Multi-investigator collaboration in orthopaedic surgery research compared to other medical fields.

An increasing emphasis has been placed across health care on evidence-based medicine with higher level studies, such as randomized trials and prospective cohort studies. Historically, clinical research in orthopaedic surgery has been dominated by studies with low patient numbers from a limited number of surgeons. The purpose of this study was to test our hypothesis that orthopaedics has fewer multi-center collaborative studies as compared to other medical disciplines.

Proud osteochondral autograft versus synthetic plugs--contact pressures with cyclical loading in a bovine knee model.

Purpose: To determine whether proud synthetic and proud osteochondral plugs conform to native surrounding cartilage after cyclical loading and if there are differences in height and contact pressure after loading.

Methods: Sixteen bovine knees were used. Each received one osteochondral plug and one of two types of synthetic plugs (Smith & Nephew TruFit® BGS plug or Kensey Nash OsseoFit® plug).

Infrapatellar branch of saphenous neurectomy for painful neuroma: a case report.

We present the case of an 18-year-old woman who was healthy other than a history of multiple arthroscopic right knee surgeries culminating in subtotal lateral meniscectomy in a valgus knee. The patient was referred to our office for evaluation for realignment osteotomy and meniscal transplantation. Her diagnosed case of neuroma of the infrapatellar branch of the saphenous nerve was managed with neurectomy, which produced prompt and complete resolution of pain.

Implementation of an objective structured clinical exam (OSCE) into orthopedic surgery residency training.

Objective: While the musculoskeletal (MSK) physical examination (PE) is an essential part of a patient encounter, we believe it is an underemphasized component of orthopedic residency education and that resident PE skills may be lacking. The purpose of this investigation was to (1) assess the attitudes regarding PE teaching in orthopedic residencies today; (2) develop an MSK objective structured clinical examination (OSCE) to assess the MSK PE knowledge and skills of our orthopedic residents.

Design: Prospective, uncontrolled, observational.

Surgical management of juvenile osteochondritis dissecans of the knee.

Purpose: Operative management of osteochondritis dissecans (OCD) in the juvenile knee is generally indicated upon failure of conservative treatment, in unstable lesions, and in lesions nearing physeal closure. We hypothesized that juvenile OCD lesions have improved clinical and radiographic outcomes with surgical treatment following failed non-surgical management, in unstable lesions, and in lesions nearing physeal closure.

Methods: Multiple medical databases were searched for Levels I-IV evidence with specific study inclusion and exclusion criteria.

Revision ACL reconstruction outcomes: MOON cohort.

Many clinicians believe that the results of revision anterior cruciate ligament (ACL) reconstruction compare unfavorably with primary ACL reconstruction. However, few prospective studies have evaluated revision ACL reconstruction using validated patient-based metrics. This study was performed to evaluate and compare the results of revision ACL reconstruction and primary ACL reconstruction.

Meniscal repair with the MaxFire device: a cadaveric study.

Objective: To use a cadaver model to evaluate an all-inside meniscal repair device (MaxFire).

Methods: Six fresh-frozen cadaveric knees (ages 30-84 years) without evidence of prior surgery were used for this study. The knees were rigidly mounted and arthroscopy performed using standard anteromedial and anterolateral portals.

Comparison of ACL fixation devices using cadaveric grafts.

We evaluated two newer forms of femoral fixation of hamstring grafts for anterior cruciate ligament reconstruction, the Endobutton direct (Smith and Nephew, Andover, MA) and Femoral intrafix (Depuy Mitek, Raynham, MA), and compare them to devices that have been evaluated in the literature, the AXL Crosspin (Biomet, Warsaw, IN) and Biotransfix II (Arthrex, Naples, FL). Paired hamstring tendon allografts were fixed in the femoral tunnel of 24 cadaveric bovine knees (6 per group) according to each device's specifications. The free ends (tibial sides) were fixed to the materials testing machine via custom-made cryo-clamps.

A biomechanical comparison of patellar tendon repair materials in a bovine model.

