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  1. Reducing the Risk of ACL Injury in Female Athletes

    ERIC Educational Resources Information Center

    McDaniel, Larry W.; Rasche, Adrienna; Gaudet, Laura; Jackson, Allen

    2010-01-01

    The Anterior Cruciate Ligament (ACL) is located behind the kneecap (patella) and connects the thigh bone (femur) to the shin bone (tibia). Stabilizing the knee joint is the primary responsibility of the ACL. Injuries that affect the ACL are three to five times more common in females than males. This is a result of anatomical, biomechanical,…

  2. Risk Factors and Predictors Of Subsequent ACL Injury After ACL Reconstruction: Prospective Analysis Of 2801 Primary ACL Reconstructions

    PubMed Central

    Kaeding, Christopher C.; Pedroza, Angela; Reinke, Emily; Huston, Laura J.; Spindler, Kurt P.

    2014-01-01

    Objectives: Retear of an ACL after an ACL reconstruction (ACLR) is devastating for all involved. Understanding risk factors and predictors of subsequent ACL tear after an ACLR is vital for patient education of subsequent risk of injury and if a predictor is modifiable, to make adjustments to minimize the risk of repeat ACL tear. The objectives of this study were 1) to identify the risk factors and predictors for ispilateral and contralateral ACL tears after primary ACLR and 2) to compare retear risk between the 2002/03 and 2007/08 cohorts. This is the largest and most comprehensive prospective analysis of this kind in the literature. Methods: Data from the 2002-2008 MOON database was used to identify risk factors for ACL retear. Subjects who had a primary ACLR with no history of contralateral knee surgery and had 2 year follow-up data were included. Subjects who had multiligament surgery were excluded. Graft type (auto-BTB, auto-hamstring, allograft), age, Marx score at time of index surgery, sport played post ACLR, sex, smoking status, lateral meniscus tear at the time of ACLR, medial meniscus tear at the time of ACLR, BMI, and MOON site were evaluated to determine their contribution to both ipsilateral retear and contralateral ACL tear. The analysis was repeated using the 2002/3 and 2007/8 cohort and included age, graft, sex, and Marx. An ANOVA with post-hoc analysis was performed to detect significant differences in age and Marx score by graft type over time. Results: A total of 2801 subjects met all inclusion/exclusion criteria. There were 165/2801 (5.89%) ipsilateral and 177/2801 (6.32%) contralateral ACL tears identified in the cohort at the two year follow-up. The odds of ipsilateral retear are 1.68 times greater for hamstring autograft (p=0.04) and 4.67 times greater for an allograft (p<0.001) compared to auto-BTB. The odds of ipsilateral retear decrease by 8% for every yearly increase in age (p < 0.001) and increases by 6% for every increased point on the

  3. Body Mass Index, Modulated by Lateral Posterior Tibial Slope, Predicts ACL Injury Risk

    PubMed Central

    Bojicic, Katherine M.; Beaulieu, Melanie L.; Krieger, Daniel Imaizumi; Ashton-Miller, James A.; Wojtys, Edward M.

    2016-01-01

    Objectives: Intervention strategies to prevent ACL injury rely on increasing knowledge of risk factors. While several modifiable and non-modifiable risk factors for ACL rupture have been identified, the interaction between them remains unknown. The aim of this study was to quantify the relationship between BMI and several knee geometries as potential risk factors for ACL injury. We hypothesized that an increased BMI in the presence of an increased posterior tibial slope or middle cartilage slope would increase risk of ACL injury. We also hypothesized that an increased BMI in the presence of a decreased posterior meniscal height or meniscal bone angle would result in an increased risk of ACL injury. Methods: Sagittal knee MRI files from 76 ACL-injured and 42 non-injured subjects were gathered from the institution’s archive. The PTS, MCS, PMH, and MBA were measured using the circle method and compared with BMI from the subject demographic. Data were analyzed using univariate and multivariate logistical regression. Figure 1 details measurements made for each knee geometry. Results: Univariate analysis of PTS showed increases in PTS significantly increase the odds of ACL tear (p = 0.043, OR =1.12). Univariate analysis of MCS showed increases of MCS significantly increase the odds of ACL tear (p = 0.037, OR = 1.12). Multivariate analysis of PTS and BMI centered around the mean (PTS*cBMI) showed increases of PTS in combination with increases in cBMI significantly increases the odds of ACL rupture (p value = .050, OR = 1.03). Table 1 shows predicted increases in ACL injury risk for combinations of increases in PTS and BMI. Conclusion: An increase in BMI will increase the risk of ACL tear when an increase in lateral posterior tibial slope is present. An increase in lateral posterior tibial slope or lateral middle cartilage slope increases the risk of an ACL tear.

  4. Gender Dimorphic ACL Strain In Response to Combined Dynamic 3D Knee Joint Loading: Implications for ACL Injury Risk

    PubMed Central

    Mizuno, Kiyonori; Andrish, Jack T.; van den Bogert, Antonie J.; McLean, Scott G.

    2009-01-01

    While gender-based differences in knee joint anatomies/laxities are well documented, the potential for them to precipitate gender-dimorphic ACL loading and resultant injury risk has not been considered. To this end, we generated gender-specific models of ACL strain as a function of any six degrees of freedom (6DOF) knee joint load state via a combined cadaveric and analytical approach. Continuously varying joint forces and torques were applied to five male and five female cadaveric specimens and recorded along with synchronous knee flexion and ACL strain data. All data (~10,000 samples) were submitted to specimen-specific regression analyses, affording ACL strain predictions as a function of the combined 6 DOF knee loads. Following individual model verifications, generalized gender-specific models were generated and subjected to 6 DOF external load scenarios consistent with both a clinical examination and a dynamic sports maneuver. The ensuing model-based strain predictions were subsequently examined for gender-based discrepancies. Male and female specimen specific models predicted ACL strain within 0.51% ± 0.10% and 0.52% ± 0.07% of the measured data respectively, and explained more than 75% of the associated variance in each case. Predicted female ACL strains were also significantly larger than respective male values for both of simulated 6 DOF load scenarios. Outcomes suggest that the female ACL will rupture in response to comparatively smaller external load applications. Future work must address the underlying anatomical/laxity contributions to knee joint mechanical and resultant ACL loading, ultimately affording prevention strategies that may cater to individual joint vulnerabilities. PMID:19464897

  5. Risk Factors and Predictors of Subsequent ACL Injury in either Knee after ACL Reconstruction: Prospective Analysis of 2488 Primary ACL Reconstructions from the MOON Cohort

    PubMed Central

    Kaeding, Christopher C.; Pedroza, Angela D.; Reinke, Emily K.; Huston, Laura J.; Spindler, Kurt P.

    2015-01-01

    Background Anterior cruciate ligament (ACL) re-injury results in worse outcomes and increases risk of post-traumatic osteoarthritis. Objectives To identify the risk factors for both ipsilateral and contralateral ACL tears after primary ACL reconstruction (ACLR). Study Design Cohort study; Level of evidence, 3. Methods Data from the Multicenter Orthopaedic Outcomes Network (MOON), a prospective longitudinal cohort, were used to identify risk factors for ACL retear. Subjects with primary ACLR, no history of contralateral knee surgery, and a minimum of 2-year follow-up data were included. Age, sex, Marx activity score, graft type, lateral meniscus tear, medial meniscus tear, sport played at index injury, and surgical facility were evaluated to determine their contribution to both ipsilateral retear and contralateral ACL tear. Results A total of 2683 subjects with average age of 27 ± 11 years (1498 men; 56%) met all study inclusion/exclusion criteria. Overall there were 4.4% ipsilateral graft tears and 3.5% contralateral ACL tears. The odds of ipsilateral retear were 5.2 times greater for an allograft (p<0.01) compared with a bone-patellar tendon-bone (BTB) autograft; the odds of retear were not significantly different between BTB autograft and hamstring autograft (p=0.12). The odds of an ipsilateral ACL retear decreased by 0.09 for every yearly increase in age (p<0.01) and increased by 0.11 for every increased point on the Marx score (p< 0.01). The odds were not significantly influenced by sex, smoking status, sport played, medial or lateral meniscus tear, or consortium site (p>0.05). The odds of a contralateral ACL tear decreased by 0.04 for every yearly increase in age (p=0.04) and increased by 0.12 for every increased point on the Marx score (p<0.01); these odds were not significantly different between sex, smoking status, sport played, graft type, medial meniscal tear, and lateral meniscal tear (p>0.05). Conclusions Younger age, higher activity level, and

  6. A Wearable Neuromuscular Device Reduces ACL Injury Risk in Female Soccer Athletes

    PubMed Central

    Decker, Michael John; Shaw, Matthew; Maddan, Casey; Campbell, Julie; Davidson, Bradley

    2016-01-01

    Objectives: Female soccer athletes have a three-fold greater risk of sustaining an ACL injury compared with their male counterparts yet only 1 in 5 teams engage in ACL risk reduction programs due to several participation barriers. The purpose of this study was to determine the effects of a wearable neuromuscular (WNM) device on postural control, performance and ACL injury risk in female soccer athletes. Methods: Seventy-nine elite youth and collegiate female soccer athletes (age range: 12-25 y) trained with a WNM device that applied bi-lateral, topical pressure to the medial quadriceps and hamstrings muscles (Topical Gear, Austin, TX). The athletes performed 7-9 weeks of pre-season training with the WNM device consisting of strength and conditioning exercises and on-field team practices (46-64 total hours of exposure). Postural control was measured in 15 athletes with and without the WNM device before and after the training program; and performance was measured in 25 athletes without the WNM device before and after the training program. Postural control was determined from a single-leg landing on a force plate from a horizontal distance normalized to leg length. The athletes were instructed to gain their balance as fast as possible upon landing and remain balanced for 5 seconds. The peak ground reaction forces (GRF) and the medial-lateral, anterior-posterior and net center of pressure (COP) velocities and displacement ranges were calculated during 2 seconds of single-leg stance. Performance measures including speed, power and endurance were measured from the 40 yard dash, vertical jump for height and the Beep test, respectively. A two-way repeated measures ANOVA and post-hoc comparisons were used to compare the postural variables; and t-tests were used to compare the performance tests (p=.05). ACL injury rates, the absolute risk reduction (ARR) and the number needed to treat (NNT) to prevent one ACL injury were calculated between the WNM intervention group and 11

  7. An Integrated Approach to Change the Outcome Part II: Targeted Neuromuscular Training Techniques to Reduce Identified ACL Injury Risk Factors

    PubMed Central

    Myer, Gregory D.; Ford, Kevin R.; Brent, Jensen L.; Hewett, Timothy E.

    2014-01-01

    Prior reports indicate that female athletes who demonstrate high knee abduction moments (KAMs) during landing are more responsive to neuromuscular training designed to reduce KAM. Identification of female athletes who demonstrate high KAM, which accurately identifies those at risk for noncontact anterior cruciate ligament (ACL) injury, may be ideal for targeted neuromuscular training. Specific neuromuscular training targeted to the underlying biomechanical components that increase KAM may provide the most efficient and effective training strategy to reduce noncontact ACL injury risk. The purpose of the current commentary is to provide an integrative approach to identify and target mechanistic underpinnings to increased ACL injury in female athletes. Specific neuromuscular training techniques will be presented that address individual algorithm components related to high knee load landing patterns. If these integrated techniques are employed on a widespread basis, prevention strategies for noncontact ACL injury among young female athletes may prove both more effective and efficient. PMID:22580980

  8. The Utility of a High-intensity Exercise Protocol to Prospectively Assess ACL Injury Risk.

    PubMed

    Bossuyt, F M; García-Pinillos, F; Raja Azidin, R M F; Vanrenterghem, J; Robinson, M A

    2016-02-01

    This study investigated the utility of a 5-min high-intensity exercise protocol (SAFT(5)) to include in prospective cohort studies investigating ACL injury risk. 15 active females were tested on 2 occasions during which their non-dominant leg was analysed before SAFT(5) (PRE), immediately after (POST0), 15 min after (POST15), and 30 min after (POST30). On the first occasion, testing included 5 maximum isokinetic contractions for eccentric and concentric hamstring and concentric quadriceps and on the second occasion, 3 trials of 2 landing tasks (i. e., single-leg hop and drop vertical jump) were conducted. Results showed a reduced eccentric hamstring peak torque at POST0, POST15 and POST30 (p<0.05) and a reduced functional HQ ratio (Hecc/Qcon) at POST15 and POST30 (p<0.05). Additionally, a more extended knee angle at POST30 (p<0.05) and increased knee internal rotation angle at POST0 and POST15 (p<0.05) were found in a single-leg hop. SAFT(5) altered landing strategies associated with increased ACL injury risk and similar to observations from match simulations. Our findings therefore support the utility of a high-intensity exercise protocol such as SAFT(5) to strengthen injury screening tests and to include in prospective cohort studies where time constraints apply. PMID:26509378

  9. Injury Risk Estimation Expertise: Cognitive-Perceptual Mechanisms of ACL-IQ.

    PubMed

    Petushek, Erich J; Cokely, Edward T; Ward, Paul; Myer, Gregory D

    2015-06-01

    Instrument-based biomechanical movement analysis is an effective injury screening method but relies on expensive equipment and time-consuming analysis. Screening methods that rely on visual inspection and perceptual skill for prognosticating injury risk provide an alternative approach that can significantly reduce cost and time. However, substantial individual differences exist in skill when estimating injury risk performance via observation. The underlying perceptual-cognitive mechanisms of injury risk identification were explored to better understand the nature of this skill and provide a foundation for improving performance. Quantitative structural and process modeling of risk estimation indicated that superior performance was largely mediated by specific strategies and skills (e.g., irrelevant information reduction), and independent of domain-general cognitive abilities (e.g., mental rotation, general decision skill). These cognitive models suggest that injury prediction expertise (i.e., ACL-IQ) is a trainable skill, and provide a foundation for future research and applications in training, decision support, and ultimately clinical screening investigations.

  10. An integrated approach to change the outcome part I: neuromuscular screening methods to identify high ACL injury risk athletes.

    PubMed

    Myer, Gregory D; Ford, Kevin R; Brent, Jensen L; Hewett, Timothy E

    2012-08-01

    An important step for treatment of a particular injury etiology is the appropriate application of a treatment targeted to the population at risk. An anterior cruciate ligament (ACL) injury risk algorithm has been defined that employs field-based techniques in lieu of laboratory-based motion analysis systems to identify athletes with high ACL injury risk landing strategies. The resultant field-based assessment techniques, in combination with the developed prediction algorithm, allow for low-cost identification of athletes who may be at increased risk of sustaining ACL injury. The combined simplicity and accuracy of the field-based tool facilitate its use to identify specific factors that may increase risk of injury in female athletes. The purpose of this report is to demonstrate novel algorithmic techniques to accurately capture and analyze measures of knee valgus motion, knee flexion range of motion, body mass, tibia length and quadriceps to hamstrings ratio with video analysis software typically used by coaches, strength and conditioning specialists, and athletic trainers. The field-based measurements and software analyses were used in a prediction algorithm to identify those at potential risk of noncontact ACL injury that may directly benefit from neuromuscular training.

  11. The effects of gender on quadriceps muscle activation strategies during a maneuver that mimics a high ACL injury risk position.

    PubMed

    Myer, Gregory D; Ford, Kevin R; Hewett, Timothy E

    2005-04-01

    While the increased incidence of serious knee injuries in female athletes is well established, the underlying neuromuscular mechanisms related to the elevated ACL injury rate has yet to be delineated. Video analysis of ACL injury during competitive sports play indicates a common body position associated with non-contact ACL injury; the tibia is externally rotated, the knee is close to full extension, the foot is planted and as the limb is decelerated it collapses into valgus. The purpose of the current prospective study was to evaluate gender differences in quadriceps muscle activation strategies when performing a physically challenging, but reproducible maneuver that mimics the high ACL injury risk position (in the absence of high velocity and high loads). Twenty physically active college-aged subjects (10 male and 10 female) performed multiple sets of the prescribed exercise. EMG recordings were employed to measure the ratio of activation between the medial and lateral quadriceps during the 4, 8, 12, 16, and 20th sets of exercise. Females demonstrated decreased RMS medial-to-lateral quadriceps ratios compared to males (F(1,18)=5.88, p=0.026). There was no main effect of set number on RMS quadriceps ratio (p>0.05). The results of this study suggest that females utilize neuromuscular activation strategies which may contribute to "dynamic valgus" and ACL rupture when performing high-risk maneuvers.

  12. Anterior Cruciate Ligament (ACL) Injuries

    MedlinePlus

    ... get ACL injuries usually play contact sports (like football) or sports that feature swift, abrupt movements such ... the things you love — like running or playing football, field hockey, or softball — can be frustrating. Recovering ...

  13. Frontal plane comparison between drop jump and vertical jump: implications for the assessment of ACL risk of injury.

    PubMed

    Cesar, Guilherme M; Tomasevicz, Curtis L; Burnfield, Judith M

    2016-11-01

    The potential to use the vertical jump (VJ) to assess both athletic performance and risk of anterior cruciate ligament (ACL) injury could have widespread clinical implications since VJ is broadly used in high school, university, and professional sport settings. Although drop jump (DJ) and VJ observationally exhibit similar lower extremity mechanics, the extent to which VJ can also be used as screening tool for ACL injury risk has not been assessed. This study evaluated whether individuals exhibit similar knee joint frontal plane kinematic and kinetic patterns when performing VJs compared with DJs. Twenty-eight female collegiate athletes performed DJs and VJs. Paired t-tests indicated that peak knee valgus angles did not differ significantly between tasks (p = 0.419); however, peak knee internal adductor moments were significantly larger during the DJ vs. VJ (p < 0.001). Pearson correlations between the DJ and VJ revealed strong correlations for knee valgus angles (r = 0.93, p < 0.001) and for internal knee adductor moments (r = 0.82, p < 0.001). Our results provide grounds for investigating whether frontal plane knee mechanics during VJ can predict ACL injuries and thus can be used as an effective tool for the assessment of risk of ACL injury in female athletes. PMID:27240279

  14. Restriction in Hip Internal Rotation is Associated with an Increased Risk of ACL Injury in NFL Combine Athletes: A Clinical and Biomechanical Study

    PubMed Central

    Bedi, Asheesh; Warren, Russell F.; Oh, Youkeun K.; Wojtys, Edward M.; Oltean, Hanna N.; Ashton-Miller, James A.; Kelly, Bryan T.

    2013-01-01

    Objectives: A deficiency in hip internal rotation secondary to femoroacetabular impingement (FAI) may result in compensatory increases in rotational stresses applied to the ACL with cutting and pivoting activities, thereby increasing the risk of ACL failure in athletes. The purpose of this study was to correlate ACL injury with hip range of motion in a consecutive series of elite, contact athletes and to test the hypothesis that a restriction in the available hip axial rotation in a dynamic in silico model of a simulated pivot landing would increase ACL strain and the risk of ACL rupture. Methods: We examined 324 football athletes attending the 2012 NFL National Invitational Camp. Hip range of internal rotation was measured by three orthopaedic surgeons and correlated with a history of ACL injury and surgical repair using generalized estimating equation logistic regression analysis. An in silico biomechanical model was used to study the effect of FAI on the peak relative ACL strain developed during a simulated pivot landing. Results: The in vivo results demonstrated that a reduction in internal rotation of the left hip was associated with a statistically significant increased odds of ACL injury in the ipsilateral or contralateral knee (OR = 0.95, P =.0001 and P < .0001, respectively). A post-estimation calculation of odds ratio for ACL injury based on deficiency in hip internal rotation demonstrated that a 30-degree reduction in left hip internal rotation was associated with 4.06 and 5.29 times greater odds of ACL injury in the ipsilateral and contralateral limbs, respectively (Figure 1A). The in silico model demonstrated that FAI systematically increased the peak ACL strain predicted during the pivot landing (Figure 1B). The peak AM-ACL strain for 5-degrees of internal rotation was 22.5% greater than the corresponding value for 10-degrees of internal rotation (i.e., a peak AM-ACL strain of 5.77% vs. 4.71%, respectively). Conclusion: FAI may significantly increase

  15. Validation of the Microsoft Kinect as a Portable and Inexpensive Screening Tool for Identifying ACL Injury Risk

    PubMed Central

    Gray, Aaron D.; Marks, Jeff M.; Stone, Erik E.; Butler, Michael C.; Skubic, Marjorie; Sherman, Seth Lawrence

    2014-01-01

    Objectives: A widespread screening tool to assess anterior cruciate ligament (ACL) injury risk should ideally be portable, inexpensive, markerless and easy to use. We hypothesize that our software program - for use with the Microsoft Kinect Motion Sensor - fulfills the above requirements. This study compares the measurements of knee abduction during a drop vertical jump (DVJ) between the Microsoft Kinect and the “gold standard” marker-based Vicon motion analysis system. Methods: Thirteen participants (10 male: 3 female; age 20-31) took part in this IRB approved study. Each participant performed between 5 and 7 DVJs, yielding a total of 84 DVJs. We simultaneously measured knee valgus motion (KVM) as measured from initial contact (IC) to the point of peak flexion (PF), frontal plane knee angle (FPKA) at both IC and PF, and knee-to-ankle separation (KASR) ratio measured at PF with the Kinect and Vicon systems. The intra-class correlation coefficient (ICC) (two-way, single measure, absolute agreement) was used to assess the degree of agreement between the Kinect and Vicon for each measure. Results: KVM had the lowest ICC value; 0.81 and 0.85 for the left and right leg, respectively. The other measures had similar ICC values of approximately 0.89 for both legs. Standard interpretations of the ICC suggest values above 0.75 indicate excellent agreement between the measurements (Table 1). Conclusion: This study demonstrates good correlation between the Microsoft Kinect and the Vicon system for measuring frontal plane knee kinematics during the DVJ. The DVJ test has been established as an ideal task for evaluating the motions that put athletes at risk for ACL injuries. Screening and early detection of ACL injury risk factors may lead to a relative risk reduction between 30% to 80% with an appropriate ACL injury prevention program. As compared to the “gold standard” Vicon system, the Microsoft Kinect is a portable, inexpensive, marker-less, and expedient system that

  16. Adolescent ACL injury: treatment considerations.

    PubMed

    Pavlovich, Raymond; Goldberg, Steven H; Bach, Bernard R

    2004-04-01

    Anterior cruciate ligament (ACL) injury in a skeletally immature patient presents unique treatment challenges. In many cases, conservative treatment with bracing and physical therapy fails, resulting in recurrent instability, pain, swelling, and meniscal and chondral injury. The goal of surgical reconstruction is to recreate ACL stability without causing growth plate arrest, leg-length discrepancy, or angular deformity. Patient characteristics such as skeletal age, Tanner stage, onset of menses, family member height, growth spurt, recent change in foot size, and growth charts can help the surgeon approximate the degree of skeletal maturity and aid in selecting the timing and safest type of reconstruction. Numerous surgical techniques, ranging from an extra-articular reconstruction to intra-articular graft passage without physeal violation to standard transtibial and transfemoral tunnel placement with physeal violation, have been popularized. The majority of existing studies are retrospective case series, describing a particular author's specific technique experience. This article reviews the basic science and clinical literature, presents a treatment algorithm, and provides several case studies.

  17. Incidence of Second ACL Injuries 2 Years After Primary ACL Reconstruction and Return to Sport

    PubMed Central

    Paterno, Mark V.; Rauh, Mitchell J.; Schmitt, Laura C.; Ford, Kevin R.; Hewett, Timothy E.

    2014-01-01

    ipsilateral injury (0.47/1000 AEs). Overall, 29.5% of athletes suffered a second ACL injury within 24 months of RTS, with 20.5% sustaining a contralateral injury and 9.0% incurring a retear injury of the ipsilateral graft. There was a trend toward a higher proportion of female participants (23.7%) who suffered a contralateral injury compared with male participants (10.5%) (P = .18). Conversely, for ipsilateral injuries, the incidence proportion between female (8.5%) and male (10.5%) participants was similar. Conclusion These data support the hypothesis that in the 24 months after ACLR and RTS, patients are at a greater risk to suffer a subsequent ACL injury compared with young athletes without a history of ACL injuries. In addition, the contralateral limb of female patients appears at greatest risk. PMID:24753238

  18. The role of ACL injury in the development of posttraumatic knee osteoarthritis.

    PubMed

    Friel, Nicole A; Chu, Constance R

    2013-01-01

    Acute anterior cruciate ligament (ACL) tears are most frequently sustained by young, physically active individuals. ACL injuries are seen at high incidence in adolescents and young adults performing sports and occupational activities that involve pivoting. Young women participating in pivoting sports have a 3 to 5 times higher risk of ACL injury than men. Studies show that ACL injury increases osteoarthritis (OA) risk with symptomatic OA appearing in roughly half of individuals 10-15 years later. Because the majority of patients sustaining acute ACL tears are younger than 30, this leads to early onset OA with associated pain and disability during premium work and life growth years between ages 30 and 50. Effective strategies to prevent ACL injury and to reduce subsequent OA risk in those sustaining acute ACL tears are needed.

  19. UNDERSTANDING AND PREVENTING ACL INJURIES: CURRENT BIOMECHANICAL AND EPIDEMIOLOGIC CONSIDERATIONS - UPDATE 2010

    PubMed Central

    Ford, Kevin R.; Hoogenboom, Barbara J.; Myer, Gregory D.

    2010-01-01

    This invited clinical commentary summarizes the current state of knowledge in the area of prevention of anterior cruciate ligament (ACL) injuries. ACL injuries occur with a four to six fold greater incidence in female compared to male athletes playing the same high risk sports. The combination of increased risk of ACL injury and a 10-fold increase in sports participation since the enactment of Title IX in 1972 has led to an almost epidemic rise in ACL injuries in female athletes. Examination of the mechanisms responsible for this sex disparity in ACL rupture accelerated in the last two decades. A summary of these findings and a synthesis and framework for understanding the results of the intense investigation of this research are detailed herein. This clinical commentary focuses on the current understanding, identification and interventional targeting of the primary neuromuscular and biomechanical risk factors associated with the ACL injury mechanism in high-risk individuals. PMID:21655382

  20. Preventing ACL Injuries in Females: What Physical Educators Need to Know

    ERIC Educational Resources Information Center

    Toscano, Lisa; Carroll, Brianne

    2015-01-01

    Anterior cruciate ligament (ACL) injuries happen at a frequent rate, especially in girls and women. While there are many factors that contribute to ACL tears, teaching proper landing techniques and strengthening certain muscles can decrease the incidence of ACL tears, especially in women. This article reviews some of the high-risk factors that…

  1. The female ACL: why is it more prone to injury?

    PubMed

    Ireland, Mary Lloyd

    2002-10-01

    Multiple factors are responsible for ACL tears. The key factor in the gender discrepancy appears to be dynamic, not static, and proximal, not distal. The factors involved in evaluating the female ACL are multiple. However, it is the dynamic movement patterns ot hip and knee position with increased flexion and a coordinated proximal muscle firing pattern to keep the body in a safe landing position that are the most critical factors. An ACL injury at an early age is a life-changing event. We can very successfully reconstruct and rehabilitate an ACL, but we cannot stop there. We must now go into the prevention arena. In the United States there is tremendous variation in the exposure and acquisition of skills of physical activities in our youth. Today, children are often playing inside, using computers and watching television-missing out on the opportunity to learn safe movement patterns. Therefore, physical movement classes should occur very early in life, teaching children to land safely and in control, similar to the cry of "get down, stay down" routinely heard during youth soccer. Similarly, specific strength training programs can address landing as well as foot movements during cutting in basketball. Coaches should issue stern warnings when athletes demonstrate a high-risk movement patterns such as one-leg landings, out-of-control baseline landings, or straight-leg landings. The warnings may serve to keep the athlete from "touching the hot stove again" for fear of getting burned. No athlete feels she will be the one to get injured. Therefore, prospective analysis is likely to be received more warmly by the athletes if the program is presented with an emphasis on performance improvement rather than injury prevention. With increased participation in these programs, multiple-center analysis will have the power necessary to determine which factors significantly predispose athletes to ACL injury. The future for injury prevention is bright. We must rise to the challenge.

  2. Gender, Vertical Height and Horizontal Distance Effects on Single-Leg Landing Kinematics: Implications for Risk of non-contact ACL Injury

    PubMed Central

    Ali, Nicholas; Rouhi, Gholamreza; Robertson, Gordon

    There is a lack of studies investigating gender differences in whole-body kinematics during single-leg landings from increasing vertical heights and horizontal distances. This study determined the main effects and interactions of gender, vertical height, and horizontal distance on whole-body joint kinematics during single-leg landings, and established whether these findings could explain the gender disparity in non-contact anterior cruciate ligament (ACL) injury rate. Recreationally active males (n=6) and females (n=6) performed single-leg landings from a takeoff deck of vertical height of 20, 40, and 60 cm placed at a horizontal distance of 30, 50 and 70 cm from the edge of a force platform, while 3D kinematics and kinetics were simultaneously measured. It was determined that peak vertical ground reaction force (VGRF) and the ankle flexion angle exhibited significant gender differences (p=0.028, partial η 2 =0.40 and p=0.035, partial η 2 =0.37, respectively). Peak VGRF was significantly correlated to the ankle flexion angle (r= −0.59, p=0.04), hip flexion angle (r= −0.74, p=0.006), and trunk flexion angle (r= −0.59, p=0.045). Peak posterior ground reaction force (PGRF) was significantly correlated to the ankle flexion angle (r= −0.56, p=0.035), while peak knee abduction moment was significantly correlated to the knee flexion angle (r= −0.64, p=0.03). Rearfoot landings may explain the higher ACL injury rate among females. Higher plantar-flexed ankle, hip, and trunk flexion angles were associated with lower peak ground reaction forces, while higher knee flexion angle was associated with lower peak knee abduction moment, and these kinematics implicate reduced risk of non-contact ACL injury. PMID:24146702

  3. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement

    PubMed Central

    Renstrom, P; Ljungqvist, A; Arendt, E; Beynnon, B; Fukubayashi, T; Garrett, W; Georgoulis, T; Hewett, T E; Johnson, R; Krosshaug, T; Mandelbaum, B; Micheli, L; Myklebust, G; Roos, E; Roos, H; Schamasch, P; Shultz, S; Werner, S; Wojtys, E; Engebretsen, L

    2014-01-01

    The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes. Because female athletes have a much higher incidence of ACL injuries in sports such as basketball and team handball than male athletes, the IOC Medical Commission invited a multidisciplinary group of ACL expert clinicians and scientists to (1) review current evidence including data from the new Scandinavian ACL registries; (2) critically evaluate high-quality studies of injury mechanics; (3) consider the key elements of successful prevention programmes; (4) summarise clinical management including surgery and conservative management; and (5) identify areas for further research. Risk factors for female athletes suffering ACL injury include: (1) being in the preovulatory phase of the menstrual cycle compared with the postovulatory phase; (2) having decreased intercondylar notch width on plain radiography; and (3) developing increased knee abduction moment (a valgus intersegmental torque) during impact on landing. Well-designed injury prevention programmes reduce the risk of ACL for athletes, particularly women. These programmes attempt to alter dynamic loading of the tibiofemoral joint through neuromuscular and proprioceptive training. They emphasise proper landing and cutting techniques. This includes landing softly on the forefoot and rolling back to the rearfoot, engaging knee and hip flexion and, where possible, landing on two feet. Players are trained to avoid excessive dynamic valgus of the knee and to focus on the “knee over toe position” when cutting. PMID:18539658

  4. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement.

    PubMed

    Renstrom, P; Ljungqvist, A; Arendt, E; Beynnon, B; Fukubayashi, T; Garrett, W; Georgoulis, T; Hewett, T E; Johnson, R; Krosshaug, T; Mandelbaum, B; Micheli, L; Myklebust, G; Roos, E; Roos, H; Schamasch, P; Shultz, S; Werner, S; Wojtys, E; Engebretsen, L

    2008-06-01

    The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes. Because female athletes have a much higher incidence of ACL injuries in sports such as basketball and team handball than male athletes, the IOC Medical Commission invited a multidisciplinary group of ACL expert clinicians and scientists to (1) review current evidence including data from the new Scandinavian ACL registries; (2) critically evaluate high-quality studies of injury mechanics; (3) consider the key elements of successful prevention programmes; (4) summarise clinical management including surgery and conservative management; and (5) identify areas for further research. Risk factors for female athletes suffering ACL injury include: (1) being in the preovulatory phase of the menstrual cycle compared with the postovulatory phase; (2) having decreased intercondylar notch width on plain radiography; and (3) developing increased knee abduction moment (a valgus intersegmental torque) during impact on landing. Well-designed injury prevention programmes reduce the risk of ACL for athletes, particularly women. These programmes attempt to alter dynamic loading of the tibiofemoral joint through neuromuscular and proprioceptive training. They emphasise proper landing and cutting techniques. This includes landing softly on the forefoot and rolling back to the rearfoot, engaging knee and hip flexion and, where possible, landing on two feet. Players are trained to avoid excessive dynamic valgus of the knee and to focus on the "knee over toe position" when cutting.

  5. ACL injury risk in elite female youth soccer: Changes in neuromuscular control of the knee following soccer-specific fatigue.

    PubMed

    De Ste Croix, M B A; Priestley, A M; Lloyd, R S; Oliver, J L

    2015-10-01

    Fatigue is known to influence dynamic knee joint stability from a neuromuscular perspective, and electromechanical delay (EMD) plays an important role as the feedback activation mechanism that stabilizes the joint. The aim of this study was to investigate the influence of soccer-specific fatigue on EMD in U13-, U15-, and U17-year-old female soccer players. Thirty-six youth soccer players performed eccentric actions of the hamstrings in a prone position at 60, 120, and 180°/s before and after a soccer-specific fatigue trial. Surface electromyography was used to determine EMD from the semitendinosus, biceps femoris and gastrocnemius. A time × age × muscle × velocity repeated measures analysis of variance was used to explore the influence of fatigue on EMD. A significant main effect for time (P = 0.001) indicated that EMD was significantly longer post- compared with pre-fatigue (58.4% increase). A significant time × group interaction effect (P = 0.046) indicated EMD was significantly longer in the U13 age group compared with the U15 (P = 0.011) and U17 (P = 0.021) groups and greater post-fatigue. Soccer-specific fatigue compromised neuromuscular feedback mechanisms and the age-related effects may represent a more compliant muscle-tendon system in younger compared with older girls, increasing risk of injury.

  6. Three-Dimensional MRI-Based Statistical Shape Model and Application to a Cohort of Knees with Acute ACL Injury

    PubMed Central

    Pedoia, Valentina; Lansdown, Drew A.; Zaid, Musa; McCulloch, Charles E.; Souza, Richard; Ma, C. Benjamin; Li, Xiaojuan

    2016-01-01

    Objective The aim of this study is to develop a novel 3D magnetic resonance imaging (MRI)-based Statistical Shape Modeling (SSM) and apply it in knee MRIs in order to extract and compare relevant shapes of the tibia and femur in patients with and without acute ACL injuries. Methods Bilateral MR images were acquired and analyzed for 50 patients with acute ACL injuries and for 19 control subjects. A shape model was extracted for the tibia and femur using an SSM algorithm based on a set of matched landmarks that are computed in a fully automatic manner. Results Shape differences were detected between the knees in the ACL-injury group and control group, suggesting a common shape feature that may predispose these knees to injury. Some of the detected shape features that discriminate between injured and control knees are related to intercondylar width and posterior tibia slope, features that have been suggested in previous studies as ACL morphological risk factors. However, shape modeling has the great potential to quantify these characteristics with a comprehensive description of the surfaces describing complex 3D deformation that cannot be represented with simple geometric indexes. Conclusions 3D MRI-based bone shape quantification has the ability to identify specific anatomic risk factors for ACL injury. A better understanding of the role in bony shape on ligamentous injuries could help in the identification of subjects with an increased risk for an ACL tear and to develop targeted prevention strategies, including education and training. PMID:26050865

  7. Successful feed-forward strategies following ACL injury and reconstruction.

    PubMed

    Bryant, Adam L; Newton, Robert U; Steele, Julie

    2009-10-01

    The purpose of this study was to elucidate the most successful feed-forward strategies responsible for enhancing dynamic restraint following anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR). Ten male ACL deficient (ACLD) subjects (18-35 years) together with 27 matched males who had undergone ACLR (14 using a patella tendon graft and 13 using a combined semitendinosus and gracilis graft) and 22 matched-control subjects were recruited. After their knee functionality (0- to 100-point scale) was rated using the Cincinnati Knee Rating System, each subject performed a maximal, countermovement hop for distance on their involved limb while EMG data were collected from the vastus lateralis (VL), vastus medialis (VM), semitendinosus (ST) and biceps femoris (BF) muscles. Acceleration transients at the proximal tibia were recorded using a uniaxial accelerometer mounted at the level of the tibial tuberosity. Whilst pre-programmed muscle activation strategies and tibial acceleration transients when landing from a single-leg long hop for distance were not contingent upon ACL status, a number of significant correlations were identified between neuromuscular variables and knee functionality of ACLD and ACLR subjects. Increased hamstring preparatory activity together with a greater ability to control tibial motion during dynamic deceleration was associated with higher levels of knee functionality in the ACLD subjects. Successful feed-forward strategies following ACLR were related to graft selection; STGT subjects with superior knee function activated their quadriceps earlier and were better able to synchronise peak hamstring muscle activity closer to initial ground contact whilst more functional PT subjects demonstrated enhanced tibial control despite a lack of evidence supporting modified pre-programmed muscular activation patterns. Our conclusion was that more functional individuals used sensory feedback to build treatment-specific, feed-forward strategies to

  8. Landing on an Unstable Surface Decreases ACL Biomechanical Risk Factors

    PubMed Central

    Shultz, Rebecca; Malone, Maria; Swank, Kat; Andrews, Rob; Braun, Hillary J.; Slider, Amy; Dragoo, Jason L.

    2013-01-01

    Objectives: Quadriceps dominant athletes are at a higher risk for anterior cruciate ligament (ACL) injuries because they lack sufficient hamstring activation resulting in a higher Quadricips: hamstring ratio. Muscular co-contraction (low Q:H) is needed to protect the intra-articular structures of the knee. Exercises that promote co-contraction and proprioception have been shown to reduce quadriceps dominance, enhance knee stability and alter neuromuscular firing patterns. The purpose of this investigation was to examine whether landing on an unstable surface (Bosu Ball) induced a greater amount of co-contraction at the knee compared to a stable surface. Methods: Thirty-one Division I NCAA female athletes performed 3 single leg drop jumps per leg on 2 surfaces. Subjects dropped from a 30 cm step first onto the floor (stable surface), and onto a Bosu ball (unstable surface). Each landing was held for a minimum of 2 seconds. Subjects were familiar with Bosu ball training. Muscle activity of the lateral hamstring and vastus lateralis were used to estimate peak hamstring activity and the Quadriceps:Hamstring (Q:H) co-contraction ratio at the time of peak quadriceps activity. Kinematic data were also collected (Vicon) and used to evaluate the following peak measurements: knee flexion angle, hip flexion angle, and trunk flexion and sway angles (Visual3D). All variables were assessed between the time of landing and the end of deceleration. A 1-level ANOVA was used to test for significant differences across the sports in for each variable of interest. Significance was set at p<0.05. Results: Max co-contraction (Q:H) was significantly reduced when athletes landed on an unstable surface (45% lower, p<0.01 Table 1, Figure 1A) compared to the stable surface. Peak hamstring activity was higher when landing on an unstable surface (15% higher, p=0.05, Table 1) compared to a stable surface. Peak knee flexion angles were 21% greater when athletes landed on a stable surface compared

  9. Uni-directional Coupling between Tibiofemoral Frontal and Axial Plane Rotation Supports Valgus Collapse Mechanism of ACL Injury

    PubMed Central

    Kiapour, Ata M.; Kiapour, Ali; Goel, Vijay K.; Quatman, Carmen E.; Wordeman, Samuel C.; Hewett, Timothy E.; Demetropoulos, Contantine K.

    2015-01-01

    Despite general agreement on the effects of knee valgus and internal tibial rotation on anterior cruciate (ACL) loading, compelling debate persists on the interrelationship between these rotations and how they contribute to the multi-planar ACL injury mechanism. This study investigates coupling between knee valgus and internal tibial rotation and their effects on ACL strain as a quantifiable measure of injury risk. Nineteen instrumented cadaveric legs were imaged and tested under a range of knee valgus and internal tibial torques. Posterior tibial slope and the medial tibial depth, along with changes in tibiofemoral kinematics and ACL strain, were quantified. Valgus torque significantly increased knee valgus rotation and ACL strain (p<0.02), yet generated minimal coupled internal tibial rotation (p=0.537). Applied internal tibial torque significantly increased internal tibial rotation and ACL strain and generated significant coupled knee valgus rotation (p<0.001 for all comparisons). Similar knee valgus rotations (7.3° vs 7.4°) and ACL strain levels (4.4% vs 4.9%) were observed under 50 N-m of valgus and 20 N-m of internal tibial torques, respectively. Coupled knee valgus rotation under 20 N-m of internal tibial torque was significantly correlated with internal tibial rotation, lateral and medial tibial slopes, and medial tibial depth (R2>0.30; p<0.020). These findings demonstrate uni-directional coupling between knee valgus and internal tibial rotation in a cadaveric model. Although both knee valgus and internal tibial torques contribute to increased ACL strain, knee valgus rotation has the ultimate impact on ACL strain regardless of loading mode. PMID:26070647

  10. Uni-directional coupling between tibiofemoral frontal and axial plane rotation supports valgus collapse mechanism of ACL injury.

    PubMed

    Kiapour, Ata M; Kiapour, Ali; Goel, Vijay K; Quatman, Carmen E; Wordeman, Samuel C; Hewett, Timothy E; Demetropoulos, Constantine K

    2015-07-16

    Despite general agreement on the effects of knee valgus and internal tibial rotation on anterior cruciate ligament (ACL) loading, compelling debate persists on the interrelationship between these rotations and how they contribute to the multi-planar ACL injury mechanism. This study investigates coupling between knee valgus and internal tibial rotation and their effects on ACL strain as a quantifiable measure of injury risk. Nineteen instrumented cadaveric legs were imaged and tested under a range of knee valgus and internal tibial torques. Posterior tibial slope and the medial tibial depth, along with changes in tibiofemoral kinematics and ACL strain, were quantified. Valgus torque significantly increased knee valgus rotation and ACL strain (p<0.020), yet generated minimal coupled internal tibial rotation (p=0.537). Applied internal tibial torque significantly increased internal tibial rotation and ACL strain and generated significant coupled knee valgus rotation (p<0.001 for all comparisons). Similar knee valgus rotations (7.3° vs 7.4°) and ACL strain levels (4.4% vs 4.9%) were observed under 50 Nm of valgus and 20 Nm of internal tibial torques, respectively. Coupled knee valgus rotation under 20 Nm of internal tibial torque was significantly correlated with internal tibial rotation, lateral and medial tibial slopes, and medial tibial depth (R(2)>0.30; p<0.020). These findings demonstrate uni-directional coupling between knee valgus and internal tibial rotation in a cadaveric model. Although both knee valgus and internal tibial torques contribute to increased ACL strain, knee valgus rotation has the ultimate impact on ACL strain regardless of loading mode.

  11. Quantifying Quadriceps Muscle Strength in Patients With ACL Injury, Focal Cartilage Lesions, and Degenerative Meniscus Tears

    PubMed Central

    Eitzen, Ingrid; Grindem, Hege; Nilstad, Agnethe; Moksnes, Håvard; Risberg, May Arna

    2016-01-01

    Background: Reduced quadriceps strength influences knee function and increases the risk of knee osteoarthritis. Thus, it is of significant clinical relevance to precisely quantify strength deficits in patients with knee injuries. Purpose: To evaluate isokinetic concentric quadriceps muscle strength torque values, assessed both from peak torque and at specific knee flexion joint angles, in patients with anterior cruciate ligament (ACL) injury, focal cartilage lesions, and degenerative meniscus tears. Study Design: Cohort study; Level of evidence, 3. Methods: Data were synthesized from patients included in 3 previously conducted research projects: 2 prospective cohort studies and 1 randomized controlled trial. At the time of inclusion, all patients were candidates for surgery. Isokinetic concentric quadriceps muscle strength measurements (60 deg/s) were performed at baseline (preoperative status) and after a period of progressive supervised exercise therapy (length of rehabilitation period: 5 weeks for ACL injury, 12 weeks for cartilage lesions and degenerative meniscus). Outcome measures were peak torque and torque at specific knee flexion joint angles from 20° to 70°. All patients had unilateral injuries, and side-to-side deficits were calculated. For comparisons between and within groups, we utilized 1-way analysis of variance and paired t tests, respectively. Results: In total, 250 patients were included. At baseline, cartilage patients had the most severe deficit (39.7% ± 24.3%; P < .001). Corresponding numbers for ACL and degenerative meniscus subjects were 21.7% (±13.2%) and 20.7% (±16.3%), respectively. At retest, there was significant improvement in all groups (P < .001), with remaining deficits of 24.7% (±18.5%) for cartilage, 16.8% (±13.9%) for ACL, and 3.3% (±17.8%) for degenerative meniscus. Peak torque was consistently measured at 60° of knee flexion, whereas the largest mean deficits were measured at 30° at baseline and 70° at retest for the

  12. Systematic review: Annual incidence of ACL injury and surgery in various populations.

    PubMed

    Moses, Bassam; Orchard, John; Orchard, Jessica

    2012-07-01

    Accurate documentation of injury incidence is critical for study of injury risk factors and prevention. Comparisons of published incidences of anterior cruciate ligament (ACL) injuries and surgical reconstructions are difficult, however, because of the variations in units. Some studies report absolute time-based denominators (such as annual incidence or incidence per 100,000 person years), whereas others report exposure-based denominators (such as incidence per 1,000 player hours or athlete exposures). We converted exposure-based units into annual incidences to compare various studies. National population studies show annual incidence rates of up to 0.05% per person per year in Australia. Professional athletes in basketball, soccer, and the other football codes report an annual incidence of 0.15%-3.7% in studies with at least a moderate sample size. Annual ACL incidence in amateur sporting groups was generally higher than the entire population but lower than among professional athletes. Converting incidence rates to annual units allowed better comparisons to be made between population rates across different studies.

  13. Risk Factors for Anterior Cruciate Ligament Injury

    PubMed Central

    Smith, Helen C.; Vacek, Pamela; Johnson, Robert J.; Slauterbeck, James R.; Hashemi, Javad; Shultz, Sandra

    2012-01-01

    Context: Injuries to the anterior cruciate ligament (ACL) of the knee are immediately debilitating and can cause long-term consequences, including the early onset of osteoarthritis. It is important to have a comprehensive understanding of all possible risk factors for ACL injury to identify individuals who are at risk for future injuries and to provide an appropriate level of counseling and programs for prevention. Objective: This review, part 1 of a 2-part series, highlights what is known and still unknown regarding anatomic and neuromuscular risk factors for injury to the ACL from the current peer-reviewed literature. Data Sources: Studies were identified from MEDLINE (1951–March 2011) using the MeSH terms anterior cruciate ligament, knee injury, and risk factors. The bibliographies of relevant articles and reviews were cross-referenced to complete the search. Study Selection: Prognostic studies that utilized the case-control and prospective cohort study designs to evaluate risk factors for ACL injury were included in this review. Results: A total of 50 case-control and prospective cohort articles were included in the review, and 30 of these studies focused on neuromuscular and anatomic risk factors. Conclusions: Several anatomic and neuromuscular risk factors are associated with increased risk of suffering ACL injury—such as female sex and specific measures of bony geometry of the knee joint, including decreased intercondylar femoral notch size, decreased depth of concavity of the medial tibial plateau, increased slope of the tibial plateaus, and increased anterior-posterior knee laxity. These risk factors most likely act in combination to influence the risk of ACL injury; however, multivariate risk models that consider all the aforementioned risk factors in combination have not been established to explore this interaction. PMID:23016072

  14. A Commentary on Real-Time Biofeedback to Augment Neuromuscular Training for ACL Injury Prevention in Adolescent Athletes

    PubMed Central

    Kiefer, Adam W.; Kushner, Adam M.; Groene, John; Williams, Christopher; Riley, Michael A.; Myer, Gregory D.

    2015-01-01

    Anterior cruciate ligament injury and the associated long-term sequelae, such as immediate reductions in physical inactivity, increased adiposity and increased risk of osteoarthritis throughout adulthood, are a major health concern for adolescent athletes. Current interventions for injury prevention may have limited effectiveness, are susceptible to issues of compliance and have not achieved the widespread acceptance necessary to promote full adoption. Neuromuscular training (NMT) is a well-established training intervention introduced to affect change in modifiable biomechanical risk factors to reduce the risk of injury in these athletes. Despite moderate success, neuromuscular training is still limited by its reliance on subjective feedback and after the fact (i.e., offline) objective feedback techniques. The purpose of this commentary is to discuss technological tools that could be used to enhance and objectify targeted biofeedback interventions to complement NMT. Electromyography, force plates, motion sensors, and camera-based motion capture systems are innovative tools that may have realistic feasibility for integration as biofeedback into NMT programs to improve training outcomes. Improved functional deficit identification and corrective analysis may further improve and optimize athletic performance, and decrease the risk of sports-related injury during sport performance. Key points Specific, targeted interventions that isolate injury risk factors and can help correct modifiable neuromuscular deficits are essential. Current training interventions for anterior cruciate ligament (ACL) injury prevention have only demonstrated limited effectiveness and have not achieved the widespread acceptance necessary to promote full adoption to reduce ACL injury rates. The paper provides an overview of innovative strategies and technological tools that could be used to enhance and objectify targeted biofeedback interventions to complement neuromuscular training (NMT

  15. A Commentary on Real-Time Biofeedback to Augment Neuromuscular Training for ACL Injury Prevention in Adolescent Athletes.

    PubMed

    Kiefer, Adam W; Kushner, Adam M; Groene, John; Williams, Christopher; Riley, Michael A; Myer, Gregory D

    2015-03-01

    Anterior cruciate ligament injury and the associated long-term sequelae, such as immediate reductions in physical inactivity, increased adiposity and increased risk of osteoarthritis throughout adulthood, are a major health concern for adolescent athletes. Current interventions for injury prevention may have limited effectiveness, are susceptible to issues of compliance and have not achieved the widespread acceptance necessary to promote full adoption. Neuromuscular training (NMT) is a well-established training intervention introduced to affect change in modifiable biomechanical risk factors to reduce the risk of injury in these athletes. Despite moderate success, neuromuscular training is still limited by its reliance on subjective feedback and after the fact (i.e., offline) objective feedback techniques. The purpose of this commentary is to discuss technological tools that could be used to enhance and objectify targeted biofeedback interventions to complement NMT. Electromyography, force plates, motion sensors, and camera-based motion capture systems are innovative tools that may have realistic feasibility for integration as biofeedback into NMT programs to improve training outcomes. Improved functional deficit identification and corrective analysis may further improve and optimize athletic performance, and decrease the risk of sports-related injury during sport performance. Key pointsSpecific, targeted interventions that isolate injury risk factors and can help correct modifiable neuromuscular deficits are essential.Current training interventions for anterior cruciate ligament (ACL) injury prevention have only demonstrated limited effectiveness and have not achieved the widespread acceptance necessary to promote full adoption to reduce ACL injury rates.The paper provides an overview of innovative strategies and technological tools that could be used to enhance and objectify targeted biofeedback interventions to complement neuromuscular training (NMT) including

  16. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies.

    PubMed

    Griffin, L Y; Agel, J; Albohm, M J; Arendt, E A; Dick, R W; Garrett, W E; Garrick, J G; Hewett, T E; Huston, L; Ireland, M L; Johnson, R J; Kibler, W B; Lephart, S; Lewis, J L; Lindenfeld, T N; Mandelbaum, B R; Marchak, P; Teitz, C C; Wojtys, E M

    2000-01-01

    An estimated 80,000 anterior cruciate ligament (ACL) tears occur annually in the United States. The highest incidence is in individuals 15 to 25 years old who participate in pivoting sports. With an estimated cost for these injuries of almost a billion dollars per year, the ability to identify risk factors and develop prevention strategies has widespread health and fiscal importance. Seventy percent of ACL injuries occur in noncontact situations. The risk factors for non-contact ACL injuries fall into four distinct categories: environmental, anatomic, hormonal, and biomechanical. Early data on existing neuromuscular training programs suggest that enhancing body control may decrease ACL injuries in women. Further investigation is needed prior to instituting prevention programs related to the other risk factors.

  17. Patients With Isolated PCL Injuries Improve From Surgery as Much as Patients With ACL Injuries After 2 Years

    PubMed Central

    Owesen, Christian; Sivertsen, Einar Andreas; Engebretsen, Lars; Granan, Lars-Petter; Årøen, Asbjørn

    2015-01-01

    Background: Reports on outcome after posterior cruciate ligament (PCL) reconstruction often contain both isolated PCL and combined knee ligament injuries. This makes it difficult to conclude on the outcome after reconstruction of isolated PCL injuries. Purpose: To investigate the outcome after PCL reconstruction in patients with an isolated PCL injury and to compare this with the outcome of patients treated with reconstruction after isolated anterior cruciate ligament (ACL) injuries. Study Design: Cohort study; Level of evidence, 3. Methods: Seventy-one patients with an isolated PCL injury that was reconstructed surgically and who had registered in the Norwegian Knee Ligament Registry between 2004 and 2010 were included in this study. Patients with isolated ACL reconstructions (n = 9661) who had registered in the same period were included for comparison. Knee Injury and Osteoarthritis Outcome Score (KOOS) was used as the patient-reported outcome measure. Preoperative and 2-year postoperative KOOS scores were compared. Changes in KOOS score reported by the PCL patients were compared with changes reported by the ACL patients. Results: At the 2-year postoperative follow-up of the PCL-reconstructed patients, the patient-reported outcome was improved, measured by KOOS as follows: pain, 15.1 (95% CI, 8.5-21.8; P < .001); symptoms, 0.9 (95% CI, –6.6 to 8.3; P = .82); activities of daily living, 13.2 (95% CI, 6.6-13.9; P < .001); sports, 20.7 (95% CI, 11.8-29.4; P < .001); and quality of life, 26.6 (95% CI, 18.9-34.2; P < .001). According to the KOOS, the incremental improvements were similar for PCL and ACL patients. Time from injury to surgery was longer for the PCL patients compared with ACL patients (median, 21.5 vs 8.0 months; P < .001). Conclusion: Patients undergoing PCL reconstruction can expect the same improvements in KOOS score as patients undergoing ACL reconstruction. However, PCL patients start out with an inferior score on average and consequently end up

  18. THE EFFECT OF CONSERVATIVELY TREATED ACL INJURY ON KNEE JOINT POSITION Sense

    PubMed Central

    Herrington, Lee

    2016-01-01

    ABSTRACT Background Proprioception is critical for effective movement patterns. However, methods of proprioceptive measurement in previous research have been inconsistent and lacking in reliability statistics making it applications to clinical practice difficult. Researchers have suggested that damage to the anterior cruciate ligament (ACL) can alter proprioceptive ability due to a loss of functioning mechanoreceptors. The majority of patients opt for reconstructive surgery following this injury. However, some patients chose conservative rehabilitation options rather than surgical intervention. Purpose The purpose of this study was to determine the effect of ACL deficiency on knee joint position sense following conservative, non-operative treatment and return to physical activity. A secondary purpose was to report the reliability and measurement error of the technique used to measure joint position sense, (JPS) and comment on the clinical utility of this measurement. Study Design Observational study design using a cross-section of ACL deficient patients and matched uninjured controls. Methods Twenty active conservatively treated ACL deficient patients who had returned to physical activity and twenty active matched controls were included in the study. Knee joint position sense was measured using a seated passive-active reproductive angle technique. The average absolute angle of error score, between 10 °-30 ° of knee flexion was determined. This error score was derived from the difference between the target and repositioning angle. Results The ACL deficient patients had a greater error score (7.9 °±3.6) and hence poorer static proprioception ability that both the contra-lateral leg (2.0 °±1.6; p = 0.0001) and the control group (2.6 °±0.9; p = 0.0001). The standard error of the mean (SEM) of this JPS technique was 0.5 ° and 0.2 ° and the minimum detectable change (MDC) was 1.3 ° and 0.4 ° on asymptomatic and symptomatic subjects

  19. Potential for Non-Contact ACL Injury Between Step-Close-Jump and Hop-Jump Tasks.

    PubMed

    Wang, Li-I; Gu, Chin-Yi; Chen, Wei-Ling; Chang, Mu-San

    2010-01-01

    This study aimed to compare the kinematics and kinetics during the landing of hop-jump and step-close-jump movements in order to provide further inferring that the potential risk of ACL injuries. Eleven elite male volleyball players were recruited to perform hop-jump and step-close-jump tasks. Lower extremity kinematics and ground reaction forces during landing in stop-jump tasks were recorded. Lower extremity kinetics was calculated by using an inverse dynamic process. Step-close-jump tasks demonstrated smaller peak proximal tibia anterior shear forces during the landing phase. In step-close-jump tasks, increasing hip joint angular velocity during initial foot-ground contact decreased peak posterior ground reaction force during the landing phase, which theoretically could reduce the risk of ACL injury. Key pointsThe different landing techniques required for these two stop-jump tasks do not necessarily affect the jump height.Hop-jump decreased the hip joint angular velocity at initial foot contact with ground, which could lead to an increasing peak posterior GRF during the landing phase.Hop-jump decreased hip and knee joint angular flexion displacement during the landing, which could increase the peak vertical loading rate during the landing phase.

  20. Electromechanical delay of the hamstrings during eccentric muscle actions in males and females: Implications for non-contact ACL injuries.

    PubMed

    De Ste Croix, Mark B A; ElNagar, Youssif O; Iga, John; James, David; Ayala, Francisco

    2015-12-01

    Sex differences in neuromuscular functioning has been proposed as one of the factors behind an increased relative risk of non-contact anterior cruciate ligament (ACL) injury in females. The aim of this study was to explore sex differences in electromechanical delay (EMD) of the hamstring muscles during eccentric muscle actions and during a range of movement velocities. This study recruited 110 participants (55 males, 55 females) and electromyography of the semitendinosus, semimembranosus and biceps femoris was determined during eccentric actions at 60, 120 and 240°/s. No significant sex differences were observed irrespective of muscle examined or movement velocity. Irrespective of sex EMD significantly increased with increasing movement velocity (P < 0.01). There was no significant difference in the EMD of the 3 muscles examined. Our findings suggest that during eccentric actions of the hamstrings that there are no sex differences, irrespective of movement velocity. This would suggest that other factors are probably responsible for the increased relative risk of non-contact ACL injury in females compared to males. PMID:26522999

  1. The Natural History and Tailored Treatment of ACL Injury.

    ERIC Educational Resources Information Center

    Evans, Nick A.; Chew, Hall F.; Stanish, William D.

    2001-01-01

    Bodily responses to an anterior cruciate ligament injury can range from minor to very significant. Understanding factors influencing the course can help physicians determine effective treatment strategies. Certain patterns, such as complete disruption and participation in high-demand sports, highlight the need for an aggressive approach.…

  2. Rehabilitation after ACL Injury: A Fluoroscopic Study on the Effects of Type of Exercise on the Knee Sagittal Plane Arthrokinematics

    PubMed Central

    Norouzi, Sadegh; Esfandiarpour, Fateme; Shakourirad, Ali; Salehi, Reza; Akbar, Mohammad; Farahmand, Farzam

    2013-01-01

    A safe rehabilitation exercise for anterior cruciate ligament (ACL) injuries needs to be compatible with the normal knee arthrokinematics to avoid abnormal loading on the joint structures. The objective of this study was to measure the amount of the anterior tibial translation (ATT) of the ACL-deficient knees during selective open and closed kinetic chain exercises. The intact and injured knees of fourteen male subjects with unilateral ACL injury were imaged using uniplanar fluoroscopy, while the subjects performed forward lunge and unloaded/loaded open kinetic knee extension exercises. The ATTs were measured from fluoroscopic images, as the distance between the tibial and femoral reference points, at seven knee flexion angles, from 0° to 90°. No significant differences were found between the ATTs of the ACL-deficient and intact knees at all flexion angles during forward lunge and unloaded open kinetic knee extension (P < 0.05). During loaded open kinetic knee extension, however, the ATTs of the ACL deficient knees were significantly larger than those of the intact knees at 0° (P = 0.002) and 15° (P = 0.012). It was suggested that the forward lunge, as a weight-bearing closed kinetic chain exercise, provides a safer approach for developing muscle strength and functional stability in rehabilitation program of ACL-deficient knees, in comparison with open kinetic knee extension exercise. PMID:24066288

  3. Rehabilitation after ACL injury: a fluoroscopic study on the effects of type of exercise on the knee sagittal plane arthrokinematics.

    PubMed

    Norouzi, Sadegh; Esfandiarpour, Fateme; Shakourirad, Ali; Salehi, Reza; Akbar, Mohammad; Farahmand, Farzam

    2013-01-01

    A safe rehabilitation exercise for anterior cruciate ligament (ACL) injuries needs to be compatible with the normal knee arthrokinematics to avoid abnormal loading on the joint structures. The objective of this study was to measure the amount of the anterior tibial translation (ATT) of the ACL-deficient knees during selective open and closed kinetic chain exercises. The intact and injured knees of fourteen male subjects with unilateral ACL injury were imaged using uniplanar fluoroscopy, while the subjects performed forward lunge and unloaded/loaded open kinetic knee extension exercises. The ATTs were measured from fluoroscopic images, as the distance between the tibial and femoral reference points, at seven knee flexion angles, from 0° to 90°. No significant differences were found between the ATTs of the ACL-deficient and intact knees at all flexion angles during forward lunge and unloaded open kinetic knee extension (P < 0.05). During loaded open kinetic knee extension, however, the ATTs of the ACL deficient knees were significantly larger than those of the intact knees at 0° (P = 0.002) and 15° (P = 0.012). It was suggested that the forward lunge, as a weight-bearing closed kinetic chain exercise, provides a safer approach for developing muscle strength and functional stability in rehabilitation program of ACL-deficient knees, in comparison with open kinetic knee extension exercise. PMID:24066288

  4. Comparative adaptations of lower limb biomechanics during unilateral and bilateral landings after different neuromuscular-based ACL injury prevention protocols.

    PubMed

    Brown, Tyler N; Palmieri-Smith, Riann M; McLean, Scott G

    2014-10-01

    Potentially valuable anterior cruciate ligament (ACL) injury prevention strategies are lengthy, limiting training success. Shorter protocols that achieve beneficial biomechanical adaptations may improve training effectiveness. This study examined whether core stability/balance and plyometric training can modify female landing biomechanics compared with the standard neuromuscular and no training models. Forty-three females had lower limb biomechanics analyzed during unilateral and bilateral landings immediately before and after a 6-week neuromuscular or no training programs. Sagittal and frontal plane hip and knee kinematics and kinetics were submitted to 3-way repeated-measures analyses of variance to test for the main and interaction effects of training group, landing type, and testing time. Greater peak knee flexion was evident in the standard neuromuscular group following training, during both bilateral (p = 0.027) and unilateral landings (p = 0.076 and d = 0.633). The plyometric group demonstrated reduced hip adduction (p = 0.010) and greater knee flexion (p = 0.065 and d = 0.564) during bilateral landings following training. The control group had significant reduction in peak stance knee abduction moment (p = 0.003) posttraining as compared with pretraining. The current outcomes suggest that significant biomechanical changes are possible by an isolated plyometric training component. The benefits, however, may not be evident across all landing types, seemingly limited to simplistic, bilateral landings. Integrated training protocols may still be the most effective training model, currently improving knee flexion posture during both bilateral and unilateral landings following training. Future prevention efforts should implement integrated training protocols that include plyometric exercises to reduce ACL injury risk of female athletes. PMID:24714537

  5. Preventing ACL injuries in team-sport athletes: a systematic review of training interventions.

    PubMed

    Stojanovic, Marko D; Ostojic, Sergej M

    2012-07-01

    The purpose of this systematic review was to assess the efficacy of training interventions aimed to prevent and to reduce anterior cruciate ligament injury (ACLI) rates in team sport players. We searched MEDLINE from January 1991 to July 2011 using the terms knee, ACL, anterior cruciate ligament, injury, prevention, training, exercise, and intervention. Nine out of 708 articles met the inclusion criteria and were independently rated by two reviewers using the McMaster Occupational Therapy Evidence-Based Practice Research Group scale. Consensus scores ranged from 3 to 8 out of 10. Seven out of nine studies demonstrated that training interventions have a preventive effect on ACLI. Collectively, the studies indicate there is moderate evidence to support the use of multifaceted training interventions, which consisted of stretching, proprioception, strength, plyometric and agility drills with additional verbal and/or visual feedback on proper landing technique to decrease the rate of ACLIs in team sport female athletes, while the paucity of data preclude any conclusions for male athletes.

  6. Risk factors and prevention strategies of non-contact anterior cruciate ligament injuries.

    PubMed

    Laible, Catherine; Sherman, Orrin H

    2014-01-01

    In recent years, the number of women playing sports has increased significantly. The passage of Title IX in 1972 had a significant effect in encouraging female participation in sports. This increase in women's sports participation also led to a rise in noncontact anterior cruciate ligament (ACL) injuries. As ACL injuries in young female athletes have be- come a public health issue, much research has been done on risk factors and prevention strategies.

  7. Tibial articular cartilage and meniscus geometries combine to influence female risk of anterior cruciate ligament injury.

    PubMed

    Sturnick, Daniel R; Van Gorder, Robert; Vacek, Pamela M; DeSarno, Michael J; Gardner-Morse, Mack G; Tourville, Timothy W; Slauterbeck, James R; Johnson, Robert J; Shultz, Sandra J; Beynnon, Bruce D

    2014-11-01

    Tibial plateau subchondral bone geometry has been associated with the risk of sustaining a non-contact ACL injury; however, little is known regarding the influence of the meniscus and articular cartilage interface geometry on risk. We hypothesized that geometries of the tibial plateau articular cartilage surface and meniscus were individually associated with the risk of non-contact ACL injury. In addition, we hypothesized that the associations were independent of the underlying subchondral bone geometry. MRI scans were acquired on 88 subjects that suffered non-contact ACL injuries (27 males, 61 females) and 88 matched control subjects that were selected from the injured subject's teammates and were thus matched on sex, sport, level of play, and exposure to risk of injury. Multivariate analysis of the female data revealed that increased posterior-inferior directed slope of the middle articular cartilage region and decreased height of the posterior horn of the meniscus in the lateral compartment were associated with increased risk of sustaining a first time, non-contact ACL injury, independent of each other and of the slope of the tibial plateau subchondral bone. No measures were independently related to risk of non-contact ACL injury among males.

  8. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: a review of prevention programs aimed to modify risk factors and to reduce injury rates.

    PubMed

    Alentorn-Geli, Eduard; Myer, Gregory D; Silvers, Holly J; Samitier, Gonzalo; Romero, Daniel; Lázaro-Haro, Cristina; Cugat, Ramón

    2009-08-01

    Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players participating in the game as on 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes a significant loss of time from competition in soccer, which has served as the strong impetus to conduct research that focuses to determine the risk factors for injury, and more importantly, to identify and teach techniques to reduce this injury in the sport. This research emphasis has afforded a rapid influx of literature aimed to report the effects of neuromuscular training on the risk factors and the incidence of non-contact ACL injury in high-risk soccer populations. The purpose of the current review is to sequence the most recent literature relating the effects of prevention programs that were developed to alter risk factors associated with non-contact ACL injuries and to reduce the rate of non-contact ACL injuries in soccer players. To date there is no standardized intervention program established for soccer to prevent non-contact ACL injuries. Multi-component programs show better results than single-component preventive programs to reduce the risk and incidence of non-contact ACL injuries in soccer players. Lower extremity plyometrics, dynamic balance and strength, stretching, body awareness and decision-making, and targeted core and trunk control appear to be successful training components to reduce non-contact ACL injury risk factors (decrease landing forces, decrease varus/valgus moments, and increase effective muscle activation) and prevent non-contact ACL injuries in soccer players, especially in female athletes. Pre-season injury prevention combined with an in-season maintenance program may be advocated to prevent injury. Compliance may in fact be the limiting factor to the overall success of ACL injury interventions targeted to soccer players regardless of gender. Thus

  9. Is there a potential relationship between prior hamstring strain injury and increased risk for future anterior cruciate ligament injury?

    PubMed

    Opar, David A; Serpell, Benjamin G

    2014-02-01

    Hamstring strain injuries (HSIs) are the most prevalent injury in a number of sports, and while anterior cruciate ligament (ACL) injuries are less common, they are far more severe and have long-term implications, such as an increased risk of developing osteoarthritis later in life. Given the high incidence and severity of these injuries, they are key targets of injury preventive programs in elite sport. Evidence has shown that a previous severe knee injury (including ACL injury) increases the risk of HSI; however, whether the functional deficits that occur after HSI result in an increased risk of ACL injury has yet to be considered. In this clinical commentary, we present evidence that suggests that the link between previous HSI and increased risk of ACL injury requires further investigation by drawing parallels between deficits in hamstring function after HSI and in women athletes, who are more prone to ACL injury than men athletes. Comparisons between the neuromuscular function of the male and female hamstring has shown that women display lower hamstring-to-quadriceps strength ratios during isokinetic knee flexion and extension, increased activation of the quadriceps compared with the hamstrings during a stop-jump landing task, a greater time required to reach maximal isokinetic hamstring torque, and lower integrated myoelectrical hamstring activity during a sidestep cutting maneuver. Somewhat similarly, in athletes with a history of HSI, the previously injured limb, compared with the uninjured limb, displays lower eccentric knee flexor strength, a lower hamstrings-to-quadriceps strength ratio, lower voluntary myoelectrical activity during maximal knee flexor eccentric contraction, a lower knee flexor eccentric rate of torque development, and lower voluntary myoelectrical activity during the initial portion of eccentric contraction. Given that the medial and lateral hamstrings have different actions at the knee joint in the coronal plane, which hamstring head is

  10. Effects of ACL reconstruction surgery on muscle activity of the lower limb during a jump-cut maneuver in males and females.

    PubMed

    Coats-Thomas, Margaret S; Miranda, Daniel L; Badger, Gary J; Fleming, Braden C

    2013-12-01

    We compared muscle activity of the quadriceps, hamstring, and gastrocnemius muscles when ACL-intact (ACL(INT)) and ACL-reconstructed (ACL(REC)) male and female subjects performed a jump-cut task. Surface electromyography sensors were used to evaluate time to peak muscle activity and muscle activity ratios. Rectus femoris (RF) and vastus medialis (VM) peak timing was 71 and 78 ms earlier in ACL(INT) than in ACL(REC) subjects, respectively. Biceps femoris (BF) peak timing was 90 ms earlier in ACL(INT) than in ACL(REC) subjects and 75 ms earlier in females than in males. Medial gastrocnemius (MG) muscle peak timing was 77 ms earlier in ACL(INT) than in ACL(REC) subjects. Lateral gastrocnemius (LG) and MG muscle peak times were 106 ms and 87 ms earlier in females than in males, respectively. The RF, VM, BF, and MG peaked later in ACL(REC) than in ACL(INT) subjects. There was evidence suggesting that the loading phase quadriceps:hamstring (quad:ham) muscle activity ratio was greater in ACL(REC) than in ACL(INT) subjects. Finally, the injury risk phase quad:ham muscle activity ratio was 4.8 times greater in females than in males. In conclusion, differences exist in muscle activity related to ACL status and sex that could potentially help explain graft failure risk and the sex bias.

  11. Predicting success in ACL reconstruction.

    PubMed

    Shalvoy, Robert M

    2014-11-03

    Anterior Cruciate Ligament (ACL) injury and ACL reconstruction is common in the United States. However, when compared to the standards of other orthopedics procedures today, ACL reconstruction is NOT predictably successful in restoring patients to their pre-injury state. Only 60-70% of reconstructed patients resume their previous level of activity and many patients experience some degree of osteoarthritis. The reasons for such limitations of success are many. A recent renewal of interest in the many variables affecting ACL reconstruction and the understanding of the varying needs of patients with ACL injury holds promise for improving success even today as well as ultimately providing a normal knee for patients after ACL reconstruction.

  12. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors.

    PubMed

    Alentorn-Geli, Eduard; Myer, Gregory D; Silvers, Holly J; Samitier, Gonzalo; Romero, Daniel; Lázaro-Haro, Cristina; Cugat, Ramón

    2009-07-01

    Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players by 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes the most time lost from competition in soccer which has influenced a strong research focus to determine the risk factors for injury. This research emphasis has afforded a rapid influx of literature defining potential modifiable and non-modifiable risk factors that increase the risk of injury. The purpose of the current review is to sequence the most recent literature that reports potential mechanisms and risk factors for non-contact ACL injury in soccer players. Most ACL tears in soccer players are non-contact in nature. Common playing situations precluding a non-contact ACL injury include: change of direction or cutting maneuvers combined with deceleration, landing from a jump in or near full extension, and pivoting with knee near full extension and a planted foot. The most common non-contact ACL injury mechanism include a deceleration task with high knee internal extension torque (with or without perturbation) combined with dynamic valgus rotation with the body weight shifted over the injured leg and the plantar surface of the foot fixed flat on the playing surface. Potential extrinsic non-contact ACL injury risk factors include: dry weather and surface, and artificial surface instead of natural grass. Commonly purported intrinsic risk factors include: generalized and specific knee joint laxity, small and narrow intercondylar notch width (ratio of notch width to the diameter and cross sectional area of the ACL), pre-ovulatory phase of menstrual cycle in females not using oral contraceptives, decreased relative (to quadriceps) hamstring strength and recruitment, muscular fatigue by altering neuromuscular control, decreased "core" strength and proprioception, low trunk, hip, and knee flexion angles, and high

  13. Anterior cruciate ligament injuries in the female athlete.

    PubMed

    Toth, A P; Cordasco, F A

    2001-01-01

    With the participation of women in athletics growing rapidly over the last two decades, a disturbing gender-specific pre-disposition has emerged regarding anterior cruciate ligament (ACL) injuries of the knee. Female athletes have a two- to eightfold higher incidence of ACL injury than their male counterparts. It is estimated that 38,000 women sustain ACL tears per year. The majority of ACL injuries in female athletes occur through noncontact mechanisms, most often during deceleration activities, such as landing from a jump or cutting. The risk factors for noncontact ACL injuries can be categorized as intrinsic (anatomic and hormonal) and extrinsic (environmental and biomechanical). This article will discuss these risk factors that are thought to contribute to the higher incidence of ACL injuries in women, the development of prevention strategies, and the outcomes of ACL reconstruction in women.

