Pediatric sports elbow injuries.

Elbow injuries in the pediatric and adolescent population represent a spectrum of pathology that can be categorized as medial tension injuries, lateral compression injuries, and posterior shear injuries. Early and accurate diagnosis can improve outcomes for both nonoperative and operative treatments. Prevention strategies are important to help reduce the increasing incidence of elbow injuries in youth athletes.

Arthroscopic management of a chronic primary anterior shoulder dislocation.

Chronic anterior dislocation of the glenohumeral joint often leads to functional impairment and pain. Duration of dislocation is correlated with complications, and this injury is traditionally treated with an open procedure. A right-hand - dominant woman in her late 70s presented with traumatic chronic anterior dislocation of the glenohumeral joint.

The rising incidence of acromioplasty.

Background: Acromioplasty is considered a technically simple procedure but has become controversial with regard to its indications and therapeutic value.

Methods: Two complementary databases were used to ascertain the frequency of acromioplasty over a recent span of time. In Part A, the New York Statewide Planning and Research Cooperative System (SPARCS) ambulatory surgery database was searched from 1996 to 2006 to identify all ambulatory surgery acromioplasties as well as all orthopaedic ambulatory surgery procedures.

Nonoperative treatment of superior labrum anterior posterior tears: improvements in pain, function, and quality of life.

Background: Although there are multiple reports documenting successful outcomes with operative treatment of superior labrum anterior posterior (SLAP) tears, there are few reports on the results of nonoperative treatment.

Hypothesis: Nonoperative treatment of SLAP tears will result in improved outcomes over pretreatment values using validated, patient-derived outcome instruments.

Study Design: Case series; Level of evidence, 4.

Treatment of glenohumeral arthrosis.

The successful diagnosis and treatment of glenohumeral arthrosis in the young and active patient can be challenging to even the most experienced of clinicians. A thorough preoperative evaluation, including a detailed understanding of patient expectations, facilitates the selection of a treatment strategy. Arthroscopy is the gold standard for detecting chondral injuries, and it is increasingly used as an effective first line of management.

Management of the throwing shoulder: cuff, labrum and internal impingement.

Repetitive throwing or other overhead activity places great stress on the shoulder. As a result, the shoulder is a common site of injury in athletes. Addressing throwing-related injuries requires an understanding of throwing biomechanics and pathology.

Surgical treatment of distal biceps rupture.

Rupture of the distal biceps tendon accounts for 10% of all biceps brachii ruptures. Injuries typically occur in the dominant elbow of men aged 40 to 49 years during eccentric contraction of the biceps. Degenerative changes, decreased vascularity, and tendon impingement may precede rupture.

Current treatment strategies for bicolumnar distal humerus fractures.

Management of distal humerus fractures continues to challenge orthopaedic surgeons. The unique and complex anatomy of the distal humerus, involving the ulnohumeral and radiocapitellar joints, makes anatomic reduction difficult and hardware placement challenging. However, long-term results of well-performed open reduction and internal fixation demonstrate satisfactory outcomes in most patients.

Childhood obesity.

Obesity is increasing at an alarming rate throughout the world. Today it is estimated that there are more than 300 million obese people world-wide. Obesity is a condition of excess body fat often associated with a large number of debilitating and life-threatening disorders.

Interobserver and intraobserver reliability of the Walch classification in primary glenohumeral arthritis.

Introduction: In 1999, Walch et al introduced a novel classification scheme for glenoid morphology in patients with primary glenohumeral arthritis and reported substantial intraobserver and interobserver reliability. This classification system has been widely used by shoulder surgeons but a recent independent evaluation revealed considerable lower agreement. The goal of this study was to evaluate the reproducibility of the Walch classification.

Improving bone density at the rotator cuff footprint increases supraspinatus tendon failure stress in a rat model.

The purpose of this study was to investigate whether supraspinatus tendon failure stress at the footprint can increase by improving the bone density at the rotator cuff footprint in a rat model. Bilateral ovariectomies were performed in twenty-four 4-month-old Sprague-Dawley rats. Half received bisphosphonate (zoledronic acid) and the other half received no treatment (OVX + ZOM and OVX, respectively).

Partial humeral head resurfacing and Latarjet coracoid transfer for treatment of recurrent anterior glenohumeral instability.

Bone deficiencies of either the humeral head or glenoid fossa may cause recurrent shoulder instability following soft tissue stabilization procedures. The engaging Hill-Sachs lesion, a major risk factor for instability, has been identified in a majority of patients with recurrent anterior instability. Guidance for surgical management of large humeral head deficiency presents few available options, with even fewer clinical data to support any one technique.

Distal biceps tendon repair: a cadaveric analysis of suture anchor and interference screw restoration of the anatomic footprint.

Background: Distal biceps tendon repair with interference screw or double suture-anchor fixation are 2 successful techniques performed with either 1- or 2-incision approaches. No study has examined the accuracy and quality of the repaired tendon footprint with these devices and approaches.

