Achilles Tendon Ruptures in Young Female Basketball Players: A Case Series.

Achilles tendon ruptures are a common entity in middle-aged male athletes. There have been limited reports of these injuries in female athletes in general and no reports that we are aware of teenage female athletes with complete tears that required surgical intervention. We present a case series of three female basketball players treated at the same institution by the same surgeon under the age of 20 over a 9-month period with complete Achilles tendon ruptures that underwent surgery. Clinicians should be aware of this pathology when seeing female athletes with calf pain

Herniated disc disease: diagnostics

This issue of eMedRef provides information to clinicians on the pathophysiology, diagnosis, and therapeutics of herniated disc disease

Outcomes of intra-articular corticosteroid injections for adolescents with hip pain.

Intra-articular injection of corticosteroid and anesthetic (CSI) is a useful diagnostic tool for hip pain secondary to labral tears or femoroacetabular impingement (FAI). However, the effectiveness of CSI as a stand-alone treatment for hip pain in adolescents is unknown. The purpose of this study is to evaluate the use of CSI for the treatment of hip pain and determine factors that may affect outcomes after injection. Retrospective analysis of 18 patients and 19 hips that underwent fluoroscopic guided hip injection for the treatment of pain at a single institution from 2012 to 2015 was carried out in this study. Mean age at the time of injection was 15.1 years (range 13-17) with mean follow-up of 29.4 months. Fifty-two percent (10/19 hips) went on to surgery after the injection. Average time to surgical conversion was 12.8 months after CSI. Cam or pincer morphologies were present in 90% (9/10 hips) of the operative group. Patients with FAI were more likely to need surgery than patients without bony abnormalities (RR= 10, 95% CI 1.6-64.2, P = 0.0001). There was no difference in the presence of labral tears in the operative and non-operative groups (100% versus 89%, P = 0.47). For adolescents without bony abnormalities, 90% improved with CSI alone and did not require further treatment within 2.4 years. Fluoroscopic guided corticosteroid hip injection may have limited efficacy for the treatment of hip pain secondary to FAI in adolescents. However, for patients without osseous deformity, CSI may offer prolonged improvement of symptoms even in the presence of labral tears

Use of Posterior Hamstring Harvest During Anterior Cruciate Ligament Reconstruction in the Pediatric and Adolescent Population.

Background:Posterior hamstring harvest has been described in the adult population in a limited fashion, but no study is available describing the use of posterior hamstring harvest in an active pediatric and adolescent cohort. At times, surgeons may be faced with a challenging anterior harvest due to patient anatomic characteristics, particularly the anatomic features and size of the pes tendons. Clinicians need to have multiple harvest approaches at their disposal. Complications with hamstring harvest such as premature graft transection are more problematic in this population due to higher failure rates with allograft tissue. The posterior harvest via its more proximal location may allow for easier tendon identification, visualization of the accessory attachments, and longer preserved tendon length if transection error occurs when the anterior approach is avoided based on surgical technique, patient anatomic characteristics, and surgeon and patient preference. Purpose:To describe the technique of a posterior hamstring harvest in pediatric and adolescent patients and to analyze complications. Study Design:Case series; Level of evidence, 4. Methods:This study was a retrospective review of a consecutive series of pediatric and adolescent patients who underwent posterior hamstring harvest. During surgery, the patient's leg was abducted and externally rotated to expose the posteromedial aspect of the knee. A 2-cm incision was made overlying the palpable medial hamstring at the popliteal crease. The posterior hamstring tendons were first harvested proximally with an open tendon stripper and distally with a closed stripper. Preoperative, intraoperative, and postoperative findings and complications were analyzed. Results:A total of 214 patients (mean ± SD age, 15.7 ± 4.1 years; range, 8.0-19.8 years) underwent posterior harvest, with a mean ± SD follow-up of 1.83 ± 1.05 years. No complications occurred in our series related to graft harvest-no graft transections, neurovascular injuries, secondary procedures for wound healing or closure, cosmetic concerns, or limitations in return to activity due to the posterior incision. Conclusion:The posterior hamstring harvest is a safe and reliable technique to harvest autograft tendon in pediatric and adolescent anterior cruciate ligament reconstructions. The posterior technique entailed no complications related to harvest. No patients expressed any cosmetic concerns about their incision or had limitations in return to sport due to the posterior harvest

Comparing Outcomes Between the Over-the-Top and All-Epiphyseal Techniques for Physeal-Sparing ACL Reconstruction: A Narrative Review.