  14. Basketball knee injuries and the anterior cruciate ligament.

    PubMed

    Emerson, R J

    1993-04-01

    Basketball arguably may present the greatest risk for anterior cruciate ligament (ACL) injury because it is well known that ACL injuries may occur with external or internal rotation of the tibia with or without hyperextension. All of these mechanical phenomena occur repetitively in a running, jumping, and cutting sport such as basketball. This article discusses the diagnosis and mechanism of injury as well as treatment of ACL injury.

  15. ACL-Injured Subjects Have Smaller ACLs Than Matched Controls: An MRI Study

    PubMed Central

    Chaudhari, Ajit M.W.; Zelman, Eric A.; Flanigan, David C.; Kaeding, Christopher C.; Nagaraja, Haikady N.

    2013-01-01

    Background Very few studies examining the predisposing anatomical factors leading to anterior cruciate ligament (ACL) injuries have examined the ACL itself, and none of these directly examined the difference in ACL properties between injured and matched control subjects. Hypothesis ACL total volume of people who have experienced a non-contact ACL injury is smaller than that of matched controls. Methods Contours of the ACL were manually identified in sagittal MR images and volumes were calculated for 27 contralateral, healthy knees of individuals after non-contact ACL injury and for 27 control subjects matched for gender, height, age, and weight. Validation of this method was performed on 5 porcine knees. Stepwise multiple regression was used to determine the difference in ACL volume between injured and control subjects while considering gender, height, weight, and age as potential covariates. Results Contralateral ACL volume for injured subjects was significantly smaller than non-injured subjects (p=0.0208) by 231 mm3 after adjusting for weight, which was also a significant contributor to ACL volume (p<0.0001). At the average body mass of 72.7kg, subjects with a non-contact ACL injury had an average contralateral ACL volume of 1921 mm3, while the corresponding control group had an average volume of 2151 mm3. Gender, height, and age were not significant when weight was included in the regression model. Conclusions This study shows that there are anthropometric differences between the knees of subjects with a non-contact ACL injury and those without an ACL injury, suggesting that ACL volume may play a direct role in non-contact ACL injury. PMID:19307330

  16. Case study: Muscle atrophy and hypertrophy in a premier league soccer player during rehabilitation from ACL injury.

    PubMed

    Milsom, Jordan; Barreira, Paulo; Burgess, Darren J; Iqbal, Zafar; Morton, James P

    2014-10-01

    The onset of injury and subsequent period of immobilization and disuse present major challenges to maintenance of skeletal muscle mass and function. Although the characteristics of immobilization-induced muscle atrophy are well documented in laboratory studies, comparable data from elite athletes in free-living conditions are not readily available. We present a 6-month case-study account from a professional soccer player of the English Premier League characterizing rates of muscle atrophy and hypertrophy (as assessed by DXA) during immobilization and rehabilitation after ACL injury. During 8 weeks of inactivity and immobilization, where the athlete adhered to a low carbohydrate-high protein diet, total body mass decreased by 5 kg attributable to 5.8 kg loss and 0.8 kg gain in lean and fat mass, respectively. Changes in whole-body lean mass was attributable to comparable relative decreases in the trunk (12%, 3.8 kg) and immobilized limb (13%, 1.4 kg) whereas the nonimmobilized limb exhibited smaller declines (7%, 0.8 kg). In Weeks 8 to 24, the athlete adhered to a moderate carbohydrate-high protein diet combined with structured resistance and field based training for both the lower and upper-body that resulted in whole-body muscle hypertrophy (varying from 0.5 to 1 kg per week). Regional hypertrophy was particularly pronounced in the trunk and nonimmobilized limb during weeks 8 to 12 (2.6 kg) and 13 to 16 (1.3 kg), respectively, whereas the previously immobilized limb exhibited slower but progressive increases in lean mass from Week 12 to 24 (1.2 kg). The athlete presented after the totality of the injured period with an improved anthropometrical and physical profile.

  17. Treatment of Type 3 Arthrofibrosis Following Arthroscopic Reconstruction of ACL and Posterolateral Corner Injury with Tibia Plateau Fracture in a Professional Dancer

    PubMed Central

    Aksu, Neslihan; Abay, Burak; Soydan, Ramazan; Atansay, Vefa

    2014-01-01

    Objectives: Arthrofibrosis is a serious complication following the reconstruction of anterior cruciate ligament (ACL) and posterolateral corner (PLC) injury. Loss of motion caused by arthrofibrosis can be disabling in young and active patients. We report the clinical results of the treatment of arthrofibrosis following arthroscopic reconstruction of ACL with ipsilateral hamstring tendon graft and surgically repairing PLC with 2 suture anchors in a 30 year-old professional dancer, treated with surgical lysis and manipulation under general anesthesia followed by aggressive physical therapy. Methods: A 30 year-old male professional dancer presented with pain, effusion and severe instability in his left knee after falling in a dance event. The pain was evaluated on Visual analog scale (VAS) as 6 to 8. At the physical examination, anterior drawer test was evaluated as grade 3, pivot shift test, varus test, dial test and posterolateral drawer test were found positive. The Tegner Lysholm score was evaluated as 22 (poor). Under general anesthesia, left knee had tendency to external rotation and recurvatum when leg was suspended by toes. A magnetic resonance image (MRI) revealed the presence of a total ACL rupture, PLC injury and a fracture of lateral tibia plateau. The patient was treated with arthroscopic reconstruction of ACL with ipsilateral hamstring tendon graft fixed with endobutton through femoral tunnel and bio interference screw through tibial tunnel and PLC injury was treated with 2 suture anchors. Postoperatively first day, quadriceps musculature and active and passive ROM exercises was trained. During postoperatively third week, the patient was allowed to mobilize nonweight bearing with the use of two crutches without functional knee brace. At the sixth week, arthroscopic lysis was performed due to type 3 arthrofibrosis. At the tenth week, manipulation was performed to the left knee under general anesthesia. Results: At the 3 month- follow-up, the patient

  18. Anterior Cruciate Ligament Injuries in National Football League Athletes From 2010 to 2013

    PubMed Central

    Dodson, Christopher C.; Secrist, Eric S.; Bhat, Suneel B.; Woods, Daniel P.; Deluca, Peter F.

    2016-01-01

    Background: There is a high incidence of anterior cruciate ligament (ACL) injuries among National Football League (NFL) athletes; however, the incidence of reinjury in this population is unknown. Purpose: This retrospective epidemiological study analyzed all publicly disclosed ACL tears occurring in NFL players between 2010 and 2013 to characterize injury trends and determine the incidence of reinjury. Study Design: Descriptive epidemiological study. Methods: A comprehensive online search identified any NFL player who had suffered an ACL injury from 2010 to 2013. Position, playing surface, activity, and date were recorded. Each player was researched for any history of previous ACL injury. The NFL games database from USA Today was used to determine the incidence of ACL injuries on artificial turf and grass fields. Databases from Pro Football Focus and Pro Football Reference were used to determine the injury rate for each position. Results: NFL players suffered 219 ACL injuries between 2010 and 2013. Forty players (18.3%) had a history of previous ACL injury, with 27 (12.3%) retears and 16 (7.3%) tears contralateral to a previous ACL injury. Five players (2.28%) suffered their third ACL tear. Receivers (wide receivers and tight ends) and backs (linebackers, fullbacks, and halfbacks) had significantly greater injury risk than the rest of the NFL players, while perimeter linemen (defensive ends and offensive tackles) had significantly lower injury risk than the rest of the players. Interior linemen (offensive guards, centers, and defensive tackles) had significantly greater injury risk compared with perimeter linemen. ACL injury rates per team games played were 0.050 for grass and 0.053 for turf fields (P > .05). Conclusion: In this retrospective epidemiological study of ACL tears in NFL players, retears and ACL tears contralateral to a previously torn ACL constituted a substantial portion (18.3%) of total ACL injuries. The significant majority of ACL injuries in

  19. Lower Extremity Malalignments and Anterior Cruciate Ligament Injury History

    PubMed Central

    Hertel, Jay; Dorfman, Jennifer H.; Braham, Rebecca A.

    2004-01-01

    To identify if lower extremity malalignments were associated with increased propensity of a history of anterior cruciate ligament (ACL) ruptures in males and females using a case control design. Twenty subjects (10 males, 10 females) had a history of ACL injury and twenty (10 males, 10 females) had no history of ACL injury. Subjects were assessed for navicular drop, quadriceps angle, pelvic tilt, hip internal and external rotation range of motion, and true and apparent leg length discrepancies. Statistical analysis was performed to identify differences in these measures in regard to injury history and gender, and to identify if any of these measures were predictive of ACL injury history. Increased navicular drop and anterior pelvic tilt were found to be statistically significant predictors of ACL injury history regardless of gender. Limbs that had previously suffered ACL ruptures were found to have increased navicular drop and anterior pelvic tilt compared to uninjured limbs. Based on the results of this retrospective study, the lower extremity malalignments examined do not appear to predispose females to tearing their ACLs more than males. Key Points Hyperpronation and greater anterior pelvic tilt were the two malalignments most associated with history of ACL injury. Females had larger quadriceps angles than males, but this measure was not significantly related to ACL injury history. Not all structural differences between genders help explain the increased risk of ACL injuries in female athletes. PMID:24624006

  20. A Hypothesis: Could Portable Natural Grass be a Risk Factor for Knee Injuries?

    PubMed Central

    Orchard, John; Rodas, Gil; Til, Lluis; ArdevÒl, Jordi; Chivers, Ian

    2008-01-01

    Previous study has shown a likely link between increased shoe- surface traction and risk of knee Anterior Cruciate Ligament (ACL) injury. Portable natural grass systems are being used more often in sport, but no study to date has investigated their relative safety. By their nature, they must have high resistance to falling apart and therefore newly laid systems may be at risk of creating excessive shoe-surface traction. This study describes two clusters of knee injuries (particularly non-contact ACL injuries), each occurring to players of one professional football team at single venue, using portable grass, in a short space of time. The first series included two ACL injuries, one posterolateral complex disruption and one lateral ligament tear occurring in two rugby league games on a portable bermudagrass surface in Brisbane, Australia. The second series included four non-contact ACL injuries over a period of ten weeks in professional soccer games on a portable Kentucky bluegrass/perennial ryegrass surface in Barcelona, Spain. Possible intrinsic risk factors are discussed but there was no common risk shared by the players. Although no measures of traction were made at the Brisbane venue, average rotational traction was measured towards the end of the injury cluster at Camp Nou, Barcelona, to be 48 Nm. Chance undoubtedly had a part to play in these clusters, but the only obvious common risk factor was play on a portable natural grass surface soon after it was laid. Further study is required to determine whether portable natural grass systems may exhibit high shoe-surface traction soon after being laid and whether this could be a risk factor for knee injury. Key pointsExcessive shoe-surface traction is a hypothesised risk factor for knee ligament injuries, including anterior cruciate ligament injuries.Portable natural grass systems (by their nature in order to prevent grass rolls or squares from falling apart) will tend to exhibit high resistance to tearing when first

  1. Sociodemographic and environmental risk factors for American cutaneous leishmaniasis (ACL) in the State of Alagoas, Brazil.

    PubMed

    Pedrosa, Fernando de Araújo; Ximenes, Ricardo Arraes de Alencar

    2009-08-01

    The multiplicity of factors involved in the transmission of the American cutaneous leishmaniasis (ACL) constitutes a challenge to its control. Thus, knowledge of such factors may contribute extremely toward redefining the control strategies. The aim of this study was to identify sociodemographic and environmental factors relating to ACL transmission in the State of Alagoas, Brazil. A case-control study with incident cases was conducted. Diagnostic criteria were the presence of compatible skin lesions, laboratory confirmation, and clinical cure after treatment. Two control groups were matched to cases by sex and age: one comprising neighbors and the other from a community-based draw; controls were individuals with no lesion and a negative Montenegro intradermal reaction. Between July 1, 2004 and February 1, 2007, 98 cases and the same number of controls per group were selected. In the multivariate analysis, for both control groups, ACL was associated with absence of a gas stove and forest less than 200 m away; for neighborhood controls with schooling of 4 years or less, family income greater than one minimum salary, birds inside the home, forest-related leisure activities, and rural work or school activities; and for community controls with non-durable wall material in the house, per capita income greater than US$ 28.31, animals inside the house, and absence of dogs and cats around the house. Specific control measures are recommended for areas with similar characteristics: protection for individuals undertaking forest-related leisure activities; distancing houses from forests by more than 200 m; and elimination of bird or other animal-rearing inside homes. General measures of improved housing and living conditions are also recommended.

  2. Anterior Cruciate Ligament Injuries in Pediatric Athletes Presenting to Sports Medicine Clinic

    PubMed Central

    Stracciolini, Andrea; Stein, Cynthia J.; Zurakowski, David; Meehan, William P.; Myer, Gregory D.; Micheli, Lyle J.

    2015-01-01

    Background: Limited data exist regarding the effect of the growth process on anterior cruciate ligament (ACL) injury risk in male versus female children. Hypothesis: The proportion of ACL injuries/sports injuries presenting to clinic will vary by age, sex, and body mass index (BMI). Study Design: Cross-sectional epidemiologic study. Level of Evidence: Level 3. Methods: The study group consisted of a randomly selected 5% probability sample of all children 5 to 17 years of age presenting to a sports medicine clinic from January 1, 2000 to December 31, 2009; 2133 charts were reviewed. Data collected included demographics, height and weight, injury mechanism, diagnosis, treatment, previous injury, and organized sports. Results: A total of 206 ACL tears were analyzed (104 girls, 102 boys). Girls were slightly older than boys (15.1 ± 1.7 vs 14.3 ± 2.1 years; P < 0.01). Male-female comparison of ACL injury/total injury by age revealed that girls had a steeper increase by age than boys. Among 5- to 12-year-olds, boys had a higher ACL injury/total injury ratio than girls (all P < 0.01). Children 13 to 17 years of age showed no significant difference for sex in ACL injury/total injury ratio. As age advanced, the proportion of ACL injuries/total injuries increased for both girls (P < 0.01) and boys (P = 0.04). BMI was independently associated with an ACL injury (P < 0.01). Conclusion: The proportion of ACL injuries/total injuries was similar for boys and girls aged 13 to 17 years. Girls showed a significantly steeper increase in ACL injury proportion versus boys through puberty. Clinical Relevance: This study will increase clinician awareness of ACL injury occurrence in young male and female athletes 5 to 12 years of age. Injury prevention efforts should target young girls before the onset of puberty and before injury occurs. PMID:25984258

  3. Military movement training program improves jump-landing mechanics associated with anterior cruciate ligament injury risk.

    PubMed

    Owens, Brett D; Cameron, Kenneth L; Duffey, Michele L; Vargas, Donna; Duffey, Michael J; Mountcastle, Sally B; Padua, Darin; Nelson, Bradley J

    2013-01-01

    As part of the physical education program at the United States Military Academy, all cadets complete a movement training course designed to develop skills and improve performance in military-related physical tasks as well as obstacle navigation. The purpose of this study was to determine if completion of this course would also result in changes in jump-landing technique that reduce the risk of anterior cruciate ligament (ACL) injury. Analysis of landing mechanics on a two-footed jump landing from a height of 30 cm with a three-dimensional motion capture system synchronized with two force plates revealed both positive and negative changes. Video assessment using the Landing Error Scoring System (LESS) revealed an overall improved landing technique (p=.001) when compared to baseline assessments. The studied military movement course appears to elicit mixed but overall improved lower extremity jump-landing mechanics associated with risk for ACL injury. PMID:23449058

  4. A wearable system to assess risk for anterior cruciate ligament injury during jump landing: measurements of temporal events, jump height, and sagittal plane kinematics.

    PubMed

    Dowling, Ariel V; Favre, Julien; Andriacchi, Thomas P

    2011-07-01

    The incidence of anterior cruciate ligament (ACL) injury remains high, and there is a need for simple, cost effective methods to identify athletes at a higher risk for ACL injury. Wearable measurement systems offer potential methods to assess the risk of ACL injury during jumping tasks. The objective of this study was to assess the capacity of a wearable inertial-based system to evaluate ACL injury risk during jumping tasks. The system accuracy for measuring temporal events (initial contact, toe-off), jump height, and sagittal plane angles (knee, trunk) was assessed by comparing results obtained with the wearable system to simultaneous measurements obtained with a marker-based optoelectronic reference system. Thirty-eight healthy participants (20 male and 18 female) performed drop jumps with bilateral and unilateral support landing. The mean differences between the temporal events obtained with both systems were below 5 ms, and the precisions were below 24 ms. The mean jump heights measured with both systems differed by less than 1 mm, and the associations (Pearson correlation coefficients) were above 0.9. For the discrete angle parameters, there was an average association of 0.91 and precision of 3.5° for the knee flexion angle and an association of 0.77 and precision of 5.5° for the trunk lean. The results based on the receiver-operating characteristic (ROC) also demonstrated that the proposed wearable system could identify movements at higher risk for ACL injury. The area under the ROC plots was between 0.89 and 0.99 for the knee flexion angle and between 0.83 and 0.95 for the trunk lean. The wearable system demonstrated good concurrent validity with marker-based measurements and good discriminative performance in terms of the known risk factors for ACL injury. This study suggests that a wearable system could be a simple cost-effective tool for conducting risk screening or for providing focused feedback. PMID:21823747

  5. Anterior cruciate ligament injuries: etiology and prevention.

    PubMed

    Brophy, Robert H; Silvers, Holly J; Mandelbaum, Bert R

    2010-03-01

    The relatively high risk of noncontact anterior cruciate ligament (ACL) rupture among female athletes has been a major impetus for investigation into the etiology of this injury. A number of risk factors have been identified, both internal and external to the athlete, including neuromuscular, anatomical, hormonal, shoe-surface interaction, and environmental, such as weather. The anatomic and neuromuscular risk factors, often gender related, are the focus of most ACL injury prevention programs. Although studies have shown that biomechanic- centered prevention programs can reduce the risk of ACL injury, many questions remain unanswered. More research is needed to increase our understanding of the risk factors for ACL injury; how injury prevention programs work and can the clinical application of such programs be optimized. PMID:20160623

  6. Timing Sequence of Multi-Planar Knee Kinematics Revealed by Physiologic Cadaveric Simulation of Landing: Implications for ACL Injury Mechanism

    PubMed Central

    Kiapour, Ata M.; Quatman, Carmen E.; Goel, Vijay K.; Wordeman, Samuel C.; Hewett, Timothy E.; Demetropoulos, Constantine K.

    2013-01-01

    Background Challenges in accurate, in vivo quantification of multi-planar knee kinematics and relevant timing sequence during high-risk injurious tasks pose challenges in understanding the relative contributions of joint loads in non-contact injury mechanisms. Biomechanical testing on human cadaveric tissue, if properly designed, offers a practical means to evaluate joint biomechanics and injury mechanisms. This study seeks to investigate detailed interactions between tibiofemoral joint multi-planar kinematics and anterior cruciate ligament strain in a cadaveric model of landing using a validated physiologic drop-stand apparatus. Methods Sixteen instrumented cadaveric legs, 45(SD 7) years (8 female and 8 male) were tested. Event timing sequence, change in tibiofemoral kinematics (position, angular velocity and linear acceleration) and change in anterior cruciate ligament strain were quantified. Findings The proposed cadaveric model demonstrated similar tibiofemoral kinematics/kinetics as reported measurements obtained from in vivo studies. While knee flexion, anterior tibial translation, knee abduction and increased anterior cruciate ligament strain initiated and reached maximum values almost simultaneously, internal tibial rotation initiated and peaked (p<0.015 for all comparisons) significantly later. Further, internal tibial rotation reached 1.8(SD 2.5)°, almost 63% of its maximum value, at the time that peak anterior cruciate ligament strain occurred, while both anterior tibial translation and knee abduction had already reached their peaks. Interpretation Together, these findings indicate that although internal tibial rotation contributes to increased anterior cruciate ligament strain, it is secondary to knee abduction and anterior tibial translation in its effect on anterior cruciate ligament strain and potential risk of injury. PMID:24238957

  7. Single-legged hop tests as predictors of self-reported knee function in non-operatively treated individuals with ACL injury

    PubMed Central

    Grindem, Hege; Logerstedt, David; Eitzen, Ingrid; Moksnes, Håvard; Axe, Michael J.; Snyder-Mackler, Lynn; Engebretsen, Lars; Risberg, May Arna

    2013-01-01

    Background Previous studies have found significant predictors for functional outcome after ACL reconstruction, however, studies examining predictors for functional outcome in non-operatively treated individuals are lacking. Hypothesis Single-legged hop tests predict self-reported knee function (IKDC2000) in non-operatively treated ACL-injured individuals 1 year after baseline testing. Study Design Cohort study (prognosis); Level of evidence, 2. Methods Ninety-one non-operatively treated subjects with an ACL injury were tested using 4 one-legged hop tests on average 74 ± 30 days after injury in a prospective cohort study. Eighty-one subjects (89 %) completed the IKDC2000 1 year later. Subjects with an IKDC2000 score equal to or higher than the age- and gender-specific 15th percentile score from previously published data on an uninjured population were classified as having self-reported function within normal ranges. Logistic regression analyses were performed to identify predictors of self-reported knee function. The Area Under the Curve (AUC) from Receiver Operating Characteristic curves was used as a measure of discriminative accuracy. Optimal limb symmetry index (LSI) cutoff for the best single-legged hop test was defined as the LSI with the highest product of sensitivity and specificity. Results Single hop for distance symmetry indexes predicted self-reported knee function at the 1-year follow-up (p=0.036). Combinations of any 2 hop tests (AUC=0.64–0.71) did not give a higher discriminative accuracy than the single hop alone (AUC=0.71). A cutoff of 88 % (LSI) for the single hop revealed a sensitivity of 71.4 % and a specificity of 71.7 %. Conclusion The single hop for distance (LSI) significantly predicted self-reported knee function after 1 year in non-operatively treated ACL-injured subjects. Combinations of 2 single-legged hop tests did not lead to higher discriminative accuracy than the single hop alone. PMID:21828364

  8. Multicenter trial of motion analysis for injury risk prediction: lessons learned from prospective longitudinal large cohort combined biomechanical - epidemiological studies.

    PubMed

    Hewett, Timothy E; Roewer, Benjamin; Ford, Kevin; Myer, Greg

    2015-01-01

    Our biodynamics laboratory group has conducted large cohort biomechanical-epidemiological studies targeted at identifying the complex interactions among biomechanical, biological, hormonal, and psychosocial factors that lead to increased risk of anterior cruciate ligament (ACL) injuries. The findings from our studies have revealed highly sensitive and specific predictors for ACL injury. Despite the high incidence of ACL injuries among young athletes, larger cohorts are needed to reveal the underlying mechanistic causes of increased risk for ACL injury. In the current study, we have outlined key factors that contribute to the overall success of multicenter, biomechanical-epidemiological investigations designed to test a larger number of athletes who otherwise could not be recruited, screened, or tested at a single institution. Twenty-five female volleyball players were recruited from a single high school team and tested at three biodynamics laboratories. All athletes underwent three-dimensional motion capture analysis of a drop vertical jump task. Kinematic and kinetic variables were compared within and among laboratories. Reliability of peak kinematic variables was consistently rated good-to-excellent. Reliability of peak kinetic variables was consistently rated goodto-excellent within sites, but greater variability was observed between sites. Variables measured in the sagittal plane were typically more reliable than variables measured in the coronal and transverse planes. This study documents the reliability of biomechanical variables that are key to identification of ACL injury mechanisms and of athletes at high risk. These findings indicate the feasibility of executing multicenter, biomechanical investigations that can yield more robust, reliable, and generalizable findings across larger cohorts of athletes. PMID:26537810

  9. Multicenter trial of motion analysis for injury risk prediction: lessons learned from prospective longitudinal large cohort combined biomechanical - epidemiological studies

    PubMed Central

    Hewett, Timothy E.; Roewer, Benjamin; Ford, Kevin; Myer, Greg

    2015-01-01

    Our biodynamics laboratory group has conducted large cohort biomechanical-epidemiological studies targeted at identifying the complex interactions among biomechanical, biological, hormonal, and psychosocial factors that lead to increased risk of anterior cruciate ligament (ACL) injuries. The findings from our studies have revealed highly sensitive and specific predictors for ACL injury. Despite the high incidence of ACL injuries among young athletes, larger cohorts are needed to reveal the underlying mechanistic causes of increased risk for ACL injury. In the current study, we have outlined key factors that contribute to the overall success of multicenter, biomechanical-epidemiological investigations designed to test a larger number of athletes who otherwise could not be recruited, screened, or tested at a single institution. Twenty-five female volleyball players were recruited from a single high school team and tested at three biodynamics laboratories. All athletes underwent three-dimensional motion capture analysis of a drop vertical jump task. Kinematic and kinetic variables were compared within and among laboratories. Reliability of peak kinematic variables was consistently rated good-to-excellent. Reliability of peak kinetic variables was consistently rated goodto-excellent within sites, but greater variability was observed between sites. Variables measured in the sagittal plane were typically more reliable than variables measured in the coronal and transverse planes. This study documents the reliability of biomechanical variables that are key to identification of ACL injury mechanisms and of athletes at high risk. These findings indicate the feasibility of executing multicenter, biomechanical investigations that can yield more robust, reliable, and generalizable findings across larger cohorts of athletes. PMID:26537810

  10. Active living and injury risk.

    PubMed

    Parkkari, J; Kannus, P; Natri, A; Lapinleimu, I; Palvanen, M; Heiskanen, M; Vuori, I; Järvinen, M

    2004-04-01

    The purpose of this study was to get reliable insight into injury risk in various commuting and lifestyle activities, as well as recreational and competitive sports. A cohort of 3 657 persons was randomly selected from the 15- to 74-year-old Finnish population. Ninety-two percent (n = 3 363) of the subjects accepted to participate the one-year follow-up, record all their physical activities that lasted 15 min or more, and register all acute and overuse injuries that occurred during these activities. To collect the information, the study subjects were interviewed by phone by the trained personnel of the Statistics Finland three times in four-month intervals. The individual injury risk per exposure time was relatively low, ranging from 0.19 to 1.5 per 1 000 hours of participation, in commuting and lifestyle activities including walking and cycling to work, gardening, home repair, hunting and fishing, and, in sports such as golf, dancing, swimming, walking, and rowing. The risk was clearly higher in squash, orienteering, and contact and team sports, such as judo, wrestling, karate, rinkball, floorball, basketball, soccer, ice hockey, volleyball, and Finnish baseball ranging from 6.6 to 18.3 per 1 000 hours of participation. However, the highest absolute number of injuries occurred in low-risk activities, such as gardening, walking, home-repair, and cycling, because they are performed so often. In conclusion, individual injury risk per exposure hours is relatively low in commuting and lifestyle activities compared to many recreational and competitive sports. However, at a population level, these low-to-moderate intensity activities are widely practised producing a rather high absolute number of injuries, and thus, preventive efforts are needed in these activities, too.

  11. Postural stability does not differ among female sports with high risk of anterior cruciate ligament injury.

    PubMed

    Cortes, Nelson; Porter, Larissa D; Ambegaonkar, Jatin P; Caswell, Shane V

    2014-12-01

    Dancers have a lower incidence of anterior cruciate ligament (ACL) injury compared to athletes in sports that involve cutting and landing motions. Balance can impact ACL injury risk and is related to neuromuscular control during movement. The purpose of this study was to investigate whether balance differences exist among female dancers and female soccer and basketball athletes. Fifty-eight female dancers, soccer, and basketball athletes (16.5 ± 1.6 yrs, 1.6 ± 0.2 m, 60.2 ± 14.1 kg) completed the Stability Evaluation Test (SET) on the NeuroCom VSR Sport (NeuroCom International, Clackamas, OR) to measure sway velocity. Video records of the SET test were used for Balance Error Scoring System (BESS) test scoring. A oneway ANCOVA compared composite sway velocity and BESS scores among sports. There was no statistically significant difference for sway velocity or BESS among sports (sway velocity soccer 2.3 ± 0.4, dance 2.2 ± 0.4, and basketball 2.4 ± 0.4; BESS soccer 13.6 ± 5.0, dance 11.9 ± 5.5, and basketball 14.9 ± 5.1, p>0.05). Balance was similar among athletes participating in different sports (dance, basketball, and soccer). Quasi-static balance may not play a significant role in neuromuscular control during movement and not be a significant risk factor to explain the disparity in ACL injury incidence among sports. Future research should examine the effects of dynamic balance and limb asymmetries among sports to elucidate on the existing differences on ACL injury incidence rates. PMID:25433258

  12. Postural stability does not differ among female sports with high risk of anterior cruciate ligament injury.

    PubMed

    Cortes, Nelson; Porter, Larissa D; Ambegaonkar, Jatin P; Caswell, Shane V

    2014-12-01

    Dancers have a lower incidence of anterior cruciate ligament (ACL) injury compared to athletes in sports that involve cutting and landing motions. Balance can impact ACL injury risk and is related to neuromuscular control during movement. The purpose of this study was to investigate whether balance differences exist among female dancers and female soccer and basketball athletes. Fifty-eight female dancers, soccer, and basketball athletes (16.5 ± 1.6 yrs, 1.6 ± 0.2 m, 60.2 ± 14.1 kg) completed the Stability Evaluation Test (SET) on the NeuroCom VSR Sport (NeuroCom International, Clackamas, OR) to measure sway velocity. Video records of the SET test were used for Balance Error Scoring System (BESS) test scoring. A oneway ANCOVA compared composite sway velocity and BESS scores among sports. There was no statistically significant difference for sway velocity or BESS among sports (sway velocity soccer 2.3 ± 0.4, dance 2.2 ± 0.4, and basketball 2.4 ± 0.4; BESS soccer 13.6 ± 5.0, dance 11.9 ± 5.5, and basketball 14.9 ± 5.1, p>0.05). Balance was similar among athletes participating in different sports (dance, basketball, and soccer). Quasi-static balance may not play a significant role in neuromuscular control during movement and not be a significant risk factor to explain the disparity in ACL injury incidence among sports. Future research should examine the effects of dynamic balance and limb asymmetries among sports to elucidate on the existing differences on ACL injury incidence rates.

  13. Prognosis and Predictors of ACL Reconstructions using the MOON Cohort: A Model for Comparative Effectiveness Studies

    PubMed Central

    Spindler, Kurt P.; Parker, Richard D.; Andrish, Jack T.; Kaeding, Christopher C.; Wright, Rick W.; Marx, Robert G.; McCarty, Eric C.; Amendola, Annunziato; Dunn, Warren R.; Huston, Laura J.; Harrell, Frank E.

    2012-01-01

    Injury to the anterior cruciate ligament (ACL) threatens an active lifestyle and exposes the patient to risk of early osteoarthritis (OA). ACL reconstruction is typically chosen by individuals to allow a return to their previous work and sports activities. Primary ACL reconstruction (ACLR) has in general been effective at restoring functional stability, but patients’ modifiable predictors of both short- and long-term validated outcomes and OA are largely unknown. The Multicenter Orthopaedic Outcomes Network (MOON) consortium was established in 2002 to enroll and longitudinally follow a population cohort of ACL reconstructed patients. The objective was to establish patient-specific predictive models of clinically important outcomes. Over the past 10 years, the overarching aims of this NIAMS-funded prospective multicenter cohort of ACL reconstructions has been three-fold: 1) to identify both short- and long-term prognosis and predictors of sports function, activity level, and general health through validated patient-reported outcomes, 2) to identify the symptoms and signs of OA, and 3) to quantify the incidence of ACL reconstruction graft and/or contralateral ACL failures and additional surgical procedures. This manuscript summarizes the Kappa Delta Ann Doner Vaughan Award paper and presentation at the 2012 ORS/AAOS Annual Meeting. PMID:22912340

  14. The incidence of knee and anterior cruciate ligament injuries over one decade in the Belgian Soccer League.

    PubMed

    Quisquater, Laurent; Bollars, Peter; Vanlommel, Luc; Claes, Steven; Corten, Kristoff; Bellemans, Johan

    2013-10-01

    In an epidemiological study we assessed the evolution in the incidence and possible risk factors of knee injuries, especially anterior cruciate ligament (ACL) injuries, in Belgian soccer over one decade. Two soccer seasons (1999-2000 and 2009-2010) were compared and 56,364 injury reports registered by the KBVB-URBSFA were retrieved. Knee injuries totaled 9.971 cases, 5.495 in the first season (1999-2000) and 4.476 in the second (2009-2010): a significant decrease in incidence from 1.5 per 100 players in 2000 to 1.2 knee injuries in 2010. Six percent of all knee injuries were ACL injuries. The reported incidence of ACL tears slightly increased from 0.081 to 0.084 per 100 players. Female gender, competition and age over 18 years were prognosticators for ACL injuries. Enhanced prevention programs for ACL injuries, especially in those sports groups are warranted.

  15. Brain Activation for Knee Movement Measured Days Before Second Anterior Cruciate Ligament Injury: Neuroimaging in Musculoskeletal Medicine

    PubMed Central

    Grooms, Dustin R.; Page, Stephen J.; Onate, James A.

    2015-01-01

    Background Anterior cruciate ligament (ACL) injury has multifactorial causes encompassing mechanical, hormonal, exposure, and anatomical factors. Alterations in the central nervous system also play a role, but their influence after injury, recovery, and recurrent injury remain unknown. Modern neuroimaging techniques can be used to elucidate the underlying functional and structural alterations of the brain that predicate the neuromuscular control adaptations associated with ACL injury. This knowledge will further our understanding of the neural adaptations after ACL injury and rehabilitation and in relation to injury risk. In this paper, we describe the measurement of brain activation during knee extension-flexion after ACL injury and reconstruction and 26 days before a contralateral ACL injury. Methods Brain functional magnetic resonance imaging data for an ACL-injured participant and a matched control participant were collected and contrasted. Results Relative to the matched control participant, the ACL-injured participant exhibited increased activation of motor-planning, sensory-processing, and visual-motor control areas. A similar activation pattern was present for the contralateral knee that sustained a subsequent injury. Conclusions Bilateral neuroplasticity after ACL injury may contribute to the risk of second injury, or aspects of neurophysiology may be predisposing factors to primary injury. Clinical Implications Sensory-visual-motor function and motor-learning adaptations may provide targets for rehabilitation. PMID:26509775

  16. PATIENT-SPECIFIC AND SURGERY-SPECIFIC FACTORS THAT AFFECT RETURN TO SPORT AFTER ACL RECONSTRUCTION

    PubMed Central

    Lynch, Andrew; Rabuck, Stephen; Lynch, Brittany; Davin, Sarah; Irrgang, James

    2016-01-01

    Context Anterior cruciate ligament (ACL) reconstruction is frequently performed to allow individuals to return to their pre-injury levels of sports participation, however, return to pre-injury level of sport is poor and re-injury rates are unacceptably high. Re-injury is likely associated with the timeframe and guidelines for return to sport (RTS). It is imperative for clinicians to recognize risk factors for re-injury and to ensure that modifiable risk factors are addressed prior to RTS. The purpose of this commentary is to summarize the current literature on the outcomes following return to sport after ACL reconstruction and to outline the biologic and patient-specific factors that should be considered when counseling an athlete on their progression through rehabilitation. Evidence Acquisition A comprehensive literature search was performed to identify RTS criteria and RTS rates after ACL reconstruction with consideration paid to graft healing, anatomic reconstruction, and risk factors for re-injury and revision. Results were screened for relevant original research articles and review articles, from which results were summarized. Study Design Clinical Review of the Literature Results Variable RTS rates are presented in the literature due to variable definitions of RTS ranging from a high threshold (return to competition) to low threshold (physician clearance for return to play). Re-injury and contralateral injury rates are greater than the risk for primary ACL injury, which may be related to insufficient RTS guidelines based on time from surgery, which do not allow for proper healing or resolution of post-operative impairments and elimination of risk factors associated with both primary and secondary ACL injuries. Conclusions RTS rates to pre-injury level of activity after ACLR are poor and the risk for graft injury or contralateral injury requiring an additional surgery is substantial. Resolving impairments while eliminating movement patterns associated with

  17. Anterior Cruciate Ligament Injuries in Children and Adolescents.

    PubMed

    Fabricant, Peter D; Kocher, Mininder S

    2016-10-01

    Dramatic increases in youth competitive athletic activity, early sport specialization, and year-round training and competition, along with increased awareness of anterior cruciate ligament (ACL) injuries in children, have led to a commensurate increase in the frequency of ACL tears in the skeletally immature. Recent understanding of the risks of nonoperative treatment and surgical delay have supported a trend toward early operative treatment. This article discusses treatment strategies for ACL injuries in children and adolescents, and offers our preferred treatment strategy for skeletally immature youth athletes with ACL tears. PMID:27637664

  18. Long-Term Data Reveal Rate and Risk Factors for Subsequent Surgeries Following Initial ACL Reconstruction

    MedlinePlus

    ... we have not known the rate and risk factors for subsequent knee surgery until now,” said senior author Kurt Spindler, M.D., of Vanderbilt University. In the Multicenter Orthopaedic Outcomes Network (MOON) study, ...

  19. Stereoscopic filming for investigating evasive side-stepping and anterior cruciate ligament injury risk

    NASA Astrophysics Data System (ADS)

    Lee, Marcus J. C.; Bourke, Paul; Alderson, Jacqueline A.; Lloyd, David G.; Lay, Brendan

    2010-02-01

    Non-contact anterior cruciate ligament (ACL) injuries are serious and debilitating, often resulting from the performance of evasive sides-stepping (Ssg) by team sport athletes. Previous laboratory based investigations of evasive Ssg have used generic visual stimuli to simulate realistic time and space constraints that athletes experience in the preparation and execution of the manoeuvre. However, the use of unrealistic visual stimuli to impose these constraints may not be accurately identifying the relationship between the perceptual demands and ACL loading during Ssg in actual game environments. We propose that stereoscopically filmed footage featuring sport specific opposing defender/s simulating a tackle on the viewer, when used as visual stimuli, could improve the ecological validity of laboratory based investigations of evasive Ssg. Due to the need for precision and not just the experience of viewing depth in these scenarios, a rigorous filming process built on key geometric considerations and equipment development to enable a separation of 6.5 cm between two commodity cameras had to be undertaken. Within safety limits, this could be an invaluable tool in enabling more accurate investigations of the associations between evasive Ssg and ACL injury risk.

  20. Maximizing quadriceps strength after ACL reconstruction.

    PubMed

    Palmieri-Smith, Riann M; Thomas, Abbey C; Wojtys, Edward M

    2008-07-01

    The primary objectives of ACL surgery and rehabilitation are to restore knee function to preinjury levels and promote long-term joint health. Often these goals are not achieved, however. The quadriceps is critical to dynamic joint stability, and weakness of this muscle group is related to poor functional outcomes. Because of this, identifying strategies to minimize quadriceps weakness following ACL injury and reconstruction is of great clinical interest. This article reviews the current literature and critically discusses current rehabilitation approaches to restore quadriceps muscle function after ACL reconstruction.

  1. Increased Risk of Revision after ACL Reconstruction with Soft Tissue Allograft Compared to Autograft

    PubMed Central

    Maletis, Gregory; Chen, Jason; Inacio, Maria Carolina Secorun; Love, Rebecca; Funahashi, Tadashi Ted

    2016-01-01

    Objectives: The use of allograft tissue for anterior cruciate ligament reconstruction (ACLR) remains controversial. Numerous meta-analysis and systematic reviews of small clinical studies have not found differences between autograft and allograft outcomes but large registry studies have shown an increased risk of revision with allografts. The purpose of this study was to compare the risk of aseptic revision between bone-patellar tendon-bone (BPTB) autografts, hamstring tendon autografts and soft tissue allografts. Methods: A retrospective cohort study of prospectively collected data was conducted using an US ACLR Registry. A cohort of primary unilateral ACLR cases reconstructed with BPTB autografts, hamstring autografts and soft tissue allografts (from any site) was identified. Aseptic revision was the end point of the study. Type of graft and allograft processing methods (non-processed, <1.8Mrads with and without chemical processing (Allowash or AlloTrue methods), >1.8 Mrads irradiation with and without chemical processing, and chemical processing alone (BioCleanse)) were the exposures of interest evaluated. Time from surgery was evaluated as an effect modifier. All analyses were adjusted for age, gender, and race. Kaplan-Meier curves and Cox proportional hazard models were employed. Hazard ratios (HR), 95% confidence intervals (CI) are provided. Results: The cohort had 14015 cases, 8924 (63.7%) were male, 6397 (45.6%) were White, 4557 (32.5%) cases used BPTB autograft, 3751 (26.8%) cases used soft tissue allograft and 5707 (40.7%) cases used hamstring autograft. The median age was 34.6 years-old (IQR 24.1-43.2) for allograft cases and 24.3 years-old (IQR 17.7-33.8) for hamstring autograft cases, and 22.0 years-old (IQR 17.6-30.0) for BPTB autograft cases. Compared to hamstring tendon autografts, an increased risk of revision was found in allografts processed with >1.8Mrads without chemical processing after 2.5 years (HR: 3.88 95%CI 1.48-10.12), and >1.8Mrads with

  2. Hip adductors' strength, flexibility, and injury risk.

    PubMed

    Hrysomallis, Con

    2009-08-01

    The hip adductor muscle group plays an important role in both movement and stability at the hip joint in many athletic pursuits. Injury to this muscle group has been reported in a number of sports, among them, ice hockey, soccer, Australian football, and swimming. The identification of muscle characteristics that predispose a muscle to injury is an important step in developing conditioning programs to reduce injury risk. Muscle strength and range of motion are 2 parameters that may influence injury risk. The aim of this review was to examine the relationship between hip adductors' strength, flexibility, and injury risk. Strength testing has involved isokinetic or hand-held dynamometry. Flexibility has usually been assessed by goniometry during maximal hip abduction. An association has been reported between adductor strength deficits and injury for ice hockey players. Low adductor flexibility has also been identified as a risk factor for injury in soccer players. An intervention program that strengthened the hip adductors had some success in reducing injury risk for ice hockey players. There is some low- to moderate-level evidence from cohort studies to suggest that flexibility and strength are related to injury risk in particular sports and that an intervention program may be effective in reducing injury risk. Higher level evidence from randomized controlled trials is required to firmly establish the link between hip adductor flexibility, strength, and injury. PMID:19620912

  3. ALCOHOL INTAKE AND RISK OF INJURY

    PubMed Central

    CREMONTE, MARIANA; CHERPITEL, CHERYL J.

    2014-01-01

    Injuries constitute a leading cause of morbidity and mortality in the world, with intentional injuries and those related to traffic most important, due to their social impact and high prevalence. Although alcohol consumption has been identified as a risk factor for injuries, few studies have assessed risk separately for intentional injuries and unintentional injuries caused by traffic, and by other causes. The objective of this paper was to estimate the risk of injuries after acute alcohol consumption for intentional injuries and unintentional traffic and non-traffic injuries, using, alternatively, two exposure measures: self-reported drinking prior to the event and blood alcohol concentration. A probability sample was collected of 540 patients from the emergency department of a hospital in Argentina. Logistic regressions were performed, with and without adjusting for gender, age and drinking pattern. Higher risks were found when blood alcohol concentration was used as a measure of consumption, compared to self-report. The highest risk estimates were obtained for intentional injuries, followed by unintentional traffic and, lastly, by unintentional non-traffic injuries. After controlling for confounders, risks for intentional and unintentional traffic injuries appeared similar for those above and below the legal limit. Results point to a significant involvement of alcohol in the regional context. PMID:25188654

  4. Risk Factors at Time of Primary ACL Reconstruction that Contribute to Significant Chondral Surface Change at Time of Revision ACL Reconstruction

    PubMed Central

    Kaeding, Christopher C.; Group, Mars

    2016-01-01

    Objectives: Articular cartilage health is an important issue following primary anterior cruciate ligament reconstruction (ACLR). It is not clear what risk factors at the time of primary reconstruction affect future articular cartilage health. The purpose of this study was to examine risk factors affecting chondral surface change in a cohort from the time of primary ACLR to revision ACLR. Methods: Subjects who had both primary and revision data contained in the MOON and MARS registries were included. Data included chondral surface status (grade and size) at time of primary and revision, meniscal status (no treatment/repair, ≤33% excision, >33% excision) at time of primary, time from primary to revision ACLR, and age, sex, BMI, Marx, KOOS, and IKDC at time of revision. Significant chondral surface change was defined as >25% deterioration between time of primary and revision in the femoral condyle, tibial plateau, patella, or trochlea. Logistic regression was used to test each variable’s contribution to significant chondral surface change in the medial compartment, lateral compartment, and patellofemoral compartment. Results: 134 subjects met our inclusion criteria. 34/134 (25.4%) had significant lateral compartment chondral surface change, 32/134 (23.9%) had significant medial compartment chondral surface change, and 31/134 (23.1%) had significant patellofemoral chondral surface change. Median age at time of revision was 19.5 years [IQ range 17-25] and median time from primary to revision was 462.5 days [IQ range 292-1049]. KOOS and IKDC at revision were not associated with significant chondral surface change in any compartment. Patients with >33% of their lateral meniscus excised had 13.5 times the odds of having significant lateral compartment surface change compared to subjects who either did not have lateral meniscal damage, had it repaired, or had an excision of ≤33% controlling for age (p<0.001). Patients with ≤33% excision of their medial meniscus had

  5. Risk factors for anterior cruciate ligament injury in high school and college athletes.

    PubMed

    Woodford-Rogers, B; Cyphert, L; Denegar, C R

    1994-12-01

    The anterior cruciate (ACL) is the most frequently ruptured ligament of the knee. Some authors have suggested that excessive internal tibial rotation concomitant with hyperpronation of the subtalar joint during stance and inherent knee joint laxity may predispose an athlete to knee injury. Over a period of 2 years, we identified 14 ACL-injured football players and eight ACL-injured female basketball players and gymnasts. We matched them by sport, team, position, and level of competition with 22 athletes without history of ACL injury. Measures of navicular drop, calcaneal alignment, and anterior knee joint laxity with a KT-1000 were obtained from the uninjured knee of the ACL-injured athletes and compared with measures obtained from the ACL-noninjured athletes. ACL-injured athletes had greater amounts of navicular drop, suggesting greater subtalar pronation and greater anterior knee joint laxity. Discriminant analysis and multiple regression indicated that these variables correctly predicted injury status for 87.5% of the females and for 70.5% of all cases. These results suggest that the more an athlete pronates and the greater the anterior knee joint laxity, the greater the association with ACL injury.

  6. Elevated gastrocnemius forces compensate for decreased hamstrings forces during the weight-acceptance phase of single-leg jump landing: implications for anterior cruciate ligament injury risk.

    PubMed

    Morgan, Kristin D; Donnelly, Cyril J; Reinbolt, Jeffrey A

    2014-10-17

    Approximately 320,000 anterior cruciate ligament (ACL) injuries in the United States each year are non-contact injuries, with many occurring during a single-leg jump landing. To reduce ACL injury risk, one option is to improve muscle strength and/or the activation of muscles crossing the knee under elevated external loading. This study's purpose was to characterize the relative force production of the muscles supporting the knee during the weight-acceptance (WA) phase of single-leg jump landing and investigate the gastrocnemii forces compared to the hamstrings forces. Amateur male Western Australian Rules Football players completed a single-leg jump landing protocol and six participants were randomly chosen for further modeling and simulation. A three-dimensional, 14-segment, 37 degree-of-freedom, 92 muscle-tendon actuated model was created for each participant in OpenSim. Computed muscle control was used to generate 12 muscle-driven simulations, 2 trials per participant, of the WA phase of single-leg jump landing. A one-way ANOVA and Tukey post-hoc analysis showed both the quadriceps and gastrocnemii muscle force estimates were significantly greater than the hamstrings (p<0.001). Elevated gastrocnemii forces corresponded with increased joint compression and lower ACL forces. The elevated quadriceps and gastrocnemii forces during landing may represent a generalized muscle strategy to increase knee joint stiffness, protecting the knee and ACL from external knee loading and injury risk. These results contribute to our understanding of how muscle's function during single-leg jump landing and should serve as the foundation for novel muscle-targeted training intervention programs aimed to reduce ACL injuries in sport. PMID:25218505

  7. Recovery of Psychological Readiness May Differ Between Genders Following ACL Reconstruction in Adolescent Athletes

    PubMed Central

    Milewski, Matthew David; Kostyun, Regina; Iannicelli, Julie P.; Kostyun, Kyle J.; Solomito, Matthew; Nissen, Carl W.

    2016-01-01

    Objectives: Injury to the anterior cruciate ligament (ACL) is a traumatic and emotional event for adolescent athletes. Preparation to return to play (RTP) and the potential risk of re-injury are often equally as emotional as the injury, and have been identified as possible limiting factors to a successful rehabilitation and RTP. In order to create a comprehensive rehabilitation model, further understanding of psychological readiness following surgical intervention is needed. The purpose of this study was to determine if clinical outcomes of subjective knee function and psychological readiness differ between genders following ACL reconstruction surgery in adolescent athletes, and if higher knee function and physiological readiness was associated with an earlier to RTP. Methods: Athletes who underwent ACL reconstruction surgery and were successfully returned back to unrestricted sport were included in the analysis. At approximately six months post surgery, knee function was assessed using the validated International Knee Documentation Committee (IKDC) Subjective Form, and psychological readiness was assessed using the validated ACL-Return to Sport after Injury (ACL-RSI) scale. Formal clearance to resume unrestricted sport was obtained from clinic notes. A T-test was used to determine if demographics, IKDC and ACL-RSI scores between genders. A mixed effects random intercept regression model was used to determine the association of time to RTP with IKDC and ACL-RSI scores. Results: A total of 45 adolescent athletes (23 females) were included in this analysis. No significant differences were found between males and females for age (16.2±1.5 years, 16.3±2.2 years) and average time to RTP (7.3±2.0 months, 7.3±1.8 months). No significant differences in IKDC scores were found between males and females (88±10%, 87±10%). A trend was identified that males demonstrated higher ACL-RSI scores at six month post surgery than females (81±14%, 72±17%, p = 0.063). In females

  8. [Pattern of injuries and risk of injury in skateboarding].

    PubMed

    Feiler, S; Frank, M

    2000-06-01

    After the first big wave in the late seventies skateboarding is facing a revival as a leisure sport nowadays. 63 Skateboarders with a mean age of 18.1 years were personally interview with a survey form. 148 injuries with a resulting sport break of at least one week were registered. Sprains (36.5%), bruises (24.3%), fractures (18.2%) and lacerations of the skin (12.8%) were the most common injuries. 86.5% were injuries of the extremities almost equally distributed among the upper and lower limbs. Most fractures happened to the upper limbs (81.5%) mainly distal of the elbow joint. Sprains were mainly located at the lower limbs (70.4%) especially at the ankle joint as the most vulnerable part of the body (26.4% of all injuries). 101 injuries (68.2%) were treated by physicians. The resulting risk of injury was one injury per athlete and 1000 hours of exposure time. A higher acceptance of prophylactic measures could minimize the risk of injury. Parallels to inline skating and snowboarding can be shown.

  9. ACL Reconstruction With Autografts Weighing Performance Considerations and Postoperative Care.

    PubMed

    Grant, John A; Mohtadi, Nicholas G

    2003-04-01

    Anterior cruciate ligament (ACL) reconstruction is the treatment of choice for patients who experience episodes of instability and a decreased quality of life after ACL rupture. The bone-patellar tendon-bone and hamstring autografts are the current standards for ACL reconstruction. Primary care physicians, especially sports medicine clinicians, are the first-line providers of nonoperative care for patients who have ACL injuries. Care providers need to know the biologic and biomechanic properties of these grafts, clinical indications for each graft, and rehabilitation considerations to appropriately counsel their patients. PMID:20086463

  10. Feedback Techniques to Target Functional Deficits Following Anterior Cruciate Ligament Reconstruction: Implications for Motor Control and Reduction of Second Injury Risk

    PubMed Central

    Benjaminse, Anne; Hewett, Timothy E.; Paterno, Mark V.; Ford, Kevin R.; Otten, Egbert; Myer, Gregory D.

    2014-01-01

    Primary anterior cruciate ligament (ACL) injury prevention training has been shown to reduce the risk of injury. Less is known about the effect of prevention on second injury after ACL reconstruction (ACLR). Given recent findings that second injury rates exceed 20 % in only the first year following the return to sport, it is imperative that rehabilitation after ACLR is scrutinized so that second injury preventative strategies can be optimized. A potential limitation of current rehabilitative processes following ACLR could be a deficiency in the transition from conscious awareness achieved during rehabilitation sessions to unexpected and automatic movements required for athletic activities on the field. Learning strategies with an internally directed focus have traditionally been utilized but may be less suitable for acquisition of control of complex motor skills required for sport reintegration. Conversely, an externally focused rehabilitation strategy may enhance skill acquisition more efficiently and increase the potential to transfer to competitive sport. This article presents new insights gained from the motor learning domain that may improve neuromuscular training programmes via increased retention from improved techniques and may ultimately reduce the incidence of second ACL injuries. PMID:24062274

  11. Quantification of the role of tibial posterior slope in knee joint mechanics and ACL force in simulated gait.

    PubMed

    Marouane, H; Shirazi-Adl, A; Hashemi, J

    2015-07-16

    The anterior cruciate ligament (ACL) rupture is a common knee joint injury with higher prevalence in female athletes. In search of contributing mechanisms, clinical imaging studies of ACL-injured individuals versus controls have found greater medial-lateral posterior tibial slope (PTS) in injured population irrespective of the sex and in females compared to males, with stronger evidence on the lateral plateau slope. To quantify these effects, we use a lower extremity musculoskeletal model including a detailed finite element (FE) model of the knee joint to compute the role of changes in medial and/or lateral PTS by ±5° and ±10° on knee joint biomechanics, in general, and ACL force, in particular, throughout the stance phase of gait. The model is driven by reported kinematics/kinetics of gait in asymptomatic subjects. Our predictions showed, at all stance periods, a substantial increase in the anterior tibial translation (ATT) and ACL force as PTS increased with reverse trends as PTS decreased. At mid-stance, for example, ACL force increased from 181 N to 317 N and 460 N as PTS increased by 5° and 10°, respectively, while dropped to 102 N and 0 N as PTS changed by -5° and -10°, respectively. These effects are caused primarily by change in PTS at the tibial plateau that carries a larger portion of joint contact force. Steeper PTS is a major risk factor, especially under activities with large compression, in markedly increasing ACL force and its vulnerability to injury. Rehabilitation and ACL injury prevention programs could benefit from these findings.

  12. Quality of Movement for Athletes Six Months Post ACL Reconstruction

    PubMed Central

    deMille, Polly; Nguyen, Joseph; Brown, Allison; Do, Huong; Selvaggio, Elizabeth; Chiaia, Theresa

    2016-01-01

    Objectives: Anterior cruciate ligament (ACL) injury prevention programs evaluate quality of movement (QM) to identify and correct high-risk movement patterns. However, return to play (RTP) decisions post-ACL reconstruction (ACLR) are often based on non-sport relatedquantitative measures such as isokinetic tests and/or time from surgery, with six months post-ACLR being a common expectation for RTP. The purpose of this study was to evaluate whether athletes are ready to RTP 6 months post ACLR using a QM assessment (QMA). Methods: A QMA including nine dynamic tasks (squat, single leg [SL] stance, step down, SL squat, jump in place, side to side jump, broad jump, hop to opposite, SL hop) progressing from double- to single-limb vertical and horizontal movements was administered to 136 athletes at five to seven months post-ACLR. Tasks were viewed from the frontal and sagittal planes by a physical therapist and performance specialist. Movements were evaluated live for risk factors associated with ACL injury (strategy, depth, control, symmetry, and alignment). The proportion of patients exhibiting risky movement patterns for each task was calculated. Fisher’s Exact test was used to determine if there were differences in movement patterns between males and females. Results: The proportion of patients demonstrating risky movement patterns for a task ranged from 48% to 100%. All 136 patients exhibited risky movement patterns for at least one task and 60% of patients displayed risky movement patterns in five or more of the nine tasks. Rates of risky movement patterns were not different between males and females for all tasks (P>0.1 for all tasks). Conclusion: Six months has been cited as a probable time for RTP post-ACLR; thus this is the expectation of the athlete. Our data show that athletes demonstrate multiple QM patterns associated with initial ACL injury, as well as 2nd injury at five to seven months post-operatively. Altered movement patterns evident in tasks as

  13. Postural Stability During Single-Leg Stance: A Preliminary Evaluation of Noncontact Lower Extremity Injury Risk.

    PubMed

    Dingenen, Bart; Malfait, Bart; Nijs, Stefaan; Peers, Koen H E; Vereecken, Styn; Verschueren, Sabine M P; Janssens, Luc; Staes, Filip F

    2016-08-01

    Study Design Controlled laboratory study with a prospective cohort design. Background Postural stability deficits during single-leg stance have been reported in persons with anterior cruciate ligament (ACL) injury, ACL reconstruction, and chronic ankle instability. It remains unclear whether impaired postural stability is a consequence or cause of these injuries. Objectives To prospectively investigate whether postural stability deficits during single-leg stance predict noncontact lower extremity injuries. Methods Fifty injury-free female athletes performed a transition task from double-leg stance to single-leg stance with eyes closed. Center-of-pressure displacement, the main outcome variable, was measured during the first 3 seconds after the time to a new stability point was reached during single-leg stance. Noncontact lower extremity injuries were recorded at a 1-year follow-up. Results Six participants sustained a noncontact ACL injury or ankle sprain. Center-of-pressure displacement during the first 3 seconds after the time to a new stability point was significantly increased in the injured (P = .030) and noninjured legs (P = .009) of the injured group compared to the respective matched legs of the noninjured group. The area under the receiver operating characteristic curve (AUC) analysis revealed significant discriminative accuracy between groups for the center-of-pressure displacement during the first 3 seconds after the time to a new stability point of the injured (AUC = 0.814, P = .015) and noninjured legs (AUC = 0.897, P = .004) of the injured group compared to the matched legs of the noninjured group. Conclusion This preliminary study suggests that postural stability measurements during the single-leg stance phase of the double- to single-leg stance transition task may be a useful predictor of increased risk of noncontact lower extremity injury. Further research is indicated. Level of Evidence Prognosis, level 4. J Orthop Sports PhysTher 2016

  14. Defending Puts the Anterior Cruciate Ligament at Risk During Soccer

    PubMed Central

    Brophy, Robert H.; Stepan, Jeffrey G.; Silvers, Holly J.; Mandelbaum, Bert R.

    2015-01-01

    Background: Soccer athletes are at risk for anterior cruciate ligament (ACL) injury. To date, there are limited studies on the mechanisms of ACL injuries in soccer athletes and no video-based analysis or sex-based comparison of these mechanisms. Hypothesis: There is no difference in ACL injury mechanisms among soccer athletes by sex. Study design: Case series. Level of evidence: Level 4. Methods: Fifty-five videos of ACL injuries in 32 male and 23 female soccer players were reviewed. Most athletes were professionals (22 males, 4 females) or collegiate players (8 males, 14 females). Visual analysis of each case was performed to describe the injury mechanisms in detail (game situation, player behavior, and lower extremity alignment). Results: The majority of ACL injuries occurred when the opposing team had the ball and the injured athlete was defending (73%). Females were more likely to be defending when they injured their ACLs (87% vs 63% for males, P = 0.045). The most common playing action was tackling (51%), followed by cutting (15%). Most injuries occurred due to a contact mechanism (56%) with no significant difference for sex. Females were more likely to suffer a noncontact injury in their left knee (54%) than males (33%) (P = 0.05). Conclusion: Soccer players are at greatest risk for ACL injury when defending, especially when tackling the opponent in an attempt to win possession of the ball. Females are more likely to injure their ACLs when defending and are at greater risk for noncontact injuries in their left lower extremity. Clinical Relevance: Soccer ACL injury prevention programs should include proper defending and tackling techniques, particularly for female athletes. PMID:26131302

  15. Disability and risk of school related injury

    PubMed Central

    Ramirez, M; Peek-Asa, C; Kraus, J

    2004-01-01

    Objective: Approximately six million children with disabilities attend school in the United States. Cognitive and physical limitations may compromise their ability to handle environmental hazards and hence increase their risk for injury. The objective of this study was to describe the epidemiology of school related injury among children enrolled in 17 special education schools in one large, urban school district. Design: Altogether 6769 schoolchildren with disabilities were followed up from 1994–98. Injury and population data were collected from pupil accident reports and existing school records. Associations were estimated through generalized estimating equations. Results: A total of 697 injuries were reported for a rate of 4.7/100 students per year. Children with multiple disabilities had a 70% increased odds of injury compared with the developmentally disabled (odds ratio (OR) 1.7, 95% confidence interval (CI) 1.3 to 2.3). The physically disabled (OR 1.4, 95% CI 1.0 to 1.9) had a modest increased odds of injury. Cuts, bruises, and abrasions composed almost three fourths of all injuries; almost half of these injuries were to the face. Falls (34%) and insults by other students (31%) were the most common external causes. More than a fourth of injuries were sports related, and 21% occurred on the playground/athletic field. Injury patterns differed across disabilities. Conclusions: Although limited to one school district, the population studied is the largest cohort thus far of schoolchildren with disabilities. With this large study base, potentially high risk groups were identified and circumstances of injury described. This information is imperative for developing and improving school based injury prevention measures. PMID:14760022

  16. Injury Risk in International Rugby Union

    PubMed Central

    Moore, Isabel S.; Ranson, Craig; Mathema, Prabhat

    2015-01-01

    Background: Within international Rugby Union, only injury rates during the Rugby World Cup have been reported. Therefore, injury rates and types during other international tournaments are unknown. Purpose: To assess the 3-year incidence, severity, nature, and causes of match and training injuries sustained during different international tournaments played by the Welsh national Rugby Union team. Study Design: Descriptive epidemiology study. Methods: Injury data for all players (n = 78) selected for 1 national Rugby Union team over a 3-year period were analyzed using the international consensus statement methods. Player height (cm) and mass (kg) were recorded. Tournaments were grouped for comparisons as: autumn tournaments (2012 and 2013), Rugby World Cup (RWC; 2011), Six Nations (2012, 2013, and 2014), and summer tournaments (2012, 2013, and 2014). Injury incidence (injuries/1000 hours), prevalence (% of players unavailable), and severity (days lost) were calculated for each tournament. Injury location, type, and cause of match and training injuries were analyzed. Results: Match injury incidence was highest during autumn tournaments (262.5/1000 match-hours) and lowest during the RWC (178.6/1000 match-hours). Summer tournaments had the highest training incidence (5.5 injuries/1000 training-hours). Mild injuries were most likely during the RWC (risk ratio [RR], 2.02; 95% CI, 1.26-3.24), while severe injuries were most likely during autumn tournaments (RR, 3.27; 95% CI, 1.70-6.29). Quadriceps hematomas (18.8/1000 match-hours; 95% CI, 11.3-31.1) and concussions (13.8/1000 match-hours; 95% CI, 7.6-24.8) were the most common match injuries, with shoulder dislocations being the most severe (111 mean days lost per injury). Conclusion: Injury rates were considerably higher than those previously reported for multiple teams during RWC tournaments. Further investigation of injury rates and risk factors is recommended to accurately gauge their impact within international Rugby

  17. Relationship between jump landing kinematics and peak ACL force during a jump in downhill skiing: a simulation study.

    PubMed

    Heinrich, D; van den Bogert, A J; Nachbauer, W

    2014-06-01

    Recent data highlight that competitive skiers face a high risk of injuries especially during off-balance jump landing maneuvers in downhill skiing. The purpose of the present study was to develop a musculo-skeletal modeling and simulation approach to investigate the cause-and-effect relationship between a perturbed landing position, i.e., joint angles and trunk orientation, and the peak force in the anterior cruciate ligament (ACL) during jump landing. A two-dimensional musculo-skeletal model was developed and a baseline simulation was obtained reproducing measurement data of a reference landing movement. Based on the baseline simulation, a series of perturbed landing simulations (n = 1000) was generated. Multiple linear regression was performed to determine a relationship between peak ACL force and the perturbed landing posture. Increased backward lean, hip flexion, knee extension, and ankle dorsiflexion as well as an asymmetric position were related to higher peak ACL forces during jump landing. The orientation of the trunk of the skier was identified as the most important predictor accounting for 60% of the variance of the peak ACL force in the simulations. Teaching of tactical decisions and the inclusion of exercise regimens in ACL injury prevention programs to improve trunk control during landing motions in downhill skiing was concluded.

  18. PRP Augmentation for ACL Reconstruction.

    PubMed

    Andriolo, Luca; Di Matteo, Berardo; Kon, Elizaveta; Filardo, Giuseppe; Venieri, Giulia; Marcacci, Maurilio

    2015-01-01

    Current research is investigating new methods to enhance tissue healing to speed up recovery time and decrease the risk of failure in Anterior Cruciate Ligament (ACL) reconstructive surgery. Biological augmentation is one of the most exploited strategies, in particular the application of Platelet Rich Plasma (PRP). Aim of the present paper is to systematically review all the preclinical and clinical papers dealing with the application of PRP as a biological enhancer during ACL reconstructive surgery. Thirty-two studies were included in the present review. The analysis of the preclinical evidence revealed that PRP was able to improve the healing potential of the tendinous graft both in terms of histological and biomechanical performance. Looking at the available clinical evidence, results were not univocal. PRP administration proved to be a safe procedure and there were some evidences that it could favor the donor site healing in case of ACL reconstruction with patellar tendon graft and positively contribute to graft maturation over time, whereas the majority of the papers did not show beneficial effects in terms of bony tunnels/graft area integration. Furthermore, PRP augmentation did not provide superior functional results at short term evaluation. PMID:26064903

  19. Anterior cruciate ligament (ACL) injury

    MedlinePlus

    ... side of your knee, such as during a football tackle Overextend your knee joint Quickly stop moving ... running, landing from a jump, or turning Basketball, football, soccer, and skiing are common sports linked to ...

  20. Establishment size and risk of occupational injury.

    PubMed

    Oleinick, A; Gluck, J V; Guire, K E

    1995-07-01

    data in the literature on turnover rate by establishment size and risk of injury by time on the job. None of these analyses explains the lower injury rates reported for small establishments. This leaves underreporting of injuries from small establishments as a substantial possibility. If small establishments were subject to the same injury incidence rates as midsize establishments, then the 1986 survey for Michigan may have missed as many as 54,000 injuries (and far more nationally). We suggest that BLS undertake methodological studies to validate the completeness of reporting from small establishments.

  1. Language acculturation and pediatric injury risk.

    PubMed

    Schwebel, David C; Brezausek, Carl M

    2009-06-01

    The number of immigrant children in the US continues to grow rapidly, but pediatric immigrant health remains a poorly understood domain. Previous research suggests immigrant children have reduced risk for injury, but the reason for that finding remains unknown. One leading hypothesis is cultural-less acculturated children in the United States appear to be protected from injury-but the combined influence of immigrant status and acculturation is unclear. This study examines the roles of immigration and language acculturation on pediatric injury risk. Samples of 8,526 children and 4,010 adolescents included in the 2003 California Health Interview Survey were studied. The primary analytic technique was Poisson regressions predicting incidents of injury requiring professional medical attention. Predictor variables included demographic characteristics, health insurance availability, birthplace (US vs. other), and language acculturation. Both birthplace and language acculturation were related to children's and to adolescent's risk for unintentional injury, but language acculturation emerged as the stronger univariate predictor and only multivariate predictor of injury in both models. Possible interpretations of the results are discussed.

  2. Repaired ACL More Likely to Tear Again in Young Women

    MedlinePlus

    ... risk for a repeat tear of the knee's anterior cruciate ligament (ACL) after surgery to repair it, a new study says. The study included just over 500 male and female athletes who underwent ACL reconstruction with a hamstring graft and were followed for ...

  3. Predictors of Lateral Compartment Joint Space Difference at a Minimum of Two Years after ACL Reconstruction

    PubMed Central

    Jones, Morgan H.; Reinke, Emily; Duryea, Jeffrey; Fleming, Braden C.; Obuchowski, Nancy; Winalski, Carl S.; Spindler, Kurt P.

    2016-01-01

    Objectives: ACL reconstruction effectively restores knee stability and allows a return to athletic activities after ACL injury, but patients are still at higher risk of developing post-traumatic OA. Patient reported outcomes from the Multicenter Orthopaedic Outcomes Network (MOON) prospective longitudinal cohort of over 1500 patients undergoing ACL reconstruction showed no increase in OA symptoms (KOOS subscale) at 2 or 6 years after surgery. Therefore, identification of structural changes of OA that may precede the onset of symptoms is of critical importance for determining risk factors for the initiation and progression of post-traumatic OA in addition to measuring the effectiveness of potential disease-modifying treatments. One structural measure of OA is radiographic joint space width (JSW). We previously demonstrated that meniscus treatment and age predict narrower medial compartment JSW. Methods: 335 patients from the MOON cohort (154 males, 181 females, median age 18 years at the time of surgery) were recruited at a minimum of 2 years following surgery for on-site evaluations including bilateral metatarsophalangeal joint (MTP) radiographs to assess JSW. To minimize bias related to pre-existing knee injury or OA, subjects were 35 years or younger, were injured playing a sport, had primary ACL reconstruction without prior meniscus or articular cartilage surgery, did not undergo subsequent ACL revision, and had a surgically normal contralateral knee. Radiographic JSW was measured in the lateral compartment of both knees using a validated semiautomated method. The association of age, sex, BMI, meniscus treatment, and articular cartilage treatment with lateral compartment JSW differences (JSD) between the reconstructed and normal knees was examined using multivariable generalized linear models. The Holm-Bonferroni method was used to account for multiple comparisons. Results: The mean lateral compartment JSW was 7.73 mm and (95% CI 7.61-7.85 mm) for ACL

  4. Rationale and implementation of anterior cruciate ligament injury prevention warm-up programs in female athletes.

    PubMed

    Bien, Daniel P

    2011-01-01

    The sex disparity in anterior cruciate ligament (ACL) injury risk and the subsequent adverse effects on knee joint health, psychosocial well-being, and financial costs incurred have produced a surge in research on risk factors and interventions designed to decrease this disparity and overall incidence. Biomechanical and neuromuscular differences have been identified throughout the trunk and lower extremity that may increase noncontact ACL injury risk in female athletes. Evidence demonstrates that many risk factors are modifiable with intervention programs and that athletic performance measures can be enhanced. No universally accepted ACL injury prevention program currently exists, and injury prevention programs are diverse. Anterior cruciate ligament injury prevention programs introduced in a warm-up format offer multiple benefits, primarily, improved compliance based on improved practicality of implementation. However, drawbacks of warm-up style formats also exist, most notably that a lack of equipment and resources may preclude measurable improvements in athletic performance that foster improved compliance among participants. The purpose of this review is to analyze the current literature researching possible biomechanical and neuromuscular risk factors in noncontact ACL injury in female athletes and the most effective means of implementing critical elements of a program to decrease ACL injury risk in female athletes while improving athletic performance. Hip and hamstring training, core stabilization, plyometrics, balance, agility, neuromuscular training with video and verbal feedback to modify technique, and stretching appear to be essential components of these programs. Further research is critical to determine ideal training program volume, intensity, duration, and frequency.

