Biomedical subjects

D N Caborn

Publications and source records attributed to D N Caborn.

At least 19 recordsLinked to original sources

PubMed2001

Delayed gastrocnemius muscle response to sudden perturbation in rehabilitated patients with anterior cruciate ligament reconstruction.

This nonrandomized, posttest-only comparison between two experimental groups and a control group compared the lower extremity muscle activation latencies of patients following rehabilitated unilateral anterior cruciate ligament (ACL) reconstruction (allograft or autograft bone-patellar tendon-bone tissue) and normal control subjects. Twenty-three subjects (seven allograft, eight autograft, eight normal control) of similar age, height, weight, isokinetic knee extensor, and flexor peak torque/bodyweight, functional capability (single leg broad jump and single leg vertical jump) and recreational activity level participated in this study. Experimental group subjects were 21.3+/-5 months (allograft) and 27.6+/-10 months (autograft) after surgery. Kinematic and electromyographic data were sampled during ten randomly timed unilateral perturbations. Experimental group gastrocnemius latencies were delayed (allograft 59.5+/-25 ms, autograft 69+/-20 ms) compared to the control group (31.8+/-11 ms). The allograft (r=0.80) and autograft (r=0.40) unilateral ACL reconstruction groups displayed moderate and weak positive relationships between anterior knee laxity and knee angular displacements following perturbation, respectively. Control group subjects did not display significant relationships between these variables (r=-0.07). In the allograft group there was also a moderate inverse relationship between gastrocnemius latency and knee angular displacement following perturbation (r=-72). The autograft (r=-0.06) and control (r=-0.21) groups did not show similar relationships between these variables. Delayed gastrocnemius latencies for the experimental groups suggested prolonged neuromuscular deficits during weight-bearing dynamic knee stabilization. Knee angular displacement magnitude following sudden perturbation was related more strongly to knee laxity and gastrocnemius latency among subjects who had undergone ACL reconstruction using allograft bone-patellar tendon-bone tissue.

Adult↗

PubMed2001

Posterior cruciate ligament reconstruction (double bundle) using anterior tibialis tendon allograft.

Posterior cruciate ligament (PCL) reconstruction using a double-bundle technique has been described. However, reconstruction with a cryopreserved anterior tibialis tendon allograft and bioabsorbable fixation has not been described. The purpose of this article is to present this surgical technique with discussion and rationale for its indication and use in patients with PCL-deficient knees.

Absorbable Implants↗

PubMed2000

Technical note: alternative soft-tissue graft preparation technique for cruciate ligament reconstruction.

Reconstruction of both the anterior cruciate ligament and posterior cruciate ligament has become increasingly common in orthopaedic practice. Once the gold standard for graft choice, the bone-patellar tendon-bone autograft has lost favor because of complications associated with its use. Attention has turned to other graft sources that lack a bone plug on 1 or both sides, such as hamstring autograft, and allografts including quadriceps, Achilles, and tibialis anterior tendons. We have developed a technique for graft preparation that can be used for a wide range of graft choices that has been shown both to provide better protection of the graft from interference screw damage, and to increase sequential compression of the graft in the bony tunnel, enhancing pull-out strength.

Anterior Cruciate Ligament↗

PubMed2000

Biomechanical comparison of quadriceps tendon fixation with patellar tendon bone plug interference fixation in cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to use current fixation techniques and compare the stiffness and ultimate tensile failure of the tendinous end of the quadriceps tendon (QT) with the bone plug end of the bone-patellar tendon-bone (BPTB) graft using current techniques of fixation. TYPE OF STUDY: Randomized trial of elderly cadaver knees. MATERIALS AND METHODS: Tibial and femoral biodegradable interference fixation and femoral EndoButton (Smith & Nephew, Acufex, Mansfield, MA) fixation in bone tunnels with the QT and the BPTB graft were compared by using 10 pairs of elderly cadavers and biomechanical testing. Two groups, fixation at time zero (simulating fixation in the operating room) and testing after 1, 000 loading cycles (simulating patient rehabilitation exercises), were used. RESULTS: At time zero fixation, stiffness of the soft tissue QT tibial tunnel interference fixation was 59% less stiff than the stiffness of the interference fixation of a BPTB plug in a femoral tunnel (P =.11). The EndoButton femoral fixation resulted in a decrease in stiffness at time zero compared with femoral tunnel interference fixation of the soft tissue QT (P =.03). All groups improved stiffness with cycling the construct to 1,000 cycles. CONCLUSIONS: Placement of the QT tendinous end of the graft in the femoral bone tunnel when using a interference fixation will approximate the stiffness of a bone plug in the tibial bone tunnel with interference fixation. The EndoButton fixation is not as stiff as either of the femoral interference fixation options. The addition of more than 20 loading cycles could remove laxity from the graft fixation-graft cruciate ligament complex and improve its stiffness.

