Last month's column listed several abstracts of interest. This month I will continue with several more abstracts that will:
Osteochondritis dissecans (osteonecrosis) of the medial condyle of the knee is far more common than with the lateral condyle. The researchers examined the femoral condyles of cadaver knees and found that primarily the superior medial genicular artery supplied the medial condyle and that the intraosseous supply was from a single nutrient artery. The superior and inferior lateral genicular arteries supply the lateral condyle. The intraosseous supply consists of an arcade of vessels with multiple branches.
There appears, then, to be a significant difference between the blood supply to the medial versus the lateral condyle that might account for the more frequent occurrence of osteonecrosis of the medial condyle. Additionally, it was found that the femoral tunnel used in posterior cruciate ligament reconstructions might significantly interfere with the blood supply to the medial condyle, resulting in the observed occurrence of vascular necrosis with this procedure.
I am often asked how to determine who needs anterior cruciate ligament (ACL) reconstruction versus those who would do well with nonoperative approaches such as exercise and bracing. The standard response is that the less active, older individual is less likely to need surgery. But what about all the others? The author of this study developed a questionnaire specific to quality of life for patients with ACL deficiency. It was passed through several stages of refinement, including input from patients and orthopedic surgeons.
The outcome of the pilot study indicates that this 32-item questionnaire was able to distinguish those patients needing surgery versus those whose quality of life was high enough to avoid surgery. The maximum scoring possible is 100. Patients who needed surgery had an average score of only 31/100 versus those who were treated nonoperatively (average score: 79/100). The questionnaire uses a 100mm visual analog scale (VAS) format and surveys several areas of quality, including symptoms and physical complaints, workþrelated concerns, activities and sports, and lifestyle and social/economical factors. The questionnaire is included at the end of the article for your use.
Although chiropractors do not perform surgery, we are often asked whether surgery should be considered for meniscus injury, and also what type of surgery is best. This article helps define some differences between two common arthroscopic approaches to meniscus repair.
It is well-known that total meniscectomy leads to early degenerative changes in the knee. Unfortunately, even partial meniscectomy will often lead to advanced degenerative changes. Therefore, when possible, meniscal repair is recommended. Unfortunately, healing rates are reported between 50% and 89% with two common approaches used: (1) the outside-in and (2) the insideþout technique.
The advantage of the inside-out technique is that it allows for more consistent suture placement perpendicular to the tear; however, it requires a larger incision and involves more risk of neurovascular damage. The outside-in technique reduces the risk and does not require a large incision; however, it only can address anterior and middle-third tears. This is due mainly to the anterior placement of the needles.
This study confirmed that posterior horn tears of the medial meniscus did not heal well or at all with the outside-in technique. The authors recommend the outside-in technique for all lateral meniscus tears and for anterior and middle tears of the medial meniscus, reserving the inside-out technique for posterior tears of the medial meniscus.
Like rugby, soccer utilizes no head protection for its players. The advantage in soccer is that the head can be used to manipulate the ball. Because of this tendency, there has been an attack on this technique (called heading). The accusation is that it leads to head trauma and may lead to serious consequences.
This study indicates that collision with another player accounted for about half of the concussions for men and about 80% for women. The odds of a player having a concussion in soccer over a ten-year period were 50% for men and 22% for women. The authors suggest that the impact from collision would likely be more consequential than from the small impact from a soccer ball. Head injuries account for between 4% to 22% of all soccer injuries (2-3% are concussions). Child and adolescent concussions from football account for up to 10% of all injuries. Comparing concussions as a percentage of all childhood or adolescent injuries, wrestling concussions account for 2%; 11% for horseback riding; 1.9% for rugby; and 1.7% for soccer. For adults, the numbers are 9% of all injuries, 6% of injuries in rugby and 5% of injuries in football.
This is an excellent review of posterior cruciate ligament injury. Included is a detailed review of treatment outcomes using conservative and surgical approaches, drawings and MRI images of the PCL (normal and torn), review of the accuracy of clinical testing procedures, and small algorithms for acute and chronic PCL tear management.
Thomas Souza, DC, DACBSP
San Jose, California
arrwes-aol.com
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