  5. Risk Factors for Complications of Traumatic Injuries.

    PubMed

    de Aguiar Júnior, Wagner; Saleh, Carmen Mohamad Rida; Whitaker, Iveth Yamaguchi

    2016-01-01

    Complications in hospitalized trauma patients are major causes of morbidity and mortality. The aims of this study were to identify the in-hospital trauma patients' complications and identify the risk factors for complications in this population. A retrospective analysis was conducted in a sample from a Brazilian hospital. The sample consisted of 407 patients, 194 (47.66%) of whom had records of complications. The most common complications were infections (41.80%). The risk factors related to the complications were age, length of hospital stay, external causes, and injury severity. The complications were frequent in this sample, and the risk for complications was characterized by multiple factors. PMID:27618375

  6. Update on rehabilitation following ACL reconstruction

    PubMed Central

    Nyland, John; Brand, Emily; Fisher, Brent

    2010-01-01

    As anterior cruciate ligament (ACL) reconstruction has evolved to less invasive, more anatomical approaches, rehabilitation of the injured athlete has likewise become more progressive and innovative, with a sound understanding of graft and fixation strength and biologic healing-remodeling constraints. This review discusses these innovations including specific considerations before surgery, when planning rehabilitation timetables, and the importance of reestablishing nonimpaired active and passive knee range of motion and biarticular musculotendinous extensibility in positions of function. Concepts of self-efficacy or confidence and reestablishing the “athlete role” are also addressed. Since ACL injury and reinjury are largely related to the influence of structure-form-function on dynamic knee joint stability, the interrelationships between sensorimotor, neuromuscular, and conventional resistance training are also discussed. Although pivot shift “giving way” relates to function loss following ACL injury, anterior translational laxity often does not. Although there is growing evidence that progressive eccentric training may benefit the patient following ACL reconstruction, there is less evidence supporting the use of functional ACL knee braces. Of considerable importance is selecting and achieving a criteria-based progression to sports-specific training, reestablishing osseous homeostasis and improved bone density, blending open and closed kinetic chain exercises at the appropriate time period, and appreciating the influence of the trunk, upper extremities, and sports equipment use on knee loads. We believe that knee dysfunction and functional recovery should be considered from a local, regional, and global perspective. These concepts are consolidated into our approach to prepare patients for return to play including field testing and maintenance training. PMID:24198553

  7. Effect of Neurocognition and Concussion on Musculoskeletal Injury Risk

    PubMed Central

    Herman, Daniel C.; Zaremski, Jason L.; Vincent, Heather K.; Vincent, Kevin R.

    2015-01-01

    Research regarding musculoskeletal injury risk has focused primarily on anatomical, neuromuscular, hormonal, and environmental risk factors; however, subsequent injury risk screening and intervention programs have been largely limited to neuromuscular factors and have faced challenges in both implementation and efficacy. Recent studies indicate that poor neurocognitive performance, either at baseline or in the aftermath of a concussion, is associated with elevated risk of musculoskeletal injury. Despite the relatively limited current understanding regarding the nature of the relationship between different aspects of neurocognitive performance and musculoskeletal injury risk, this is a promising area of research that may yield significant advances in musculoskeletal injury risk stratification, rehabilitation, and prevention. PMID:25968852

  8. Augmented Feedback Supports Skill Transfer and Reduces High-Risk Injury Landing Mechanics

    PubMed Central

    Myer, Gregory D.; Stroube, Benjamin W.; DiCesare, Christopher A.; Brent, Jensen L.; Ford, Kevin R.; Heidt, Robert S.; Hewett, Timothy E.

    2014-01-01

    Background There is a current need to produce a simple, yet effective method for screening and targeting possible deficiencies related to increased anterior cruciate ligament (ACL) injury risk. Hypothesis Frontal plane knee angle (FPKA) during a drop vertical jump will decrease upon implementing augmented feedback into a standardized sport training program. Study Design Controlled laboratory study. Methods Thirty-seven female participants (mean ± SD: age, 14.7 ±1.5 years; height, 160.9 ± 6.8 cm; weight, 54.5 ± 7.2 kg) were trained over 8 weeks. During each session, each participant received standardized training consisting of strength training, plyometrics, and conditioning. They were also videotaped running on a treadmill at a standardized speed and performing a repeated tuck jump for 10 seconds. Study participants were randomized into 2 groups and received augmented feedback on either their jumping (AF) or sprinting (CTRL) form. Average (mean of 3 trials) and most extreme (trial with greatest knee abduction) FPKA were calculated from 2-dimensional video captured during performance of the drop vertical jump. Results After testing, a main effect of time was noted, with the AF group reducing their FPKA average by 37.9% over the 3 trials while the CTRL group demonstrated a 26.7% reduction average across the 3 trials (P < .05). Conversely, in the most extreme drop vertical jump trial, a significant time-by-group interaction was noted (P < .05). The AF group reduced their most extreme FPKA by 6.9° (pretest, 18.4° ± 12.3°; posttest, 11.4° ± 10.1°) on their right leg and 6.5° (pretest, 16.3° ± 14.5°; posttest, 9.8° ± 10.7°) on their left leg, which represented a 37.7% and 40.1 % reduction in FPKA, respectively. In the CTRL group, no similar changes were noted in the right (pretest, 16.9° ± 14.3°; posttest, 14.0° ± 12.3°) or left leg (pretest, 9.8° ± 11.1°; posttest, 7.2° ± 9.2°) after training. Conclusion Providing athletes with augmented

  9. Posttraumatic knee osteoarthritis following anterior cruciate ligament injury: Potential biochemical mediators of degenerative alteration and specific biochemical markers

    PubMed Central

    LI, HONG; CHEN, CHEN; CHEN, SHIYI

    2015-01-01

    As a common injury, anterior cruciate ligament (ACL) injury is unable to heal itself naturally, which possibly increases knee instability, accelerates the risk of joint degeneration and leads to knee osteoarthritis (OA) in the ACL-injured knee. Thus, ACL reconstruction using an autograft or allograft tendon is proposed to maintain the biomechanical stability of the knee joint. However, previous studies demonstrate that surgical management of ACL reconstruction failed to abrogate the development of OA completely, indicating that biochemical disturbance is responsible for the osteoarthritic changes observed following ACL injury. Inflammatory mediators are elevated subsequent to ACL injury or rupture, inducing matrix metalloproteinase production, proteoglycan degradation, collagen destruction, chondrocyte necrosis and lubricin loss. These potential biochemical mediators may aid in the development of effective biological management to reduce the onset of future posttraumatic OA. Furthermore, during the degenerative process of cartilage, there are a number of cartilage-specific biomarkers, which play a critical step in the loss of structural and functional integrity of cartilage. The present review illustrates several specific biomarkers in the ACL-injured knee joint, which may provide effective diagnostic and prognostic tools for investigating cartilage degenerative progression and future posttraumatic OA of ACL-injured patients. PMID:25798238

  10. Bridge-Enhanced ACL Repair: A Review of the Science and the Pathway through FDA Investigational Device Approval

    PubMed Central

    Proffen, Benedikt L.; Perrone, Gabriel S.; Roberts, Gordon; Murray, Martha M.

    2016-01-01

    Injuries to the anterior cruciate ligament (ACL) are currently treated with replacement of the torn ligament with a graft of tendon harvested from elsewhere in the knee. This procedure, called "ACL reconstruction," is excellent for restoring gross stability to the knee; however, there are relatively high graft failure rates in adolescent patients,4, 12, 60 and the ACL reconstruction procedure does not prevent the premature osteoarthritis seen in patients after an ACL injury.1, 46, 52 Thus, new solutions are needed for ACL injuries. Researchers have been investigating the use of scaffolds, growth factors and cells to supplement a suture repair of the ACL (bio-enhanced repair). In this paper, we will review the varied approaches, which have been investigated for stimulating ACL healing and repair in preclinical models and how one of these technologies was able to move from promising preclinical results to FDA acceptance of an Investigational Device Exemption (IDE) application for a first-in-human study. PMID:25631206

  11. Histological Predictors of Maximum Failure Loads Differ Between the Healing ACL and ACL Grafts After 6 and 12 Months In Vivo

    PubMed Central

    Proffen, Benedikt L.; Fleming, Braden C.; Murray, Martha M.

    2013-01-01

    Background: Bioenhanced anterior cruciate ligament (ACL) repair, where the suture repair is supplemented with a biological scaffold, is a promising novel technique to stimulate healing after ACL rupture. However, the histological properties of a successfully healing ACL and how they relate to the mechanical properties have not been fully described. Purpose: To determine which histological features best correlate with the mechanical properties of the healing ACL repairs and ACL grafts in a porcine model at 6 and 12 months after injury. Study Design: Controlled laboratory study. Methods: A total of 48 Yucatan mini-pigs underwent ACL transection followed by: (1) conventional ACL reconstruction with bone–patellar tendon–bone (BPTB) allograft, (2) bioenhanced ACL reconstruction with BPTB allograft using a bioactive scaffold, or (3) bioenhanced ACL repair using the same bioactive scaffold. After 6 and 12 months of healing, structural properties of the ACL or graft (yield and failure load, linear stiffness) were measured. Following mechanical testing, ACL specimens were histologically analyzed for cell and vascular density and qualitatively assessed using the advanced Ligament Maturity Index. Results: After 6 months of healing, the cellular organization subscore was most predictive of yield load (r 2 = 0.98), maximum load (r 2 = 0.89), and linear stiffness (r 2 = 0.95) of the healing ACL, while at 12 months, the collagen subscore (r 2 = 0.68) became the best predictor of maximum load. For ACL grafts, the reverse was true, with the collagen subscore predictive of yield and maximum loads at 6 months (r 2 = 0.55) and graft cellularity predictive of maximum load of the graft at 12 months (r 2 = 0.50). Conclusion: These findings suggest there may be key biological differences in development and maintenance of ACL tissue after repair or reconstruction, with early ligament function dependent on cellular population of the repair but early graft function dependent on the

  12. Understanding perceptions of injury risk associated with playing junior cricket.

    PubMed

    White, Peta E; Finch, Caroline F; Dennis, Rebecca; Siesmaa, Emma

    2011-03-01

    Preventing sports injuries in children is important, but there is limited information about children's perceptions of injury risk or their injury beliefs and attitudes. This study investigated injury risk perceptions in a sample of junior sports participants across different age levels of play. Junior cricket players (n=284, aged 8-16) completed a survey about their injury risk perceptions. Survey questions asked about players' perceived injury risk to themselves compared to cricketers in general, as well as their perceived injury risk across different playing position, ground condition, and protective equipment use scenarios. Chi-square analysis found that risk perceptions were significantly higher in U12 and U14 players for both batting and fielding compared to U16 players and that U16 players had a higher risk perception associated with bowling. Players tended to see themselves as less likely to be injured than cricketers in general and perceived there to be a high risk of injury when fielding close to the batter and a comparatively low risk of injury when fielding in the outfield. Junior players also perceived there to be a high injury risk associated with playing on hard and bumpy grounds. Despite their relatively accurate perceptions of risk and appreciation for the importance of protective equipment, junior players need continual reminding of the importance of safety strategies by coaches and others. Coaches need to inform players that fielding injuries can occur anywhere on the ground, and include skills practice accordingly.

  13. ACL reconstruction in children: a transphyseal technique.

    PubMed

    Lemaitre, G; Salle de Chou, E; Pineau, V; Rochcongar, G; Delforge, S; Bronfen, C; Haumont, T; Hulet, C

    2014-06-01

    The annual incidence of ACL tears is increasing steadily in pediatric patients. Chronic anterior instability causes meniscal lesions at a frequency that increases significantly with the injury-to-surgery interval. Conservative therapy, simple suturing, and isolated extra-articular tendon reconstruction are associated with high failure rates. Intra-articular arthroscopy-assisted tendon reconstruction is a good treatment method, although several different techniques have been described. We used a transphyseal technique with a hamstring tendon graft to treat 14 knees in 13 patients with a mean age of 13 years and 7 months. Mean injury-to-surgery interval was 6 months. Strict compliance with technical rules is required when using this technique. Bone tunnel diameter must not exceed 8 mm. Bone tunnels must be as vertical and central as possible. The fixation material must not bridge the physis (at the femur, cortical fixation; and at the tibia, fixation using a resorbable screw no longer than 25 mm combined with a staple). Meniscal lesions were present in half the knees and meniscal preservation considered mandatory. Conservative treatment of concomitant lesions was performed routinely. After a mean follow-up of 15 months, no recurrent tears or revision procedures for meniscectomy had been recorded. The IKDC grade was A or B in 93% of knees. The mean subjective IKDC score was 83.3 and the Lysholm score was in the excellent or good range in 93% of knees. Of the 14 knees, 2 exhibited signs suggesting femoral epiphysiodesis, with 4° of valgus deformity compared to the contra-lateral knee and no clinical consequences. Transphyseal reconstruction with open physes conducted in strict compliance with technical rules can be performed to control the instability and preserve the menisci. Nevertheless, this technique carries a risk of epiphysiodesis, chiefly at the femur.

  14. Stability Outcomes following Computer-Assisted ACL Reconstruction

    PubMed Central

    Christino, Melissa A.; Vopat, Bryan G.; Matson, Andrew P.; Reinert, Steven E.; Shalvoy, Robert M.

    2015-01-01

    Purpose. The purpose of this study was to determine whether intraoperative prereconstruction stability measurements and/or patient characteristics were associated with final knee stability after computer-assisted ACL reconstruction. Methods. This was a retrospective review of all patients who underwent computer-assisted single-bundle ACL reconstruction by a single surgeon. Prereconstruction intraoperative stability measurements were correlated with patient characteristics and postreconstruction stability measurements. 143 patients were included (87 male and 56 female). Average age was 29.8 years (SD ± 11.8). Results. Females were found to have significantly more pre- and postreconstruction internal rotation than males (P < 0.001 and P = 0.001, resp.). Patients with additional intra-articular injuries demonstrated more prereconstruction anterior instability than patients with isolated ACL tears (P < 0.001). After reconstruction, these patients also had higher residual anterior translation (P = 0.01). Among all patients with ACL reconstructions, the percent of correction of anterior translation was found to be significantly higher than the percent of correction for internal or external rotation (P < 0.001). Conclusion. Anterior translation was corrected the most using a single-bundle ACL reconstruction. Females had higher pre- and postoperative internal rotation. Patients with additional injuries had greater original anterior translation and less operative correction of anterior translation compared to patients with isolated ACL tears. PMID:25883804

  15. Altered Loading in the Injured Knee after ACL Rupture

    PubMed Central

    Gardinier, Emily S.; Manal, Kurt; Buchanan, Thomas S.; Snyder-Mackler, Lynn

    2012-01-01

    Articular loading is an important factor in the joint degenerative process for individuals with anterior cruciate ligament (ACL) rupture. Evaluation of loading for a population that exhibits neuromuscular compensation for injury requires an approach which can incorporate individual muscle activation strategies in its estimation of muscle forces. The purpose of this study was to evaluate knee joint contact forces for patients with ACL deficiency using an EMG-driven modeling approach to estimate muscle forces. Thirty (30) athletes with acute, unilateral ACL rupture underwent gait analysis after resolving range of motion, effusion, pain and obvious gait impairments. Electromyography was recorded bilaterally from 14 lower extremity muscles and input to a musculoskeletal model for estimation of muscle forces and joint contact forces. Gait mechanics were consistent with previous reports for individuals with ACL-deficiency. Our major finding was that joint loading was altered in the injured limb after acute ACL injury; patients walked with decreased contact force on their injured knee compared to their uninjured knee. Both medial and lateral compartment forces were reduced without a significant change in the distribution of tibiofemoral load between compartments. This is the first study to estimate medial and lateral compartment contact forces in patients with acute ACL rupture using an approach which is sensitive to individual muscle activation patterns. Further work is needed to determine whether this early decreased loading of the injured limb is involved in the development of osteoarthritis in these patients. PMID:23097309

  16. Popliteus function in ACL-deficient patients.

    PubMed

    Weresh, M J; Gabel, R H; Brand, R A; Tearse, D S

    1994-01-01

    Anterior cruciate ligament (ACL) injuries commonly result in anterolateral instability, resulting in a "pivot shift" phenomenon. Given that popliteus muscle stimulation results in a pivot shift, others have postulated that the popliteus muscle has a role in the pivot shift phenomenon. We hypothesized that patients with instability from ACL injuries may have excessive popliteus muscle activity. Therefore, we studied the EMG activity (using fine wire electrodes) of the popliteus muscle in sixteen normal subjects and ten ACL-deficient subjects. We recorded the EMG in six activities (level walking and jogging, ascending walking and jogging, and descending walking and jogging). Person's Product Moment Correlations were above 0.7, except in the case of ascending the treadmill (r = 0.427) and ascending jogging (r = 0.645), suggesting that the timing of the signals was similar for injured and uninjured limbs. Variance ratios for the injured and uninjured limbs were statistically similar, suggesting similar variability of patterns. Thus, we observed only minor popliteus EMG signal differences in this group of patients. We conclude that the popliteus muscle does not contribute to instability in the studied activities.

  17. Biomechanical and neuromuscular characteristics of male athletes: implications for the development of anterior cruciate ligament injury prevention programs.

    PubMed

    Sugimoto, Dai; Alentorn-Geli, Eduard; Mendiguchía, Jurdan; Samuelsson, Kristian; Karlsson, Jon; Myer, Gregory D

    2015-06-01

    Prevention of anterior cruciate ligament (ACL) injury is likely the most effective strategy to reduce undesired health consequences including reconstruction surgery, long-term rehabilitation, and pre-mature osteoarthritis occurrence. A thorough understanding of mechanisms and risk factors of ACL injury is crucial to develop effective prevention programs, especially for biomechanical and neuromuscular modifiable risk factors. Historically, the available evidence regarding ACL risk factors has mainly involved female athletes or has compared male and female athletes without an intra-group comparison for male athletes. Therefore, the principal purpose of this article was to review existing evidence regarding the investigation of biomechanical and neuromuscular characteristics that may imply aberrant knee kinematics and kinetics that would place the male athlete at risk of ACL injury. Biomechanical evidence related to knee kinematics and kinetics was reviewed by different planes (sagittal and frontal/coronal), tasks (single-leg landing and cutting), situation (anticipated and unanticipated), foot positioning, playing surface, and fatigued status. Neuromuscular evidence potentially related to ACL injury was reviewed. Recommendations for prevention programs for ACL injuries in male athletes were developed based on the synthesis of the biomechanical and neuromuscular characteristics. The recommendations suggest performing exercises with multi-plane biomechanical components including single-leg maneuvers in dynamic movements, reaction to and decision making in unexpected situations, appropriate foot positioning, and consideration of playing surface condition, as well as enhancing neuromuscular aspects such as fatigue, proprioception, muscle activation, and inter-joint coordination.

  18. Popliteus function in ACL-deficient patients.

    PubMed

    Weresh, M J; Gabel, R H; Brand, R A; Tearse, D S

    1997-02-01

    Anterior cruciate ligament (ACL) injuries commonly result in anterolateral rotary instability and a 'pivot shift' phenomenon. Since popliteus muscle stimulation causes a pivot shift, some postulate the popliteus muscle plays a role in causing pivot shifts. To see if patients with pivot shifts exhibited excessive popliteus muscle activity, we studied fine-wire EMGs of the popliteus in 16 normal subjects and 10 ACL-deficient subjects. Subjects performed six activities (level walking and jogging, ascending walking and jogging, and descending walking and jogging). Except for minor timing differences in ascending treadmill and ascending jogging, the signals were similar for injured and uninjured limbs; similar variance ratios suggested similar pattern variability. Thus, we observed only minor popliteus EMG signal differences in this group of patients. We conclude that the popliteus muscle does not actively contribute to instability in the studied activities.

  19. Effect of Timing of Surgery in Partially Injured ACLs.

    PubMed

    Li, Bin; Bai, Lunhao; Fu, Yonghui; Wang, Guangbin; He, Ming; Wang, Jiashi

    2012-05-01

    The purpose of this study was to explore the optimal timing for surgical intervention of partially injured anterior cruciate ligaments (ACL). Thirty-eight patients were divided into early (n=17) or delayed (n=21) surgery groups based on the interval between injury and surgery. Minimum follow-up was 2 years. The outcome measures used were the International Knee Documentation Committee score, Lysholm knee score, Tegner activity rating, range of motion, and arthrometer measurements. The findings of this study indicate that early surgical reconstruction of partially ruptured ACLs did not result in arthrofibrosis but may prevent secondary loosening of the intact bundles and further meniscal and chondral injury.

  20. Impact Differences in Ground Reaction Force and Center of Mass Between the First and Second Landing Phases of a Drop Vertical Jump and their Implications for Injury Risk Assessment

    PubMed Central

    Bates, Nathaniel A.; Ford, Kevin R.; Myer, Gregory D.; Hewett, Timothy E.

    2013-01-01

    The drop vertical jump (DVJ) task is commonly used to assess biomechanical performance measures that are associated with ACL injury risk in athletes. Previous investigations have solely assessed the first landing phase. We examined the first and second landings of a DVJ for differences in the magnitude of vertical ground reaction force (vGRF) and position of center of mass (CoM). A cohort of 239 adolescent female basketball athletes completed a series of DVJ tasks from an initial box height of 31 cm. Dual force platforms and a three dimensional motion capture system recorded force and positional data for each trial. There was no difference in peak vGRF between landings (p = 0.445), but side-to-side differences increased from the first to second landing (p = 0.007). Participants demonstrated a lower minimum CoM during stance in the first landing than the second landing (p < 0.001). The results have important implications for the future assessment of ACL injury risk behaviors in adolescent female athletes. Greater side-to-side asymmetry in vGRF and higher CoM during impact indicate the second landing of a DVJ may exhibit greater perturbation and better represent in-game mechanics associated with ACL injury risk. PMID:23538000

  1. Impact differences in ground reaction force and center of mass between the first and second landing phases of a drop vertical jump and their implications for injury risk assessment.

    PubMed

    Bates, Nathaniel A; Ford, Kevin R; Myer, Gregory D; Hewett, Timothy E

    2013-04-26

    The drop vertical jump (DVJ) task is commonly used to assess biomechanical performance measures that are associated with ACL injury risk in athletes. Previous investigations have solely assessed the first landing phase. We examined the first and second landings of a DVJ for differences in the magnitude of vertical ground reaction force (vGRF) and position of center of mass (CoM). A cohort of 239 adolescent female basketball athletes completed a series of DVJ tasks from an initial box height of 31 cm. Dual force platforms and a three dimensional motion capture system recorded force and positional data for each trial. There was no difference in peak vGRF between landings (p=0.445), but side-to-side differences increased from the first to second landing (p=0.007). Participants demonstrated a lower minimum CoM during stance in the first landing than the second landing (p<0.001). The results have important implications for the future assessment of ACL injury risk behaviors in adolescent female athletes. Greater side-to-side asymmetry in vGRF and higher CoM during impact indicate the second landing of a DVJ may exhibit greater perturbation and better represent in-game mechanics associated with ACL injury risk.

  2. Characteristics of anterior cruciate ligament injuries in Australian football.

    PubMed

    Cochrane, Jodie L; Lloyd, David G; Buttfield, Alec; Seward, Hugh; McGivern, Jeanne

    2007-04-01

    Anterior cruciate ligament (ACL) injuries are the most costly injuries in football at both professional and amateur levels (Orchard J, Seward H, McGivern J, Hood S. Intrinsic and extrinsic risk factors for anterior cruciate ligament injury in Australian footballers. Am J Sports Med 2001;29:196-200.). In this study video analysis of 34 ACL injuries in Australian football was performed to investigate the causes of these injuries. Factors that may have contributed to the cause of the injury were analysed, rated and reported. The factors analysed were: type of manoeuvre, direction the knee 'gave way', running speed, knee angle, cutting angle and if the player was accelerating or decelerating. The majority of the injuries analysed occurred in non-contact situations (56%). Of these 37% occurred during sidestepping manoeuvres, 32% in landing, 16% land and step, 10% stopping/slowing and 5% crossover cut manoeuvres. Ninety-two percent of the non-contact injuries occurred at extended knee angles of 30 degrees or less, which is also commonly known to place stress on the ACL and reduce the protective role of hamstrings. Over half (54%) of non-contact injuries occurred whilst decelerating. It would be expected that greater speed and angle cut too would increase the frequency of ACL injury. The results could not confirm this with most injuries occurring at running speeds of slow jogging to running and equal number of injuries occurred at cutting to angles of the ranges 15-45 degrees and 45-75 degrees. These results give greater understanding into potential causes or contributors of ACL injury and information to assist in the development of knee injury prevention programs. PMID:16807104

  3. Caffeinated Alcohol, Sensation Seeking, and Injury Risk

    PubMed Central

    McCoy, Thomas P.; Egan, Kathleen L.; Goldin, Shoshanna; Rhodes, Scott D.; Wolfson, Mark

    2013-01-01

    Background College students who consume caffeinated alcoholic beverages (CaffAlc) are at increased injury risk. This study examines the extent to which a sensation-seeking personality accounts for the relationship between consumption of CaffAlc and negative outcomes. Methods A Web-based survey was administered to stratified random samples of 4907 college students from eight North Carolina universities in Fall 2009. Sensation seeking was assessed using the Brief Sensation-Seeking Scale (BSSS) (α=0.81). Data were analyzed using linear and logistic regression. Results 3390 students (71.2%) reported past 30-day drinking, of whom 786 (23.2%) consumed CaffAlc. CaffAlc past 30-day drinkers had higher BSSS scores (3.8 vs. 3.4; p<0.001), compared to non-CaffAlc drinkers. Consumption of CaffAlc was associated with more frequent binge drinking (p<0.001) and drunken days in a typical week (p<0.001), even after adjusting for the BSSS score. CaffAlc students were more likely to be taken advantage of sexually (adjusted odds ratio [AOR]=1.70, p=0.012), drive under the influence of alcohol (AOR=2.00, p<0.001), and ride with a driver under the influence of alcohol (AOR=1.87, p<0.001). Injury requiring medical treatment was more prevalent among CaffAlc students with higher BSSS-8 scores (interaction p=0.024), even after adjustment for drinking levels and student characteristics. Conclusions Sensation seeking does not fully account for the increase in risky drinking among college students who consume CaffAlc, nor does it moderate the relationship between CaffAlc and drinking behaviors. Sensation seeking moderates the risk of alcohol-associated injury requiring medical treatment among college students who consume CaffAlc. Those with strong sensation-seeking dispositions are at the highest risk of alcohol-associated injury requiring medical treatment. PMID:24761275

  4. Risk of cervical injuries in mixed martial arts

    PubMed Central

    Kochhar, T; Back, D; Mann, B; Skinner, J

    2005-01-01

    Background: Mixed martial arts have rapidly succeeded boxing as the world's most popular full contact sport, and the incidence of injury is recognised to be high. Objective: To assess qualitatively and quantitatively the potential risk for participants to sustain cervical spine and associated soft tissue injuries. Methods: Four commonly performed manoeuvres with possible risks to the cervical spine were analysed with respect to their kinematics, and biomechanical models were constructed. Results: Motion analysis of two manoeuvres revealed strong correlations with rear end motor vehicle impact injuries, and kinematics of the remaining two suggested a strong risk of injury. Mathematical models of the biomechanics showed that the forces involved are of the same order as those involved in whiplash injuries and of the same magnitude as compression injuries of the cervical spine. Conclusions: This study shows that there is a significant risk of whiplash injuries in this sport, and there are no safety regulations to address these concerns. PMID:15976168

  5. Knee functional recovery and limb-to-limb symmetry restoration after anterior cruciate ligament (ACL) rupture and ACL reconstruction

    NASA Astrophysics Data System (ADS)

    Nawasreh, Zakariya Hussein

    Anterior cruciate ligament (ACL) rupture is a common sport injury of young athletes who participate in jumping, cutting, and pivoting activities. Although ACL reconstruction (ACLR) surgery has the goal of enabling athletes to return to preinjury activity levels, treatment results often fall short of this goal. The outcomes after ACLR are variable and less than optimal with low rate of return to preinjury activity level and high risk for second ACL injury. Factors related to the knee functional limitations, strength deficits, and limb-to-limb movement asymmetry may be associated with poor outcomes after ACLR. Additionally, the criteria that are used to determine a patient's readiness to return to the preinjury activity level are undefined which may also be associated with poor outcomes after ACLR. The clinical decision-making to clear patients' for safe and successful return to high physical activities should be based on a universal comprehensive set of objective criteria that ensure normal knee function and limb-to-limb symmetry. A battery of return to activity criteria (RTAC) that emphases normal knee function and limb-to-limb movement symmetry has been constituted to better ensure safe and successful return to preinjury activity level. Yet, only variables related to patients' demographics, concomitant injuries, and treatment measures have been used to predict return to preinjury activity levels after ACLR. However, the ability of RTAC variables that ensure normal knee function and limb movement symmetry to predict the return to participate in the same preinjury activity level after ACLR has not been investigated. In light of this background, the first aim of the present study was to compare functional knee performance-based and patient-reported measures of those who PASS and who FAIL on RTAC at 6 months (6-M) following ACLR with those at 12 months (12-M) and 24 months (24-M) following ACLR and to determine how performance-based and patient-reported measures

  6. Occupational injury risk by sex in a manufacturing cohort

    PubMed Central

    Tessier-Sherman, Baylah; Cantley, Linda F; Galusha, Deron; Slade, Martin D; Taiwo, Oyebode A; Cullen, Mark R

    2014-01-01

    Objectives This study expands previous research comparing injury risk for women and men in a cohort of 24 000 US aluminium manufacturing workers in 15 facilities from 2001 to 2010. Methods We compared injury rates (all injury, first aid, medical treatment, restricted work and lost work time) by sex and by job and sex. Using a mixed effect modelling approach, we calculated ORs and 95% CIs adjusting for age, job tenure, ethnicity and year as fixed effects and person, job and plant as random effects. Additionally, we modelled the data stratified by plant type to examine potential differences in injury risk between smelter (generally recognised as more hazardous) and fabrication production environments. Results Risk of injury was higher for women in four out of the five injury outcomes: all injuries combined (OR: 1.58, CI 1.48 to 1.67), injuries requiring first aid (OR: 1.61, CI 1.54 to 1.70), injuries requiring medical treatment (OR: 1.18, CI 1.03 to 1.36) and injuries requiring restricted work (OR: 1.65, CI 1.46 to 1.87). No difference in the risk of lost time injury by sex was found in this cohort. Analyses stratified by plant type showed similarly elevated injury risk for women, although the risk estimates were higher in smelters than fabrication plants. Conclusions To our knowledge, this is the largest single-firm study examining injury risk by sex with sufficient data to appropriately adjust for job. We show a consistently higher injury risk for women compared with men in the smelting and fabrication environments. PMID:24924313

  7. Pedestrian injury risk and the effect of age.

    PubMed

    Niebuhr, Tobias; Junge, Mirko; Rosén, Erik

    2016-01-01

    Older adults and pedestrians both represent especially vulnerable groups in traffic. In the literature, hazards are usually described by the corresponding injury risks of a collision. This paper investigates the MAIS3+F risk (the risk of sustaining at least one injury of AIS 3 severity or higher, or fatal injury) for pedestrians in full-frontal pedestrian-to-passenger car collisions. Using some assumptions, a model-based approach to injury risk, allowing for the specification of individual injury risk parameters for individuals, is presented. To balance model accuracy and sample size, the GIDAS (German In-depth Accident Study) data set is divided into three age groups; children (0-14); adults (15-60); and older adults (older than 60). For each group, individual risk curves are computed. Afterwards, the curves are re-aggregated to the overall risk function. The derived model addresses the influence of age on the outcome of pedestrian-to-car accidents. The results show that older people compared with younger people have a higher MAIS3+F injury risk at all collision speeds. The injury risk for children behaves surprisingly. Compared to other age groups, their MAIS3+F injury risk is lower at lower collision speeds, but substantially higher once a threshold has been exceeded. The resulting injury risk curve obtained by re-aggregation looks surprisingly similar to the frequently used logistic regression function computed for the overall injury risk. However, for homogenous subgroups - such as the three age groups - logistic regression describes the typical risk behavior less accurately than the introduced model-based approach. Since the effect of demographic change on traffic safety is greater nowadays, there is a need to incorporate age into established models. Thus far, this is one of the first studies incorporating traffic participant age to an explicit risk function. The presented approach can be especially useful for the modeling and prediction of risks, and for the

  8. Pedestrian injury risk and the effect of age.

    PubMed

    Niebuhr, Tobias; Junge, Mirko; Rosén, Erik

    2016-01-01

    Older adults and pedestrians both represent especially vulnerable groups in traffic. In the literature, hazards are usually described by the corresponding injury risks of a collision. This paper investigates the MAIS3+F risk (the risk of sustaining at least one injury of AIS 3 severity or higher, or fatal injury) for pedestrians in full-frontal pedestrian-to-passenger car collisions. Using some assumptions, a model-based approach to injury risk, allowing for the specification of individual injury risk parameters for individuals, is presented. To balance model accuracy and sample size, the GIDAS (German In-depth Accident Study) data set is divided into three age groups; children (0-14); adults (15-60); and older adults (older than 60). For each group, individual risk curves are computed. Afterwards, the curves are re-aggregated to the overall risk function. The derived model addresses the influence of age on the outcome of pedestrian-to-car accidents. The results show that older people compared with younger people have a higher MAIS3+F injury risk at all collision speeds. The injury risk for children behaves surprisingly. Compared to other age groups, their MAIS3+F injury risk is lower at lower collision speeds, but substantially higher once a threshold has been exceeded. The resulting injury risk curve obtained by re-aggregation looks surprisingly similar to the frequently used logistic regression function computed for the overall injury risk. However, for homogenous subgroups - such as the three age groups - logistic regression describes the typical risk behavior less accurately than the introduced model-based approach. Since the effect of demographic change on traffic safety is greater nowadays, there is a need to incorporate age into established models. Thus far, this is one of the first studies incorporating traffic participant age to an explicit risk function. The presented approach can be especially useful for the modeling and prediction of risks, and for the

  9. Performance and return-to-sport after ACL reconstruction in NFL quarterbacks.

    PubMed

    Erickson, Brandon J; Harris, Joshua D; Heninger, Jacob R; Frank, Rachel; Bush-Joseph, Charles A; Verma, Nikhil N; Cole, Brian J; Bach, Bernard R

    2014-08-01

    Anterior cruciate ligament (ACL) rupture is a significant injury in National Football League (NFL) quarterbacks. The purpose of this study was to determine (1) return-to-sport (RTS) rate in NFL quarterbacks following ACL reconstruction, (2) performance upon RTS, and (3) the difference in RTS and performance between players who underwent ACL reconstruction and controls. Thirteen quarterbacks (14 knees) who met inclusion criteria underwent ACL reconstruction while in the NFL. Matched controls were selected from the NFL during the same time span to compare and analyze age, body mass index (BMI), position, performance, and NFL experience. Student t tests were performed for analysis of within- and between-group variables. Bonferroni correction was used in the setting of multiple comparisons. Twelve quarterbacks (13 knees; 92%) were able to RTS in the NFL. Mean player age was 27.2±2.39 years. Mean career length in the NFL following ACL reconstruction was 4.85±2.7 years. Only 1 player needed revision ACL reconstruction. In both cases and controls, player performance was not significantly different from preinjury performance after ACL reconstruction (or index year in controls). There was also no significant performance difference between case and control quarterbacks following ACL reconstruction (or index year in controls). There is a high rate of RTS in the NFL following ACL reconstruction. In-game performance following ACL reconstruction was not significantly different from preinjury or from controls.

  10. Anterior cruciate ligament- specialized post-operative return-to-sports (ACL-SPORTS) training: a randomized control trial

    PubMed Central

    2013-01-01

    Background Anterior cruciate ligament reconstruction (ACLR) is standard practice for athletes that wish to return to high-level activities; however functional outcomes after ACLR are poor. Quadriceps strength weakness, abnormal movement patterns and below normal knee function is reported in the months and years after ACLR. Second ACL injuries are common with even worse outcomes than primary ACLR. Modifiable limb-to-limb asymmetries have been identified in individuals who re-injure after primary ACLR, suggesting a neuromuscular training program is needed to improve post-operative outcomes. Pre-operative perturbation training, a neuromuscular training program, has been successful at improving limb symmetry prior to surgery, though benefits are not lasting after surgery. Implementing perturbation training after surgery may be successful in addressing post-operative deficits that contribute to poor functional outcomes and second ACL injury risk. Methods/Design 80 athletes that have undergone a unilateral ACLR and wish to return to level 1 or 2 activities will be recruited for this study and randomized to one of two treatment groups. A standard care group will receive prevention exercises, quadriceps strengthening and agility exercises, while the perturbation group will receive the same exercise program with the addition of perturbation training. The primary outcomes measures will include gait biomechanics, clinical and functional measures, and knee joint loading. Return to sport rates, return to pre-injury level of activity rates, and second injury rates will be secondary measures. Discussion The results of this ACL-Specialized Post-Operative Return To Sports (ACL-SPORTS) Training program will help clinicians to better determine an effective post-operative treatment program that will improve modifiable impairments that influence outcomes after ACLR. Trial registration Randomized Control Trial NIH 5R01AR048212-07. ClinicalTrials.gov: NCT01773317 PMID:23522373

  11. Exercise affects joint injury risk in young Thoroughbreds in training.

    PubMed

    Reed, Suzanne R; Jackson, Brendan F; Wood, James L N; Price, Joanna S; Verheyen, Kristien L P

    2013-06-01

    The aim of this study was to identify exercise-related risk factors for carpal and metacarpo- and metatarso-phalangeal (MCP/MTP) joint injury occurrence in young Thoroughbreds in flat race training. In a 2-year prospective cohort study, daily exercise and joint injury data were collected from horses in 13 training yards in England. Four injury categories were defined: (1) localised to a carpal or MCP/MTP joint based on clinical examination and/or use of diagnostic analgesia with no diagnostic imaging performed; (2) localised to a carpal or MCP/MTP joint with no abnormalities detected on diagnostic images; (3) abnormality of subchondral bone and/or articular margin(s) identified using diagnostic imaging; (4) fracture or fragmentation identified by diagnostic imaging. Multivariable Cox regression analysis was conducted to determine risk factors for injury occurrence, by type (carpal or MCP/MTP) and category. Exercise distances at canter and high speed in different time periods were modelled as continuous time-varying variables. A total of 647 horses spent 7785months at risk of joint injury and 184 injuries were recorded. Increasing daily canter distance reduced the risk of Category 1 and Category 3 injuries whereas greater 30-day canter distances increased Category 4 injury risk. More weekly high-speed exercise increased Category 1 injury risk. MCP/MTP injury risk reduced with increasing daily canter distance but increased with accumulation of canter or high-speed exercise since entering training, whereas accumulation of canter exercise was marginally associated with reduced carpal injury risk. Risk of all injury types varied significantly between trainers. The results of this study suggest that regular canter exercise is generally beneficial for joint health, while accumulation of high-speed exercise detrimentally affects MCP/MTP joints.

  12. Tennis specific limitations in players with an ACL deficient knee

    PubMed Central

    Maquirriain, J; Megey, P J

    2006-01-01

    Background Complete rupture of the anterior cruciate ligament (ACL) causes significant alteration of knee joint kinematics. Untreated patients often develop joint instability, chronic articular degeneration, and knee dysfunction. Demands on the ACL produced by playing tennis have not been investigated. Objective To identify subjective sport‐specific limitations in tennis players with isolated unilateral ACL deficiency. Study design Prospective case–control study. Methods 16 players (mean (SD) age, 39.9 (2.3) years; 14 men) with a chronic unilateral ACL deficient knee and 16 healthy controls (38.25 (8.47) years; 14 men) were recruited. ACL deficiency was confirmed by clinical and magnetic resonance imaging. A Lysholm score was obtained in all patients, together with subjective evaluation of their current tennis performance compared with pre‐injury levels, applying a 0–100% visual scale. Both groups completed a questionnaire on tennis specific abilities. Results Lysholm scores were: 85.6 (10.3) points in the study group and 100 (0) points in the control group (p<0.001, t test for independent samples). Injured players evaluated their current tennis performance as 66.8 (15.2)% compared with 100% pre‐injury level (p<0.005, t test for dependent samples). Abilities affected in the ACL deficient group were landing after a smash stroke (p<0.001); stopping abruptly and changing (p<0.001); playing a three set singles match (p<0.05); and playing on a hard court surface (p<0.001, Kolmogorov‐Smirnov test). Conclusions There are specific limitations associated with complete isolated ACL rupture, including subjective tennis performance impairment, limitations landing after a smash, stopping and changing step direction, difficulties playing a three set singles match, and playing on hard court surfaces. PMID:16632578

  13. Knee instability scores for ACL reconstruction.

    PubMed

    Rahnemai-Azar, Ata A; Naendrup, Jan-Hendrik; Soni, Ashish; Olsen, Adam; Zlotnicki, Jason; Musahl, Volker

    2016-06-01

    Despite abundant biological, biomechanical, and clinical research, return to sport after anterior cruciate ligament (ACL) injury remains a significant challenge. Residual rotatory knee laxity has been identified as one of the factors responsible for poor functional outcome. To improve and standardize the assessment of knee instability, a variety of instability scoring systems is available. Recently, devices to objectively quantify static and dynamic clinical exams have been developed to complement traditional subjective grading systems. These devices enable an improved evaluation of knee instability and possible associated injuries. This additional information may promote the development of new treatment algorithms and allow for individualized treatment. In this review, the different subjective laxity scores as well as complementary objective measuring systems are discussed, along with an introduction of injury to an individualized treatment algorithm. PMID:26980119

  14. Study Links Severe Head Injury to Parkinson's Risk

    MedlinePlus

    ... 159811.html Study Links Severe Head Injury to Parkinson's Risk Researchers only found an association, could not ... of consciousness may increase the risk of developing Parkinson's disease, new research suggests. "It could be that ...

  15. Risk of injury in African American hospital workers.

    PubMed

    Simpson, C L; Severson, R K

    2000-10-01

    Very few data exist that describe the risk of injury in African American health care workers, who are highly represented in health care occupations. The present study examined the risk for work-related injury in African American hospital workers. Hospital Occupational Health Service medical records and a hospital human resource database were used to compare risk of injury between African American and white workers after adjusting for gender, age, physical demand of the job, and total hours worked. Risk of work-related injury was 2.3 times higher in African Americans. This difference was not explained by the other independent variables. Differences in injury reporting, intra-job workload, psychosocial factors, and organizational factors are all potential explanations for racial disparity in occupational injury. More research is needed to clarify these findings. PMID:11039167

  16. Exposure corrected risk estimates for childhood product related injuries.

    PubMed

    Senturia, Y D; Binns, H J; Christoffel, K K; Tanz, R R

    1993-08-01

    This study assesses the effect of exposure correction on injury risk estimates for children, using Chicago-area survey data on age-specific exposure of children to seven products: amusement park rides, sleds, bunkbeds, skateboards, fireworks, toboggans, and air guns and rifles. National Electronic Injury Surveillance System estimates for 1987 were used as numerators with two denominators: (i) uncorrected age-specific U.S. Census estimates for 1987 and (ii) these estimates corrected for exposure. Except for bunkbeds, skateboards and sleds, corrected injury risk decreased as age increased. Uncorrected population injury rates underestimated the risk posed to product-using children, especially those who are youngest and those who use skateboards.

  17. Prevention of Lower Extremity Injuries in Basketball

    PubMed Central

    Taylor, Jeffrey B.; Ford, Kevin R.; Nguyen, Anh-Dung; Terry, Lauren N.; Hegedus, Eric J.

    2015-01-01

    Context: Lower extremity injuries are common in basketball, yet it is unclear how prophylactic interventions affect lower extremity injury incidence rates. Objective: To analyze the effectiveness of current lower extremity injury prevention programs in basketball athletes, focusing on injury rates of (1) general lower extremity injuries, (2) ankle sprains, and (3) anterior cruciate ligament (ACL) tears. Data Sources: PubMed, MEDLINE, CINAHL, SPORTDiscus, and the Cochrane Register of Controlled Trials were searched in January 2015. Study Selection: Studies were included if they were randomized controlled or prospective cohort trials, contained a population of competitive basketball athletes, and reported lower extremity injury incidence rates specific to basketball players. In total, 426 individual studies were identified. Of these, 9 met the inclusion criteria. One other study was found during a hand search of the literature, resulting in 10 total studies included in this meta-analysis. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 2. Data Extraction: Details of the intervention (eg, neuromuscular vs external support), size of control and intervention groups, and number of injuries in each group were extracted from each study. Injury data were classified into 3 groups based on the anatomic diagnosis reported (general lower extremity injury, ankle sprain, ACL rupture). Results: Meta-analyses were performed independently for each injury classification. Results indicate that prophylactic programs significantly reduced the incidence of general lower extremity injuries (odds ratio [OR], 0.69; 95% CI, 0.57-0.85; P < 0.001) and ankle sprains (OR, 0.45; 95% CI, 0.29-0.69; P < 0.001), yet not ACL ruptures (OR, 1.09; 95% CI, 0.36-3.29; P = 0.87) in basketball athletes. Conclusion: In basketball players, prophylactic programs may be effective in reducing the risk of general lower extremity injuries and ankle sprains, yet not ACL injuries. PMID

  18. Over the top or endobutton for ACL reconstruction?

    PubMed

    Verdano, Michele Arcangelo; Pedrabissi, Bianca; Lunini, Enricomaria; Pellegrini, Andrea; Ceccarelli, Francesco

    2012-08-01

    There are an estimated 80-100,000 ACL repairs in the US each year: most ACL tears occurs from noncontact injuries. The 3.9% of the knee ligament injuries undergoes surgery: in the 80% of these patients, this means ACL reconstruction. The purpose of this study is to compare two surgical techniques normally used for acl recustruction; the first one is the intra- extra articular technique with single bundle fixed with staples and the second one is the intra-articular technique with double bundle and endobutton post-fixation. We evaluate the clinical outcome of our patients at the time of 4 years follow up. From January 2006 to April 2009 40 patients underwent to ACL reconstruction, all operated by using hamstring tendons: 20 patients with an average age of 28,75 years (12 men and 8 women) underwent surgery using the intra-extra articular technique, whereas the remaining 20 patients with an average age of 34,5 years (11 men and 9 women) benefited the intra-articular technique with double bundle ligament and endobutton post-fixation. Our study shows no substancial difference between these'two technique, but clinical outcome measures (I.K.D.C., Lysholm and Tegner) estimated better results for the double bundle technique with Endobutton post-fixation. (www.actabiomedica.it).

  19. Surgical treatment of combined PCL-ACL medial and lateral side injuries (global laxity): surgical technique and 2- to 18-year results.

    PubMed

    Fanelli, Gregory C; Edson, Craig J

    2012-09-01

    The multiple ligament injured knee is a severe injury that may also involve neurovascular injuries, fractures, and other systemic injuries. Surgical treatment offers good functional results documented in the literature by physical examination, arthrometer testing, stress radiography, and knee ligament rating scales. Mechanical tensioning devices are helpful with cruciate ligament tensioning. Some low grade medial collateral ligament (MCL) complex injuries may be amenable to brace treatment, while high grade medial side injuries require combined surgical repair-reconstruction. Lateral posterolateral injuries are most successfully treated with combined surgical repair-reconstruction. Surgical timing in acute multiple ligament injured knee cases depends on the ligaments injured, injured extremity vascular status, skin condition of the extremity, degree of instability, and the patients overall health. Allograft tissue is preferred for these complex surgical procedures. Delayed reconstruction of 2 to 3 weeks may decrease the incidence of arthrofibrosis, and it is important to address all components of the instability. Currently, there is no conclusive evidence that double-bundle posterior cruciate ligament (PCL) reconstruction provides superior results to single-bundle PCL reconstruction in the multiple ligament injured knee. The purpose of this article is to discuss G.F.'s surgical technique for combined PCL and anterior cruciate ligament, medial, and lateral side reconstructions in acute and chronic multiple ligament injured knees with global laxity. This article will focus on recognizing and defining the instability pattern, the use of external fixation, surgical timing, graft selection and preparation, G.F.'s preferred surgical technique, mechanical graft tensioning, perioperative antibiotics, specialized operating teams, postoperative rehabilitation, and our results of treatment in these complex surgical cases.

  20. Risk of Early Childhood Injuries in Twins and Singletons

    ERIC Educational Resources Information Center

    Roudsari, Bahman S.; Utter, Garth H.; Kernic, Mary A.; Mueller, Beth A.

    2006-01-01

    The incidence of twin births in the United States (US) has increased more than 65 per cent since 1980. However, the risk of injury to multiple-birth children is unknown. We sought to compare the risk of injury-related hospitalization and death between multiples and singletons. We conducted a retrospective cohort study using linked birth…

  1. Management of anterior cruciate ligament injuries in skeletally immature individuals.

    PubMed

    Moksnes, Håvard; Engebretsen, Lars; Risberg, May Arna

    2012-03-01

    Anterior cruciate ligament (ACL) injuries in skeletally immature individuals remain a challenge for the child, the parents, orthopaedic surgeons, and physical therapists. The main challenges are the potential risk of recurrent instability, secondary injuries following nonoperative treatment, and the risks involved with surgical treatment due to the vulnerability of the epiphyseal growth plates. We first present the physiological background for considerations that must be made when advising on treatment alternatives for skeletally immature individuals after ACL injury. The implications of continuous musculoskeletal development for treatment decisions are emphasized. No randomized controlled trials have been performed to investigate outcomes of different treatment algorithms. There is no consensus in the literature on clinical treatment decision criteria for whether a skeletally immature child should undergo transphyseal ACL reconstruction, physeal sparing ACL reconstruction, or nonoperative treatment. Additionally, well-described rehabilitation programs designed for either nonoperative treatment or postoperative rehabilitation have not been published. Based on the currently available evidence, we propose a treatment algorithm for the management of ACL injuries in skeletally immature individuals. Finally, we suggest directions for future prospective studies, which should include development of valid and reliable outcome measures and specific rehabilitation programs. PMID:21891880

  2. Gait and Neuromuscular Asymmetries after Acute ACL Rupture

    PubMed Central

    Gardinier, Emily S.; Manal, Kurt; Buchanan, Thomas S.; Snyder-Mackler, Lynn

    2012-01-01

    The decreased internal knee extensor moment is a significant gait asymmetry among patients with anterior cruciate ligament (ACL) deficiency, yet the muscular strategy driving this altered moment for the injured limb is unclear. Purpose To determine whether patients with ACL deficiency and characteristic knee instability would demonstrate normal extensor and increased flexor muscle force to generate a decreased internal extensor moment (i.e. employ a hamstring facilitation strategy). Methods Gait analysis was performed on 31 athletes with acute ACL rupture who exhibited characteristic knee instability after injury. Peak internal knee extensor moment was calculated using inverse dynamics and muscle forces were estimated using an EMG-driven modeling approach. Comparisons were made between the injured and contralateral limbs. Results As expected, patients demonstrated decreased peak knee flexion (p=0.028) and internal knee extensor moment (p=0.0004) for their injured limb, but exhibited neither an isolated decrease in extensor force (quadriceps avoidance), nor an isolated increase in flexor force (hamstring facilitation) at peak knee moment. Instead, they exhibited decreased muscle force from both flexor (p=0.0001) and extensor (p=0.0103) groups. This strategy of decreased muscle force may be explained in part by muscle weakness which frequently accompanies ACL injury, or by apprehension, low confidence and fear of further injury. Conclusions This is the first study to estimate muscle forces in the ACL-deficient knee using an EMG-driven approach. These results affirm the existence of neuromuscular asymmetries in the individuals with ACL deficiency and characteristic knee instability. PMID:22330021

  3. Multicenter Orthopaedic Outcome Network Early Anti-inflammatory Treatment in Patients with Acute ACL Tear” (MOON-AAA) Clinical Trial

    PubMed Central

    Lattermann, Christian; Proffitt, Mary; Huston, Laura J.; Gammon, Lee; Johnson, Darren L.; Kraus, Virginia B.; Spindler, Kurt P.

    2016-01-01

    Objectives: We present the early results from the “Multicenter Orthopaedic Outcome Network Early Anti-inflammatory Treatment in Patients with Acute ACL Tear and Painful Effusions” (MOON-AAA) clinical trial (figure 1). This trial allows for a well controlled prospective cohort of patients with isolated ACL injury at risk for OA. We compared the effect of a single versus a repeated dosage of Kenalog within the first two weeks after ACL injury and its effect on chondral degradation in the first 4 weeks prior to surgical reconstruction of the ACL. Methods: 49 patients with isolated ACL tears were enrolled. Knee joints were aspirated and patients received an injection with 40 mg Kenalog either within 4 days, 10 days, both time points or not at all (saline injection control). Serum, synovial fluid and urine were collected at 3 time points. Permutated block randomization, triple blinding, independent monitoring and standardized x-ray was performed to comply with GCP standards. Patient reported outcomes were collected at 6 time points up to 6 months post-ACL reconstruction(IKDC, KOOS and Marx activity level). A standardized synovial fluid biomarker panel was analyzed according to OARSI guidelines. Statistical analysis were performed using SAS mixed models analysis. Results: Serum analysis shows significant change after injury. Chondrodegradatory markers such as CTX-II, MMP-1 and MMP-3 as well as COMP indicate a progressive destruction of chondral matrix and collagen breakdown . There is a dramatic (250%) increase of CTX-II in the first 4 weeks. Matrix proteins such as MMP-1 and 3 as well as COMP show an initial increase and then a steep decline (see figure 1). Inflammatory markers (IL-1 alpha, IL-1beta, IRAP) show a decline from the time of injury. IL-1 alpha, however shows a dramatic uptake after week 2. This longitudinal data confirms a dramatic onset of early osteoarthritic biomarker profiles immediately after ACL injury as measured in synovial fluid

  4. Injury rates and injury risk factors among federal bureau of investigation new agent trainees

    PubMed Central

    2011-01-01

    Background A one-year prospective examination of injury rates and injury risk factors was conducted in Federal Bureau of Investigation (FBI) new agent training. Methods Injury incidents were obtained from medical records and injury compensation forms. Potential injury risk factors were acquired from a lifestyle questionnaire and existing data at the FBI Academy. Results A total of 426 men and 105 women participated in the project. Thirty-five percent of men and 42% of women experienced one or more injuries during training. The injury incidence rate was 2.5 and 3.2 injuries/1,000 person-days for men and women, respectively (risk ratio (women/men) = 1.3, 95% confidence interval = 0.9-1.7). The activities most commonly associated with injuries (% of total) were defensive tactics training (58%), physical fitness training (20%), physical fitness testing (5%), and firearms training (3%). Among the men, higher injury risk was associated with older age, slower 300-meter sprint time, slower 1.5-mile run time, lower total points on the physical fitness test (PFT), lower self-rated physical activity, lower frequency of aerobic exercise, a prior upper or lower limb injury, and prior foot or knee pain that limited activity. Among the women higher injury risk was associated with slower 300-meter sprint time, slower 1.5-mile run time, lower total points on the PFT, and prior back pain that limited activity. Conclusion The results of this investigation supported those of a previous retrospective investigation emphasizing that lower fitness and self-reported pain limiting activity were associated with higher injury risk among FBI new agents. PMID:22166096

  5. Rash After ACL Reconstruction: Asking the Right Questions.

    PubMed

    Smith, Andrew H; Bach, Bernard R

    2004-10-01

    A 40-year-old recreational athlete injured his left knee on a "moon bouncer" at his child's birthday party. Before the injury, he regularly went hiking and downhill skiing and played basketball and tennis. Because the injury caused persistent symptoms of knee instability, he elected to undergo an anterior cruciate ligament (ACL) reconstruction using allograft. At the time of surgery, the patient's skin examination was unremarkable, and no surgical complications were noted. The patient went home on the day of surgery.

  6. High tibial osteotomy in the ACL-deficient knee with medial compartment osteoarthritis.

    PubMed

    Herman, Benjamin V; Giffin, J Robert

    2016-09-01

    High tibial osteotomy (HTO) has traditionally been used to treat varus gonarthrosis in younger, active patients. Varus malalignment increases the risk of progression of medial compartment osteoarthritis and an HTO can be performed to realign the mechanical axis of the lower limb towards the lateral compartment, thereby decreasing contact pressures in the medial compartment. Anterior cruciate ligament (ACL) insufficiency may lead to post-traumatic arthritis due to altered joint loading and associated injuries to the menisci and articular cartilage. Understanding the importance of posterior tibial slope and its role in sagittal knee stability has led to the development of biplane osteotomies designed to flatten the posterior tibial slope in the ACL deficient knee. Altering the alignment in both the sagittal and coronal planes helps improve stability as well as alter the load in the medial compartment. Detailed history, physical exam and radiographic analysis guide treatment decisions in this high demand patient population. Lateral closing wedge (LCW) and medial opening wedge (MOW) HTOs have been performed and their potential advantages and disadvantages have been well described. Given the triangular shape of the proximal tibia, it is imperative that the surgeon pay close attention to the geometry of the osteotomy "gap" when performing MOW HTO to avoid inadvertently increasing the posterior tibial slope. Simultaneous ACL reconstruction may require technique modifications depending on the type of HTO and ACL graft chosen. With appropriate patient selection and good surgical technique, it is reasonable to expect patients to return to activities of daily living and recreational sports without debilitating pain or instability. PMID:27358200

  7. Prevention and Screening Programs for Anterior Cruciate Ligament Injuries in Young Athletes

    PubMed Central

    Swart, Eric; Redler, Lauren; Fabricant, Peter D.; Mandelbaum, Bert R.; Ahmad, Christopher S.; Wang, Y. Claire

    2014-01-01

    Background: Anterior cruciate ligament (ACL) injuries are common among young athletes. Biomechanical studies have led to the development of training programs to improve neuromuscular control and reduce ACL injury rates as well as screening tools to identify athletes at higher risk for ACL injury. The purpose of this study was to evaluate the cost-effectiveness of these training methods and screening strategies for preventing ACL injuries. Methods: A decision-analysis model was created to evaluate three strategies for a population of young athletes participating in organized sports: (1) no training or screening, (2) universal neuromuscular training, and (3) universal screening, with neuromuscular training for identified high-risk athletes only. Risk of injury, risk reduction from training, and sensitivity and specificity of screening were based on published data from clinical trials. Costs of training and screening programs were estimated on the basis of the literature. Sensitivity analyses were performed on key model parameters to evaluate their effect on base case conclusions. Results: Universal neuromuscular training of all athletes was the dominant strategy, with better outcomes and lower costs compared with screening. On average, the implementation of a universal training program would save $100 per player per season, and would reduce the incidence of ACL injury from 3% to 1.1% per season. Screening was not cost-effective within the range of reported sensitivity and specificity values. Conclusions and Clinical Relevance: Given its low cost and ease of implementation, neuromuscular training of all young athletes represents a cost-effective strategy for reducing costs and morbidity from ACL injuries. While continued innovations on inexpensive and accurate screening methods to identify high-risk athletes remain of interest, improving existing training protocols and implementing neuromuscular training into routine training for all young athletes is warranted. PMID

  8. Anterior Cruciate Ligament Injury Prevention and Rehabilitation: Let's Get It Right.

    PubMed

    Wilk, Kevin E

    2015-10-01

    Anterior cruciate ligament (ACL) injuries are among the most common and functionally disabling conditions in orthopaedics and sports medicine. As professionals, we need to do a better job of screening individuals to determine who is at greatest risk of sustaining an ACL injury, as well as implementing injury prevention programs. We also need to do a better job with programs that return individuals to their preinjury activity levels, including implementing thorough functional testing to determine if a patient is ready to return to sports or strenuous activities post-ACLR.

  9. Physical training risk factors for musculoskeletal injury in female soldiers.

    PubMed

    Roy, Tanja C; Songer, Thomas; Ye, Feifei; LaPorte, Ronald; Grier, Tyson; Anderson, Morgan; Chervak, Michelle

    2014-12-01

    Musculoskeletal injuries (MSIs) result in the most medical encounters, lost duty days, and permanent disability. Women are at greater risk of injury than men and physical training is the leading cause of injury. The purpose of this study was to investigate the demographic, body composition, fitness, and physical training risk factors for injuries in female Soldiers serving in garrison Army units over the past 12 months. Self-report survey was collected from 625 women. The ankle was the most frequently injured body region, 13%. Running was the activity most often associated with injury, 34%. In univariate analysis lower rank, older age, history of deployment, no unit runs, weekly frequency of personal resistance training, and history of injury were all associated with injury. In multivariate analysis rank, history of injury, weekly frequency of unit runs, and weekly frequency of personal resistance training were the best combination of predictors of injury. Running once or twice a week with the unit protected against MSIs, whereas participating in personal resistance training sessions once or twice a week increased the risk of MSIs. With more emphasis on running and resistance training, the U.S. Army could reduce injuries and save billions of dollars in training and health care costs.

  10. Risk of blood contamination and injury to operating room personnel.

    PubMed Central

    Quebbeman, E J; Telford, G L; Hubbard, S; Wadsworth, K; Hardman, B; Goodman, H; Gottlieb, M S

    1991-01-01

    The potential for transmission of deadly viral diseases to health care workers exists when contaminated blood is inoculated through injury or when blood comes in contact with nonintact skin. Operating room personnel are at particularly high risk for injury and blood contamination, but data on the specifics of which personnel are at greater risk and which practices change risk in this environment are almost nonexistent. To define these risk factors, experienced operating room nurses were employed solely to observe and record the injuries and blood contaminations that occurred during 234 operations involving 1763 personnel. Overall 118 of the operations (50%) resulted in at least one person becoming contaminated with blood. Cuts or needlestick injuries occurred in 15% of the operations. Several factors were found to significantly alter the risk of blood contamination or injury: surgical specialty, role of each person, duration of the procedure, amount of blood loss, number of needles used, and volume of irrigation fluid used. Risk calculations that use average values to include all personnel in the operating room or all operations performed substantially underestimate risk for surgeons and first assistants, who accounted for 81% of all body contamination and 65% of the injuries. The area of the body contaminated also changed with the surgical specialty. These data should help define more appropriate protection for individuals in the operating room and should allow refinements of practices and techniques to decrease injury. Images Fig. 1. PMID:1953115

  11. Controversies in knee rehabilitation: anterior cruciate ligament injury.

    PubMed

    Failla, Mathew J; Arundale, Amelia J H; Logerstedt, David S; Snyder-Mackler, Lynn

    2015-04-01

    Controversy in management of athletes exists after anterior cruciate ligament (ACL) injury and reconstruction. Consensus criteria for evaluating successful outcomes following ACL injury include no reinjury or recurrent giving way, no joint effusion, quadriceps strength symmetry, restored activity level and function, and returning to preinjury sports. Using these criteria, the success rates of current management strategies after ACL injury are reviewed and recommendations are provided for the counseling of athletes after ACL injury.

  12. Editorial Commentary: Tibial Tubercle-Trochlear Groove Distance as an Independent Risk Factor for Noncontact Anterior Cruciate Ligament Injury Is Possible but Remains Uncertain.

    PubMed

    Rossi, Michael J

    2016-01-01

    The MRI tibial tubercle-trochlear groove distance is statistically significantly higher in adolescent and young adults with noncontact anterior cruciate ligament (ACL) tears compared with those without tears. The authors use lateral thinking to assess this marker for extensor mechanism alignment as a potential risk factor for ACL tear. Yet the approximate 2 mm increase seen in those with ACL tears portends unproven clinical significance.

  13. Risk factors for injuries during airborne static line operations.

    PubMed

    Knapik, Joseph J; Steelman, Ryan

    2014-01-01

    US Army airborne operations began in World War II. Continuous improvements in parachute technology, aircraft exit procedures, and ground landing techniques have reduced the number of injuries over time from 27 per 1,000 descents to about 6 per 1,000 jumps. Studies have identified a number of factors that put parachutists at higher injury risk, including high wind speeds, night jumps, combat loads, higher temperatures, lower fitness, heavier body weight, and older age. Airborne injuries can be reduced by limiting risker training (higher wind speeds, night jumps, combat load) to the minimum necessary for tactical and operational proficiency. Wearing a parachute ankle brace (PAB) will reduce ankle injuries without increasing other injuries and should be considered by all parachutists, especially those with prior ankle problems. A high level of upper body muscular endurance and aerobic fitness is not only beneficial for general health but also associated with lower injury risk during airborne training.

  14. Risk factors for injuries during airborne static line operations.

    PubMed

    Knapik, Joseph J; Steelman, Ryan

    2014-01-01

    US Army airborne operations began in World War II. Continuous improvements in parachute technology, aircraft exit procedures, and ground landing techniques have reduced the number of injuries over time from 27 per 1,000 descents to about 6 per 1,000 jumps. Studies have identified a number of factors that put parachutists at higher injury risk, including high wind speeds, night jumps, combat loads, higher temperatures, lower fitness, heavier body weight, and older age. Airborne injuries can be reduced by limiting risker training (higher wind speeds, night jumps, combat load) to the minimum necessary for tactical and operational proficiency. Wearing a parachute ankle brace (PAB) will reduce ankle injuries without increasing other injuries and should be considered by all parachutists, especially those with prior ankle problems. A high level of upper body muscular endurance and aerobic fitness is not only beneficial for general health but also associated with lower injury risk during airborne training. PMID:25344715

  15. Anterior Cruciate Ligament: Structure, Injuries and Regenerative Treatments.

    PubMed

    Negahi Shirazi, Ali; Chrzanowski, Wojciech; Khademhosseini, Ali; Dehghani, Fariba

    2015-01-01

    Anterior cruciate ligament (ACL) is one of the most vulnerable ligaments of the knee. ACL impairment results in episodic instability, chondral and meniscal injury and early osteoarthritis. The poor self-healing capacity of ACL makes surgical treatment inevitable. Current ACL reconstructions include a substitution of torn ACL via biological grafts such as autograft, allograft. This review provides an insight of ACL structure, orientation and properties followed by comparing the performance of various constructs that have been used for ACL replacement. New approaches, undertaken to induce ACL regeneration and fabricate biomimetic scaffolds, are also discussed. PMID:26545750

  16. Anterior Cruciate Ligament: Structure, Injuries and Regenerative Treatments.

    PubMed

    Negahi Shirazi, Ali; Chrzanowski, Wojciech; Khademhosseini, Ali; Dehghani, Fariba

    2015-01-01

    Anterior cruciate ligament (ACL) is one of the most vulnerable ligaments of the knee. ACL impairment results in episodic instability, chondral and meniscal injury and early osteoarthritis. The poor self-healing capacity of ACL makes surgical treatment inevitable. Current ACL reconstructions include a substitution of torn ACL via biological grafts such as autograft, allograft. This review provides an insight of ACL structure, orientation and properties followed by comparing the performance of various constructs that have been used for ACL replacement. New approaches, undertaken to induce ACL regeneration and fabricate biomimetic scaffolds, are also discussed.

  17. Lightning Injuries-Who Is at Greatest Risk?

    PubMed

    Cherington, M; Vervalin, C

    1990-08-01

    In brief A bicyclist was struck by lightning after he sought shelter under an isolated tree. He suffered spinal cord and peripheral nerve injury, but eventually was able to walk with the aid of a walker. The sports activities that are associated with the highest number of lightning injuries and deaths are water sports, golf, camping, hiking, baseball, and football. Athletes and outdoor recreationists should know how to reduce their risk of injury during a lightning storm.

  18. Injury incidence, risk factors and prevention in Australian rules football.

    PubMed

    Hrysomallis, Con

    2013-05-01

    Along with the enjoyment and the other positive benefits of sport participation, there is also the risk of injury that is elevated in contact sport. This review provides a summary of injury incidence in Australian rules football (ARF), identifies injury risk factors, assesses the efficacy of interventions to reduce injury risk and makes recommendations for future research. The most common injuries were found to be muscle strains, particularly hamstrings; joint ligament sprains, especially ankle; haematomas and concussion. The most severe joint injury was anterior cruciate ligament rupture. Mouthguards are commonly worn and have been shown to reduce orofacial injury. There is evidence that thigh pads can reduce the incidence of thigh haematomas. There is a reluctance to wear padded headgear and an attempt to assess its effectiveness was unsuccessful due to low compliance. The most readily identified risk factor was a history of that injury. There were conflicting findings as to the influence strength imbalances or deficit has on hamstring injury risk in ARF. Static hamstring flexibility was not related to risk but low hip flexor/quadriceps flexibility increased hamstring injury risk. High lower-limb and high hamstring stiffness were associated with an elevated risk of hamstring injury. Since stiffness can be modulated through strength or flexibility training, this provides an area for future intervention studies. Low postural balance ability was related to a greater risk of ankle injury in ARF, players with poor balance should be targeted for balance training. There are preliminary data signifying a link between deficiencies in hip range of motion and hip adductor strength with groin pain or injury. This provides support for future investigation into the effectiveness of an intervention for high-risk players on groin injury rate. Low cross-sectional area of core-region muscle has been associated with more severe injuries and a motor control exercise intervention

  19. Injury incidence, risk factors and prevention in Australian rules football.

    PubMed

    Hrysomallis, Con

    2013-05-01

    Along with the enjoyment and the other positive benefits of sport participation, there is also the risk of injury that is elevated in contact sport. This review provides a summary of injury incidence in Australian rules football (ARF), identifies injury risk factors, assesses the efficacy of interventions to reduce injury risk and makes recommendations for future research. The most common injuries were found to be muscle strains, particularly hamstrings; joint ligament sprains, especially ankle; haematomas and concussion. The most severe joint injury was anterior cruciate ligament rupture. Mouthguards are commonly worn and have been shown to reduce orofacial injury. There is evidence that thigh pads can reduce the incidence of thigh haematomas. There is a reluctance to wear padded headgear and an attempt to assess its effectiveness was unsuccessful due to low compliance. The most readily identified risk factor was a history of that injury. There were conflicting findings as to the influence strength imbalances or deficit has on hamstring injury risk in ARF. Static hamstring flexibility was not related to risk but low hip flexor/quadriceps flexibility increased hamstring injury risk. High lower-limb and high hamstring stiffness were associated with an elevated risk of hamstring injury. Since stiffness can be modulated through strength or flexibility training, this provides an area for future intervention studies. Low postural balance ability was related to a greater risk of ankle injury in ARF, players with poor balance should be targeted for balance training. There are preliminary data signifying a link between deficiencies in hip range of motion and hip adductor strength with groin pain or injury. This provides support for future investigation into the effectiveness of an intervention for high-risk players on groin injury rate. Low cross-sectional area of core-region muscle has been associated with more severe injuries and a motor control exercise intervention

  20. Measuring injury risk factors: question reliability in a statewide sample

    PubMed Central

    Koziol-McLain, J.; Brand, D.; Morgan, D.; Leff, M.; Lowenstein, S.

    2000-01-01

    Background—Recently (1996–98), Colorado added 15 questions pertaining to injury related risks and behaviors to the behavioral risk factor surveillance system (BRFSS). Questions addressed bicycle helmet use, traffic crashes, exposure to violence, suicidal behavior, and gun storage. Objective—To measure the test-retest reliability of these injury related questions. Methods—Of 330 BRFSS participants, 229 (69%) were called a second time and reasked nine selected injury questions. Retests were completed 7–28 days after the original interview. Results—Test-retest agreement was very high (κ >0.80) for bicycle helmet use, domestic police visits, and gun ownership. All other injury risk questions had substantial agreement (κ >0.60). Conclusions—The injury related questions added to the Colorado BRFSS have high test-retest reliability. PMID:10875674

  1. [Occupational injury risk in the shoe industry: frequency, types of injuries and equipment involved, improvement interventions].

    PubMed

    Tognon, Ilaria Desirée

    2012-01-01

    The aim of the work has been to evaluate the risk of injuries connected to the use of machinery and work tools in the footwear industry. The analysis of the data related to injuries in the footwear industry, deduced from the registers of injuries collected in the investigated factories, shows that most accidents arise from the contact of the operator's hands with tools and machinery parts during their use. Risk factors generally include the inherent specific danger of some work tools and machines, the lack or inadequacy of safety devices, the obsolescence of the equipment, the imprudence and underestimation of risk. PMID:22697028

  2. Knee functional recovery and limb-to-limb symmetry restoration after anterior cruciate ligament (ACL) rupture and ACL reconstruction

    NASA Astrophysics Data System (ADS)

    Nawasreh, Zakariya Hussein

    Anterior cruciate ligament (ACL) rupture is a common sport injury of young athletes who participate in jumping, cutting, and pivoting activities. Although ACL reconstruction (ACLR) surgery has the goal of enabling athletes to return to preinjury activity levels, treatment results often fall short of this goal. The outcomes after ACLR are variable and less than optimal with low rate of return to preinjury activity level and high risk for second ACL injury. Factors related to the knee functional limitations, strength deficits, and limb-to-limb movement asymmetry may be associated with poor outcomes after ACLR. Additionally, the criteria that are used to determine a patient's readiness to return to the preinjury activity level are undefined which may also be associated with poor outcomes after ACLR. The clinical decision-making to clear patients' for safe and successful return to high physical activities should be based on a universal comprehensive set of objective criteria that ensure normal knee function and limb-to-limb symmetry. A battery of return to activity criteria (RTAC) that emphases normal knee function and limb-to-limb movement symmetry has been constituted to better ensure safe and successful return to preinjury activity level. Yet, only variables related to patients' demographics, concomitant injuries, and treatment measures have been used to predict return to preinjury activity levels after ACLR. However, the ability of RTAC variables that ensure normal knee function and limb movement symmetry to predict the return to participate in the same preinjury activity level after ACLR has not been investigated. In light of this background, the first aim of the present study was to compare functional knee performance-based and patient-reported measures of those who PASS and who FAIL on RTAC at 6 months (6-M) following ACLR with those at 12 months (12-M) and 24 months (24-M) following ACLR and to determine how performance-based and patient-reported measures

  3. Childhood Problem Behaviors and Injury Risk over the Life Course

    ERIC Educational Resources Information Center

    Jokela, Markus; Power, Chris; Kivimaki, Mika

    2009-01-01

    Background: Childhood externalizing and internalizing behaviors have been associated with injury risk in childhood and adolescence, but it is unknown whether this association continues to hold in adulthood. We examined whether externalizing and internalizing behaviors expressed in childhood predict injuries in childhood, adolescence, and…

  4. Teens' Knowledge of Risk Factors for Sports Injuries

    ERIC Educational Resources Information Center

    Ward, Cynthia W.

    2004-01-01

    Youth participation in sports has increased greatly over the past 20 years. Consequently, there has been a rise in the number of sports injuries. A study was conducted to determine teen's level of physical activity, knowledge about risk factors for sports injuries, use of protective equipment, and parental involvement. Two groups of teens, one of…

  5. Injury Risk Spikes While Cancer Patients Seek Diagnosis

    MedlinePlus

    ... medical and drug therapy complications, accidents and self-harm To use the sharing features on this page, ... 8,300 injuries from accidents or intentional self-harm, the study findings showed. The risk for medical- ...

