Lateral Meniscal Tears Can be Safely Repaired "All-Inside" Without Peroneal Nerve Injury: Case Series and Literature Review.

Introduction: The menisci are a pair of fibrocartilaginous structures important for the normal biomechanical function of the knees. Tears are common, and multiple approaches have been used to repair meniscal tears. Of the approaches, the all-inside approach has historically been avoided for tears to the posterior aspect of the lateral meniscus (LM) due to the risk of popliteal and common peroneal neurovascular injury.

Novel Meniscus Transfer Technique: A Case Report.

The meniscus is an essential component of the knee joint, acting as a shock absorber as well as assisting in the transmission of forces. Due to the meniscus importance of the knee, much of the current literature focuses on treatment techniques that can spare and repair the meniscus when it is torn. The unique vasculature of the meniscus often makes repair difficult or, in many cases, impossible.

Anatomical and surgical considerations of the pectoralis muscle.

Introduction: The pectoralis major (PM) muscle is the largest and most superior muscle of the anterior chest wall. The PM plays an important role in flexion, adduction, and internal rotation of the arm. The pectoralis major's size, strength, and anatomical location make it an excellent candidate in transfer surgeries due to its ability to restore balancing forces that may be lost in scapular winging and subscapularis tears.

Tibial Eminence Fracture and Pediatric ACL Avulsion Diagnosis and Treatment: A Case Report.

Introduction: Tibial eminence fractures resulting from the avulsion of the anterior cruciate ligament (ACL) insertion are a common knee injury in the pediatric population. This injury is traditionally corrected through internal fixation using a guide pin and a cannulated screw. Due to the reported consequences of cannulated screws impinging on the joint space, we explored an alternative procedure to address this injury without the use of cannulated screws.

Comparison of Graft Type and Fixation Method in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis Based on Randomized Control Studies.

Background: The anterior cruciate ligament (ACL) is the most commonly injured ligament in the knee. ACL reconstruction (ACLR) proves the standard for treating this injury. However, graft choice and method of fixation remain a heavily debated topic.

Knee Extension Lag Treated with Posterior Capsulotomy of the Knee: A Case Report and Review of the Literature.

Introduction: The posterior capsule of the knee plays an important role in maintaining the integrity of the knee joint. Pathologies involving the posterior capsule have been implicated in developing flexion contractures. Posterior capsulotomy is a well-studied modality for this issue, performed through either an open or arthroscopic approach.

Medial and Lateral Patellar Instability Leading to Medial Patellofemoral Ligament and Lateral Retinaculum Reconstruction: A Case Report.

Case: Combined medial and lateral patellar instability is exceptionally rare with only 3 reported cases to date. Here, we present the case of a 37-year-old White woman with multiple recurrent medial and lateral patellar instability. After failure of conservative care with bracing and therapy, she underwent surgical stabilization with medial and lateral allograft reconstruction.

Pain Relief and the Opioid Crisis in the United States and Canada.

Opioid analgesics hijack the body's innate wellness machinery (eg, naloxone blocks the placebo effect) and alleviate both physical and emotional pain. Starting in the 1980s, marketing and advocacy created an opioid-centric pain relief strategy based on the idea that physicians undermanage pain and worry too much about addiction. The increase of prescription opioids in the ecosystem (along with a resurgence in heroin use) contributed to dependence, misuse, overdoses, and overdose deaths.

Opioid Prescribing Practices of Orthopaedic Surgeons: Results of a National Survey.

Introduction: Opioids are widely used after orthopaedic procedures. Nonmedical opioid use is a growing public health issue.

Methods: An anonymous online survey was distributed by e-mail to the orthopaedic societies of all 50 states and several large private practices to assess practicing orthopaedic surgeons' opioid prescribing practices.

The contribution of leg press and knee extension strength and power to physical function in people with knee osteoarthritis: A cross-sectional study.

Unlabelled: The purposes of this study were to 1) determine the additional contributions of leg press and knee extensor power, over and above that of strength, to the performance of physical function tasks in people with knee osteoarthritis, and 2) compare the ability of bilateral leg press to unilateral knee extensor strength and power to predict functional task performance.

Methods: A cross-sectional, exploratory study of 40 individuals with tibiofemoral knee osteoarthritis resulting in moderate impairments in physical function was conducted. Physical function (Get-up and Go, timed stair climb and descent, and five time chair rise) and muscle performance (leg press and knee extension strength and power) were assessed.

Quadriceps Strength Predicts Self-reported Function Post-ACL Reconstruction.

Introduction/purpose: Quadriceps strength is a useful clinical predictor of self-reported function after anterior cruciate ligament reconstruction (ACLR). However, it remains unknown if quadriceps strength normalized to body mass (QBM) or quadriceps strength limb symmetry index (QLSI) is the best predictor of self-reported function in individuals with ACLR. We sought to determine whether QBM and QLSI are able to predict individuals with ACLR who self-report high function (≥90% on the international knee documentation committee (IKDC) index).

Diagnostic and therapeutic considerations in idiopathic hypereosinophilia with warm autoimmune hemolytic anemia.

