Osteochondritis Dissecans Lesions of the Knee: Evidence-Based Treatment.

Osteochondritis dissecans (OCD) of the knee is a potentially disabling condition in adolescent and young adults, which is likely multifactorial in origin. In recent years, there have been notable improvements in identification and treatment. Clinical presentation varies based mostly on OCD lesion stability.

A systematic approach to CT evaluation of non-arthritic hip pain.

Bone morphology has been increasingly recognized as a significant variable in the evaluation of non-arthritic hip pain in young adults. Increased availability and use of multidetector CT in this patient population has contributed to better characterization of the osseous structures compared to traditional radiographs. Femoral and acetabular version, sites of impingement, acetabular coverage, femoral head-neck morphology, and other structural abnormalities are increasingly identified with the use of CT scan.

Periacetabular osteotomy after failed hip arthroscopy demonstrates improved outcomes in a heterogenous patient population: a systematic review.

Purpose: To evaluate the literature on patients undergoing periacetabular osteotomy after failed hip arthroscopy (PAO-FHA) for (1) patient demographics and hip morphology, (2) changes in preoperative to postoperative patient-reported outcomes (PROs), and (3) PROs in comparison to primary periacetabular osteotomy (PAO) patients.

Methods: A systematic literature search of Pubmed, CINAHL/Medline, and cochrane databases was performed in accordance with PRISMA guidelines. The search phrase was "(periacetabular osteotomy or PAO or rotational osteotomy) and (hip arthroscopy or arthroscopic)".

Open Ischiofemoral Impingement Decompression.

Ischiofemoral impingement is a relatively rare cause of posterior hip pain associated with narrowing of the space between the lateral aspect of the ischium and the lesser trochanter. Symptoms typically consist of lower buttock, groin, and/or medial thigh pain, which is commonly exacerbated by adduction, extension, and external rotation of the hip. This condition can be treated nonoperatively in many circumstances; however, recalcitrant cases may require surgical intervention.

Groin Pain Syndrome Known as Sports Hernia: A Review.

Importance: Groin pain in active individuals and athletes without clinical evidence of hernia or hip pathologic findings is challenging for health care clinicians and aggravating for those experiencing pain. Frequently called sports hernia or athletic pubalgia, many surgeons continue to refute the diagnosis because there is a lack of consensus and clear comprehension of the basic pathophysiologic features of this groin pain syndrome.

Observations: Understanding the anatomic and pathophysiologic findings of groin pain syndrome is necessary to appropriately treat this problem.

Functional Results and Outcomes After Repair of Partial Proximal Hamstring Avulsions at Midterm Follow-up.

Background: Partial avulsions of the proximal hamstring origin remain a challenging problem with nonoperative treatments frequently providing limited success. The literature is limited regarding the outcomes of operative management in the active and athletic population.

Hypothesis: Surgical fixation of proximal hamstring ruptures will have favorable outcomes at midterm follow-up.

The REVision Using Imaging to Guide Staging and Evaluation (REVISE) in ACL Reconstruction Classification.

Revision anterior cruciate ligament (ACL) procedures are increasing in incidence and possess markedly inferior clinical outcomes (76% satisfaction) and return-to-sports (57%) rates than their primary counterparts. Given their complexity, a universal language is required to identify and communicate the technical challenges faced with revision procedures and guide treatment strategies. The proposed REV: ision using I: maging to guide S: taging and E: valuation (REVISE) ACL (anterior cruciate ligament) Classification can serve as a foundation for this universal language that is feasible and practical with acceptable inter-rater agreement.

A Systematic Summary of Systematic Reviews on the Topic of Hip Arthroscopic Surgery.

Background: There is a rapidly growing body of literature on the topic of hip arthroscopic surgery.

Purpose: To provide an overall summary of systematic reviews published on the indications, complications, techniques, outcomes, and information related to hip arthroscopic surgery.

Study Design: Systematic review; Level of evidence, 4.

Refractory pain following hip arthroscopy: evaluation and management.

With increased knowledge and understanding of hip pathology, hip arthroscopy is rapidly becoming a popular treatment option for young patients with hip pain. Despite improved clinical and radiographic outcomes with arthroscopic treatment, some patients may have ongoing pain and less than satisfactory outcomes. While the reasons leading to failed hip arthroscopy are multifactorial, patient selection, surgical technique and rehabilitation all play a role.

Laparoscopic Treatment of Pubic Symphysis Instability With Anchors and Tape Suture.

Patients with pubic symphysis instability who had failed nonoperative treatments may benefit from surgical repair. This disease process is rare, most commonly seen in postpartum women and athletes, and its surgical treatment is invasive and nonphysiological. Currently described surgical interventions, although limited, include plating, which provides an overly rigid construct with the risk of failure and possibly poor long-term outcomes particularly in athletes, and treatments such as curettage, more commonly used in the treatment of osteitis pubis.

