Reliability of EOS compared to conventional radiographs for evaluation of lower extremity deformity in adult patients.

Objective: The purpose of this study was to compare reliability of lower extremity imaging measurements using EOS and conventional X-ray (CR) of adult patients with mechanical axis malalignment.

Materials And Methods: Ten patients (20 lower limbs) of mean age of 31.6 years (range 21-39) with post-traumatic deformities who presented for evaluation of osteotomies and/or ligament and cartilage reconstructions were prospectively enrolled.

Prospective Outcomes of Cryopreserved Osteochondral Allograft for Patellofemoral Cartilage Defects at Minimum 2-Year Follow-up.

Objective: To analyze the clinical outcomes, knee function, and activity level of patients after treatment of full-thickness cartilage defects involving the patellofemoral compartment of the knee with cryopreserved osteochondral allograft.

Design: Nineteen patients with cartilage defects involving the patellofemoral compartment were treated. The average age was 31 years (range 15-45 years), including 12 females and 7 males.

Open Reduction, Bone Grafting, and Internal Fixation of Osteochondritis Dissecans Lesion of the Knee.

Osteochondritis dissecans (OCD) of the femoral condyle is an idiopathic focal bone abnormality affecting the subchondral bone and can result in unstable osteochondral lesions. The treatment of unstable OCD lesions with open reduction and internal fixation with metallic compression screws is well documented in the literature. Fixation is performed to prevent dislodgement of unstable OCD lesions or fix displaced fragments that have been surgically reduced.

Open Implantation of Autologous Chondrocytes Cultured on Porcine Collagen Membrane for the Treatment of a Full-Thickness Patellar Cartilage Lesion.

Large cartilage defects in the knee are debilitating for patients and challenging for surgeons to treat. Autologous chondrocyte implantation (ACI) has gained popularity over the past 20 years and has become the treatment of choice for large cartilage defects for some surgeons. Termed matrix-applied ACI (MACI), use of autologous chondrocytes cultured on porcine collagen membrane has recently been approved by the U.

Oral Contraceptive Pills Are Not a Risk Factor for Deep Vein Thrombosis or Pulmonary Embolism After Arthroscopic Shoulder Surgery.

Background: Worldwide, more than 100 million women between the ages of 15 and 49 years take oral contraceptive pills (OCPs). OCP use increases the risk of venous thromboembolism (VTE) through its primary drug, ethinylestradiol, which slows liver metabolism, promotes tissue retention, and ultimately favors fibrinolysis inhibition and thrombosis.

Purpose: To evaluate the effects of OCP use on VTE after arthroscopic shoulder surgery.

High tibial osteotomy with modern PEEK implants is safe and leads to lower hardware removal rates when compared to conventional metal fixation: a multi-center comparison study.

Purpose: Various implant materials have been used in medial, opening-wedge high tibial osteotomy (HTO) including traditional metal and modern polyetheretherketone (PEEK) implants. The purpose of this study was to compare metal and PEEK implants and determine safety, varus deformity correction, as well as short- to mid-term hardware removal and arthroplasty rates.

Methods: HTO performed with metal and PEEK implants were reviewed between 2000 and 2015 at two institutions with a minimum of 2 years follow-up.

Femoral Cortical Button Malposition Rates in Anterior Cruciate Ligament Reconstruction: A Retrospective Review.

The purpose of this study was to determine the rate of malposition of the femoral cortical button during anterior cruciate ligament reconstruction and to present a classification system of femoral cortical button positioning that is both accurate and reproducible. A total of 361 patients undergoing primary anterior cruciate ligament reconstruction during a 5-year period were identified, and postoperative button position was graded as follows: reduced and congruent (entirety of button <2 mm from cortex); reduced and incongruent (part of button <2 mm from cortex, part of button >2 mm from cortex); displaced (entirety of button >2 mm from cortex); intraosseous (all or part of button remains within bone); or ungradable. Radiographs were evaluated by 2 orthopedic surgeons at 2 time points to define interrater and intrarater reliability.

