Citations

AbstractWhile it is generally accepted that most partial and isolated medial collateral ligament (MCL) injuries can be treated non‐operatively, ideal treatment of the MCL in multi‐ligament knee injuries remains controversial. High failure rates with repair of the posterolateral corner in the multi‐ligament injured knee have been recently reported, favoring reconstruction instead. The same maybe true for MCL injuries, however evidence‐based treatment recommendations are lacking in the current orthopedic literature. The purpose of this study was to perform an evidence‐based systematic review of the operative management (repair and/or reconstruction) of the MCL in the setting of multi‐ligament knee injuries. A comprehensive search of MEDLINE and the Cochrane databases for all relevant articles published in English from 1978 to 2008 on the outcomes of surgical management (repair and/or reconstruction) of the MCL in the setting of combined ligament injuries was performed. Inclusion criteria included articles published in (1) English, (2) on human subjects, (3) between the years of 1978 and 2008, (4) had minimum 12‐month follow‐up, with a mean of at least 24 months, (5) on surgical management of MCL injuries, (6) associated with multi‐ligament injuries (three or more ligaments) and/or knee dislocation, and (7) reported objective outcome data on the respective patient cohorts. Exclusion criteria consisted of technique papers, case reports, studies that included fractures associated with MCL injury and those that included pediatric patients. The review identified eight relevant studies. Five articles focused on MCL repair, while three articles focused on MCL reconstruction. No prospective studies compared MCL repair or reconstruction with non‐operative treatment or directly compared MCL reconstruction with MCL repair. Currently there is a paucity of objective data on the outcomes regarding surgical management of MCL tears in the combined ligament injured knee. This systematic review demonstrated satisfactory results in both repair and reconstruction groups. Future objective outcome‐based studies as well as comparative studies are needed to further evaluate the optimal treatment modality before evidence‐based recommendations can be made. Therefore, individual treatment decisions for each patient should be based on the characteristics and nature of the injury.

Purpose The purpose of this systematic review was to address the treatment of multiligament knee injuries, specifically ( 1 ) surgical versus nonoperative treatment, ( 2 ) repair versus reconstruction of injured ligamentous structures, and ( 3 ) early versus late surgery of damaged ligaments. Methods Two independent reviewers performed a search on PubMed from 1966 to August 2007 using the terms “knee dislocation,” “multiple ligament–injured knee,” and “multiligament knee reconstruction.” Study inclusion criteria were ( 1 ) levels I to IV evidence, ( 2 ) “multiligament” defined as disruption of at least 2 of the 4 major knee ligaments, ( 3 ) measures of functional and clinical outcome, and ( 4 ) minimum of 12 months' follow‐up, with a mean of at least 24 months. Results Four studies compared surgical treatment with nonoperative treatment. There was a higher percentage of excellent/good International Knee Documentation Committee (IKDC) scores (58% v 20%) in surgically treated patients, as well as higher rates for return to work (72% v 52%) and return to full sport (29% v 10%). Two studies compared repair with reconstruction of damaged structures, with similar mean Lysholm scores (88 v 87) and excellent/good IKDC scores (51% v 48%). However, repair of the posterolateral corner had a higher failure rate (37% v 9%). Similarly, repair of the cruciates yielded decreased stability and range of motion and a lower return to preinjury activity levels (0% v 33%). There were 5 studies comparing early surgery (≤3 weeks) with late surgery. Early treatment resulted in higher mean Lysholm scores (90 v 82) and a higher percentage of excellent/good IKDC scores (47% v 31%), as well as higher sports activity scores (89 v 69) on the Knee Outcome Survey. Conclusions Our review suggests that early operative treatment of the multiligament‐injured knee yields improved functional and clinical outcomes compared with nonoperative management or delayed surgery. Repair of the posterolateral corner may yield higher revision rates compared with reconstruction.

Abstract Following the death of a youth hockey coach in a fight with a parent in 2000, the Mayo Clinic Sports Medicine Center and Minnesota Hockey collaborated to implement a three-component Hockey Education Program (HEP). HEP was initiated in 2003 to ensure youth players develop sportsmanship, skills, and a Fair Play approach to the game. Another goal was to decrease attrition of players, coaches, and officials. Coaching Excellence, a component of HEP, is based on 25 years of youth sport research. The HEP manuals Coaches Who Never Lose and Sports and Your Child contain the philosophy, objectives, and guidelines to ensure implementation of HEP components across players, coaches, and parents. The Skill Development component emphasizes learning age-appropriate hockey skills though skill progression. Increasing the practice-to-game ratio to 3–4 practices per game greatly increases the maximum time players skate with the puck during developmental years. Pre- and post-season Skills Challenges allow coaches, players, and parents to gauge improvement, and structure practices to address identified skill deficits. The Fair Play (FP) component emphasizes sportsmanship. Teams earn a FP point each game if they incur less than a preset number of penalty minutes. A coach receiving a game misconduct or a parent/spectator asked to leave the game will cause the team to forfeit their FP point. FP points are factored into league standings across the state. This past season, 17 678 records of game data were obtained and 25 % (4420) were randomly selected for analysis. The data analysis permits comparison across seasons and changes are made accordingly. Based on four years of data, most Minnesota youth hockey games are played in a sportsmanlike manner. Checking from behind and head contact penalties have decreased since the penalty minutes for these dangerous infractions were increased.

