Journal of Orthopaedic & Sports Physical Therapy - Michael J. Axe, MD

Performance Profile-Directed Simulated Game: An Objective Functional Evaluation for Baseball Pitchers*

A. Eugene Coleman, Michael J. Axe, James R. Andrews
To objectively evaluate the function of the throwing shoulder after an injury, a preinjury performance profile should have been recorded and a simulated game based upon this profile be established for comparison. The performance profile must include a strength or power component (fastball velocity), an accuracy component (fastball-for-strike percentage), and an endurance component (the decrease in fastball velocity per inning). The simulated game requires a specific number of innings, a specific number of pitches per inning, a pitch selection ratio, a rest interval between innings, and a means to record the data. This information is not available in most circumstances. The authors have collected data from 98 starting pitchers in the National Baseball League from 1983 through 1985 to develop a profile for those pitchers lacking preinjury performance profiles. Since 1983, in 486 games, 145,886 consecutive pitches were logged using a custom data form and entered into an IBM- 360 computer. Based upon the summation of the performance profiles of these pitchers, a simulated game should be 61/3 + 1 l/3 innings with 15 + 2.4 pitches per inning. The interval between innings pitched should be a minimum of 9 minutes and one should expect a 2% or 1.5 mph decrease in the fastball velocity from the first through the sixth innings with a fastball-for-strike percentage of 64%. While this is a study of major league starting pitchers, the concept of a preinjury performance profile to define full rehabilitation is applicable from the Babe Ruth league through professional baseball.

J Ortho Sports Phys Ther 1987;9(3):101-105.

Proximal Tibiofibular Dislocation/Sublaxation

Michael J. Axe, Lynn Snyder-Mackler

A 19-year-old male soccer player presented with pain in the right anterolateral proximal leg region 5 days after injury. Despite negative plain radiographs and lack of joint deformity there was suspicion of an anterolateral proximal tibiofibular joint dislocation that spontaneously reduced. Magnetic resonance imaging (MRI) confirmed the diagnosis of a recent dislocation.

J Orthop Sports Phys Ther. 2008;38(2):87. doi:10.2519/jospt.2008.0402

KEY WORDS: proximal tibiofibular dislocation

Influence of Age, Gender, and Injury Mechanism on the Development of Dynamic Knee Stability After Acute ACL Rupture

Wendy J. Hurd, Michael J. Axe, Lynn Snyder-Mackler
STUDY DESIGN: Cross-sectional study. OBJECTIVES: To determine whether the distribution of those with and without dynamic knee stability after anterior cruciate ligament (ACL) rupture differs by age, gender, and contact versus non-contact injury mechanisms. BACKGROUND: There is a differential return to preinjury activities after ACL rupture. It is unknown if there are specific patient groups who are more or less likely to experience good dynamic knee stability after ACL rupture. METHODS AND MEASURES: The study sample consisted of 345 consecutive, highly active patients with complete, isolated ACL insufficiency. Based on the results of a screening examination, patients were categorized as having either good (potential coper) or poor (noncoper) dynamic knee stability. Descriptive and chi-square statistics were calculated to describe patient characteristics and identify the proportion of potential copers and noncopers based on age, gender, and injury mechanism. RESULTS: The groups with the greatest proportion of noncopers were women (P=0.002), mid-aged adults (35-44 years old) (P<0.001), and individuals who sustained a noncontact ACL injury (P=0.011). CONCLUSIONS: Women who sustain an ACL rupture, and those who sustain an ACL rupture via a noncontact mechanism frequently experience dynamic knee instability. A profile of demographic characteristics of those most likely to experience knee instability after ACL rupture may facilitate improved patient outcomes. LEVEL OF EVIDENCE: Prognosis, Level 2b.

J Orthop Sports Phys Ther. 2008;38(2):36-41, published online 7 September 2007. doi:10.2519/jospt.2008.2609

KEY WORDS: clinical research, joint instability, knee

Proposed Practice Guidelines for Nonoperative Anterior Cruciate Ligament Rehabilitation of Physically Active Individuals

G. Kelley Fitzgerald, Michael J. Axe, Lynn Snyder-Mackler

Nonoperative management of anterior cruciate ligament (ACL) rupture has not been a successful option for those who participate in high-level physical activity. However, there are instances when patients may want to attempt to return to physically demanding activities with nonoperative rehabilitation for an ACL injury. The purpose of this commentary is to describe guidelines for nonoperative management of physically active individuals with ACL injuries who wish to return to preinjury levels of physical activity. The guidelines are based on the results of 2 clinical studies that improved the overall success of nonoperative management of physically active individuals with ACL ruptures. A decision-making process for selecting appropriate candidates for nonoperative management (rehabilitation candidates) is described. Individuals are classified as rehabilitation candidates if they have no concomitant ligament or mensical damage associated with the ACL injury, have a unilateral ACL injury, and meet all 4 of the following criteria: (1) timed hop test score of 80% or more of the uninjured limb, (2) Knee Outcome Survey Activities of Daily Living Scale score of 80% or more, (3) global rating of knee function of 60% or more, and (4) no more than 1 episode of giving way since the incident injury to the time of testing. Individuals meeting the criteria of a rehabilitation candidate undergo an intensive rehabilitation program before returning to high-level activity. The rehabilitation program consisting of lower extremity muscle strength training, cardiovascular endurance training, agility and sport-specific skill training, and a training program using balance perturbations is described.

J Orthop Sports Phys Ther. 2000;30(4):194-203.

Key Words: anterior cruciate ligament, knee, rehabilitation