ACL Reconstruction Basics: Quadruple (4-Strand) Hamstring Autograft Harvest.

Hamstring tendon autograft remains a popular graft choice for anterior cruciate ligament (ACL) reconstruction. Although there are a variety of autograft and allograft options available for ACL reconstruction, advantages of hamstring tendon autografts include decreased postoperative knee pain and an overall easier surgical recovery compared with bone patellar tendon bone autograft. In addition, 4-stranded (quadruple) hamstring grafts are among the strongest grafts biomechanically (at time equals zero).

Shoulder Arthroscopy in the Lateral Decubitus Position.

Arthroscopic shoulder surgery can be performed in both the beach chair and lateral decubitus positions. The lateral decubitus position allows for excellent exposure to all aspects of the glenohumeral joint and is therefore frequently employed in procedures such as stabilization, in which extensive visualization of the inferior and posterior aspects of the joint is required. Improved visualization is imparted due to applied lateral and axial traction on the operative arm, which increases the glenohumeral joint space.

Shoulder Arthroscopy in the Beach Chair Position.

Arthroscopic shoulder surgery can be performed in both the beach chair and lateral decubitus positions. The beach chair position is a reliable, safe, and effective position to perform nearly all types of shoulder arthroscopic procedures. The advantages of the beach chair position include the ease of setup, limited brachial plexus stress, increased glenohumeral and subacromial visualization, anesthesia flexibility, and the ability to easily convert to an open procedure.

Clinical Outcomes of Arthroscopic 360° Capsular Release for Idiopathic Adhesive Capsulitis in the Lateral Decubitus Position.

Purpose: To report outcomes after arthroscopic 360° capsular release in the lateral decubitus position for idiopathic glenohumeral adhesive capsulitis without manipulation under anesthesia.

Methods: A retrospective case series of patients who underwent arthroscopic capsular release in the lateral decubitus position for idiopathic adhesive capsulitis with minimum 2-year follow-up was conducted. Patient demographics, preoperative range of motion (ROM), postoperative ROM, and the postoperative outcome scores, visual analog scale for pain, Single Assessment Numeric Evaluation, Simple Shoulder Test, and American Shoulder and Elbow Surgeons scores, were recorded.

Patient Compliance With Electronic Patient Reported Outcomes Following Shoulder Arthroscopy.

Purpose: To determine the patient compliance in completing electronically administered patient-reported outcome (PRO) scores following shoulder arthroscopy, and to determine if dedicated research assistants improve patient compliance.

Methods: Patients undergoing arthroscopic shoulder surgery from January 1, 2014, to December 31, 2014, were prospectively enrolled into an electronic data collection system with retrospective review of compliance data. A total of 143 patients were included in this study; 406 patients were excluded (for any or all of the following reasons, such as incomplete follow-up, inaccessibility to the order sets, and inability to complete the order sets).

Biomechanical Analysis of Latarjet Screw Fixation: Comparison of Screw Types and Fixation Methods.

Purpose: To compare the initial fixation stability, failure strength, and mode of failure of 5 different screw types and fixation methods commonly used for the classic Latarjet procedure.

Methods: Thirty-five fresh-frozen cadaveric shoulder specimens were allocated into 5 groups. A 25% anteroinferior glenoid defect was created, and a classic Latarjet coracoid transfer procedure was performed.

Does Age Influence the Efficacy of Demineralized Bone Matrix Enriched with Concentrated Bone Marrow Aspirate in Lumbar Fusions?

Study Design: Retrospective study.

Objective: Evaluate the effect of age on the efficacy of allograft/demineralized bone matrix (DBM) enriched with concentrated bone marrow aspirate (BMA) in posterolateral lumbar fusions (PLFs).

Summary Of Background Data: Cell-based therapies such as concentrated BMA have been developed as a potential alternative to iliac crest bone graft (ICBG).

How Comprehensive and Efficient Are Patient-Reported Outcomes for Rotator Cuff Tears?

Background: Increasing emphasis is placed on patient-reported outcomes (PROs) after common orthopaedic procedures as a measure of quality. When considering PRO utilization in patients with rotator cuff tears, several different PROs exist with varying levels of accuracy and utilization.

Hypothesis/purpose: Understanding which disease-specific PRO may be most efficiently administered in patients after rotator cuff repair may assist in promoting increased patient and physician adoption of these useful scores.

The Use of Accessory Portals in Bankart Repair With Posterior Extension in the Lateral Decubitus Position.

The Bankart lesion, in which the anteroinferior labrum is detached from the glenoid, is the critical anatomic lesion in the majority of patients with anterior glenohumeral instability. Some patients with anterior glenohumeral instability will have Bankart lesions with posterior extension beyond the 6-o'clock position, and achieving anatomic labral repair in these cases can present a technical challenge. In our experience, the lateral decubitus position and use of accessory portals allow superior visualization of the inferior half of the glenohumeral joint for glenoid and labral preparation, anchor placement, and suture management.

Patient Reported Outcomes Measurement Information System (PROMIS) in the upper extremity: the future of outcomes reporting?

Patient reported outcomes (PROs) serve an integral role in clinical research by helping to determine the impact of clinical care as experienced by the patient. With recent initiatives in health care policy and pay for performance, outcome reporting is now recognized as a policy-driven requirement in addition to a clinical research tool. For outcome measures to satisfy these regulatory requirements and provide value in understanding disease outcomes, they must be responsive and efficient.

Arthroscopic 360° Capsular Release for Adhesive Capsulitis in the Lateral Decubitus Position.

Idiopathic adhesive capsulitis of the shoulder is a relatively common condition that results in pain and loss of motion due to capsular thickening and fibrosis. Most cases are successfully treated with conservative management including physical therapy and intra-articular steroid injections. If conservative management fails, arthroscopic capsular release allows precise release of thickened capsular tissue with a lower risk of complications and less soft-tissue trauma than manipulation under anesthesia alone.

Outcomes of Demineralized Bone Matrix Enriched with Concentrated Bone Marrow Aspirate in Lumbar Fusion.

Background: Multiple studies have demonstrated that a significant amount of variability exists in various demineralized bone matrix (DBM) formulations, which casts doubts on its reliability in consistently promoting fusion. Bone marrow aspirate (BMA) is a cellular based graft that contains mesenchymal stem cells (MSCs) and growth factors can confer osteogenic and osteoinductive potential to DBM. The goal of this study was to describe the outcome of DBM enriched with concentrated BMA in patients undergoing combined lumbar interbody and posterolateral fusion.

Assessment and Evaluation of Glenoid Bone Loss.

The preoperative assessment of anterior glenoid bone loss is a critical step in surgical planning for patients with recurrent anterior glenohumeral instability. The structural integrity of the glenoid has been identified as one of the most important factors influencing the success of operative repair. The currently accepted gold standard for glenoid structural assessment among most orthopaedic surgeons is the use of 3-dimensional reconstructed computed tomography images with the humeral head digitally subtracted, yielding an en face sagittal oblique view of the glenoid.

Clinical and radiographic outcomes of concentrated bone marrow aspirate with allograft and demineralized bone matrix for posterolateral and interbody lumbar fusion in elderly patients.

Purpose: Cell-based therapies such as concentrated bone marrow aspirate (BMA) with allograft and demineralized bone matrix (DBM) have been developed as a potential alternative to iliac crest bone graft (ICBG) in spinal fusion. BMA contains mesenchymal stem cells (MSCs) and growth factors that confer osteogenic and osteoinductive potential to osteoconductive scaffolds like allograft and DBM. It is well established that there is an age-related decline in bone marrow MSC population and efficacy.