Shoulder Lesions Do Not Increase Inflammatory Biomarkers in Patients Undergoing Surgery for Glenohumeral Instability: An Exploratory Study.

Circulating protein biomarkers have demonstrated utility as a diagnostic tool in predicting musculoskeletal disease severity, but their utility in the evaluation of shoulder lesions associated with shoulder instability is unknown. Thus, the purpose of this exploratory study was to determine whether preoperative biomarkers of cartilage turnover and inflammation are associated with specific shoulder lesions in shoulder instability. Thirty-three patients (29.

Osteochondral Allograft Transplantation of the Knee in Patients with an Elevated Body Mass Index.

Objective: To characterize the graft survivorship and clinical outcomes of osteochondral allograft transplantation (OCA) of the knee in patients with an elevated body mass index (BMI).

Design: Prospective data on 38 consecutive patients with a BMI ≥30 kg/m treated with OCA from 2000 to 2015 were reviewed. Complications, reoperations, and patient responses to validated outcome measures were examined.

Decline in clinical scores at long-term follow-up of arthroscopically treated discoid lateral meniscus in children.

Purpose: The purpose of this study was to examine the long-term clinical outcomes of arthroscopic partial meniscectomy for the treatment of discoid lateral meniscus in children.

Methods: A previous study identified 34 consecutive patients that underwent arthroscopic meniscal saucerization by one of the two surgeons between 1997 and 2002. Patients were asked to complete several outcomes questionnaires and were given the opportunity to receive a knee exam performed by their treating surgeon.

The Association of Vitamin D Status in Lower Extremity Muscle Strains and Core Muscle Injuries at the National Football League Combine.

Purpose: To evaluate the association between serum vitamin D level and the prevalence of lower extremity muscle strains and core muscle injuries in elite level athletes at the National Football League (NFL) combine.

Methods: During the 2015 NFL combine, all athletes with available serum vitamin D levels were included for study. Baseline data were collected, including age, race, body mass index, position, injury history specific to lower extremity muscle strain or core muscle injury, and Functional Movement Screen scores.

Further Research Is Needed to Define the Benefits of Non-operative Rotator Cuff Treatment.

Kukkonen et al.'s "Treatment of Nontraumatic Rotator Cuff Tears: A Randomized Controlled Trial with Two Years of Clinical and Imaging Follow-up" compared the efficacy of physical therapy, acromioplasty, and rotator cuff repair for the treatment of degenerative supraspinatus tendon tears in patients aged over 55. This review examines the authors' findings and their implications on clinical practice.

Displaced Proximal Humerus Fractures: is a Sling as Good as a Plate?

The treatment of displaced proximal humerus fractures is challenging and complex, as its success is predicated on multiple factors. While it is clear that a majority of proximal humerus fractures may be treated nonoperatively, it is less clear which patients benefit from surgical management. The PROFHER trial, a randomized controlled study, used patient-reported outcomes to compare surgical to nonsurgical management of displaced proximal humerus fractures.

Arthroscopically Assisted Open Reduction-Internal Fixation of Ankle Fractures: Significance of the Arthroscopic Ankle Drive-through Sign.

Standalone open reduction-internal fixation (ORIF) of unstable ankle fractures is the current standard of care. Intraoperative stress radiographs are useful for assessing the extent of ligamentous disruption, but arthroscopic visualization has been shown to be more accurate. Concomitant arthroscopy at the time of ankle fracture ORIF is useful for accurately diagnosing and managing syndesmotic and deltoid ligament injuries.

Scapular Notching.

Developed in 1985, the Grammont-style reverse total shoulder arthroplasty offered a biomechanical advantage for the deltoid muscle as well as predictably reduced pain and improved shoulder function in rotator cuff-deficient shoulders. Despite favorable outcomes, reverse total shoulder arthroplasty is associated with a unique set of complications, one of which is scapular notching. Scapular notching is believed to be a result of mechanical impingement of the humeral component on the lateral scapular pillar.

