From 1980 to 1985, 40 patients under the age of 14 with open physes were treated for midsubstance tears of the ACL at the Methodist Sports Medicine Center. In this series, 16 were treated conservatively with rehabilitation, bracing, and counseling on activity modification. The remaining 24 patients underwent arthroscopic examination and either an extraarticular or intraarticular reconstruction based on growth potential. The average followup was 27 months for the conservative group and 26 months for the surgical group. In the conservative group, six patients underwent arthroscopy for meniscal tears, four medial and two lateral. Only seven patients returned to sports, all experiencing recurrent episodes of giving way, effusions, and pain. In the surgical group, 12 medial and 6 lateral meniscal tears were found at arthroscopy. There were 10 extraarticular reconstructions and 14 intraarticular reconstructions. All 24 returned to sports activity, and 22 of the 24 are still competing. The two remaining patients both suffered reinjury 3 years after their surgery. We recommend arthroscopy and examination under anesthesia for the young patient with ACL tears. Based on the amount of instability, presence or absence of meniscal tears, and athletic desires of the patient and his or her family, a treatment plan can be undertaken.

To evaluate the theory that isolated posterior cruciate ligament injuries do well when treated nonoperatively, we reviewed 40 patients (mean age, 33 years at followup; average interval from injury, 6 years) who completed a modified Noyes knee questionnaire and were reevaluated by physical examination, radiographs, and isokinetic testing. Thirty of the injuries to the posterior cruciate ligament were sports-related. On the questionnaire, 65% of the patients revealed that their activity level after injury was limited and 49% stated that the involved knee had not recovered fully despite rehabilitation. Ninety percent complained of knee pain with activity and 43% complained of problems with walking. The longer the interval between injury and this followup, the lower the knee questionnaire score and the greater the radiographic degenerative changes. The patients as a group exhibited excellent muscular strength with a mean isokinetic score of 99% of the contralateral extremity. There was no correlation between isokinetic testing and knee questionnaire score. Patients with greater posterior laxity, as measured by the posterior drawer examination, appeared to have greater subjective complaints. Our study suggests that patients with isolated posterior cruciate ligament injuries treated nonoperatively may maintain excellent muscle strength, but significant symptoms and degenerative changes increase with increasing interval from injury.

Between 1976 and 1988 we treated 75 junior high athletes who had midsubstance ruptures of the anterior cruciate ligament and open physes. Thirty-eight children were initially treated conservatively and later had an intraarticular patellar tendon graft reconstruction, 2 patients underwent extraarticular reconstruction and then later had a patellar tendon graft intraarticular reconstruction, and 20 children had a patellar tendon graft reconstruction initially. In all 60 patients the tibial and femoral tunnels were drilled through the open physes. Minimum followup was 2 years (mean, 4.2). Fifty-five of the 60 children were able to return to their original sports; 5 were active in less strenuous sports. No incidence of abnormal growth related to the intraarticular reconstructive surgery was recorded. Three children tore their anterior cruciate ligament grafts more than 2 years after surgery. Our records showed that conservative treatment of the active junior high athlete with an anterior cruciate ligament rupture failed in each case because of recurrent giving way or meniscal tears. Definitive treatment with an intraarticular autogenous patellar tendon graft reconstruction yielded good to excellent results and eliminated subsequent instability episodes and meniscal tears in our study group.

Thirty-nine subjects volunteered for this blinded, randomized, and controlled study to assess the clinical examination skills of orthopaedic surgeons with fellowship training in sports medicine. Eighteen of the patients had 19 chronic isolated posterior cruciate ligament tears. The controls were 9 patients with 9 anterior cruciate ligament-deficient knees, 12 subjects with normal knees, and the contralateral normal knees of the ligament-deficient patients. To eliminate preexamination bias, all examiners were blinded from the examinee's history, identity, and diagnosis. The overall clinical examination accuracy for all orthopaedic surgeons was 96%. The accuracy for detecting a posterior cruciate ligament tear was 96%, with a 90% sensitivity and a 99% specificity. The examination accuracy was higher for grade II and III posterior laxity than for grade I laxity. Eighty-one percent of the time, the examiners agreed on the grade of the posterior cruciate ligament tear for any given patient. The posterior drawer test, which included palpation of the tibia-femur step-off, was the most sensitive and specific clinical test. A thorough and precise physical examination, coupled with a patient history, can be considered diagnostic in the majority of isolated posterior cruciate ligament injuries. With this accuracy level known, the natural history of isolated posterior cruciate ligament tears can be reliably documented and studied.

In brief Professional golfers' injuries are usually related to their swings. A wide variety of acute and chronic injuries have been reported, including carpal fractures, ulnar and median nerve neuropathies, tendinitis, skin rashes, and eye injuries. There have been two deaths. In this study questionnaires were mailed to 500 professional golfers, and 226 were returned. During their careers 103 men and 87 women were injured, an average of two injuries per player. The left wrist, lower back, and left hand were most commonly injured. Repetitive practice swings caused the most injuries in both men and women.