Hypereosinophilic syndrome (HES) encompasses numerous diverse conditions resulting in peripheral hypereosinophilia that cannot be explained by hypersensitivity, infection, or atopy and that is not associated with known systemic diseases with specific organ involvement. HES is often attributed to neoplastic or reactive causes, such as chronic eosinophilic leukemia, although a majority of cases remains unexplained and are considered idiopathic. Here, we review the current diagnosis and management of HES and present a unique case of profound hypereosinophilia associated with warm autoimmune hemolytic anemia requiring intensive management.

Longitudinal Evaluation of Stair Walking Biomechanics in Patients with ACL Injury.

Purpose: After anterior cruciate ligament (ACL) injury and reconstruction, abnormal biomechanics during daily tasks may have prominent and detrimental long-term consequences on knee joint health. The purpose of this study was to longitudinally evaluate hip and knee joint biomechanics during stair ascent and descent in patients with acute ACL injury and at return to activity after ACL reconstruction.

Methods: Twenty individuals with unilateral ACL injury (age, 20.

Hip abductor strength in people with knee osteoarthritis: A cross-sectional study of reliability and association with function.

Background: To investigate the clinical importance of hip abductor (HA) strength in people with knee osteoarthritis (OA), the purposes of this study were to 1) compare the association of HA strength and physical function to that of knee extensor (KE) strength and physical function, and 2) determine the reliability of the assessment of HA strength using a hand-held dynamometer.

Methods: Thirty-five individuals [58 years standard deviation 10 years old] with knee osteoarthritis participated. Physical function was assessed with performance-based [Get-Up and Go (GUG), stair climb and descent (SC), and five times chair rise (CR)] and self-reported (WOMAC function) measures.

Neural Excitability Alterations After Anterior Cruciate Ligament Reconstruction.

Context: Neuromuscular dysfunction is common after anterior cruciate ligament reconstruction (ACL-R). However, little is known about quadriceps spinal-reflex and descending corticomotor excitability after ACL-R. Understanding the effects of ACL-R on spinal-reflex and corticomotor excitability will help elucidate the origins of neuromuscular dysfunction.

Contributions of neural excitability and voluntary activation to quadriceps muscle strength following anterior cruciate ligament reconstruction.

Background: Persistent quadriceps weakness is common following anterior cruciate ligament reconstruction (ACLr). Alterations in spinal-reflexive excitability, corticospinal excitability and voluntary activation have been hypothesized as underlying mechanisms contributing to quadriceps weakness. The aim of this study was to evaluate the predictive capabilities of spinal-reflexive excitability, corticospinal excitability and voluntary activation on quadriceps strength in healthy and ACLr participants.

Nicotinic receptor agonists reduce L-DOPA-induced dyskinesias in a monkey model of Parkinson's disease.

Abnormal involuntary movements or dyskinesias are a serious complication of long-term l-DOPA treatment of Parkinson's disease, for which there are few treatment options. Accumulating preclinical data show that nicotine decreases l-DOPA-induced dyskinesias (LIDs), suggesting that it may be a useful antidyskinetic therapy for Parkinson's disease. Here, we investigated whether nicotinic acetylcholine receptor (nAChR) agonists reduced LIDs in nonhuman primates.

Negligence, genuine error, and litigation.

Not all medical injuries are the result of negligence. In fact, most medical injuries are the result either of the inherent risk in the practice of medicine, or due to system errors, which cannot be prevented simply through fear of disciplinary action. This paper will discuss the differences between adverse events, negligence, and system errors; the current medical malpractice tort system in the United States; and review current and future solutions, including medical malpractice reform, alternative dispute resolution, health courts, and no-fault compensation systems.

Medical malpractice reform: the role of alternative dispute resolution.

Background: Alternative dispute resolution (ADR) refers to techniques used to resolve conflicts without going to the courtroom. As healthcare and malpractice costs continue to rise, there is growing interest in tactics such as early apology, mediation, and arbitration in the medical arena.

Questions/purposes: (1) Why is ADR needed? (2) Is ADR useful in health care? (3) What are the current legal and political developments favoring ADR? (4) What obstacles remain?

Methods: We performed MEDLINE, PubMed, and Google Scholar searches with key words "medical malpractice", "ADR", and "alternative dispute resolution" to obtain public policy studies, law review articles, case analyses, ADR surveys, and healthcare review articles.

Biomechanical verification that PCL reconstruction is unnecessary in the muscle-stabilized knee.

Treatment of isolated posterior cruciate ligament (PCL) injuries is controversial. This is due in part to the discrepancy between clinical and biomechanical studies in the literature. Clinically, isolated PCL injuries are treated nonoperatively, and patients do well as long as they have adequate quadriceps function.

Transitioning to anatomic anterior cruciate ligament graft placement.

Anterior cruciate ligament (ACL) reconstruction techniques continue to improve. Recent biomechanical studies have found improved rotational stability as femoral tunnel placement becomes more horizontal and closer to the true ACL footprint. Clinical studies also correlate improved outcomes with these more anatomic reconstructions.

Meniscus transplantation: current concepts.

Treatment options are limited for young, meniscal-deficient patients with pain. This patient population is not age appropriate for total joint replacement, yet the loss of the meniscus leaves them at significant risk for the development of osteoarthritis. One increasingly popular option is the use of allograft meniscal transplantation.