Anterior Cruciate Ligament↗

PubMed2000

Radiographic analysis of femoral tunnel position in anterior cruciate ligament reconstruction.

Successful reconstruction of the anterior cruciate ligament (ACL) depends on anatomic placement of a graft ligament substitute. This study examined the accuracy of a plain radiograph in determining femoral tunnel position during ACL reconstruction. Nine cadaveric distal femurs had six separate tunnels made in each specimen: 12:00 (high position), 1:30 (anatomic position), and 3:00 (low position) in the left femora and 12:00 (high), 10:30 (anatomic), and 9:00 (low) in the right femora. At each position on the clock face, two 9-mm tunnels were drilled, leaving 2 mm (correct) and 12 mm (incorrect) of posterior wall intact. With a radiopaque tunnel dilator in each tunnel, a true lateral radiograph, a 10 degree externally rotated lateral radiograph, and a 10 degree internally rotated lateral radiograph were obtained. All radiographs were analyzed for femoral tunnel placement in the anteroposterior plane with the four-quadrant method described by Harner et al and the ratio method described by Aglietti et al. Statistically significant differences could only be distinguished between anatomic (10:30), anterior (12-mm rim), and posterior (2-mm rim) positions. There were no statistically significant differences for any of the other positions when comparing true laterals to true laterals, true laterals to internal or external oblique views, or when comparing internal and external oblique views. A malpositioned anterior tunnel (12-mm rim posterior), which was "low" at 9:00 or "high" at 12:00 in the notch (malplaced), could not be distinguished reliably from an anatomically correct placed tunnel with a single-plane lateral radiograph.

Analysis of Variance↗

PubMed1999

Hamstring extensibility and transverse plane knee control relationship in athletic women.

Athletic women are at particular risk for sustaining a non-contact anterior cruciate ligament (ACL) injury. The hamstrings are vital to providing dynamic knee motion control in the sagittal and transverse planes during running stance, and some have suggested this function is enhanced when they are less extensible. This study attempted to determine the correlational relationships between hamstring extensibility and transverse plane knee kinematics and from these data to describe the dynamic transverse plane knee motion control capabilities of the hamstrings. Twenty normal athletic women (mean +/- SD; aged 21 +/- 1.6 years; height 163.3 +/- 5.7 cm; weight 60.1 +/- 3.6 kg) were evaluated for active hamstring extensibility and transverse plane knee kinematic relationships during crossover-cut stance phase. Following crossover-cut training (3 weeks) using the left (preferred) lower extremity as the stance limb, hamstring extensibility was measured. Following this, subjects were fitted with 9 retroreflective markers denoting the local segmental coordinate systems (3 markers each) of the left foot, leg and thigh. Kinematic (3-dimensional, four phase-locked cameras, 200 Hz) knee and ankle data were sampled and analyzed. Descriptive statistics and Pearson correlations between hamstring extensibility and knee and ankle kinematic variables were calculated. Statistical significance was set at P < or = 0.05 with Bonferroni adjustments. Hamstring extensibility (12 degrees +/- 8 degrees terminal extension) revealed low but significant positive correlations with tibial external rotation (6 degrees +/- 10.7 degrees) at heelstrike (19.3 degrees +/- 8.5 degrees knee flexion) (r = 0.62, P = 0.004) and tibial internal rotation (-13 degrees +/- 8.4 degrees) at peak knee flexion (57.8 degrees +/- 9.3 degrees) following heelstrike (r = 0.47, P = 0.01). Increased hamstring extensibility resulted in increased tibial external rotation at heelstrike and decreased tibial internal rotation at peak knee flexion. Increased hamstring extensibility may improve knee extensor efficiency at heelstrike by enabling greater tibial external rotation and protect the ACL at peak knee flexion by decreasing the tibial internal rotation magnitude.

Adult↗

PubMed1999

An anatomic evaluation of T-Fix suture device placement for arthroscopic all-inside meniscal repair.