Isolated Medial Patellofemoral Ligament Reconstruction with Semitendinosus Tendon Allograft.

Background: Medial patellofemoral ligament (MPFL) reconstruction is recommended to surgically stabilize the patella against excessive lateral patellar translation. It is currently the cornerstone of treatment for recurrent lateral patellar instability. The MPFL is often disrupted during acute patellar dislocations but may also be attenuated in the setting of recurrent lateral instability.

Bacterial Contamination of a Marking Pen in Anterior Cruciate Ligament Reconstruction.

Background: A sterile surgical marking pen is commonly used during anterior cruciate ligament reconstruction (ACLR) to outline the proposed skin incision and then to mark the graft during preparation. Once in contact with the skin, the pen is a potential source of bacterial transmission and subsequent infections after ACLR.

Purpose/hypothesis: The purpose of this study was to assess whether the skin marking pen is a fomite for contamination during arthroscopic ACLR.

Revisiting Fulkerson's Original Technique for Tibial Tubercle Transfer: Easing Technical Demand and Improving Versatility.

Tibial tubercle osteotomy is a well-described treatment option for a variety of patellofemoral disorders. Many techniques have evolved since its inception, including combinations of anteriorization, medialization, and distalization of the tibial tubercle. Although differing in their indications and end goal destination of the tubercle, these techniques share the challenging technical demands of achieving successful correction based off preoperative planning and prevention of intraoperative complications.

MRI and Arthroscopy Correlation in the Patellofemoral Joint.

The patellofemoral joint is an articulation between the patella and the femoral trochlea, which serves to increase the lever arm of the extensor mechanism. The stability of the patella within the trochlear groove is supported statically by the bony confines of the groove itself, as well as the medial patellofemoral ligament, and dynamically by the vastus musculature. Pathologic changes seen on magnetic resonance imaging (MRI) are frequently well correlated with findings found by arthroscopy at the time of surgery.

Patellofemoral Articulating Osteochondral (Kissing) Lesion Treated with Autologous Chondrocyte Implantation: A Case Report.

Introduction: Autologous chondrocyte implantation (ACI) is an effective treatment for chondral defects of the knee; however, its use in kissing lesions is less well documented.

Case Report: A 23-year-old female with a kissing lesion of the patellofemoral compartment on magnetic resonance imaging underwent two-stage ACI to her medial patella (20 mm × 22 mm) and medial trochlea (27 mm × 18 mm). At 1-year follow-up, the patient had returned to all activities with near-complete resolution of symptoms and substantial improvement in clinical outcome scores.

Medial patellofemoral ligament reconstruction: patient selection and perspectives.

Patellofemoral instability is a painful and often recurring disorder with many negative long-term consequences. After a period of failed nonoperative management, surgical intervention has been used to reduce the incidence of patellar subluxation and dislocations. Medial patellofemoral ligament (MPFL) reconstruction successfully addresses patellofemoral instability by restoring the deficient primary medial patellar soft tissue restraint.

Insights into the Epiphyseal Cartilage Origin and Subsequent Osseous Manifestation of Juvenile Osteochondritis Dissecans with a Modified Clinical MR Imaging Protocol: A Pilot Study.

Purpose To retrospectively determine if a modified clinical magnetic resonance (MR) imaging protocol provides information on the origin of juvenile osteochondritis dissecans (JOCD) lesions and allows for staging on the basis of the proposed natural history of JOCD to better guide clinical management of the disease. Materials and Methods This institutional review board-approved, HIPAA-compliant, retrospective study was performed in 13 consecutive patients (mean age, 14.9 years; age range, 10-22 years; nine male and four female patients) and one additional comparative patient (a 44-year-old man), in which 19 knees with 20 JOCD lesions were imaged.

Osteochondral Autograft Transfer Versus Microfracture in the Knee: A Meta-analysis of Prospective Comparative Studies at Midterm.

Purpose: To compare microfracture (MFX) and osteochondral autograft transfer (OAT) surgical techniques to determine (1) postoperative activity level, (2) subjective patient outcomes, (3) failure rates, and (4) assess if any lesion characteristics favored one technique over the other.