Increased Lateral Tibial Slope Is a Risk Factor for Pediatric Anterior Cruciate Ligament Injury: An MRI-Based Case-Control Study of 152 Patients.

Background: Increased posterior tibial slope is associated with increased risk of anterior cruciate ligament (ACL) injury in adults. A similar association has not been rigorously examined in children and adolescents.

Purpose: To determine whether alterations in posterior tibial slope are associated with ACL tears in pediatric and adolescent patients and to quantify changes in tibial slope by age.

Mechanisms of post-traumatic osteoarthritis after ACL injury.

Anterior cruciate ligament (ACL) rupture is a common and devastating injury with long-term sequelae that include meniscal tears, chondral injury, and an increased risk of knee osteoarthritis (OA). ACL reconstruction is recommended to protect against knee instability, reduce the likelihood of meniscal tears and further surgery, and enable earlier return to sporting activities. ACL reconstruction, however, does not reduce the incidence of early-onset OA.

A narrative review of surgical resident duty hour limits: where do we go from here?

Background: Resident duty hour limits have been a point of debate among educators, administrators, and policymakers alike since the Libby Zion case in 1984. Advocates for duty hour limits in the surgical subspecialties cite improvements in patient safety, whereas opponents claim that limiting resident duty hours jeopardizes resident education and preparedness for independent surgical practice.

Methods: Using orthopaedic surgery as an example, we describe the historical context of the implementation of the duty hour standards, provide a review of the literature presenting data that both supports and refutes continued restrictions, and outline suggestions for policy going forward that prioritize patient safety while maintaining an enhanced environment for resident education.

Pediatric flatfoot: cause, epidemiology, assessment, and treatment.

Purpose Of Review: The current review includes the most up to date literature on the cause, epidemiology, diagnosis, and treatment of pediatric flatfeet.

Recent Findings: Recent systematic reviews concur that the evidence supporting the use of orthotics in pediatric flexible flatfeet is poor. Multiple studies have recently reported on the results of arthroereisis, yet these are mostly retrospective and do not include a comparative group or long-term follow up.

Is deltoid and lateral ligament reconstruction necessary in varus and valgus ankle osteoarthritis, and how should these procedures be performed?

Varus and valgus ankle deformities represent a challenge to the foot and ankle surgeons. The presence of degenerative changes of the tibiotalar joint articular surfaces introduces an additional layer of complexity. Reconstruction of such deformities requires a customized approach to each patient.

Recurrent and metastatic primary cutaneous mucinous carcinoma after excision and Mohs micrographic surgery.

Primary cutaneous mucinous carcinoma is a neoplasm of sweat gland origin. Optimal management guidelines have not been established for this rare tumor. It is treated most commonly by traditional excision and more recently by Mohs micrographic surgery in an effort to decrease its recurrence rate.

Use of a nonpledgeted suture technique is safe and efficient for aortic valve replacement.

Objective: The use of pledgeted sutures to secure the prosthetic valve to the annulus during aortic valve replacement is thought to decrease the incidence of paravalvular leak. We hypothesized that use of nonpledgeted sutures in aortic valve replacement would provide equivalent outcomes to those of a pledgeted suture technique.

Methods: Between January 1995 and April 2009, a total of 802 patients (511 nonpledgeted, 291 pledgeted) underwent isolated aortic valve replacement, including 671 patients who underwent primary, isolated aortic valve replacement (412 nonpledgeted, 259 pledgeted).

Primary cutaneous Langerhans cell sarcoma without Birbeck granules: indeterminate cell sarcoma?

An 88-year-old white male presented with a rapidly growing skin nodule on the scalp. Clinically, the nodule did not appear unusual for an ordinary cutaneous neoplasm on sun-exposed skin of an elderly white male. Histopathological examination showed sheet-like epithelioid tumor cell growth with a vaguely nested pattern and frank malignant features, resembling malignant melanoma.