  6. Evaluating eye injury risk of Airsoft pellet guns by parametric risk functions.

    PubMed

    Kennedy, Eric A; Ng, Tracy P; Duma, Stefan M

    2006-01-01

    Over 2.4 million eye injuries occur each year in the United States as a result of trauma. New toy guns, commonly referred to as Airsoft guns are increasingly becoming responsible for ocular injuries in children. The purpose of this study was to determine the ocular injury risk of these Airsoft guns by experimental testing and the use of previously generated ocular injury risk functions. A total of 26 Airsoft pellet impact tests were performed on both post-mortem human and porcine eyes in a laboratory environment. Projectile parameters of diameter, mass, and velocity were used to calculate the injury potential of these impacts for five different ocular injuries: corneal abrasion, lens dislocation, hyphema, retinal damage, and globe rupture. Globe rupture was not observed in any of the experimental tests, which is consistent with that reported in the literature. The two most likely ocular injuries caused by these Airsoft guns are corneal abrasion and hyphema, at nearly a 100% and a greater than 75% risk of injury, respectively. This is consistent with the types of injuries reported in the literature, with corneal abrasion and hyphema being the most frequently occurring ocular injuries due to Airsoft guns. More experimental data on retinal injuries is necessary to make an accurate assessment of the risk of retinal damage from blunt impacts. In summary, the potential for ocular injury from Airsoft guns is great and protective equipment such as protective eyewear should be considered mandatory during operation.

  7. Accounting for sampling variability, injury under-reporting, and sensor error in concussion injury risk curves.

    PubMed

    Elliott, Michael R; Margulies, Susan S; Maltese, Matthew R; Arbogast, Kristy B

    2015-09-18

    There has been recent dramatic increase in the use of sensors affixed to the heads or helmets of athletes to measure the biomechanics of head impacts that lead to concussion. The relationship between injury and linear or rotational head acceleration measured by such sensors can be quantified with an injury risk curve. The utility of the injury risk curve relies on the accuracy of both the clinical diagnosis and the biomechanical measure. The focus of our analysis was to demonstrate the influence of three sources of error on the shape and interpretation of concussion injury risk curves: sampling variability associated with a rare event, concussion under-reporting, and sensor measurement error. We utilized Bayesian statistical methods to generate synthetic data from previously published concussion injury risk curves developed using data from helmet-based sensors on collegiate football players and assessed the effect of the three sources of error on the risk relationship. Accounting for sampling variability adds uncertainty or width to the injury risk curve. Assuming a variety of rates of unreported concussions in the non-concussed group, we found that accounting for under-reporting lowers the rotational acceleration required for a given concussion risk. Lastly, after accounting for sensor error, we find strengthened relationships between rotational acceleration and injury risk, further lowering the magnitude of rotational acceleration needed for a given risk of concussion. As more accurate sensors are designed and more sensitive and specific clinical diagnostic tools are introduced, our analysis provides guidance for the future development of comprehensive concussion risk curves. PMID:26296855

  8. Accounting for sampling variability, injury under-reporting, and sensor error in concussion injury risk curves.

    PubMed

    Elliott, Michael R; Margulies, Susan S; Maltese, Matthew R; Arbogast, Kristy B

    2015-09-18

    There has been recent dramatic increase in the use of sensors affixed to the heads or helmets of athletes to measure the biomechanics of head impacts that lead to concussion. The relationship between injury and linear or rotational head acceleration measured by such sensors can be quantified with an injury risk curve. The utility of the injury risk curve relies on the accuracy of both the clinical diagnosis and the biomechanical measure. The focus of our analysis was to demonstrate the influence of three sources of error on the shape and interpretation of concussion injury risk curves: sampling variability associated with a rare event, concussion under-reporting, and sensor measurement error. We utilized Bayesian statistical methods to generate synthetic data from previously published concussion injury risk curves developed using data from helmet-based sensors on collegiate football players and assessed the effect of the three sources of error on the risk relationship. Accounting for sampling variability adds uncertainty or width to the injury risk curve. Assuming a variety of rates of unreported concussions in the non-concussed group, we found that accounting for under-reporting lowers the rotational acceleration required for a given concussion risk. Lastly, after accounting for sensor error, we find strengthened relationships between rotational acceleration and injury risk, further lowering the magnitude of rotational acceleration needed for a given risk of concussion. As more accurate sensors are designed and more sensitive and specific clinical diagnostic tools are introduced, our analysis provides guidance for the future development of comprehensive concussion risk curves.

  9. Persons with reconstructed ACL exhibit altered knee mechanics during high-speed maneuvers.

    PubMed

    Lee, S-P; Chow, J W; Tillman, M D

    2014-06-01

    Anterior cruciate ligament (ACL) injury is a sports trauma that causes long-term disability. The function of the knee during dynamic activities can be severely limited even after successful surgical reconstruction. This study examined the effects of approach velocity during side-step cutting on knee joint mechanics in persons with reconstructed ACL (ACLR). 22 participants (11 with unilateral ACLR, 11 matched-controls) participated. Knee joint mechanics were tested in 3 approach conditions: counter-movement, one-step, and running. Dependent variables, including peak knee flexion, extension, valgus, varus, internal rotation, external rotation angles and corresponding peak joint moments, were assessed during the stance phase of cutting. Two 2×3 ("group" by "approach condition") mixed MANOVA tests were used to examine the effects of ACLR and approach velocity on knee mechanics. ACLR participants exhibited higher knee internal rotator moment (0.22 vs. 0.13 Nm/kg, p=0.003). Inter-group comparisons revealed that the ACLR participants exhibited significantly higher abductor and internal rotator moments only in the running condition (1.86 vs. 1.16 Nm/kg, p=0.018; 0.28 vs. 0.17 Nm/kg, p=0.010, respectively). Our findings suggested that patients with ACLR may be at increased risk of re-injury when participating in high-demand physical activities. Task demand should be considered when prescribing progressive therapeutic interventions to ACLR patients.

  10. Reliability of 3-Dimensional Measures of Single-Leg Drop Landing Across 3 Institutions: Implications for Multicenter Research for Secondary ACL-Injury Prevention

    PubMed Central

    Myer, Gregory D.; Bates, Nathaniel A.; DiCesare, Christopher A.; Barber Foss, Kim D.; Thomas, Staci M.; Wordeman, Samuel C.; Sugimoto, Dai; Roewer, Benjamin D.; Medina McKeon, Jennifer M.; Di Stasi, Stephanie L.; Noehren, Brian W.; McNally, Michael; Ford, Kevin R.; Kiefer, Adam W.; Hewett, Timothy E.

    2016-01-01

    Context Due to the limitations of single-center studies in achieving appropriate sampling with relatively rare disorders, multicenter collaborations have been proposed to achieve desired sampling levels. However, documented reliability of biomechanical data is necessary for multicenter injury-prevention studies and is currently unavailable. Objective To measure the reliability of 3-dimensional (3D) biomechanical waveforms from kinetic and kinematic variables during a single-leg landing (SLL) performed at 3 separate testing facilities. Design Multicenter reliability study. Setting 3 laboratories. Patients 25 female junior varsity and varsity high school volleyball players who visited each facility over a 1-mo period. Intervention Subjects were instrumented with 43 reflective markers to record 3D motion as they performed SLLs. During the SLL the athlete balanced on 1 leg, dropped down off of a 31-cm-high box, and landed on the same leg. Kinematic and kinetic data from both legs were processed from 2 trials across the 3 laboratories. Main Outcome Measures Coefficients of multiple correlations (CMC) were used to statistically compare each joint angle and moment waveform for the first 500 ms of landing. Results Average CMC for lower-extremity sagittal-plane motion was excellent between laboratories (hip .98, knee .95, ankle .99). Average CMC for lower-extremity frontal-plane motion was also excellent between laboratories (hip .98, knee .80, ankle .93). Kinetic waveforms were repeatable in each plane of rotation (3-center mean CMC ≥.71), while knee sagittal-plane moments were the most consistent measure across sites (3-center mean CMC ≥.94). Conclusions CMC waveform comparisons were similar relative to the joint measured to previously published reports of between-sessions reliability of sagittal- and frontal-plane biomechanics performed at a single institution. Continued research is needed to further standardize technology and methods to help ensure that highly

  11. Sports-related knee injuries in female athletes: what gives?

    PubMed

    Dugan, Sheila A

    2005-02-01

    Knee injuries occur commonly in sports, limiting field and practice time and performance level. Although injury etiology relates primarily to sports specific activity, female athletes are at higher risk of knee injury than their male counterparts in jumping and cutting sports. Particular pain syndromes such as anterior knee pain and injuries such as noncontact anterior cruciate ligament (ACL) injuries occur at a higher rate in female than male athletes at a similar level of competition. Anterior cruciate ligament injuries can be season or career ending, at times requiring costly surgery and rehabilitation. Beyond real-time pain and functional limitations, previous injury is implicated in knee osteoarthritis occurring later in life. Although anatomical parameters differ between and within the sexes, it is not likely this is the single reason for knee injury rate disparities. Clinicians and researchers have also studied the role of sex hormones and dynamic neuromuscular imbalances in female compared with male athletes in hopes of finding the causes for the increased rate of ACL injury. Understanding gender differences in knee injuries will lead to more effective prevention strategies for women athletes who currently suffer thousands of ACL tears annually. To meet the goal in sports medicine of safely returning an athlete to her sport, our evaluation, assessment, treatments and prevention strategies must reflect not only our knowledge of the structure and innervations of the knee but neuromuscular control in multiple planes and with multiple forces while at play.

  12. Effectiveness of Knee Injury and Anterior Cruciate Ligament Tear Prevention Programs: A Meta-Analysis

    PubMed Central

    Collins, Jamie E.; Yang, Heidi Y.; Goczalk, Melissa G.; Katz, Jeffrey N.; Losina, Elena

    2015-01-01

    Objective Individuals frequently involved in jumping, pivoting or cutting are at increased risk of knee injury, including anterior cruciate ligament (ACL) tears. We sought to use meta-analytic techniques to establish whether neuromuscular and proprioceptive training is efficacious in preventing knee and ACL injury and to identify factors related to greater efficacy of such programs. Methods We performed a systematic literature search of studies published in English between 1996 and 2014. Intervention efficacy was ascertained from incidence rate ratios (IRRs) weighted by their precision (1/variance) using a random effects model. Separate analyses were performed for knee and ACL injury. We examined whether year of publication, study quality, or specific components of the intervention were associated with efficacy of the intervention in a meta-regression analysis. Results Twenty-four studies met the inclusion criteria and were used in the meta-analysis. The mean study sample was 1,093 subjects. Twenty studies reported data on knee injury in general terms and 16 on ACL injury. Maximum Jadad score was 3 (on a 0–5 scale). The summary incidence rate ratio was estimated at 0.731 (95% CI: 0.614, 0.871) for knee injury and 0.493 (95% CI: 0.285, 0.854) for ACL injury, indicating a protective effect of intervention. Meta-regression analysis did not identify specific intervention components associated with greater efficacy but established that later year of publication was associated with more conservative estimates of intervention efficacy. Conclusion The current meta-analysis provides evidence that neuromuscular and proprioceptive training reduces knee injury in general and ACL injury in particular. Later publication date was associated with higher quality studies and more conservative efficacy estimates. As study quality was generally low, these data suggest that higher quality studies should be implemented to confirm the preventive efficacy of such programs. PMID:26637173

  13. Overuse Injury: Are Students at Risk?

    ERIC Educational Resources Information Center

    O'Hanlon, Anne

    1986-01-01

    Use of computer keyboards requires repetitive movements that may cause "overuse injuries" among students. Education on computer literacy must include warning of these negative side effects and must instill safe operating habits among students. (10 references) (CJH)

  14. Incidence of acute volleyball injuries: a prospective cohort study of injury mechanisms and risk factors.

    PubMed

    Bahr, R; Bahr, I A

    1997-06-01

    The purpose of the study was to examine the incidence and mechanisms of acute volleyball injuries, with particular reference to possible risk factors for ankle injuries. Coaches and players in the top two divisions of the Norwegian Volleyball Federation were asked to keep records of exposure time and all acute volleyball injuries causing a player to miss at least one playing day during one season. We found 89 injuries among 272 players during 51588 player hours, 45837 h of training and 5751 h of match play. The total injury incidence was 1.7 +/- 0.2 per 1000 h of play, 1.5 +/- 0.2 during training and 3.5 +/- 0.8 during match play. The ankle (54%) was the most commonly injured region, followed by the lower back (11%), knee (8%), shoulder (8%) and fingers (7%). Of the ankle injuries, 79% were recurrences, and the relative risk of injury was 3.8 (P < 0.0001) for previously injured ankles (38 of 232) vs. non-injured ankles (10 of the 234). Moreover, a reinjury was observed in 21 of the 50 ankles that had suffered an ankle sprain within the last 6 months (42.0 +/- 7.0%; risk ratio: 9.8 vs. uninjured ankles; P < 0.000001). The data indicate that external supports should be worn for 6-12 months after an ankle sprain and that specific injury prevention programs may be developed for ankle sprains in volleyball. PMID:9200321

  15. Role of gastrocnemius activation in knee joint biomechanics: gastrocnemius acts as an ACL antagonist.

    PubMed

    Adouni, M; Shirazi-Adl, A; Marouane, H

    2016-01-01

    Gastrocnemius is a premier muscle crossing the knee, but its role in knee biomechanics and on the anterior cruciate ligament (ACL) remains less clear when compared to hamstrings and quadriceps. The effect of changes in gastrocnemius force at late stance when it peaks on the knee joint response and ACL force was initially investigated using a lower extremity musculoskeletal model driven by gait kinematics-kinetics. The tibiofemoral joint under isolated isometric contraction of gastrocnemius was subsequently analyzed at different force levels and flexion angles (0°-90°). Changes in gastrocnemius force at late stance markedly influenced hamstrings forces. Gastrocnemius acted as ACL antagonist by substantially increasing its force. Simulations under isolated contraction of gastrocnemius confirmed this role at all flexion angles, in particular, at extreme knee flexion angles (0° and 90°). Constraint on varus/valgus rotations substantially decreased this effect. Although hamstrings and gastrocnemius are both knee joint flexors, they play opposite roles in respectively protecting or loading ACL. Although the quadriceps is also recognized as antagonist of ACL, at larger joint flexion and in contrast to quadriceps, activity in gastrocnemius substantially increased ACL forces (anteromedial bundle). The fact that gastrocnemius is an antagonist of ACL should help in effective prevention and management of ACL injuries.

  16. Evidence-Based ACL Reconstruction

    PubMed Central

    Rodriguez-Merchan, E. Carlos

    2015-01-01

    There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACL) reconstruction. The purpose of this article is to answer the following questions: 1) Bone-patellar tendon-bone reconstruction (BPTB-R) or hamstrimg reconstruction (H-R); 2) Double bundle or single bundle; 3) Allograft or authograft; 4) Early or late reconstruction; 5) Rate of return to sports after ACL reconstruction; 6) Rate of osteoarthritis after ACL reconstruction. A Cochrane Library and PubMed (MEDLINE) search of systematic reviews and meta-analysis related to ACL reconstruction was performed. The key words were: ACL reconstruction, systematic reviews and meta-analysis. The main criteria for selection were that the articles were systematic reviews and meta-analyses focused on the aforementioned questions. Sixty-nine articles were found, but only 26 were selected and reviewed because they had a high grade (I-II) of evidence. BPTB-R was associated with better postoperative knee stability but with a higher rate of morbidity. However, the results of both procedures in terms of functional outcome in the long-term were similar. The double-bundle ACL reconstruction technique showed better outcomes in rotational laxity, although functional recovery was similar between single-bundle and double-bundle. Autograft yielded better results than allograft. There was no difference between early and delayed reconstruction. 82% of patients were able to return to some kind of sport participation. 28% of patients presented radiological signs of osteoarthritis with a follow-up of minimum 10 years. PMID:25692162

  17. Evidence-Based ACL Reconstruction.

    PubMed

    Rodriguez-Merchan, E Carlos

    2015-01-01

    There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACL) reconstruction. The purpose of this article is to answer the following questions: 1) Bone-patellar tendon-bone reconstruction (BPTB-R) or hamstrimg reconstruction (H-R); 2) Double bundle or single bundle; 3) Allograft or authograft; 4) Early or late reconstruction; 5) Rate of return to sports after ACL reconstruction; 6) Rate of osteoarthritis after ACL reconstruction. A Cochrane Library and PubMed (MEDLINE) search of systematic reviews and meta-analysis related to ACL reconstruction was performed. The key words were: ACL reconstruction, systematic reviews and meta-analysis. The main criteria for selection were that the articles were systematic reviews and meta-analyses focused on the aforementioned questions. Sixty-nine articles were found, but only 26 were selected and reviewed because they had a high grade (I-II) of evidence. BPTB-R was associated with better postoperative knee stability but with a higher rate of morbidity. However, the results of both procedures in terms of functional outcome in the long-term were similar. The double-bundle ACL reconstruction technique showed better outcomes in rotational laxity, although functional recovery was similar between single-bundle and double-bundle. Autograft yielded better results than allograft. There was no difference between early and delayed reconstruction. 82% of patients were able to return to some kind of sport participation. 28% of patients presented radiological signs of osteoarthritis with a follow-up of minimum 10 years. PMID:25692162

  18. Injuries in professional modern dancers: incidence, risk factors, and management.

    PubMed

    Shah, Selina; Weiss, David S; Burchette, Raoul J

    2012-03-01

    Modern (or contemporary) dance has become increasingly popular, yet little has been reported with respect to modern dance injuries and their consequences. The purpose of this study is to define the incidence, risk factors, and management of musculoskeletal injuries in professional modern dancers. A total of 184 dancers in the United States completed an anonymous 17-page questionnaire on their injuries, including extensive details regarding the two most severe injuries that had occurred in the prior 12 months. According to their self-reports, a total of 82% of the dancers had suffered between one and seven injuries. The foot and ankle (40%) was the most common site of injury, followed by the lower back (17%) and the knee (16%). The rate of injuries was 0.59 per 1,000 hours of class and rehearsal. Injured male dancers returned to full dancing after a median of 21 days, while females returned after a median of 18 days. Most dancers missed no performances due to injury. Of the medical consultations sought by dancers for their injuries, 47% were made to physicians, 41% to physical therapists, and 34% to chiropractors. The majority of dancers adhered to the advice given them by consultants (87% of males and 78% of females for the most severe injury). While the majority of injuries were considered work-related (61% of the most severe injury and 69% of the second most severe), few were covered by Workers' Compensation insurance (12% and 5% respectively). These professional modern dancers suffer from a rate of injury similar to other groups of professional dancers. Most dancers return to a partial level of dancing several weeks before attempting full-capacity dancing.

  19. Injuries in professional modern dancers: incidence, risk factors, and management.

    PubMed

    Shah, Selina; Weiss, David S; Burchette, Raoul J

    2012-03-01

    Modern (or contemporary) dance has become increasingly popular, yet little has been reported with respect to modern dance injuries and their consequences. The purpose of this study is to define the incidence, risk factors, and management of musculoskeletal injuries in professional modern dancers. A total of 184 dancers in the United States completed an anonymous 17-page questionnaire on their injuries, including extensive details regarding the two most severe injuries that had occurred in the prior 12 months. According to their self-reports, a total of 82% of the dancers had suffered between one and seven injuries. The foot and ankle (40%) was the most common site of injury, followed by the lower back (17%) and the knee (16%). The rate of injuries was 0.59 per 1,000 hours of class and rehearsal. Injured male dancers returned to full dancing after a median of 21 days, while females returned after a median of 18 days. Most dancers missed no performances due to injury. Of the medical consultations sought by dancers for their injuries, 47% were made to physicians, 41% to physical therapists, and 34% to chiropractors. The majority of dancers adhered to the advice given them by consultants (87% of males and 78% of females for the most severe injury). While the majority of injuries were considered work-related (61% of the most severe injury and 69% of the second most severe), few were covered by Workers' Compensation insurance (12% and 5% respectively). These professional modern dancers suffer from a rate of injury similar to other groups of professional dancers. Most dancers return to a partial level of dancing several weeks before attempting full-capacity dancing. PMID:22390950

  20. Overrepresentation of the COL3A1 AA genotype in Polish skiers with anterior cruciate ligament injury

    PubMed Central

    Ficek, K; Maciejewska-Karłowska, A; Sawczuk, M; Ziętek, P; Król, P; Zmijewski, P; Pokrywka, A; Cięszczyk, P

    2015-01-01

    Although various intrinsic and extrinsic risk factors for anterior cruciate ligament (ACL) rupture have been identified, the exact aetiology of the injury is not yet fully understood. Type III collagen is an important factor in the repair of connective tissue, and certain gene polymorphisms may impair the tensile strength. The aim of this study was to examine the association of the COL3A1 rs1800255 polymorphism with ACL rupture in Polish male recreational skiers. A total of 321 male Polish recreational skiers were recruited for this study; 138 had surgically diagnosed primary ACL ruptures (ACL-injured group) and 183 were apparently healthy male skiers (control group – CON) who had no self-reported history of ligament or tendon injury. Both groups had a comparable level of exposure to ACL injury. Genomic DNA was extracted from the oral epithelial cells. All samples were genotyped on a real-time polymerase chain reaction instrument. The genotype distribution in the ACL-injured group was significantly different than in CON (respectively: AA=10.1 vs 2.2%, AG=22.5 vs 36.1, GG=67.4 vs 61.8%; p=0.0087). The AA vs AG+GG genotype of COL3A1 (odds ratio (OR)=5.05; 95% confidence interval (CI), 1.62-15.71, p=0.003) was significantly overrepresented in the ACL-injured group compared with CON. The frequency of the A allele was higher in the ACL-injured group (21.4%) compared with CON (20.2%), but the difference was not statistically significant (p=0.72). This study revealed an association between the COL3A1 rs1800255 polymorphism and ACL ruptures in Polish skiers. PMID:26060338

  1. Overrepresentation of the COL3A1 AA genotype in Polish skiers with anterior cruciate ligament injury.

    PubMed

    Stępień-Słodkowska, M; Ficek, K; Maciejewska-Karłowska, A; Sawczuk, M; Ziętek, P; Król, P; Zmijewski, P; Pokrywka, A; Cięszczyk, P

    2015-06-01

    Although various intrinsic and extrinsic risk factors for anterior cruciate ligament (ACL) rupture have been identified, the exact aetiology of the injury is not yet fully understood. Type III collagen is an important factor in the repair of connective tissue, and certain gene polymorphisms may impair the tensile strength. The aim of this study was to examine the association of the COL3A1 rs1800255 polymorphism with ACL rupture in Polish male recreational skiers. A total of 321 male Polish recreational skiers were recruited for this study; 138 had surgically diagnosed primary ACL ruptures (ACL-injured group) and 183 were apparently healthy male skiers (control group - CON) who had no self-reported history of ligament or tendon injury. Both groups had a comparable level of exposure to ACL injury. Genomic DNA was extracted from the oral epithelial cells. All samples were genotyped on a real-time polymerase chain reaction instrument. The genotype distribution in the ACL-injured group was significantly different than in CON (respectively: AA=10.1 vs 2.2%, AG=22.5 vs 36.1, GG=67.4 vs 61.8%; p=0.0087). The AA vs AG+GG genotype of COL3A1 (odds ratio (OR)=5.05; 95% confidence interval (CI), 1.62-15.71, p=0.003) was significantly overrepresented in the ACL-injured group compared with CON. The frequency of the A allele was higher in the ACL-injured group (21.4%) compared with CON (20.2%), but the difference was not statistically significant (p=0.72). This study revealed an association between the COL3A1 rs1800255 polymorphism and ACL ruptures in Polish skiers. PMID:26060338

  2. Controversies in Knee Rehabilitation: Anterior Cruciate Ligament Injury

    PubMed Central

    Failla, Mathew J.; Arundale, Amelia J.H.; Logerstedt, David S.; Snyder-Mackler, Lynn

    2014-01-01

    Controversy in management of athletes exists after anterior cruciate ligament injury and reconstruction. Consensus criteria for evaluating successful outcomes following ACL injury include no re-injury or recurrent giving way, no joint effusion, quadriceps strength symmetry, restored activity level and function, and returning to pre-injury sports. Using these criterions, we will review the success rates of current management strategies after ACL injury and provide recommendations for the counseling of athletes after ACL injury. PMID:25818715

  3. MUSCLE STRENGTH AND QUALITATIVE JUMP-LANDING DIFFERENCES IN MALE AND FEMALE MILITARY CADETS: THE JUMP-ACL STUDY.

    PubMed

    Beutler, Ai; de la Motte, Sj; Marshall, Sw; Padua, DA; Boden, Bp

    2009-01-01

    Recent studies have focused on gender differences in movement patterns as risk factors for ACL injury. Understanding intrinsic and extrinsic factors which contribute to movement patterns is critical to ACL injury prevention efforts. Isometric lower-extremity muscular strength, anthropometrics, and jump-landing technique were analyzed for 2,753 cadets (1,046 female, 1,707 male) from the U.S. Air Force, Military and Naval Academies. Jump-landings were evaluated using the Landing Error Scoring System (LESS), a valid qualitative movement screening tool. We hypothesized that distinct anthropometric factors (Q-angle, navicular drop, bodyweight) and muscle strength would predict poor jump-landing technique in males versus females, and that female cadets would have higher scores (more errors) on a qualitative movement screen (LESS) than males. Mean LESS scores were significantly higher in female (5.34 ± 1.51) versus male (4.65 ± 1.69) cadets (P<.001). Qualitative movement scores were analyzed using factor analyses, yielding five factors, or "patterns", contributing to poor landing technique. Females were significantly more likely to have poor technique due to landing with less hip and knee flexion at initial contact (P<.001), more knee valgus with wider landing stance (P<.001), and less flexion displacement over the entire landing (P<.001). Males were more likely to have poor technique due to landing toe-out (P<.001), with heels first, and with an asymmetric foot landing (P<.001). Many of the identified factor patterns have been previously proposed to contribute to ACL injury risk. However, univariate and multivariate analyses of muscular strength and anthropometric factors did not strongly predict LESS scores for either gender, suggesting that changing an athlete's alignment, BMI, or muscle strength may not directly improve his or her movement patterns. PMID:21132103

  4. Electrospinning polymer blends for biomimetic scaffolds for ACL tissue engineering

    NASA Astrophysics Data System (ADS)

    Garcia, Vanessa Lizeth

    The anterior cruciate ligament (ACL) rupture is one of the most common knee injuries. Current ACL reconstructive strategies consist of using an autograft or an allograft to replace the ligament. However, limitations have led researchers to create tissue engineered grafts, known as scaffolds, through electrospinning. Scaffolds made of natural and synthetic polymer blends have the potential to promote cell adhesion while having strong mechanical properties. However, enzymes found in the knee are known to degrade tissues and affect the healing of intra-articular injuries. Results suggest that the natural polymers used in this study modify the thermal properties and tensile strength of the synthetic polymers when blended. Scanning electron microscopy display bead-free and enzyme biodegradability of the fibers. Raman spectroscopy confirms the presence of the natural and synthetic polymers in the scaffolds while, amino acid analysis present the types of amino acids and their concentrations found in the natural polymers.

  5. Transphyseal ACL Reconstruction in Skeletally Immature Patients

    PubMed Central

    Cruz, Aristides I.; Lakomkin, Nikita; Fabricant, Peter D.; Lawrence, J. Todd R.

    2016-01-01

    , surgeons should be aware that if an independent femoral tunnel technique is utilized during transphyseal ACL reconstruction, more physeal tissue is at risk and tunnels are more eccentrically placed across the physis when drilling at more horizontal angles. Prior studies have shown that greater physeal involvement and eccentric tunnels may increase the risk of growth disturbance. PMID:27331075

  6. The ACL Message Passing Library

    SciTech Connect

    Painter, J.; McCormick, P.; Krogh, M.; Hansen, C.; Colin de Verdiere, G.

    1995-09-01

    This paper presents the ACL (Advanced Computing Lab) Message Passing Library. It is a high throughput, low latency communications library, based on Thinking Machines Corp.`s CMMD, upon which message passing applications can be built. The library has been implemented on the Cray T3D, Thinking Machines CM-5, SGI workstations, and on top of PVM.

  7. Geometric profile of the tibial plateau cartilage surface is associated with the risk of non-contact anterior cruciate ligament injury.

    PubMed

    Beynnon, Bruce D; Vacek, Pamela M; Sturnick, Daniel R; Holterman, Leigh Ann; Gardner-Morse, Mack; Tourville, Timothy W; Smith, Helen C; Slauterbeck, James R; Johnson, Robert J; Shultz, Sandra J

    2014-01-01

    The purpose of this study was to determine if geometry of the articular surfaces of the tibial plateau is associated with non-contact anterior cruciate ligament (ACL) injury. This was a longitudinal cohort study with a nested case-control analysis. Seventy-eight subjects who suffered a non-contact ACL tear and a corresponding number of controls matched by age, sex, and sport underwent 3 T MRI of both knees. Surface geometry of the tibial articular cartilage was characterized with polynomial equations and comparisons were made between knees on the same person and between ACL-injured and control subjects. There was no difference in surface geometry between the knees of the control subjects. In contrast, there were significant differences in the surface geometry between the injured and normal knees of the ACL-injured subjects, suggesting that the ACL injury changed the cartilage surface profile. Therefore, comparisons were made between the uninjured knees of the ACL-injured subjects and the corresponding knees of their matched controls and this revealed significant differences in the surface geometry for the medial (p < 0.006) and lateral (p < 0.001) compartments. ACL-injured subjects tended to demonstrate a posterior-inferior directed orientation of the articular surface relative to the long axis of the tibia, while the control subjects were more likely to show a posterior-superior directed orientation.

  8. Can child injury prevention include healthy risk promotion?

    PubMed Central

    Brussoni, Mariana; Brunelle, Sara; Pike, Ian; Sandseter, Ellen Beate Hansen; Herrington, Susan; Turner, Heather; Belair, Scott; Logan, Louise; Fuselli, Pamela; Ball, David J

    2015-01-01

    To reflect on the role of risk-taking and risky play in child development and consider recommendations for the injury prevention field, a symposium was held prior to the November 2013 Canadian Injury Prevention and Safety Promotion Conference. Delegates heard from Canadian and international researchers, practitioners and play safety experts on child development, play space design and playground safety, provision of recreation, and legal and societal perceptions of risk and hazard. The presenters provided multidisciplinary evidence and perspectives indicating the potential negative effect on children's development of approaches to injury prevention that prioritise safety and limit children's opportunities for risky play. Delegates considered the state of the field of injury prevention and whether alternative approaches were warranted. Each presenter prepared a discussion paper to provide the opportunity for dialogue beyond attendees at the symposium. The resulting discussion papers provide a unique opportunity to consider and learn from multiple perspectives in order to develop a path forward. PMID:25535208

  9. Can child injury prevention include healthy risk promotion?

    PubMed

    Brussoni, Mariana; Brunelle, Sara; Pike, Ian; Sandseter, Ellen Beate Hansen; Herrington, Susan; Turner, Heather; Belair, Scott; Logan, Louise; Fuselli, Pamela; Ball, David J

    2015-10-01

    To reflect on the role of risk-taking and risky play in child development and consider recommendations for the injury prevention field, a symposium was held prior to the November 2013 Canadian Injury Prevention and Safety Promotion Conference. Delegates heard from Canadian and international researchers, practitioners and play safety experts on child development, play space design and playground safety, provision of recreation, and legal and societal perceptions of risk and hazard. The presenters provided multidisciplinary evidence and perspectives indicating the potential negative effect on children's development of approaches to injury prevention that prioritise safety and limit children's opportunities for risky play. Delegates considered the state of the field of injury prevention and whether alternative approaches were warranted. Each presenter prepared a discussion paper to provide the opportunity for dialogue beyond attendees at the symposium. The resulting discussion papers provide a unique opportunity to consider and learn from multiple perspectives in order to develop a path forward.

  10. Can child injury prevention include healthy risk promotion?

    PubMed

    Brussoni, Mariana; Brunelle, Sara; Pike, Ian; Sandseter, Ellen Beate Hansen; Herrington, Susan; Turner, Heather; Belair, Scott; Logan, Louise; Fuselli, Pamela; Ball, David J

    2015-10-01

    To reflect on the role of risk-taking and risky play in child development and consider recommendations for the injury prevention field, a symposium was held prior to the November 2013 Canadian Injury Prevention and Safety Promotion Conference. Delegates heard from Canadian and international researchers, practitioners and play safety experts on child development, play space design and playground safety, provision of recreation, and legal and societal perceptions of risk and hazard. The presenters provided multidisciplinary evidence and perspectives indicating the potential negative effect on children's development of approaches to injury prevention that prioritise safety and limit children's opportunities for risky play. Delegates considered the state of the field of injury prevention and whether alternative approaches were warranted. Each presenter prepared a discussion paper to provide the opportunity for dialogue beyond attendees at the symposium. The resulting discussion papers provide a unique opportunity to consider and learn from multiple perspectives in order to develop a path forward. PMID:25535208

  11. Identifying and mitigating risks for agricultural injury associated with obesity.

    PubMed

    King, Nathan; Janssen, Ian; Hagel, Louise; Dosman, James; Lawson, Joshua; Trask, Catherine; Pickett, William

    2016-12-01

    In some occupational contexts overweight and obesity have been identified as risk factors for injury. The purpose of this study was to examine this hypothesis within farm work environments and then to identify specific opportunities for environmental modification as a preventive strategy. Data on farm-related injuries, height and weight used to calculate body mass index (BMI), and demographic characteristics were from the Phase 2 baseline survey of the Saskatchewan Farm Injury Cohort; a large cross-sectional mail-based survey conducted in Saskatchewan, Canada from January through May 2013. Multivariable logistic regression was used to examine associations between BMI and injury. Injury narratives were explored qualitatively. Findings were inconsistent and differed according to gender. Among women (n = 927), having overweight (adjusted OR: 2.94; 95% CI: 1.29 to 6.70) but not obesity (1.10; 95% CI: 0.35 to 3.43) was associated with an increased odds of incurring a farm-related injury. No strong or statistically significant effects were observed for men (n = 1406) with overweight or obesity. While injury-related challenges associated with obesity have been addressed in other occupational settings via modification of the worksite, such strategies are challenging to implement in farm settings because of the diversity of work tasks and associated hazards. We conclude that the acute effects of overweight in terms of injury do require consideration in agricultural populations, but these should also be viewed with a differentiation based on gender.

  12. Biomechanical Risk Estimates for Mild Traumatic Brain Injury

    PubMed Central

    Funk, J. R.; Duma, S. M.; Manoogian, S. J.; Rowson, S.

    2007-01-01

    The objective of this study was to characterize the risk of mild traumatic brain injury (MTBI) in living humans based on a large set of head impact data taken from American football players at the collegiate level. Real-time head accelerations were recorded from helmet-mounted accelerometers designed to stay in contact with the player’s head. Over 27,000 head impacts were recorded, including four impacts resulting in MTBI. Parametric risk curves were developed by normalizing MTBI incidence data by head impact exposure data. An important finding of this research is that living humans, at least in the setting of collegiate football, sustain much more significant head impacts without apparent injury than previously thought. The following preliminary nominal injury assessment reference values associated with a 10% risk of MTBI are proposed: a peak linear head acceleration of 165 g, a HIC of 400, and a peak angular head acceleration of 9000 rad/s2. PMID:18184501

  13. Knee injuries in female athletes.

    PubMed

    Hutchinson, M R; Ireland, M L

    1995-04-01

    Female athletes are at increased risk for certain sports-related injuries, particularly those involving the knee. Factors that contribute to this increased risk are the differences in sports undertaken and in gender anatomy and structure. Gender differences include baseline level of conditioning, lower extremity alignment, physiological laxity, pelvis width, tibial rotation and foot alignment. Sports like gymnastics and cheerleading create a noncontact environment, but can result in significant knee injuries. In quick stopping and cutting sports, females have an increased incidence of anterior cruciate ligament (ACL) injury by noncontact mechanisms. Patellofemoral (PF) disorders are also very common in female athletes. Awareness of these facts helps the sports medicine professional make an accurate diagnosis and institute earlier treatment-focused rehabilitation with or without surgery. Further prospective and retrospective research is needed in areas of epidemiology, mechanisms, severity and types of knee injuries. The goal is to lessen the severity of certain knee injuries and to prevent others. PMID:7604201

  14. Drinking history and risk of fatal injury: comparison among specific injury causes.

    PubMed

    Chen, Li-Hui; Baker, Susan P; Li, Guohua

    2005-03-01

    The effect of acute alcohol use on injury risk is well documented, but the relationship between drinking history and fatal injury has not been adequately studied. The authors performed a case-control analysis to explore the association between drinking history and specific causes of fatal injury. Cases (n=5549) were persons who died from injury, selected from the 1993 National Mortality Followback Survey (NMFS); controls (n=42,698) were a representative sample of the general population, selected from the 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES). Current drinkers comprised 59% of the cases compared with 44% of the controls. After adjustment for age, sex, race/ethnicity, education, marital status, employment, and drug use, the odds ratio (OR) of dying from drowning for current drinkers was 3.48 (95% confidence interval (CI)=1.94, 6.25), the highest among all causes of injury studied. The lowest adjusted odds ratio associated with current drinking was for falls (OR=1.38; 95% CI=1.05, 1.82). Being a current drinker increased the risk of dying from suicide more for females (OR=4.04; 95% CI=1.64, 9.93) than for males (OR=1.45; 95% CI=1.20, 1.74). The authors conclude that drinking history is associated with a significantly increased risk of all types of fatal injury.

  15. Anterior cruciate ligament (ACL) injury - aftercare

    MedlinePlus

    ... side of your knee, such as during a football tackle Twist your knee Quickly stop moving and ... or turning Skiers and people who play basketball, football, or soccer are more likely to have this ...

  16. The effect of previous traumatic injury on homicide risk.

    PubMed

    Griffin, Russell L; Davis, Gregory G; Levitan, Emily B; MacLennan, Paul A; Redden, David T; McGwin, Gerald

    2014-07-01

    Research has reported that a strong risk factor for traumatic injury is having a previous injury (i.e., recidivism). To date, the only study examining the relationship between recidivism and homicide reported strong associations, but was limited by possible selection bias. The current matched case-control study utilized coroner's data from 2004 to 2008. Subjects were linked to trauma registry data to determine whether the person had a previous traumatic injury. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between homicide and recidivism. Homicide risk was increased for those having a previous traumatic injury (OR 1.81, 95% CI 1.09-2.99) or a previous intentional injury (OR 2.53, 95% CI 1.24-5.17). These results suggest an association between homicide and injury recidivism, and that trauma centers may be an effective setting for screening individuals for secondary prevention efforts of homicide through violence prevention programs.

  17. Applying personal genetic data to injury risk assessment in athletes.

    PubMed

    Goodlin, Gabrielle T; Roos, Andrew K; Roos, Thomas R; Hawkins, Claire; Beache, Sydney; Baur, Stephen; Kim, Stuart K

    2014-01-01

    Recent studies have identified genetic markers associated with risk for certain sports-related injuries and performance-related conditions, with the hope that these markers could be used by individual athletes to personalize their training and diet regimens. We found that we could greatly expand the knowledge base of sports genetic information by using published data originally found in health and disease studies. For example, the results from large genome-wide association studies for low bone mineral density in elderly women can be re-purposed for low bone mineral density in young endurance athletes. In total, we found 124 single-nucleotide polymorphisms associated with: anterior cruciate ligament tear, Achilles tendon injury, low bone mineral density and stress fracture, osteoarthritis, vitamin/mineral deficiencies, and sickle cell trait. Of these single nucleotide polymorphisms, 91% have not previously been used in sports genetics. We conducted a pilot program on fourteen triathletes using this expanded knowledge base of genetic variants associated with sports injury. These athletes were genotyped and educated about how their individual genetic make-up affected their personal risk profile during an hour-long personal consultation. Overall, participants were favorable of the program, found it informative, and most acted upon their genetic results. This pilot program shows that recent genetic research provides valuable information to help reduce sports injuries and to optimize nutrition. There are many genetic studies for health and disease that can be mined to provide useful information to athletes about their individual risk for relevant injuries.

  18. Applying Personal Genetic Data to Injury Risk Assessment in Athletes

    PubMed Central

    Goodlin, Gabrielle T.; Roos, Andrew K.; Roos, Thomas R.; Hawkins, Claire; Beache, Sydney; Baur, Stephen; Kim, Stuart K.

    2015-01-01

    Recent studies have identified genetic markers associated with risk for certain sports-related injuries and performance-related conditions, with the hope that these markers could be used by individual athletes to personalize their training and diet regimens. We found that we could greatly expand the knowledge base of sports genetic information by using published data originally found in health and disease studies. For example, the results from large genome-wide association studies for low bone mineral density in elderly women can be re-purposed for low bone mineral density in young endurance athletes. In total, we found 124 single-nucleotide polymorphisms associated with: anterior cruciate ligament tear, Achilles tendon injury, low bone mineral density and stress fracture, osteoarthritis, vitamin/mineral deficiencies, and sickle cell trait. Of these single nucleotide polymorphisms, 91% have not previously been used in sports genetics. We conducted a pilot program on fourteen triathletes using this expanded knowledge base of genetic variants associated with sports injury. These athletes were genotyped and educated about how their individual genetic make-up affected their personal risk profile during an hour-long personal consultation. Overall, participants were favorable of the program, found it informative, and most acted upon their genetic results. This pilot program shows that recent genetic research provides valuable information to help reduce sports injuries and to optimize nutrition. There are many genetic studies for health and disease that can be mined to provide useful information to athletes about their individual risk for relevant injuries. PMID:25919592

  19. A review of risk factors and patterns of motorcycle injuries.

    PubMed

    Lin, Mau-Roung; Kraus, Jess F

    2009-07-01

    Per vehicle mile traveled, motorcycle riders have a 34-fold higher risk of death in a crash than people driving other types of motor vehicles. While lower-extremity injuries most commonly occur in all motorcycle crashes, head injuries are most frequent in fatal crashes. Helmets and helmet use laws have been shown to be effective in reducing head injuries and deaths from motorcycle crashes. Alcohol is the major contributing factor to fatal crashes. Enforcement of legal limits on the blood alcohol concentration is effective in reducing motorcycle deaths, while some alcohol-related interventions such as a minimal legal drinking age, increased alcohol excise taxes, and responsible beverage service specifically for motorcycle riders have not been examined. Other modifiable protective or risk factors comprise inexperience and driver training, conspicuity and daytime headlight laws, motorcycle licensure and ownership, riding speed, and risk-taking behaviors. Features of motorcycle use and potentially effective prevention programs for motorcycle crash injuries in developing countries are discussed. Finally, recommendations for future motorcycle-injury research are made. PMID:19540959

  20. Pedestrian Injury Patterns and Risk in Minibus Collisions in China

    PubMed Central

    Li, Kui; Fan, Xiaoxiang; Yin, Zhiyong

    2015-01-01

    Background The minibus, with a nearly flat front, is widely used in China, especially in the underdeveloped regions, and results in large numbers of pedestrian injuries and deaths. The purpose of this study was to determine the injury patterns and risk for pedestrians involved in these crashes. Material/Methods We conducted an in-depth investigation of minibus/pedestrian accidents in Chongqing, China, occurring between September 2000 and April 2014. The enrolled pedestrians was classified into 3 groups: young (aged 14–44 years), middle-aged (aged 45–59 years), and elderly (aged over 60 years). Pedestrian injuries were coded according to the Abbreviated Injury Scale (AIS). Results A total of 109 pedestrians, with an average age of 55.7±16.2 years, were injured or killed – 30.3% were young, 23.9% were middle-aged, and 45.9% were elderly. Pedestrians hit by a minibus had a high proportion of head, chest, and extremity injuries – 84.4%, 50.5%, and 52.3%, respectively. In addition, impact speeds in excess of 75 km/h all ultimately resulted in fatalities. At an impact speed of 30 km/h, the risk of pedestrian fatality and AIS3+ injury are approximately 12.0% and 37.2%, respectively. At 50 km/h the risks are 65.2% and 96.9%, respectively, and at 70 km/h the risks are 96.3% and 99.9%, respectively. Conclusions A higher likelihood of chest injury was associated with being older and impact speed of over 40 km/h in minibus/pedestrian collision. Our data suggest that the injury patterns of pedestrians in minibus collisions differ from that in other vehicle/pedestrian collisions. These findings could contribute to better understanding of the injury patterns and risk of pedestrian in minibus collisions in China, which may play an important role in developing measures to improve traffic safety. PMID:25754962

  1. Sex, Age, and Graft Size as Predictors of ACL Re-tear

    PubMed Central

    Nguyen, Duong

    2016-01-01

    Objectives: The minimum size required for a successful quadrupled hamstring autograft ACL reconstruction remains controversial. The risks of ACL re-tear in younger patients who tend to participate in a higher level of sports activity, and female athletes who have numerous predisposing factors, are poorly defined. Purpose: To identify risk factors for graft re-tears within 2 years of ACL surgery. The hypotheses are that female sex, a smaller size graft, and younger patients will increase the odds of failure. Study Design Cohort Study. Level of evidence, 3. Methods: A cohort of 503 athletes undergoing primary, autograft hamstring ACL reconstruction, performed by a single surgeon using the same surgical technique and rehabilitation protocol, between September-December 2012, was followed for a total duration of 2 years. Return to play was allowed between 6 and 12 months post-surgery upon completion of functional testing. Exclusion criteria included infections, revisions, double bundle techniques, multi-ligament injuries, non-compliance, BTB/allografts/hybrid grafts. Primary outcome consisted of binary data (ACL graft re-tear or no tear) as measured on physical exam (Lachman and pivot shift) and MRI. Multivariate logistic regression statistical analysis with model fitting was used to investigate the predictive value of sex, age, and graft size on ACL re-tear. Secondary sensitivity analyses were performed on the adolescent subgroup, age and graft size as categorical variables, and testing for interactions among variables. Sample size was calculated based on the rule of 10 events per independent variable for logistic regression. Results: The mean age of the 503 athletes was 27.5 (SD 10.6; range = 12-61). There were 235 females (47%) and 268 males (53%) with a 6% rate of re-tears (28 patients; 17 females). Mean graft size was 7.9 (SD 0.6; range = 6-10). Univariate analyses of graft size, sex, and age only in the model showed that younger age (odds ratio [OR] = 0.86; 95

  2. Constraints influencing sports wheelchair propulsion performance and injury risk

    PubMed Central

    2013-01-01

    The Paralympic Games are the pinnacle of sport for many athletes with a disability. A potential issue for many wheelchair athletes is how to train hard to maximise performance while also reducing the risk of injuries, particularly to the shoulder due to the accumulation of stress placed on this joint during activities of daily living, training and competition. The overall purpose of this narrative review was to use the constraints-led approach of dynamical systems theory to examine how various constraints acting upon the wheelchair-user interface may alter hand rim wheelchair performance during sporting activities, and to a lesser extent, their injury risk. As we found no studies involving Paralympic athletes that have directly utilised the dynamical systems approach to interpret their data, we have used this approach to select some potential constraints and discussed how they may alter wheelchair performance and/or injury risk. Organism constraints examined included player classifications, wheelchair setup, training and intrinsic injury risk factors. Task constraints examined the influence of velocity and types of locomotion (court sports vs racing) in wheelchair propulsion, while environmental constraints focused on forces that tend to oppose motion such as friction and surface inclination. Finally, the ecological validity of the research studies assessing wheelchair propulsion was critiqued prior to recommendations for practice and future research being given. PMID:23557065

  3. Father-Child Interactions and Children's Risk of Injury

    ERIC Educational Resources Information Center

    StGeorge, Jennifer; Fletcher, Richard; Freeman, Emily; Paquette, Daniel; Dumont, Caroline

    2015-01-01

    Unintentional injury is an important cause of infant and child hospitalisation and parents play a key role in reducing children's risk-taking behaviour. Studies show that maternal and paternal parenting and supervision of children differ, but there is little research showing how fathers' parenting may influence children's tendency to engage in…

  4. Self-reported previous knee injury and low knee function increase knee injury risk in adolescent female football.

    PubMed

    Clausen, M B; Tang, L; Zebis, M K; Krustrup, P; Hölmich, P; Wedderkopp, N; Andersen, L L; Christensen, K B; Møller, M; Thorborg, K

    2016-08-01

    Knee injuries are common in adolescent female football. Self-reported previous knee injury and low Knee injury and Osteoarthritis Outcome Score (KOOS) are proposed to predict future knee injuries, but evidence regarding this in adolescent female football is scarce. The aim of this study was to investigate self-reported previous knee injury and low KOOS subscale score as risk factors for future knee injuries in adolescent female football. A sample of 326 adolescent female football players, aged 15-18, without knee injury at baseline, were included. Data on self-reported previous knee injury and KOOS questionnaires were collected at baseline. Time-loss knee injuries and football exposures were reported weekly by answers to standardized text-message questions, followed by injury telephone interviews. A priori, self-reported previous knee injury and low KOOS subscale scores (< 80 points) were chosen as independent variables in the risk factor analyses. The study showed that self-reported previous knee injury significantly increased the risk of time-loss knee injury [relative risk (RR): 3.65, 95% confidence (CI) 1.73-7.68; P < 0.001]. Risk of time-loss knee injury was also significantly increased in players with low KOOS subscale scores (< 80 points) in Activities of Daily Living (RR: 5.0), Sport/Recreational (RR: 2.2) and Quality of Life (RR: 3.0) (P < 0.05). In conclusion, self-reported previous knee injury and low scores in three KOOS subscales significantly increase the risk of future time-loss knee injury in adolescent female football. PMID:26179111

  5. Gait adaptation in ACL deficient patients before and after anterior cruciate ligament reconstruction surgery.

    PubMed

    Knoll, Zsolt; Kiss, Rita M; Kocsis, László

    2004-06-01

    The objective of this study is to determine how kinematical parameters and electromyography data of selected muscles may change as a result of anterior cruciate ligament (ACL) deficiency and following ACL reconstruction. The study was conducted on 25 anterior cruciate ligament deficient subjects prior to and 6 weeks, 4 months, 8 months and 12 months following ACL reconstructive surgery using the bone-patellar tendon-bone technique. Gait analysis was performed by applying the zebris three-dimensional ultrasound-based system with surface electromyograph (zebris). Kinematic data were recorded for the lower limb. The muscles surveyed include vastus lateralis and medialis, biceps femoris and adductor longus. The results obtained from the injured subjects were compared with those of 51 individuals without any ACL damage whatsoever. Acute ACL deficient patients exhibited a quadriceps avoidance pattern prior to and 6 weeks following surgery. No quadriceps avoidance phenomenon develops in chronic ACL deficient patients. In operated individuals, tempo-spatial parameters and the knee angle regained a normal pattern for the ACL-deficient limb during gait as early as 4 months following surgery. However, the relative ACL movement parameter, which describes the tibial translation into the direction of ACL, and the EMG traces show no significant statistical difference compared with the same values of the healthy control group just 8 months following surgery. The analysis of spatial-temporal parameters and EMG traces show that the development of a quadriceps avoidance pattern is less common than previously reported. These data suggest that anterior cruciate ligament deficiency and reconstruction produce considerable changes in the lower extremity gait pattern. The results suggest that gait parameters tend to shift towards a normal value pattern; and the re-establishment of pre-injury gait patterns-including the normal biphase of muscles-takes at least 8 months to occur.

  6. Adolescent Balloon Analog Risk Task and Behaviors that Influence Risk of Motor Vehicle Crash Injury

    PubMed Central

    Vaca, Federico E.; Walthall, Jessica M.; Ryan, Sheryl; Moriarty-Daley, Alison; Riera, Antonio; Crowley, Michael J.; Mayes, Linda C.

    2013-01-01

    Risk-taking propensity is a pivotal facet of motor vehicle crash involvement and subsequent traumatic injury in adolescents. Clinical encounters are important opportunities to identify teens with high risk-taking propensity who may later experience serious injury. Our objective was to compare self-reports of health risk behavior with performance on the Balloon Analog Risk Task (BART), a validated metric of risk-taking propensity, in adolescents during a clinical encounter. 100 adolescent patients from a hospital emergency department and adolescent health clinic completed a computer-based survey of self-reported risk behaviors including substance use behaviors and behaviors that influence crash involvement. They then completed the BART, a validated laboratory-based risk task in which participants earn points by pumping up a computer-generated balloon with greater pumps leading to increased chance of balloon explosion. 20 trials were undertaken. Mean number of pumps on the BART showed a correlation of .243 (p=.015) with self-reported driver/passenger behaviors and attitudes towards driving that influence risk of crash injury. Regression analyses showed that self-reports of substance use and mean number of pumps on the BART uniquely predict self-reports of behaviors influencing the risk of crash injury. The BART is a promising correlate of real-world risk-taking behavior related to traffic safety. It remains a valid predictor of behaviors influencing risk of crash injury when using just 10 trials, suggesting its utility as a quick and effective screening measure for use in busy clinical environments. This tool may be an important link to prevention interventions for those most at-risk for future motor vehicle crash involvement and injury. PMID:24406948

  7. Unilateral Stance Strategies of Athletes With ACL Deficiency

    PubMed Central

    Di Stasi, Stephanie L.; Hartigan, Erin H.; Snyder-Mackler, Lynn

    2013-01-01

    Aberrant movement strategies are characteristic of ACL-deficient athletes with recurrent knee instability (non-copers), and may instigate premature or accelerate joint degradation. Biomechanical evaluation of kinematic changes over time may elucidate noncopers’ responses to neuromuscular intervention and ACL reconstruction (ACLR). Forty noncopers were randomized into a perturbation group or a strength training only group. We evaluated the effects of perturbation training, and then gender on knee angle and tibial position during a unilateral standing task before and after ACLR. No statistically significant interactions were found. Before surgery, the strength training only group demonstrated knee angle asymmetry, but 6 months after ACLR, both groups presented with similar knee flexion between limbs. Aberrant and asymmetrical tibial position was found only in females following injury and ACLR. Neither treatment group showed distinct unilateral standing strategies following intervention; however, males and female noncopers appear to respond uniquely to physical therapy and surgery. PMID:22983931

  8. Diffuse Axonal Injury: Epidemiology, Outcome and Associated Risk Factors

    PubMed Central

    Vieira, Rita de Cássia Almeida; Paiva, Wellingson Silva; de Oliveira, Daniel Vieira; Teixeira, Manoel Jacobsen; de Andrade, Almir Ferreira; de Sousa, Regina Márcia Cardoso

    2016-01-01

    Diffuse axonal injury (DAI), a type of traumatic injury, is known for its severe consequences. However, there are few studies describing the outcomes of DAI and the risk factors associated with it. This study aimed to describe the outcome for patients with a primary diagnosis of DAI 6 months after trauma and to identify sociodemographic and clinical factors associated with mortality and dependence at this time point. Seventy-eight patients with DAI were recruited from July 2013 to February 2014 in a prospective cohort study. Patient outcome was analyzed using the Extended Glasgow Outcome Scale (GOS-E) within 6 months of the traumatic injury. The mean Injury Severity Score was 35.0 (SD = 11.9), and the mean New Injury Severity Score (NISS) was 46.2 (SD = 15.9). Mild DAI was observed in 44.9% of the patients and severe DAI in 35.9%. Six months after trauma, 30.8% of the patients had died, and 45.1% had shown full recovery according to the GOS-E. In the logistic regression model, the severity variables – DAI with hypoxia, as measured by peripheral oxygen saturation, and hypotension with NISS value – had a statistically significant association with patient mortality; on the other hand, severity of DAI and length of hospital stay were the only significant predictors for dependence. Therefore, severity of DAI emerged as a risk factor for both mortality and dependence. PMID:27812349

  9. Injury risk due to collisions in Major League Baseball.

    PubMed

    Rosenbaum, D A; Davis, S W

    2014-07-01

    Purpose is to determine if Major League Baseball plays at risk for collisions have higher injury rates than typical base running plays. 2002-2011 Major League Baseball play data was obtained: non-force putouts by catcher at home plate (Catcher Tag Out), groundball force outs at 2(nd) base with less than 2 outs (Double Play Attempt), and the control play, outfield assisted non-force putouts of runners attempting to advance to 2(nd) or 3(rd) base (Outfield Assist 2(nd)/3(rd)). This list was cross-referenced with 2002-2011 disabled lists to see if an involved player went on the disabled list the day of or day after the play. An on-line search for each match determined if the injury was attributable to that play. Rate calculated per 1 000 plays, severity in days on disabled list. Injury rate and severity for Catcher Tag Out was 6.98 and 45.6 respectively, Double Play Attempt 0.42 and 41.3, Outfield Assist 2(nd/)3(rd) 1.56 and 47.0. Injury rate for Catcher Tag Out was higher (P = 0.03) than the control while Double Play Attempt trended lower (P = 0.05). There was no difference in severity. Catcher Tag Outs carry greater injury risk than typical base running plays. Major League Baseball should consider prohibiting base path collisions.

  10. Car insurance and the risk of car crash injury.

    PubMed

    Blows, Stephanie; Ivers, Rebecca Q; Connor, Jennie; Ameratunga, Shanthi; Norton, Robyn

    2003-11-01

    Despite speculation about the role of vehicle insurance in road traffic accidents, there is little research estimating the direction or extent of the risk relationship. Data from the Auckland Car Crash Injury Study (1998-1999) were used to examine the association between driving an uninsured motor vehicle and car crash injury. Cases were all cars involved in crashes in which at least one occupant was hospitalized or killed anywhere in the Auckland region. Controls were 588 drivers of randomly selected cars on Auckland roads. Participants completed a structured interview. Uninsured drivers had significantly greater odds of car crash injury compared to insured drivers after adjustment for age, sex, level of education, and driving exposure (odds ratio 4.77, 95% confidence interval 2.94-7.75). The causal mechanism for insurance and car crash injury is not easily determined. Although we examined the effects of multiple potential confounders in our analysis including socioeconomic status and risk-taking behaviours, both of which have been previously observed to be associated with both insurance status and car crash injury, residual confounding may partly explain this association. The estimated proportion of drivers who are uninsured is between 5 and 15% in developed countries, representing a significant public health problem worthy of further investigation. PMID:12971933

  11. Validation of a novel method for quantifying and comparing regional ACL elongations during uniaxial tensile loading.

    PubMed

    Beaulieu, Mélanie L; Haladik, Jeffrey A; Bey, Michael J; McLean, Scott G

    2012-10-11

    Given the complex three-dimensional (3D) knee joint loading associated with anterior cruciate ligament (ACL) injuries, accurate site- and bundle-specific strain measurements are critical. The purpose of this study was to quantify tensile load-induced migrations of radio-opaque markers injected directly into the ACL, as a first step in validating a roentgen stereophotogrammetric analysis-based method for measuring ligament strain. Small markers were inserted into the femur and tibia, as well as injected into the antero-medial bundle of the ACL of eight (42-56 yrs) femur-ACL-tibia complexes (FATCs). The FATCs were then loaded under tension along the ligament's longitudinal axis by a material testing machine from 10 N to 50 N, 100 N, 125 N, and 150 N, each over 10 load-unload cycles. Complexes were imaged before the loading protocol, between each loading sequence, and after the protocol via biplane radiography. Marker migrations within the ACL tissue were quantified as the difference in their 3D positions between the pre- and each post-loading condition. Negligible migration was evident, with the lowest average root mean square values observed along the longitudinal axis of the ACL, ranging from 0.128 to 0.219 mm. Further, neither marker location nor load magnitude significantly affected migration values. This innovative method, therefore, presents as a plausible means to measure global and regional ACL strains, as small as 0.75% strain. In particular, it may provide important new insights in ACL strain behaviors during complex 3D knee load states associated with ligament injury. PMID:22939290

  12. The Curveball as a Risk Factor for Injury

    PubMed Central

    Grantham, W. Jeffrey; Iyengar, Jaicharan J.; Byram, Ian R.; Ahmad, Christopher S.

    2015-01-01

    Context: The curveball is regarded by many as a potential risk factor for injury in youth baseball pitchers. Objective: To critically evaluate the scientific evidence regarding the curveball and its impact on pitching biomechanics and the overall risk of arm injuries in baseball pitchers. Study Type: Systematic review. Level of Evidence: Level 3. Data Sources: Ovid MEDLINE from 1946 to 2012. Study Selection: Ten biomechanical studies on kinematic or electromyographic analysis of pitching a curveball were included, as well as 5 epidemiologic studies that assessed pain or injury incidence in pitchers throwing the curveball. Data Extraction: When possible, demographic, methodology, kinetics, and kinematics variables and pain/injury incidence were compiled. Results: Two biomechanical studies found greater horizontal adduction of the shoulder at ball release and less shoulder internal torque during the curveball pitching motion. Two studies demonstrated less proximal force and less torque at the elbow as the arm accelerated when throwing a curveball compared with a fastball, as well as greater supination of the forearm and less wrist extension. Electromyographic data suggested increased activity of extensor and supinator muscles for curveballs. No studies found increased force or torque about the elbow or shoulder. Three epidemiologic studies showed no significant association between pitching a curveball and upper extremity pain or injury. One retrospective epidemiologic study reported a 52% increase in shoulder pain in pitchers throwing a curveball, although this may have been due to confounders. Conclusion: Despite much debate in the baseball community about the curveball’s safety in youth pitchers, limited biomechanical and most epidemiologic data do not indicate an increased risk of injury when compared with the fastball. PMID:25553209

  13. Identifying and mitigating risks for agricultural injury associated with obesity.

    PubMed

    King, Nathan; Janssen, Ian; Hagel, Louise; Dosman, James; Lawson, Joshua; Trask, Catherine; Pickett, William

    2016-12-01

    In some occupational contexts overweight and obesity have been identified as risk factors for injury. The purpose of this study was to examine this hypothesis within farm work environments and then to identify specific opportunities for environmental modification as a preventive strategy. Data on farm-related injuries, height and weight used to calculate body mass index (BMI), and demographic characteristics were from the Phase 2 baseline survey of the Saskatchewan Farm Injury Cohort; a large cross-sectional mail-based survey conducted in Saskatchewan, Canada from January through May 2013. Multivariable logistic regression was used to examine associations between BMI and injury. Injury narratives were explored qualitatively. Findings were inconsistent and differed according to gender. Among women (n = 927), having overweight (adjusted OR: 2.94; 95% CI: 1.29 to 6.70) but not obesity (1.10; 95% CI: 0.35 to 3.43) was associated with an increased odds of incurring a farm-related injury. No strong or statistically significant effects were observed for men (n = 1406) with overweight or obesity. While injury-related challenges associated with obesity have been addressed in other occupational settings via modification of the worksite, such strategies are challenging to implement in farm settings because of the diversity of work tasks and associated hazards. We conclude that the acute effects of overweight in terms of injury do require consideration in agricultural populations, but these should also be viewed with a differentiation based on gender. PMID:27413685

  14. Risk of severe driver injury by driving with psychoactive substances.

    PubMed

    Hels, Tove; Lyckegaard, Allan; Simonsen, Kirsten Wiese; Steentoft, Anni; Bernhoft, Inger Marie

    2013-10-01

    Driving with alcohol and other psychoactive substances imposes an increased risk of severe injury accidents. In a population-based case-control design, the relative risks of severe driver injury (MAIS≥2) by driving with ten substance groups were approximated by odds ratios (alcohol, amphetamines, benzoylecgonine, cocaine, cannabis, illicit opiates, benzodiazepines and Z-drugs, i.e. zolpidem and zopiclone, medicinal opioids, alcohol-drug combinations and drug-drug combinations). Data from six countries were included in the study: Belgium, Denmark, Finland, Italy, Lithuania and the Netherlands. Case samples (N=2490) were collected from severely injured drivers of passenger cars or vans in selected hospitals in various regions of the countries. Control samples (N=15,832) were sampled in a uniform sampling scheme stratified according to country, time, road type and season. Relative risks were approximated by odds ratios and calculated by logistic regression. The estimates were adjusted for age, gender and country. The highest risk of the driver being severely injured was associated with driving positive for high concentrations of alcohol (≥0.8 g/L), alone or in combination with other psychoactive substances. For alcohol, risk increased exponentially with blood alcohol concentration (BAC). The second most risky category contained various drug-drug combinations, amphetamines and medicinal opioids. Medium increased risk was associated with medium sized BACs (at or above 0.5 g/L, below 0.8 g/L) and benzoylecgonine. The least risky drug seemed to be cannabis and benzodiazepines and Z-drugs. For male drivers, the risk of being severely injured by driving with any of the psychoactive substances was about 65% of that of female drivers. For each of the substance groups there was a decrease in the risk of severe driver injury with increasing age. It is concluded that among psychoactive substances alcohol still poses the largest problem in terms of driver risk of getting

  15. Risk of marginal mandibular nerve injury in neck dissection.

    PubMed

    Møller, Martin Nue; Sørensen, Christian Hjort

    2012-02-01

    The immediate and permanent frequency of injury to the marginal mandibular branch of the facial nerve (MMN) after neck dissection has only scarcely been addressed in the medical literature. We investigated the risk of injury in 159 consecutive patients after neck dissection for various reasons in level I B and level II A, respectively. In 95 patients with oral cancer 13 (14%) of the cases had malfunction of the lower lip domain 2 weeks after neck dissection in level I B indicating paresis to the MMN. Follow-up analyses 1-2 years after the operation showed permanent paralysis in 4 to 7% of the cases in whom two of them had the nerve sacrificed for oncologic reasons during the operation. In 18 patients with parotic cancer the corresponding permanent frequency of MMN paralysis was 11.1%. In 46 patients with neck dissection in level II A but not in level I B, no paresis of the MMN was registered. Recognition of the MMN during the operation, pre- or postoperative radiation therapy, re-operation for deep hemorrhage, age, gender or postoperative infection did not have any statistically significant influence on the frequency of MMN injury. In conclusion we found a moderate risk of injury to the MMN after neck dissection in level I B whereas the corresponding risk after level II A dissection was negligible. PMID:21553271

  16. The Injury Risk to Wheelchair Occupants Using Motor Vehicle Transportation

    PubMed Central

    Songer, Thomas J.; Fitzgerald, Shirley G.; Rotko, Katherine A.

    2004-01-01

    The transportation safety experience for persons using wheelchairs is largely unknown. Motor vehicle crash involvement and injury frequency was examined in a telephone interview completed by 596 wheelchair users. Overall, 42% were drivers. Most subjects also rode as passengers in private vehicles (87%) and public vehicles (61%). Wheelchair use as a seat in the vehicle was higher among passengers than drivers. Crash involvement was highest among drivers and lower in passengers. Reported injuries from non-crash scenarios, though, were higher in passengers compared to drivers. Persons seated in wheelchairs in vehicles appear to be at a greater safety risk. PMID:15319121

  17. Diving the wreck: risk and injury in sport scuba diving.

    PubMed

    Hunt, J C

    1996-07-01

    This paper utilizes psychoanalytic theory to examine risk and injury in the case of a male deep sea diver. It examines the unconscious conflicts which appeared to fuel the diver's involvement in deep diving and to lead to a near fatal incident of decompression sickness. Particular attention is paid to the role of the diver's father in the evolution of the preoedipal and oedipal fantasies and conflicts which appear to be linked to the injury. The research is based on interviews with and fieldwork among recreational and deep divers.

  18. A prospective investigation of injury incidence and injury risk factors among army recruits in military police training

    PubMed Central

    2013-01-01

    Background United States Army military police (MP) training is a 19-week course designed to introduce new recruits to basic soldiering skills, Army values and lifestyle, and law enforcement skills and knowledge. The present investigation examined injury rates and injury risk factors in MP training. Methods At the start of training, 1,838 male and 553 female MP recruits were administered a questionnaire containing items on date of birth, height, weight, tobacco use, prior physical activity, injury history, and menstrual history. Injuries during training were obtained from electronic medical records and the training units provided data on student graduation and attrition. Results Successfully graduating from the course were 94.3% of the men and 83.7% of the women. Experiencing at least one injury during training were 34.2% of the men and 66.7% of the women (risk ratio (women/men) = 1.95, 95% confidence interval = 1.79-2.13). Recruits were at higher injury risk if they reported that they were older, had smoked in the past, or had performed less frequent exercise or sports prior to MP training. Men were at higher injury risk if they reported a prior injury and women were at higher risk if they reported missing at least six menstrual cycles in the last year or had previously been pregnant. Conclusion The present investigation was the first to identify injury rates and identify specific factors increasing injury risk during MP training. PMID:23327563

  19. Assessment scale of risk for surgical positioning injuries 1

    PubMed Central

    Lopes, Camila Mendonça de Moraes; Haas, Vanderlei José; Dantas, Rosana Aparecida Spadoti; de Oliveira, Cheila Gonçalves; Galvão, Cristina Maria

    2016-01-01

    ABSTRACT Objective: to build and validate a scale to assess the risk of surgical positioning injuries in adult patients. Method: methodological research, conducted in two phases: construction and face and content validation of the scale and field research, involving 115 patients. Results: the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning contains seven items, each of which presents five subitems. The scale score ranges between seven and 35 points in which, the higher the score, the higher the patient's risk. The Content Validity Index of the scale corresponded to 0.88. The application of Student's t-test for equality of means revealed the concurrent criterion validity between the scores on the Braden scale and the constructed scale. To assess the predictive criterion validity, the association was tested between the presence of pain deriving from surgical positioning and the development of pressure ulcer, using the score on the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning (p<0.001). The interrater reliability was verified using the intraclass correlation coefficient, equal to 0.99 (p<0.001). Conclusion: the scale is a valid and reliable tool, but further research is needed to assess its use in clinical practice. PMID:27579925

  20. Motorcycle helmet type and the risk of head injury and neck injury during motorcycle collisions in California.

    PubMed

    Erhardt, Taryn; Rice, Thomas; Troszak, Lara; Zhu, Motao

    2016-01-01

    The use of novelty motorcycle helmets is often prompted by beliefs that wearing a standard helmet can contribute to neck injury during traffic collisions. The goal of this analysis was to examine the association between helmet type and neck injury risk and the association between helmet type and head injury. Data were collected during the investigation of motorcycle collisions of any injury severity by the California Highway Patrol (CHP) and 83 local law enforcement agencies in California between June 2012 and July 2013. We estimated head injury and neck injury risk ratios from data on 7051 collision-involved motorcyclists using log-binomial regression. Helmet type was strongly associated with head injury occurrence but was not associated with the occurrence of neck injury. Rider age, rider alcohol use, and motorcycle speed were strong, positive predictors of both head and neck injury. Interventions to improve motorcycle helmet choice and to counteract misplaced concerns surrounding neck injury risk are likely to lead to reductions in head injury, brain injury, and death. PMID:26496484

  1. Risk factors for dive injury: a survey study.

    PubMed

    Beckett, Adam; Kordick, Mary Frances

    2007-01-01

    Scuba diving is a world sport, but it is not medically regulated. Study objectives sought to identify risk behaviors, preexisting medical conditions, compliance to dive guidelines, and injury patterns of recreational scuba divers. An Internet-based survey examined risk behaviors and diver safety practices. Responses from 682 of 770 (88.6%) divers revealed that 80.6% were certified; 51.7% of certified divers reported diving injuries versus 75.0% for noncertified divers (RR = 1.31; 95% CI: 1.16-1.48; P < 0.001); suspected decompression symptoms were witnessed by 52.6% of divers; 32.7% of certified divers reported medical problems including hypertension, asthma, diabetes, and epilepsy. No significant differences were observed in injuries among the certified divers based on dive frequency (P = 1.000), medical conditions (P = 0.750), smoking (P = 0.545), alcohol (P = 0.649), or illicit substances use (P = 0.230). Among certified divers, there was a positive association with fewer diving injuries but not with diving frequency, preexisting medical condition(s), smoking, alcohol, or illicit substance use.

  2. Risk factors of hand climbing-related injuries.

    PubMed

    Lion, A; van der Zwaard, B C; Remillieux, S; Perrin, P P; Buatois, S

    2016-07-01

    This study aimed to investigate the protective mechanisms or risk factors that can be related to the occurrence of hand climbing-related injuries (CRIH ). CRIH (tendon, pulley, muscle, and joint injuries) were retrospectively screened in 528 adult climbers. The questionnaire contained anthropometric items (e.g., body mass index - BMI), as well as items regarding climbing and basic training activities (warm-up, cool-down and session durations, number of session per week, hydration, practice level, climbing surface, and duration of the cardiovascular training). Higher skilled climbers and climbers with BMI above 21 kg/m(2) were more likely to have experienced CRIH (P < 0.01). Climbers with BMI above 20 kg/m(2) were more likely to have tendon injuries while those with a BMI above 21 kg/m(2) were more likely to have pulley injuries (P < 0.01). Skilled climbers, who climb more difficult routes, may use smaller grip size and a reduced number of fingers. Higher BMI will require a higher force to climb. Both high level and elevated BMI may increase the demands to the hands and fingers leading to CRIH . These risk factors are difficult to address as we cannot recommend the climbers to climb easier routes and decrease their BMI below 20 kg/m(2) . PMID:26105683

  3. Risk of Anterior Cruciate Ligament Fatigue Failure Is Increased by Limited Internal Femoral Rotation During In Vitro Repeated Pivot Landings

    PubMed Central

    Beaulieu, Mélanie L.; Wojtys, Edward M.; Ashton-Miller, James A.