Methods: A comprehensive review of literature was performed of all studies comparing MFX and OAT. Studies included were all prospective studies that reported on activity-based outcome measures such as Tegner activity scores and subjective outcomes such as the International Knee Documentation Committee score.

Long-term Outcomes After Osteochondral Allograft: A Systematic Review at Long-term Follow-up of 12.3 Years.

Purpose: To (1) evaluate long-term outcomes of osteochondral allograft (OCA) with regard to clinical outcome scores, reoperation and failure rates, and (2) examine if certain factors predispose patients to worse outcomes.

Methods: A comprehensive review was performed with specific inclusion criteria for studies with long-term outcomes after OCA. Studies reported on patient clinical scores such as Hospital for Special Surgery score, Knee Society Score (knee and function score), and Lysholm score.

Autologous Chondrocyte Implantation Using a Bilayer Collagen Membrane with Bone Graft and Anteromedialization of the Tibial Tubercle for the Treatment of a Large Osteochondral Defect in the Lateral Knee Trochlea: A Case Report.

Case: Autologous chondrocyte implantation (ACI) is an established technique for the treatment of osteochondral lesions of the knee. For larger lesions with a substantial amount of bone loss, ACI using a bilayer collagen membrane with bone-grafting has been demonstrated to offer good to excellent results in the tibiofemoral joint, but little has been reported on its use in the patellofemoral joint. We report on the 2-year follow-up of this technique of ACI with bone-grafting used for the treatment of a large osteochondral defect in the lateral aspect of the trochlea of the knee in an 18-year-old, active female patient.

Anterior cruciate ligament assessment using arthrometry and stress imaging.

Arthrometry and stress imaging are useful clinical tools for the objective assessment of anterior cruciate ligament (ACL) integrity. They are most frequently used for the diagnosis of a complete ACL tear when other workup is equivocal, in conjunction with history and clinical exam findings. Other applications include the diagnosis of partial ACL tears, injury prognosis, and post-operative monitoring.

Part II: The 50°/60° fibular tunnel trajectory for posterolateral corner reconstruction in a cadaver model.

Purpose: Using data from our MRI study, we found that a tunnel oriented 50° externally rotated and 60° cephalad would better connect the fibular collateral ligament (FCL) insertion to the popliteofibular ligament (PFL) insertion as compared to a traditional anterior-to-posterior (A-P) fibular tunnel. The purpose of this study was to test that finding in a cadaver model.

Methods: In eight cadaver knee pairs (16 knees), a guide pin was driven from the fibular FCL insertion point in a 50° externally rotated and 60° cephalad trajectory in 8 knees, and in a traditional A-P trajectory in the contralateral 8 knees.

Anatomic and radiographic comparison of arthroscopic suprapectoral and open subpectoral biceps tenodesis sites.

Background: Arthroscopic suprapectoral and open subpectoral surgical techniques are both commonly utilized approaches for proximal biceps tenodesis of the long head of the biceps brachii. A central limitation to the widespread use of an arthroscopic approach for biceps tenodesis is that the tendon may be tenodesed too proximally in the bicipital groove, leading to persistent pain and tendinopathy. Purpose/

Hypothesis: The purpose of this study was to determine the in vivo tenodesis location using arthroscopic suprapectoral and open subpectoral techniques for proximal biceps tenodesis in relation to clinically pertinent anatomic and radiographic landmarks.

A simple evaluation of anterior cruciate ligament femoral tunnel position: the inclination angle and femoral tunnel angle.

Background: Postoperative determination of tunnel position after anterior cruciate ligament (ACL) reconstruction can be challenging.

Hypothesis: The femoral tunnel angle and inclination angle are reliable methods for evaluating tunnel position after ACL reconstruction while aiding in determining whether an ACL reconstruction falls outside an anatomic range as defined on 3-dimensional (3D) computed tomography (CT).

Study Design: Cohort study (diagnosis); Level of evidence, 3.