In this study, sports participation was the most common mechanism, but not to the same extent seen in the European or US military studies. Basketball was the most commonly involved sport, as compared to soccer in Europe. Age and BMI had a directly proportional correlation with time to diagnosis.

Level III, retrospective review.

We studied the medium-term outcome of the Bernese periacetabular osteotomy in 52 patients (58 hips) with symptomatic developmental dysplasia of the hip and a mean age of 37.6 years (13 to 48). The operations were performed between 1993 and 2005 by the senior author with a mean follow-up of 66.7 months (13 to 153). There were 42 women (47 hips) and ten men (11 hips). Of these patients, 24 (30 hips) had an osteotomy on the right side and 22 (28 hips) on the left. Six patients had bilateral operations. The clinical outcome was assessed using the modified Merle d'Aubigne scale, and pre- and post-operative radiological evaluation using the modified Tonnis osteoarthritis score, the centre-edge angle, the acetabular index, the status of Shenton's line, and the cross-over sign. The mean centre-edge angle and the acetabular index were 14 degrees (2 degrees to 34 degrees ) and 23.6 degrees (0 degrees to 40 degrees ) before operation, and 36.6 degrees (16 degrees to 72 degrees ) and 7.9 degrees (0 degrees to 28 degrees ) after, respectively (p < 0.001, analysis of variance (ANOVA)). Shenton's line was intact in 23 hips (39.6%) before operation and in 48 hips (82.8%) after. The cross-over sign was present in 31 hips (53.4%) before and in three hips (5.2%) after operation (p < 0.001, ANOVA). The total Merle d'Aubigne clinical score improved from a mean of 12.6 (9 to 15) to 16.0 (12 to 18) points (p < 0.001, ANOVA). Only four hips required subsequent total hip replacement. Our results indicate that the Bernese periacetabular osteotomy provides good symptomatic relief for patients with little to no arthritis (Tonnis type 0 or 1) with an underlying deformity that can be corrected to a position of a stable, congruent hip joint.

Background Achilles tendon ruptures are common in middle-aged athletes. Diagnosis is based on clinical examination or imaging. Although MRI is commonly used to document ruptures, there is no literature supporting its routine use and we wondered whether it was necessary. Questions/purposes We (1) determined the sensitivity of physical examination in diagnosing acute Achilles ruptures, (2) compared the sensitivity of physical examination with that of MRI, and (3) assessed care delays and impact attributable to MRI. Methods We retrospectively compared 66 patients with surgically confirmed acute Achilles ruptures and preoperative MRI with a control group of 66 patients without preoperative MRI. Clinical diagnostic criteria were an abnormal Thompson test, decreased resting tension, and palpable defect. Time to diagnosis and surgical procedures were compared with those of the control group.

This investigation suggests that up to 5 mm of physiologic motion can occur at the pubic symphysis in asymptomatic individuals, as demonstrated by alternating-single-leg-stance radiographs.

No abstract

Level IV, prospective case series.

Context:Anterior cruciate ligament (ACL) reconstruction is a safe, common, and effective method of restoring stability to the knee after injury, but evolving techniques of reconstruction carry inherent risk. Infection after ACL reconstruction, while rare, carries a high morbidity, potentially resulting in a poor clinical outcome.Evidence Acquisition:Data were obtained from previously published peer-reviewed literature through a search of the entire PubMed database (up to December 2012) as well as from textbook chapters.Results:Treatment with culture-specific antibiotics and debridement with graft retention is recommended as initial treatment, but with persistent infection, consideration should be given to graft removal. Graft type likely has no effect on infection rates.Conclusion:The early diagnosis of infection and appropriate treatment are necessary to avoid the complications of articular cartilage damage and arthrofibrosis.