Predictors of Revision Surgery After Anterior Cruciate Ligament Reconstruction.

Background: Arthroscopically assisted anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. Graft failure after reconstruction remains a devastating complication, often requiring revision surgery and less aggressive or modified rehabilitation. Worse functional and patient-reported outcomes are reported compared with primary reconstruction.

The Prevalence of Symptomatic Deep Venous Thrombosis and Pulmonary Embolism After Anterior Cruciate Ligament Reconstruction.

Background: Arthroscopically assisted anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. The incidence and risk factors of venous thromboembolism (VTE) after ACL reconstruction remain unclear.

Purpose: To define the incidence of VTE after ACL reconstruction and identify associated risk factors in a large cohort of patients.

Variability of acetabular coverage between supine and weightbearing pelvic radiographs.

Background: Radiographic measures of acetabular coverage are essential screening tools used to characterize bony structure contributing to femoroacetabular impingement (FAI). Small changes in pelvic tilt result in altered radiographic measures of acetabular coverage. Positional changes in pelvic tilt are known to occur between the supine and weightbearing positions.

The effect of pelvic tilt on radiographic markers of acetabular coverage.

Background: Radiographic indices of acetabular coverage are crucial to objectively characterize femoroacetabular impingement and plan bony decompression. It is established that changes in pelvic inclination result in alterations of acetabular crossover; however, it is unclear what influence this has on other measures of acetabular anatomy.

Hypothesis: The objective of the present study was to determine if, and to what degree, a variation in pelvic tilt alters 4 measures of acetabular anatomy: the angle of Sharp, Tönnis angle, percentage of acetabular crossover, and lateral center edge angle (LCEA).

Management of clavicle nonunion and malunion.

Background: Clavicle fractures are common injuries of the shoulder girdle and occasionally result in nonunion or symptomatic malunion. When present, these chronic injuries can result in considerable shoulder dysfunction. A number of surgical techniques have been described for the management of these injuries.

Snapping scapula syndrome: diagnosis and management.

Scapulothoracic bursitis and snapping scapula syndrome are rare diagnoses that contribute to considerable morbidity in some patients. These conditions represent a spectrum of disorders characterized by pain with or without mechanical crepitus. They are commonly identified in young, active patients who perform repetitive overhead activities.

Biomechanical analysis of two-tendon posterosuperior rotator cuff tear repairs: extended linked repairs and augmented repairs.

Purpose: The purpose of this study was to compare single-row (SR), extended double-row (DR), and augmented, extended double-row (aDR) rotator cuff repairs in a two-tendon, posterosuperior rotator cuff tear (RCT) model with intact rotator cuff tendons.

Methods: RCTs were created and randomly assigned to SR, DR, or aDR repair (5 each) in 20 cadaveric shoulder specimens. A collagen scaffold was used for augmentation.

Acromioclavicular joint separations.

Acromioclavicular (AC) joint separations are common injuries of the shoulder girdle, especially in the young and active population. Typically the mechanism of this injury is a direct force against the lateral aspect of the adducted shoulder, the magnitude of which affects injury severity. While low-grade injuries are frequently managed successfully using non-surgical measures, high-grade injuries frequently warrant surgical intervention to minimize pain and maximize shoulder function.

Reconstruction of posterior glenoid deficiency using distal tibial osteoarticular allograft.

Posterior shoulder instability with glenoid deficiency is a rare entity and its surgical treatment is challenging. Reconstructive techniques have focused on extra-articular structural bone transfer that obstructs humeral translation and thereby prevents glenohumeral dislocation. However, long-term results are not as promising.

Arthroscopic reconstruction of the ligamentum teres: technique and early outcomes.

Femoroacetabular impingement causes groin pain and decreased athletic performance in active adults. This bony conflict may result in femoroacetabular subluxation if of sufficient magnitude. The ligamentum teres has recently been reported to be capable of withstanding tensile loads similar to that of the anterior cruciate ligament, and patents with early subluxation of the hip may become dependent on the secondary restraint that is potentially provided by the ligamentum teres.

Technique and outcomes of arthroscopic scapulothoracic bursectomy and partial scapulectomy.

Purpose: The purpose of this study was to assess the efficacy of arthroscopic scapulothoracic bursectomy in patients with snapping scapula syndrome with a minimum of 2 years' follow-up.