A variety of techniques are used for physeal-sparing anterior cruciate ligament (ACL) reconstruction; however, there is no clear consensus on the ideal surgical technique, the frequency of complications, and how to best avoid growth disturbance. The purpose of this study was to compare outcomes and complications between over-the-top and all-epiphyseal ACL reconstruction techniques. The hypothesis was that both physeal-sparing reconstruction techniques are efficacious, with similar risk of growth disturbance and complications. The Embase and PubMed databases were queried for studies on ACL ruptures in the skeletally immature population from 1985 to 2018. Full-text English studies were included (N = 160). Studies reporting rerupture and/or complications after physeal-sparing ACL reconstruction, specifically growth disturbance, were included (n = 10). Studies were separated into 2 groups: an all-epiphyseal group with femoral and tibial fixation points within the epiphysis and a group that had over-the-top femoral and tibial physeal-sparing reconstruction. Complications not specific to the pediatric population were excluded. Demographics, evaluation of skeletal maturity, surgical technique, growth disturbance, rerupture, and patient-reported outcome scores were collected. Data were analyzed in aggregate. The 10 studies included 482 knees. The mean age was 12.0 years; 81% of patients were male; and mean follow-up was 47.7 months. A total of 178 patients underwent all-epiphyseal reconstruction, and 298 had the femoral graft placed over the top. The rerupture rate was 9.0% (16 of 178) in the all-epiphyseal group and 7.2% (14 of 195) in the over-the-top group, of which 82% required revision reconstruction. Six patients had overgrowth in the all-epiphyseal group (mean, 1.8 cm) and 1 patient in the over-the-top group (1.5 cm). Three angular deformities occurred, all of which were in the over-the-top group. Both physeal-sparing ACL reconstruction techniques are successful. Overgrowth was more common in the all-epiphyseal group and angular deformity in the over-the-top group. Rerupture rates were similar between the groups. The authors recommend standardization of skeletal age assessment and baseline lower extremity alignment films

Reducing Power Consumption in Sensor Network Using Sensor MAC Protocol

© ASEE 2009Wireless sensor networks are quickly gaining popularity due to the fact that they are potentially low cost solutions to a variety of real world challenges. Their low cost provides a means to deploy large sensor arrays in a variety of conditions capable of performing both military and civilian tasks. This technology consists of some of the electronic devices which work to run this system successfully and all those have some amount of power consumptions. It is a challenge of maximizing the processing capabilities and energy reserves of Wireless sensor nodes while also securing them against attackers. So, finally we have decided to work on finding out the optimum solution for controlling the power and saving energy. There are number of ways to reduce power consumption and MAC protocol is one of them. So we describe Sensor MAC protocol to reduce power consumption

Open reduction of proximal humerus fractures in the adolescent population.

PURPOSE: Proximal humerus fractures in the pediatric population are a relatively uncommon injury, with the majority of injuries treated in a closed fashion due to the tremendous remodeling potential of the proximal humerus in the skeletally immature. Yet, in adolescent patients, open treatment is, at times, necessary due to unsatisfactory alignment following a closed reduction, loss of previously achieved closed reduction, and limited remodeling when close to skeletal maturity. The purpose of our study was to examine the open reduction of adolescent proximal humerus fractures. METHODS: A retrospective review of the outcomes of proximal humerus fractures in the adolescent population which were consecutively treated at our institution with open reduction was performed. RESULTS: Ten children met the inclusion criteria, with a mean age of 14.3 years (±1.3) and a mean weight of 60.7 kg (±14.9) at the time of injury. There were seven Salter-Harris 2 fractures and three Salter-Harris 1 fractures. The largest mean angulation was 55.0° (±33.9) and the largest mean displacement was 87.0 % (±22.8). Intra-operatively, impediments to closed reduction within the fracture site which were found included: periosteum (90.0 %), biceps tendon (90.0 %), deltoid muscle (70.0 %), and comminuted bone (10.0 %). K-wire fixation was most commonly used (70.0 %), followed by flexible nails (20.0 %) and cannulated screws (10.0 %) for fixation. All patients achieved radiographic union at a mean of 4.0 weeks (±0.7), had non-painful full shoulder range of motion and rotator cuff strength at final follow-up (mean 7.7 ± 4.6 months), and returned to pre-injury sporting activities. CONCLUSIONS: The operative treatment of proximal humerus fracture, particularly in adolescents with severe displacement/angulation having failed closed methods of treatment, is increasingly considered to be an acceptable modality of treatment. In addition to the long head of the biceps, periosteum, deltoid muscle, and bone fragments in combination can prevent fracture reduction. Surgeon preference and skill should dictate implant choice, and the risk of physeal damage utilizing these implants in this age group is low