Pain Management After Hip Arthroscopy: Systematic Review of Randomized Controlled Trials and Cohort Studies.

Background: Hip arthroscopy is often associated with significant postoperative pain and opioid-associated side effects. Effective pain management after hip arthroscopy improves patient recovery and satisfaction and decreases opioid-related complications.

Purpose: To collect, examine, and provide a comprehensive review of the available evidence from randomized controlled trials and comparative studies on pain control after hip arthroscopy.

Effect of Glenoid Version and Width on Outcomes of Arthroscopic Posterior Shoulder Stabilization.

Background: Despite an increased awareness of the condition, the diagnosis, classification, and treatment of recurrent posterior shoulder instability remain challenging. No clear relationship has been established between glenohumeral morphologic characteristics and the risk for posterior shoulder instability or with outcomes after treatment.

Purpose: To examine the structure of the glenoid in a large series of athletic patients with symptomatic unidirectional posterior instability and to correlate these findings with the objective and subjective clinical outcome of arthroscopic posterior capsulolabral repair.

Novel measure of articular instability based on contact stress confirms that the anterior cruciate ligament is a critical stabilizer of the lateral compartment.

Knee instability following anterior cruciate ligament (ACL) rupture is common, compromising function, and causing cartilage and meniscal damage. In this study, instability at the level of the articular surfaces was characterized with a new measure: articular instability. Articular instability was defined as the change in location of the center of contact stress per unit of applied load.

The recognition and evaluation of patterns of compensatory injury in patients with mechanical hip pain.

Context: In active individuals with femoroacetabular impingement (FAI), the resultant reduction in functional range of motion leads to high impaction loads at terminal ranges. These increased forces result in compensatory effects on bony and soft tissue structures within the hip joint and hemipelvis. An algorithm is useful in evaluating athletes with pre-arthritic, mechanical hip pain and associated compensatory disorders.

Abnormal tibiofemoral contact stress and its association with altered kinematics after center-center anterior cruciate ligament reconstruction: an in vitro study.

Background: Abnormal tibiofemoral contact stress and aberrant kinematics may influence the progression of osteoarthritis in the anterior cruciate ligament (ACL)-deficient and the ACL-reconstructed knee. However, relationships between contact stress and kinematics after ACL reconstruction are poorly understood. Therefore, we posed the following research questions: (1) How do ACL deficiency and reconstruction affect the kinematics of and contact stress in the tibiofemoral joint? (2) What kinematic differences are associated with abnormal contact stress after ACL reconstruction?

Hypothesis: Center-center ACL reconstruction will not restore knee kinematics and contact stress.

Practice patterns for subacromial decompression and rotator cuff repair: an analysis of the American Board of Orthopaedic Surgery database.

Background: Recently there have been several evolving trends in the practice of shoulder surgery. Arthroscopic subacromial decompression has been performed with greater frequency by orthopaedic surgeons, and there has been considerable recent interest in arthroscopic rotator cuff repair. The purpose of this study was to identify trends in practice patterns for subacromial decompression and rotator cuff repair over time and in relation to the location of practice, fellowship training, and declared subspecialty of the surgeon.

The role of the tibial slope in sustaining and treating anterior cruciate ligament injuries.

Purpose: A steep tibial slope may contribute to anterior cruciate ligament (ACL)-injuries, a higher degree of instability in the case of ACL insufficiency, and recurrent instability after ACL reconstruction. A better understanding of the significance of the tibial slope could improve the development of ACL injury screening and prevention programmes, might serve as a basis for individually adapted rehabilitation programmes after ACL reconstruction and could clarify the role of slope-decreasing osteotomies in the treatment of ACL insufficiency. This article summarizes and discusses the current published literature on these topics.

Proximal humeral fractures.

Proximal humeral fractures may present with many different configurations in patients with varying co-morbities and expectations. As a result, the treating physician must understand the fracture pattern, the quality of the bone, other patient-related factors, and the expanding range of reconstructive options to achieve the best functional outcome and to minimize complications. Current treatment options range from non-operative treatment with physical therapy to fracture fixation using percutaneous or open techniques to arthroplasty reconstructions.

Posterior cruciate ligament: anatomy, biomechanics, and outcomes.

The optimal treatment of posterior cruciate ligament ruptures remains controversial despite numerous recent basic science advances on the topic. The current literature on the anatomy, biomechanics, and clinical outcomes of posterior cruciate ligament reconstruction is reviewed. Recent studies have quantified the anatomic location and biomechanical contribution of each of the 2 posterior cruciate ligament bundles on tunnel placement and knee kinematics during reconstruction.

Biomechanical consequences of a tear of the posterior root of the medial meniscus. Surgical technique.

Background: Tears of the posterior root of the medial meniscus are becoming increasingly recognized. They can cause rapidly progressive arthritis, yet their biomechanical effects are not understood. The goal of this study was to determine the effects of posterior root tears of the medial meniscus and their repairs on tibiofemoral joint contact pressure and kinematics.