Abstract Ice hockey is a fast-paced, aggressive sport whose participants are subject to relatively high rates of injury. Although there is a growing emphasis on the epidemiology of ice hockey research and its application towards reducing injuries, the literature has never been organized into an accessible database. Ice hockey is played in North America, Europe, Scandinavia, the U.K., and several other non-English speaking countries, yet injury reports not written in English are often ignored in review articles. The purpose of this project was to synthesize the existing world literature on ice hockey injuries into a framework of epidemiologic criteria, accessible in an organized, retrievable library. An extensive search of the following databases was done: MEDLINE, BIOSIS, EMBASE, NTIS, CURRENT CONTENTS, DISSERTATION ABSTRACTS, SPORT DISCUS, CINAHL, and WEB OF SCIENCE. Key words used were “ice hockey” and “injuries,” and the search range was 1966 to July 2007. Endnote X (Thompson Corp., Stamford, CT) was used for reference compilation. Eight hundred sixty seven documents were catalogued, from 27 countries in 8 languages. Documents were first categorized by type, including injury (226), equipment (45), case reports (94), review articles (294), editorials (39), or as focusing on the physiological, psychological, or medical aspects of ice hockey (169). Documents were then subdivided by study type and whether they were prospective (117) or retrospective (109). Further subdivisions beyond these levels were based on the inclusion of certain critical epidemiological criteria, including exposure time, a clear definition of “injury,” and the level of play, among others. This comprehensive database should make future ice hockey research more efficient, as well as promote sound epidemiology and a more global perspective.

Purpose The goal of this study was to compare open and arthroscopic surgical techniques for “cam‐type” femoroacetabular impingement in terms of feasibility and reliability. Methods We used 5 fresh‐frozen cadaver specimens (10 hips). Anteroposterior and cross‐table radiographs were taken for each. The head‐neck union diameter was measured for each. The amount of bone resection at the anterolateral quadrant of the head‐neck union was planned for each, with specific references to width, length, depth, and position. One side was randomly assigned to the open group and the other to the arthroscopic group. Surgical time, position of the osteotomy, and variation of the length, width, and depth of the final osteotomy with respect to the proposed dimensions were compared. Results In all specimens partial resection of the anterior‐lateral femoral head‐neck junction with improvement of the femoral head‐neck offset was accomplished. A statistically significant difference ( P < .05) was observed for surgical time between the open and arthroscopic groups (shorter in open group). Conclusions When comparing surgical precision, no statistically significant differences were found between the open and arthroscopic procedures in any of the measurements. The depth and width of the osteoplasty were reliably obtained by the arthroscopic technique. However, there was a tendency to underestimate the osteoplasty length with the arthroscopic procedure. Positioning the osteoplasty was also less reliable with the arthroscopic procedure than with the open procedure because of the tendency to place the osteoplasty more posterior and distally than intended. Clinical Relevance Surgical resection of the femoral neck prominence and/or part of the anterolateral neck has been reported to improve femoral head offset and alleviate impingement. This study attempts to document the accuracy of this resection when done arthroscopically compared with an open procedure.

The records of patients aged 50 years or over who underwent primary reconstruction of the anterior cruciate ligament between 1990 and 2002 were reviewed. There were 35 knees in 34 patients that met the inclusion criteria. The mean age of the patients was 57 years (50 to 66) and the mean clinical follow-up was for 72 months (25 to 173). A total of 23 knees were reconstructed with patellar tendon allograft, and 12 with patellar tendon autograft. The mean pre-operative knee extension was 1° (−5° to 10°) and flexion was 129° (125° to 150°) and at follow-up these values were 0° (−5° to 5°) and 135° (120° to 150°), respectively. Pre-operatively there were 31 knees (89%) with a Lachman grade 2+ or 3+. Post-operatively, 33 knees (94%) were Lachman grade 0 or 1+. The mean pre- and post-operative International Knee Documentation Committee scores were 39 (23 to 72) and 90 (33 to 100) respectively. The mean pre- and post-operative Lysholm scores were 50 (18 to 68) and 92 (28 to 100) respectively and the mean University of California Los Angeles activity scores were 8.5 before injury (4 to 10), 4.3 (3 to 6) after injury and 8.3 (4 to 10) post-operatively. There were three graft failures (8.6%) requiring revision. We conclude that reconstruction of the anterior cruciate ligament in carefully-selected patients aged 50 years or over can achieve similar results to those in younger patients, with no increased risk of complications.

Prompted by an intrigue with the challenges of goaltending, questionnaires were given to 67 youth hockey goalies. Seventy-six percent responded that the psychological aspects of the position caused the greatest difficulties. A subsequent study examined the relationship between psychological, situational, and physiological variables and on-ice performance. Goalies completed psychometric instruments before going on the ice and their electrocardiograms were monitored during on-ice stations. Subjects were videotaped at the Puck Shooting Machine (PSM) station. Mean heart rate (HR) was 163 beats per minute (bpm) at the PSM and 175 bpm at other stressful stations (e.g., breakaway and slap shot). Goalies with 100% saves (N=7) were older, more experienced, less anxious, and had faster HR's than those who performed poorly. Because elevated arousal levels were detected at the goalie camp, a subsequent study of different Bantam, High School, and Junior A goalies (N=13) were studied during 31 games. Rapid HR's were sustained during games, even when goalies were standing still.

The incidence of aggression in ice hockey and the consequences of violent on-ice behavior is of major concern to those interested in the safety of the sport. The purpose of this paper is to examine the history of aggression in hockey, how it is measured and why it happens. A hypothetical integrated model of antecedents of aggression in hockey is presented which may guide future research investigations. Officiating in ice hockey, penalty statistics at specific levels of participation, and the categorization of penalties are discussed. An assessment was done to determine whether there has been a change in player's perceptions of the attitudes of significant others toward aggression. The results were compared to previous research [1], which examined reinforcers of aggressive behavior in hockey players. A case study of an injured hockey player is presented which depicts the physical and psychosocial consequences of a penalized aggressive on-ice incident. Steps that can be taken to reduce aggression and identify barriers that are likely to impede attempts to reduce aggression in the game will be discussed. Suggestions for future research are presented.