We evaluated the biomechanical properties of FiberWire (Arthrex, Inc, Naples, Florida), a new suture material, for both repair and augmentation as compared to standard Ethibond suture (Ethicon, Inc, Somerville, New Jersey), hypothesizing that primary repair and cerclage augmentation with the new suture material would have similar biomechanical properties as a standard repair with wire augmentation. Forty-five fresh bovine knees were placed in 3 groups of equal size: (1) #5 Ethibond tendon repair plus 18-gauge wire augmentation; (2) #5 FiberWire repair plus #5 FiberWire augmentation; and (3) #5 Ethibond repair plus #5 FiberWire augmentation. A straight static pullout test was performed, randomly alternating between the different groups.

Patellar tendon reconstruction with semitendinosus-gracilis autograft.

We present a case of a 24-year-old, otherwise healthy, man who sustained a right knee injury after a fall. A small, comminuted inferior pole patella fracture with medial and lateral retinacular tears was encountered that required a small, nonarticular partial patellectomy and patellar tendon repair. An uneventful postoperative course was complicated by a fall onto a flexed knee and rerupture of the patellar tendon at 3 months following surgery.

Magnetic resonance imaging in traumatic hip subluxation.

Athletic traumatic hip subluxations are rare. Classic radiographic features have been well described. This case highlights the potential pitfalls of immediate magnetic resonance imaging.

Hop tests correlate with IKDC and KOOS at minimum of 2 years after primary ACL reconstruction.

Purpose: The hypothesis of this study was that single-legged horizontal hop test ratios would correlate with IKDC, KOOS, and Marx activity level scores in patients 2 years after primary ACL reconstruction.

Methods: Individual patient-reported outcome tools and hop test ratios on 69 ACL reconstructed patients were compared using correlations and multivariable modeling. Correlations between specific questions on the IKDC and KOOS concerning the ability to jump and hop ratios were also performed.

The classification systems of stress fractures: a systematic review.

Background: Stress fractures of the upper and lower extremity are troublesome overuse injuries in athletes and nonathletes alike. These injuries have a broad spectrum of severity and prognosis. We performed a systematic search of the literature, which revealed multiple classification systems; however, we did not uncover a general system that offered both validated radiographic and clinical parameters.

Contact pressure comparison of proud osteochondral autograft plugs versus proud synthetic plugs.

Osteochondral autograft transfer is an accepted treatment for chondral and osteochondral defects of the knee. Synthetic plugs may eventually be used for primary treatment of defects. Currently they are largely used for osteochondral donor site backfill.

Quantitative assessment of mobile protein levels in human knee synovial fluid: feasibility of chemical exchange saturation transfer (proteinCEST) MRI of osteoarthritis.

Purpose: To establish the feasibility of chemical exchange saturation transfer (proteinCEST) MRI in the differentiation of osteoarthritis (OA) knee joints from non-OA joints by detecting mobile protein and peptide levels in synovial fluid by determining their relative distribution.

Materials And Methods: A total of 25 knees in 11 men and 12 women with knee injuries were imaged using whole knee joint proteinCEST MRI sequence at 3 T. The joint synovial fluid was segmented and the asymmetric magnetization transfer ratio at 3.

The use of continuous passive motion following knee cartilage defect surgery: a systematic review.

We evaluated the clinical evidence of using continuous passive motion postoperatively after treating articular cartilage lesions of the knee. We hypothesized that postoperatively, the use of continuous passive motion improves the outcomes of cartilage restoration procedures. Multiple medical databases (MEDLINE, EMBASE, CINAHL, PubMed, Sport-Discus, and Cochrane) were searched for Level I through IV evidence with specific study inclusion and exclusion criteria.

Biological knee reconstruction: a systematic review of combined meniscal allograft transplantation and cartilage repair or restoration.

Purpose: Combined meniscal allograft transplantation (MAT) and cartilage repair or restoration is a recognized treatment for patients with painful, meniscus-deficient knees and full-thickness cartilage damage. The purpose of this systematic review was to compare outcomes after combined MAT and cartilage repair/restoration with the outcomes of isolated MAT or cartilage repair/restoration.

Methods: Multiple databases were searched with specific inclusion and exclusion criteria for clinical outcome studies after combined MAT and cartilage repair or restoration.

