Paper 187: Fatigue of the Serratus Anterior Muscle During Training in Competitive Swimmers

ABSTRACTS Sprains and fractures of the lower leg among alpine skiers are related to measurable or observable qualities of the release system. Serious sprains of the knee are not. A substantial reduction in injuries below the knee can be expected if potentially defective equipment can be identified and repaired or replaced. Existing standards for retail and rental procedures are adequate to identify such defective equipment. However, training and supervision of shop personnel will have to improve if current lower leg injury rates are to be reduced. Paper 187: Fatigue of the Serratus Anterior Muscle During Training in Competitive Swimmers PERNILLE MADSEN, AALBORG, DENMARK SUSANNE JENSEN, AALBORG, DENMARK ULRICK WELTER, AALBORG, DENMARK KLAUS BAK, COPENHAGEN OE, DENMARK, PRESENTER · CVU, Aalborg, Denmark Introduction: Competitive swimmers are subject to high volume and high repetition training demands. Shoulder injuries are the most common complaint in swimmers. Some investigations suggest that these injuries may be caused by scapular dyskinesis, specifically due to imbalance between the trapezius muscle and the serratus anterior muscle (SA). The purpose of the current study was to evaluate the validity of two simple tests for scapular dyskinesis and furthermore to rule out the prevalence of scapular dyskinesis during a normal swim training session. Material and method: Fourteen competitive swimmers (mean age 17, ranges 15.22 years), with no history of shoulder were tested at four time intervals during a swim training session. The test battery included observations of scapular dyskinesis during simple scaption (3 repetitions) and wall push-ups. Each test was graded from 1 to 3, grade 3 being severe signs of fatigue of the SA. The tests were evaluated for interobserver validity using Kappa-analysis. Results: The scaption test resulted in a weighted Kappavalue of 0.75, and the wall push-up test in a weighted Kappa of 0.69. Fatigue signs were seen in 36% after the first time interval (1/4 of a training session), in another 43 % after one half of the training session, and in another 14% after ¾ of the training session. There were no further cases of SA fatigue during the last quarter of the training session. This result in a cumulated prevalence of objective scapular dyskinesis of 93% in painfree swimmers. Conclusion: A simple scaption test and a wall push-up test result in substantial Kappa-values. The prevalence of abnormal scapular kinesis during a normal training session is dramatically high. Scapular dyskinesis, that can

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lead to secondary impingement, responsible for many cases of painful swimmer’s shoulder, may be susceptible to preventive training. An ongoing intervention study, to rule out the influence of scapula stabilisation exercises and its role on preventing shoulder pain in swimmers, is running. Paper 188: One Stage Arthroscopically Assisted Combined ACL and PCL Reconstruction of the Posterolateral Corner Structures Using Autogenous Hamstring Grafts MICHAEL STROBEL, STRAUBING, GERMANY, PRESENTER WOLF PETERSEN, MUENSTER, GERMANY MARTIN S. SCHULZ, STRAUBING, GERMANY KAI RUSSE, ESSEN, GERMANY · Orthopaedische Gemeinschaftspraxis Straubing, Straubing, Germany Purpose: This study presents the results of 17 arthroscopically assisted one stage reconstructions of the anterior -, (ACL) and posterior cruciate ligament (PCL) with reconstruction of the posterolateral corner structures (PLC) using autogenous hamstring grafts in chronic knee injuries. Type of Study: Prospective case series. Methods: 17 patients (13 men and 4 women) with chronic multiligamentous injuries were reviewed after a minimum follow-up of 2 years (range 24 to 66.3 months). Arthroscopically assisted combined ACL/PCL reconstructions with autogenous semitendinous-, gracilis tendon grafts were performed using the single-incision endoscopic ACL technique and the single femoral tunnel-single bundle transtibial tunnel PCL technique. The PLC were reconstructed with a free autogenous semitendinous tendon graft. All patients were evaluated with a subjective questionnaire, the International Knee Documentation Committee (IKDC) score, radiological assessment, KT-1000 arthrometer testing, stress- radiography and physical examination Results: The mean time from injury to the reconstructive procedure was 70.2 ⫾96.7 months (range 5.1 312.6 months). At final IKDC evaluation 4 patients (29.4%) were graded level B, 10 patients (58.8%) level C and 2 patients (11.8%) level D. The mean postoperative subjective IKDC score was 71.8 ⫾19.3 points. Severe subjective instability was reduced significantly through the operative procedure (p⬍ 0.001). Mean posterior tibial displacement as measured through stress-radiography at 90 of knee flexion was reduced from ⫺15.06 ⫾4.68mm preoperatively to ⫺7.12 ⫾3.37mm postoperatively (p⬍0.001). Mean anterior tibial displacement was 0.94 ⫾ 2.75mm preoperatively compared to ⫺1.59 ⫾3.50mm postoperatively (p⬍0.01). 3 patients exhibited a fixed posterior tibial subluxation (posterior tibial displacement