We reviewed 13 patients with end stage jumper's knee, 10 with patellar tendon ruptures, and 3 with ruptures of the quadriceps tendon to evaluate our long-term results in treating these tendon ruptures in an athletic population. The focus was on the natural history, the time until return, and the level of return, to athletic activity. Jumper's knee affected all patients to a varying degree prior to rupture. Basketball was the most common sport involved. At followup, averaging 4 1/2 years, patients underwent functional and clinical, as well as Cybex and roentgenographic, evaluations. Results indicated patellar tendon ruptures, where the ruptures are complete, have a more favorable prognosis than those of the quadriceps tendon which are incomplete. All of the latter patients continued to have quadriceps tendinitis following repair. In both groups, the poor results were obtained in patients with chondromalacia and/or patella alta. Cybex testing yielded results of greater than 100% strength in three patients with patellar tendon ruptures, but no patient with quadriceps rupture had comparable test results. There was no apparent relationship between ruptures and cortisone injections. Patellar and quadriceps tendon ruptures from indirect injury in athletes represent the end stage of jumper's knee and result from repetitive microtrauma. Excellent function usually follows repair of patellar tendon ruptures when surgery is performed early and care is taken to restore normal patellar tendon length. Results of quadriceps ruptures are less satisfactory since these ruptures are usually incomplete and all degenerative tissue may not be involved in the healing response.
A review of 107 cases in which the Bristow-Helfet procedure was done for recurrent anterior shoulder subluxation and dislocation is presented. The redislocation rate was 2% with very few complications. Eighty-nine percent of the patients were satisfied with the procedure. Mean loss of external rotation was 12.6 degrees. Six of the 41 patients with dominant shoulder surgery were capable of throwing in the same manner as they did prior to injury. Five of 24 patients (21%) with a diagnosis of recurrent anterior subluxation continued to have symptoms of instability following surgery. Associated symptoms of posterior or voluntary subluxation may preclude a satisfactory result.
Posterior shoulder lesions have terminated the careers of throwing athletes.We wish to present four case reports of posterior shoulder lesions which underwent operative intervention in an attempt to alleviate the individual's symptomatology and permit a return to throwing. The four cases are those of active professional baseball players whose careers were all but terminated due to intractable posterior shoulder symptoms during and after throwing. None of the individuals responded to multiple conservative regimens.The basic operative approach in the four cases (F. W. J., primary surgeon) was as follows: with the patient prone and the involved extremity draped free, an incision was made over the scapula spine laterally; the deltoid was reflected from the spine and split in the interval between the middle and posterior thirds; the posterior capsule and glenoid were reached between the interval of the infraspinatus and teres minor; the capsule was opened longitudinally; the lesion was identified and removed (Fig. 1); closure of the capsule and various layers was carried out.Postoperatively a sling was used for 1 week, followed by progressive active range of motion exercises for 3 weeks. Throwing was commenced at 8 to 10 weeks. Pitching began at three-quarter speed at 12 to 14 weeks and at full speed at 4 to 5 months. CASE REPORTSCase 1-G. N. This 25-year-old right-handed professional pitcher initially presented with a complaint of right shoulder pain of 2-year duration. The patient's initial problem was noted 2 years earlier and was characterized by a gradual onset of diffuse pain while throwing with significant velocity. The patient noted pain throughout the 1972 season in the posterior shoulder region. Temporary relief was gained with rest and injections of local analgesic and steroid compounds. The patient's performance level during the 1972 season was below normal. Due to persistence of symptoms, the patient was unable to participate in the 1973 season. Over the course of time, the pain localized deep to the area of the junction of the posterior middle third of the right deltoid. With attempts at throwing, the patient had pain as well as a feeling of weakness. There was no history of paresthesia nor radiculitis.Various oral medications brought about no relief, nor did multiple injections of analgesics and steroids by other physicians-approximately 10 in number. The patient noted the pain when placing the arm in the abducted and externally rotated position with the hand behind the head, as well as when placing the involved extremity across the chest in an adducted, internally rotated position.Physical examination revealed a normal range of motion, with approximately 15° more external rotation on the involved extremity than on the uninvolved. No atrophy was noted. Manual moAddress requests for reprints to Dr. Stephen J. Lombardo, 575 East Hardy Street, Inglewood, California 90301.
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