This investigation documented the locations of endoscopically applied T-Fix suture devices (Acufex Microsurgical, Mansfield, MA) placed in six fresh-frozen cadaveric knees (age, 60 to 72 years) in relationship to the joint capsule, and adjacent neurovascular and musculotendinous structures. Five T-Fix devices were placed in the posterior meniscal regions at approximately 20 degree intervals. Gross dissection enabled T-Fix bar and suture placement identification. Fifty total devices were placed (23 medially and 27 laterally). Lateral: None of the devices penetrated more superficially than the deepest capsular layer (layer III). Six of the 27 devices placed at the posterior horn of the lateral meniscus pierced the popliteus tendon. None of the bars pierced the lateral collateral ligament (layer III). All devices placed at the posterolateral knee were outside the arcuate ligament (layer III) but inside the fabellofibular ligament (layer II). Medial: Seven of the 23 devices pierced the deep medial collateral ligament (MCL, layer III), and 4 pierced the superficial MCL (layer II). Three devices pierced the sartorius tendon (layer I) and one pierced the gracilis tendon (layer II). None of the medial devices created a plicating effect on the posterior capsule. None of the devices were placed near neurovascular structures. Devices placed within the posterior meniscal horns had a > or =1.5-cm buffer zone from the popliteal neurovascular bundle. Most bars (36 of 50) were anchored to the capsular layer (layer III) after piercing the meniscocapsular junction (layer II). T-Fix devices simulating arthroscopic all-inside meniscal repair provided well-positioned, solid suture anchorage through the junction with no neurovascular involvement. Care needs to be taken when placing lateral (popliteus muscle) and medial (gracilis, sartorius tendons and superficial MCL) devices to avoid possible soft tissue tenodesis.

Aged↗

PubMed1999

The radiographic position of medial and lateral meniscal horns as a basis for meniscal reconstruction.

This investigation attempted to determine the radiographic position of human meniscal horn bony insertion sites. This information would prove vital for anatomically correct osseous tunnel placement necessary for the restoration of a functional meniscus after reconstructive surgery. The native bony insertion sites of the medial and lateral meniscus in 13 fresh-frozen human cadaver knees were radiographically examined. After insertion site outline with 22-gauge fine wire, anteroposterior and lateral radiographs were obtained. Radiographic landmarks were then described in detail. Each meniscal horn was found to have a distinct bony insertion site with characteristic and consistent radiographic landmarks defining its margins. Using an arthroscopic guide, 3/32-inch fine wires were drilled into the center of the lateral (5 specimens) and medial (5 specimens) meniscal horns to validate these locations and to establish the clinical usefulness of these measures. Improved understanding of meniscal horn insertion site locations should improve osseous tunnel placements during meniscal transplantation. In the presence of a properly sized allograft, anatomically correct tunnel placement increases the likelihood of restoring normal meniscal function.

Arthroscopy↗

PubMed1999

Electromyographic timing analysis of forward and backward cycling.

PURPOSE: Backward walking to running progressions are becoming a popular, nontraditional component of functional knee rehabilitation programs. The purpose of this electromyographic (EMG) and motion analysis study was to compare the activation duration of the vastus medialis, vastus lateralis, rectus femoris, medial hamstrings, lateral hamstring, tibialis anterior, and gastrocnemius muscles during forward and backward cycling. We hypothesized that the hamstrings would demonstrate greater activation duration during backward cycling. METHODS: The right lower extremity of 12 healthy subjects (6 male and 6 female) was instrumented with surface EMG electrodes and retroreflective markers to confirm lower extremity kinematic consistency between conditions. RESULTS: Statistical analysis of hip, knee, and ankle kinematics (200 Hz sampling rate) and gender failed to reveal significant differences between conditions (P > 0.05). Quadrant analysis of muscle activation duration with Bonferroni corrections for multiple comparisons revealed that medial and lateral hamstring activation duration was greater during the early recovery phase (quadrant III) of backward cycling than forward cycling (P < 0.00156). Rectus femoris activation duration was greater in the early propulsive phase of backward cycling (quadrant 1) (P < 0.00156) and in the early recovery phase of forward cycling (quadrant III) (P < 0.00156). CONCLUSIONS: These findings lend support for the use of backward cycling during the early recovery phase (quadrant III) to achieve a selective hamstring muscle response of relatively decreased patellofemoral stress and anterior cruciate ligament strain.