    2015-01-01

    Background A reduced range of hip internal rotation is associated with increased peak anterior cruciate ligament (ACL) strain and risk for injury. It is unknown, however, whether limiting the available range of internal femoral rotation increases the susceptibility of the ACL to fatigue failure. Hypothesis Risk of ACL failure is significantly greater in female knee specimens with a limited range of internal femoral rotation, smaller femoral-ACL attachment angle, and smaller tibial eminence volume during repeated in vitro simulated single-leg pivot landings. Study Design Controlled laboratory study. Methods A custom-built testing apparatus was used to simulate repeated single-leg pivot landings with a 4×-body weight impulsive load that induces knee compression, knee flexion, and internal tibial torque in 32 paired human knee specimens from 8 male and 8 female donors. These test loads were applied to each pair of specimens, in one knee with limited internal femoral rotation and in the contralateral knee with femoral rotation resisted by 2 springs to simulate the active hip rotator muscles’ resistance to stretch. The landings were repeated until ACL failure occurred or until a minimum of 100 trials were executed. The angle at which the ACL originates from the femur and the tibial eminence volume were measured on magnetic resonance images. Results The final Cox regression model (P = .024) revealed that range of internal femoral rotation and sex of donor were significant factors in determining risk of ACL fatigue failure. The specimens with limited range of internal femoral rotation had a failure risk 17.1 times higher than did the specimens with free rotation (P = .016). The female knee specimens had a risk of ACL failure 26.9 times higher than the male specimens (P = .055). Conclusion Limiting the range of internal femoral rotation during repetitive pivot landings increases the risk of an ACL fatigue failure in comparison with free rotation in a cadaveric model

  4. Effect of Vehicle Incompatibility on Child Occupant Injury Risk

    PubMed Central

    Kallan, Michael J.; Arbogast, Kristy B.; Durbin, Dennis R.

    2005-01-01

    With the vehicle fleet of family transportation in the United States continuing to evolve primarily through the increasing number of light truck vehicles (LTV), studying the effects of vehicle incompatibility has become increasingly important. Using data collected from a population-based sample of child-involved crashes in insured vehicles, we explored the effect of variations in crash partner vehicle type on child occupant injury risk, stratified by direction of impact. Children in passenger cars and LTVs involved in onside collisions were at an increased risk of serious injury if struck by a LTV as compared to a passenger vehicle (passenger cars and minivans). Though smaller in magnitude, this trend was also present in offside and rear crashes as well. PMID:16179154

  5. Requirements specification for automated fall and injury risk assessment.

    PubMed

    Currie, Leanne M; Mellino, Lourdes V; Cimino, James J; Li, Jianhua; Bakken, Suzanne

    2006-01-01

    Fall and injury prevention continues to be a challenge in the acute care environment. Identification of patients at risk can guide preventive care for these individuals. The following study employed usability engineering methods via a series of focus groups, to specify functional and design requirements for an automated Fall-Injury Risk Assessment Instrument. Focus groups were held with interdisciplinary decision makers and end-users to identify functional and design specifications for the automated instrument. The results were mapped to usability heuristics, which were used to guide design decisions. The main elements identified were data completeness, workflow processes, resource access, and cognitive burden. The main usability factors identified were efficiency of user, match with real world, error prevention, recognition not recall and minimalist design. Focus groups are a useful methodology to specify requirements for healthcare applications. Outcomes evaluation of the automated instrument is in process. PMID:17102234

  6. ACLS.

    PubMed

    Handley, A J

    2001-09-01

    It must be emphasised that the published International Guidelines 2000 contain an in-depth presentation of the scientific evidence behind advanced life support. The exact interpretation of this evidence, and the algorithms adopted by a national resuscitation council will depend upon various factors such as local interpretation of the evidence, local practice and availability of drugs. The ERC is publishing its own summaries of the guideline changes and the sequences of action for both BLS and ALS and these papers are recommended for further reading.

  7. Examining the feasibility of a Microsoft Kinect ™ based game intervention for individuals with anterior cruciate ligament injury risk.

    PubMed

    Zhiyu Huo; Griffin, Joseph; Babiuch, Ryan; Gray, Aaron; Willis, Bradley; Marjorie, Skubic; Shining Sun

    2015-01-01

    We describe a feasibility study in which the Microsoft Kinect is used for a game-based exercise to strengthen posterior chain muscles which are often weak in those at high risk of anterior cruciate ligament (ACL) injury. In the game, subjects perform a single posterior chain strengthening exercise. The game uses a side-scrolling video display driven by a hip abduction exercise while a player lies down on the floor. Leg lifts beyond a predetermined angle trigger the jumping action of an animated tiger. We describe the scene and game control, which uses depth images from the Kinect. Although Kinect-based skeletal data are used for many games, the skeletal model does not yield good estimates for positions on the floor. Our proposed system uses multiple leg angle estimators for different angle regions to recognize the player lying down and capture the angle between two legs. We conducted an experiment that validates our system with marker-based Vicon ground truth data. We also present results of an end-to-end test using the game, showing feasibility.

  8. Examining the feasibility of a Microsoft Kinect ™ based game intervention for individuals with anterior cruciate ligament injury risk.

    PubMed

    Zhiyu Huo; Griffin, Joseph; Babiuch, Ryan; Gray, Aaron; Willis, Bradley; Marjorie, Skubic; Shining Sun

    2015-01-01

    We describe a feasibility study in which the Microsoft Kinect is used for a game-based exercise to strengthen posterior chain muscles which are often weak in those at high risk of anterior cruciate ligament (ACL) injury. In the game, subjects perform a single posterior chain strengthening exercise. The game uses a side-scrolling video display driven by a hip abduction exercise while a player lies down on the floor. Leg lifts beyond a predetermined angle trigger the jumping action of an animated tiger. We describe the scene and game control, which uses depth images from the Kinect. Although Kinect-based skeletal data are used for many games, the skeletal model does not yield good estimates for positions on the floor. Our proposed system uses multiple leg angle estimators for different angle regions to recognize the player lying down and capture the angle between two legs. We conducted an experiment that validates our system with marker-based Vicon ground truth data. We also present results of an end-to-end test using the game, showing feasibility. PMID:26737918

  9. Examining Measures of Weight as Risk Factors for Sport-Related Injury in Adolescents

    PubMed Central

    Nettel-Aguirre, Alberto; Doyle-Baker, Patricia K.; Macpherson, Alison; Emery, Carolyn A.

    2016-01-01

    Objectives. To examine body mass index (BMI) and waist circumference (WC) as risk factors for sport injury in adolescents. Design. A secondary analysis of prospectively collected data from a pilot cluster randomized controlled trial. Methods. Adolescents (n = 1,040) at the ages of 11–15 years from two Calgary junior high schools were included. BMI (kg/m2) and WC (cm) were measured from direct measures at baseline assessment. Categories (overweight/obese) were created using validated international (BMI) and national (WC) cut-off points. A Poisson regression analysis controlling for relevant covariates (sex, previous injury, sport participation, intervention group, and aerobic fitness level) estimated the risk of sport injury [incidence rate ratios (IRR) with 95% confidence intervals (CI)]. Results. There was an increased risk of time loss injury (IRR = 2.82, 95% CI: 1.01–8.04) and knee injury (IRR = 2.07, 95% CI: 1.00–6.94) in adolescents that were overweight/obese; however, increases in injury risk for all injury and lower extremity injury were not statistically significant. Estimates suggested a greater risk of time loss injury [IRR = 1.63 (95% CI: 0.93–2.47)] in adolescents with high measures of WC. Conclusions. There is an increased risk of time loss injury and knee injury in overweight/obese adolescents. Sport injury prevention training programs should include strategies that target all known risk factors for injury. PMID:27525304

  10. Examining Measures of Weight as Risk Factors for Sport-Related Injury in Adolescents.

    PubMed

    Richmond, Sarah A; Nettel-Aguirre, Alberto; Doyle-Baker, Patricia K; Macpherson, Alison; Emery, Carolyn A

    2016-01-01

    Objectives. To examine body mass index (BMI) and waist circumference (WC) as risk factors for sport injury in adolescents. Design. A secondary analysis of prospectively collected data from a pilot cluster randomized controlled trial. Methods. Adolescents (n = 1,040) at the ages of 11-15 years from two Calgary junior high schools were included. BMI (kg/m(2)) and WC (cm) were measured from direct measures at baseline assessment. Categories (overweight/obese) were created using validated international (BMI) and national (WC) cut-off points. A Poisson regression analysis controlling for relevant covariates (sex, previous injury, sport participation, intervention group, and aerobic fitness level) estimated the risk of sport injury [incidence rate ratios (IRR) with 95% confidence intervals (CI)]. Results. There was an increased risk of time loss injury (IRR = 2.82, 95% CI: 1.01-8.04) and knee injury (IRR = 2.07, 95% CI: 1.00-6.94) in adolescents that were overweight/obese; however, increases in injury risk for all injury and lower extremity injury were not statistically significant. Estimates suggested a greater risk of time loss injury [IRR = 1.63 (95% CI: 0.93-2.47)] in adolescents with high measures of WC. Conclusions. There is an increased risk of time loss injury and knee injury in overweight/obese adolescents. Sport injury prevention training programs should include strategies that target all known risk factors for injury. PMID:27525304

  11. Examining Measures of Weight as Risk Factors for Sport-Related Injury in Adolescents.

    PubMed

    Richmond, Sarah A; Nettel-Aguirre, Alberto; Doyle-Baker, Patricia K; Macpherson, Alison; Emery, Carolyn A

    2016-01-01

    Objectives. To examine body mass index (BMI) and waist circumference (WC) as risk factors for sport injury in adolescents. Design. A secondary analysis of prospectively collected data from a pilot cluster randomized controlled trial. Methods. Adolescents (n = 1,040) at the ages of 11-15 years from two Calgary junior high schools were included. BMI (kg/m(2)) and WC (cm) were measured from direct measures at baseline assessment. Categories (overweight/obese) were created using validated international (BMI) and national (WC) cut-off points. A Poisson regression analysis controlling for relevant covariates (sex, previous injury, sport participation, intervention group, and aerobic fitness level) estimated the risk of sport injury [incidence rate ratios (IRR) with 95% confidence intervals (CI)]. Results. There was an increased risk of time loss injury (IRR = 2.82, 95% CI: 1.01-8.04) and knee injury (IRR = 2.07, 95% CI: 1.00-6.94) in adolescents that were overweight/obese; however, increases in injury risk for all injury and lower extremity injury were not statistically significant. Estimates suggested a greater risk of time loss injury [IRR = 1.63 (95% CI: 0.93-2.47)] in adolescents with high measures of WC. Conclusions. There is an increased risk of time loss injury and knee injury in overweight/obese adolescents. Sport injury prevention training programs should include strategies that target all known risk factors for injury.

  12. The child and adolescent athlete: a review of three potentially serious injuries.

    PubMed

    Caine, Dennis; Purcell, Laura; Maffulli, Nicola

    2014-01-01

    The increased participation of children and adolescents in organized sports worldwide is a welcome trend given evidence of lower physical fitness and increased prevalence of overweight in this population. However, the increased sports activity of children from an early age and continued through the years of growth, against a background of their unique vulnerability to injury, gives rise to concern about the risk and severity of injury. Three types of injury-anterior cruciate ligament (ACL) injury, concussion, and physeal injury - are considered potentially serious given their frequency, potential for adverse long-term health outcomes, and escalating healthcare costs. Concussion is probably the hottest topic in sports injury currently with voracious media coverage and exploding research interest. Given the negative cognitive effects of concussion, it has the potential to have a great impact on children and adolescents during their formative years and potentially impair school achievement and, if concussion management is not managed appropriately, there can be long term negative impact on cognitive development and ability to resume sports participation. Sudden and gradual onset physeal injury is a unique injury to the pediatric population which can adversely affect growth if not managed correctly. Although data are lacking, the frequency of stress-related physeal injury appears to be increasing. If mismanaged, physeal injuries can also lead to long-term complications which could negatively affect ability to participate in sports. Management of ACL injuries is an area of controversy and if not managed appropriately, can affect long-term growth and recovery as well as the ability to participate in sports. This article considers the young athlete's vulnerability to injury, with special reference to ACL injury, concussion, and physeal injury, and reviews current research on epidemiology, diagnosis, treatment, and prevention of these injury types. This article is intended

  13. Effects of ACL Reconstructive Surgery on Temporal Variations of Cytokine Levels in Synovial Fluid.

    PubMed

    Bigoni, Marco; Turati, Marco; Gandolla, Marta; Sacerdote, Paola; Piatti, Massimiliano; Castelnuovo, Alberto; Franchi, Silvia; Gorla, Massimo; Munegato, Daniele; Gaddi, Diego; Pedrocchi, Alessandra; Omeljaniuk, Robert J; Locatelli, Vittorio; Torsello, Antonio

    2016-01-01

    Anterior cruciate ligament (ACL) reconstruction restores knee stability but does not reduce the incidence of posttraumatic osteoarthritis induced by inflammatory cytokines. The aim of this research was to longitudinally measure IL-1β, IL-6, IL-8, IL-10, and TNF-α levels in patients subjected to ACL reconstruction using bone-patellar tendon-bone graft. Synovial fluid was collected within 24-72 hours of ACL rupture (acute), 1 month after injury immediately prior to surgery (presurgery), and 1 month thereafter (postsurgery). For comparison, a "control" group consisted of individuals presenting chronic ACL tears. Our results indicate that levels of IL-6, IL-8, and IL-10 vary significantly over time in reconstruction patients. In the acute phase, the levels of these cytokines in reconstruction patients were significantly greater than those in controls. In the presurgery phase, cytokine levels in reconstruction patients were reduced and comparable with those in controls. Finally, cytokine levels increased again with respect to control group in the postsurgery phase. The levels of IL-1β and TNF-α showed no temporal variation. Our data show that the history of an ACL injury, including trauma and reconstruction, has a significant impact on levels of IL-6, IL-8, and IL-10 in synovial fluid but does not affect levels of TNF-α and IL-1β. PMID:27313403

  14. Effects of ACL Reconstructive Surgery on Temporal Variations of Cytokine Levels in Synovial Fluid

    PubMed Central

    Bigoni, Marco; Gandolla, Marta; Sacerdote, Paola; Piatti, Massimiliano; Castelnuovo, Alberto; Franchi, Silvia; Gorla, Massimo; Munegato, Daniele; Gaddi, Diego; Pedrocchi, Alessandra; Omeljaniuk, Robert J.; Locatelli, Vittorio; Torsello, Antonio

    2016-01-01

    Anterior cruciate ligament (ACL) reconstruction restores knee stability but does not reduce the incidence of posttraumatic osteoarthritis induced by inflammatory cytokines. The aim of this research was to longitudinally measure IL-1β, IL-6, IL-8, IL-10, and TNF-α levels in patients subjected to ACL reconstruction using bone-patellar tendon-bone graft. Synovial fluid was collected within 24–72 hours of ACL rupture (acute), 1 month after injury immediately prior to surgery (presurgery), and 1 month thereafter (postsurgery). For comparison, a “control” group consisted of individuals presenting chronic ACL tears. Our results indicate that levels of IL-6, IL-8, and IL-10 vary significantly over time in reconstruction patients. In the acute phase, the levels of these cytokines in reconstruction patients were significantly greater than those in controls. In the presurgery phase, cytokine levels in reconstruction patients were reduced and comparable with those in controls. Finally, cytokine levels increased again with respect to control group in the postsurgery phase. The levels of IL-1β and TNF-α showed no temporal variation. Our data show that the history of an ACL injury, including trauma and reconstruction, has a significant impact on levels of IL-6, IL-8, and IL-10 in synovial fluid but does not affect levels of TNF-α and IL-1β. PMID:27313403

  15. Race and the risk of fatal injury at work.

    PubMed Central

    Loomis, D; Richardson, D

    1998-01-01

    OBJECTIVES:This study examined employment patterns of African-American and White workers and rates of unintentional fatal injuries, METHODS: Medical examiner and census data were used to compare occupational fatality rates for African Americans and Whites in North Carolina and to adjust for racial differences in employment patterns. RESULTS: African Americans' occupational fatality rate was higher by a factor of 1.3 to 1.5. Differences in employment structure appear to explain much of this disparity. However, the fatality rate for African-American men would have been elevated even if they had had the same employment patterns as White men. CONCLUSIONS: inequalities in access to the labor market, unequal distribution of risk within jobs, and explicit discrimination are all potential explanations for racial disparities in occupational injury mortality. These conditions can be addressed through a combination of social and workplace interventions, including efforts to improve conditions for the most disadvantaged workers. PMID:9584031

  16. Risk Factors for Vertebral Artery Injuries in Cervical Spine Trauma

    PubMed Central

    Dabke, Harshad V.

    2014-01-01

    Blunt cerebrovascular injuries (i.e. involvement of carotid and vertebral arteries) are increasingly being recognized in setting of cervical spine trauma/fractures and are associated with high incidence of stroke/morbidity and mortality. The incidence of vertebral artery injuries (VAI) is more common than previously thought and regular screening is seldom performed. However there exists no screening criteria and conflicting reports exists between spine and trauma literature. Many clinicians do not routinely screen/evaluate patients presenting with cervical spine trauma for potential VAI. This article provides a brief summary of existing evidence regarding the incidence of VAI in the background of cervical trauma/fractures. The type and fracture pattern that is associated with a high risk of VAI warranting mandatory screening/further work-up is discussed. A brief overview of diagnostic modalities and their respective sensitivity/specificity along with available treatment options is also summarized. PMID:25317310

  17. The child and adolescent athlete: a review of three potentially serious injuries

    PubMed Central

    2014-01-01

    The increased participation of children and adolescents in organized sports worldwide is a welcome trend given evidence of lower physical fitness and increased prevalence of overweight in this population. However, the increased sports activity of children from an early age and continued through the years of growth, against a background of their unique vulnerability to injury, gives rise to concern about the risk and severity of injury. Three types of injury–anterior cruciate ligament (ACL) injury, concussion, and physeal injury – are considered potentially serious given their frequency, potential for adverse long-term health outcomes, and escalating healthcare costs. Concussion is probably the hottest topic in sports injury currently with voracious media coverage and exploding research interest. Given the negative cognitive effects of concussion, it has the potential to have a great impact on children and adolescents during their formative years and potentially impair school achievement and, if concussion management is not managed appropriately, there can be long term negative impact on cognitive development and ability to resume sports participation. Sudden and gradual onset physeal injury is a unique injury to the pediatric population which can adversely affect growth if not managed correctly. Although data are lacking, the frequency of stress-related physeal injury appears to be increasing. If mismanaged, physeal injuries can also lead to long-term complications which could negatively affect ability to participate in sports. Management of ACL injuries is an area of controversy and if not managed appropriately, can affect long-term growth and recovery as well as the ability to participate in sports. This article considers the young athlete’s vulnerability to injury, with special reference to ACL injury, concussion, and physeal injury, and reviews current research on epidemiology, diagnosis, treatment, and prevention of these injury types. This article is

  18. Evaluation, management, rehabilitation, and prevention of anterior cruciate ligament injury: current concepts.

    PubMed

    Micheo, William; Hernández, Liza; Seda, Carlos

    2010-10-01

    The anterior cruciate ligament (ACL) is essential for both static and dynamic stability of the knee. It is commonly injured during sports activities by noncontact mechanisms that include landing with the knee in valgus and extension, sudden deceleration, change of direction, and rotation. Several modifiable and nonmodifiable risk factors predispose athletes to this injury, especially women. Early diagnosis, treatment directed to protect secondary knee structures, and rehabilitation play an important role in the management of ACL injury. Despite a lack of scientifically validated and published guidelines to help clinicians decide between conservative or surgical treatment, criteria such as pain, recurrent instability, injury to secondary structures, and desired level of activity should be considered. Accelerated rehabilitation protocols for patients who have and have not undergone an operation are available and recommended with goals of reducing complications such as recurrent injury, loss of motion, residual weakness, and associated osteoarthritis. However, injury prevention protocols could be the next big step in management of ACL injury with emphasis on reducing modifiable risk factors in susceptible individuals who participate in sports.

  19. Unintentional Injury Risk in School-Age Children: Examining Interrelations between Parent and Child Factors

    ERIC Educational Resources Information Center

    Wells, Melissa; Morrongiello, Barbara A.; Kane, Alexa

    2012-01-01

    Objective: Research on children's risk of injury reveals that parent and child factors are often interrelated. This study examined relations between children's risk taking, parent appraisal of this risk taking, and children's rate of injury in youth 8 and 9 years old. Methods: Responses to questionnaires and laboratory tasks were used to examine…

  20. Rehabilitation Predictors of Clinical Outcome following Revision ACL Reconstruction

    PubMed Central

    Wright, Rick W.; Group, Mars

    2016-01-01

    Objectives: Revision ACL reconstruction has been documented to have worse outcomes compared with primary ACL reconstructions. The reasons why remain unknown. The purpose of this study was to determine whether rehabilitation-related factors prescribed at the time of ACL revision reconstruction significantly influence two year outcomes, as well as the incidence of incurring a subsequent re-operation. Our hypothesis was that immediate versus passive, active range of motion (ROM) and weightbearing will result in improved outcomes without incidence of subsequent surgery. Use of postoperative and functional return to sport braces will not improve return to sports function. Methods: Revision ACL reconstruction patients were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, surgical technique and pathology, prescribed post-op and rehabilitation instructions (ie. timing of weightbearing, timing of passive and active ROM, use of postoperative and return to sport braces) and a series of validated patient reported outcome instruments (IKDC, KOOS, and Marx activity rating score). Patients were followed up for 2 years, and asked to complete the identical set of outcome instruments. Because meniscal repair, meniscal transplants, HTOs, concurrent ligamentous reconstructions, and certain chondral treatments (ie. microfracture, abrasion arthroplasty, mosiacplasty, etc) are known to affect prescribed rehab treatments, patients with these pathologies were excluded from the analyses. Regression analysis was used to control for age, gender, activity level, baseline outcome scores, and the above-mentioned rehabilitation-related variables, in order to assess the risk factors for clinical outcomes 2 years after revision ACL reconstruction. Results: A total of 843 patients met the inclusion criteria and were successfully enrolled. 482 (57%) were males, with a median cohort age of 27 years. Baseline characteristics of the cohort are

  1. Muscle Strength and Qualitative Jump-Landing Differences in Male and Female Military Cadets: The Jump-ACL Study

    PubMed Central

    Beutler, Anthony I.; de la Motte, Sarah J.; Marshall, Stephen W.; Padua, Darin A.; Boden, Barry P.

    2009-01-01

    Recent studies have focused on gender differences in movement patterns as risk factors for ACL injury. Understanding intrinsic and extrinsic factors which contribute to movement patterns is critical to ACL injury prevention efforts. Isometric lower- extremity muscular strength, anthropometrics, and jump-landing technique were analyzed for 2,753 cadets (1,046 female, 1,707 male) from the U.S. Air Force, Military and Naval Academies. Jump- landings were evaluated using the Landing Error Scoring System (LESS), a valid qualitative movement screening tool. We hypothesized that distinct anthropometric factors (Q-angle, navicular drop, bodyweight) and muscle strength would predict poor jump-landing technique in males versus females, and that female cadets would have higher scores (more errors) on a qualitative movement screen (LESS) than males. Mean LESS scores were significantly higher in female (5.34 ± 1.51) versus male (4.65 ± 1.69) cadets (p < 0.001). Qualitative movement scores were analyzed using factor analyses, yielding five factors, or “patterns”, contributing to poor landing technique. Females were significantly more likely to have poor technique due to landing with less hip and knee flexion at initial contact (p < 0.001), more knee valgus with wider landing stance (p < 0. 001), and less flexion displacement over the entire landing (p < 0.001). Males were more likely to have poor technique due to landing toe-out (p < 0.001), with heels first, and with an asymmetric foot landing (p < 0.001). Many of the identified factor patterns have been previously proposed to contribute to ACL injury risk. However, univariate and multivariate analyses of muscular strength and anthropometric factors did not strongly predict LESS scores for either gender, suggesting that changing an athlete’s alignment, BMI, or muscle strength may not directly improve his or her movement patterns. Key points Important differences in male and female landing technique can be captured using

  2. Risk factors for lower extremity injury: a review of the literature

    PubMed Central

    Murphy, D; Connolly, D; Beynnon, B

    2003-01-01

    Prospective studies on risk factors for lower extremity injury are reviewed. Many intrinsic and extrinsic risk factors have been implicated; however, there is little agreement with respect to the findings. Future prospective studies are needed using sufficient sample sizes of males and females, including collection of exposure data, and using established methods for identifying and classifying injury severity to conclusively determine addtional risk factors for lower extremity injury. PMID:12547739

  3. Organophosphate Poisoning and Subsequent Acute Kidney Injury Risk

    PubMed Central

    Lee, Feng-You; Chen, Wei-Kung; Lin, Cheng-Li; Lai, Ching-Yuan; Wu, Yung-Shun; Lin, I-Ching; Kao, Chia-Hung

    2015-01-01

    Abstract Small numbers of the papers have studied the association between organophosphate (OP) poisoning and the subsequent acute kidney injury (AKI). Therefore, we used the National Health Insurance Research Database (NHIRD) to study whether patients with OP poisoning are associated with a higher risk to have subsequent AKI. The retrospective cohort study comprised patients aged ≥20 years with OP poisoning and hospitalized diagnosis during 2000–2011 (N = 8924). Each OP poisoning patient was frequency-matched to 4 control patients based on age, sex, index year, and comorbidities of diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, coronary artery disease, and stroke (N = 35,696). We conducted Cox proportional hazard regression analysis to estimate the effects of OP poisoning on AKI risk. The overall incidence of AKI was higher in the patients with OP poisoning than in the controls (4.85 vs 3.47/1000 person-years). After adjustment for age, sex, comorbidity, and interaction terms, patients with OP poisoning were associated with a 6.17-fold higher risk of AKI compared with the comparison cohort. Patients with highly severe OP poisoning were associated with a substantially increased risk of AKI. The study found OP poisoning is associated with increased risk of subsequent AKI. Future studies are encouraged to evaluate whether long-term effects exist and the best guideline to prevent the continuously impaired renal function. PMID:26632728

  4. Epidemiology of Spinal Cord Injuries and Risk Factors for Complete Injuries in Guangdong, China: A Retrospective Study

    PubMed Central

    Wang, Peng; Huang, Lin; Tang, Yong; Wang, Wenhao; Chen, Keng; Ye, Jichao; Lu, Ciyong; Wu, Yanfeng; Shen, Huiyong

    2014-01-01

    Background Spinal cord injuries are highly disabling and deadly injuries. Currently, few studies focus on non-traumatic spinal cord injuries, and there is little information regarding the risk factors for complete injuries. This study aims to describe the demographics and the injury characteristics for both traumatic and non-traumatic spinal cord injuries and to explore the risk factors for complete spinal cord injuries. Methods A retrospective study was performed by reviewing the medical records of 3,832 patients with spinal cord injuries who were first admitted to the sampled hospitals in Guangdong, China. The demographics and injury characteristics of the patients were described and compared between the different groups using the chi-square test. Logistic regression was conducted to analyze the risk factors for complete spinal cord injuries. Results The proportion of patients increased from 7.0% to 14.0% from 2003 to 2011. The male-to-female ratio was 3.0∶1. The major cause of spinal cord injuries was traffic accidents (21.7%). Many of the injured were workers (36.2%), peasants (22.8%), and unemployed people (13.9%); these occupations accounted for 72.9% of the total sample. A multivariate logistic regression model revealed that the OR (95% CI) for male gender compared to female gender was 1.25 (1.07–1.89), the OR (95%CI) for having a spinal fracture was 1.56 (1.35–2.60), the OR (95%CI) for having a thoracic injury was 1.23 (1.10–2.00), and the OR (95%CI) for having complications was 2.47 (1.96–3.13). Conclusion The proportion of males was higher than the proportion of females. Workers, peasants and the unemployed comprised the high-risk occupational categories. Male gender, having a spinal fracture, having a thoracic injury, and having complications were the major risk factors for a complete injury. We recommend that preventive measures should focus on high-risk populations, such as young males. PMID:24489652

  5. Age-Infusion Approach to Derive Injury Risk Curves for Dummies from Human Cadaver Tests

    PubMed Central

    Yoganandan, Narayan; Banerjee, Anjishnu; Pintar, Frank A.

    2015-01-01

    Injury criteria and risk curves are needed for anthropomorphic test devices (dummies) to assess injuries for improving human safety. The present state of knowledge is based on using injury outcomes and biomechanical metrics from post-mortem human subject (PMHS) and mechanical records from dummy tests. Data from these models are combined to develop dummy injury assessment risk curves (IARCs)/dummy injury assessment risk values (IARVs). This simple substitution approach involves duplicating dummy metrics for PMHS tested under similar conditions and pairing with PMHS injury outcomes. It does not directly account for the age of each specimen tested in the PMHS group. Current substitution methods for injury risk assessments use age as a covariate and dummy metrics (e.g., accelerations) are not modified so that age can be directly included in the model. The age-infusion methodology presented in this perspective article accommodates for an annual rate factor that modifies the dummy injury risk assessment responses to account for the age of the PMHS that the injury data were based on. The annual rate factor is determined using human injury risk curves. The dummy metrics are modulated based on individual PMHS age and rate factor, thus “infusing” age into the dummy data. Using PMHS injuries and accelerations from side-impact experiments, matched-pair dummy tests, and logistic regression techniques, the methodology demonstrates the process of age-infusion to derive the IARCs and IARVs. PMID:26697422

  6. Pattern of joint damage in persons with knee osteoarthritis and concomitant ACL tears.

    PubMed

    Stein, Verena; Li, Ling; Lo, Grace; Guermazi, Ali; Zhang, Yuqing; Kent Kwoh, C; Eaton, Charles B; Hunter, David J

    2012-05-01

    Anterior cruciate ligament (ACL) tears are known to be a risk factor for incident knee osteoarthritis (OA). At the present time, it is unknown whether an incidental ACL tear in those with established knee OA alters the pattern of synovial joint damage. Therefore, our aim was to assess whether ACL tears in persons with knee OA are associated with specific patterns of cartilage loss, meniscal degeneration, and bone marrow lesion (BML) location. We included 160 participants from the progression subcohort of the Osteoarthritis Initiative (OAI) Study, an ongoing 4-year, multicenter study, focusing on knee OA. Regional cartilage morphometry measures including cartilage volume (mm(3)), denuded area, normalized cartilage volume, bone surface area, as well as location of meniscal pathology and BMLs in index knees on the same side were compared between those with and without ACL tears. Of the 160 subjects (51% women, age 62.1 (±9.9), BMI 30.3 (±4.7) kg/m(2)), 14.4% had an ACL tear. After adjusting for age, BMI and gender participants with ACL tears had significantly greater cartilage volume in the posterior lateral femur (P = 0.04) and the central medial tibia (0.001) compared to those without ACL tears. Normalized cartilage volume was not different between those with and without ACL tears. In addition, individuals with ACL tears had significantly larger bone surface areas in the medial tibia (P = 0,006), the central medial tibia (P = 0.008), the posterior lateral femur (P = 0.004), and the posterior medial femur (P = 0.04). Furthermore, participants with ACL tears showed significantly more meniscal derangement in the lateral posterior horn (P = 0.019) and significantly more BMLs in the lateral femur (P = 0.0025). We found clear evidence of predominant lateral tibiofemoral involvement, with OA-associated findings on MRI, including increased denuded area and bone surface area, BMLs, and meniscal derangement in knees of individuals with ACL tears compared to those without.

  7. Reducing the risk of needlestick injuries in hospital

    PubMed Central

    Denny, James

    2014-01-01

    After performing procedures involving sharps, many wards in St George's Hospital have no quick and accessible ‘point of care’ sharps bin for their safe disposal. Instead one must transport potentially hazardous equipment away from the bedside, risking injury and exposure to persons en route. Results from a questionnaire showed that 73% felt they were indeed poorly placed, 95% felt a portable sharps bin system was a good idea, and 95% felt their introduction would be safer. A one month trial of portable sharps bins on the Acute Medical Unit (AMU) showed that 97% felt that the portable sharps bin system reduced risk to themselves and others, 81% felt safer using them, and 90% felt safer knowing their colleagues were using them too. A recent audit in a six month period within 2012 established there were 148 reported needlestick injuries in St George's Hospital. This quality improvement project showed that a majority consensus felt that a portable sharps bin system would be safer than the system currently used and could potentially help reduce these numbers. This project also comes at a time when new EU legislation calls for safer sharps use and disposal and thus offers a solution to ultimately provide better, safer and more advanced safety practices when disposing of sharp equipment. PMID:26734224

  8. Transverse femoral implant prominence: four cases demonstrating a preventable complication for ACL reconstruction.

    PubMed

    Argintar, Evan; Scherer, Benjamin; Jordan, Tom; Klimkiewicz, John

    2010-12-01

    Anterior cruciate ligament (ACL) tear is a commonly occurring injury that often demands surgical reconstruction. Although the utility of this operation is widely accepted, many specific components, including graft fixation technique, remain controversial. Many clinicians favor transverse femoral implant fixation for soft tissue ACL grafts. This technique can be accomplished successfully; however, in a minority of the cases, the femoral implant can be excessively prominent, leading to iatrogenic postoperative iliotibial band syndrome. This article presents 4 patients that developed postoperative iliotibial band syndrome resulting from transverse femoral implant prominence. Despite achievement of knee ligamentous stability, implant prominence compromised final clinical results following ACL reconstruction. Through change in Lysholm value, we reviewed the clinical outcomes of these patients following femoral implant hardware removal for treatment of iliotibial band syndrome. On hardware removal, all patients demonstrated complete symptomatic improvement, mirroring an average Lysholm value increase of 38. We believe transverse femoral implant prominence is avoidable, and subsequent iliotibial band syndrome is a preventable postoperative complication.

  9. Extra-articular extraosseous migration of a bioabsorbable femoral interference screw after ACL reconstruction.

    PubMed

    Sharma, Vivek; Curtis, Christine; Micheli, Lyle

    2008-10-01

    Anterior cruciate ligament (ACL) reconstruction is quite commonly used to treat anterior knee instability. Surgeon preference and patient functional goals determine graft selection and graft fixation techniques. Interference screws are considered a safe and effective device for graft fixation in surgical ACL reconstruction. Poly-L-lactide acid (PLLA) bioabsorbable interference screws are becoming increasingly popular in ACL reconstruction surgery. There are several reasons why they may be more advantageous than metallic screws, including reduced graft laceration during insertion, ease of performance of revision procedures, avoidance of graft injury encountered with aperture fixation using metallic screws, and fewer artifacts on magnetic resonance images (MRI). Few studies describe complications associated with PLLA bioabsorbable screws, particularly extra-articular screw migration. This article presents a case of an extra-articular extraosseous migration of the femoral bioabsorbable interference screw. This case further demonstrates the problem of the femoral bioabsorbable interference screw.

  10. [Climatic risk zoning for banana and litchi's chilling injury in South China].

    PubMed

    Li, Na; Huo, Zhi-guo; He, Nan; Xiao, Jing-jing; Wen, Quan-pei

    2010-05-01

    Based on the 1951-2006 climatic observation data from 224 meteorological stations in South China (Guangdong Province, Guangxi Autonomous Region, and Fujian Province) and the historical information about the chilling injury losses of banana and litchi, the accumulated harmful chilling for the processes with minimum daily temperature < or = 5.0 degrees C and more than 3 days was used to indicate the climatic risk of chilling injury during the whole growth season, and an integrated climatic index with the background of climate change was constructed. The maps of geographical distribution of climatic risk probability for each grade chilling injury, and of integrated climatic risk zoning for banana and litchi's chilling injury were drawn, and the spatial variation of climatic risk for banana and litchi's chilling injury was commented. The results indicated that in the study area, climate warming might lead to the decrease of cold resistance of banana and litchi, which could increase the disaster risk of chilling injury. The geographical distribution of climatic risk probability for banana and litchi's chilling injury showed a zonal pattern. According to the integrated climatic risk index, the banana and litchi's chilling injury region was divided into three risk types, i.e., high risk, moderate risk, and low risk, which provided an important basis for the adjustment of agricultural production structure.

  11. Factors Influencing Running-Related Musculoskeletal Injury Risk Among U.S. Military Recruits.

    PubMed

    Molloy, Joseph M

    2016-06-01

    Running-related musculoskeletal injuries among U.S. military recruits negatively impact military readiness. Low aerobic fitness, prior injury, and weekly running distance are known risk factors. Physical fitness screening and remedial physical training (or discharging the most poorly fit recruits) before entry-level military training have tended to reduce injury rates while decreasing attrition, training, and medical costs. Incorporating anaerobic running sessions into training programs can offset decreased weekly running distance and decrease injury risk. Varying lower extremity loading patterns, stride length or cadence manipulation, and hip stability/strengthening programming may further decrease injury risk. No footstrike pattern is ideal for all runners; transitioning to forefoot striking may reduce risk for hip, knee, or tibial injuries, but increase risk for calf, Achilles, foot or ankle injuries. Minimal evidence associates running surfaces with injury risk. Footwear interventions should focus on proper fit and comfort; the evidence does not support running shoe prescription per foot type to reduce injury risk among recruits. Primary injury mitigation efforts should focus on physical fitness screening, remedial physical training (or discharge for unfit recruits), and continued inclusion of anaerobic running sessions to offset decreased weekly running distance. PMID:27244060

  12. Operative and nonoperative treatment options for ACL tears in the adult patient: a conceptual review.

    PubMed

    Bogunovic, Ljiljana; Matava, Matthew J

    2013-11-01

    Injury to the anterior cruciate ligament (ACL) is common among athletic individuals. Both nonoperative and operative treatment options exist. The optimal treatment of an adult with an ACL tear depends on several patient-specific factors, including age, occupation, and desired activity level. In less active patients with sedentary jobs, nonoperative management, consisting of physical therapy, bracing, and activity modification can yield successful results. In active patients who want to resume participation in jumping, cutting, or pivoting sports, patients who have physically demanding occupations, or patients who fail a trial of nonoperative management, ACL reconstruction is recommended. Reconstruction utilizing autograft tissue is preferred over allograft, especially in the younger athlete, but allograft tissue is a reasonable option in the older (aged > 40 years) and less active adult, as well. Successful results have been achieved with both patellar tendon and hamstring grafts. The optimal treatment in adult patients with ACL tears should be based on careful consideration of the patient's goals for return to activity, knee-specific comorbidities, such as coexistent meniscal pathology or osteoarthritis, and his or her willingness to follow a detailed rehabilitation regimen. Our article provides an overview of current nonoperative and operative treatment options for adults with ACL tears, considers the outcomes of both nonoperative and operative strategies, and provides general recommendations as to the ideal management for a given patient. PMID:24231595

  13. Displaced Medial and Lateral Bucket Handle Meniscal Tears With Intact ACL and PCL.

    PubMed

    Boody, Barrett S; Omar, Imran M; Hill, James A

    2015-08-01

    Bucket handle lesions are vertical longitudinal tears in the meniscus that may displace centrally into the respective medial or lateral compartment, frequently causing mechanical symptoms, including pain, perceived instability, and mechanical locking. Bucket handle meniscal tears are most commonly from a traumatic etiology and are frequently found with concomitant anterior cruciate ligament (ACL) injuries. Multiple imaging signs and associations have been described for the diagnosis of bucket handle meniscus tears, including coronal truncation, absent bow tie sign, double posterior cruciate ligament (PCL), double ACL, displacement of the bucket handle fragment, and disproportionate posterior horn signs. Among meniscal pathology encountered on magnetic resonance imaging or during arthroscopy, bucket handle meniscal tears are infrequent occurrences. Furthermore, the occurrence of displaced medial and lateral bucket handle tears found on imaging and during arthroscopy is very uncommon and is only sparsely reported in the literature. When displaced medial and lateral bucket handle meniscal segments are visualized within the intercondylar notch along with the ACL and PCL, the radiologic findings are referred to as the "quadruple cruciate" sign or the "Jack and Jill lesion." Of the few case reports described in the literature, only one noted displaced medial and lateral bucket handle meniscus tears with an intact ACL and PCL. The current case report outlines a similar rare case of the quadruple cruciate sign: displaced medial and lateral bucket handle meniscal tears located within the intercondylar notch and an intact ACL and PCL.

  14. USE OF SPATIOTEMPORAL GAIT PARAMETERS TO DETERMINE RETURN TO SPORTS AFTER ACL RECONSTRUCTION

    PubMed Central

    LEPORACE, GUSTAVO; METSAVAHT, LEONARDO; ZEITOUNE, GABRIEL; MARINHO, THIAGO; OLIVEIRA, TAINÁ; PEREIRA, GLAUBER RIBEIRO; OLIVEIRA, LISZT PALMEIRA DE; BATISTA, LUIZ ALBERTO

    2016-01-01

    Objective : To compare gait spatiotemporal parameters of healthy and ACL reconstructed subjects in order to classify the status of gait normality. Methods : Fourteen healthy subjects and eight patients submitted to ACL reconstruction walked along a walkway while the lower limbs movement was captured by an infrared camera system. The frames where the initial contact and toe-off took place were determined and the following dependent variables, which were compared between groups through the Mann-Whitney test (a=0.05) were calculated: percentage of time in initial double stance, percentage of time in single stance, percentage of time in terminal double stance, stride length and gait velocity. Initially, all variables were compared between groups using a Mann-Whitney test. A logistic regression was applied, including all dependent variables, to create a model that could differentiate healthy and ACL reconstructed subjects. Results : ACL reconstructed group showed no differences in any spatiotemporal parameter of gait (p > 0.05) in relation to the control group, although the angular kinematic differences of the knee remained altered, as evidenced in a study with a similar sample. Conclusion : The regression classified all subjects as healthy, including the ACL reconstructed group, suggesting the spatiotemporal variables should not be used as the sole criterion of return to sports activities at the same level as prior to injury. Level of Evidence III, Case Control Study. PMID:26981039

  15. Mothers' responses to sons and daughters engaging in injury-risk behaviors on a playground: implications for sex differences in injury rates.

    PubMed

    Morrongiello, B A; Dawber, T

    2000-06-01

    Videotapes of children engaging in injury-risk activities on a playground were shown to mothers, who were asked to intervene by stopping the tape and saying whatever they would to their child in the situation shown. Results revealed that mothers of daughters were more likely to judge behaviors as posing some degree of injury risk, and they intervened more frequently and quickly than mothers of sons. Mothers' speed to intervene positively correlated with both children's injury history and their risk-taking tendencies, indicating that mothers of children who were previously injured and who often engaged in injury-risk behaviors had a higher degree of tolerance for children's risk taking than mothers of children who experienced fewer injuries and less frequently engaged in injury-risk behaviors. Mothers' verbalizations to children's risk taking revealed that daughters received more cautions and statements communicating vulnerability for injury, whereas sons received more statements encouraging risk-taking behavior. PMID:10788304

  16. Management of Acute Combined ACL-Medial and Posteromedial Instability of the Knee.

    PubMed

    Medvecky, Michael J; Tomaszewski, Paul

    2015-06-01

    Medial collateral ligament (MCL) injuries are the most common ligamentous injury of the knee. The extent of injury can range from a minor first-degree (1-degree) sprain to an extensive third-degree (3-degree) sprain that can propagate across the knee, rupturing one or both cruciate ligaments, and result in a knee subluxation or dislocation. A common pattern involves the combined anterior cruciate ligament (ACL) and MCL injury that is the focus of this chapter. The vast majority of these combined medial-sided injuries are treated nonoperatively with delayed reconstruction of the ACL injury in athletically active individuals. The MCL and associated medial structures are carefully assessed on physical examination, and classification of injury is based upon abnormal limits of joint motion. In vitro cadaveric biomechanical testing has given us a better understanding of ligament deficiency and altered joint motion. Consistency in terminology is necessary for proper classification of injury and reproducible categorization of injury patterns to be able to compare both nonoperative and operative treatment of various injury patterns.

  17. Risk Factors Associated with Self-Injurious Behavior among a National Sample of Undergraduate College Students

    ERIC Educational Resources Information Center

    Taliaferro, Lindsay A.; Muehlenkamp, Jennifer J.

    2015-01-01

    Objective: Nonsuicidal self-injury (NSSI) and suicidality among undergraduates represent important public health issues. This analysis identified risk factors that distinguished 3 groups, those who reported no history of self-harm; self-injury, but no suicide attempts (NSSI only); and self-injury and a suicide attempt (NSSI + SA) in the past year.…

  18. Comparison of risk factors for cervical spine, head, serious, and fatal injury in rollover crashes.

    PubMed

    Funk, James R; Cormier, Joseph M; Manoogian, Sarah J

    2012-03-01

    Previous epidemiological studies of rollover crashes have focused primarily on serious and fatal injuries in general, while rollover crash testing has focused almost exclusively on cervical spine injury. The purpose of this study was to examine and compare the risk factors for cervical spine, head, serious, and fatal injury in real world rollover crashes. Rollover crashes from 1995-2008 in the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) were investigated. A large data set of 6015 raw cases (2.5 million weighted) was generated. Nonparametric univariate analyses, univariate logistic regression, and multivariate logistic regression were conducted. Complete or partial ejection, a lack of seatbelt use, a greater number of roof inversions, and older occupant age significantly increased the risk of all types of injuries studied (p<0.05). Far side seating position increased the risk of fatal, head, and cervical spine injury (p<0.05), but not serious injury in general. Higher BMI was associated with an increased risk of fatal, serious, and cervical spine injury (p<0.05), but not head injury. Greater roof crush was associated with a higher rate of fatal and cervical spine injury (p<0.05). Vehicle type, occupant height, and occupant gender had inconsistent and generally non-significant effects on injury. This study demonstrates both common and unique risk factors for different types of injuries in rollover crashes. PMID:22269486

  19. Graft Diameter matters in Hamstring ACL reconstruction

    PubMed Central

    Clatworthy, Mark

    2016-01-01

    Objective: Recently techniques have been developed to increase graft diameter in hamstring ACL reconstruction with the hope to decrease graft failure. To date there is limited evidence to show that a smaller graft diameter results in a higher ACL failure rate. Method: The factors for failure in 1480 consecutive single surgeon hamstring ACL reconstructions were evaluated prospectively. Patients were followed for 2-15 years. A multivariate analysis was performed which looked at graft size, age, sex, time to surgery, meniscal integrity, meniscal repair and ACL graft placement to determine whether graft diameter matters in determining the failure of hamstring ACL reconstruction. Results: Graft diameters ranged from 6-10 mm. The mean graft diameter for all patients was 7.75 mm. 83 ACL reconstructions failed. The mean size of graft failures was 7.55 mm ACL reconstructions that failed had a significantly smaller hamstring graft diameter p=0.001. The Hazard Ratio for a smaller diameter graft is 0.517 p=<0.0001. For every 1 mm decrease in graft diameter there is a 48.3% higher chance of failure. The multivariate analysis showed a hazard ratio of 0.543 p=0.002. For every 1 mm decrease in graft diameter there is a 45.7% higher chance of failure. Conclusion: Smaller diameter hamstring grafts do have a higher failure rate. Grafts ≤ 7.5 mm had twice the failure rate of grafts ≥8 mm using a multivariate analysis for every 1 mm decrease in graft diameter there is a 45.7% higher chance of failure.

  20. Evaluation of injury and fatality risk in rock and ice climbing.

    PubMed

    Schöffl, Volker; Morrison, Audry; Schwarz, Ulrich; Schöffl, Isabelle; Küpper, Thomas

    2010-08-01

    Rock and ice climbing are widely considered to be 'high-risk' sporting activities that are associated with a high incidence of severe injury and even death, compared with more mainstream sports. However, objective scientific data to support this perception are questionable. Accordingly, >400 sport-specific injury studies were analysed and compared by quantifying the injury incidence and objectively grading the injury severity (using the National Advisory Committee for Aeronautics score) per 1000 hours of sporting participation. Fatalities were also analysed. The analysis revealed that fatalities occurred in all sports, but it was not always clear whether the sport itself or pre-existing health conditions contributed or caused the deaths. Bouldering (ropeless climbing to low heights), sport climbing (mostly bolt protected lead climbing with little objective danger) and indoor climbing (climbing indoors on artificial rock structures), showed a small injury rate, minor injury severity and few fatalities. As more objective/external dangers exist for alpine and ice climbing, the injury rate, injury severity and fatality were all higher. Overall, climbing sports had a lower injury incidence and severity score than many popular sports, including basketball, sailing or soccer; indoor climbing ranked the lowest in terms of injuries of all sports assessed. Nevertheless, a fatality risk remains, especially in alpine and ice climbing. In the absence of a standard definition for a 'high-risk' sport, categorizing climbing as a high-risk sport was found to be either subjective or dependent on the definition used. In conclusion, this analysis showed that retrospective data on sport-specific injuries and fatalities are not reported in a standardized manner. To improve preventative injury measures for climbing sports, it is recommended that a standardized, robust and comprehensive sport-specific scoring model should be developed to report and fully evaluate the injury risk, severity

  1. Interactions between collagen gene variants and risk of anterior cruciate ligament rupture.

    PubMed

    O'Connell, Kevin; Knight, Hayley; Ficek, Krzysztof; Leonska-Duniec, Agata; Maciejewska-Karlowska, Agnieszka; Sawczuk, Marek; Stepien-Slodkowska, Marta; O'Cuinneagain, Dion; van der Merwe, Willem; Posthumus, Michael; Cieszczyk, Pawel; Collins, Malcolm

    2015-01-01

    The COL5A1 and COL12A1 variants are independently associated with modulating the risk of anterior cruciate ligament (ACL) rupture in females. The objective of this study was to further investigate if COL3A1 and COL6A1 variants independently, as well as, collagen gene-gene interactions, modulate ACL rupture risk. Three hundred and thirty-three South African (SA, n = 242) and Polish (PL, n = 91) participants with diagnosed ACL ruptures and 378 controls (235 SA and 143 PL) were recruited. Participants were genotyped for COL3A1 rs1800255 G/A, COL5A1 rs12722 (T/C), COL6A1 rs35796750 (T/C) and COL12A1 rs970547 (A/G). No significant associations were identified between COL6A1 rs35796750 and COL3A1 rs1800255 genotypes and risk of ACL rupture in the SA cohort. The COL3A1 AA genotype was, however, significantly (p = 0.036) over-represented in the PL ACL group (9.9%, n = 9) when compared to the PL control (CON) group (2.8%, n = 4). Although there were genotype distribution differences between the SA and PL cohorts, the T+A-inferred pseudo-haplotype constructed from COL5A1 and COL12A1 was significantly over-represented in the female ACL group when compared to the female CON group within the SA (T+A ACL 50.5%, T+A CON 38.1%, p = 0.022), PL (T+A ACL 56.3%, T+A CON 36.3%, p = 0.029) and combined (T+A ACL 51.8%, T+A CON 37.5%, p = 0.004) cohorts. In conclusion, the novel main finding of this study was a significant interaction between the COL5A1 rs12722 T/C and COL12A1 rs970547 A/G variants and risk of ACL injury. These results highlight the importance of investigating gene-gene interactions in the aetiology of ACL ruptures in multiple independent cohorts. PMID:25073002

  2. Abnormal landing strategies after ACL reconstruction.

    PubMed

    Gokeler, A; Hof, A L; Arnold, M P; Dijkstra, P U; Postema, K; Otten, E

    2010-02-01

    The objective was to analyze muscle activity and movement patterns during landing of a single leg hop for distance after anterior cruciate ligament (ACL) reconstruction. Nine (six males, three females) ACL-reconstructed patients 6 months after surgery and 11 (eight males, three females) healthy control subjects performed the hop task. Electromyographic signals from lower limb muscles were analyzed to determine onset time before landing. Biomechanical data were collected using an Optotrak Motion Analysis System and force plate. Matlab was used to calculate kinetics and joint kinematics. Side-to-side differences in ACL-reconstructed patients and healthy subjects as well as differences between the patients and control group were analyzed. In ACL-reconstructed limbs, significantly earlier onset times were found for all muscles, except vastus medialis, compared with the uninvolved side. The involved limbs had significantly reduced knee flexion during the take-off and increased plantarflexion at initial contact. The knee extension moment was significantly lower in the involved limb. In the control group, significantly earlier onset times were found for the semitendinosus, vastus lateralis and medial gastrocnemius of the non-dominant side compared with the dominant side. Muscle onset times are earlier and movement patterns are altered in the involved limb 6 months after ACL reconstruction.

  3. A prospective investigation of injury incidence and risk factors among army recruits in combat engineer training

    PubMed Central

    2013-01-01

    Background United States Army combat engineer (ENG) training is an intense 14-week course designed to introduce new recruits to basic soldiering activities, Army values and lifestyle, and engineering skills and knowledge. The present investigation examined injury rates and injury risk factors in ENG training. Methods At the start of their training, 1,633 male ENG recruits were administered a questionnaire containing items on date of birth, height, weight, tobacco use, prior physical activity, and injury history. Injuries during training were obtained from electronic medical records and the training units provided data on student graduation and attrition. Risk factors were identified using Cox regression. Results Ninety-two percent of the recruits successfully graduated from the course and 47% of the recruits experienced one or more injuries during training. Univariate Cox regression demonstrated that recruits were at higher injury risk if they reported that they were older, had a higher or lower body mass index, had smoked in the past, had performed less exercise (aerobic or muscle strength) or sports prior to ENG training, had experienced a previous time-loss lower limb injury (especially if they had not totally recovered from that injury), or had a lower educational level. Conclusions The present investigation was the first to identify injury rates and identify specific factors increasing injury risk during ENG training. The identified risk factors provide a basis for recommending future prevention strategies. PMID:23497620

  4. Risk factors for hamstring injuries in male soccer players: a systematic review of prospective studies.

    PubMed

    van Beijsterveldt, A M C; van de Port, I G L; Vereijken, A J; Backx, F J G

    2013-06-01

    Hamstring injuries are common injuries in soccer players. In view of the high incidence and the serious consequences, identifying risk factors related to hamstring injuries is essential. The aim of this systematic review was therefore to identify risk factors for hamstring injuries in male adult soccer players. PubMed, Embase/Medline, Cumulative Index to Nursing and Allied Health Literature, and SPORTDiscus were systematically searched, and prospective studies investigating risk factors for hamstring injuries in adult male soccer players were included. The methodological quality of the included articles was assessed using a standardized set of predefined criteria. Seven of the 11 studies identified, involving a total of 1775 players and 344 hamstring injuries, met the inclusion criteria. All but one of the included studies met at least five of nine methodological criteria, causing them to be qualified as 'high quality'. The included studies used univariate as well as multivariate analyses to identify risk factors for hamstring injury. The results from the multivariate analyses suggest that previous hamstring injury is most strongly related to hamstring injury. Conflicting evidence is found for age and hamstring length or flexibility as risk factors for the occurrence of hamstring injuries.

  5. Assessing Risk of Injury in People with Mental Retardation Living in an Intermediate Care Facility

    ERIC Educational Resources Information Center

    Konarski, Edward A.; Tasse, Marc

    2005-01-01

    A brief instrument to assess risk of injury was applied retrospectively for 2 years and prospectively for 1 year to all people living in a large ICF/MR. Results suggest that the percentage of people who experienced an injury significantly increased across the levels of increasing risk indicated by the assessment. Furthermore, people who…

  6. ALL‐EPIPHYSEAL ACL RECONSTRUCTION: A THREE‐YEAR FOLLOW‐UP

    PubMed Central

    Akinleye, Sheriff D.; Sewick, Amy

    2013-01-01

    Background/Introduction: With an increasing number of pre‐adolescents participating in sports, anterior cruciate ligament injuries and resultant reconstruction in the skeletally immature athlete are becoming more common. Many different surgical techniques and rehabilitation protocols have been proposed for the treatment of anterior cruciate ligament (ACL) injuries, but there is a lack of agreement as to which approach results in the best outcome. Rehabilitation protocols have marked variation regarding postoperative weight bearing, immobilization, bracing, and length. Case description: This is a case of a ten year old female who sustained bilateral ACL tears within the period of a year. The purpose of this case report is to describe the early result and subsequent rehabilitation following bilateral physeal‐sparing all‐epiphyseal ACL reconstructions on a skeletally immature patient with a three‐year follow‐up. Outcomes: The early post‐surgical recovery period on the first injured knee was complicated by knee stiffness requiring manipulation. Following this minor setback, the patient met all physical therapy goals and had no additional complications. The rehabilitation after the second surgery followed a typical course. At three‐year follow‐up, the patient had grown an additional seven inches, with radiographic evidence of symmetric physeal growth and joint stability. She has returned to playing competitive sports. Discussion and Conclusion: This innovative physeal‐sparing technique has huge implications as, historically; the feared complication of growth disturbance and angular deformity from transphyseal ACL reconstruction has complicated the management of ACL injuries in children and pre‐adolescents. This case report demonstrates the success of this technique, and the subsequent rehabilitation, as this patient did not experience a reduction in long‐term bone growth. Level of Evidence: 5 Case Report PMID:23772346

  7. Differences in Mechanisms of Failure, Intraoperative Findings, and Surgical Characteristics Between Single- and Multiple-Revision ACL Reconstructions

    PubMed Central

    Chen, James L.; Allen, Christina R.; Stephens, Thomas E.; Haas, Amanda K.; Huston, Laura J.; Wright, Rick W.; Feeley, Brian T.

    2013-01-01

    Background The factors that lead to patients failing multiple anterior cruciate ligament (ACL) reconstructions are not well understood. Hypothesis Multiple-revision ACL reconstruction will have different characteristics than first-time revision in terms of previous and current graft selection, mode of failure, chondral/meniscal injuries, and surgical charactieristics. Study Design Case-control study; Level of evidence, 3. Methods A prospective multicenter ACL revision database was utilized for the time period from March 2006 to June 2011. Patients were divided into those who underwent a single-revision ACL reconstruction and those who underwent multiple-revision ACL reconstructions. The primary outcome variable was Marx activity level. Primary data analyses between the groups included a comparison of graft type, perceived mechanism of failure, associated injury (meniscus, ligament, and cartilage), reconstruction type, and tunnel position. Data were compared by analysis of variance with a post hoc Tukey test. Results A total of 1200 patients (58% men; median age, 26 years) were enrolled, with 1049 (87%) patients having a primary revision and 151 (13%) patients having a second or subsequent revision. Marx activity levels were significantly higher (9.77) in the primary-revision group than in those patients with multiple revisions (6.74). The most common cause of reruptures was a traumatic, noncontact ACL graft injury in 55% of primary-revision patients; 25% of patients had a nontraumatic, gradual-onset recurrent injury, and 11% had a traumatic, contact injury. In the multiple-revision group, a nontraumatic, gradual-onset injury was the most common cause of recurrence (47%), followed by traumatic noncontact (35%) and nontraumatic sudden onset (11%) (P < .01 between groups). Chondral injuries in the medial compartment were significantly more common in the multiple-revision group than in the single-revision group, as were chondral injuries in the patellofemoral

  8. Pedestrian injury risk functions based on contour lines of equal injury severity using real world pedestrian/passenger-car accident data.

    PubMed

    Niebuhr, Tobias; Junge, Mirko; Achmus, Stefanie

    2013-01-01

    Injury risk assessment plays a pivotal role in the assessment of the effectiveness of Advanced Driver Assistance Systems (ADAS) as they specify the injury reduction potential of the system. The usual way to describe injury risks is by use of injury risk functions, i.e. specifying the probability of an injury of a given severity occurring at a specific technical accident severity (collision speed). A method for the generation of a family of risk functions for different levels of injury severity is developed. The injury severity levels are determined by use of a rescaled version of the Injury Severity Score (ISS) namely the ISSx. The injury risk curves for each collision speed is then obtained by fixing the boundary conditions and use of a case-by-case validated GIDAS subset of pedestrian-car accidents (N=852). The resultant functions are of exponential form as opposed to the frequently used logistic regression form. The exponential approach in combination with the critical speed value creates a new injury risk pattern better fitting for high speed/high energy crashes. Presented is a family of pedestrian injury risk functions for an arbitrary injury severity. Thus, the effectiveness of an ADAS can be assessed for mitigation of different injury severities using the same injury risk function and relying on the internal soundness of the risk function with regard to different injury severity levels. For the assessment of emergency braking ADAS, a Zone of Effective Endangerment Increase (ZEEI), the speed interval in which a one percent speed increase results at least in a one percent of injury risk increase, is defined. The methodology presented is kept in such general terms that a direct adaption to other accident configurations is easily done. PMID:24406954

  9. Pedestrian injury risk functions based on contour lines of equal injury severity using real world pedestrian/passenger-car accident data

    PubMed Central

    Niebuhr, Tobias; Junge, Mirko; Achmus, Stefanie

    2013-01-01

    Injury risk assessment plays a pivotal role in the assessment of the effectiveness of Advanced Driver Assistance Systems (ADAS) as they specify the injury reduction potential of the system. The usual way to describe injury risks is by use of injury risk functions, i.e. specifying the probability of an injury of a given severity occurring at a specific technical accident severity (collision speed). A method for the generation of a family of risk functions for different levels of injury severity is developed. The injury severity levels are determined by use of a rescaled version of the Injury Severity Score (ISS) namely the ISSx. The injury risk curves for each collision speed is then obtained by fixing the boundary conditions and use of a case-by-case validated GIDAS subset of pedestrian-car accidents (N=852). The resultant functions are of exponential form as opposed to the frequently used logistic regression form. The exponential approach in combination with the critical speed value creates a new injury risk pattern better fitting for high speed/high energy crashes. Presented is a family of pedestrian injury risk functions for an arbitrary injury severity. Thus, the effectiveness of an ADAS can be assessed for mitigation of different injury severities using the same injury risk function and relying on the internal soundness of the risk function with regard to different injury severity levels. For the assessment of emergency braking ADAS, a Zone of Effective Endangerment Increase (ZEEI), the speed interval in which a one percent speed increase results at least in a one percent of injury risk increase, is defined. The methodology presented is kept in such general terms that a direct adaption to other accident configurations is easily done. PMID:24406954

  10. Pedestrian injury risk functions based on contour lines of equal injury severity using real world pedestrian/passenger-car accident data.

    PubMed

    Niebuhr, Tobias; Junge, Mirko; Achmus, Stefanie

    2013-01-01

    Injury risk assessment plays a pivotal role in the assessment of the effectiveness of Advanced Driver Assistance Systems (ADAS) as they specify the injury reduction potential of the system. The usual way to describe injury risks is by use of injury risk functions, i.e. specifying the probability of an injury of a given severity occurring at a specific technical accident severity (collision speed). A method for the generation of a family of risk functions for different levels of injury severity is developed. The injury severity levels are determined by use of a rescaled version of the Injury Severity Score (ISS) namely the ISSx. The injury risk curves for each collision speed is then obtained by fixing the boundary conditions and use of a case-by-case validated GIDAS subset of pedestrian-car accidents (N=852). The resultant functions are of exponential form as opposed to the frequently used logistic regression form. The exponential approach in combination with the critical speed value creates a new injury risk pattern better fitting for high speed/high energy crashes. Presented is a family of pedestrian injury risk functions for an arbitrary injury severity. Thus, the effectiveness of an ADAS can be assessed for mitigation of different injury severities using the same injury risk function and relying on the internal soundness of the risk function with regard to different injury severity levels. For the assessment of emergency braking ADAS, a Zone of Effective Endangerment Increase (ZEEI), the speed interval in which a one percent speed increase results at least in a one percent of injury risk increase, is defined. The methodology presented is kept in such general terms that a direct adaption to other accident configurations is easily done.

  11. Anterior cruciate ligament injury: diagnosis, management, and prevention.

    PubMed

    Cimino, Francesca; Volk, Bradford Scott; Setter, Don

    2010-10-15

    There are an estimated 80,000 to 100,000 anterior cruciate ligament (ACL) repairs in the United States each year. Most ACL tears occur from noncontact injuries. Women experience ACL tears up to nine times more often than men. Evaluation of the ACL should be performed immediately after an injury if possible, but is often limited by swelling and pain. When performed properly, a complete knee examination is more than 80 percent sensitive for an ACL injury. The Lachman test is the most accurate test for detecting an ACL tear. Magnetic resonance imaging is the primary study used to diagnose ACL injury in the United States. It can also identify concomitant meniscal injury, collateral ligament tear, and bone contusions. Treatment consists of conservative management or surgical intervention, with the latter being the better option for patients who want to return to a high level of activity. Patients who undergo surgery must commit to appropriate rehabilitation for the best outcome. Long-term sequelae of ACL injury include knee osteoarthritis in up to 90 percent of patients. Primary prevention of ACL injury includes specific proprioceptive and neuromuscular training exercises to improve knee stability.

  12. Recovery-stress balance and injury risk in professional football players: a prospective study.

    PubMed

    Laux, Philipp; Krumm, Bertram; Diers, Martin; Flor, Herta

    2015-01-01

    Professional football is a contact sport with a high risk of injury. This study was designed to examine the contribution of stress and recovery variables as assessed with the Recovery-Stress Questionnaire for Athletes (RESTQ-Sport) to the risk of injury in professional football players. In a prospective, non-experimental cohort design, 22 professional football players in the highest German football league were observed over the course of 16 months. From January 2010 until April 2011, the players completed the RESTQ-Sport a total of 222 times in monthly intervals. In addition, injury data were assessed by the medical staff of the club. Overall, 34 traumatic injuries and 10 overuse injuries occurred. Most of the injuries were located in the lower limb (79.5%), and muscle and tendon injuries (43.2%) were the most frequently occurring injury type. In a generalised linear model, the stress-related scales Fatigue (OR 1.70, P = 0.007), Disturbed Breaks (OR 1.84, P = 0.047) and Injury (OR 1.77, P < 0.001) and the recovery-related scale Sleep Quality (OR 0.53, P = 0.010) significantly predicted injuries in the month after the assessment. These results support the importance of frequent monitoring of recovery and stress parameters to lower the risk of injuries in professional football. PMID:26168148

  13. Anterior cruciate ligament injuries in the female athlete. Potential risk factors.

    PubMed

    Huston, L J; Greenfield, M L; Wojtys, E M

    2000-03-01

    In the general population, an estimated one in 3000 individuals sustains an anterior cruciate ligament injury per year in the United States, corresponding to an overall injury rate of approximately 100,000 injuries annually. This national estimate is low for women because anterior cruciate ligament injury rates are reported to be two to eight times higher in women than in men participating in the same sports, presenting a sizable health problem. With the growing participation of women in athletics and the debilitating nature of anterior cruciate ligament injuries, a better understanding of mechanisms of injury in women sustaining anterior cruciate ligament injuries is essential. Published studies strongly support noncontact mechanisms for anterior cruciate ligament tears in women, which make these injuries even more perplexing. Speculation on the possible etiology of anterior cruciate ligament injuries in women has centered on anatomic differences, joint laxity, hormones, and training techniques. Investigators have not agreed on causal factors for this injury, but they have started to profile the type of athlete who is at risk. In the current study the most recent scientific studies of intrinsic and extrinsic risk factors thought to be contributing to the high rate of female anterior cruciate ligament injuries will be reviewed, important differences will be highlighted, and recommendations proposed to alleviate or minimize these risk factors among female athletes will be reported where appropriate.

  14. Recovery–stress balance and injury risk in professional football players: a prospective study

    PubMed Central

    Laux, Philipp; Krumm, Bertram; Diers, Martin; Flor, Herta

    2015-01-01

    Abstract Professional football is a contact sport with a high risk of injury. This study was designed to examine the contribution of stress and recovery variables as assessed with the Recovery-Stress Questionnaire for Athletes (RESTQ-Sport) to the risk of injury in professional football players. In a prospective, non-experimental cohort design, 22 professional football players in the highest German football league were observed over the course of 16 months. From January 2010 until April 2011, the players completed the RESTQ-Sport a total of 222 times in monthly intervals. In addition, injury data were assessed by the medical staff of the club. Overall, 34 traumatic injuries and 10 overuse injuries occurred. Most of the injuries were located in the lower limb (79.5%), and muscle and tendon injuries (43.2%) were the most frequently occurring injury type. In a generalised linear model, the stress-related scales Fatigue (OR 1.70, P = 0.007), Disturbed Breaks (OR 1.84, P = 0.047) and Injury (OR 1.77, P < 0.001) and the recovery-related scale Sleep Quality (OR 0.53, P = 0.010) significantly predicted injuries in the month after the assessment. These results support the importance of frequent monitoring of recovery and stress parameters to lower the risk of injuries in professional football. PMID:26168148

  15. Residential building stakeholders' attitudes and beliefs regarding nail gun injury risks and prevention.

    PubMed

    Albers, James T; Hudock, Stephen D; Lowe, Brian D

    2013-01-01

    Pneumatic nail guns are ubiquitous at residential construction sites across the United States. These tools are noted for the traumatic injuries that can occur from their operation. Different trigger mechanisms on these tools are associated with different levels of risk. Residential building subcontractors and workers, both native-born and immigrant, were brought together in focus groups to discuss their attitudes and beliefs regarding risk factors for nail gun injury as well as barriers to the adoption of safer technology. Participants' comments are organized first by influences on traumatic injury occurrence or prevention and later by sociotechnical system category. Participants attributed influences on injury risk to personal and external causation factors in all sociotechnical system categories; however, participants more frequently described influences on injury prevention as related to workers' behaviors, rather than to external factors. A discussion of these influences with respect to attribution theory and sociotechnical models of injury causation is presented.

  16. Neuromuscular Risk Factors for Knee and Ankle Ligament Injuries in Male Youth Soccer Players.

    PubMed

    Read, Paul J; Oliver, Jon L; De Ste Croix, Mark B A; Myer, Gregory D; Lloyd, Rhodri S

    2016-08-01

    Injuries reported in male youth soccer players most commonly occur in the lower extremities, and include a high proportion of ligament sprains at the ankle and knee with a lower proportion of overuse injuries. There is currently a paucity of available literature that examines age- and sex-specific injury risk factors for such injuries within youth soccer players. Epidemiological data have reported movements that lead to non-contact ligament injury include running, twisting and turning, over-reaching and landing. Altered neuromuscular control during these actions has been suggested as a key mechanism in females and adult populations; however, data available in male soccer players is sparse. The focus of this article is to review the available literature and elucidate prevalent risk factors pertaining to male youth soccer players which may contribute to their relative risk of injury. PMID:26856339

  17. RESIDENTIAL BUILDING STAKEHOLDERS’ ATTITUDES AND BELIEFS REGARDING NAIL GUN INJURY RISKS AND PREVENTION

    PubMed Central

    ALBERS, JAMES T.; HUDOCK, STEPHEN D.; LOWE, BRIAN D.

