A modified Delphi consensus statement on patellar instability: part I.

Aims: The aim of this study was to establish consensus statements on the diagnosis, nonoperative management, and indications, if any, for medial patellofemoral complex (MPFC) repair in patients with patellar instability, using the modified Delphi approach.

Methods: A total of 60 surgeons from 11 countries were invited to develop consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest within patellar instability.

A modified Delphi consensus statement on patellar instability: part II.

Aims: The aim of this study was to establish consensus statements on medial patellofemoral ligament (MPFL) reconstruction, anteromedialization tibial tubercle osteotomy, trochleoplasty, and rehabilitation and return to sporting activity in patients with patellar instability, using the modified Delphi process.

Methods: This was the second part of a study dealing with these aspects of management in these patients. As in part I, a total of 60 surgeons from 11 countries contributed to the development of consensus statements based on their expertise in this area.

Shoulder arthroplasty in the setting of previous stabilization surgery: a systematic review of matched case control studies at minimum 2 years follow-up.

Background: Anterior shoulder instability causes considerable patient morbidity and the volume of shoulder stabilization surgery being performed annually is rising. Despite stabilization surgery, instability arthropathy in the long-term may arise requiring consideration of shoulder arthroplasty. This study evaluated the outcomes of shoulder arthroplasty following previous stabilization surgery with their associated changes in bony anatomy or soft tissue structure.

Arthroscopic Rotator Cuff Repair Results in Improved Clinical Outcomes and Low Revision Rates at 10-Year Follow-Up: A Systematic Review.

Purpose: To study the literature to evaluate the functional outcomes, radiologic outcomes, and revision rates following arthroscopic rotator cuff repair (ARCR) at a minimum of 10-years follow-up.

Methods: Two independent reviewers performed a literature search of PubMed, Embase, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Only studies reporting on outcomes of ARCR with a minimum 10-year follow-up were considered for inclusion.

Retching as an unusual cause of bilateral posterior shoulder fracture dislocation.

Bilateral posterior shoulder fracture dislocation is a debilitating injury and is quite rare. This injury pattern has been described in the literature as either secondary to seizure, electrocution or major trauma. We present a case of an elderly man who appears to have sustained the injury after an episode of retching and vomiting.

A Curious Case of a Wooden Toothpick Inside a Child's Knee: A Case Report.

Case: A 10-year-old boy presented with vague symptoms, a few days after a nondescript injury to his left knee. History, examination and blood tests, and imaging were unremarkable. Because of his severe pain, we proceeded to arthroscopy.

Ten Inventions That Shaped Modern Orthopedics.

The current field of orthopedics is the result of many decades of minor and major advancements. The evolution of orthopedics has culminated into the modern field seen today. This article presents 10 inventions that played a key role in shaping modern orthopedics.

Arthroscopic anterior shoulder stabilisation in overhead sport athletes: 5-year follow-up.

Introduction: Shoulder instability following traumatic glenohumeral dislocation is a common injury sustained by athletes particularly in contact and collision sports. Overhead contact sports such as gaelic football and hurling pose a unique hazard to the glenohumeral joint, increasing the risk of dislocation.

Aims: To assess return to sport, level of play, recurrence and functional outcomes in gaelic football and hurling athletes in comparison with players of other sports.

The long-term outcomes following internal fixation for intracapsular hip fractures in an Irish tertiary referral centre.

Background: The burden associated with hip fractures is increasing worldwide. Arthroplasty procedures are more commonly performed for intracapsular fractures due to increased risk of compromise to the femoral head blood supply. However, we know from the Irish Hip Fracture Database that a significant proportion of these fractures undergo internal fixation.

Hip Fracture in a Patient with Primary Hyperparathyroidism: Medical and Surgical Lessons.

Hyperparathyroidism is a condition which can be primary, secondary or tertiary and is characterized by increased calcium levels, low phosphate levels, and elevated parathyroid hormone (PTH) levels. Primary hyperthyroidism can cause severe bone resorption leading to bone pains and pathological fracture. We present the case of a patient with severe primary hyperparathyroidism with an atraumatic fracture at the neck of the femur and multiple medical comorbidities presenting a surgical challenge.

Giant Cell Tumour of Knee Popliteus Muscle Synovial Sheath.

The giant cell tumour of the tendon sheath (GCTTS) is the second most common soft tissue benign tumour and rarely presents in the knee. We report a rare presentation of a GCTTS in the knee with corresponding magnetic resonance imaging (MRI), an arthroscopic picture, and histological presentation. It is a rare occurrence but should be considered as a differential in atraumatic knee pain presentation.

: Hoodwinked by torticollis.

A 2-year-old girl presented to the emergency department with a 3-day history of a painful stiff neck after getting a kick to her head from her older brother. Her general practitioner had recently started her on oral antibiotics for otitis media. Plain film imaging of her cervical spine on admission revealed anterior subluxation of C2 on C3 suggestive of bifacetal dislocation.