Adult↗

PubMed1999

Shoulder proprioception: latent muscle reaction times.

PURPOSE: The purpose of this study was to identify electromyographic (EMG) differences in the latent muscle reaction timing (LMRT) of the rotator cuff between trained overhead throwers and control subjects in response to sudden internal rotation perturbation (P < or = 0.05). METHODS: Subjects included 15 trained overhead throwers (male intercollegiate baseball players) and 15 untrained subjects (males not active in competitive throwing sports). Subjects were tested while seated, with their dominant glenohumeral joint positioned in 90 degrees abduction/external rotation (scapular plane), their elbow flexed to 90 degrees, and their forearm placed in the perturbation device. Rotator cuff LMRT was assessed as they tried to decelerate a variably timed, sudden internal rotation force. EMG sampling (2000 Hz, 2-s duration) began immediately before perturbation. RESULTS: Trained throwers had slower infraspinatus (P = 0.011) and teres minor (P = 0.024) LMRT and decreased supraspinatus (P = 0.001) and posterior deltoid (P = 0.0001) muscle activation duration compared with control subjects. CONCLUSIONS: These results suggest that the rotator cuff muscles of trained throwers may be downregulated in response to sudden internal rotation perturbation. Although these adaptations would enable greater internal rotation velocities during overhead throwing, they may also contribute to glenohumeral joint pathology. The identification of changes in rotator cuff LMRT in response to sudden internal rotation perturbation suggests an area of acquired neuromuscular imbalance warranting consideration by those involved in the rehabilitation and conditioning of the overhead throwing athlete.

Adolescent↗

PubMed1999

Intrarater reliability of selected clinical outcome measures following anterior cruciate ligament reconstruction.

STUDY DESIGN: Single group repeated measures following anterior cruciate ligament (ACL) reconstruction. OBJECTIVES: The purpose of this study was to evaluate the intrarater reliability of selected clinical outcome measures in patients having ACL reconstruction. BACKGROUND: Several investigations have reported the reliability of isokinetic testing and knee ligament arthrometry. Fewer studies have examined the reliability of lower extremity functional tests, with most of these studies evaluating normal subjects. METHODS AND MEASURES: Fifteen physically active males with unilateral ACL-reconstructed knees were evaluated with the KT-1000, Biodex isokinetic dynamometer, and 3 functional hop tests on 5 occasions. RESULTS: Intraclass correlation coefficients (ICCs) revealed good to high intrarater reliability (ICC > 0.80) of the functional hop tests and isokinetic peak torque values ICCs were higher for the involved limb than the uninvolved limb using the scores from the KT-1000 Manual Maximum Test. CONCLUSIONS: The outcome measures examined in this investigation have been shown to be reliable in patients with ACL reconstructions, and support previous investigations in nonimpaired populations. Further research is needed to examine the validity of these postoperative outcome measures in patients with ACL reconstructions.

Adolescent↗

PubMed1999

Effects of a 2-hour cheerleading practice on dynamic postural stability, knee laxity, and hamstring extensibility.

STUDY DESIGN: One group; pretest, posttest design. OBJECTIVE: To assess the effect of a 2-hour cheerleading practice on the anterior knee laxity, hamstring extensibility, and dynamic postural stability (preferred stance leg during vision-denied unilateral stance) of 17 nonimpaired members of a college cheerleading team (8 females, 9 males; 18-25 years old). BACKGROUND: Anterior knee laxity and hamstring extensibility increase following exercise. The relationship between exercise induced anterior knee laxity, hamstring extensibility, and dynamic postural stability, however, has not been examined. METHODS AND MEASURES: Pre- and postpractice measurements were compared using paired t tests and Bonferroni's correction for multiple comparisons. A 3 x 2 analysis of variance (force level applied to the arthrometer by condition) and Tukey honest significant difference post hoc test were used to evaluate specific arthrometer force level by condition effects (P < .05). RESULTS: Mean laxity at 133 N and hamstring extensibility increased (mean +/- SD) 1.5 +/- 1 mm and 3 +/- 4 degrees, respectively, following practice. Mean medial-lateral stabiliometer platform angulation (frontal plane position) moved medially following practice (2.9 +/- 3 degrees) and produced a weak correlation with increased knee laxity (r = 0.58). Hamstring extensibility did not significantly relate to stabiliometry or knee laxity variables. CONCLUSIONS: The relationship between the medially directed platform angulation and the increase in anterior knee laxity following cheerleading practice suggests a relationship between subtalar joint position and anterior cruciate ligament strain.