Methods: In this institutional review board-approved retrospective study, 23 shoulders in 21 consecutive patients were identified that had undergone arthroscopic treatment of snapping scapula syndrome. Each patient described mechanical symptoms with failure of nonsurgical modalities and reported symptomatic relief from a local anesthetic injection before surgical intervention.

An association between the inferior humeral head osteophyte and teres minor fatty infiltration: evidence for axillary nerve entrapment in glenohumeral osteoarthritis.

Background: Glenohumeral osteoarthritis often results in inferior humeral osteophytes. Anatomic studies suggest that the axillary neurovascular bundle is in close proximity to the glenohumeral capsule. We therefore hypothesize that an inferior humeral osteophyte of sufficient magnitude could encroach on the axillary nerve and result in measurable fatty infiltration of the teres minor muscle.

Glenohumeral joint preservation: a review of management options for young, active patients with osteoarthritis.

The management of osteoarthritis of the shoulder in young, active patients is a challenge, and the optimal treatment has yet to be completely established. Many of these patients wish to maintain a high level of activity, and arthroplasty may not be a practical treatment option. It is these patients who may be excellent candidates for joint-preservation procedures in an effort to avoid or delay joint replacement.

Rehabilitation after arthroscopic rotator cuff repair: current concepts review and evidence-based guidelines.

Purpose: To provide an overview of the characteristics and timing of rotator cuff healing and provide an update on treatments used in rehabilitation of rotator cuff repairs. The authors' protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is discussed.

Background: If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment.

Surgical anatomy of the shoulder.

The glenohumeral articulation is a versatile joint that requires a complex integration of bony ligamentous, musculotendinous, and neurovascular structures for proper function. Injuries resulting from dysfunction are common and potentially debilitating. Many of these injuries can be managed nonsurgically; however, if surgical treatment is indicated, a thorough knowledge of the anatomy of the shoulder girdle is critical.

Management of multidirectional instability of the shoulder.

Multidirectional shoulder instability is defined as symptomatic instability in two or more directions. Instability occurs when static and dynamic shoulder stabilizers become incompetent due to congenital or acquired means. Nonspecific activity-related pain and decreased athletic performance are common presenting complaints.

Treatment of clavicle fractures: current concepts review.

Clavicle fractures are common in adults and children. Most commonly, these fractures occur within the middle third of the clavicle and exhibit some degree of displacement. Whereas many midshaft clavicle fractures can be treated nonsurgically, recent evidence suggests that more severe fracture types exhibit higher rates of symptomatic nonunion or malunion.

Arthroscopic trans-capsular axillary nerve decompression: indication and surgical technique.

Symptomatic axillary nerve compression is rare yet results in debilitating pain, weakness, and decreased athletic performance in some patients. If nonoperative modalities fail, surgical intervention is necessary to reduce symptoms and avoid functional decline. Traditionally, open techniques have been described to decompress the axillary nerve and are reported to provide satisfactory results.

Arthroscopic management of glenohumeral arthrosis: humeral osteoplasty, capsular release, and arthroscopic axillary nerve release as a joint-preserving approach.

Glenohumeral arthrosis frequently results in substantial discomfort and activity limitations. Shoulder arthroplasty has been shown to provide reliable pain relief under these circumstances in older, less active populations. Younger patients, however, who desire to continue participation in high-demand activities, may not be optimal candidates for glenohumeral arthroplasty.

Open Reduction and Internal Fixation of Intra-Articular Calcaneal Fractures Via an Extensile Lateral Approach.

Introduction: Although displaced intra-articular calcaneal fractures were historically treated nonoperatively because of unreliable outcomes, they are now commonly treated with open reduction and internal fixation (ORIF).

Step 1 Preoperative Planning And Operative Setup: Coronal images are most helpful.

Step 2 Incision And Soft-tissue Management: Elevate the flap using the "no-touch" technique to minimize wound complications.

Van neck disease: osteochondrosis of the ischiopubic synchondrosis.

Background: Van Neck disease (VND) is a benign skeletal abnormality of children involving a hyperostosis of the ischiopubic synchondrosis (IPS) seen on radiographs. Patients typically complain of vague groin or buttock pain. Few descriptions of this disorder exist and it easily can be mistaken for other entities, particularly osteomyelitis or tumor.