Severe musculoskeletal infection variant in Lemierre's syndrome.

Lemierre's syndrome is a severe complication of Fusobacterium necrophorum oropharyngeal infection associated with metastatic foci of infection, internal jugular vein thrombosis, and septicemia. Musculoskeletal manifestations include isolated or multifocal septic arthritis, soft tissue abscesses, pyomyositis, and osteomyelitis. This article describes a case of a variant of Lemierre's syndrome in a 17-year-old girl, demonstrating a relentless case of limb infection refractory to multiple surgical debridements and broad-spectrum and targeted antibiotics.

The effects of lesion size and location on subchondral bone contact in experimental knee articular cartilage defects in a bovine model.

Purpose: To determine how femoral condyle chondral defect size and location influence subchondral bone contact within the defect.

Methods: Full-thickness, circular chondral defects (0.2 to 5.

Surgical techniques and outcomes after anterior cruciate ligament reconstruction in preadolescent patients.

Purpose: To determine whether any anterior cruciate ligament (ACL) reconstruction technique is clinically superior in skeletally immature patients with wide-open physes.

Methods: We searched Medline and Embase from 1966 to mid July 2009. Inclusion criteria required clinical studies of ACL reconstructions to define skeletally immature patients as having at least 1 of the following criteria: (1) chronologic age of less than 15 years in boys or less than 14 years in girls; (2) bone age of less than 15 years in boys or less than 14 years in girls; (3) Tanner stage I, II, or III; and (4) at least 10 cm of total growth after the reconstruction.

Autologous chondrocyte implantation: a systematic review.

Background: The purpose of the present study was to determine (1) whether the current literature supports the choice of using autologous chondrocyte implantation over other cartilage procedures with regard to clinical outcome, magnetic resonance imaging, arthroscopic assessment, and durability of treatment, (2) whether the current literature supports the use of a specific generation of autologous chondrocyte implantation, and (3) whether there are patient-specific and defect-specific factors that influence outcomes after autologous chondrocyte implantation in comparison with other cartilage repair or restoration procedures.

Methods: We conducted a systematic review of multiple databases in which we evaluated Level-I and II studies comparing autologous chondrocyte implantation with another cartilage repair or restoration technique as well as comparative intergenerational studies of autologous chondrocyte implantation. The methodological quality of studies was evaluated with use of Delphi list and modified Coleman methodology scores.

Evaluation of high-strength orthopedic sutures: a head-to-head comparison.

The goal of this study was to determine whether a difference in cycles to failure or mode of failure would be observed among specimens of 3 high-strength suture materials, and whether different suture configurations would affect knot security. Ten representative specimens of Ethibond (Ethicon, Inc, Somerville, New Jersey), FiberWire (Arthrex, Inc, Naples, Florida), MaxBraid (Biomet, Inc, Warsaw, Indiana), and Orthocord (DePuy Orthopaedics, Warsaw, Indiana) were tied in 6 different knot configurations commonly used in orthopedic procedures. Each specimen was cyclically loaded between 9 and 180 N at a rate of 1 Hz until the specimen failed or reached a maximum of 3500 cycles.

Articular contact pressures of meniscal repair techniques at various knee flexion angles.

Articular cartilage injury can occur after meniscal repair with biodegradable implants. Previous contact pressure analyses of the knee have been based on the tibial side of the meniscus at limited knee flexion angles. We investigated articular contact pressures on the posterior femoral condyle with different knee flexion angles and surgical repair techniques.

Which preoperative factors, including bone bruise, are associated with knee pain/symptoms at index anterior cruciate ligament reconstruction (ACLR)? A Multicenter Orthopaedic Outcomes Network (MOON) ACLR Cohort Study.

Background: Increased knee pain at the time of anterior cruciate ligament reconstruction may potentially predict more difficult rehabilitation, prolonged recovery, and/or be predictive of increased knee pain at 2 years.

Hypothesis: A bone bruise and/or other preoperative factors are associated with more knee pain/symptoms at the time of index anterior cruciate ligament reconstruction, and the presence of a bone bruise would be associated with specific demographic and injury-related factors.

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