Adolescent↗

PubMed1999

Does pulsed low intensity ultrasound allow early return to normal activities when treating stress fractures? A review of one tarsal navicular and eight tibial stress fractures.

We sought to evaluate the efficacy of daily pulsed low intensity ultrasound (LIUS) with early return to activities for the treatment of lower extremity stress fractures. Eight patients (2 males, 6 females) with radiographic and bone scan confirmed tibial stress fractures participated in this study. Additionally, a case report of a tarsal navicular stress fracture is described. All patients except one were involved in athletics. Prior to the study, subjects completed a 5 question, 10 cm visual analog scale (VAS) regarding pain level (10 = extreme pain, 1 = no pain) and were assessed for functional performance. Subjects received 20-minute LIUS treatments 5 times a week for 4 weeks. Subjects maintained all functional activities during the treatment period. Seven patients with posterior-medial stress fractures participated without a brace. Subjects were re-tested after 4 weeks of treatment. Mann-Whitney U tests (VAS data) and paired t-tests (functional tests) assessed statistical significance (p<0.05). Although the intensity of practice was diminished in some instances, no time off from competitive sports was prescribed for the patients with the tibial stress fractures. The patient with the anterior tibial stress fracture underwent tibial intramedullary nailing at the conclusion of a season of play. In this uncontrolled experience, treatment of tibial stress fractures with daily pulsed LIUS was effective in pain relief and early return to vigorous activity without bracing for the patients with posterior-medial stress fractures.

Basketball↗

PubMed1999

Crossover cutting during hamstring fatigue produces transverse plane knee control deficits.

OBJECTIVE: To assess the effects of eccentric work-induced hamstring fatigue on sagittal and transverse plane (axial) knee and ankle biodynamics and kinetics during a running crossover cut directional change (functional pivot shift). DESIGN AND SETTING: A pretest-posttest, single-group intervention experimental design was employed. All data were collected in a biodynamics laboratory. SUBJECTS: Twenty healthy athletic females were trained for 3 weeks in crossover cutting before testing. MEASUREMENTS: Data were sampled during 3 unfatigued and 3 fatigued (20% eccentric isokinetic knee-flexor torque reduction) crossover cut trials. Three-dimensional kinematic and ground reaction-force data were sampled at 200 Hz and 1000 Hz, respectively, and joint moment estimates were calculated. Data were standardized to initial force-plate heelstrike for comparisons of mean differences between conditions using paired t tests with Bonferroni adjustments. Pearson product-moment correlations compared kinematic and eccentric hamstring-torque relationships. RESULTS: During internal rotation phase 1, between heelstrike and impact absorption, mean internal rotation velocity increased by 21.2 degrees /s +/- 114 degrees /s. During internal rotation phase II, mean peak transverse plane knee rotation during propulsion decreased by 3.1 degrees +/- 9 degrees . During internal rotation phase II, mean peak ankle plantar flexor moment onsets occurred 12.7 +/- 53 milliseconds earlier, and this activation demonstrated a moderately positive relationship with the onset of mean peak knee internal rotation during propulsion and a weak negative relationship with mean peak hamstring torque/lean body weight. CONCLUSIONS: The increased knee internal rotation velocity during phase I indicates transverse plane dynamic knee-control deficits during hamstring fatigue. Earlier peak ankle plantar-flexor moments and decreased internal rotation during phase II in the presence of hamstring fatigue may represent compensatory attempts at dynamic knee stabilization from the posterior lower leg musculature during the pivot shift portion of the crossover cut. The weak relationship between decreased hamstring torque/lean body weight and delayed knee internal rotation during propulsion further supports greater dependence on ankle plantar flexors for dynamic knee stabilization compensation.

Journal Article↗

PubMed1999

The relationship of body weight and clinical foot and ankle measurements to the heel forces of forward and backward walking.