    2015-01-01

    Pneumatic nail guns are ubiquitous at residential construction sites across the United States. These tools are noted for the traumatic injuries that can occur from their operation. Different trigger mechanisms on these tools are associated with different levels of risk. Residential building subcontractors and workers, both native-born and immigrant, were brought together in focus groups to discuss their attitudes and beliefs regarding risk factors for nail gun injury as well as barriers to the adoption of safer technology. Participants’ comments are organized first by influences on traumatic injury occurrence or prevention and later by sociotechnical system category. Participants attributed influences on injury risk to personal and external causation factors in all sociotechnical system categories; however, participants more frequently described influences on injury prevention as related to workers’ behaviors, rather than to external factors. A discussion of these influences with respect to attribution theory and sociotechnical models of injury causation is presented. PMID:24704813

  18. Injuries in Runners; A Systematic Review on Risk Factors and Sex Differences

    PubMed Central

    van der Worp, Maarten P.; ten Haaf, Dominique S. M.; van Cingel, Robert; de Wijer, Anton; Nijhuis-van der Sanden, Maria W. G.; Staal, J. Bart

    2015-01-01

    Background The popularity of running continues to increase, which means that the incidence of running-related injuries will probably also continue to increase. Little is known about risk factors for running injuries and whether they are sex-specific. Objectives The aim of this study was to review information about risk factors and sex-specific differences for running-induced injuries in adults. Search Strategy The databases PubMed, EMBASE, CINAHL and Psych-INFO were searched for relevant articles. Selection Criteria Longitudinal cohort studies with a minimal follow-up of 1 month that investigated the association between risk factors (personal factors, running/training factors and/or health and lifestyle factors) and the occurrence of lower limb injuries in runners were included. Data Collection and Analysis Two reviewers’ independently selected relevant articles from those identified by the systematic search and assessed the risk of bias of the included studies. The strength of the evidence was determined using a best-evidence rating system. Sex differences in risk were determined by calculating the sex ratio for risk factors (the risk factor for women divided by the risk factor for men). Main Results Of 400 articles retrieved, 15 longitudinal studies were included, of which 11 were considered high-quality studies and 4 moderate-quality studies. Overall, women were at lower risk than men for sustaining running-related injuries. Strong and moderate evidence was found that a history of previous injury and of having used orthotics/inserts was associated with an increased risk of running injuries. Age, previous sports activity, running on a concrete surface, participating in a marathon, weekly running distance (30–39 miles) and wearing running shoes for 4 to 6 months were associated with a greater risk of injury in women than in men. A history of previous injuries, having a running experience of 0–2 years, restarting running, weekly running distance (20–29

  19. NFL Combine Athletic Performance after ACL Reconstruction

    PubMed Central

    Marshall, Nathan E.; Keller, Robert A.; Mehran, Nima; Austin, William; Moutzouros, Vasilios

    2016-01-01

    Objectives: The purpose of this study was to determine the functional performance of NFL combine participants after ACL reconstruction compared with an age-, size-, and position-matched control group. The hypothesis was that there would be no difference between players after ACL reconstruction as compared with controls in functional athletic performance. Methods: A total of 98 NFL-caliber athletes who had undergone primary ACL reconstruction and participated in the NFL scouting combine between 2010 and 2014 were reviewed and compared with an age-, size-, and position-matched control group. Data recorded for each player included a 40-yard dash, vertical leap, broad jump, shuttle drill, and 3-cone drill. Results: With regard to speed and acceleration, the mean 40-yard dash time for ACL-reconstructed players was 4.74 seconds (range, 4.33-5.55 seconds) compared with controls at 4.74 seconds (range, 4.34-5.38 seconds; P = .96). Jumping performance was also similar, with a mean vertical leap for ACL-reconstructed players of 33.35 inches (range, 23-43 inches) and broad jump of 113.9 inches (range, 96-136 inches) compared with respective values for the controls of 33.22 inches (range, 23.5-43.5 inches; P = .84) and 113.9 inches (range, 92-134 inches; P = .99). Agility and quickness testing measures also did not show a statistically significantly difference, with ACL-reconstructed players performing the shuttle drill in 4.37 seconds (range, 4.02-4.84 seconds) and the 3-cone drill in 7.16 seconds (range, 6.45-8.14 seconds), respectively, compared with respective times for the controls of 4.37 seconds (range, 3.96-5.00 seconds; P = .91) and 7.18 seconds (range, 6.64-8.24 seconds; P = .75). Conclusion: This study suggests that after ACL reconstruction, high-caliber athletes can achieve equivalent levels of perfor- mance with no statistically significant differences compared with matched controls. This information is unique when advising high-level athletes on athletic

  20. Perturbation training prior to ACL reconstruction improves gait asymmetries in non-copers.

    PubMed

    Hartigan, Erin; Axe, Michael J; Snyder-Mackler, Lynn

    2009-06-01

    We investigated whether preoperative perturbation training would help anterior cruciate ligament (ACL) deficient individuals who complain of knee instability ("non-copers") regain quadriceps strength and walk normally after ACL reconstruction. Nineteen non-copers with acute ACL injury were randomly assigned into a perturbation group (PERT) or a strengthening group (STR). The PERT group received specialized neuromuscular training and progressive quadriceps strength training, whereas the STR group received progressive quadriceps strength training only. We compared quadriceps strength indexes and knee excursions during the mid-stance phase of gait preoperatively to data collected 6 months after ACL reconstruction. Analyses of Variance with repeated measures (time/limb) were conducted to compare quadriceps strength index values over time (time x group) and differences in knee excursions in limbs between groups over time (limb x time x group). If significance was found, post hoc analyses were performed using paired and independent t-tests. Quadriceps strength indexes before intervention (Pert: 87.2%; Str: 75.8%) improved 6 months after ACL reconstruction in both groups (Pert: 97.1%; Str: 94.4%). Non-copers who received perturbation training preoperatively had no differences in knee excursions between their limbs 6 months after ACL reconstruction (p = 0.14), whereas those who received just strength training continued to have smaller knee excursions during the mid-stance phase of gait (p = 0.007). Non-copers strength and knee excursions were more symmetrical 6 months postoperatively in the group that received perturbation training and progressive quadriceps strength training than the group who received strength training alone.

  1. The Effects of Balance Training on Static and Dynamic Postural Stability Indices After Acute ACL Reconstruction

    PubMed Central

    Akbari, Asghar; Ghiasi, Fateme; Mir, Mohsen; Hosseinifar, Mohammad

    2016-01-01

    Background: Proprioception and postural stability play an important role in knee movements. However, there are controversies about the overall recovery time of proprioception following knee surgery and onset of balance and neuromuscular training after ACL reconstruction. Therefore, it is necessary to evaluate the effect of balance training in early stage of knee rehabilitation after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to evaluate the effect of balance exercises on postural stability indices in subjects with anterior cruciate ligament (ACL) reconstruction. Methods: The study was a controlled randomized trial study. Twenty four patients who had ACL reconstructed (balance training group) and twenty four healthy adults without any knee injury (control group) were recruited in the study. The balance exercises group performed balance exercises for 2 weeks. Before and after the interventions, overall, anteroposterior, and mediolateral stability indices were measured with a Biodex Balance System in bilateral and unilateral stance positions with the eyes open and closed. T-tests were used for statistical analysis (p<0.05). Results: Results showed that amount of static stability indices did not change after training and there were not significant differences in static stability indices before and after balance training (p>0.05). Although amount of dynamic stability indices decreased, there were not significant differences in dynamic stability indices before and after balance training (p>0.05). Amount of dynamic stability indices were decreased in balance training group, however, there were not significant differences between groups (p>0.05). Conclusion: These results support that balance exercise could partially improved dynamic stability indices in early stage of ACL reconstruction rehabilitation. The results of this study suggest that balance exercises should be part of the rehabilitation program following ACL reconstruction. PMID

  2. Pilot study of female high school basketball players' anterior cruciate ligament injury knowledge, attitudes, and practices.

    PubMed

    Iversen, M D; Friden, C

    2009-08-01

    An anterior cruciate ligament (ACL) injury prevention program was evaluated. One hundred and thirteen female high school varsity and junior varsity basketball players and 12 coaches participated in an 8-week educational and skills program. Demographic and injury history data were collected. At pre-intervention and at the end of season, knowledge, attitudes, and practices about ACL risk and injury prevention were assessed via questionnaires, and frequency of two-footed landings were videotaped during games. Univariate statistics described the sample. Paired t-tests evaluated the program's impact. Cronbach's alpha, correlations, and kappa statistics assessed the validity and reliability of questionnaires and video analysis. Of the 113 players, 74 completed the study. The players' mean age was 16.25 years (SD=1.07; range=14.2-18.8). Baseline knowledge score was 57.2%, practice 58.4%, and attitude 73.5%. The mean baseline knowledge score of the 12 coaches (mean age=40.8 years; SD=10.3; range=26.9-56.3) was 68.7%. Players' knowledge about ACL injury prevention improved (t=2.57; P<0.01). No changes in attitudes toward injury prevention were found (t(diff)=1.88; P<0.06). Inter-rater reliability of two-footed landings observed was acceptable (kappa=0.72). Videotape analyses revealed a 5.5% increase in landing performance (t(diff)=9.6; P<0.0001). The program increased knowledge about ACL injury risk and improved player's landing skills.

  3. Pre-operative factors predicting good outcome in terms of health-related quality of life after ACL reconstruction.

    PubMed

    Månsson, O; Kartus, J; Sernert, N

    2013-02-01

    The life situation of many patients changes after an anterior cruciate ligament (ACL) rupture and subsequent reconstruction, and this may affect their health-related quality of life in many ways. It is well known that the overall clinical results after ACL reconstruction are considered good, but pre-operative predictive factors for a good post-operative clinical outcome after ACL reconstruction have not been studied in as much detail. The purpose of this study was to identify pre-operative factors that predict a good post-operative outcome as measured by the Short Form 36 (SF-36) and Knee Osteoarthritis Outcome Score (KOOS) 3-6 years after ACL reconstruction. Seventy-three patients scheduled for ACL reconstruction were clinically examined pre-operatively. The SF-36 and KOOS questionnaires were sent by mail to these patients 3-6 years after reconstruction. Predictive factors for health-related quality of life were investigated using a stepwise regression analysis. In conclusion, pre-operative factors, such as pivot shift, knee function, and range of motion, may predict a good post-operative outcome and explain up to 25% in terms of health-related quality of life after ACL reconstruction. Furthermore, it appears that the patients' pre-injury and pre-operative Tegner activity levels are important predictors of post-operative health-related quality of life.

  4. Preventing recurring injuries from violence: the risk of assault among Cleveland youth after hospitalization.

    PubMed Central

    Litacker, D

    1996-01-01

    OBJECTIVES: Although interpersonal violence has increased among urban youth, its epidemiology remains unclear. To prevent such violence, identifying the susceptible population is important. METHODS: Medical records for 998 patients aged 5 to 25 years at an urban hospital were reviewed to compare data for patients admitted for assault-related injuries, those admitted for unintentional injuries, and those for problems other than injuries. RESULTS: Those initially admitted for treatment of assault were found to be at greater risk of subsequent treatment for assault than those admitted for noninjuries. CONCLUSIONS: Admission for injuries caused by violence may increase risk for future assaults; hospitalization may offer an opportunity to interrupt these patterns. PMID:8916535

  5. Catastrophic injury in rugby union: is the level of risk acceptable?

    PubMed

    Fuller, Colin W

    2008-01-01

    Rugby union is a full contact sport with a relatively high overall risk of injury and a small specific risk of fatal and catastrophic spinal injury. Although catastrophic injuries in rugby union cause public concern and generate strong emotive reactions, the magnitude of society's concern about this type of injury is often dominated by people's perceptions rather than by actual levels of risk. This article assesses published values for the risk of catastrophic injuries in rugby union, evaluates these against the risk standards of the UK Health and Safety Executive (HSE) and compares the values with the risks associated with other common sport and non-sport activities. The assessment showed that the risks of sustaining a catastrophic injury in rugby union in England (0.8/100,000 per year), Ireland (0.9/100,000 per year) and Argentina (1.9/100,000 per year) were within the HSE's 'acceptable' region of risk (0.1-2/100,000 per year), whilst the risks in New Zealand (4.2/100,000 per year), Australia (4.4/100,000 per year) and Fiji (13/100,000 per year) were within the 'tolerable' region of risk (2-100/100,000 per year). The risk of sustaining a catastrophic injury in rugby union was generally lower than or comparable with the levels reported for a wide range of other collision sports, such as ice hockey (4/100,000 per year), rugby league (2/100,000 per year) and American Football (2/100,000 per year). In addition, the risk of catastrophic injury in rugby union was comparable with that experienced by most people in work-based situations and lower than that experienced by motorcyclists, pedestrians and car occupants. Whilst ranking risks provides an effective way of assessing their acceptability, it is recognized that representing risks by a single risk value can be misleading, as account must also be taken of the public's perception of the risks and the inherent differences in the types of risk being considered. However, an acceptable level of risk is often regarded as

  6. Extrinsic and intrinsic risk factors associated with injuries in young dancers aged 8-16 years.

    PubMed

    Steinberg, Nili; Siev-Ner, Itzhak; Peleg, Smadar; Dar, Gali; Masharawi, Youssef; Zeev, Aviva; Hershkovitz, Israel

    2012-01-01

    In the present study, we tried to determine the association between joint ranges of motion, anatomical anomalies, body structure, dance discipline, and injuries in young female recreational dancers. A group of 1336 non-professional female dancers (age 8-16 years), were screened. The risk factors considered for injuries were: range of motion, body structure, anatomical anomalies, dance technique, and dance discipline. Sixty-one different types of injuries and symptoms were identified and later classified into four major categories: knee injuries, foot or ankle tendinopathy, back injuries, and non-categorized injuries. We found that 569 (42.6%) out of the 1336 screened dancers, were injured.The following factors were found to be associated with injuries (P < 0.05): (a) range of motion (e.g. dancers with hyper hip abduction are more prone to foot or ankle tendinopathies than dancers with hypo range of motion; (b) anatomical anomalies (scoliotic dancers manifested a higher rate of injuries than non-scoliotic dancers); (c) dance technique (dancers with incorrect technique of rolling-in were found to have more injuries than dancers with correct technique); (d) dance discipline (an association between time of practice en pointe and injury was observed); and (e) early age of onset of menarche decreased risk for an injury. No association between body structure and injury was found. Injuries among recreational dancers should not be overlooked, and therefore precautionary steps should be taken to reduce the risk of injury, such as screening for joint range of motion and anatomical anomalies. Certain dance positions (e.g. en pointe) should be practised only when the dancer has already acquired certain physical skills, and these practices should be time controlled.

  7. Balancing the risk of injury to gymnasts: how effective are the counter measures?

    PubMed Central

    Daly, R; Bass, S; Finch, C

    2001-01-01

    Background—To minimise injury risk and maximise gymnastics performance, coaches, parents, and health professionals working with young gymnasts need to understand and practise safe gymnastics. Aims—To (a) identify the various injury counter measures specific to gymnastics, (b) critically review the literature describing each injury prevention measure, and (c) assess, using available risk factor and injury data, the weight of evidence to support each of these counter measures. Specific recommendations for further research and implementation strategies to prevent injury and improve safety are also given. Methods—The relevant literature was identified through the use of Medline (1966 to May 1998) and SPORT Discus (1975 to May 1998) searches, hand searching of journals and reference lists, and discussions with key Australian gymnastics organisations. Results—The key gymnastics injury counter measures identified in this review include coaching (physical preparation, education, spotting, and performance technique), equipment, and the health support system (medical screening, treatment, and rehabilitation). Categorisation of the type of evidence for the effectiveness of each of these counter measures in preventing injury showed that most of it is based on informal opinion/anecdotal evidence, uncontrolled data based studies, and several prospective epidemiological studies. There is no evidence from formally controlled trials or specific evaluation studies of counter measures for gymnastics. Conclusions—Although gymnastics is a sport associated with young participants and frequent high volume, high impact training, there is a paucity of information on injury risk factors and the effectiveness of injury practices. Further controlled trials are needed to examine the extent to which injury prevention counter measures can prevent or reduce the occurrence of injury and re-injury. Particular attention should be devoted to improving training facilities, the design and

  8. Anterior cruciate ligament injuries in female athletes: why are women more susceptible?

    PubMed

    Moeller, J L; Lamb, M M

    1997-04-01

    Anterior cruciate ligament (ACL) injuries occur most frequently in planting and cutting sports such as basketball, soccer, and volleyball. National Collegiate Athletic Association injury data show that female athletes injure the ACL more frequently than their male counterparts do. The greater incidence of ACL injuries in women probably stems from complex, interrelated factors, possibly including hamstring-quadriceps strength imbalances, joint laxity, and the use of ankle braces. Successful treatment often includes surgery.

  9. Stress fractures of the femur after ACL reconstruction with transfemoral fixation.

    PubMed

    Arriaza, Rafael; Señaris, Jose; Couceiro, Gonzalo; Aizpurua, Jesus

    2006-11-01

    The ACL reconstruction with hamstring tendons has become increasingly popular, in part because it is assumed that the complication rate associated with the technique and their severity are lower than with patellar tendon. Two cases of stress reaction of the medial supracondylar area of the femur after ACL reconstruction with hamstring tendons using BioTransfix (Arthrex, Naples, FL, USA) devices for fixation within femur are presented. Both patients were professional athletes (one soccer and one basketball player), and it is hypothesized that the accelerated rehabilitation program used might have represented a risk factor for stress fractures when associated with the guide pin exit hole in the medial femoral cortex. To our knowledge, no such cases have been published to date, but it is important to consider this possibility if an unexplained pain arises in the rehabilitation process of an ACL reconstruction using transfemoral fixation.

  10. Paraffin-related injury in low-income South African communities: knowledge, practice and perceived risk

    PubMed Central

    Swart, Dehran; Hui, Siu-kuen Azor; Simpson, Jennifer; Hobe, Phumla

    2009-01-01

    Abstract Objective To explore what individuals at risk of injury from using paraffin (also known as kerosene) know about paraffin safety, what they do to protect themselves and their families from paraffin-related injury, and how they perceive their risk for such injury. Also, to explore interrelations between these factors and age, sex, education and income. Methods A sample of 238 individuals was randomly recruited from low-income housing districts near Cape Town, South Africa in 2007. Trained research assistants interviewed participants to explore their knowledge about paraffin-related safety and their perceived risk of injury from using paraffin. Researchers inspected participants’ homes to evaluate paraffin safety practices. Descriptive and correlational analyses were conducted. Findings Participants had relatively low levels of knowledge about paraffin-related safety. They had high levels of unsafe practice and their perceived risk of injury was moderate. Knowledge of paraffin safety and safe practices were positively correlated with each other. Greater knowledge showed a negative correlation with the perception of being at risk for injury, but safe practices showed no correlation with perceived risk of injury. Formal education, the number of children in the home and frequency of paraffin use were positively correlated with knowledge but not with safe practices. The only significant correlate to safe practices was greater income, perhaps a reflection of the impact of financial resources on paraffin safety practices. Conclusion To develop successful paraffin safety interventions, it is necessary to understand baseline levels of knowledge, practice and perceived risk of injury among at-risk populations. Our findings could be of value for designing interventions that will increase knowledge, improve safe practices and lead to the accurate perception of the risk of injury from using paraffin. PMID:19784450

  11. Prevention of anterior cruciate ligament injuries.

    PubMed

    Hewett, T E; Myer, G D; Ford, K R

    2001-12-01

    Numerous studies have found that female athletes who participate in jumping and pivoting sports are four to six times more likely to sustain a knee ligament injury, such as anterior cruciate ligament (ACL) injury, than male athletes participating in the same sports [1-8]. A widening gender gap in the number of serious knee ligament injuries exists due to geometric growth in female athletic participation, coupled with the four- to sixfold higher injury rate. More than 50,000 serious knee injuries are projected to occur in female varsity intercollegiate and high school athletics each year [9, 10]. Most ACL injuries occur by noncontact mechanisms, often during landing from a jump or making a lateral pivot while running [2, 11]. Knee instability, due to ligament dominance (decreased medial-lateral neuromuscular control of the joint), quadriceps dominance (increased quadriceps recruitment and decreased hamstring recruitment and strength), and leg dominance (side-to-side differences in strength, flexibility, and coordination) are possible contributing factors to the increased incidence of knee injury in female athletes [5, 6]. In this review, dynamic neuromuscular analysis (DNA) training is defined, and a rationale is presented for correcting the neuromuscular imbalances that may result in dynamic knee instability during sports play. Dynamic neuromuscular training has been shown to increase knee stability and decrease knee injury rates in female athletes [5, 12.., 13.]. Preliminary research on athlete screening and injury prediction based on the three aforementioned imbalances also is presented with recommendations for developing screening protocols for the identification of high-risk athletes.

  12. Biomechanical Characterization of a Model of Noninvasive, Traumatic Anterior Cruciate Ligament Injury in the Rat.

    PubMed

    Maerz, Tristan; Kurdziel, Michael D; Davidson, Abigail A; Baker, Kevin C; Anderson, Kyle; Matthew, Howard W T

    2015-10-01

    The onset of post-traumatic osteoarthritis (PTOA) remains prevalent following traumatic joint injury such as anterior cruciate ligament (ACL) rupture, and animal models are important for studying the pathomechanisms of PTOA. Noninvasive ACL injury using the tibial compression model in the rat has not been characterized, and it may represent a more clinically relevant model than the common surgical ACL transection model. This study employed four loading profiles to induce ACL injury, in which motion capture analysis was performed, followed by quantitative joint laxity testing. High-speed, high-displacement loading repeatedly induces complete ACL injury, which causes significant increases in anterior-posterior and varus laxity. No loading protocol induced valgus laxity. Tibial internal rotation and anterior subluxation occurs up to the point of ACL failure, after which the tibia rotates externally as it subluxes over the femoral condyles. High displacement was more determinative of ACL injury compared to high speed. Low-speed protocols induced ACL avulsion from the femoral footprint whereas high-speed protocols caused either midsubstance rupture, avulsion, or a combination injury of avulsion and midsubstance rupture. This repeatable, noninvasive ACL injury protocol can be utilized in studies assessing PTOA or ACL reconstruction in the rat.

  13. Unintentional childhood injuries in sub-Saharan Africa: an overview of risk and protective factors.

    PubMed

    Ruiz-Casares, Mónica

    2009-01-01

    The rate of unintentional injuries for children in sub-Saharan Africa has reached 53.1 per 100,000, the highest for regions across all income levels. This paper reviews the relevant literature on the epidemiology of unintentional childhood injuries in the region, with an emphasis on the risk factors associated with it. Several demographic, socioeconomic, and environmental factors contributing to injuries in children have been documented for the main causes of injury. Despite the high burden, child injury prevention and control programs and policies are limited or non-existent in many countries in the region. Accurate data regarding these injuries across and within countries is incomplete. Population-based estimates and investigations into context-specific risk factors, safety attitudes, and behaviours are needed to inform the development of effective interventions.

  14. Injury risk is low among world-class volleyball players: 4-year data from the FIVB Injury Surveillance System

    PubMed Central

    Bere, Tone; Kruczynski, Jacek; Veintimilla, Nadège; Hamu, Yuichiro; Bahr, Roald

    2015-01-01

    Background Little is known about the rate and pattern of injuries in international volleyball competition. Objective To describe the risk and pattern of injuries among world-class players based on data from the The International Volleyball Federation (FIVB) Injury Surveillance System (ISS) (junior and senior, male and female). Methods The FIVB ISS is based on prospective registration of injuries by team medical staff during all major FIVB tournaments (World Championships, World Cup, World Grand Prix, World League, Olympic Games). This paper is based on 4-year data (September 2010 to November 2014) obtained through the FIVB ISS during 32 major FIVB events (23 senior and 9 junior). Results The incidence of time-loss injuries during match play was 3.8/1000 player hours (95% CI 3.0 to 4.5); this was greater for senior players than for junior players (relative risk: 2.04, 1.29 to 3.21), while there was no difference between males and females (1.04, 0.70 to 1.55). Across all age and sex groups, the ankle was the most commonly injured body part (25.9%), followed by the knee (15.2%), fingers/thumb (10.7%) and lower back (8.9%). Injury incidence was greater for centre players and lower for liberos than for other player functions; injury patterns also differed between player functions. Conclusions Volleyball is a very safe sport, even at the highest levels of play. Preventive measures should focus on acute ankle and finger sprains, and overuse injuries in the knee, lower back and shoulder. PMID:26194501

  15. Femoral tunnel malposition in ACL revision reconstruction.

    PubMed

    Morgan, Joseph A; Dahm, Diane; Levy, Bruce; Stuart, Michael J

    2012-11-01

    The Multicenter Anterior Cruciate Ligament (ACL) Revision Study (MARS) group was formed to study a large cohort of revision ACL reconstruction patients. The purpose of this subset analysis study of the MARS database is to describe specific details of femoral tunnel malposition and subsequent management strategies that surgeons chose in the revision setting. The design of this study is a case series. The multicenter MARS database is compiled from a questionnaire regarding 460 ACL reconstruction revision cases returned by 87 surgeons. This subset analysis described technical aspects and operative findings in specifically those cases in which femoral tunnel malposition was cited as the cause of primary ACL reconstruction failure. Of the 460 revisions included for study, 276 (60%) cases cited a specific "technical cause of failure." Femoral tunnel malposition was cited in 219 (47.6%) of 460 cases. Femoral tunnel malposition was cited as the only cause of failure in 117 cases (25.4%). Surgeons judged the femoral tunnel too vertical in 42 cases (35.9%), too anterior in 35 cases (29.9%), and too vertical and anterior in 31 cases (26.5%). Revision reconstruction involved the drilling of an entirely new femoral tunnel in 91 cases (82.1%). For primary reconstruction, autograft tissue was used in 82 cases (70.1%). For revision reconstruction, autograft tissue was used in 61 cases (52.1%) and allograft tissue in 56 cases (47.9%). Femoral tunnel malposition in primary ACL reconstruction was the most commonly cited reason for graft failure in this cohort. Graft selection is widely variable among surgeons.

  16. Femoral Tunnel Malposition in ACL Revision Reconstruction

    PubMed Central

    Morgan, Joseph A.; Dahm, Diane; Levy, Bruce; Stuart, Michael J.

    2013-01-01

    The Multicenter Anterior Cruciate Ligament (ACL) Revision Study (MARS) group was formed to study a large cohort of revision ACL reconstruction patients. The purpose of this subset analysis study of the MARS database is to describe specific details of femoral tunnel malposition and subsequent management strategies that surgeons chose in the revision setting. The design of this study is a case series. The multicenter MARS database is compiled from a questionnaire regarding 460 ACL reconstruction revision cases returned by 87 surgeons. This subset analysis described technical aspects and operative findings in specifically those cases in which femoral tunnel malposition was cited as the cause of primary ACL reconstruction failure. Of the 460 revisions included for study, 276 (60%) cases cited a specific “technical cause of failure.” Femoral tunnel malposition was cited in 219 (47.6%) of 460 cases. Femoral tunnel malposition was cited as the only cause of failure in 117 cases (25.4%). Surgeons judged the femoral tunnel too vertical in 42 cases (35.9%), too anterior in 35 cases (29.9%), and too vertical and anterior in 31 cases (26.5%). Revision reconstruction involved the drilling of an entirely new femoral tunnel in 91 cases (82.1%). For primary reconstruction, autograft tissue was used in 82 cases (70.1%). For revision reconstruction, autograft tissue was used in 61 cases (52.1%) and allograft tissue in 56 cases (47.9%). Femoral tunnel malposition in primary ACL reconstruction was the most commonly cited reason for graft failure in this cohort. Graft selection is widely variable among surgeons. PMID:23150344

  17. Acute Kidney Injury Increases Risk of ESRD among Elderly

    PubMed Central

    Ishani, Areef; Xue, Jay L.; Himmelfarb, Jonathan; Eggers, Paul W.; Kimmel, Paul L.; Molitoris, Bruce A.; Collins, Allan J.

    2009-01-01

    Risk for ESRD among elderly patients with acute kidney injury (AKI) has not been studied in a large, representative sample. This study aimed to determine incidence rates and hazard ratios for developing ESRD in elderly individuals, with and without chronic kidney disease (CKD), who had AKI. In the 2000 5% random sample of Medicare beneficiaries, clinical conditions were identified using Medicare claims; ESRD treatment information was obtained from ESRD registration during 2 yr of follow-up. Our cohort of 233,803 patients were hospitalized in 2000, were aged ≥67 yr on discharge, did not have previous ESRD or AKI, and were Medicare-entitled for ≥2 yr before discharge. In this cohort, 3.1% survived to discharge with a diagnosis of AKI, and 5.3 per 1000 developed ESRD. Among patients who received treatment for ESRD, 25.2% had a previous history of AKI. After adjustment for age, gender, race, diabetes, and hypertension, the hazard ratio for developing ESRD was 41.2 (95% confidence interval [CI] 34.6 to 49.1) for patients with AKI and CKD relative to those without kidney disease, 13.0 (95% CI 10.6 to 16.0) for patients with AKI and without previous CKD, and 8.4 (95% CI 7.4 to 9.6) for patients with CKD and without AKI. In summary, elderly individuals with AKI, particularly those with previously diagnosed CKD, are at significantly increased risk for ESRD, suggesting that episodes of AKI may accelerate progression of renal disease. PMID:19020007

  18. Acute kidney injury increases risk of ESRD among elderly.

    PubMed

    Ishani, Areef; Xue, Jay L; Himmelfarb, Jonathan; Eggers, Paul W; Kimmel, Paul L; Molitoris, Bruce A; Collins, Allan J

    2009-01-01

    Risk for ESRD among elderly patients with acute kidney injury (AKI) has not been studied in a large, representative sample. This study aimed to determine incidence rates and hazard ratios for developing ESRD in elderly individuals, with and without chronic kidney disease (CKD), who had AKI. In the 2000 5% random sample of Medicare beneficiaries, clinical conditions were identified using Medicare claims; ESRD treatment information was obtained from ESRD registration during 2 yr of follow-up. Our cohort of 233,803 patients were hospitalized in 2000, were aged > or = 67 yr on discharge, did not have previous ESRD or AKI, and were Medicare-entitled for > or = 2 yr before discharge. In this cohort, 3.1% survived to discharge with a diagnosis of AKI, and 5.3 per 1000 developed ESRD. Among patients who received treatment for ESRD, 25.2% had a previous history of AKI. After adjustment for age, gender, race, diabetes, and hypertension, the hazard ratio for developing ESRD was 41.2 (95% confidence interval [CI] 34.6 to 49.1) for patients with AKI and CKD relative to those without kidney disease, 13.0 (95% CI 10.6 to 16.0) for patients with AKI and without previous CKD, and 8.4 (95% CI 7.4 to 9.6) for patients with CKD and without AKI. In summary, elderly individuals with AKI, particularly those with previously diagnosed CKD, are at significantly increased risk for ESRD, suggesting that episodes of AKI may accelerate progression of renal disease.

  19. Influence of Extrinsic Risk Factors on National Football League Injury Rates

    PubMed Central

    Lawrence, David W.; Comper, Paul; Hutchison, Michael G.

    2016-01-01

    Background: The risk of injury associated with American football is significant, with recent reports indicating that football has one of the highest rates of all-cause injury, including concussion, of all major sports. There are limited studies examining risk factors for injuries in the National Football League (NFL). Purpose: To identify risk factors for NFL concussions and musculoskeletal injuries. Study Design: Case-control study; Level of evidence, 3. Methods: Injury report data were collected prospectively for each week over the 2012-2013 and 2013-2014 regular seasons for all 32 teams. Poisson regression models were used to identify the relationship between predetermined variables and the risk of the 5 most frequent injuries (knee, ankle, hamstring, shoulder, and concussion). Results: A total of 480 games or 960 team games (TGs) from the 2012-2013 and 2013-2014 regular seasons were included in this study. A trend to an increasing risk of concussion and TG ankle injury with decreasing mean game-day temperature was observed. The risk of TG concussion (incidence rate ratio [IRR], 2.16; 95% CI, 1.35-3.45; P = .001) and TG ankle injury (IRR, 1.48; 95% CI, 1.10-1.98; P = .01) was significantly greater for TGs played at a mean game-day temperature of ≤9.7°C (≤49.5°F) compared with a mean game-day temperature of ≥21.0°C (≥69.8°F). The risk of TG shoulder injury was significantly increased for TGs played on grass surfaces (IRR, 1.36; 95% CI, 1.02-1.81; P = .038) compared with synthetic surfaces. The risk of TG injury was not associated with time in season, altitude, time zone change prior to game, or distance traveled to a game. Conclusion: This study evaluated extrinsic risk factors for injury in the NFL. A hazardous association was identified for risk of concussion and ankle injury with colder game-day temperature. Further research should be conducted to substantiate this relationship and its potential implication for injury prevention initiatives. PMID

  20. Golf--recognising the risk of severe eye injury.

    PubMed

    Townley, D; Kirwan, C; O'Keefe, M

    2008-06-01

    Golf related ocular injuries are uncommon but frequently result in severe injury necessitating removal of the eye. As golf increases in popularity, it is vital that awareness is raised among both players and spectators regarding the potential hazards. We determined the nature and frequency of golf related eye injury at our unit from 1990 to 2007. Patient age, nature of injury, management and visual outcome were documented. 10 patients (7 adults, 3 children) sustained golf related eye trauma over this time. 7 cases involved injury inflicted by a golf ball and 3 by a golf club. 7 eyes required enucleation or evisceration. Visual acuity in the remaining 3 eyes ranged from 6/6 to less than 6/60. Golf related ocular injuries while uncommon, frequently have devastating consequences. Public awareness must be raised in order to promote greater safety on the golf course.

  1. Evaluation of eye injury risk from projectile shooting toys using the focus headform - biomed 2009.

    PubMed

    Bisplinghoff, Jill A; Duma, Stefan M

    2009-01-01

    Half of eye injuries in the United States are caused by a blunt impact and more specifically, eye injuries effecting children often result from projectile shooting toys. The purpose of this study is to evaluate the risk of eye injuries of currently available projectile shooting toys. In order to assess the risk of each toy, a Facial and Ocular Countermeasure Safety (FOCUS) headform was used to measure the force applied to the eye during each hit for a total of 18 tests. The selected toys included a dart gun, a foam launcher, and a ball launcher. The force ranged from 4-93 N and was analyzed using the injury risk function for globe rupture for the FOCUS headform. Projectile characteristics were also examined using normalized energy to determine risk of corneal abrasion, hyphema, lens dislocation, retinal damage and globe rupture. It was found that the three toys tested produced peak loads corresponding with risk of globe rupture between 0% and 17.3%. The normalized energy results show no risk of hyphema, lens dislocation, retinal damage or globe rupture and a maximum risk of corneal abrasion of 5.9%. This study concludes that although there are many eye injuries caused by projectiles, the selected toys show a very low risk of eye injury.

  2. The role of risk-taking and errors in children's liability to unintentional injury.

    PubMed

    Rowe, Richard; Maughan, Barbara

    2009-07-01

    There is likely to be heterogeneity in the processes putting children at risk of injury. This paper examines whether errors may form a dissociable process from risk-taking. We further examine whether these constructs mediate the links between emotional and behavioural problems and unintentional injury. We designed the parent-report Children's Injury Related Behaviour (CIRB) questionnaire to measure errors and risk-taking in everyday activities. The sample consisted of 499 children aged 4-11 years recruited from the community. Principal components analysis showed that a two factor solution was appropriate and provided scales to measure risk and error with good psychometric properties. Both risk and error scales were independently related to injury history. Errors were associated with conduct problems, emotional problems and hyperactivity. Risk-taking was associated with conduct problems and hyperactivity only. Risk-taking and errors accounted for the links of conduct problems and hyperactivity with injury involvement. The distinction between risk and error has implications for research and interventions to reduce childhood injuries. PMID:19540954

  3. Terror Attacks Increase the Risk of Vascular Injuries

    PubMed Central

    Heldenberg, Eitan; Givon, Adi; Simon, Daniel; Bass, Arie; Almogy, Gidon; Peleg, Kobi

    2014-01-01

    Objectives: Extensive literature exists about military trauma as opposed to the very limited literature regarding terror-related civilian trauma. However, terror-related vascular trauma (VT), as a unique type of injury, is yet to be addressed. Methods: A retrospective analysis of the Israeli National Trauma Registry was performed. All patients in the registry from 09/2000 to 12/2005 were included. The subgroup of patients with documented VT (N = 1,545) was analyzed and further subdivided into those suffering from terror-related vascular trauma (TVT) and non-terror-related vascular trauma (NTVT). Both groups were analyzed according to mechanism of trauma, type and severity of injury and treatment. Results: Out of 2,446 terror-related trauma admissions, 243 sustained TVT (9.9%) compared to 1302 VT patients from non-terror trauma (1.1%). TVT injuries tend to be more complex and most patients were operated on. Intensive care unit admissions and hospital length of stay was higher in the TVT group. Penetrating trauma was the prominent cause of injury among the TVT group. TVT group had a higher proportion of patients with severe injuries (ISS ≥ 16) and mortality. Thorax injuries were more frequent in the TVT group. Extremity injuries were the most prevalent vascular injuries in both groups; however NTVT group had more upper extremity injuries, while the TVT group had significantly much lower extremity injuries. Conclusion: Vascular injuries are remarkably more common among terror attack victims than among non-terror trauma victims and the injuries of terror casualties tend to be more complex. The presence of a vascular surgeon will ensure a comprehensive clinical care. PMID:24910849

  4. Risk factors and musculoskeletal injuries associated with all-terrain vehicle accidents.

    PubMed

    Balthrop, Paul M; Nyland, John; Roberts, Craig S

    2009-02-01

    Accidents, injuries, and deaths sustained via all-terrain vehicle (ATV) use are on the rise. In addition to safe and proper ATV operation, accident-related risk factors include operator controllable behaviors such as helmet use, alcohol use, and deciding whether or not to carry a passenger. What the operator has little or no control over, however, is the inherently unstable ATV design with its narrow wheelbase, short turning radius, and high center of gravity, in addition to common use of low tire pressure to maximize maneuverability. These factors lead to musculoskeletal injuries that consist predominantly of extremity fractures, primarily through rollover events. There is a need for improved ATV operator safety education and more stringent regulations. The purpose of this review is to identify the accident and injury risk factors associated with ATV operation and to compare them with bicycle and motorcycle accident and injury risk factors to enable emergency medical professionals to develop better patient management and injury prevention strategies.

  5. Incidence of injury in Texas girls' high school basketball.

    PubMed

    Gomez, E; DeLee, J C; Farney, W C

    1996-01-01

    We studied the incidence of injury in girl's varsity basketball to characterize injury demographics in high school athletics. We defined a reportable injury as one that occurred during organized practice or competition, resulted in either missed practice or game time, required physician consultation, or involved the head or face. We prospectively evaluated the athletes on team rosters during the 1993 to 1994 season from 100 randomly selected Class 4A and 5A Texas public high schools that employed full-time certified athletic trainers. The 890 student athletes from 80 schools ranged in age from 14 to 18 years. Four hundred thirty-six injuries were reported for a rate of 0.49 per athlete per season. Injury risk, calculated on the basis of exposure time, was 0.4% per hour per athlete. Although game time accounted for only 12.5% of exposure time, it represented one half of the total injuries. Sprains and strains (56%) were the most common injuries, followed by contusions (15%) and dental injuries (14%). Injuries to the ankle (31%) and knee (19%) were by far the most common. There were 34 severe injuries defined as requiring surgery or hospitalization, for a rate of 0.038 per athlete per season. Knee injuries were by far the most likely to require surgeries, and ACL injuries accounted for 69% of the severe knee injuries.

  6. Mesenchymal Stem Cells for Enhancing Biologic Healing after Anterior Cruciate Ligament Injuries.

    PubMed

    Jang, Ki-Mo; Lim, Hong Chul; Bae, Ji Hoon

    2015-01-01

    Arthroscopic anterior cruciate ligament (ACL) reconstruction using tendon grafts is the current gold standard for the treatment of ACL tears in active patients. However, many patients still experience residual knee instability, knee pain and progressive cartilage degeneration following ACL reconstruction. Recent developments in mesenchymal stem cell (MSC)-based approaches for treating musculoskeletal injuries have led to the application of MSCs for enhancing healing after ACL injuries. The purpose of this article is to review recent pre-clinical and clinical studies using MSCs for the enhancement of biologic healing of ACL injuries. Because of the success of pre-clinical studies, MSC-based approaches are now thought to be promising treatment options for enhancing biologic healing of ACL grafts and restoring the functional properties to the levels of the native ACL, and ultimately improving clinical outcomes.

  7. Injury Risk Factors in a Small-Scale Gold Mining Community in Ghana's Upper East Region.

    PubMed

    Long, Rachel N; Sun, Kan; Neitzel, Richard L

    2015-07-24

    Occupational injury is one of many health concerns related to small-scale gold mining (ASGM), but few data exist on the subject, especially in sub-Saharan Africa. In 2011 and 2013, we examined accidents, injuries, and potential risk factors in a Ghanaian ASGM community. In 2011, 173 participants were surveyed on occupational history and health, and 22 of these were surveyed again in 2013. Injury rates were estimated at 45.5 and 38.5 injuries per 100 person-years in 2011 and in 2013, respectively; these rates far surpass those of industrialized mines in the U.S. and South Africa. Demographic and job characteristics generally were not predictive of injury risk, though there was a significant positive association with injury risk for males and smokers. Legs and knees were the most common body parts injured, and falling was the most common cause of injury. The most common type of injuries were cuts or lacerations, burns and scalds, and contusions and abrasions. Only two miners had ever received any occupational safety training, and PPE use was low. Our results suggest that injuries should be a priority area for occupational health research in ASGM.

  8. Cross-cultural comparison of patients undergoing ACL reconstruction in the United States and Norway.

    PubMed

    Magnussen, Robert A; Granan, Lars-Petter; Dunn, Warren R; Amendola, Annunziato; Andrish, Jack T; Brophy, Robert; Carey, James L; Flanigan, David; Huston, Laura J; Jones, Morgan; Kaeding, Christopher C; McCarty, Eric C; Marx, Robert G; Matava, Matthew J; Parker, Richard D; Vidal, Armando; Wolcott, Michelle; Wolf, Brian R; Wright, Rick W; Spindler, Kurt P; Engebretsen, Lars

    2010-01-01

    Data from large prospectively collected anterior cruciate ligament (ACL) cohorts are being utilized to address clinical questions regarding ACL injury demographics and outcomes of ACL reconstruction. These data are affected by patient and injury factors as well as surgical factors associated with the site of data collection. The aim of this article is to compare primary ACL reconstruction data from patient cohorts in the United States and Norway, demonstrating the similarities and differences between two large cohorts. Primary ACL reconstruction data from the Multicenter Orthopaedic Outcomes Network (MOON) in the United States and the Norwegian National Knee Ligament Registry (NKLR) were compared to identify similarities and differences in patient demographics, activity at injury, preoperative Knee injury and Osteoarthritis Outcome Score (KOOS), time to reconstruction, intraarticular pathology, and graft choice. Seven hundred and thirteen patients from the MOON cohort were compared with 4,928 patients from the NKLR. A higher percentage of males (NKLR 57%, MOON 52%; P < 0.01) and increased patient age (NKLR 27 years, MOON 23 years; P\\0.001) were noted in the NKLR population. The most common sports associated with injury in the MOON cohort were basketball (20%), soccer (17%), and American football (14%); while soccer (42%), handball (26%), and downhill skiing (10%) were most common in the NKLR. Median time to reconstruction was 2.4 (Interquartile range [IQR] 1.2-7.2) months in the MOON cohort and 7.9 (IQR 4.2-17.8) months in the NKLR cohort (P < 0.001). Both meniscal tears (MOON 65%, NKLR 48%; P < 0.001) and articular cartilage defects (MOON 46%, NKLR 26%; P < 0.001) were more common in the MOON cohort. Hamstring autografts (MOON 44%, NKLR 63%) and patellar tendon autografts (MOON 42%, NKLR 37%) were commonly utilized in both cohorts. Allografts were much more frequently utilized in the MOON cohort (MOON 13%, NKLR 0.04%; P < 0.001). Significant diversity in patient

  9. Mediated effects of physical risk factors, leader-member exchange and empowerment in predicting perceived injury risk.

    PubMed

    Muldoon, Jeffery; Matthews, Russell A; Foley, Caroline

    2012-04-01

    In the context of conservation of resources theory, we examine the indirect (mediated) effects of physical risk factors, leader-member exchange (LMX) and empowerment on perceived injury risk in a heterogeneous sample (N = 226) of individuals employed in occupations related to production, construction and installation/maintenance. Positioning work role stressors and upward safety communications as two important mediating variables, as predicted, LMX and empowerment demonstrated significant indirect effects on perceived injury risk. Results from our model also provide preliminary evidence that an asymmetrical dualistic process exists in terms of the effect physical risk factors have on perceived injury risk via depletion of both psychological (i.e. role stressors) and physical resources (i.e. physical symptoms). Theoretical and practical implications based on the results of our model are also discussed.

  10. Physeal Disruption During ACL Reconstruction in Skeletally Immature Patients

    PubMed Central

    Cruz, Aristides Ignacio; Lakomkin, Nikita; Fabricant, Peter D.; Lawrence, John Todd R.

    2016-01-01

    studies noting the safety of transphyseal ACL reconstruction have utilized a vertical femoral tunnel, surgeons should be aware that if an independent femoral tunnel drilling technique is utilized during transphyseal ACL reconstruction, the physis is at greater risk when drilling at more horizontal angles. Angles greater than 25º from the transverse axis may safely create <6% physeal area damage.

  11. Head Start and Unintended Injury: The Use of the Family Map Interview to Document Risk

    ERIC Educational Resources Information Center

    Whiteside-Mansell, Leanne; Johnson, Danya; Aitken, Mary M.; Bokony, Patti A.; Conners-Burrow, Nicola; McKelvey, Lorraine

    2010-01-01

    Much is known about how to provide safe environments for preschool children (3-5 years-of-age); however, many preschool children still experience preventable injuries--particularly children living in poverty. This study examined the use of an assessment tool used to identify children at risk for unintended injury in two large, federally funded…

  12. Multimodal injury risk analysis of road users at signalized and non-signalized intersections.

    PubMed

    Strauss, Jillian; Miranda-Moreno, Luis F; Morency, Patrick

    2014-10-01

    This paper proposes a multimodal approach to study safety at intersections by simultaneously analysing the safety and flow outcomes for both motorized and non-motorized traffic. This study uses an extensive inventory of signalized and non-signalized intersections on the island of Montreal, Quebec, Canada, containing disaggregate motor-vehicle, cyclist and pedestrian flows, injury data, geometric design, traffic control and built environment characteristics in the vicinity of each intersection. Bayesian multivariate Poisson models are used to analyze the injury and traffic flow outcomes and to develop safety performance functions for each mode at both facilities. After model calibration, contributing injury frequency factors are identified. Injury frequency and injury risk measures are then generated to carry out a comparative study to identify which mode is at greatest risk at intersections in Montreal. Among other results, this study identified the significant effect that motor-vehicle traffic imposes on cyclist and pedestrian injury occurrence. Motor-vehicle traffic is the main risk determinant for all injury and intersection types. This highlights the need for safety improvements for cyclists and pedestrians who are, on average, at 14 and12 times greater risk than motorists, respectively, at signalized intersections. Aside from exposure measures, this work also identifies some geometric design and built environment characteristics affecting injury occurrence for cyclists, pedestrians and motor-vehicle occupants. PMID:24945759

  13. Risk Factors Associated with Self-Injurious Behaviors in Children and Adolescents with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Duerden, Emma G.; Oatley, Hannah K.; Mak-Fan, Kathleen M.; McGrath, Patricia A.; Taylor, Margot J.; Szatmari, Peter; Roberts, S. Wendy

    2012-01-01

    While self-injurious behaviors (SIB) can cause significant morbidity for children with autism spectrum disorders (ASD), little is known about its associated risk factors. We assessed 7 factors that may influence self-injury in a large cohort of children with ASD: (a) atypical sensory processing; (b) impaired cognitive ability; (c) abnormal…

  14. Intercondylar Notch Stenosis of Knee Osteoarthritis and Relationship between Stenosis and Osteoarthritis Complicated with Anterior Cruciate Ligament Injury

    PubMed Central

    Chen, Cong; Ma, Yinhua; Geng, Bin; Tan, Xiaoyi; Zhang, Bo; Jayswal, Chandan Kumar; Khan, Md. Shahidur; Meng, Huiqiang; Ding, Ning; Jiang, Jin; Wu, Meng; Wang, Jing; Xia, Yayi

    2016-01-01

    Abstract The aim of this study was to research whether the patients with knee osteoarthritis (OA) exist intercondylar notch stenosis and the relationship between stenosis and OA complicated with anterior cruciate ligament (ACL) injury from magnetic resonance imaging (MRI). A total of 79 cases of moderate–severe OA patients and 71 cases of healthy people were collected; among these OA patients, 38 were OA complicated with ACL injury and 41 were simple OA. The intercondylar notch was divided into A, U, and W types according to the notch shape in the axial sequence of MRI. Measurement of the notch width index (NWI) in the sequences of axial (NWI-1), coronal (NWI-2), and ACL attachment point at femoral (NWI-A) was done. The differences of NWI in different groups and different sequences were compared and the NWI cut-off values in different sequences were resolved by a receiver operating characteristic (ROC) curve which could be used as indicators for intercondylar notch narrowing were calculated. The proportion of type A in moderate–severe OA group was larger than healthy group, and similar to OA complicated with ACL injury and simple OA groups (P <0.05). The NWI values of the moderate–severe OA group in three sequences were smaller than the healthy group, and similar to OA complicated with ACL injury and simple OA groups (P <0.001). The cut-off values of ROC curve were NWI-1 <0.266, NWI-2 <0.247, and NWI-A <0.253 in the moderate–severe OA group, and NWI-1 <0.263, NWI-2 <0.246, and NWI-A <0.253 in the OA complicated with ACL injury group. The intercondylar notch of moderate–severe OA patients exist significant stenosis. Type A is one of the variables that predispose a notch to stenosis. Intercondylar notch stenosis and type A are risk factors for moderate–severe OA patients complicated with ACL injury. PMID:27124033

  15. Behavioral and nonbehavioral risk factors for occupational injuries and health problems among Belgian farmers.

    PubMed

    Van den Broucke, Stephan; Colémont, Ariane

    2011-10-01

    Preventive interventions to reduce occupational injuries and diseases among farmers require an appraisal of the relative importance of the various risk factors. This paper describes the results of a cross-sectional study investigating determinants of occupational health and injuries among 510 Belgian farmers, looking at health-related behaviors (machinery use, animal handling, fall prevention, and pesticide use), as well as nonbehavioral risk factors (demographic characteristics, farm characteristics, and participation in safety training). Education level and number of employees on the farm were identified as nonbehavioral risk factors for injuries, with highly educated farmers and working with one employee associated with a higher injury risk. In contrast, none of the nonbehavioral factors were related to occupational disease. Unsafe machinery use, animal handling, fall prevention, and pesticide use were behavioral risk factors for injuries, with unsafe pesticide use representing the highest risk. Unsafe machinery and pesticide use were also risks for disease. Significant differences in self-reported behavior were found for gender, age, number of employees, and the interaction between age and education. The study highlights the importance of behavioral factors as determinants of occupational injuries and diseases among farmers, and suggests that tailored preventive interventions should be developed to accommodate for differences in these behaviors among subgroups of farmers.

  16. Injury risk associated with physical demands and school environment characteristics among a cohort of custodial workers.

    PubMed

    Koehoorn, Mieke; Ostry, Aleck; Hossain, Shahadut; Village, Judy

    2011-08-01

    Few epidemiological studies have investigated the relationship between work exposures and injury risk among custodians. The relationship between injury risk and occupational physical demands (e.g. pushing/pulling, lifting) and school environment characteristics (e.g. school type, season) was investigated among a cohort of 581 school custodians over a 4-year period. In the final Poisson regression models, the risk of injury was associated with time spent in pushing/pulling tasks in a dose-response manner increasing to a five-fold risk among the highest quartile of exposure (risk ratio = 5.15, 95% CI 1.00, 26.5). Injury risk was also associated with working during the school year compared to the summer, working in a school with grass vs. gravel grounds and working in a school with detached classrooms. Results help to target interventions such as alternative methods for floor cleaning to reduce the pushing/pulling demands of custodial work and to support decisions for alternatives to detached classrooms and grass surfaces. Statement of Relevance: This study examines ergonomic factors (physical demand exposures, school environment characteristics) associated with injury risk among custodial school workers. The findings help schools to target interventions to reduce the physical demands associated with injuries and to design school environments to reduce exposures.

  17. Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques

    PubMed Central

    Labronici, Pedro José; Reder, Vitor Rodrigues; de Araujo Marins Filho, Guilherme Ferreira; Pires, Robinson Esteves Santos; Fernandes, Hélio Jorge Alvachian; Mercadante, Marcelo Tomanik

    2016-01-01

    Objective To ascertain whether the number of screws or pins placed in the calcaneus might increase the risk of injury when three different techniques for treating calcaneal fractures. Method 126 radiographs of patients who suffered displaced calcaneal fractures were retrospectively analyzed. Three surgical techniques were analyzed on an interobserver basis: 31 radiographs of patients treated using plates that were not specific for the calcaneus, 48 using specific plates and 47 using an external fixator. The risk of injury to the anatomical structures in relation to each Kirschner wire or screw was determined using a graded system in accordance with the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire/screw was quantified using the additive law of probabilities for the product, for independent events. Results All of the models presented high explanatory power for the risk evaluated, since the coefficient of determination values (R2) were greater than 98.6 for all the models. Therefore, the set of variables studied explained more than 98.6% of the variations in the risks of injury to arteries, veins or nerves and can be classified as excellent models for prevention of injuries. Conclusion The risk of injury to arteries, veins or nerves is not defined by the total number of pins/screws. The region and the number of pins/screws in each region define and determine the best distribution of the risk. PMID:27069891

  18. Acute kidney injury in dengue fever using Acute Kidney Injury Network criteria: incidence and risk factors.

    PubMed

    Mehra, Nikita; Patel, Amish; Abraham, Georgi; Reddy, Yogesh N V; Reddy, Yuvaram N V

    2012-07-01

    The aim of this study was to assess incidence and risk factors for acute kidney injury (AKI) in patients with dengue fever (DF). A total of 223 patients (males, 130; females, 93; mean age, 26.2 ± 18.2 years) from a tertiary care centre in southern India were retrospectively analysed. Acute renal failure (ARF) developed in 24 (10.8%) patients. Based on the Acute Kidney Injury Network (AKIN) criteria, the results revealed that: 12 (5.4%) had mild AKI; seven (3.1%) had moderate AKI; and five (2.2%) had severe AKI. A further 54 (24%) were diagnosed with dengue haemorrhagic fever (DHF); 11 (5%) were co-infected with leptospirosis; thrombocytopenia was present in 157 (70%); and 64 (29%) were hypotensive. Patients were divided into either group A (with AKI) or group B (without AKI), and group A was divided into mild (A1), moderate (A2) and severe (A3) subgroups. We recorded: a higher total white count (A = 9824; B = 6706; P = 0.01); serum glutamic pyruvic transaminase (SGPT; A = 450; B = 144; P = 0.001); alkaline phosphatase (ALP) levels (A = 207; B = 42; P = 0.001); lower albumin (A = 2.65; B = 3.09; P < 0.001); and serum bicarbonate (A = 20.57; B = 23.21; P = 0.009). Hypotension (P = 0.01), coexisting viral hepatitis (P < 0.001), sepsis (P < 0.001), multiple organ dysfunction syndrome (MODS; P < 0.001) and the need for inotropes (P < 0.001) were associated with DF. Total white count (P = 0.038), glomerular filtration rate (GFR) on discharge (P = 0.034), specific gravity of urine (P = 0.006), ALP (P = 0.013), SGPT (P = 0.042), MODS (P = 0.05) and use of platelet fresh frozen plasma (FFP; P = 0.007) were significantly different between mild, moderate and severe AKI subgroups. Twenty-two (9%) died. AKI is associated with an increased mortality in DF (P = 0.005).

  19. Assessing the Risk of Crew Injury Due to Dynamic Loads During Spaceflight

    NASA Technical Reports Server (NTRS)

    Somers, J. T.; Gernhardt, M.; Newby, N.

    2014-01-01

    Spaceflight requires tremendous amounts of energy to achieve Earth orbit and to attain escape velocity for interplanetary missions. Although the majority of the energy is managed in such a way as to limit the accelerations on the crew, several mission phases may result in crew exposure to dynamic loads. In the automotive industry, risk of serious injury can be tolerated because the probability of a crash is remote each time a person enters a vehicle, resulting in a low total risk of injury. For spaceflight, the level of acceptable injury risk must be lower to achieve a low total risk of injury because the dynamic loads are expected on each flight. To mitigate the risk of injury due to dynamic loads, the NASA Human Research Program has developed a research plan to inform the knowledge gaps and develop relevant tools for assessing injury risk. The risk of injury due to dynamic loads can be further subdivided into extrinsic and intrinsic risk factors. Extrinsic risk factors include the vehicle dynamic profile, seat and restraint design, and spacesuit design. Human tolerance to loads varies considerably depending on the direction, amplitude, and rise-time of acceleration therefore the orientation of the body to the dynamic vector is critical to determining crew risk of injury. Although a particular vehicle dynamic profile may be safe for a particular design, the seat, restraint, and suit designs can affect the risk of injury due to localized effects. In addition, characteristics intrinsic to the crewmember may also contribute to the risk of injury, such as crewmember sex, age, anthropometry, and deconditioning due to spaceflight, and each astronaut may have a different risk profile because of these factors. The purpose of the research plan is to address any knowledge gaps in the risk factors to mitigate injury risk. Methods for assessing injury risk have been well documented in other analogous industries and include human volunteer testing, human exposure to dynamic

  20. 16 CFR 1211.4 - General requirements for protection against risk of injury.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... reference was approved by the Director of the Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR... intended to reduce the risk of fire, electric shock, or injury to persons, including entrapment...

  1. The risk of childhood injury on Boston's playground equipment and surfaces.

    PubMed Central

    Bond, M T; Peck, M G

    1993-01-01

    The Childhood Injury Prevention Program of the Boston Department of Health and Hospitals conducted a survey of injury risk in Boston's playgrounds. A standardized checklist was used to assess a 25% sample of public playgrounds for hazards. Climbers accounted for 34% of the hazards observed and had the greatest proportion of significant hazards. The surfacing material in 100% of the playgrounds observed was unsafe. Urban children risk exposure to hazardous playground equipment frequently situated above unsafe surfacing material. PMID:8484458

  2. Sleep quality and the risk of work injury: a Swiss case-control study.

    PubMed

    Uehli, Katrin; Miedinger, David; Bingisser, Roland; Dürr, Selina; Holsboer-Trachsler, Edith; Maier, Sabrina; Mehta, Amar J; Müller, Roland; Schindler, Christian; Zogg, Stefanie; Künzli, Nino; Leuppi, Jörg D

    2014-10-01

    Sleep problems are a well-known risk factor for work injuries, but less is known about which vulnerable populations are most at risk. The aims of this study were to investigate the association between sleep quality and the risk of work injury and to identify factors that may modify the association. A case-control study including 180 cases and 551 controls was conducted at the University Hospital in Basel, Switzerland, from 1 December 2009 to 30 June 2011. Data on work injuries and sleep quality were collected. Adjusted odds ratios and 95% confidence intervals of the association between sleep quality and work injury were estimated in multivariable logistic regression analyses and were stratified by hypothesized effect modifiers (age, gender, job risk, shift work, sleep duration and working hours). Poor sleep quality was associated significantly with work injury of any type (P < 0.05) and with being caught in particular (P < 0.05). The association between poor sleep quality and work injury was significantly higher for workers older than 30 years (odds ratio>30 1.30 versus odds ratio≤30 0.91, P < 0.01), sleeping 7 h or less per night (odds ratio≤7 1.17 versus odds ratio>7 0.79, P < 0.05) and working 50 h or more per week (odds ratio≥50 1.79 versus odd ratio<50 1.10, P < 0.01). Work injury risk increased with increasing severity of sleep problems (P < 0.05). Prior work injury frequency increased with decreasing sleep quality (P < 0.05). Older age, short sleep duration and long working hours may enhance the risk of work injuries associated with sleep quality.

  3. Biomechanical risk factors and mechanisms of knee injury in golfers.

    PubMed

    Marshall, Robert N; McNair, Peter J

    2013-09-01

    Knee injuries in golf comprise approximately 8% of all injuries, and are considered to result from overuse, technical faults or a combination of those factors. This review examines factors involved in injury, including the structure of the knee joint, kinematics and kinetics of the golf swing, forces sustained by knee joint structures and the potential for joint injury as well as injury prevention strategies. The golf swing generates forces and torques which tend to cause internal or external rotation of the tibia on the femur, and these are resisted by the knee ligaments and menisci. Research has shown that both maximum muscle forces and the forces sustained during a golf swing are less than that required to cause damage to the ligaments. However, the complex motion of the golf swing, involving both substantial forces and ranges of rotational movement, demands good technique if the player is to avoid injuring their knee joint. Most knee injury in golf is likely related to joint laxity, previous injuries or arthritis, and such damage may be exacerbated by problems in technique or overuse. In addition to appropriate coaching, strategies to remedy discomfort include specific exercise programmes, external bracing, orthotics and equipment choices.

  4. Biomechanical risk factors and mechanisms of knee injury in golfers.

    PubMed

    Marshall, Robert N; McNair, Peter J

    2013-09-01

    Knee injuries in golf comprise approximately 8% of all injuries, and are considered to result from overuse, technical faults or a combination of those factors. This review examines factors involved in injury, including the structure of the knee joint, kinematics and kinetics of the golf swing, forces sustained by knee joint structures and the potential for joint injury as well as injury prevention strategies. The golf swing generates forces and torques which tend to cause internal or external rotation of the tibia on the femur, and these are resisted by the knee ligaments and menisci. Research has shown that both maximum muscle forces and the forces sustained during a golf swing are less than that required to cause damage to the ligaments. However, the complex motion of the golf swing, involving both substantial forces and ranges of rotational movement, demands good technique if the player is to avoid injuring their knee joint. Most knee injury in golf is likely related to joint laxity, previous injuries or arthritis, and such damage may be exacerbated by problems in technique or overuse. In addition to appropriate coaching, strategies to remedy discomfort include specific exercise programmes, external bracing, orthotics and equipment choices. PMID:24245048

  5. Imaging chronic traumatic brain injury as a risk factor for neurodegeneration.

    PubMed

    Little, Deborah M; Geary, Elizabeth K; Moynihan, Michael; Alexander, Aristides; Pennington, Michelle; Glang, Patrick; Schulze, Evan T; Dretsch, Michael; Pacifico, Anthony; Davis, Matthew L; Stevens, Alan B; Huang, Jason H

    2014-06-01

    Population-based studies have supported the hypothesis that a positive history of traumatic brain injury (TBI) is associated with an increased incidence of neurological disease and psychiatric comorbidities, including chronic traumatic encephalopathy, Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis. These epidemiologic studies, however, do not offer a clear definition of that risk, and leave unanswered the bounding criteria for greater lifetime risk of neurodegeneration. Key factors that likely mediate the degree of risk of neurodegeneration include genetic factors, significant premorbid and comorbid medical history (e.g. depression, multiple head injuries and repetitive subconcussive impact to the brain, occupational risk, age at injury, and severity of brain injury). However, given the often-described concerns in self-report accuracy as it relates to history of multiple TBIs, low frequency of patient presentation to a physician in the case of mild brain injuries, and challenges with creating clear distinctions between injury severities, disentangling the true risk for neurodegeneration based solely on population-based studies will likely remain elusive. Given this reality, multiple modalities and approaches must be combined to characterize who are at risk so that appropriate interventions to alter progression of neurodegeneration can be evaluated. This article presents data from a study that highlights uses of neuroimaging and areas of needed research in the link between TBI and neurodegenerative disease.

  6. Biomechanical approaches to identify and quantify injury mechanisms and risk factors in women's artistic gymnastics.

    PubMed

    Bradshaw, Elizabeth J; Hume, Patria A

    2012-09-01

    Targeted injury prevention strategies, based on biomechanical analyses, have the potential to help reduce the incidence and severity of gymnastics injuries. This review outlines the potential benefits of biomechanics research to contribute to injury prevention strategies for women's artistic gymnastics by identification of mechanisms of injury and quantification of the effects of injury risk factors. One hundred and twenty-three articles were retained for review after searching electronic databases using key words, including 'gymnastic', 'biomech*', and 'inj*', and delimiting by language and relevance to the paper aim. Impact load can be measured biomechanically by the use of instrumented equipment (e.g. beatboard), instrumentation on the gymnast (accelerometers), or by landings on force plates. We need further information on injury mechanisms and risk factors in gymnastics and practical methods of monitoring training loads. We have not yet shown, beyond a theoretical approach, how biomechanical analysis of gymnastics can help reduce injury risk through injury prevention interventions. Given the high magnitude of impact load, both acute and accumulative, coaches should monitor impact loads per training session, taking into consideration training quality and quantity such as the control of rotation and the height from which the landings are executed. PMID:23072044

  7. Paralympic athletes' perceptions of their experiences of sports-related injuries, risk factors and preventive possibilities.

    PubMed

    Fagher, Kristina; Forsberg, Anna; Jacobsson, Jenny; Timpka, Toomas; Dahlström, Örjan; Lexell, Jan

    2016-11-01

    Our knowledge of sports-related injuries in para-sport is limited and there are no data on how Paralympic athletes themselves perceive an injury. The aim of this qualitative study was to explore Paralympic athletes' perceptions of their experiences of sports-related injuries, risk factors and preventive possibilities. Eighteen Swedish Paralympic athletes with vision impairment, intellectual impairment, spinal cord injury, cerebral palsy, myelomeningocele, dysplasia and neuromuscular disorder, representing 10 different para-sports, were interviewed. The qualitative phenomenographic method was used to interpret the data. The analysis revealed nine categories of perceptions of experiences. The athletes perceived that their impairments were involved in the cause and consequential chains associated with a sports-related injury. Other categories that denoted and described these injuries were: sport overuse, risk behaviour, functional limitations, psychological stressors, the normalised pain, health hazards, individual possibilities to prevent sports-related injuries and unequal prerequisites. This qualitative study revealed that Paralympic athletes' perceptions of their experiences of sports-related injuries are complex and multifactorial, and in several ways differ from able-bodied athletes. This needs to be considered in the sports health and safety work within the Paralympic Movement as well as in the design of future injury surveillance systems and preventive programmes.

  8. Motorcycle helmet use and the risk of head, neck, and fatal injury: Revisiting the Hurt Study.

    PubMed

    Rice, Thomas M; Troszak, Lara; Ouellet, James V; Erhardt, Taryn; Smith, Gordon S; Tsai, Bor-Wen

    2016-06-01

    Most studies find strong evidence that motorcycle helmets protect against injury, but a small number of controversial studies have reported a positive association between helmet use and neck injury. The most commonly cited paper is that of Goldstein (1986). Goldstein obtained and reanalyzed data from the Hurt Study, a prospective, on-scene investigation of 900 motorcycle collisions in the city of Los Angeles. The Goldstein results have been adopted by the anti-helmet community to justify resistance to compulsory motorcycle helmet use on the grounds that helmets may cause neck injuries due to their mass. In the current study, we replicated Goldstein's models to understand how he obtained his unexpected results, and we then applied modern statistical methods to estimate the association of motorcycle helmet use with head injury, fatal injury, and neck injury among collision-involved motorcyclists. We found Goldstein's analysis to be critically flawed due to improper data imputation, modeling of extremely sparse data, and misinterpretation of model coefficients. Our new analysis showed that motorcycle helmets were associated with markedly lower risk of head injury (RR 0.40, 95% CI 0.31-0.52) and fatal injury (RR 0.44, 95% CI 0.26-0.74) and with moderately lower but statistically significant risk of neck injury (RR 0.63, 95% CI 0.40-0.99), after controlling for multiple potential confounders. PMID:26998593

  9. Prehospital ACLS--does it work?

    PubMed

    Maheshwari, Alok; Mehrotra, Avanti; Gupta, Anoop K; Thakur, Ranjan K

    2002-11-01

    Cardiac disease is the most common cause of death in the United States, and sudden cardiac arrest frequently claims the lives of men and women during their most productive years. It is believed that much better survival rates can be achieved for victims of cardiac arrest through optimizing the "chain of survival" as described by the American Heart Association. The relative and incremental benefit of full prehospital ACLS over basic life support and defibrillation is unproven, however. This is an important issue in this era of cost containment. Some of the ongoing studies including the OPALS study may clarify the cost effectiveness and relative efficacy of rapid defibrillation and full ACLS programs for victims of prehospital cardiac arrest [6].

  10. Reliability and Validity of Observational Risk Screening in Evaluating Dynamic Knee Valgus

    PubMed Central

    Ekegren, Christina L.; Miller, William C.; Celebrini, Richard G.; Eng, Janice J.; MacIntyre, Donna L.

    2012-01-01

    Study Design Nonexperimental methodological study. Objectives To determine the interrater and intrarater reliability and validity of using observational risk screening guidelines to evaluate dynamic knee valgus. Background A deficiency in the neuromuscular control of the hip has been identified as a key risk factor for non-contact anterior cruciate ligament (ACL) injury in post pubescent females. This deficiency can manifest itself as a valgus knee alignment during tasks involving hip and knee flexion. There are currently no scientifically tested methods to screen for dynamic knee valgus in the clinic or on the field. Methods Three physiotherapists used observational risk screening guidelines to rate 40 adolescent female soccer players according to their risk of ACL injury. The rating was based on the amount of dynamic knee valgus observed on a drop jump landing. Ratings were evaluated for intrarater and interrater agreement using kappa coefficients. Sensitivity and specificity of ratings were evaluated by comparing observational ratings with measurements obtained using 3-dimensional (3D) motion analysis. Results Kappa coefficients for intrarater and interrater agreement ranged from 0.75 to 0.85, indicating that ratings were reasonably consistent over time and between physiotherapists. Sensitivity values were inadequate, ranging from 67–87%. This indicated that raters failed to detect up to a third of “truly high risk” individuals. Specificity values ranged from 60–72% which was considered adequate for the purposes of the screen. Conclusion Observational risk screening is a practical and cost-effective method of screening for ACL injury risk. Rater agreement and specificity were acceptable for this method but sensitivity was not. To detect a greater proportion of individuals at risk of ACL injury, coaches and clinicians should ensure that they include additional tests for other high risk characteristics in their screening protocols. PMID:19721212

  11. Mechanization, the labor process, and injury risks in the Canadian meat packing industry.

    PubMed

    Novek, J; Yassi, A; Spiegel, J

    1990-01-01

    During the 1980s, Canada's major manufacturing industries experienced considerable financial restructuring and technological transformation, largely in response to recessionary pressures. At the same time, the rate of lost-time injuries in Canadian manufacturing rose steadily. This article explores the relationship between these sets of factors. The meat packing industry has been selected as a case study of the interaction between industrial organization, the labor process, and the risk of workplace injuries. The authors suggest that the following factors have contributed to high and rising injury rates in the meat industry during the 1980s: consolidation into a smaller number of large, highly specialized, and mechanized plants; deteriorating labor relations in the face of falling profits; and an intensified labor process stressing line speedups and a growing risk of repetitive strain injuries. These observations are supported by a detailed analysis of the relationship between the labor process and workplace injuries at one packing plant considered typical for the industry.

  12. Comparison of injury mortality risk in motor vehicle crash versus other etiologies.

    PubMed

    Kilgo, Patrick D; Weaver, Ashley A; Barnard, Ryan T; Love, Timothy P; Stitzel, Joel D

    2014-06-01

    The mortality risk ratio (MRR), a measure of the proportion of people who died that sustained a given injury, is reported to be among the most powerful discriminators of mortality following trauma. The primary aim was to determine whether mechanistic differences exist and are quantifiable when comparing MRR-based injury severity across two broadly defined etiologies (motor vehicle crash (MVC) versus non-MVC) for the clarification of important injury types that have some room for improvement by emergency treatment and vehicle design. All International Classification of Diseases, 9th revision (ICD-9) coded injuries in the National Trauma Data Bank (NTDB) database were stratified into MVC and non-MVC groups and the MRR for each injury was computed within each group. Injuries were classified as 11 different types for MRR comparison between etiologies. Overall, MRRs for specific injuries were 10-18% lower for MVC compared to non-MVC etiologies. MVCs however produced much higher mean MRRs for crushing injuries (0.184 versus 0.072) and internal injuries to the thorax, abdomen, and pelvis (0.200 versus 0.169). Non-MVCs produced much higher MRRs for intracranial injuries (0.199 versus 0.250). Analysis of the top 95% most frequent MVC injuries revealed higher MVC MRR values for 78% of the injuries with MRR ratios indicating an average 50% increase in a given injury's MRR when MVC was the etiology. Addressing the large differences in MRR in between etiologies for identical injuries could provide a reduction in fatalities and may be important to patient triage and vehicle safety design. PMID:24646525

  13. Review and Meta-analysis of Emerging Risk Factors for Agricultural Injury.

    PubMed

    Jadhav, Rohan; Achutan, Chandran; Haynatzki, Gleb; Rajaram, Shireen; Rautiainen, Risto

    2016-01-01

    Agricultural injury is a significant public health problem globally. Extensive research has addressed this problem, and a growing number of risk factors have been reported. The authors evaluated the evidence for frequently reported risk factors earlier. The objective in the current study was to identify emerging risk factors for agricultural injury and calculate pooled estimates for factors that were assessed in two or more studies. A total of 441 (PubMed) and 285 (Google Scholar) studies were identified focusing on occupational injuries in agriculture. From these, 39 studies reported point estimates of risk factors for injury; 38 of them passed the Newcastle-Ottawa criteria for quality and were selected for the systematic review and meta-analysis. Several risk factors were significantly associated with injury in the meta-analysis. These included older age (vs. younger), education up to high school or higher (vs. lower), non-Caucasian race (vs. Caucasian), Finnish language (vs. Swedish), residence on-farm (vs. off-farm), sleeping less than 7-7.5 hours (vs. more), high perceived injury risk (vs. low), challenging social conditions (vs. normal), greater farm sales, size, income, and number of employees on the farm (vs. smaller), animal production (vs. other production), unsafe practices conducted (vs. not), computer use (vs. not), dermal exposure to pesticides and/or chemicals (vs. not), high cooperation between farms (vs. not), and machinery condition fair/poor (vs. excellent/good). Eighteen of the 25 risk factors were significant in the meta-analysis. The identified risk factors should be considered when designing interventions and selecting populations at high risk of injury.