Hypothesis: A 2-incision approach will allow a more anatomic repair of the distal biceps footprint compared with a 1-incision anterior approach.

The docking technique for medial patellofemoral ligament reconstruction: surgical technique and clinical outcome.

Background: Current techniques of medial patellofemoral ligament (MPFL) reconstruction vary with respect to methods of fixation on the femur and the patella. This article presents the outcomes of a surgical technique for reconstruction of the MPFL that uses a soft tissue graft with interference screw fixation on the femur and a docking technique for fixation on the patella.

Hypothesis: Patients with patellar instability who are treated with the docking technique for MPFL reconstruction will have improvements in knee symptoms and function, with a high percentage achieving good to excellent results at early follow-up.

Evaluation of glenoid capsulolabral complex insertional anatomy and restoration with single- and double-row capsulolabral repairs.

Background: The purpose of this study was to evaluate the normal glenoid insertional anatomy of the anterior-inferior capsulolabral complex and to compare the ability of a single-row repair and a double-row suture bridge repair to restore the insertional anatomy.

Methods: Eight fresh frozen cadaver shoulders were dissected and the native glenoid insertion of the anterior-inferior capsulolabral complex was digitized. Bankart lesions were created, the shoulders were randomized to receive either the standard single-row suture anchor repair or a double-row suture bridge repair, and the insertion repair sites were then digitized.

Simulation of surgical glenoid resurfacing using three-dimensional computed tomography of the arthritic glenohumeral joint: the amount of glenoid retroversion that can be corrected.

Hypothesis: The magnitude of glenoid retroversion that can be surgically corrected in total shoulder arthroplasty and still enable implantation of a glenoid component has not been established. We hypothesized that increased retroversion will require smaller glenoid components for successful implantation when the glenoid is surgically corrected and that correction beyond 20 degrees of retroversion is not feasible without peg penetration.

Methods: Using 3-dimensional models created from computed tomography of 19 patients with advanced shoulder osteoarthritis, we simulated glenoid resurfacing on varying degrees of retroverted, osteoarthritic glenoids using an in-line 3-peg glenoid component and asymmetric reaming to correct version.

Elbow medial collateral ligament injuries.

Elbow medial collateral ligament sprain occurs when the elbow is subjected to a valgus force exceeding the tensile properties of the medial collateral ligament (MCL). This is an injury seen more often in throwing athletes. Understanding the differential diagnosis of medial elbow pain is paramount to diagnose MCL injury as well as addressing other medial elbow pathology.

The ruptured Achilles tendon: operative and non-operative treatment options.

The Achilles tendon is the strongest and thickest tendon in the human body. Like any other tendon in the body, however, it is susceptible to rupture. Many surgeons advocate early operative repair of the ruptured Achilles tendon, citing decreased re-rupture rates and improved functional outcome.

Medial collateral ligament injuries of the knee: current treatment concepts.

The medial collateral ligament is one of the most commonly injured ligaments of the knee. Most injuries result from a valgus force on the knee. The increased participation in football, ice hockey, and skiing has all contributed to the increased frequency of MCL injuries.

The effects of timing of pediatric knee ligament surgery on short-term academic performance in school-aged athletes.

Background: Orthopaedic injuries negatively affect the academic lives of children.

Hypothesis: The timing of anterior cruciate ligament (ACL) and medial patellofemoral ligament (MPFL) reconstructions affects academic performance in school-aged athletes.

Study Design: Cohort study; Level of evidence, 2.

Two-dimensional strain fields on the cross-section of the human patellofemoral joint under physiological loading.

The objective of this study was to provide a detailed experimental assessment of the two-dimensional cartilage strain distribution on the cross-section of the human patellofemoral joint (PFJ) subjected to physiological load magnitudes and rates. The medial side of six human PFJs sectioned along their mid-sagittal plane was loaded up to the equivalent of two body weights on a whole joint, and strain measurements obtained from digital image correlation are reported at 0.5s.

Investigation of the frictional response of osteoarthritic human tibiofemoral joints and the potential beneficial tribological effect of healthy synovial fluid.

Objective: This study tests the hypothesis that the natural progression of osteoarthritis (OA) in human joints leads to an increase in the friction coefficient. This hypothesis is based on the expectation that the wear observed in OA may be exacerbated by higher friction coefficients. A corollary hypothesis is that healthy synovial fluid (SF) may help mitigate the increase in the friction coefficient in diseased joints.

Rotator cuff repair fluid extravasation characteristics are influenced by repair technique.

Background: This study evaluates rotator cuff repair fluid extravasation characteristics for different rotator cuff repair techniques.

Methods: Eight fresh-frozen cadaveric shoulders were dissected free of soft tissues, with the glenohumeral joint capsule and rotator cuff muscles being left intact. A custom fluid infusion device was used to deliver fluid at constant pressure into the glenohumeral joint.