OBJECTIVE: To compare and contrast the relationships of selected static clinical measurements with the heel forces of forward and backward walking among healthy high school athletes. DESIGN AND SETTING: Single-group, cross-order-controlled, repeated-measures design. All data were collected in a high school athletic training room. SUBJECTS: Seventeen healthy high school student-athlete volunteers. MEASUREMENTS: We performed static clinical measurements of the foot, ankle, and knee using handheld goniometers. We used a metric ruler to assess navicular drop and a beam balance platform scale to measure body weight. Mean peak heel forces were measured using F-scan insole force sensors. Data were sampled for 3 5-second trials (50-Hz sampling rate). Mean peak heel forces were determined from 3 to 5 consecutive right foot contacts during forward and backward walking at approximately 4.02 to 4.83 km/h (2.5 to 3.0 mph). Subjects wore their own athletic shoes and alternated their initial walking direction. RESULTS: Forward stepwise multiple regression analyses revealed that body weight, navicular drop, and standing foot angle predicted mean peak heel forces during forward and backward walking. CONCLUSIONS: Heel forces during forward and backward walking increase as body weight and navicular drop magnitude increase, and they decrease as standing foot angle increases. Subtle differences in foot, ankle, and knee joint postures and kinematics can affect heel forces even among normal subjects. Injury and protective bracing or taping may further affect these heel forces.

Journal Article↗

PubMed1998

The human glenohumeral joint. A proprioceptive and stability alliance.

The glenohumeral joint, because of its relatively poor osseous and capsuloligamentous stability, depends upon the proprioceptive and stabilizing capabilities of musculotendinous structures more than any other joint in the human body. The purpose of this review is to compare the morphology, histology, and sensorimotor functional relationships of the human glenohumeral joint with the more abundant animal research data. From a synthesis of this information, a proprioceptive and stability alliance is proposed for the human glenohumeral joint which is initiated by mechanoreceptor activation from capsuloligamentous and musculotendinous structures, resulting in reflex-mediated protective muscular responses that are ultimately under the bias and sensitivity control of upper levels of the central nervous system hierarchy. The clinical impact of these findings as they relate to rehabilitation and conditioning strategies, surgical intervention, aging, and injury are discussed in addition to future research directions.

Aging↗

PubMed1998

Quadrupled semitendinosus-gracilis autograft fixation in the femoral tunnel: a comparison between a metal and a bioabsorbable interference screw.

Although semitendinosus-gracilis (SG) grafts for anterior cruciate ligament reconstruction have many potential benefits, effective fixation remains a challenge. This study assessed differences between the maximum pullout forces needed to detach a quadrupled SG graft from a femoral tunnel when secured by either a metal or a bioabsorbable interference screw. Sixteen paired fresh frozen quadrupled SG autografts (x, 8.4 mm; range, 7-10 mm) from 8 donors were anchored into cadaveric femoral tunnels by either a 7-mm metal or a 7-mm bioabsorbable screw after bone mineral density (BMD) assessment and before undergoing a longitudinal 20 mm/min traction force. Statistical analysis compared BMD (gm/cm2), insertional torque (N-m), and maximum load at pullout (N) between screw types. Insertional torques (.28-1.21, N-m range) did not correlate (P>.05) to BMD or maximum load at pullout (x +/- S.D.) 242 +/- 90.7 N (metal screw) and 341.1 +/- 162.9 N (bioabsorbable screw). Differences did not exist between the maximum load at pullout for bioabsorbable or metal screw fixation (P = .16). Careful graft preparation, sizing, and matched tunnel placement enables interference fit and fixation capable of reliably withstanding the low-level rehabilitation loads to which the graft is exposed until bony ingrowth occurs.

Absorption↗

PubMed1998

The pars interarticularis stress reaction, spondylolysis, and spondylolisthesis progression.

OBJECTIVE: To review the classification, etiology, clinical and radiologic evaluation, and management of the pars interarticularis stress reaction, spondylolysis, and spondylolisthesis progression. DATA SOURCES: Grateful Med was searched from 1980 to 1998 using the terms "spondylolysis," "spondylolisthesis," "female athlete" "spondylogenic," and "pars interarticularis." DATA SYNTHESIS: The progression from pars interarticularis stress reaction through spondylolysis to spondylolisthesis is common in adolescent athletes, and, because of hormonal influences and cheerleading and gymnastic maneuvers, females are particularly at risk. Proper diagnosis and management include a thorough evaluation, radiographs (possibly with technetium bone scan or single-photon emission computed tomography), activity modification, dietary counseling, a therapeutic exercise program focusing on proper trunk and hip muscle strength and extensibility balances, and education regarding proper back postures, positioning, lifting mechanics, and jump landings. CONCLUSIONS/RECOMMENDATIONS: The athletic trainer plays an integral part in managing this injury progression, particularly with identifying at-risk individuals and intervening appropriately.

Journal Article↗