  14. Review and Meta-analysis of Emerging Risk Factors for Agricultural Injury.

    PubMed

    Jadhav, Rohan; Achutan, Chandran; Haynatzki, Gleb; Rajaram, Shireen; Rautiainen, Risto

    2016-01-01

    Agricultural injury is a significant public health problem globally. Extensive research has addressed this problem, and a growing number of risk factors have been reported. The authors evaluated the evidence for frequently reported risk factors earlier. The objective in the current study was to identify emerging risk factors for agricultural injury and calculate pooled estimates for factors that were assessed in two or more studies. A total of 441 (PubMed) and 285 (Google Scholar) studies were identified focusing on occupational injuries in agriculture. From these, 39 studies reported point estimates of risk factors for injury; 38 of them passed the Newcastle-Ottawa criteria for quality and were selected for the systematic review and meta-analysis. Several risk factors were significantly associated with injury in the meta-analysis. These included older age (vs. younger), education up to high school or higher (vs. lower), non-Caucasian race (vs. Caucasian), Finnish language (vs. Swedish), residence on-farm (vs. off-farm), sleeping less than 7-7.5 hours (vs. more), high perceived injury risk (vs. low), challenging social conditions (vs. normal), greater farm sales, size, income, and number of employees on the farm (vs. smaller), animal production (vs. other production), unsafe practices conducted (vs. not), computer use (vs. not), dermal exposure to pesticides and/or chemicals (vs. not), high cooperation between farms (vs. not), and machinery condition fair/poor (vs. excellent/good). Eighteen of the 25 risk factors were significant in the meta-analysis. The identified risk factors should be considered when designing interventions and selecting populations at high risk of injury. PMID:27088816

  15. Risk taking in hospitalized patients with acute and severe traumatic brain injury.

    PubMed

    Fecteau, Shirley; Levasseur-Moreau, Jean; García-Molina, Alberto; Kumru, Hatiche; Vergara, Raúl Pelayo; Bernabeu, Monste; Roig, Teresa; Pascual-Leone, Alvaro; Tormos, José Maria

    2013-01-01

    Rehabilitation can improve cognitive deficits observed in patients with traumatic brain injury (TBI). However, despite rehabilitation, the ability of making a choice often remains impaired. Risk taking is a daily activity involving numerous cognitive processes subserved by a complex neural network. In this work we investigated risk taking using the Balloon Analogue Risk Task (BART) in patients with acute TBI and healthy controls. We hypothesized that individuals with TBI will take less risk at the BART as compared to healthy individuals. We also predicted that within the TBI group factors such as the number of days since the injury, severity of the injury, and sites of the lesion will play a role in risk taking as assessed with the BART. Main findings revealed that participants with TBI displayed abnormally cautious risk taking at the BART as compared to healthy subjects. Moreover, healthy individuals showed increased risk taking throughout the task which is in line with previous work. However, individuals with TBI did not show this increased risk taking during the task. We also investigated the influence of three patients' characteristics on their performance at the BART: Number of days post injury, Severity of the head injury, and Status of the frontal lobe. Results indicate that performance at the BART was influenced by the number of days post injury and the status of the frontal lobe, but not by the severity of the head injury. Reported findings are encouraging for risk taking seems to naturally improve with time postinjury. They support the need of conducting longitudinal prospective studies to ultimately identify impaired and intact cognitive skills that should be trained postinjury. PMID:24386232

  16. Effect of systematic ergonomic hazard identification and control implementation on musculoskeletal disorder and injury risk

    PubMed Central

    Cantley, Linda F; Taiwo, Oyebode A; Galusha, Deron; Barbour, Russell; Slade, Martin D; Tessier-Sherman, Baylah; Cullen, Mark R

    2014-01-01

    Objectives This study aimed to examine the effect of an ergonomic hazard control (HC) initiative, undertaken as part of a company ergonomics standard, on worker injury risk. Methods Using the company's ergonomic hazards database to identify jobs with and without ergonomic HC implementation and linking to individual job and injury histories, injury risk among person-jobs with HC implementation (the HC group) was compared to those without HC (NoHC group) using random coefficient models. Further analysis of the HC group was conducted to determine the effect of additional ergonomic hazards controlled on injury risk. Results Among 123jobs at 17 plant locations, 347 ergonomic hazards were quantitatively identified during the study period. HC were implemented for 204 quantified ergonomic hazards in 84 jobs, impacting 10 385 persons (12 967 person-jobs). No HC were implemented for quantified ergonomic hazards in the remaining 39 jobs affecting 4155 persons (5046 person-jobs). Adjusting for age, sex, plant origin, and year to control for any temporal trend in injury risk, the relative risk (RR) for musculoskeletal disorder (MSD) was 0.85 and the RR for any injury or MSD was 0.92 in the HC compared to NoHC group. Among the HC group, each ergonomic hazard controlled was associated with risk reduction for MSD and acute injury outcomes (RR 0.93). Conclusion Systematic ergonomic HC through participatory ergonomics, as part of a mandatory company ergonomics standard, is associated with MSD and injury risk reduction among workers in jobs with HC implemented. PMID:24142048

  17. Vehicle mass and injury risk in two-car crashes: A novel methodology.

    PubMed

    Tolouei, Reza; Maher, Mike; Titheridge, Helena

    2013-01-01

    This paper introduces a novel methodology based on disaggregate analysis of two-car crash data to estimate the partial effects of mass, through the velocity change, on absolute driver injury risk in each of the vehicles involved in the crash when absolute injury risk is defined as the probability of injury when the vehicle is involved in a two-car crash. The novel aspect of the introduced methodology is in providing a solution to the issue of lack of data on the speed of vehicles prior to the crash, which is required to calculate the velocity change, as well as a solution to the issue of lack of information on non-injury two-car crashes in national accident data. These issues have often led to focussing on relative measures of injury risk that are not independent of risk in the colliding cars. Furthermore, the introduced methodology is used to investigate whether there is any effect of vehicle size above and beyond that of mass ratio, and whether there are any effects associated with the gender and age of the drivers. The methodology was used to analyse two-car crashes to investigate the partial effects of vehicle mass and size on absolute driver injury risk. The results confirmed that in a two-car collision, vehicle mass has a protective effect on its own driver injury risk and an aggressive effect on the driver injury risk of the colliding vehicle. The results also confirmed that there is a protective effect of vehicle size above and beyond that of vehicle mass for frontal and front to side collisions.

  18. Fifteen Year Prospective Comparison of Patellar & Hamstring Tendon Grafts for ACL Reconstruction

    PubMed Central

    Roe, Justin; Salmon, Lucy; Kok, Alison; Linklater, James; Pinczewski, Leo

    2016-01-01

    Objective: This prospective longitudinal study compares isolated endoscopic ACL reconstruction utilizing 4-strand hamstring tendon (HT) or patellar tendon (PT) autograft over a 15-year period with respect to clinical outcomes and the development of osteoarthritis. Method: 90 consecutive patients with isolated ACL rupture were reconstructed with a PT autograft and 90 patients received HT autograft, with an identical surgical technique. Patients were assessed at 2, 5, 7, 10 and 15 years. Assessment included the IKDC Knee Ligament Evaluation including radiographic evaluation, KT1000, kneeling pain, and clinical outcomes. Results: Subjects who received the PT graft had significantly worse outcomes at 15 years for the variables of radiologically detectable osteoarthritis (p=0.001), motion loss (p=0.02), single leg hop test (p=0.002), participation in strenuous activity (p=0.03), knee related decrease in activity level (p=0.002) and kneeling pain (p=0.03). There was no significant difference between the HT and PT groups in overall IKDC grade (p=0.28). ACL graft rupture occurred in 16% of HT group and 8% of the PT group (p=0.10). Contralateral ACL rupture occurred in significantly more PT patients (24%) than HT patients (12%) (p=0.03). Conclusion: Significant differences have developed at 15 years after surgery which were not seen at earlier reviews. Compared to the HT Group, the PT group had significantly worse outcomes with respect to radiological osteoarthritis, range of motion and functional tests but no significant difference in laxity was identified. There was a high incidence of ACL injury after reconstruction, to both the reconstructed and the contralateral knee.

  19. Strength Asymmetry and Landing Mechanics at Return to Sport after ACL Reconstruction

    PubMed Central

    Schmitt, Laura C.; Paterno, Mark V.; Ford, Kevin R.; Myer, Gregory D.; Hewett, Timothy E.

    2014-01-01

    Purpose Evidence-based quadriceps femoris muscle (QF) strength guidelines for return to sport following anterior cruciate ligament (ACL) reconstruction are lacking. This study investigated the impact of QF strength asymmetry on knee landing biomechanics at the time of return to sport following ACL reconstruction. Methods Seventy-seven individuals (17.4 years) at the time of return to sport following primary ACL reconstruction (ACLR group) and 47 uninjured control individuals (17.0 years) (CTRL group) participated. QF strength was assessed and Quadriceps Index calculated (QI = [involved strength/uninvolved strength]*100%). The ACLR group was sub-divided based on QI: High Quadriceps (HQ, QI≥90%) and Low-Quadriceps (LQ, QI<85%). Knee kinematic and kinetic variables were collected during a drop vertical jump maneuver. Limb symmetry during landing, and discrete variables were compared among the groups with multivariate analysis of variance and linear regression analyses. Results The LQ group demonstrated worse asymmetry in all kinetic and ground reaction force variables compared to the HQ and CTRL groups, including reduced involved limb peak knee external flexion moments (p<.001), reduced involved limb (p=.003) and increased uninvolved limb (p=.005) peak vertical ground reaction forces, and higher uninvolved limb peak loading rates (p<.004). There were no differences in the landing patterns between the HQ and CTRL groups on any variable (p>.05). In the ACLR group, QF strength estimated limb symmetry during landing after controlling for graft type, meniscus injury, knee pain and symptoms. Conclusion At the time of return to sport, individuals post-ACL reconstruction with weaker QF demonstrate altered landing patterns. Conversely, those with nearly symmetrical QF strength demonstrate landing patterns similar to uninjured individuals. Consideration of an objective QF strength measure may aid clinical decision-making to optimize sports participation following ACL

  20. Magnetic Resonance Imaging of Cartilage Contact and Bound Water in ACL-Deficient and ACL Reconstructed Knees

    PubMed Central

    Baer, Geoffrey Scott; Kaiser, Jarred; Vignos, Michael; Liu, Fang; Smith, Colin Robert; Kijowski, Richard; Thelen, Darryl

    2016-01-01

    Objectives: Osteoarthritis (OA) is common following ACL-reconstructive (ACLR) surgery (6). The cause of early OA is not understood, but theories have focused on osteochondral damage at the time of injury (2) and abnormal joint mechanics following surgical repair (7). In this study, we investigate the inter-relationship of cartilage mechanics and biomarkers of OA in both ACL-deficient (ACLD) and ACLR knees. Our approach employs a novel dynamic MR sequence to measure joint mechanics (3) and the recently developed mcDESPOT to assess regional variations in water bound to proteoglycan (PG) (5). We hypothesize that bound water will be diminished in the cartilage of ACLD knees and, after surgery, will continue to adapt in a manner that reflects altered cartilage loading. This abstract presents initial observations on a cross-section of healthy, ACLD and ACLR knees. Methods: The dominant knees of 8 healthy controls, ACLD knees of 5 patients and ACLR knees of 8 patients were imaged in a 3 T MRI scanner (Table). Controls had no history of pain, injury, or surgery to their knee. Patients had no additional ligament injury and no meniscal damage. ACLD subjects were imaged prior to reconstructive surgery. Femoral and tibial cartilage were segmented from MR images and cartilage thickness was calculated. The mcDESPOT sequence provided a fraction map of water bound to PG (Fpg). Subjects flexed their knee against an inertial load at 0.5 Hz, while a SPGR-VIPR sequence continuously acquired volumetric data. Kinematics were obtained using model tracking of the dynamic images (3). Cartilage was registered to the bone segments for all frames, and contact patterns were characterized by the proximity between surfaces. Spatial representations of tibial cartilage contact, thickness and Fpg were co-registered for each subject. Results: Our initial images suggest lower Fpg values in ACLD knees, primarily on the posterior-lateral tibia. This is also observed in ACLR knees, with additional

  1. Assessing the relative risk of severe injury in automotive crashes for older female occupants.

    PubMed

    Hill, John D; Boyle, Linda Ng

    2006-01-01

    A logistic regression model was used in the prediction of injury severity for individuals who are involved in a vehicular crash. The model identified females and older occupants (segmented by age 55-74, and 75 and older) as having a significantly higher risk of severe injuries in a crash. Further, interactions of older females with other factors, such as occupant seat position, crash type, and environmental factors were also shown to significantly impact the relative risk of a severe injury. This study revealed that females 75 years and older had the lowest odds of injury among all female occupants studied (OR=1.16) while females between 55 and 74 years old have higher risk of severe injuries (OR=1.74). All older females (55 and older) were at greater risk for head-on, side-impact and rear-end collisions. Seatbelt use reduced severe injuries for females in this age group, but not to the same extent as the rest of the population studied. Additionally, crashes in severe weather, which were less likely to result in severe injuries for the general population, increased the risk of severe injuries to females that were 55 and older. Among occupants of light trucks, sport utility vehicles and vans, older females were less likely than others to be severely injured. In this case, older females appear better off in vehicles which are larger and protect better in severe crashes. This research demonstrates that circumstances surrounding a crash greatly impact the severity of injuries sustained by older female occupants.

  2. Proprioception in the ACL-ruptured knee: the contribution of the medial collateral ligament and patellar ligament. An in vivo experimental study in the cat.

    PubMed

    Bonsfills, N; Raygoza, J J; Boemo, E; Garrido, J; Núñez, A; Gómez-Barrena, E

    2007-01-01

    In the absence of anterior cruciate ligament (ACL), secondary restraints such as menisci, ligaments, and tendons restrict anterior knee laxity. Strain detection at these sites could define the contribution of this alternative signalling system to knee proprioception after ACL injury. The hypothesis in this study questions if measurements of anterior tibial translation (ATT) from surface strain gauges on the insertions of the medial collateral ligament (MCL) and the patellar tendon (PT) are sufficiently sensitive and specific to differentiate normal, stable knees from acutely unstable knees due to ACL section. Twelve cats received miniaturized strain gauges on the surface of MCL and PT distal insertions. A purpose-made receiver transformed into measurements any voltage variation obtained during passive knee flexion-extension and anterior tibial translation manoeuvres. Variables under evaluation included first peak latency, normalized amplitude, and slope of voltage along time. Femorotibial displacements were video recorded, digitized, and used as the ATT reference. The proposed system detected significant changes in the slope of the voltage/time signal, with higher specificity and sensitivity during ATT after experimental ACL section. Changes were not significant during flexion or extension. It was found that a pattern of earlier and more intense strain in MCL and PT distal insertions was found during ATT in the ACL deficient knee. Enhanced pattern recognition learning from these structures could be a future target for proprioceptive training after ACL injury.

  3. Injuries in women's basketball.

    PubMed

    Trojian, Thomas H; Ragle, Rosemary B

    2008-03-01

    Women's basketball has changed over time. It is a faster paced game than it was 30 years ago. Greatplayers, like Anne Meyers,who was the first, and only, woman to be signed to an NBA contract, would agree today's game is different. The game is played mostly "below the rim" but with players like Candice Parker, Sylvia Fowles and Maya Moore able to dunk the ball, the game is still changing. The one thing that remains constant in basketball, especially women's basketball, is injury. The majority of injuries in women's basketball are similar to those in men's basketball. Studies at the high school and college level show similar injury rates between women and men. ACL injuries are one exception, with female athletes having atwo to four times higher rate ofACL injuries. In this article, we review the common injuries in women's basketball. We discuss treatment issues and possible preventive measures.

  4. Safe system approach to reducing serious injury risk in motorcyclist collisions with fixed hazards.

    PubMed

    Bambach, M R; Mitchell, R J

    2015-01-01

    Collisions with fixed objects in the roadway environment account for a substantial proportion of motorcyclist fatalities. Many studies have identified individual roadway environment and/or motorcyclist characteristics that are associated with the severity of the injury outcome, including the presence of roadside barriers, helmet use, alcohol use and speeding. However, no studies have reported the cumulative benefit of such characteristics on motorcycling safety. The safe system approach recognises that the system must work as a whole to reduce the net injury risk to road users to an acceptable level, including the four system cornerstone areas of roadways, speeds, vehicles and people. The aim of the present paper is to consider these cornerstone areas concomitantly, and quantitatively assess the serious injury risk of motorcyclists in fixed object collisions using this holistic approach. A total of 1006 Australian and 15,727 (weighted) United States motorcyclist-fixed object collisions were collected retrospectively, and the serious injury risks associated with roadside barriers, helmet use, alcohol use and speeding were assessed both individually and concomitantly. The results indicate that if safety efforts are made in each of the safe system cornerstone areas, the combined effect is to substantially reduce the serious injury risk of fixed hazards to motorcyclists. The holistic approach is shown to reduce the serious injury risk considerably more than each of the safety efforts considered individually. These results promote the use of a safe system approach to motorcycling safety. PMID:24974348

  5. Preterm birth and unintentional injuries: risks to children, adolescents and young adults show no consistent pattern

    PubMed Central

    Calling, Susanna; Palmér, Karolina; Jönsson, Lena; Sundquist, Jan; Winkleby, Marilyn; Sundquist, Kristina

    2012-01-01

    Aim Preterm birth is associated with a number of physical and mental health issues. The aim of this study was to find out if there was also any association between individuals born preterm in Sweden between 1984 and 2006 and the risk of unintentional injuries during childhood, adolescence and young adulthood. Methods The study followed 2,297,134 individuals, including 5.9% born preterm, from 1985 to 2007 for unintentional injuries leading to hospitalisation or death (n=244,021). The males and females were divided into four age groups: 1–5 years, 6–12 years, 13–18 years and 19–23 years. Hazard ratios were calculated for falls, transport injuries and other injuries. Results After adjusting for a comprehensive set of covariates, some of the preterm subgroups demonstrated slightly increased risks of unintentional injuries, while others showed slightly decreased risks. However, most of the estimates were borderline or non-significant in both males and females. In addition, the absolute risk differences between individuals born preterm and full term were small. Conclusion Despite the association between preterm birth and a variety of physical and mental health consequences, this study shows that there is no consistent risk pattern between preterm birth and unintentional injuries in childhood, adolescence and young adulthood. PMID:23181809

  6. Safe system approach to reducing serious injury risk in motorcyclist collisions with fixed hazards.

    PubMed

    Bambach, M R; Mitchell, R J

    2015-01-01

    Collisions with fixed objects in the roadway environment account for a substantial proportion of motorcyclist fatalities. Many studies have identified individual roadway environment and/or motorcyclist characteristics that are associated with the severity of the injury outcome, including the presence of roadside barriers, helmet use, alcohol use and speeding. However, no studies have reported the cumulative benefit of such characteristics on motorcycling safety. The safe system approach recognises that the system must work as a whole to reduce the net injury risk to road users to an acceptable level, including the four system cornerstone areas of roadways, speeds, vehicles and people. The aim of the present paper is to consider these cornerstone areas concomitantly, and quantitatively assess the serious injury risk of motorcyclists in fixed object collisions using this holistic approach. A total of 1006 Australian and 15,727 (weighted) United States motorcyclist-fixed object collisions were collected retrospectively, and the serious injury risks associated with roadside barriers, helmet use, alcohol use and speeding were assessed both individually and concomitantly. The results indicate that if safety efforts are made in each of the safe system cornerstone areas, the combined effect is to substantially reduce the serious injury risk of fixed hazards to motorcyclists. The holistic approach is shown to reduce the serious injury risk considerably more than each of the safety efforts considered individually. These results promote the use of a safe system approach to motorcycling safety.

  7. Anterior cruciate ligament injuries in snowboarders: a quadriceps-induced injury.

    PubMed

    Davies, Hywel; Tietjens, Barry; Van Sterkenburg, Maayke; Mehgan, Andrew

    2009-09-01

    Anterior cruciate ligament (ACL) injuries in snowboarders are rare. However, in expert boarders landing big jumps, ACL injuries are occurring more frequently. We identified 35 snowboarders with an identical injury mechanism. All these patients were landing from a jump. All described a flat landing on a flexed knee with significant knee compression. In 31 of 35 boarders, it was the front knee that was injured. Only two riders felt there was any twisting component to their injury. We postulate that the ACL rupture is due to maximal eccentric quadriceps contraction, as the boarder resists a compressive landing. Internal tibial rotation of the front knee in the snowboarding stance results in preloading of the ACL predisposing to injury.

  8. ACL repair might induce further abnormality of gamma loop in the intact side of the quadriceps femoris.

    PubMed

    Konishi, Y U

    2011-04-01

    The purpose of this study was to investigate the effect of surgery on the gamma-loop in the quadriceps of patients with ACL injuries. We compared the response to vibration stimulation in subjects with ACL repair, subjects with ACL rupture, and normal subjects, by measuring the maximal strength and integrated electromyography (I-EMG) of the quadriceps. Pre-vibration data were obtained from each subject by measuring the MVC of the knee extension and the I-EMG from the vastus medialis, vastus lateralis, and rectus femoris. Vibration stimulation was applied to the infrapatellar tendon, followed immediately by repeating maximal strength and I-EMG recording. The results of this study indicated that alpha motor neuron activity of the intact side of the vastus lateralis in response to prolonged vibration stimulation was altered by surgery, but no effect was detected in the injured side. The results could suggest that abnormality of the gamma-loop existed even in the quadriceps of patients with ACL rupture since the vibration stimulus failed to elicit changes in ACL-rupture group as compared with those of normal subjects. In comparison, abnormality of the gamma-loop in the intact side of the QF was probably induced by the rupture, and further abnormality of gamma-loop was induced by surgery.

  9. Should critical care nurses be ACLS-trained?

    PubMed

    Hagyard-Wiebe, Tammy

    2007-01-01

    The aim of resuscitation is to sustain life with intact neurological functioning and the same quality of life previously experienced by the patient. Advanced cardiac life support (ACLS) was designed to achieve this aim. However the requirement for ACLS training for critical care nurses working in Canadian critical care units is inconsistent across the country. The purposes of this article are to explore the evidence surrounding ACLS training for critical care nurses and its impact on resuscitation outcomes, and to review the evidence surrounding ACLS knowledge and skill degradation with strategies to support code blue team efficiency for an effective resuscitation. Using the search terms ACLS training, resuscitation, critical care, and nursing, two databases, CINAHL and MEDLINE, were used. The evidence supports the need for ACLS training for critical care nurses. The evidence also supports organized ongoing refresher courses, multidisciplinary mock code blue practice using technologically advanced simulator mannequins, and videotaped reviews to prevent knowledge and skill degradation for effective resuscitation efforts.

  10. A Case-Crossover Study of Heat Exposure and Injury Risk in Outdoor Agricultural Workers

    PubMed Central

    Bonauto, David K.; Sheppard, Lianne; Busch-Isaksen, Tania; Calkins, Miriam; Adams, Darrin; Lieblich, Max; Fenske, Richard A.

    2016-01-01

    Background Recent research suggests that heat exposure may increase the risk of traumatic injuries. Published heat-related epidemiological studies have relied upon exposure data from individual weather stations. Objective To evaluate the association between heat exposure and traumatic injuries in outdoor agricultural workers exposed to ambient heat and internal heat generated by physical activity using modeled ambient exposure data. Methods A case-crossover study using time-stratified referent selection among 12,213 outdoor agricultural workers with new Washington State Fund workers’ compensation traumatic injury claims between 2000 and 2012 was conducted. Maximum daily Humidex exposures, derived from modeled meteorological data, were assigned to latitudes and longitudes of injury locations on injury and referent dates. Conditional logistic regression was used to estimate odds ratios of injury for a priori daily maximum Humidex categories. Results The mean of within-stratum (injury day and corresponding referent days) standard deviations of daily maximum Humidex was 4.8. The traumatic injury odds ratio was 1.14 (95% confidence interval 1.06, 1.22), 1.15 (95% confidence interval 1.06, 1.25), and 1.10 (95% confidence interval 1.01, 1.20) for daily maximum Humidex of 25–29, 30–33, and ≥34, respectively, compared to < 25, adjusted for self-reported duration of employment. Stronger associations were observed during cherry harvest duties in the June and July time period, compared to all duties over the entire study period. Conclusions Agricultural workers laboring in warm conditions are at risk for heat-related traumatic injuries. Combined heat-related illness and injury prevention efforts should be considered in high-risk populations exposed to warm ambient conditions in the setting of physical exertion. PMID:27716794

  11. Leg Power As an Indicator of Risk of Injury or Illness in Police Recruits

    PubMed Central

    Orr, Robin; Pope, Rodney; Peterson, Samantha; Hinton, Benjamin; Stierli, Michael

    2016-01-01

    Tactical trainees, like those entering the police force, are required to undergo vigorous training as part of their occupational preparation. This training has the potential to cause injuries. In addition, the physical training, communal living and pressures of tactical training are known to induce immune suppression and have the potential to increase the risk of illness. The aim of this study was to investigate the relationship between leg power, as measured by a vertical jump (VJ), and rates of reported injuries and illnesses during police recruit training. Retrospective data from recruits (n = 1021) undergoing basic police recruit training at an Australian Police Force College was collected. Recruits completed a VJ assessment at the commencement of their second state of training. Formally reported illness and injuries were collected 12 weeks later, following completion of training. Correlations between VJ height and rates of reported illness and injury were low (r = −0.16 and −0.09, respectively) but significant (p < 0.005), with VJ height accounting for 2.6% and 0.8% of the variance in illness and injury rates, respectively. In terms of relative risks, recruits with the lowest recorded VJ heights were more than three times as likely as those with highest VJ heights to suffer injury and/or illness. Police recruits with lower VJ height are at a significantly greater risk of suffering an injury or illness during police basic recruit training. PMID:26907311

  12. Leg Power As an Indicator of Risk of Injury or Illness in Police Recruits.

    PubMed

    Orr, Robin; Pope, Rodney; Peterson, Samantha; Hinton, Benjamin; Stierli, Michael

    2016-02-19

    Tactical trainees, like those entering the police force, are required to undergo vigorous training as part of their occupational preparation. This training has the potential to cause injuries. In addition, the physical training, communal living and pressures of tactical training are known to induce immune suppression and have the potential to increase the risk of illness. The aim of this study was to investigate the relationship between leg power, as measured by a vertical jump (VJ), and rates of reported injuries and illnesses during police recruit training. Retrospective data from recruits (n = 1021) undergoing basic police recruit training at an Australian Police Force College was collected. Recruits completed a VJ assessment at the commencement of their second state of training. Formally reported illness and injuries were collected 12 weeks later, following completion of training. Correlations between VJ height and rates of reported illness and injury were low (r = -0.16 and -0.09, respectively) but significant (p < 0.005), with VJ height accounting for 2.6% and 0.8% of the variance in illness and injury rates, respectively. In terms of relative risks, recruits with the lowest recorded VJ heights were more than three times as likely as those with highest VJ heights to suffer injury and/or illness. Police recruits with lower VJ height are at a significantly greater risk of suffering an injury or illness during police basic recruit training.

  13. Risk of venous thromboembolism in patients with splenic injury and splenectomy. A nationwide cohort study.

    PubMed

    Lin, Jiun-Nong; Chen, Hsuan-Ju; Lin, Ming-Chia; Lai, Chung-Hsu; Lin, Hsi-Hsun; Yang, Chih-Hui; Kao, Chia-Hung

    2016-01-01

    The spleen is a crucial organ in humans. However, little is known about the association of venous thromboembolism (VTE) with splenic injury and splenectomy in trauma patients. The aim of this study was to determine the subsequent risk of VTE following splenic injury and splenectomy. A nationwide retrospective cohort study was conducted by analysing data from the National Health Insurance Research Database in Taiwan. We included 6,162 splenic injury patients (3,033 splenectomised and 3,129 nonsplenectomised patients) and 24,648 comparison patients who were selected by frequency match based on sex, age, and the index year during 2000-2006. All patients were followed until the occurrence of VTE, 31 December, 2011, death, or withdrawal from the insurance program. The age of patients with splenic injury was 41.93 ± 16.44 years. The incidence rates of VTE were 11.81, 8.46, and 5.21 per 10,000 person-years in the splenic injury patients with splenectomy, splenic injury patients without splenectomy, and comparison patients, respectively. Compared with the comparison cohort, splenic injury patients with splenectomy exhibited a 2.21-fold risk of VTE (95% confidence interval [CI], 1.43-3.43), whereas those without splenectomy exhibited a 1.71-fold risk of VTE (95% CI, 1.05-2.80). The overall incidence rate of VTE was 1.97-fold higher in the splenic injury cohort than the comparison cohort (95% CI, 1.38-2.81). Although splenectomy increased the risk of VTE 1.35-fold compared with no splenectomy, the difference was not statistically significant (95% CI, 0.74-2.45). These results may alert physicians and patients to the complications of splenic injury and splenectomy.

  14. Risk factors associated with the severity of injury outcome for paediatric road trauma.

    PubMed

    Mitchell, R J; Bambach, M R; Foster, K; Curtis, K

    2015-05-01

    Road trauma is one of the most common causes of injury for children. Yet risk factors associated with different levels of injury severity for childhood road trauma have not been examined in-depth. This study identifies crash and injury risk factors associated with the severity of non-fatal injury outcome for paediatric road trauma. A retrospective analysis was conducted of paediatric road trauma identified in linked police-reported and hospitalisation records during 1 January 2001 to 31 December 2011 in New South Wales (NSW), Australia. The linkage rate was 54%. Injury severity was calculated from diagnosis classifications in hospital records using the International Classification of Disease Injury Severity Score. Univariate and multi-variable logistic regression was conducted. There were 2412 car occupants, 1701 pedestrians and 612 pedal cyclists hospitalised where their hospital record linked to a police report. For car occupants, unauthorised vehicle drivers had twice the odds (OR: 2.21, 95%CI 1.47-3.34) and learner/provisional drivers had one and a half times higher odds (OR: 1.54, 95%CI 1.15-2.07) of a child car occupant sustaining a serious injury compared to a minor injury. For pedal cyclists and pedestrians, there were lower odds of a crash occurring during school commuting time and higher odds of a crash occurring during the weekend or on a dry road for children who sustained a serious versus a minor injury. Injury prevention initiatives, such as restraint and helmet use, that should reduce injury and/or crash severity are advocated.

  15. The association between traumatic brain injury and suicide: are kids at risk?

    PubMed

    Richard, Yvonne F; Swaine, Bonnie R; Sylvestre, Marie-Pierre; Lesage, Alain; Zhang, Xun; Feldman, Debbie Ehrmann

    2015-07-15

    Traumatic brain injury (TBI) in late adolescence and adulthood is associated with a higher risk of suicide; however, it is unknown whether this association is also present in people who sustained a TBI during childhood. The purpose of the present study was to determine whether experiencing a TBI during childhood is a risk factor for suicide later in life and to examine whether the risk of suicide differs by sex or injury severity. A cohort of 135,703 children aged 0-17 years was identified from the Quebec population-based physician reimbursement database in 1987, and follow-up was conducted until 2008. Of the children in this cohort, 21,047 had sustained a TBI. Using a survival analysis with time-dependent indicators of TBI, we found a higher risk of suicide for people who sustained a TBI during childhood (hazard ratio (HR) = 1.49, 95% confidence interval (CI): 1.04, 2.14), adolescence (HR = 1.57, 95% CI: 1.09, 2.26), and adulthood (HR = 2.53, 95% CI: 1.79, 3.59). When compared with less severe injuries, such as concussions and cranial fractures, more severe injuries, such as intracranial hemorrhages, were associated with a higher risk of suicide (HR = 2.18 vs. 2.77, respectively). Repeated injuries were associated with higher risks of suicide in all age groups. PMID:26121988

  16. The association between traumatic brain injury and suicide: are kids at risk?

    PubMed

    Richard, Yvonne F; Swaine, Bonnie R; Sylvestre, Marie-Pierre; Lesage, Alain; Zhang, Xun; Feldman, Debbie Ehrmann

    2015-07-15

    Traumatic brain injury (TBI) in late adolescence and adulthood is associated with a higher risk of suicide; however, it is unknown whether this association is also present in people who sustained a TBI during childhood. The purpose of the present study was to determine whether experiencing a TBI during childhood is a risk factor for suicide later in life and to examine whether the risk of suicide differs by sex or injury severity. A cohort of 135,703 children aged 0-17 years was identified from the Quebec population-based physician reimbursement database in 1987, and follow-up was conducted until 2008. Of the children in this cohort, 21,047 had sustained a TBI. Using a survival analysis with time-dependent indicators of TBI, we found a higher risk of suicide for people who sustained a TBI during childhood (hazard ratio (HR) = 1.49, 95% confidence interval (CI): 1.04, 2.14), adolescence (HR = 1.57, 95% CI: 1.09, 2.26), and adulthood (HR = 2.53, 95% CI: 1.79, 3.59). When compared with less severe injuries, such as concussions and cranial fractures, more severe injuries, such as intracranial hemorrhages, were associated with a higher risk of suicide (HR = 2.18 vs. 2.77, respectively). Repeated injuries were associated with higher risks of suicide in all age groups.

  17. The Association Between Traumatic Brain Injury and Suicide: Are Kids at Risk?

    PubMed Central

    Richard, Yvonne F.; Swaine, Bonnie R.; Sylvestre, Marie-Pierre; Lesage, Alain; Zhang, Xun; Feldman, Debbie Ehrmann

    2015-01-01

    Traumatic brain injury (TBI) in late adolescence and adulthood is associated with a higher risk of suicide; however, it is unknown whether this association is also present in people who sustained a TBI during childhood. The purpose of the present study was to determine whether experiencing a TBI during childhood is a risk factor for suicide later in life and to examine whether the risk of suicide differs by sex or injury severity. A cohort of 135,703 children aged 0–17 years was identified from the Quebec population-based physician reimbursement database in 1987, and follow-up was conducted until 2008. Of the children in this cohort, 21,047 had sustained a TBI. Using a survival analysis with time-dependent indicators of TBI, we found a higher risk of suicide for people who sustained a TBI during childhood (hazard ratio (HR) = 1.49, 95% confidence interval (CI): 1.04, 2.14), adolescence (HR = 1.57, 95% CI: 1.09, 2.26), and adulthood (HR = 2.53, 95% CI: 1.79, 3.59). When compared with less severe injuries, such as concussions and cranial fractures, more severe injuries, such as intracranial hemorrhages, were associated with a higher risk of suicide (HR = 2.18 vs. 2.77, respectively). Repeated injuries were associated with higher risks of suicide in all age groups. PMID:26121988

  18. Decreased Lubricin Concentrations and Markers of Joint Inflammation in Synovial Fluids from Patients with Anterior Cruciate Ligament Injury

    PubMed Central

    Elsaid, KA; Fleming, BC; Oksendahl, HL; Machan, JT; Fadale, PD; Hulstyn, MJ; Shalvoy, R; Jay, GD

    2009-01-01

    Objective To study the effect of anterior cruciate ligament (ACL) injury on lubricin concentration in synovial fluid (SF) and its correlation with time post-injury, inflammatory cytokines, lubricin degrading enzymes, and SF proteoglycan content. Methods SF samples were obtained from both knees of 30 patients with a unilateral ACL insufficiency 32–364 days post-injury. Lubricin, inflammatory cytokines [interleukin-1 beta (IL-1β), tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6)] and catabolic enzymes [procathepsin-B and neutrophil elastase (NE)] were quantified in the SF of injured and contralateral (uninjured) joints using ELISAs. Sulfated glycosaminoglycans (sGAG) levels in SF were measured by Alcian blue binding assay. Results SF lubricin concentrations were significantly (p<0.001) reduced following ACL injury when compared to the contralateral joint. Within 12-months, the lubricin concentration of the injured knee (slope=0..006, SE=0.00010, p<0.001) approached that of the contralateral knee, which did not change with time (slope=−0.0002, SE=0.00050, p=0.71). TNF-α levels showed a significant negative relationship with log2 lubricin levels. IL-1β, TNF-α, IL-6, procathepsin-B and NE concentrations in injured SF were greater in samples whose injuries were recent compared to those that were chronic. There were no detectable cytokines or enzymes in SF of contralateral joints. sGAG concentrations were significantly (p<0.01) higher in injured SF compared to contralateral joints. Conclusions The decrease in SF lubricin concentrations following ACL injury may place the joint at an increased risk of wear-induced damage, as a consequence of lack of boundary lubrication, potentially leading to secondary osteoarthritis. The decrease in SF lubricin was associated with elevation of inflammatory cytokines. PMID:18512776

  19. A case-crossover study of transient risk factors for occupational acute hand injury

    PubMed Central

    Sorock, G; Lombardi, D; Hauser, R; Eisen, E; Herrick, R; Mittleman, M

    2004-01-01

    Background: Workers with acute hand injuries account for over 1 000 000 emergency department visits annually in the United States. Aims: To determine potential transient risk factors for occupational acute hand injury. Methods: Subjects were recruited from 23 occupational health clinics in five northeastern states in the USA. In a telephone interview, subjects were asked to report the occurrence of seven potential risk factors within a 90-minute time period before an acute hand injury. Each case also provided control information on exposures during the month before the injury. The self-matched feature of the study design controlled for stable between-person confounders. Results: A total of 1166 subjects were interviewed (891 men, 275 women), with a mean age (SD) of 37.2 years (11.4). The median time interval between injury and interview was 1.3 days. Sixty three per cent of subjects had a laceration. The relative risk of a hand injury was increased when working with equipment, tools, or work pieces not performing as expected (11.0, 95% CI 9.4 to 12.8), or when using a different work method to do a task (10.5, 95% CI 8.7 to 12.7). Other transient factors in decreasing order of relative risk were doing an unusual task, being distracted, and being rushed. Wearing gloves reduced the relative risk by 60% (0.4, 95% CI 0.3 to 0.5). Occupational category, job experience, and safety training were found to alter several of these effects. Conclusion: The results suggest the importance of these transient, potentially modifiable factors in the aetiology of acute hand injury at work. Attempts to modify these exposures by various strategies may reduce the incidence of acute hand injury at work. PMID:15031387

  20. Home injury risks to young children in Karachi, Pakistan: a pilot study

    PubMed Central

    Khan, Uzma Rahim; Chandran, Aruna; Zia, Nukhba; Huang, Cheng-Ming; De Ramirez, Sarah Stewart; Feroze, Asher; Hyder, Adnan Ali; Razzak, Junaid Abdul

    2015-01-01

    Objective To pilot an in-home unintentional injury hazard assessment tool and to quantify potential injury risks for young children in a low-income urban setting. Methods Two low-income neighbourhoods in Karachi, Pakistan, were mapped, and families with at least one child between the ages of 12 and 59 months were identified. Using existing available home injury risk information, an in-home injury risk assessment tool was drafted and tailored to the local setting. Home injury assessments were done in June–July 2010 after obtaining informed consent. Results Approximately 75.4% of mothers were educated through at least grade 12. The main risks identified were stoves within the reach of the child (n=279, 55.5%), presence of open buckets in the bathroom (n=240, 47.7%) within the reach of the child, and pedestal fans accessible to the child (n=242, 48.1%). In terms of safety equipment, a first-aid box with any basic item was present in 70% of households, but only 4.8% of households had a fire extinguisher in the kitchen. Conclusions This was the first time that an in-home, all-unintentional injury risk assessment tool was tailored and applied in the context of a low-income community in Pakistan. There was a significant burden of hazards present in the homes in these communities, representing an important opportunity for injury prevention. This pilot may have future relevance to other LMICs where child injury prevention is a critical need. PMID:23995075

  1. Farm Work-Related Injuries and Risk Factors in South Korean Agriculture.

    PubMed

    Kim, Hyocher; Räsänen, Kimmo; Chae, Hyeseon; Kim, Kyungsu; Kim, Kyungran; Lee, Kyungsuk

    2016-01-01

    Agriculture is known to be a risk-filled industry in South Korea, as it is worldwide. The aims of this study were to identify the magnitude of farm work-related injuries and evaluate the association between injury and possible risk factors. Farmers, including farm members (N = 16,160), were surveyed. After excluding 7 subjects with missing data in questions about injury, 16,153 farmer responses were used for the analysis. Of the 16,153 farmers, 3.6% answered having at least one farm work-related injury requiring outpatient treatment or hospitalization during 2012. The proportion of injured men (4.3%) was 1.5 times higher than women (2.9%). From an age perspective, the proportion was 1.3% of those aged 49 or below, 2.7% of those aged 50-59, 4.2% of those aged 60-69, 4.2% of those aged 70-79, and 3.1% of those aged 80 or above. We used a multivariate logistic regression analysis with a stepwise model (forward) for risk factors (gender, age, farm ownership, farm type, work years in agriculture, work months during 2012, night work experience, and work experience under the influence of alcohol). The increased risk of farm work-related injuries significantly remained associated with age, farm ownership, and experience of night work. Further studies should be conducted to consistently identify injury characteristics, especially for old farmers, considering the crop cultivation in Asian countries. PMID:27428880

  2. Incident-level risk factors for firefighter injuries at structural fires.

    PubMed

    Fabio, Anthony; Ta, Myduc; Strotmeyer, Stephen; Li, Wei; Schmidt, Eric

    2002-11-01

    Firefighting is a demanding occupation, laden with hazardous exposures which result in traumatic injuries. Little epidemiologic evidence exists quantifying these factors, however. We conducted an incident-level case-control study of National Fire Incident Reporting System data of the association between firefighter injury and incident characteristics. Risk factors included 5 or more alarms (OR = 3.85; 95% CI, 3.32-4.48), number of stories (> 3 vs. ground level OR = 2.49; 95% CI, 1.43 to 1.55), and at least one civilian injury (OR = 3.69; 95% CI, 3.55-3.84). Risk of injury was reduced for fires originating 49 feet and higher (OR = 0.57; 95% CI, 0.49-0.66). This analysis suggests that fireground-specific situations such as the number of stories or a civilian injury increase the risk of injury. Given the danger of firefighting, the identification of risk factors through epidemiologic methods is vital to developing safety measures. PMID:12448357

  3. Combined effects of TNF-α, IL-1β, and HIF-1α on MMP-2 production in ACL fibroblasts under mechanical stretch: an in vitro study.

    PubMed

    Wang, Yequan; Tang, Zhenyu; Xue, Ruyue; Singh, Gurinder K; Shi, Kunning; Lv, Yonggang; Yang, Li

    2011-07-01

    The dynamics between inflammatory factors, mechanical stress, and healing factors, in an intra-articular joint, are very complex after injury. Injury to intra-articular tissue [anterior cruciate ligament (ACL), synovium] results in hypoxia, accumulation of various pro-inflammatory factors, cytokines, and metalloproteases. Although the presence of increased amounts of matrix-metalloproteinases (MMP) in the joint fluid after knee injury is considered the key factor for ACL poor healing ability; however, the exact role of collective participants of the joint fluid on MMP-2 activity and production has not been fully studied yet. To investigate the combined effects of mechanical injury, inflammation and hypoxia induced factor-1α (HIF-1α) on induction of MMP-2; we mimicked the microenvironment of joint cavity after ACL injury. The results show that TNF-α and IL-1β elevate the activity of MMP-2 in a dose- and time-dependent manner. In addition, mechanical stretch further enhances the MMP-2 protein levels with TNF-α, IL-1β, and their mixture. CoCl(2) -induced HIF-1α (100 and 500 µM) also increases the levels and activity of MMP-2. Mechanical stretch has a strong additional effect on MMP-2 production with HIF-1α. Our results conclude that mechanical injury, HIF-1α and inflammatory factors collectively induce increased MMP-2 production in ACL fibroblasts, which was inhibited by NF-κB pathway inhibitor (Bay-11-7082).

  4. Risk Factors for Physical Injury Among Help-Seeking Battered Women

    PubMed Central

    Mechanic, Mindy B.; Weaver, Terri L.; Resick, Patricia A.

    2010-01-01

    Physical injuries among battered women represent risks for both acute and long-term physical health functioning. The current study assessed the nature and extent of minor and severe injuries among a help-seeking sample of battered women. Hierarchical regression analyses were conducted to assess the unique roles of physical violence, sexual coercion, psychological abuse, and stalking to the prediction of minor and severe injuries in battered women. Not unexpectedly, length of relationship abuse and severity of physical aggression were the most robust predictors of minor and severe physical injuries. Consistent with other research findings, psychological abuse and stalking, as a block, contributed uniquely to the prediction of severe injuries. Results are discussed in terms of implications for future research and intervention with battered women. PMID:18757347

  5. Management of ventricular fibrillation or unstable ventricular tachycardia in patients with congenital long-QT syndrome: a suggested modification to ACLS guidelines.

    PubMed

    Homme, Jason H; White, Roger D; Ackerman, Michael J

    2003-10-01

    Prolongation of the QT interval is a known risk factor for syncope, seizures and sudden cardiac death. Most patients with QT prolongation have an acquired cause, but congenital forms of QT prolongation are being increasingly recognized. However, existing advanced cardiac life support (ACLS) treatment algorithms for prolonged QT mediated ventricular fibrillation pertains to acquired long-QT syndrome (LQTS). Here, a young patient with out-of-hospital cardiac arrest secondary to congenital LQTS illustrates critical exceptions to the current ACLS treatment algorithms for ventricular fibrillation and unstable ventricular tachycardia when QT prolongation is congenital in origin. A clarified ACLS algorithm is proposed.

  6. Adolescent development and risk of injury: Using developmental science to improve interventions

    PubMed Central

    Johnson, Sara B.; Jones, Vanya C.

    2015-01-01

    In adolescence, there is a complex interaction among physical, cognitive, and psychosocial developmental processes, culminating in greater risk-taking and novelty-seeking. Concurrently, adolescents face an increasingly demanding environment, which results in heightened vulnerability to injury. In this paper, we provide an overview of developmental considerations for adolescent injury interventions based on developmental science including findings from behavioral neuroscience and psychology. We examine the role that typical developmental processes play in the way adolescents perceive and respond to risk and how this integrated body of developmental research adds to our understanding of how to do injury prevention with adolescents. We then highlight strategies to improve the translation of developmental research into adolescent injury prevention practice, calling on examples of existing interventions including graduated driver licensing. PMID:20876765

  7. Reducing the risk for injury while traveling for Thanksgiving holidays.

    PubMed

    2001-11-16

    Each year in the United States, motor-vehicle crashes result in approximately 40,000 deaths and 3.2 million nonfatal injuries. In 2000 during the Thanksgiving holiday, motor-vehicle crashes killed approximately 500 persons (US Department of Transportation, National Highway Traffic Safety Administration, unpublished data, 2000), and resulted in >43,000 hospital emergency department visits.

  8. Mapping cyclist activity and injury risk in a network combining smartphone GPS data and bicycle counts.

    PubMed

    Strauss, Jillian; Miranda-Moreno, Luis F; Morency, Patrick

    2015-10-01

    In recent years, the modal share of cycling has been growing in North American cities. With the increase of cycling, the need of bicycle infrastructure and road safety concerns have also raised. Bicycle flows are an essential component in safety analysis. The main objective of this work is to propose a methodology to estimate and map bicycle volumes and cyclist injury risk throughout the entire network of road segments and intersections on the island of Montreal, achieved by combining smartphone GPS traces and count data. In recent years, methods have been proposed to estimate average annual daily bicycle (AADB) volume and injury risk estimates at both the intersection and segment levels using bicycle counts. However, these works have been limited to small samples of locations for which count data is available. In this work, a methodology is proposed to combine short- and long-term bicycle counts with GPS data to estimate AADB volumes along segments and intersections in the entire network. As part of the validation process, correlation is observed between AADB values obtained from GPS data and AADB values from count data, with R-squared values of 0.7 for signalized intersections, 0.58 for non-signalized intersections and between 0.48 and 0.76 for segments with and without bicycle infrastructure. The methodology is also validated through the calibration of safety performance functions using both sources of AADB estimates, from counts and from GPS data. Using the validated AADB estimates, the factors associated with injury risk were identified using data from the entire population of intersections and segments throughout Montreal. Bayesian injury risk maps are then generated and the concentrations of expected injuries and risk at signalized intersections are identified. Signalized intersections, which are often located at the intersection of major arterials, witness 4 times more injuries and 2.5 times greater risk than non-signalized intersections. A similar

  9. Mapping cyclist activity and injury risk in a network combining smartphone GPS data and bicycle counts.

    PubMed

    Strauss, Jillian; Miranda-Moreno, Luis F; Morency, Patrick

    2015-10-01

    In recent years, the modal share of cycling has been growing in North American cities. With the increase of cycling, the need of bicycle infrastructure and road safety concerns have also raised. Bicycle flows are an essential component in safety analysis. The main objective of this work is to propose a methodology to estimate and map bicycle volumes and cyclist injury risk throughout the entire network of road segments and intersections on the island of Montreal, achieved by combining smartphone GPS traces and count data. In recent years, methods have been proposed to estimate average annual daily bicycle (AADB) volume and injury risk estimates at both the intersection and segment levels using bicycle counts. However, these works have been limited to small samples of locations for which count data is available. In this work, a methodology is proposed to combine short- and long-term bicycle counts with GPS data to estimate AADB volumes along segments and intersections in the entire network. As part of the validation process, correlation is observed between AADB values obtained from GPS data and AADB values from count data, with R-squared values of 0.7 for signalized intersections, 0.58 for non-signalized intersections and between 0.48 and 0.76 for segments with and without bicycle infrastructure. The methodology is also validated through the calibration of safety performance functions using both sources of AADB estimates, from counts and from GPS data. Using the validated AADB estimates, the factors associated with injury risk were identified using data from the entire population of intersections and segments throughout Montreal. Bayesian injury risk maps are then generated and the concentrations of expected injuries and risk at signalized intersections are identified. Signalized intersections, which are often located at the intersection of major arterials, witness 4 times more injuries and 2.5 times greater risk than non-signalized intersections. A similar

  10. Acute Vs Delayed ACL Reconstruction. Early Differences and Preliminary Two Year Results

    PubMed Central

    Eriksson, Karl; Barenius, Björn

    2016-01-01

    Objectives: Historically acute ACL reconstruction has been avoided due to reports of early rehabilitation problems with stiffness. Are these reports still valid today with modern arthroscopic techniques? Methods: 70 patients with a high recreational activity level (Tegner ≥6) who presented with a acute ACL injury were randomized to an acute reconstruction within 8 days from the injury or delayed reconstruction after 6-10 weeks. Four surgeons performed the ACL reconstructions with quadrupled semitendinosus tendon grafts and endobutton and metallic interference screw fixation. The rehabilitation training was performed at the same physiotherapy center for all patients. The follow up at 6 and 24 months included ROM, Lachman, Rolimeter, pivot shift, one leg hop, IKDC, KOOS, Lysholm and Tegner activity level. Results: There were no differences between the groups in ROM, IKDC, activity level or laxity at 6 months. Four patients had a combined extension and flexion deficit of more than 15 degrees, two from each group. In the acute group 79% had an objective IKDC grade A or B compared with 73% in the delayed group. The one leg hop index above 90% was found in 50% in the acute group and 24% in the delayed group (p=0.04). Functional data for the 2-year follow up are not available at the time of abstract writing. The median activity level according to Tegner was restored to pre-injury levels in both groups after one year, and was stationary at 2 years. The visual analogue scale (VAS) response to the question “How is your knee working on a scale from 0-100? (100 = best)” revealed 81 in the acute and 71 in the delayed group (p=0.1). To the question “How does your knee affect your activity level on a scale from 0-100? (100 = no affection)” the mean score was 75 in the acute group and 67 in the delayed group (p=0.3). At one and two years the KOOS was statistically similar between the groups but with slightly higher subscale “Sport and recreation” scores, 85 in the

  11. Musculoskeletal injuries and pain in dancers: a systematic review update.

    PubMed

    Jacobs, Craig L; Hincapié, Cesar A; Cassidy, J David

    2012-01-01

    The objective of this study was to assemble and synthesize the best available literature from 2004 to 2008 on musculoskeletal injury and pain in dancers. MEDLINE and CINAHL were the primary sources of data. Indexed terms such as dance, dancer, dancing, athletic injuries, occupational injuries, sprains and strains, musculoskeletal diseases, bone density, menstruation disturbances, and eating disorders were used to search the databases. Citations were screened for relevance using a priori criteria, and relevant studies were critically reviewed for scientific merit by the best-evidence synthesis method. After screening, 19 articles were found to be scientifically admissible. Data from accepted studies were abstracted into evidence tables relating to: prevalence and associated factors; incidence and risk factors; intervention; and injury characteristics and prognosis of musculoskeletal injury and pain in dancers. Principal findings included: a high prevalence and incidence of lower extremity, hip and back injuries; preliminary evidence that psychosocial and psychological issues such as stress and coping strategies affect injury frequency and duration; history of a previous lateral ankle sprain is associated with an increased risk of ankle sprain in the contralateral ankle in dance students; fatigue may play a role in ACL injury in dancers; acute hamstring strains in dancers affect tendon more than muscle tissue, often resulting in prolonged absence from dance. It is concluded that, while there are positive developments in the literature on the epidemiology, diagnosis, prognosis, treatment, and prevention of MSK injuries and pain in dancers, much room for improvement remains. Suggestions for future research are offered.

  12. Child Pedestrian Injury: A Review of Behavioral Risks and Preventive Strategies

    PubMed Central

    Schwebel, David C.; Davis, Aaron L.; O’Neal, Elizabeth E.

    2011-01-01

    Pedestrian injury is among the leading causes of pediatric death in the United States and much of the world. This paper is divided into two sections. First, we review the literature on behavioral risk factors for child injury. Cognitive and perceptual development risks are discussed. The roles of distraction, temperament and personality, and social influences from parents and peers are presented. We conclude the first section with brief reviews of environmental risks, pedestrian safety among special populations, and the role of sleep and fatigue on pediatric pedestrian safety. The second section of the review considers child pedestrian injury prevention strategies. Categorized by mode of presentation, we discuss parent instruction strategies, school-based instruction strategies (including crossing guards), and streetside training techniques. Technology-based training strategies using video, internet, and virtual reality are reviewed. We conclude the section on prevention with discussion of community-based interventions. PMID:23066380

  13. Arterial Stiffness: A Novel Risk Factor for Kidney Injury Progression?

    PubMed

    Georgianos, Panagiotis I; Sarafidis, Pantelis A; Liakopoulos, Vassilios

    2015-08-01

    Arterial stiffness is typical feature of vascular remodeling in chronic kidney disease (CKD). Increased arterial stiffness raises flow and pressure pulsatility and is considered the principle pathogenic mechanism of isolated systolic hypertension, left ventricular hypertrophy, and congestive heart failure. Apart from the impact of arterial stiffness on left ventricular afterload, downstream transmission of pressure pulsatility to the level of microcirculation is suggested to promote injury of other susceptible organs. This may be of particular importance for kidney injury progression, since passive renal perfusion along with low resistance and input impedance in renal microvessels make kidneys particularly vulnerable to the damaging effect of systemic pulsatile pressure. Recent studies have provided evidence that arterial stiffness culminates in elevated pulsatility and resistance in renal microvasculature, promoting structural damage of small intra-renal arterioles. Further, prospective observational studies have shown that reduced aortic compliance is closely associated with the annual rate of renal function decline and represents independent predictor of kidney injury progression to end-stage renal disease among patients with CKD. This article provides insights into the cross-talk between macrocirculation and renal microcirculation and summarizes the currently available clinical evidence linking increased arterial stiffness with kidney disease progression.

  14. Mode of Vaginal Delivery: A Modifiable Intrapartum Risk Factor for Obstetric Anal Sphincter Injury

    PubMed Central

    Simó González, Marta; Porta Roda, Oriol; Perelló Capó, Josep; Gich Saladich, Ignasi; Calaf Alsina, Joaquim

    2015-01-01

    The aim of this study was to analyze the comparative risks of this anal sphincter injury in relation to the type of intervention in vaginal delivery. We performed an observational, retrospective study of all vaginal deliveries attended at a tertiary university hospital between January 2006 and December 2009. We analyzed the incidence of obstetric anal sphincter injury for each mode of vaginal delivery: spontaneous delivery, vacuum, Thierry spatulas, and forceps. We determined the proportional incidence between methods taking spontaneous delivery as the reference. Ninety-seven of 4526 (2.14%) women included in the study presented obstetric anal sphincter injury. Instrumental deliveries showed a significantly higher risk of anal sphincter injury (2.7 to 4.9%) than spontaneous deliveries (1.1%). The highest incidence was for Thierry spatulas (OR 4.804), followed by forceps (OR 4.089) and vacuum extraction (OR 2.509). The type of intervention in a vaginal delivery is a modifiable intrapartum risk factor for obstetric anal sphincter injury. Tearing can occur in any type of delivery but proportions vary significantly. All healthcare professionals attending childbirth should be aware of the risk for each type of intervention and consider these together with the obstetric factors in each case. PMID:25722727

  15. Assessment of the Impacts of ACLS on the ISS Life Support System Using Dynamic Simulations in V-HAB

    NASA Technical Reports Server (NTRS)

    Putz, Daniel; Olthoff, Claas; Ewert, Michael; Anderson, Molly

    2016-01-01

    The Advanced Closed Loop System (ACLS) is currently under development by Airbus Defense and Space and is slated for launch to the International Space Station (ISS) in 2017. The addition of new hardware into an already complex system such as the ISS life support system (LSS) always poses operational risks. It is therefore important to understand the impacts ACLS will have on the existing systems to ensure smooth operations for the ISS. This analysis can be done by using dynamic computer simulations and one possible tool for such a simulation is the Virtual Habitat (V-HAB). Based on MATLAB, V-HAB has been under development at the Institute of Astronautics of the Technical University of Munich (TUM) since 2004 and in the past has been successfully used to simulate the ISS life support systems. The existing V-HAB ISS simulation model treated the interior volume of the space station as one large, ideally-stirred container. This model was improved to allow the calculation of the atmospheric composition inside individual modules of the ISS by splitting it into twelve distinct volumes. The virtual volumes are connected by a simulation of the inter-module ventilation flows. This allows for a combined simulation of the LSS hardware and the atmospheric composition aboard the ISS. A dynamic model of ACLS is added to the ISS Simulation and several different operating modes for both ACLS and the existing ISS life support systems are studied and the impacts of ACLS on the rest of the system are determined. The results suggest that the US, Russian and ACLS CO2 systems can operate at the same time without impeding each other. Furthermore, based on the results of this analysis, the US and ACLS Sabatier systems can be operated in parallel as well to a achieve a very low CO2 concentration in the cabin atmosphere.

  16. Assessment of the Impacts of ACLS on the ISS Life Support System using Dynamic Simulations in V-HAB

    NASA Technical Reports Server (NTRS)

    Puetz, Daniel; Olthoff, Claas; Ewert, Michael K.; Anderson, Molly S.

    2016-01-01

    The Advanced Closed Loop System (ACLS) is currently under development by Airbus Defense and Space and is slated for launch to the International Space Station (ISS) in 2017. The addition of new hardware into an already complex system such as the ISS life support system (LSS) always poses operational risks. It is therefore important to understand the impacts ACLS will have on the existing systems to ensure smooth operations for the ISS. This analysis can be done by using dynamic computer simulations and one possible tool for such a simulation is Virtual Habitat (V-HAB). Based on Matlab (Registered Trademark) V-HAB has been under development at the Institute of Astronautics of the Technical University Munich (TUM) since 2006 and in the past has been successfully used to simulate the ISS life support systems. The existing V-HAB ISS simulation model treated the interior volume of the space station as one large ideally-stirred container. This model was improved to allow the calculation of the atmospheric composition inside the individual modules of the ISS by splitting it into ten distinct volumes. The virtual volumes are connected by a simulation of the inter-module ventilation flows. This allows for a combined simulation of the LSS hardware and the atmospheric composition aboard the ISS. A dynamic model of ACLS is added to the ISS simulation and different operating modes for both ACLS and the existing ISS life support systems are studied to determine the impacts of ACLS on the rest of the system. The results suggest that the US, Russian and ACLS CO2 systems can operate at the same time without impeding each other. Furthermore, based on the results of this analysis, the US and ACLS Sabatier systems can be operated in parallel as well to achieve the highest possible CO2 recycling together with a low CO2 concentration.

  17. Injury Risk for Children in Rear Impacts: Role of the Front Seat Occupant

    PubMed Central

    Jermakian, Jessica Steps; Arbogast, Kristy B.; Durbin, Dennis R.; Kallan, Michael J.

    2008-01-01

    As more children move to the rear rows, there is a need to understand the rear impact environment for children to guide future regulatory and due care activities in this impact direction. A probability sample of 1,035 restrained child occupants, aged 0–12 years, seated in a second row outboard position in rear impact tow-away crashes, weighted to represent 10,079 children, was collected from an on-going child specific crash surveillance system between 3/1/00 and 12/31/06. These data were analyzed to quantify the overall injury risk and the influence of both front seat occupant presence and reported front seat back deformation on injury risk. Overall risk of AIS 2+ injury for restrained child occupants seated in the rear row outboard position in rear impact crashes was 2.3%. Occupants were seated in front of these children in 71% of cases and deformation of the front seat back into the child’s space was reported in 8% of cases. For those children with seatback deformation occurring directly in front of them, there was a doubling of the injury risk (4.8% vs. 2.1%, adjusted OR=2.4, 95% CI=1.2–4.8). This paper provides the first population-based estimates of the injury risk of rear row-seated children in rear impact crash events and points to the importance of understanding the role of front seat back design on rear impact injury risk for both the front seat and rear seat occupants. PMID:19026228

  18. Injury risk for children in rear impacts: role of the front seat occupant.

    PubMed

    Jermakian, Jessica Steps; Arbogast, Kristy B; Durbin, Dennis R; Kallan, Michael J

    2008-10-01

    As more children move to the rear rows, there is a need to understand the rear impact environment for children to guide future regulatory and due care activities in this impact direction. A probability sample of 1,035 restrained child occupants, aged 0-12 years, seated in a second row outboard position in rear impact tow-away crashes, weighted to represent 10,079 children, was collected from an on-going child specific crash surveillance system between 3/1/00 and 12/31/06. These data were analyzed to quantify the overall injury risk and the influence of both front seat occupant presence and reported front seat back deformation on injury risk. Overall risk of AIS 2+ injury for restrained child occupants seated in the rear row outboard position in rear impact crashes was 2.3%. Occupants were seated in front of these children in 71% of cases and deformation of the front seat back into the child's space was reported in 8% of cases. For those children with seatback deformation occurring directly in front of them, there was a doubling of the injury risk (4.8% vs. 2.1%, adjusted OR=2.4, 95% CI=1.2-4.8). This paper provides the first population-based estimates of the injury risk of rear row-seated children in rear impact crash events and points to the importance of understanding the role of front seat back design on rear impact injury risk for both the front seat and rear seat occupants. PMID:19026228

  19. Cyclist activity and injury risk analysis at signalized intersections: a Bayesian modelling approach.

    PubMed

    Strauss, Jillian; Miranda-Moreno, Luis F; Morency, Patrick

    2013-10-01

    This study proposes a two-equation Bayesian modelling approach to simultaneously study cyclist injury occurrence and bicycle activity at signalized intersections as joint outcomes. This approach deals with the potential presence of endogeneity and unobserved heterogeneities and is used to identify factors associated with both cyclist injuries and volumes. Its application to identify high-risk corridors is also illustrated. Montreal, Quebec, Canada is the application environment, using an extensive inventory of a large sample of signalized intersections containing disaggregate motor-vehicle traffic volumes and bicycle flows, geometric design, traffic control and built environment characteristics in the vicinity of the intersections. Cyclist injury data for the period of 2003-2008 is used in this study. Also, manual bicycle counts were standardized using temporal and weather adjustment factors to obtain average annual daily volumes. Results confirm and quantify the effects of both bicycle and motor-vehicle flows on cyclist injury occurrence. Accordingly, more cyclists at an intersection translate into more cyclist injuries but lower injury rates due to the non-linear association between bicycle volume and injury occurrence. Furthermore, the results emphasize the importance of turning motor-vehicle movements. The presence of bus stops and total crosswalk length increase cyclist injury occurrence whereas the presence of a raised median has the opposite effect. Bicycle activity through intersections was found to increase as employment, number of metro stations, land use mix, area of commercial land use type, length of bicycle facilities and the presence of schools within 50-800 m of the intersection increase. Intersections with three approaches are expected to have fewer cyclists than those with four. Using Bayesian analysis, expected injury frequency and injury rates were estimated for each intersection and used to rank corridors. Corridors with high bicycle volumes

  20. Childhood and adolescent injuries in elementary schools in north-western Uganda: extent, risk and associated factors.

    PubMed

    Mutto, Milton; Lawoko, Stephen; Ovuga, Emilio; Svanstrom, Leif

    2012-01-01

    Childhood injuries remain understudied in Uganda. The objective of this study was to determine the extent, nature and determinants of school-related childhood injury risk in north-western Uganda. A cohort of 1000 grade fives from 13 elementary schools was followed-up for one term. Survival and multi-level modelling techniques compared the risk rates across gender, schools and locations. Childhood injuries are common in north-western Uganda. Most of them occur during travel, breaks, practical classes and gardening, while walking, playing, learning and digging. Most injuries result from collisions with objects, sports and falls. Two-thirds of children receive first aid and hospital care. Times to injury were 72.1 and 192.9 person days (p = 0.0000). Gender differences in time to event were significant (p = 0.0091). Girls had better survival rates: cumulative prevalence of childhood injury was 36.1%; with significant gender differences (p = 0.007). Injury rate was 12.3/1000 person days, with a hazard ratio of 1.4. Compared to girls, boys had a 37% higher injury rate (p = 0.004). Rates varied among schools. Associated factors include sex and school. Rural-urban location and school differences do influence childhood injury risk. Childhood injuries are common: the risk is high, gender- and school-specific. Determinants include gender and school. Location and school contexts influence injury risk.

  1. Perceived key injury risk factors in World Cup alpine ski racing—an explorative qualitative study with expert stakeholders

    PubMed Central

    Spörri, Jörg; Kröll, Josef; Amesberger, Günter; Blake, Ollie M; Müller, Erich

    2012-01-01

    Background There is limited knowledge about key injury risk factors in alpine ski racing, particularly for World Cup (WC) athletes. Objective This study was undertaken to compile and explore perceived intrinsic and extrinsic risk factors for severe injuries in WC alpine ski racing. Methods Qualitative study. Interviews were conducted with 61 expert stakeholders of the WC ski racing community. Experts’ statements were collected, paraphrased and loaded into a database with inductively derived risk factor categories (Risk Factor Analysis). At the end of the interviews, experts were asked to name those risk factors they believed to have a high potential impact on injury risk and to rank them according to their priority of impact (Risk Factor Rating). Results In total, 32 perceived risk factors categories were derived from the interviews within the basic categories Athlete, Course, Equipment and Snow. Regarding their perceived impact on injury risk, the experts’ top five categories were: system ski, binding, plate and boot; changing snow conditions; physical aspects of the athletes; speed and course setting aspects and speed in general. Conclusions Severe injuries in WC alpine ski racing can have various causes. This study compiled a list of perceived intrinsic and extrinsic risk factors and explored those factors with the highest believed impact on injury risk. Hence, by using more detailed hypotheses derived from this explorative study, further studies should verify the plausibility of these factors as true risk factors for severe injuries in WC alpine ski racing. PMID:22872684

  2. Dose - response relationship between noise exposure and the risk of occupational injury.

    PubMed

    Yoon, Jin-Ha; Hong, Jeong-Suk; Roh, Jaehoon; Kim, Chi-Nyon; Won, Jong-Uk

    2015-01-01

    Many workers worldwide experience fatality and disability caused by occupational injuries. This study examined the relationship between noise exposure and occupational injuries at factories in Korea. A total of 1790 factories located in northern Gyeonggi Province, Korea was evaluated. The time-weighted average levels of dust and noise exposure were taken from Workplace Exposure Assessment data. Apart occupational injuries, sports events, traffic accidents, and other accidents occurring outside workplaces were excluded. The incidences of occupational injury in each factory were calculated by data from the Korea Workers' Compensation and Welfare Services. Workplaces were classified according to the incidence of any occupational injuries (incident or nonincident workplaces, respectively). Workplace dust exposure was classified as <1 or ≥ 1 mg/m³ , and noise exposure as <80, 80-89, or >90 dB. Workplaces with high noise exposure were significantly associated with being incident workplaces, whereas workplaces with high dust exposure were not. The odds ratios (95% confidence intervals) derived from a logistic regression model were 1.68 (1.27-2.24) and 3.42 (2.26-5.17) at 80-89 dB and ≥ 90 dB versus <80 dB. These associations remained significant when in a separate analysis according to high or low dust exposure level. Noise exposure increases the risk of occupational injury in the workplace. Furthermore, the risk of occupational injury increases with noise exposure level in a dose-response relationship. Therefore, strategies for reducing noise exposure level are required to decrease the risk of occupational injury.

  3. The Risk of Transphyseal Drilling in Skeletally Immature Patients With Anterior Cruciate Ligament Injury

    PubMed Central

    Faunø, Peter; Rømer, Lone; Nielsen, Torsten; Lind, Martin

    2016-01-01

    Background: Anterior cruciate ligament reconstruction (ACLR) in skeletally immature patients can result in growth plate injury, which can cause growth disturbances. Purpose: To evaluate radiological tibial and femoral length and axis growth disturbances as well as clinical outcomes in skeletally immature ACLR patients treated with a transphyseal drilling technique. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 39 pediatric patients with ACL injury and open physes at time of surgery, as diagnosed clinically and with magnetic resonance imaging (MRI), were treated using transphyseal ACLR using hamstring graft. Mean patient age was 11.7 years (range, 9.0-14.0 years). Patients were evaluated with full extremity radiographs measuring leg length discrepancy and malalignment, as well as clinical evaluation with KT-1000 arthrometer measurements and Tegner activity scale and Knee injury and Osteoarthritis Outcome Score (KOOS) outcomes after follow-up of 68 months (range, 29-148 months). Results: Of the 39 initial patients, 33 were evaluated both clinically and radiographically. We found a mean femoral length shortening of 3.5 mm (P = .01) on the operated leg. Eight patients (24%) had a more than 10-mm shortening of the operated leg, whereas only 1 patient (3%) had a 10-mm shortening of the nonoperated leg. In 27 of 33 patients (82%; P < .001), the anatomic femoral axes of the operated leg were found to be more than 2° of valgus compared with the nonoperated leg. The tibial anatomic axes changed into a less pronounced varus angulation (P = .02). The femoral-tibial anatomic axes were not significantly different when comparing the 2 legs. We did not find any statistical difference in growth arrest comparing patients treated surgically at the ages of 13 to 14 years to patients younger than 13 years. Tegner and KOOS scores were significantly lower among girls compared with boys. Side-to-side KT-1000 arthrometer difference improved from 5.2 mm

  4. The Risk of Transphyseal Drilling in Skeletally Immature Patients With Anterior Cruciate Ligament Injury

    PubMed Central

    Faunø, Peter; Rømer, Lone; Nielsen, Torsten; Lind, Martin

    2016-01-01

    Background: Anterior cruciate ligament reconstruction (ACLR) in skeletally immature patients can result in growth plate injury, which can cause growth disturbances. Purpose: To evaluate radiological tibial and femoral length and axis growth disturbances as well as clinical outcomes in skeletally immature ACLR patients treated with a transphyseal drilling technique. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 39 pediatric patients with ACL injury and open physes at time of surgery, as diagnosed clinically and with magnetic resonance imaging (MRI), were treated using transphyseal ACLR using hamstring graft. Mean patient age was 11.7 years (range, 9.0-14.0 years). Patients were evaluated with full extremity radiographs measuring leg length discrepancy and malalignment, as well as clinical evaluation with KT-1000 arthrometer measurements and Tegner activity scale and Knee injury and Osteoarthritis Outcome Score (KOOS) outcomes after follow-up of 68 months (range, 29-148 months). Results: Of the 39 initial patients, 33 were evaluated both clinically and radiographically. We found a mean femoral length shortening of 3.5 mm (P = .01) on the operated leg. Eight patients (24%) had a more than 10-mm shortening of the operated leg, whereas only 1 patient (3%) had a 10-mm shortening of the nonoperated leg. In 27 of 33 patients (82%; P < .001), the anatomic femoral axes of the operated leg were found to be more than 2° of valgus compared with the nonoperated leg. The tibial anatomic axes changed into a less pronounced varus angulation (P = .02). The femoral-tibial anatomic axes were not significantly different when comparing the 2 legs. We did not find any statistical difference in growth arrest comparing patients treated surgically at the ages of 13 to 14 years to patients younger than 13 years. Tegner and KOOS scores were significantly lower among girls compared with boys. Side-to-side KT-1000 arthrometer difference improved from 5.2 mm

  5. Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: Risk factors and management

    PubMed Central

    Shaikh, Nissar; Rhaman, M. A.; Raza, Ali; Shabana, Adel; Malstrom, Mahommad Faisal; Al-Sulaiti, Ghanem

    2016-01-01

    Background: High spinal cord injury (HSCI) is one of the devastating traumatic injuries. 80% of these patients are young male, and 93% will have major neurological disabilities. There is a paucity of literature about prolonged bradycardia in HSCI patients. The aim of this study was to know the prevalence, risk factors, precipitating factors for prolonged bradycardia in the HSCI patients. Materials and Methods: All patients who were admitted to the Intensive Care Unit (ICU) of a tertiary hospital, with spinal cord injury above level of dorsal (D4) were enrolled in this study prospectively. Patient's demographic data, mechanism, level and type of spinal injury, associated injuries, injury severity score (ISS), spinal shock, vasopressors used, time of occurrence of bradycardia, treatment for bradycardia, precipitating as well as risk factors and outcome were recorded. Results: During the study period, a total of 138 patients were admitted to the ICU with HSCI. Majority of patients were male. The most frequently associated injury in these patients was skeletal fractures (38.4%). Most common complication was pneumonia 56 (41%). Forty-five (33%) of the total patients had prolonged bradycardia; 87% of these patients had pneumonia when bradycardia occurred. 53.4% had cardiac asystole. 29 (21%) patients had bradycardia at the time of endotracheal suctioning, whereas 27 (20%) patients developed bradycardia at the time of positioning. Majority of the patients were managed conservatively. Those HSCI patients who developed prolonged bradycardia, their ISS score was statistically higher, ICU and hospital stay was significantly higher compared with those HSCI patient who did not have prolonged bradycardia. Multivariate analysis revealed that hypotension on admission; pneumonia, and tracheostomy were risk factors for the development of prolonged bradycardia in HSCI patients. Conclusion: Prolonged bradycardia was associated with significantly higher incidence of asystole

  6. Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: Risk factors and management

    PubMed Central

    Shaikh, Nissar; Rhaman, M. A.; Raza, Ali; Shabana, Adel; Malstrom, Mahommad Faisal; Al-Sulaiti, Ghanem

    2016-01-01

    Background: High spinal cord injury (HSCI) is one of the devastating traumatic injuries. 80% of these patients are young male, and 93% will have major neurological disabilities. There is a paucity of literature about prolonged bradycardia in HSCI patients. The aim of this study was to know the prevalence, risk factors, precipitating factors for prolonged bradycardia in the HSCI patients. Materials and Methods: All patients who were admitted to the Intensive Care Unit (ICU) of a tertiary hospital, with spinal cord injury above level of dorsal (D4) were enrolled in this study prospectively. Patient's demographic data, mechanism, level and type of spinal injury, associated injuries, injury severity score (ISS), spinal shock, vasopressors used, time of occurrence of bradycardia, treatment for bradycardia, precipitating as well as risk factors and outcome were recorded. Results: During the study period, a total of 138 patients were admitted to the ICU with HSCI. Majority of patients were male. The most frequently associated injury in these patients was skeletal fractures (38.4%). Most common complication was pneumonia 56 (41%). Forty-five (33%) of the total patients had prolonged bradycardia; 87% of these patients had pneumonia when bradycardia occurred. 53.4% had cardiac asystole. 29 (21%) patients had bradycardia at the time of endotracheal suctioning, whereas 27 (20%) patients developed bradycardia at the time of positioning. Majority of the patients were managed conservatively. Those HSCI patients who developed prolonged bradycardia, their ISS score was statistically higher, ICU and hospital stay was significantly higher compared with those HSCI patient who did not have prolonged bradycardia. Multivariate analysis revealed that hypotension on admission; pneumonia, and tracheostomy were risk factors for the development of prolonged bradycardia in HSCI patients. Conclusion: Prolonged bradycardia was associated with significantly higher incidence of asystole

  7. Anatomic ACL reconstruction: rectangular tunnel/bone-patellar tendon-bone or triple-bundle/semitendinosus tendon grafting.