Effects of Early Sport Specialization on Injury Load Management and Athletic Success of National Basketball Association Players.

BackgroundThe effects of early sport specialization on professional athletes resilience in handling increased workloads and athletic success have not been fully described.HypothesisNational Basketball Association (NBA) players who were multisport athletes during high school would be able to withstand higher workloads with lower injury rates and have more athletic success compared with their single-sport peers.Study designDescriptive epidemiology study.MethodsIncluded were first-round NBA draft picks from 2013 to 2023 who had played ≥1 game in their first 3 seasons after being drafted. Athletes who had participated in ≥1 high school sports in addition to basketball were classified as multisport athletes, while those who had only played basketball were classified as single-sport athletes. For each players first 3 NBA seasons, workload data (number of games played and distance traveled per game/season in meters), injury history, statistical performance (player efficiency rating), and end-of-season award history were collected through the official NBA advanced statistics database and through publicly available records.ResultsOverall, 318 athletes were included, of whom 87 (27.4%) were multisport and 231 (72.6%) were single-sport. During their first 3 seasons combined, multisport athletes played in significantly more games (148.9 ± 67.1 vs 125.8 ± 63.8; P < .01), traveled greater total distances (133,183.9 ± 239,923.0 m vs 73,879.5 ± 165,093.9 m; P < .01), and had a significantly lower percentage of games missed due to injury (13.5% vs 16.9%; P < .001) compared with single-sport athletes. There was a significant correlation between increased workload (total distance traveled) and number of injuries in single-sport athletes (ρ = 0.37; P < .001) but not in multisport athletes (ρ = 0.14; P = .20). Last, multisport players had a significantly higher player efficiency rating (12.8 ± 11.6 vs 10.5 ± 5.1; P < .05) and award achievement likelihood (40.2% vs 19.0%; P < .001).ConclusionNBA players who had participated in multiple sports during high school demonstrated an ability to withstand higher workloads while having fewer games missed due to injury when compared with players who had only played basketball. Furthermore, athletes who delayed sport specialization had greater statistical and award success in their professional careers than those who focused on early single-sport specialization

The Effects of Microplastics on Musculoskeletal Disorder; A Narrative Review.

PURPOSE OF REVIEW: The physical health impacts of microplastics have received increasing attention in recent years. However, limited data impedes a full understanding of the internal exposure to microplastics, especially concerning the musculoskeletal system. The purpose of this review is to summarize the recent literature regarding the effects of microplastics on the musculoskeletal system. RECENT FINDINGS: Microplastics have been shown to cause abnormal endochondral ossification and disrupt the normal function of pre-osteoblasts, osteocyte-like cells, and pre-osteoclasts through gene mutations, endoplasmic reticulum stress induction, and reduced autophagosome formation in bone growth areas. Although there are few reports on their effects on muscle, it has been noted that microplastics inhibit energy and lipid metabolism, decrease type I muscle fiber density, impair muscle angiogenesis, cause muscle atrophy, and increase lipid deposition. Only a few recent studies have shown that microplastics interfere with the normal function of bone growth-related cells and reduce muscle mass and quality. This review underscores the need for further research into other parts of the musculoskeletal system and studies using human tissues at the disease level