolysaccharide (LPS)-stimulated PGE(2) production in U937 human macrophages. Stimulation of U937 macrophages with LPS enhanced PGE(2) production in association with increased protein levels of cyclooxygenase-2 (COX-2). Pretreatment with HA of 2,700 kDa resulted in suppression of the LPS-mediated induction of COX-2, leading to a decrease in PGE(2) production. Likewise, the LPS-stimulated PGE(2) production was inhibited by the pretreatment with a specific COX2 inhibitor, NS-398, or a specific inhibitor of nuclear factor (NF)-kappaB, BAY11-7085. HA also decreased the degree of phosphorylation and nuclear translocation of NF-kappaB enhanced by LPS. Fluorescence cytochemistry demonstrated that HA bound to CD44, the principal HA receptor, on U937 macrophages. Anti-CD44 antibody reversed the inhibitory effects of HA on the LPS-mediated increase in PGE(2) production, COX-2 induction, and activation of NF-kappaB. These results indicate that HA suppresses the LPS-stimulated PGE(2) production via CD44 through down-regulation of NF-kappaB. Administration of HA into RA joints may decrease PGE(2) production by activated macrophages, which could result in improvement of arthritic pain.

Health literacy instrument in family medicine: the "newest vital sign" ease of use and correlates.

J Am Board Fam Med. 2010 Mar-Apr; 23(2): 195-203
Shah LC, West P, Bremmeyr K, Savoy-Moore RT

BACKGROUND: Health literacy has been defined as the ability to obtain, process, and understand the basic information needed to make appropriate health decisions. Half of adults lack the health literacy skills needed for our complex health care environment. In 2005, Weiss et al introduced the Newest Vital Sign (NVS), an instrument that can be used to quickly assess health literacy. The purpose of this study was to determine the acceptability and timeliness of using the NVS to measure the level of health literacy in various suburban, urban, and rural primary care settings. A secondary purpose was to determine the influence of taking a health class on one's level of health literacy. METHODS: In this cross-sectional design, adults were recruited from 4 primary care settings and student athletes were recruited during preparticipation sports physicals. The NVS was administered and health literacy rates were compared with known trends. A subset of 50 patients was timed during test administration, and refusals were logged throughout. The adults and the athletes were analyzed separately. RESULTS: One thousand fourteen patients (including athletes) agreed to participate (response rate, 97.5%). Average time needed to complete the NVS was 2.63 minutes. Of the adults tested, 48.1% demonstrated adequate health literacy. In logistic regression analysis, younger age, more formal education, health class participation, and body mass index were positive predictors of adequate health literacy among adults. An interaction term was used for gender/race, with white women used as the comparator. The gender/race odds ratio negatively affected literacy, with white men at 0.497 (95% CI, 0.328-0.753), non-white women at 0.177 (95% CI, 0.111-0.282), and non-white men at 0.210 (95% CI, 0.110-0.398). Among the participating middle- and high-school athletes, 59.7% had adequate health literacy. In logistic regression of this population, body mass index was a positive predictor whereas gender/race was a negative predictor. CONCLUSION: The NVS revealed health literacy status in less than 3 minutes, was widely accepted, and provided results comparable to more extensive literacy tests. Particularly, taking a health education class was associated with higher levels of health literacy among adults.

Does the Literature Confirm Superior Clinical Results in Radiographically Healed Rotator Cuffs After Rotator Cuff Repair?

Arthroscopy. 2010 Mar; 26(3): 393-403
Slabaugh MA, Nho SJ, Grumet RC, Wilson JB, Seroyer ST, Frank RM, Romeo AA, Provencher MT, Verma NN

PURPOSE: Because recurrent or persistent defects in the rotator cuff after repair are common, we sought to clarify the correlation between structural integrity of the rotator cuff and clinical outcomes through a systematic review of relevant studies. METHODS: Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Central Register of Controlled Trials were searched for all literature published from January 1966 to December 2008 that used the key words shoulder, rotator cuff, rotator cuff tear, rotator cuff repair, arthroscopic, integrity, healed, magnetic resonance imaging (MRI), computed tomography arthrography (CTA), and ultrasound. The inclusion criteria were studies (Levels I to IV) that reported outcomes after arthroscopic rotator cuff repair in healed and nonhealed repairs based on ultrasound, CTA, and/or MRI. Exclusionary criteria were studies that included open repair or subscapularis repair and studies that did not define outcomes based on healed versus nonhealed but rather used another variable (i.e., repair technique). Data were abstracted from the studies including patient demographics, tear characteristics, surgical procedure, rehabilitation, strength, range of motion, clinical scoring systems, and imaging studies. RESULTS: Thirteen studies were included in the final analysis: 5 used ultrasound, 4 used MRI, 2 used CTA, and 2 used combined CTA/MRI for diagnosis of a recurrent tear. Statistical improvement in patients who had an intact cuff at follow-up was seen in Constant scores in 6 of 9 studies; in University of California, Los Angeles scores in 1 of 2 studies; in American Shoulder and Elbow Surgeons scores in 0 of 3 studies; and in Simple Shoulder Test scores in 0 of 2 studies. Increased range of motion in forward elevation was seen in 2 of 5 studies and increased strength in forward elevation in 5 of 8 studies. CONCLUSIONS: The results suggest that some important differences in clinical outcomes likely exist between patients with healed and nonhealed rotator cuff repairs. Further study is needed to conclusively define this difference and identify other important prognostic factors related to clinical outcomes. LEVEL OF EVIDENCE: Level IV, systematic review.

Open Versus Endoscopic Excision of a Symptomatic Os Trigonum: A Comparative Study of 41 Cases.

Arthroscopy. 2010 Mar; 26(3): 384-390
Guo QW, Hu YL, Jiao C, Ao YF, Tian DX

PURPOSE: To compare the clinical results of a consecutive series of 43 cases of excision of a symptomatic os trigonum performed with an open versus hindfoot endoscopic technique. METHODS: From 1994 to 2007, 43 patients underwent a symptomatic os trigonum excision. A subjective satisfaction questionnaire and a visual analog scale score for pain were obtained, and the American Orthopaedic Foot & Ankle Society ankle and hindfoot score and the time to return to previous sports level were determined in 41 of 43 patients at follow up. Of the ankles, 16 had an open os trigonum excision and 25 had hindfoot endoscopic surgery. Group A (16 ankles, open surgery) and group B (25 ankles, endoscopic excision) were comparable concerning age, sex, profession, and concomitant injury of the ankle. RESULTS: At follow-up evaluation (12 to 86 months after surgery), group B had a significantly shorter mean time to return to previous sports level. There was no difference in postoperative visual analog scale score, American Orthopaedic Foot & Ankle Society score, subjective satisfaction rating, or rating of sensory nerve loss between the 2 groups. CONCLUSIONS: Both open surgery and hindfoot endoscopic excision of a symptomatic os trigonum were effective and safe. Patients with an endoscopic excision had a shorter time to return to previous sports level. LEVEL OF EVIDENCE: Level IV, therapeutic case series.