Focal intratendinous radiolucency: A new radiographic method for diagnosing patellar tendon ruptures.

Background: Diagnosis of patellar tendon rupture is usually based on clinical history and examination. In equivocal cases, imaging may be required. Lateral radiograph is a simple and cost-effective method for prompt diagnosis.

Thromboprophylaxis and orthopaedic surgery: options and current guidelines.

Antithrombotic therapy remains crucial in the peri- and post-operative management of patients who undergo orthopaedic surgical procedures, particularly total joint arthroplasty (TJA) and hip fracture surgery (HFS). Optimal thromboprophylaxis is currently mandatory in most orthopaedic practices to avoid the dreaded complications of venous thromboembolism (VTE). The pathogenesis of VTE is multifactorial and includes the well-known Virchow's triad of hypercoagulability, venous stasis, and endothelial damage.

A chondromimetic microsphere for in situ spatially controlled chondrogenic differentiation of human mesenchymal stem cells.

Human mesenchymal stem cells (hMSCs) have been identified as a viable cell source for cartilage tissue engineering. However, to undergo chondrogenic differentiation hMSCs require growth factors, in particular members of the transforming growth factor beta (TGF-β) family. While in vitro differentiation is feasible through continuous supplementation of TGF-β3, mechanisms to control and drive hMSCs down the chondrogenic lineage in their native microenvironment remain a significant challenge.

Advancing regenerative surgery in orthopaedic sports medicine: the critical role of the surgeon.

The constant desire to improve outcomes in orthopaedic sports medicine requires us to continuously consider the challenges faced in the surgical repair or reconstruction of soft tissue and cartilaginous injury. In many cases, surgical efforts targeted at restoring normal anatomy and functional status are ultimately impaired by the biological aspect of the natural history of these injuries, which acts as an obstacle to a satisfactory repair process after surgery. The clinical management of sports injuries and the delivery of appropriate surgical intervention are continuously evolving, and it is likely that the principles of regenerative medicine will have an increasing effect in this specialized field of orthopaedic practice going forward.

Full and surface tibial cementation in total knee arthroplasty: a biomechanical investigation of stress distribution and remodeling in the tibia.

Background: Aseptic tibial component loosening remains a major cause of total knee arthroplasty failure. The cementation technique used to achieve fixation may play a major role in loosening. Despite this, the optimum technique remains unanswered.

Influence of weather variables on pain severity in end-stage osteoarthritis.

Purpose: Patients often attribute increasing pain in an arthritic joint to changing weather patterns. Studies examining the impact of weather on pain severity have yielded equivocal and sometimes contradictory results. The relationship between subchondral pseudocysts and the role they play in this phenomenon has not been explored.

Dorgan's lateral cross-wiring of supracondylar fractures of the humerus in children: A retrospective review.

Introduction: The currently accepted treatment for displaced supracondylar humeral fractures in children is closed reduction and fixation with percutaneous Kirschner wires. The purpose of this study was to retrospectively review a novel cross-wiring technique where the cross-wire configuration is achieved solely from the lateral side, thereby reducing the risk of ulnar nerve injury.

Methods: We retrospectively reviewed all children who had undergone this procedure at our centre over a 10-year period.

Changes in the length of virtual anterior cruciate ligament fibers during stability testing: a comparison of conventional single-bundle reconstruction and native anterior cruciate ligament.

Background: Conventional tunnel positions for single-bundle (SB) transtibial anterior cruciate ligament (ACL) reconstruction are located in the posterolateral (PL) tibial footprint and the anteromedial (AM) femoral footprint, resulting in an anatomic mismatch graft that is more vertical than native fibers. This vertical mismatch position may significantly influence the ability of an ACL graft to stabilize the knee.

Hypothesis: Anatomic ACL fibers undergo a greater change in length during anterior translation and internal rotation than a conventional SB reconstruction from the PL tibial footprint to the AM femoral footprint.

Comparison of 3-dimensional obliquity and anisometric characteristics of anterior cruciate ligament graft positions using surgical navigation.

Background: Surgical navigation allows continuous intraoperative monitoring of ACL graft anisometry and 3-dimensional obliquity. However, normative anisometry and obliquity measurements for different single-bundle anterior cruciate ligament graft positions are not well described.

Hypothesis: ACL Grafts placed in anteromedial and posterolateral bundle positions will have distinct anisometric profiles and 3-dimensional obliquities.

A novel surface treatment for porous metallic implants that improves the rate of bony ongrowth.

Rapid implant fixation could prove beneficial in a host of clinical applications from total joint arthroplasty to trauma. We hypothesized that a novel self-assembled monolayer of phosphonate molecules (SAMP) covalently bonded to the oxide surface of titanium alloy would enhance bony integration. Beaded metallic rods were treated with one of three coatings: SAMP, SAMP + RGD peptide, or hydroxyapatite.