    PubMed

    Shino, Konsei; Mae, Tatsuo; Tachibana, Yuta

    2015-05-01

    Anatomic ACL reconstruction is the reasonable approach to restore stability without loss of motion after ACL tear. To mimic the normal ACL like a ribbon, our preferred procedures is the anatomic rectangular tunnel (ART) technique with a bone-patellar tendon-bone (BTB) graft or the anatomic triple bundle (ATB) procedure with a hamstring (HS) tendon graft. It is important to create tunnel apertures inside the attachment areas to lessen the tunnel widening. To identify the crescent-shaped ACL femoral attachment area, the upper cartilage margin, the posterior cartilage margin and the resident's ridge are used as landmarks. To delineate the C-shaped tibial insertion, medial intercondylar ridge, Parson's knob and anterior horn of the lateral meniscus are helpful. In ART-BTB procedure which is suitable for male patients engaged in contact sports, the parallelepiped tunnels with rectangular apertures are made within the femoral and tibial attachment areas. In ATB-HS technique which is mainly applied to female athletes engaged in non-contact sports including skiing or basketball, 2 femoral and 3 tibial round tunnels are created inside the attachment areas. These techniques make it possible for the grafts to run as the native ACL without impingement to the notch or PCL. After femoral fixation with an interference screw or cortical fixation devices including Endobutton, the graft is pretensioned in situ by repetitive manual pulls at 15-20° of flexion, monitoring the graft tension with tensioners on a tensioning boot installed on the calf. Tibial fixation with pullout sutures is achieved using Double Spike Plate and a screw at the pre-determined amount of tension of 10-20N. While better outcomes with less failure rate are being obtained compared to those in the past, higher graft tear rate remains a problem. Improved preventive training may be required to avoid secondary ACL injuries.

  8. Anatomic ACL reconstruction: rectangular tunnel/bone-patellar tendon-bone or triple-bundle/semitendinosus tendon grafting.

    PubMed

    Shino, Konsei; Mae, Tatsuo; Tachibana, Yuta

    2015-05-01

    Anatomic ACL reconstruction is the reasonable approach to restore stability without loss of motion after ACL tear. To mimic the normal ACL like a ribbon, our preferred procedures is the anatomic rectangular tunnel (ART) technique with a bone-patellar tendon-bone (BTB) graft or the anatomic triple bundle (ATB) procedure with a hamstring (HS) tendon graft. It is important to create tunnel apertures inside the attachment areas to lessen the tunnel widening. To identify the crescent-shaped ACL femoral attachment area, the upper cartilage margin, the posterior cartilage margin and the resident's ridge are used as landmarks. To delineate the C-shaped tibial insertion, medial intercondylar ridge, Parson's knob and anterior horn of the lateral meniscus are helpful. In ART-BTB procedure which is suitable for male patients engaged in contact sports, the parallelepiped tunnels with rectangular apertures are made within the femoral and tibial attachment areas. In ATB-HS technique which is mainly applied to female athletes engaged in non-contact sports including skiing or basketball, 2 femoral and 3 tibial round tunnels are created inside the attachment areas. These techniques make it possible for the grafts to run as the native ACL without impingement to the notch or PCL. After femoral fixation with an interference screw or cortical fixation devices including Endobutton, the graft is pretensioned in situ by repetitive manual pulls at 15-20° of flexion, monitoring the graft tension with tensioners on a tensioning boot installed on the calf. Tibial fixation with pullout sutures is achieved using Double Spike Plate and a screw at the pre-determined amount of tension of 10-20N. While better outcomes with less failure rate are being obtained compared to those in the past, higher graft tear rate remains a problem. Improved preventive training may be required to avoid secondary ACL injuries. PMID:25753837

  9. Understanding Gender Differences in Children's Risk Taking and Injury: A Comparison of Mothers' and Fathers' Reactions to Sons and Daughters Misbehaving in Ways that Lead to Injury

    ERIC Educational Resources Information Center

    Morrongiello, Barbara A.; Zdzieborski, Daniel; Normand, Jackie

    2010-01-01

    This study compared reactions of mothers and fathers to the risk taking behavior of sons and daughters. Mother-father pairs (N = 52) imagined their 2-year-old boy or girl behaving in risky ways in common home situations that could, and did, result in injury. Emotional and parenting reactions to the behaviors were assessed before and after injury.…

  10. A 7-year study on risks and costs of knee injuries in male and female youth participants in 12 sports.

    PubMed

    de Loës, M; Dahlstedt, L J; Thomée, R

    2000-04-01

    Knee injuries are common and account in various sports for 15-50% of all sports injuries. The cost of knee injuries is therefore a large part of the cost for medical care of sports injuries. Furthermore, the risk of acquiring a knee injury during sports is considered higher for females than for males. The nationwide organization "Youth and Sports" represents the major source of organized sports and recreation for Swiss youth and engages annually around 370000 participants in the age group of 14 to 20 years. The purpose of this study was to combine data on knee injuries from two sources, the first being data on the exposure to risk found in the activity registration in "Youth and Sports" and the second injuries with their associated costs resulting from the activities and filed at the Swiss Military Insurance. This allowed calculation of knee injury incidences, to compare risks between males and females and to estimate the costs of medical treatment. The study comprises 3864 knee injuries from 12 sports during 7 years. Females were significantly more at risk in six sports: alpinism, downhill skiing, gymnastics, volleyball, basketball and team handball. The incidences of knee injuries and of cruciate ligament injuries in particular, together with the costs per hour of participation, all displayed the same sports as the top five for both females and males: ice hockey, team handball, soccer, downhill skiing and basketball. Female alpinism and gymnastics had also high rankings. Knee injuries comprised 10% of all injuries in males and 13% in females, but their proportional contribution to the costs per hour of participation was 27% and 33%, respectively. From this study it can be concluded that females were significantly more at risk for knee injuries than males in six sports and that knee injuries accounted for a high proportion of the costs of medical treatment.

  11. Is overweight a risk factor for sports injuries in children, adolescents, and young adults?

    PubMed

    Kemler, E; Vriend, I; Paulis, W D; Schoots, W; van Middelkoop, M; Koes, B

    2015-04-01

    Physical activity and sports participation are promoted to counteract the increased prevalence of overweight and obesity in children and young adults. Both high body mass index and physical activity level have been associated with an increased risk of sports injuries. The objective is to determine the relationship between sports injuries and overweight in sports participants (4-24 years), taking physical activity into account. Data were obtained from the 2006-2011 "Injuries and Physical Activity in the Netherlands" survey. Analyses were based on a representative sample of 3846 sports participants (4-24 years). Univariate and multiple logistic regression analyses were applied to investigate the association between sports injury and weight status. Of all the sports participants, 14.7% were overweight. Compared with normal-weight sports participants, the odds of sustaining a sports injury was 0.73 [confidence interval (CI): 0.53-1.00, P = 0.050] for overweight sports participants; the odds for underweight sports participants was 0.80 (CI: 0.56-1.15, P = 0.226). There is some evidence that overweight sports participants (4-24 years) do not have an increased injury risk compared with normal-weight sports participants, even when the level of physical activity is taken into account. Additional research is recommended regarding overweight people who start to participate in a physically active lifestyle.

  12. The influence of the risk factor on the abdominal complications in colon injury management

    PubMed Central

    TORBA, M.; GJATA, A.; BUCI, S.; BUSHI, G.; ZENELAJ, A.; KAJO, I.; KOCEKU, S.; KAGJINI, K.; SUBASHI, K.

    2015-01-01

    Introduction The management of colon injuries has distinctly evolved over the last three decades. However, trauma surgeons often find themselves in a dilemma, whether to perform a diversion or to perform a primary repair. The purpose of this study is to evaluate risk factors in colon injury management and their influence on abdominal complications. Patients and methods This is a prospective study conducted at a national level I trauma center in Tirana, Albania from January 2009 to December 2012. The data with respect to demographics, physiological risk factors, intraoperative findings, and surgical procedures were collected. Colonic injury-related morbidity and mortality were analyzed. Multivariate logistic regression analysis was performed by assessing the influence of risk factors on abdominal complications. Results Of the 157 patients treated with colon injury, was performed a primary repair in 107 (68.15%) of the patients and a diversion in the remaining 50 (31.85%). The mean PATI was 18.6, while 37 (23.6%) of patients had PATI greater than 25. The complications and their frequencies according to the surgical technique used (primay repair vs diversion respectively) includes: wound infections (9.3% vs 50%), anastomotic leak (1.8% vs 8.7%), and intra-abdominal abscess (1.8% vs 6.5%). The multivariate analysis identified two independent risk factors for abdominal complications: transfusions of 4 units of blood within the first 24 hours (OR = 1.2 95% CI (1.03 –1.57) p =0.02), and diversion (OR = 9.6, 95% CI 4.4 – 21.3, p<0.001). Conclusion Blood transfusions of more than 4 units within the first 24 hours and diversion during the management of destructive colon injuries are both independent risk factors for abdominal complications. The socioeconomic impact and the need for a subsequent operation in colostomy patients are strong reasons to consider primary repair in the management of colon injuries. PMID:26017103

  13. Knee extension torque variability after exercise in ACL reconstructed knees.

    PubMed

    Goetschius, John; Kuenze, Christopher M; Hart, Joseph M

    2015-08-01

    The purpose of this study was to compare knee extension torque variability in patients with ACL reconstructed knees before and after exercise. Thirty two patients with an ACL reconstructed knee (ACL-R group) and 32 healthy controls (control group) completed measures of maximal isometric knee extension torque (90° flexion) at baseline and following a 30-min exercise protocol (post-exercise). Exercise included 30-min of repeated cycles of inclined treadmill walking and hopping tasks. Dependent variables were the coefficient of variation (CV) and raw-change in CV (ΔCV): CV = (torque standard deviation/torque mean x 100), ΔCV = (post-exercise - baseline). There was a group-by-time interaction (p = 0.03) on CV. The ACL-R group demonstrated greater CV than the control group at baseline (ACL-R = 1.07 ± 0.55, control = 0.79 ± 0.42, p = 0.03) and post-exercise (ACL-R = 1.60 ± 0.91, control = 0.94 ± 0.41, p = 0.001). ΔCV was greater (p = 0.03) in the ACL-R group (0.52 ± 0.82) than control group (0.15 ± 0.46). CV significantly increased from baseline to post-exercise (p = 0.001) in the ACL-R group, while the control group did not (p = 0.06). The ACL-R group demonstrated greater knee extension torque variability than the control group. Exercise increased torque variability more in the ACL-R group than control group.

  14. Ligamentous injuries of the knee: anterior cruciate, medial collateral, posterior cruciate, and posterolateral corner injuries.

    PubMed

    Morelli, Vincent; Bright, Crystal; Fields, Ashley

    2013-06-01

    This article discusses athletic injuries of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and posterolateral corner. Best evidence to date validates that conservative management of ACL ruptures is a reasonable strategy. Current data also seem to advocate nonoperative management of PCL injuries. All isolated MCL injuries, regardless of grade, are usually treated with a brief period of immobilization and symptomatic management. Although the surgical literature often advocates surgical treatment of posterolateral corner injuries, there have been no randomized trials substantiating that these injuries are best treated surgically.

  15. Meniscus treatment and age associated with narrower radiographic joint space width 2 – 3 years after ACL reconstruction: Data from the MOON onsite cohort

    PubMed Central

    Jones, Morgan H.; Spindler, Kurt P.; Fleming, Braden C.; Duryea, Jeffrey; Obuchowski, Nancy A.; Scaramuzza, Erica A.; Oksendahl, Heidi L.; Winalski, Carl S.; Duong, Carol L.; Huston, Laura J.; Parker, Richard D.; Kaeding, Christopher C.; Andrish, Jack T.; Flanigan, David C.; Dunn, Warren R.; Reinke, Emily K.

    2015-01-01

    Objective To identify risk factors for radiographic signs of post-traumatic OA 2–3 years after ACL reconstruction through multivariable analysis of minimum joint space width (mJSW) differences in a specially designed nested cohort. Methods A nested cohort within the Multicenter Orthopaedic Outcomes Network cohort included 262 patients (148 females, average age 20) injured in sport who underwent ACL reconstruction in a previously uninjured knee, were 35 or younger, and did not have ACL revision or contralateral knee surgery. mJSW on semi-flexed radiographs was measured in the medial compartment using a validated computerized method. A multivariable generalized linear model was constructed to assess mJSW difference between the ACL reconstructed and contralateral control knees while adjusting for potential confounding factors. Results Unexpectedly, we found the mean mJSW was 0.35 mm wider in ACL reconstructed than in control knees (5.06 mm (95% CI 4.96 – 5.15 mm) versus 4.71 mm (95% CI 4.62 – 4.80 mm), p<0.001). However, ACL reconstructed knees with meniscectomy had narrower mJSW compared to contralateral normal knees by 0.64 mm (95% C.I. 0.38 – 0.90 mm) (p<0.001). Age (p<0.001) and meniscus repair (p=0.001) were also significantly associated with mJSW difference. Conclusion Semi-flexed radiographs can detect differences in mJSW between ACL reconstructed and contralateral normal knees 2–3 years following ACL reconstruction, and the unexpected wider mJSW in ACL reconstructed knees may represent the earliest manifestation of post-traumatic osteoarthritis and warrants further study. PMID:25559582

  16. Injuries in high-risk persons and high-risk sports. A longitudinal study of 1818 school children.

    PubMed

    Backx, F J; Beijer, H J; Bol, E; Erich, W B

    1991-01-01

    In this Dutch population-based study we attempted to determine the incidence and severity of sports injuries occurring during different kind of sports in a longitudinal way. The study included 1818 school children aged 8 to 17 years. Over a period of 7 months, 399 sports injuries were reported in 324 youngsters. The most common types of injuries were contusions (43%) and sprains (21%). Medical attention was needed in 25% of all cases. Young basketball, handball and korfball players had a nearly 100% chance of suffering one sports injury per year. Volleyball especially had a high incidence rate in practice (6.7 in 1000 hours). Although physical education classes had a low incidence rate, there were significantly more fractures on the upper limb. Etiologically, sports-related factors were much more important than personal-bound factors. The injured youths spent more time in practice than the noninjured ones, both in organized and nonorganized sports (P less than 0.001). High-risk sports were characterized by contact, a high jump rate, and indoor activities. These three factors explained 78% of the total variance. The contact versus noncontact factor accounted for 48% of the medically treated injuries. An additional goal of this study was to explore the seasonal influence as an extrinsic environmental factor. We found that the duration of injury was increased in the spring (P less than 0.05). Specific preventive measures were formulated in order to reduce the number of new and recurring injuries and a proposal was made to implement injury prevention in school curriculums.

  17. Comparison of the postural control between football players following ACL reconstruction and healthy subjects

    PubMed Central

    Pahnabi, Gholamreza; Akbari, Mohammad; Ansari, Noureddin Nakhostin; Mardani, Mahmoud; Ahmadi, Mehdi; Rostami, Mohamad

    2014-01-01

    Background: Rupture of the Anterior Cruciate Ligment (ACL) is a common knee injury. The purpose of this study was to determine the balance control in football players with and without ACL reconstruction in posture of injury. Methods: Sway of the center of gravity of 15 patients with ACL reconstruction was compared with 15 healthy, age and sex-matched subjects as the control group. All tests were done unilaterally in the posture of injury, using a kistler force plate with the open and -closed eye conditions. Results: The knee of the operated side of the case group showed more displacement of the center of gravity when compared to the non-operated side in the same subject for all variables of the force plate. The operated side of the case group showed more displacement of the center of gravity for all variables of the force plate in comparison with the dominant side of knees in control group. There were significant differences between the non-operated side in the case group and the dominant side of the control group. Conclusion: All together, postural control in the operated side of the case group was weaker than the nonoperated side of the same group and the dominant limb of the control group, which might have resulted from poor proprioception. The postural control was even weaker in the non-operated side of the case group as compared with the dominant limb of the control group, which can justify the hypo mobility of limb for several months after the surgery. PMID:25664302

  18. Effects of firm size on risks and reporting of elevation fall injury in construction trades.

    PubMed

    Kines, Pete; Mikkelsen, Kim Lyngby

    2003-10-01

    Although many occupational safety programs are targeted toward large firms, the construction industry is dominated by smaller firms. This study examines the differential effect of firm size on the risk and the reporting of over 3000 serious and minor nonfatal elevation fall injuries in Danish construction industry trades (1993 to 1999). Small firms (<20 employees) accounted for 93% of all firms and 55% of worker-years. There was an inverse relationship between firm size and serious injury rates and a direct relationship between firm size and minor injury rates. An inverse relationship between firm size and injury severity odds ratios (serious versus minor) was found for carpentry, electrical work, general contracting, and the remaining other trades. Health and safety issues, legislation, and enforcement in the construction industry should, to a greater degree, be focused on smaller firms.

  19. Risk factors for severe intimate partner violence and violence-related injuries among women in India.

    PubMed

    Sabri, Bushra; Renner, Lynette M; Stockman, Jamila K; Mittal, Mona; Decker, Michele R

    2014-01-01

    Relying on an ecological framework, we examined risk factors for severe physical intimate partner violence (IPV) and related injuries among a nationally representative sample of women (N = 67,226) in India. Data for this cross-sectional study were derived from the 2005-2006 India National Family Health Survey, a nationally representative household-based health surveillance system. Logistic regression analyses were used to generate the study findings. We found that factors related to severe physical IPV and injuries included low or no education, low socioeconomic status, rural residence, greater number of children, and separated or divorced marital status. Husbands' problem drinking, jealousy, suspicion, control, and emotionally and sexually abusive behaviors were also related to an increased likelihood of women experiencing severe IPV and injuries. Other factors included women's exposure to domestic violence in childhood, perpetration of IPV, and adherence to social norms that accept husbands' violence. Practitioners may use these findings to identify women at high risk of being victimized by severe IPV or injuries for prevention and intervention strategies. Policies and programs that focus on empowering abused women and holding perpetrators accountable may protect women at risk for severe IPV or injuries that may result in death.

  20. Obesity as a Possible Risk Factor for Lost-time Injury in Registered Nurses: A Literature Review

    PubMed Central

    Jordan, Gillian; Nowrouzi-Kia, Behnam; Gohar, Basem; Nowrouzi, Behdin

    2015-01-01

    Time-loss injuries are still a major occurrence in Canada, injuring thousands of Canadian workers each year. With obesity rates on the rise across the country, as well as around the world, it is important that the possible effects of obesity in the workplace be fully understood, especially those effects linked to lost-time injuries. The aim of this paper was to evaluate predictors of workplace lost-time injuries and how they may be related to obesity or high body mass index by examining factors associated with lost-time injuries in the health care sector, a well-studied industry with the highest number of reported time loss injuries in Canada. A literature review focusing on lost-time injuries in Registered Nurses (RNs) was conducted using the keywords and terms: lost time injury, workers' compensation, occupational injury, workplace injury, injury, injuries, work, workplace, occupational, nurse, registered nurse, RN, health care, predictors, risk factors, risk, risks, cause, causes, obese, obesity, and body mass index. Data on predictors or factors associated with lost-time injuries in RNs were gathered and organized using Loisel's Work Disability Prevention Management Model and extrapolated upon using existing literature surrounding obesity in the Canadian workplace. PMID:25830063

  1. Personal and environmental factors in relation to injury risk in downhill skiing.

    PubMed

    Bouter, L M; Knipschild, P G; Volovics, A

    1989-08-01

    A case-control study was conducted among Dutch downhill skiers. This article presents data on the circumstances of the accident leading to injury and on personal and environmental risk factors for both cases (n = 572) and controls (n = 576). Most accidents (84%) happened on the pistes and ski lifts were involved in about 6% of them. Bad condition of the ski run (30%) and lost balance (24%) were the direct causes most frequently mentioned. Risk seemed to be constant for particular days and moments of the day. Injury risk for the individual appeared to rise with increasing duration of exposure, although very small durations had an elevated risk as well. A relatively low risk was observed for skiers who reported to be only moderately rested (OR = 0.4) and for those who admitted a certain fear of having a ski accident (OR = 0.6). A relatively high risk was observed for the presence of icy spots (OR = 1.4), while poor visibility (OR = 0.4), the presence of clouds (OR = 0.5), and perceived coldness (OR = 0.5) were associated with a relatively low injury risk. No recommendations for prevention can be based on these results. Most factors mentioned are not open to manipulation and further quantification should involve prospective study designs and independent measurements of these factors.

  2. Injury risk assessment of non-lethal projectile head impacts.

    PubMed

    Oukara, Amar; Nsiampa, Nestor; Robbe, Cyril; Papy, Alexandre

    2014-01-01

    Kinetic energy non-lethal projectiles are used to impart sufficient effect onto a person in order to deter uncivil or hazardous behavior with a low probability of permanent injury. Since their first use, real cases indicate that the injuries inflicted by such projectiles may be irreversible and sometimes lead to death, especially for the head impacts. Given the high velocities and the low masses involved in such impacts, the assessment approaches proposed in automotive crash tests and sports may not be appropriate. Therefore, there is a need of a specific approach to assess the lethality of these projectiles. In this framework, some recent research data referred in this article as "force wall approach" suggest the use of three lesional thresholds (unconsciousness, meningeal damages and bone damages) that depend on the intracranial pressure. Three corresponding critical impact forces are determined for a reference projectile. Based on the principle that equal rigid wall maximal impact forces will produce equal damage on the head, these limits can be determined for any other projectile. In order to validate the consistence of this innovative method, it is necessary to compare the results with other existing assessment methods. This paper proposes a comparison between the "force wall approach" and two different head models. The first one is a numerical model (Strasbourg University Finite Element Head Model-SUFEHM) from Strasbourg University; the second one is a mechanical surrogate (Ballistics Load Sensing Headform-BLSH) from Biokinetics. PMID:25400712

  3. Injury Risk Assessment of Non-Lethal Projectile Head Impacts

    PubMed Central

    Oukara, Amar; Nsiampa, Nestor; Robbe, Cyril; Papy, Alexandre

    2014-01-01

    Kinetic energy non-lethal projectiles are used to impart sufficient effect onto a person in order to deter uncivil or hazardous behavior with a low probability of permanent injury. Since their first use, real cases indicate that the injuries inflicted by such projectiles may be irreversible and sometimes lead to death, especially for the head impacts. Given the high velocities and the low masses involved in such impacts, the assessment approaches proposed in automotive crash tests and sports may not be appropriate. Therefore, there is a need of a specific approach to assess the lethality of these projectiles. In this framework, some recent research data referred in this article as “force wall approach” suggest the use of three lesional thresholds (unconsciousness, meningeal damages and bone damages) that depend on the intracranial pressure. Three corresponding critical impact forces are determined for a reference projectile. Based on the principle that equal rigid wall maximal impact forces will produce equal damage on the head, these limits can be determined for any other projectile. In order to validate the consistence of this innovative method, it is necessary to compare the results with other existing assessment methods. This paper proposes a comparison between the “force wall approach” and two different head models. The first one is a numerical model (Strasbourg University Finite Element Head Model-SUFEHM) from Strasbourg University; the second one is a mechanical surrogate (Ballistics Load Sensing Headform-BLSH) from Biokinetics. PMID:25400712

  4. Biomechanical assessment of the injury risk of stomping.

    PubMed

    Schirmer, Frederike; Muggenthaler, Holger; Hubig, Michael; Schenkl, Sebastian; Koch, Markus; Blickhan, Reinhard; Mall, Gita

    2016-05-01

    Forensic case work as well as literature shows that severe head injuries, e.g., with basilar fractures and cerebral hemorrhages due to stomps can be seen; however, there is no data basis concerning contact forces and potential influencing factors. The objective of this work was to generate a data basis of contact forces in stomping by performing experimental measurements and subsequent statistical analyses. Fifty-five volunteers participated in the present study. Each participant performed several stomps onto force plates with sturdy/soft footwear as well as with/without an elastic layer imitating the scalp. Ground reaction forces induced by jumps were also measured for sturdy and soft footwear. The results show statistically significant dependencies between maximum ground reaction forces and body weight and body height. A statistically significant influence of footwear on stomping force could only be found in tests with an elastic layer and in the jumping setup. Mean maximum stomping forces for the female volunteers were between 4694 and 5970 N; male volunteers were able to produce mean peak stomping forces between 8494 and 9016 N. Jumping forces were approximately twice the stomping forces for both male and female test persons. Regardless of footwear and gender, it can be claimed that a forceful stomp or jump to someone's head supported on the ground can cause facial and skull fractures. Thus, forceful stomps or jumps to someone's head can cause potential fatal injuries independent of footwear, gender, or fitness level.

  5. Dyschloremia Is a Risk Factor for the Development of Acute Kidney Injury in Critically Ill Patients

    PubMed Central

    Shao, Min; Li, Guangxi; Sarvottam, Kumar; Wang, Shengyu; Thongprayoon, Charat; Dong, Yue; Gajic, Ognjen

    2016-01-01

    Introduction Dyschloremia is common in critically ill patients, although its impact has not been well studied. We investigated the epidemiology of dyschloremia and its associations with the incidence of acute kidney injury and other intensive care unit outcomes. Material and Methods This is a single-center, retrospective cohort study at Mayo Clinic Hospital—Rochester. All adult patients admitted to intensive care units from January 1st, 2006, through December 30th, 2012 were included. Patients with known acute kidney injury and chronic kidney disease stage 5 before intensive care unit admission were excluded. We evaluated the association of dyschloremia with ICU outcomes, after adjustments for the effect of age, gender, Charlson comorbidity index and severity of illness score. Results A total of 6,025 patients were enrolled in the final analysis following the implementation of eligibility criteria. From the cohort, 1,970 patients (33%) developed acute kidney injury. Of the total patients enrolled, 4,174 had a baseline serum chloride. In this group, 1,530 (37%) had hypochloremia, and 257 (6%) were hyperchloremic. The incidence of acute kidney injury was higher in hypochloremic and hyperchloremic patients compared to those with a normal serum chloride level (43% vs.30% and 34% vs. 30%, respectively; P < .001). Baseline serum chloride was lower in the acute kidney injury group vs. the non-acute kidney injury group [100 mmol/L (96–104) vs. 102 mmol/L (98–105), P < .0001]. In a multivariable logistic regression model, baseline serum chloride of ≤94 mmol/L found to be independently associated with the risk of acute kidney injury (OR 1.7, 95% CI 1.1–2.6; P = .01). Discussion Dyschloremia is common in critically ill patients, and severe hypochloremia is independently associated with an increased risk of development of acute kidney injury. PMID:27490461

  6. Zolpidem Use and the Risk of Injury: A Population-Based Follow-Up Study

    PubMed Central

    Lin, Ching-Chun; Wang, Li-Hsuan; Kang, Jiunn-Horng

    2013-01-01

    Background While an association between zolpidem use and fracture and road accident was previously proposed, this study aimed to further explore the frequency and risk of a wide spectrum of injuries in subjects prescribed with zolpidem in Taiwan. Methods We identified 77,036 subjects who received Zolpidem treatment between 2005 and 2007. We randomly selected 77,036 comparison subjects who were frequency-matched based-on their demographic profiles. We individually tracked each subject for a 90-day period to identify those who subsequently suffered an injury. Cox proportional hazards regressions were performed to calculate the hazard ratio of injury between the two groups. Results The incidence rate of injury during the 90-day follow-up period for the total subjects was 18.11 (95% CI = 17.69–18.54) per 100 person-years; this was 24.35 (95% CI = 23.66–25.05) and 11.86 (95% CI = 11.39–12.36) for the study and comparison cohort, respectively. After adjusting for demographic variables, the hazard ratio (HR) of injury during the 90-day follow-up period for study subjects was 1.83 (95% CI = 1.73–1.94) that of comparison subjects. Additionally, compared to comparison subjects, the adjusted HR of injury during the 90-day follow-up period for study subjects who were prescribed Zolpidem for >30 days was as high as 2.17 (95% CI = 2.05–2.32). The adjusted HR of injury to blood vessels for study subjects was particularly high when compared to comparison subjects (HR = 6.34; 95% CI = 1.37–29.38). Conclusions We found that patients prescribed with Zolpidem were at a higher risk for a wide range of injuries. PMID:23826304

  7. Lower extremity arterial injuries over a six-year period: outcomes, risk factors, and management

    PubMed Central

    Topal, Aşkın Ender; Eren, Mehmet Nesimi; Celik, Yusuf

    2010-01-01

    Purpose: Limb loss following lower extremity arterial injury is not uncommon and has serious implications on the patient’s life and functionality. This retrospective study was performed to analyze the results of lower extremity arterial injuries and to identify the risk factors associated with amputation. Methods: Between 2002 and 2009, retrospectively collected data on 140 patients with 173 lower extremity arterial injuries were analyzed. Results: There were 133 males (95%) and 7 females (5%). The mechanism of injuries was gunshot wounds in 56.4% of cases, stab wounds in 30%, and blunt trauma in 13.4%. Associated injuries included vein injury in 45% of cases, nerve injury in 16.4%, and bone fracture in 31.4%. The most frequently injured artery was superficial femoral artery (31.2%). More than 1 artery was injured in 18.6% of patients. Surgery was carried out, with a limb salvage rate of 90.4% and a survival of 97.1%. Amputation was performed in 75% of patients in whom only 1 artery was repaired, although all crural arteries were injured. Multivariate logistic regression analysis showed that significant risk factors of outcome were below-knee multiple arterial injuries (odds ratio [OR] 6.62, P < 0.001), associated 2-bone fractures (OR 2.71, P = 0.003), development of compartment syndrome (OR 1.94, P = 0.042), and great soft tissue disruption (OR 1.74, P = 0.010). Conclusions: Limb loss may be decreased by performing prophylactic fasciotomy more often and by repairing at least 2 crural arteries. PMID:21191430

  8. Early Risk Behaviors and Adolescent Injury in 25 European and North American Countries: A Cross-National Consistent Relationship

    ERIC Educational Resources Information Center

    de Looze, Margaretha; Pickett, William; Raaijmakers, Quinten; Kuntsche, Emmanuel; Hublet, Anne; Nic Gabhainn, Saoirse; Bjarnason, Thoroddur; Molcho, Michal; Vollebergh, Wilma; ter Bogt, Tom

    2012-01-01

    Injury is a leading cause of mortality and morbidity among adolescents in developed countries. Jessor and Jessor's Problem Behavior Theory suggests an association between risk behaviors (e.g., smoking, drunkenness, cannabis use, and sexual intercourse) and adolescent injury. The present study examined whether early engagement in risk behaviors…

  9. Loss of neuromuscular control related to motion in the acutely ACL-injured knee: an experimental study.

    PubMed

    Bonsfills, N; Gómez-Barrena, E; Raygoza, J J; Núñez, A

    2008-10-01

    Ligamentomuscular and muscular stretch reflexes are known to contribute to knee joint stability. After anterior cruciate ligament (ACL) injury, a more intense and adjusted muscular response is required to maintain joint stability, but this neuromuscular control of the knee has not been clearly proved. The aim of the study is to record electromyography (EMG) signal and muscular fibre length variations in quadriceps and hamstrings of the knee with and without ACL, and to analyze and integrate the ligament strain and the muscular reaction to forced anterior tibial translation (ATT). In 17 knees from 12 cats, EMG electrodes and ultrasonomicrometry crystals were inserted into four main periarticular muscles, with strain gauges on periarticular ligament insertions. Their output signal was compared before and after ACL surgical section in series of ATT (at 90 degrees and 30 degrees knee flexion), and also during knee flexion and extension. Linear regression analysis was performed between the EMG signal and muscular fibre length variations, and between the EMG signal and the strain on ligament insertions, in the search of this reflex neuromuscular response. In the ACL deficient knees, the studied muscles showed a poor adjustment to motion of EMG firing, inversely to controls. The muscle stretch reflexes showed poorer correlation with post-peak EMG activity than the ligaments. ATT control depended mainly on hamstrings activity in control knees, whereas in unstable knees, quadriceps activity was associated with more tibial translation. Acute ACL-deficient knees showed poor neuromuscular control with weak ligamentomuscular reflexes and no muscular stretch reflexes, suggesting the ineffectiveness of acute muscular reaction to provide early mechanical knee stabilization after injury.

  10. Traumatic Brain Injury as a Risk Factor for Alzheimer's Disease: Is Inflammatory Signaling a Key Player?

    PubMed

    Djordjevic, Jelena; Sabbir, Mohammad Golam; Albensi, Benedict C

    2016-01-01

    Traumatic brain injury (TBI) has become a significant medical and social concern within the last 30 years. TBI has acute devastating effects, and in many cases, seems to initiate long-term neurodegeneration. With advances in medical technology, many people are now surviving severe brain injuries and their long term consequences. Post trauma effects include communication problems, sensory deficits, emotional and behavioral problems, physical complications and pain, increased suicide risk, dementia, and an increased risk for chronic CNS diseases, such as Alzheimer's disease (AD). In this review, we provide an introduction to TBI and hypothesize how it may lead to neurodegenerative disease in general and AD in particular. In addition, we discuss the evidence that supports the hypothesis that TBI may lead to AD. In particular, we focus on inflammatory responses as key processes in TBI-induced secondary injury, with emphasis on nuclear factor kappa B (NF-κB) signaling. PMID:26899581

  11. [ANALYSIS OF A LETHAL OUTCOME RISK AFTER TRAUMA IN HIV-INFECTED PATIENTS IN POLYSYSTEMIC INJURY].

    PubMed

    Guryev, S O; Solovyov, O S; Tanasiyenko, P V

    2016-02-01

    Abstract The data, concerning clinic--epidemiologic and clinic--nosological characteristic of a HIV-infected injured persons in polytrauma were adduced. There was established, that polysystemic injuries (PSI) in a HIV-infected persons occur in a younger injured patients, a trauma environment is quite a speciphic one (criminal trauma prevails), as well as mechanism of the injury occurrence (falling down is much more freqent), and the risk of a lethal outcome is determined by predominantly cranial, thoracic and abdominal components of injury. A lethal outcome occurrence risk in HIV-infected injured persons in PSI in accordance to the age signs and traumagenesis is lesser, than in a control body. It is necessary to prolong the investigations, concerning studying this phenomenon and other peculiarities of a traumatic disease in HIV-infected injured persons in polytrauma. PMID:27244924

  12. Risk factors for shoulder pain and injury in swimmers: A critical systematic review.

    PubMed

    Hill, Lee; Collins, Malcolm; Posthumus, Michael

    2015-11-01

    Swimming is one of the most popular recreational and competitive sporting activities. In the 2013/2014 swimming season, 9630 men and 12,333 women were registered with the National Collegiate Athletics Association in the USA. The repetitive nature of the swimming stroke and demanding training programs of its athletes raises a number of concerns regarding incidence and severity of injuries that a swimmer might experience during a competitive season. A number of risk factors have previously been identified but the level of evidence from individual studies, as well as the level of certainty that these factors predispose a swimmer to pain and injury, to our knowledge has yet to be critically evaluated in a systematic review. Therefore, the primary objective of this review is to conduct a systematic review to critically assess the published evidence for risk factors that may predispose a swimmer to shoulder pain and injury. Three electronic databases, ScienceDirect, PubMed and SpringerLink, were searched using keywords "(Injury OR pain) AND (Swim*)" and "(Shoulder) AND (Swim*)". Based on the inclusion and exclusion criteria, 2731 unique titles were identified and were analyzed to a final 29 articles. Only articles with a level of evidence of I, II and III were included according to robust study design and data analysis. The level of certainty for each risk factor was determined. No studies were determined to have a high level of certainty, clinical joint laxity and instability, internal/external rotation, previous history of pain and injury and competitive level were determined to have a moderate level of certainty. All other risk factors were evaluated as having a low level of certainty. Although several risk factors were identified from the reviewed studies, prospective cohort studies, larger sample sizes, consistent and robust measures of risk should be employed in future research. PMID:26366502

  13. Risk factors for shoulder pain and injury in swimmers: A critical systematic review.

    PubMed

    Hill, Lee; Collins, Malcolm; Posthumus, Michael

    2015-11-01

    Swimming is one of the most popular recreational and competitive sporting activities. In the 2013/2014 swimming season, 9630 men and 12,333 women were registered with the National Collegiate Athletics Association in the USA. The repetitive nature of the swimming stroke and demanding training programs of its athletes raises a number of concerns regarding incidence and severity of injuries that a swimmer might experience during a competitive season. A number of risk factors have previously been identified but the level of evidence from individual studies, as well as the level of certainty that these factors predispose a swimmer to pain and injury, to our knowledge has yet to be critically evaluated in a systematic review. Therefore, the primary objective of this review is to conduct a systematic review to critically assess the published evidence for risk factors that may predispose a swimmer to shoulder pain and injury. Three electronic databases, ScienceDirect, PubMed and SpringerLink, were searched using keywords "(Injury OR pain) AND (Swim*)" and "(Shoulder) AND (Swim*)". Based on the inclusion and exclusion criteria, 2731 unique titles were identified and were analyzed to a final 29 articles. Only articles with a level of evidence of I, II and III were included according to robust study design and data analysis. The level of certainty for each risk factor was determined. No studies were determined to have a high level of certainty, clinical joint laxity and instability, internal/external rotation, previous history of pain and injury and competitive level were determined to have a moderate level of certainty. All other risk factors were evaluated as having a low level of certainty. Although several risk factors were identified from the reviewed studies, prospective cohort studies, larger sample sizes, consistent and robust measures of risk should be employed in future research.

  14. Effects of bicycle saddle height on knee injury risk and cycling performance.

    PubMed

    Bini, Rodrigo; Hume, Patria A; Croft, James L

    2011-06-01

    Incorrect bicycle configuration may predispose athletes to injury and reduce their cycling performance. There is disagreement within scientific and coaching communities regarding optimal configuration of bicycles for athletes. This review summarizes literature on methods for determining bicycle saddle height and the effects of bicycle saddle height on measures of cycling performance and lower limb injury risk. Peer-reviewed journals, books, theses and conference proceedings published since 1960 were searched using MEDLINE, Scopus, ISI Web of Knowledge, EBSCO and Google Scholar databases, resulting in 62 references being reviewed. Keywords searched included 'body positioning', 'saddle', 'posture, 'cycling' and 'injury'. The review revealed that methods for determining optimal saddle height are varied and not well established, and have been based on relationships between saddle height and lower limb length (Hamley and Thomas, trochanteric length, length from ischial tuberosity to floor, LeMond, heel methods) or a reference range of knee joint flexion. There is limited information on the effects of saddle height on lower limb injury risk (lower limb kinematics, knee joint forces and moments and muscle mechanics), but more information on the effects of saddle height on cycling performance (performance time, energy expenditure/oxygen uptake, power output, pedal force application). Increasing saddle height can cause increased shortening of the vastii muscle group, but no change in hamstring length. Length and velocity of contraction in the soleus seems to be more affected by saddle height than that in the gastrocnemius. The majority of evidence suggested that a 5% change in saddle height affected knee joint kinematics by 35% and moments by 16%. Patellofemoral compressive force seems to be inversely related to saddle height but the effects on tibiofemoral forces are uncertain. Changes of less than 4% in trochanteric length do not seem to affect injury risk or performance

  15. Are Articular Cartilage Lesions and Meniscus Tears Predictive of IKDC, KOOS, and Marx Activity Level Outcomes after ACL Reconstruction? A 6-Year Multicenter Cohort Study

    PubMed Central

    Cox, Charles L.; Huston, Laura J.; Dunn, Warren R.; Reinke, Emily K.; Nwosu, Samuel K.; Parker, Richard D.; Wright, Rick W.; Kaeding, Christopher C.; Marx, Robert G.; Amendola, Annunziata; McCarty, Eric C.; Wolf, Brian R.; Harrell, Frank E.; Spindler, Kurt P.

    2014-01-01

    Background Identifying risk factors for inferior outcomes after ACL reconstruction (ACLR) is important for prognosis and future treatment. The goal of this study was to determine whether articular cartilage and meniscal variables are predictive of 3 validated sports outcome instruments after ACLR. Hypothesis/Purpose We hypothesized that articular cartilage lesions and meniscus tears/treatment would be predictors of the IKDC, KOOS (all 5 subscales), and Marx activity level at 6 years following ACLR. Study Design Prospective cohort, Level 1 Methods Between 2002 and 2004, 1512 ACLR subjects were prospectively enrolled and followed longitudinally with the IKDC, KOOS, and Marx activity score completed at entry, 2, and 6 years. A logistic regression model was built incorporating variables from patient demographics, surgical technique, articular cartilage injuries, and meniscus tears/treatment to determine the predictors (risk factors) of IKDC, KOOS, and Marx at 6 years. Results We completed a minimum follow-up on 86% (1307/1512) of our cohort at 6 years. The cohort was 56% male, had a median age of 23 years at the time of enrollment, with 76% reporting a non-contact injury mechanism. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC]-25%, lateral femoral condyle [LFC]-20%, medial tibial plateau [MTP]-6%, lateral tibial plateau [LTP]-12%, patella-20%, trochlear-9%) and meniscal (medial-38%, lateral-46%). Both articular cartilage lesions and meniscal tears were significant predictors of 6-year outcomes on IKDC and KOOS. Grade 3 or 4 articular cartilage lesions (excluding patella) significantly reduced IKDC and KOOS scores at 6 years. IKDC demonstrated worse outcomes with the presence of a grade 3-4 chondral lesion on the MFC, MTP, and LFC. Likewise, KOOS was negatively affected by cartilage injury. The sole significant predictor of reduced Marx activity was the presence of a grade 4 lesion

  16. Comparison of injury incidences between football teams playing in different climatic regions.

    PubMed

    Orchard, John W; Waldén, Markus; Hägglund, Martin; Orchard, Jessica J; Chivers, Ian; Seward, Hugh; Ekstrand, Jan

    2013-01-01

    Australian Football League (AFL) teams in northern (warmer) areas generally have higher rates of injury than those in southern (cooler) areas. Conversely, in soccer (football) in Europe, teams in northern (cooler) areas have higher rates of injury than those in southern (warmer) areas, with an exception being knee anterior cruciate ligament (ACL) injuries, which are more common in the southern (warmer) parts of Europe. This study examined relative injury incidence in the AFL comparing 9,477 injuries over 229,827 player-weeks from 1999-2012. There was a slightly higher injury incidence for teams from warmer parts of Australia (relative risk [RR] 1.05, 95% confidence interval [CI] 1.01-1.10) with quadriceps strains (RR 1.32, 95% CI 1.10-1.58), knee cartilage injuries (RR 1.42, 95% CI 1.16-1.74), and ankle sprains (RR 1.17, 95% CI 1.00-1.37) all being more likely in warmer region teams. Achilles injuries followed a reverse pattern, tending to be more common in cooler region teams (RR 0.70, 95% CI 0.47-1.03). In conclusion, common findings from the AFL and European soccer are that ankle sprains and ACL injuries are generally more likely in teams playing in warmer climate zones, whereas Achilles tendinopathy may be more likely in teams playing in cooler zones. These injuries may have climate or surface risk factors (possibly related to types and structure of grass and shoe-surface traction) that are universal across different football codes.

  17. The location-specific healing response of damaged articular cartilage after ACL reconstruction: short-term follow-up.

    PubMed

    Nakamura, Norimasa; Horibe, Shuji; Toritsuka, Yukiyoshi; Mitsuoka, Tomoki; Natsu-ume, Takashi; Yoneda, Kenji; Hamada, Masayuki; Tanaka, Yoshinari; Boorman, Richard S; Yoshikawa, Hideki; Shino, Konsei

    2008-09-01

    Although many different interventions have been proposed for treating cartilage lesions at the time of ACL reconstruction, the normal healing response of these injuries has not been well documented. To address this point, we compared the arthroscopic status of chondral lesions at the time of ACL reconstruction with that obtained at second-look arthroscopy. We hypothesized that there might be a location-specific difference in the healing response of damaged articular cartilage. Between September 1998 and March 2000, 383 patients underwent arthroscopically-assisted hamstring ACL reconstruction without any intervention to the articular cartilage. Among these patients, 84 patients underwent second-look arthroscopy (ranging from 6 to 52 months following initial surgery) and make up the population of the present study. Chondral injuries, left untreated at ACL reconstruction, were arthroscopically evaluated using the Outerbridge classification, and were again evaluated at second-look arthroscopy. At second-look arthroscopy, there was significant recovery of chondral lesions by Outerbridge grading on both the medial and lateral femoral condyles. Among the recovered chondral lesions, 69% of cases of the medial femoral condyle, 88% of cases of the lateral femoral condyle were partial thickness injuries (grade I and II). Conversely, there was no significant recovery of chondral lesions observed at the patello-femoral joint or tibial plateaus. Our study revealed that there was a location-specific difference in the natural healing response of chondral injury. Untreated cartilage lesions on the femoral condlyes had a superior healing response compared to those on the tibial plateaus, and in the patello-femoral joint.

  18. Route Infrastructure and the Risk of Injuries to Bicyclists: A Case-Crossover Study

    PubMed Central

    Harris, M. Anne; Reynolds, Conor C. O.; Winters, Meghan; Babul, Shelina; Chipman, Mary; Cusimano, Michael D.; Brubacher, Jeff R.; Hunte, Garth; Friedman, Steven M.; Monro, Melody; Shen, Hui; Vernich, Lee; Cripton, Peter A.

    2012-01-01

    Objectives. We compared cycling injury risks of 14 route types and other route infrastructure features. Methods. We recruited 690 city residents injured while cycling in Toronto or Vancouver, Canada. A case-crossover design compared route infrastructure at each injury site to that of a randomly selected control site from the same trip. Results. Of 14 route types, cycle tracks had the lowest risk (adjusted odds ratio [OR] = 0.11; 95% confidence interval [CI] = 0.02, 0.54), about one ninth the risk of the reference: major streets with parked cars and no bike infrastructure. Risks on major streets were lower without parked cars (adjusted OR = 0.63; 95% CI = 0.41, 0.96) and with bike lanes (adjusted OR = 0.54; 95% CI = 0.29, 1.01). Local streets also had lower risks (adjusted OR = 0.51; 95% CI = 0.31, 0.84). Other infrastructure characteristics were associated with increased risks: streetcar or train tracks (adjusted OR = 3.0; 95% CI = 1.8, 5.1), downhill grades (adjusted OR = 2.3; 95% CI = 1.7, 3.1), and construction (adjusted OR = 1.9; 95% CI = 1.3, 2.9). Conclusions. The lower risks on quiet streets and with bike-specific infrastructure along busy streets support the route-design approach used in many northern European countries. Transportation infrastructure with lower bicycling injury risks merits public health support to reduce injuries and promote cycling. PMID:23078480

  19. Effects of Stretch Shortening Cycle Exercise Fatigue on Stress Fracture Injury Risk during Landing

    ERIC Educational Resources Information Center

    James, C. Roger; Dufek, Janet S.; Bates, Barry T.

    2006-01-01

    The purpose of this study was to examine changes in landing performance during fatigue that could result in increased stress fracture injury risk. Five participants performed nonfatigued and fatigued drop landings (0.60 m), while ground reaction force (GRF), electromyographic (EMG) activity, and kinematics were recorded. Fatigue was defined as a…

  20. Suicidal Behavior and Firearm Access: Results from the Second Injury Control and Risk Survey

    ERIC Educational Resources Information Center

    Betz, Marian E.; Barber, Catherine; Miller, Matthew

    2011-01-01

    The association between home firearms and the likelihood and nature of suicidal thoughts and plans was examined using the Second Injury Control and Risk Survey, a 2001-2003 representative telephone survey of U.S. households. Of 9,483 respondents, 7.4% reported past-year suicidal thoughts, 21.3% with a plan. Similar proportions of those with and…

  1. Emotional Dysregulation and Interpersonal Difficulties as Risk Factors for Nonsuicidal Self-Injury in Adolescent Girls

    ERIC Educational Resources Information Center

    Adrian, Molly; Zeman, Janice; Erdley, Cynthia; Lisa, Ludmila; Sim, Leslie

    2011-01-01

    The purpose of this study was to examine a model of factors that place psychiatrically hospitalized girls at risk for non-suicidal self-injury (NSSI). The role of familial and peer interpersonal difficulties, as well as emotional dysregulation, were examined in relationship to NSSI behaviors. Participants were 99 adolescent girls (83.2% Caucasian;…

  2. 16 CFR 1211.4 - General requirements for protection against risk of injury.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... PRODUCT SAFETY ACT REGULATIONS SAFETY STANDARD FOR AUTOMATIC RESIDENTIAL GARAGE DOOR OPERATORS The... persons. (b) A residential garage door operator is considered to comply with the requirement in paragraph... intended to reduce the risk of fire, electric shock, or injury to persons, including entrapment...

  3. LOWER EXTREMITY FUNCTIONAL TESTS AND RISK OF INJURY IN DIVISION III COLLEGIATE ATHLETES

    PubMed Central

    Heiderscheit, Bryan C.; Manske, Robert C.; Niemuth, Paul E.; Rauh, Mitchell J.

    2013-01-01

    Purpose/Background: Functional tests have been used primarily to assess an athlete's fitness or readiness to return to sport. The purpose of this prospective cohort study was to determine the ability of the standing long jump (SLJ) test, the single‐leg hop (SLH) for distance test, and the lower extremity functional test (LEFT) as preseason screening tools to identify collegiate athletes who may be at increased risk for a time‐loss sports‐related low back or lower extremity injury. Methods: A total of 193 Division III athletes from 15 university teams (110 females, age 19.1 ± 1.1 y; 83 males, age 19.5 ± 1.3 y) were tested prior to their sports seasons. Athletes performed the functional tests in the following sequence: SLJ, SLH, LEFT. The athletes were then prospectively followed during their sports season for occurrence of low back or LE injury. Results: Female athletes who completed the LEFT in $118 s were 6 times more likely (OR=6.4, 95% CI: 1.3, 31.7) to sustain a thigh or knee injury. Male athletes who completed the LEFT in #100 s were more likely to experience a time‐loss injury to the low back or LE (OR=3.2, 95% CI: 1.1, 9.5) or a foot or ankle injury (OR=6.7, 95% CI: 1.5, 29.7) than male athletes who completed the LEFT in 101 s or more. Female athletes with a greater than 10% side‐to‐side asymmetry between SLH distances had a 4‐fold increase in foot or ankle injury (cut point: >10%; OR=4.4, 95% CI: 1.2, 15.4). Male athletes with SLH distances (either leg) at least 75% of their height had at least a 3‐fold increase (OR=3.6, 95% CI: 1.2, 11.2 for the right LE; OR=3.6, 95% CI: 1.2, 11.2 for left LE) in low back or LE injury. Conclusions: The LEFT and the SLH tests appear useful in identifying Division III athletes at risk for a low back or lower extremity sports injury. Thus, these tests warrant further consideration as preparticipatory screening examination tools for sport injury in this population. Clinical Relevance: The single‐leg hop for

  4. Child Deaths Resulting From Inflicted Injuries: Household Risk Factors and Perpetrator Characteristics

    PubMed Central

    Schnitzer, Patricia G.; Ewigman, Bernard G.

    2006-01-01

    Objective. To determine the role of household composition as an independent risk factor for fatal inflicted injuries among young children and describe perpetrator characteristics. Design, Setting, and Population. A population-based, case-control study of all children <5 years of age who died in Missouri between January 1, 1992, and December 31, 1999. Missouri Child Fatality Review Program data were analyzed. Cases all involved children with injuries inflicted by a parent or caregiver. Two age-matched controls per case child were selected randomly from children who died of natural causes. Main Outcome Measure. Inflicted-injury death. Household composition of case and control children was compared by using multivariate logistic regression. We hypothesized that children residing in households with adults unrelated to them are at higher risk of inflicted-injury death than children residing in households with 2 biological parents. Results. We identified 149 inflicted-injury deaths in our population during the 8-year study period. Children residing in households with unrelated adults were nearly 50 times as likely to die of inflicted injuries than children residing with 2 biological parents (adjusted odds ratio: 47.6; 95% confidence interval: 10.4–218). Children in households with a single parent and no other adults in residence had no increased risk of inflicted-injury death (adjusted odds ratio: 0.9; 95% confidence interval: 0.6–1.9). Perpetrators were identified in 132 (88.6%) of the cases. The majority of known perpetrators were male (71.2%), and most were the child’s father (34.9%) or the boyfriend of the child’s mother (24.2%). In households with unrelated adults, most perpetrators (83.9%) were the unrelated adult household member, and only 2 (6.5%) perpetrators were the biological parent of the child. Conclusions. Young children who reside in households with unrelated adults are at exceptionally high risk for inflicted-injury death. Most perpetrators are

  5. Risk profiles for four types of work-related injury among hospital employees: a case-control study.

    PubMed

    Thomas, Nancy I; Brown, Norman D; Hodges, Linda C; Gandy, Jay; Lawson, Louanne; Lord, Janet E; Williams, David K

    2006-02-01

    In this retrospective case-control study, researchers examined risk factors for four types of work-related injury (WRI) in hospital employees. Data were collected from employee health charts and computer databases (N = 2050) and analyzed using logistic regression. Study results showed that strain injuries were related to increased age, increased body mass index (BMI), and maintenance, custodial, and direct-caregiver employment types. Repetitive motion injuries were related to increased BMI and clerical and custodial employment types. Exposure/reaction injuries were related to increased age, increased BMI, and maintenance, custodial, and direct-caregiver employment types. Contact/assault injuries were related to increased age, increased BMI, and maintenance, custodial, and direct-caregiver employment types. All injury types were most often related to female gender and full-time employment status. Reformulating policies to improve screening, prevention, and education for those at risk for certain injury types may limit WRI occurrences and costs.

  6. Characterizing the Epidemiological Transition in Mexico: National and Subnational Burden of Diseases, Injuries, and Risk Factors

    PubMed Central

    Stevens, Gretchen; Dias, Rodrigo H; Thomas, Kevin J. A; Rivera, Juan A; Carvalho, Natalie; Barquera, Simón; Hill, Kenneth; Ezzati, Majid

    2008-01-01

    Background Rates of diseases and injuries and the effects of their risk factors can have substantial subnational heterogeneity, especially in middle-income countries like Mexico. Subnational analysis of the burden of diseases, injuries, and risk factors can improve characterization of the epidemiological transition and identify policy priorities. Methods and Findings We estimated deaths and loss of healthy life years (measured in disability-adjusted life years [DALYs]) in 2004 from a comprehensive list of diseases and injuries, and 16 major risk factors, by sex and age for Mexico and its states. Data sources included the vital statistics, national censuses, health examination surveys, and published epidemiological studies. Mortality statistics were adjusted for underreporting, misreporting of age at death, and for misclassification and incomparability of cause-of-death assignment. Nationally, noncommunicable diseases caused 75% of total deaths and 68% of total DALYs, with another 14% of deaths and 18% of DALYs caused by undernutrition and communicable, maternal, and perinatal diseases. The leading causes of death were ischemic heart disease, diabetes mellitus, cerebrovascular disease, liver cirrhosis, and road traffic injuries. High body mass index, high blood glucose, and alcohol use were the leading risk factors for disease burden, causing 5.1%, 5.0%, and 7.3% of total burden of disease, respectively. Mexico City had the lowest mortality rates (4.2 per 1,000) and the Southern region the highest (5.0 per 1,000); under-five mortality in the Southern region was nearly twice that of Mexico City. In the Southern region undernutrition and communicable, maternal, and perinatal diseases caused 23% of DALYs; in Chiapas, they caused 29% of DALYs. At the same time, the absolute rates of noncommunicable disease and injury burdens were highest in the Southern region (105 DALYs per 1,000 population versus 97 nationally for noncommunicable diseases; 22 versus 19 for injuries

  7. Reducing the risk of noncontact anterior cruciate ligament injuries in the female athlete.

    PubMed

    Barber-Westin, Sue D; Noyes, Frank R; Smith, Stephanie Tutalo; Campbell, Thomas M

    2009-10-01

    High school and collegiate female athletes have a significantly increased risk of sustaining a noncontact anterior cruciate ligament injury compared with male athletes participating in the same sport. This review summarizes the current knowledge of the risk factors hypothesized to influence this problem, and the neuromuscular training programs designed to correct certain biomechanical problems noted in female athletes. The risk factors include a genetic predisposition for sustaining a knee ligament injury, environmental factors, anatomical indices, hormonal influences, and neuromuscular factors. The greatest amount of research in this area has studied differences between female and male athletes in movement patterns during athletic tasks; muscle strength, activation, and recruitment patterns; and knee joint stiffness under controlled, preplanned, and reactive conditions in the laboratory. Neuromuscular retraining programs have been developed in an attempt to reduce these differences. The successful programs teach athletes to control the upper body, trunk, and lower body position; lower the center of gravity by increasing hip and knee flexion during activities; and develop muscular strength and techniques to land with decreased ground reaction forces. In addition, athletes are taught to preposition the body and lower extremity prior to initial ground contact to obtain the position of greatest knee joint stability and stiffness. Two published programs have significantly reduced the incidence of noncontact anterior cruciate ligament injuries in female athletes participating in basketball, soccer, and volleyball. Other programs were ineffective, had a poor study design, or had an insufficient number of participants, which precluded a true reduction in the risk of this injury. In order to determine which risk factors for noncontact anterior cruciate ligament ruptures are significant, future investigations should include larger cohorts of athletes in multiple sports

  8. Risk factors for severe injury in cyclists involved in traffic crashes in Victoria, Australia.

    PubMed

    Boufous, Soufiane; de Rome, Liz; Senserrick, Teresa; Ivers, Rebecca

    2012-11-01

    This study examines the impact of cyclist, road and crash characteristics on the injury severity of cyclists involved in traffic crashes reported to the police in Victoria, Australia between 2004 and 2008. Logistic regression analysis was carried out to identify predictors of severe injury (serious injury and fatality) in cyclist crashes reported to the police. There were 6432 cyclist crashes reported to the police in Victoria between 2004 and 2008 with 2181 (33.9%) resulting in severe injury of the cyclist involved. The multivariate analysis found that factors that increase the risk of severe injury in cyclists involved in traffic crashes were age (50 years and older), not wearing a helmet, riding in the dark on unlit roads, riding on roads zoned 70 km/h or above, on curved sections of the road, in rural locations and being involved in head-on collisions as well as off path crashes, which include losing control of vehicle, and on path crashes which include striking the door of a parked vehicle. While this study did not test effectiveness of preventative measures, policy makers should consider implementation of programs that address these risk factors including helmet programs and environmental modifications such as speed reduction on roads that are frequented by cyclists. PMID:23036419

  9. Risk and Injury Severity of Obese Child Passengers in Motor Vehicle Crashes

    PubMed Central

    Kim, Jong-Eun; Hsieh, Min-Heng; Shum, Phillip C.; Tubbs, R. Shane; Allison, David B.

    2014-01-01

    Objective To investigate the risk and injury severity on the regional body (head, neck, and chest) of obese children in frontal motor vehicle crashes. Design and Methods No physical surrogates (i.e., crash dummies) for obese children are available and experiments on pediatric cadavers are generally not feasible. Therefore, we developed computational models of obese children using medical imaging processing and state-of-the-art modeling techniques. A hybrid modeling technique was used to integrate finite element model for torso fat layer into the standard multibody model to represent various levels of obese children for 3- and 6-year-old age group. The models were used to investigate injury severity under various crash scenarios through model simulations. Results The head injury criterion and chest acceleration were observed to increase as body mass index (BMI) increased. Meanwhile, no such correlations were found between BMI and neck injury and chest deformation. Forward head and torso excursions were observed to increase as obesity increased, owing to the momentum effect of greater body mass. Conclusions Obese children appear to have greater risks of the head and chest injuries than do their non-obese counterparts in frontal motor vehicle crashes, owing to higher head and chest accelerations induced by greater body excursion. PMID:25645729

  10. Rotational head kinematics in football impacts: an injury risk function for concussion.

    PubMed

    Rowson, Steven; Duma, Stefan M; Beckwith, Jonathan G; Chu, Jeffrey J; Greenwald, Richard M; Crisco, Joseph J; Brolinson, P Gunnar; Duhaime, Ann-Christine; McAllister, Thomas W; Maerlender, Arthur C

    2012-01-01

    Recent research has suggested a possible link between sports-related concussions and neurodegenerative processes, highlighting the importance of developing methods to accurately quantify head impact tolerance. The use of kinematic parameters of the head to predict brain injury has been suggested because they are indicative of the inertial response of the brain. The objective of this study is to characterize the rotational kinematics of the head associated with concussive impacts using a large head acceleration dataset collected from human subjects. The helmets of 335 football players were instrumented with accelerometer arrays that measured head acceleration following head impacts sustained during play, resulting in data for 300,977 sub-concussive and 57 concussive head impacts. The average sub-concussive impact had a rotational acceleration of 1230 rad/s(2) and a rotational velocity of 5.5 rad/s, while the average concussive impact had a rotational acceleration of 5022 rad/s(2) and a rotational velocity of 22.3 rad/s. An injury risk curve was developed and a nominal injury value of 6383 rad/s(2) associated with 28.3 rad/s represents 50% risk of concussion. These data provide an increased understanding of the biomechanics associated with concussion and they provide critical insight into injury mechanisms, human tolerance to mechanical stimuli, and injury prevention techniques.

  11. Knee anterior laxity: a risk factor for traumatic knee injury among sportswomen?

    PubMed

    Vauhnik, Renata; Morrissey, Matthew C; Rutherford, Olga M; Turk, Zmago; Pilih, Iztok A; Pohar, Maja

    2008-09-01

    The purpose of this study was to investigate if knee anterior laxity, measured with an arthrometer, is a risk factor for traumatic knee injury in sportswomen. To allow a more complete analysis, other, easily measured variables such as anthropometry, lower leg characteristics, sport exposure and menstrual cycle characteristics were also evaluated as possible risk factors. Subjects were Slovenian sportswomen aged between 11 and 41 years participating in basketball, team handball and volleyball (N = 540). Sportswomen were tested in the pre-season and followed for one season. The data collection included: written informed consent, background questionnaire, anthropometric tests, leg dominance assessment, navicular drop test (measurement of foot pronation), passive knee extension assessment and measurement of knee anterior laxity with a KT arthrometer. Several sets of data analysis were performed including logistic regression analysis in order to build a model for predicting traumatic knee injury among sportswomen. Height and average hours of training per week were found to differ significantly (P < 0.05) between injured and uninjured sportswomen. More sportswomen injured their non-dominant leg. Traumatic knee injuries among Slovenian sportswomen participating in basketball, team handball and volleyball are associated with higher amounts of training, greater body height and greater knee anterior laxity. Only 1% of the variability in traumatic knee injuries among sportswomen were explained with those variables suggesting that there are many other variables associated with traumatic knee injuries among sportswomen than were tested in this study.

  12. Interpersonal violence: an important risk factor for disease and injury in South Africa

    PubMed Central

    2010-01-01

    Background Burden of disease estimates for South Africa have highlighted the particularly high rates of injuries related to interpersonal violence compared with other regions of the world, but these figures tell only part of the story. In addition to direct physical injury, violence survivors are at an increased risk of a wide range of psychological and behavioral problems. This study aimed to comprehensively quantify the excess disease burden attributable to exposure to interpersonal violence as a risk factor for disease and injury in South Africa. Methods The World Health Organization framework of interpersonal violence was adapted. Physical injury mortality and disability were categorically attributed to interpersonal violence. In addition, exposure to child sexual abuse and intimate partner violence, subcategories of interpersonal violence, were treated as risk factors for disease and injury using counterfactual estimation and comparative risk assessment methods. Adjustments were made to account for the combined exposure state of having experienced both child sexual abuse and intimate partner violence. Results Of the 17 risk factors included in the South African Comparative Risk Assessment study, interpersonal violence was the second leading cause of healthy years of life lost, after unsafe sex, accounting for 1.7 million disability-adjusted life years (DALYs) or 10.5% of all DALYs (95% uncertainty interval: 8.5%-12.5%) in 2000. In women, intimate partner violence accounted for 50% and child sexual abuse for 32% of the total attributable DALYs. Conclusions The implications of our findings are that estimates that include only the direct injury burden seriously underrepresent the full health impact of interpersonal violence. Violence is an important direct and indirect cause of health loss and should be recognized as a priority health problem as well as a human rights and social issue. This study highlights the difficulties in measuring the disease burden from

  13. Self-injury and aggression in tuberous sclerosis complex: cross syndrome comparison and associated risk markers

    PubMed Central

    2014-01-01

    Background Research reporting prevalence rates of self-injurious and aggressive behaviour in people with tuberous sclerosis complex (TSC) is limited. No studies have compared rates of these behaviours in TSC with those in other syndrome groups matched for degree of disability or investigated risk markers for these behaviours in TSC. Methods Data from the Challenging Behaviour Questionnaire were collected for 37 children, aged 4 to 15 years, with TSC. Odds ratios were used to compare rates of self-injury and aggression in children with TSC with children with idiopathic autism spectrum disorder (ASD), fragile X, Cornelia de Lange and Down syndromes. Characteristics were measured using the Mood Interest and Pleasure Questionnaire, the Activity Questionnaire, the Social Communication Questionnaire, the Repetitive Behaviour Questionnaire, the Wessex Behaviour Schedule and the revised Non-communicating Children Pain Checklist. Mann-Whitney U analyses were used to compare characteristics between individuals with self-injury and aggression and those not showing these behaviours. Results Rates of self-injury and aggression in TSC were 27% and 50%, respectively. These are high but not significantly different from rates in children with Down syndrome or other syndrome groups. Both self-injury and aggression were associated with stereotyped and pain-related behaviours, low mood, hyperactivity, impulsivity and repetitive use of language. Children who engaged in self-injury also had lower levels of interest and pleasure and showed a greater degree of ‘insistence on sameness’ than children who did not self-injure. Aggression was associated with repetitive behaviour. The majority of these associations remained significant when the association with level of adaptive functioning was controlled for. Conclusions Behavioural profiles can be used to identify those most at risk of developing self-injury and aggression. Further research is warranted to understand the influence of

  14. Needle stick injuries among dental students: risk factors and recommendations for prevention

    PubMed Central

    Gaballah, Kamis; Warbuton, Dorothy; Sihmbly, Kamal; Renton, Tara

    2012-01-01

    Aim To evaluate the risk factors of needle stick injuries (NSIs) sustained by undergraduate dental students and nurse students at the King's College London (KCL) Dental Institute. Materials and methods A retrospective study evaluated the incident reports relating to NSIs reported over a period of 2 years. Factors including the dental department, study year, and when the injury took place during administration of local anaesthesia (LA) and recapping conventional syringe or clearing work surface or during disposal. Results This report showed that students are at the highest risk of NSIs at the fourth year of their 5-year BDS course. About one-third of injuries were reported among this group of students followed by year 5 students (25%). Oral surgery clinics were the major source of incident reporting when compared with other specialised dental clinics within the institute. The left hands of the students were the most frequently affected by such injuries and then the right hands of student dental nurses. The attempt of needle recapping of conventional syringes was the least reported mechanism of injuries and constituted only 15% of the total injuries and mainly occurred in third year students. The most frequent injuries among student nurses were during disposal of the needle. Conclusion Less NSIs occur when using safety syringes. A non-recapping policy with immediate disposal of either the conventional or safety syringe systems after injection would prevent all clearance-related NSIs sustained by nurses. To avoid NSIs, education plays a vital role particularly with effective implementation of the change to safety syringes with appropriate training. PMID:22741025

  15. An inversion identified in acl1-1 mutant functions as an enhancer of the acl1-1 phenotype.

    PubMed

    Kamata, Naoko; Komeda, Yoshibumi

    2008-08-01

    The Arabidopsis acaulis1-1 (acl1-1) mutant exhibits severe growth defects when grown at 22 degrees C. The leaves are tiny and curled and the inflorescence stems are short. We identified an inversion mutation in the original acl1-1 plants. The acl1-1 plants were crossed with Columbia wild-type, and the acl1-1 phenotype and the inversion were segregated in the F2 generation. Compared to the original acl1-1 plants with the inversion, the genuine acl1-1 plants without the inversion grew larger and their inflorescence stems grew longer at 22 degrees C. When the plants were grown at 24 degrees C, the differences in growth became more apparent. We investigated the expression of genes located in the inversion. Two genes that were located at each end of the inversion were disrupted, and full-length transcripts were not expressed. Expressions of some genes within and adjacent to the inversion were also altered. Our results indicate that the expression of multiple genes may be involved in the enhancement of the acl1-1 phenotype.

  16. Risk Factors Associated with Injury and Mortality from Paediatric Low Speed Vehicle Incidents: A Systematic Review

    PubMed Central

    Paul Anthikkat, Anne; Page, Andrew; Barker, Ruth

    2013-01-01

    Objective. This study reviews modifiable risk factors associated with fatal and nonfatal injury from low-speed vehicle runover (LSVRO) incidents involving children aged 0–15 years. Data Sources. Electronic searches for child pedestrian and driveway injuries from the peer-reviewed literature and transport-related websites from 1955 to 2012. Study Selection. 41 studies met the study inclusion criteria. Data Extraction. A systematic narrative summary was conducted that included study design, methodology, risk factors, and other study variables. Results. The most commonly reported risk factors for LSVRO incidents included age under 5 years, male gender, and reversing vehicles. The majority of reported incidents involved residential driveways, but several studies identified other traffic and nontraffic locations. Low socioeconomic status and rental accommodation were also associated with LSVRO injury. Vehicles were most commonly driven by a family member, predominantly a parent. Conclusion. There are a number of modifiable vehicular, environmental, and behavioural factors associated with LSVRO injuries in young children that have been identified in the literature to date. Strategies relating to vehicle design (devices for increased rearward visibility and crash avoidance systems), housing design (physical separation of driveway and play areas), and behaviour (driver behaviour, supervision of young children) are discussed. PMID:23781251

  17. Pilot evaluation of an adolescent risk and injury prevention programme incorporating curriculum and school connectedness components.

    PubMed

    Chapman, R L; Buckley, L; Sheehan, M; Shochet, I M

    2013-08-01

    School connectedness is an important protective factor for adolescent risk-taking behaviour. This study examined a pilot version of the Skills for Preventing Injury in Youth (SPIY) programme, combining teacher professional development (PD) for increasing school connectedness (connectedness component) with a risk and injury prevention curriculum for early adolescents (curriculum component). A process evaluation was conducted on the connectedness component, involving assessments of programme reach, participant receptiveness and initial use, and a preliminary impact evaluation was conducted on the combined connectedness and curriculum programme. The connectedness component was well received by teacher participants, who saw benefits for both themselves and their students. Classroom observation also showed that teachers who received PD made use of the programme strategies. Grade 8 students who participated in the SPIY programme were less likely to report violent behaviour at 6-month follow-up than were control students, and trends also suggested reduced transport injuries. The results of this research support the use of the combined SPIY connectedness and curriculum components in a large-scale effectiveness trial to assess the impact of the programme on students' connectedness, risk-taking and associated injuries.

  18. Costs of reproduction in a long-lived female primate: injury risk and wound healing

    PubMed Central

    Archie, Elizabeth A.; Altmann, Jeanne; Alberts, Susan C.

    2014-01-01

    SUMMARY Reproduction is a notoriously costly phase of life, exposing individuals to injury, infectious disease, and energetic tradeoffs. The strength of these costs should be influenced by life history strategies, and in long-lived species, females may be selected to mitigate costs of reproduction because life span is such an important component of their reproductive success. Here we report evidence for two costs of reproduction that may influence survival in wild female baboons—injury risk and delayed wound healing. Based on 29 years of observations in the Amboseli ecosystem, Kenya, we found that wild female baboons experienced the highest risk of injury on days when they were most likely to be ovulating. In addition, lactating females healed from wounds more slowly than pregnant or cycling females, indicating a possible tradeoff between lactation and immune function. We also found variation in injury risk and wound healing with dominance rank and age: older and low-status females were more likely to be injured than younger or high-status females, and older females exhibited slower healing than younger females. Our results support the idea that wild non-human primates experience energetic and immune costs of reproduction, and they help illuminate life history tradeoffs in long-lived species. PMID:25045201

  19. [Alcohol and the ri