Effect of Acromioclavicular Joint Injuries on the Acromioclavicular Joint Complex and Scapulohumeral Rhythm: A Functional and Mechanical Perspective.

This overview approaches the acromioclavicular joint (ACJ) and ACJ injuries from a mechanical perspective that places the ACJ complex-the scapula, clavicle, ACJ, AC and coracoclavicular ligaments, and periscapular muscles-into the context of its ability to facilitate scapulohumeral rhythm (SHR) functions of scapula placement and humeral mobility. Mechanical concepts underlying this perspective include linkage of the scapula and clavicle into a single segment, the "claviscapula," the role of the AC and coracoclavicular ligaments in torque transduction and horizontal and vertical stability, and the deleterious effects of decoupling the claviscapular segment. The clinical examination and surgical treatment should address anatomic restoration of individual structures and the effect on the functional integrity of the entire ACJ complex within SHR.

Utilization of Interval Throwing Programs: Analysis of Athletic Trainer, Physical Therapist, and Physician Perspectives.

Context: A common component within rehabilitation recommendations for baseball pitchers is employment of an interval throwing program. However, there is a lack of a consistent set of advocated guidelines for program content and implementation for athletes at the professional and collegiate levels.

Design: Cross-sectional study.

Case-Based Understanding of the Role of the Scapula in Common Shoulder Pathologies.

Scapular dyskinesis is an extremely common component of shoulder pathology, especially in the overhead athlete; despite its prevalence, proper diagnosis and management of scapular disorders remains an enigma for many clinicians. An understanding of the contribution of the scapula to pathomechanics and clinical symptoms is necessary to optimize both surgical and nonsurgical treatment of shoulder disorders. Without correction of scapular dysfunction, even effective management of the pathoanatomy is unlikely to produce optimal results.

Glenoid retroversion does not impact clinical outcomes or implant survivorship after total shoulder arthroplasty with minimal, noncorrective reaming.

Hypothesis: Both clinical outcomes and early rates of failure will not be associated with glenoid retroversion.

Methods: All patients who underwent an anatomic total shoulder arthroplasty with minimal, noncorrective reaming between 2006 and 2016 with minimum 2-year follow-up were reviewed. Measurements for retroversion, inclination, and posterior subluxation were obtained from magnetic resonance imaging or computerized tomography.

Fibular Collateral Ligament Reconstruction Graft Options: Clinical and Radiographic Outcomes of Autograft Versus Allograft.

Purpose: To compare varus knee stability and clinical outcomes between patients who underwent fibular collateral ligament reconstruction (FCLR) or lateral collateral ligament (LCL) reconstruction with autografts versus allografts when undergoing concomitant anterior cruciate ligament reconstruction (ACLR).

Methods: All patients who underwent primary ACLR and concomitant FCLR from 2010 to 2017 performed by a single surgeon (R.F.

Total shoulder arthroplasty outcomes after noncorrective, concentric reaming of B2 glenoids.

Background: Total shoulder arthroplasty (TSA) is an effective procedure for the treatment of glenohumeral osteoarthritis (GHOA) delivering reliable pain relief and improved shoulder function. Abnormal glenoid morphologies are common, and biconcave glenoids are enigmas that have been associated with poor clinical outcomes and implant survivorship.

Purpose: To assess the clinical outcome scores of patients who underwent noncorrective, concentric reaming for TSA with biconcave glenoids (B2).

Medial Patellotibial Ligament Reconstruction Improves Patella Tracking When Combined With Medial Patellofemoral Reconstruction: An In Vitro Kinematic Study.

Purpose: To investigate the isolated and combined effects of medial patellofemoral ligament (MPFL) and medial patellotibial ligament (MPTL) deficiency and reconstruction on patellofemoral kinematics.

Methods: Sixteen matched-paired female cadaveric knee specimens with a mean age of 53.5 years (range, 26-65) were tested in 5 conditions: (1) intact, (2) MPFL or MPTL cut, (3) MPFL and MPTL combined cut, (4) MPFL or MPTL reconstruction, and (5) MPFL and MPTL combined reconstruction.

The identification and treatment of snapping posterior tendons of the knee improves patient clinical outcomes.

Purpose: To assess the most common presenting symptoms, clinical outcomes, and patient satisfaction following treatment of either snapping medial pes anserinus hamstrings or snapping lateral biceps femoris tendons.

Methods: Consecutive patients with a minimum 2-year follow-up after isolated medial hamstring release for a diagnosis of medial snapping pes anserinus tendons or patients treated with primary biceps repair for lateral snapping biceps femoris tendons were evaluated. Clinical outcome scores of the following domains were collected: SF12, WOMAC score, Lysholm Knee Survey, and a simple numeric patient satisfaction score (0-10).

Clinical Presentation and Outcomes Associated With Fabellectomy in the Setting of Fabella Syndrome.

Background: Clinical outcomes pertaining to isolated lateral fabellectomy in the setting of fabella syndrome are limited to small case reports at this time.

Purpose: To assess the most common presenting symptoms, clinical outcomes, and satisfaction after fabella excision in the setting of fabella syndrome.

Study Design: Case series; Level of evidence, 4.

Incidence of Displaced Posterolateral Tibial Plateau and Lateral Femoral Condyle Impaction Fractures in the Setting of Primary Anterior Cruciate Ligament Tear.

Background: Bone bruising of the posterolateral tibial plateau and the lateral femoral condyle sulcus terminalis has a well-established association with anterior cruciate ligament (ACL) tears. Impaction fractures of the femur and tibia may occur in these locations; however, there is a paucity of literature describing these fractures.

Purpose: The primary objective was to quantify the incidence, size, and location of impaction fractures of the posterolateral tibial plateau and lateral femoral condyle in patients with primary ACL tears.

Morphologic Variants of Posterolateral Tibial Plateau Impaction Fractures in the Setting of Primary Anterior Cruciate Ligament Tear.

Background: Impaction fractures of the posterolateral tibial plateau commonly occur in the setting of anterior cruciate ligament (ACL) tears, with considerable variability found in fracture size and morphologic features.

Purpose: The primary objective was to characterize different morphologic variants of posterolateral tibial plateau impaction fractures. The secondary objective was to investigate the association between these impaction fracture variants and concomitant meniscal and ligamentous injuries.

Distal Clavicular Augmentation with Acromioclavicular and Coracoclavicular Ligament Reconstruction in the Setting of Iatrogenic Induced Acromioclavicular Instability.

Although chronic pain and dysfunction of the acromioclavicular (AC) joint can reliably be treated with distal clavicle excision, disruption of the local stabilizing ligamentous structures may result in iatrogenic instability of the joint. Iatrogenic AC joint instability is a rare condition caused by over resection of the distal clavicle with unintended injury to the stabilizing ligaments in the treatment of AC joint pain. Addressing postresection instability can prove to be difficult because most reconstruction techniques are intended for patients with traumatic AC joint instability with the goal of creating an anatomically stable joint.

Alternative Management of the Capsule in the Bristow-Latarjet Procedure.

The Bristow-Latarjet procedure is considered the current gold standard for the management of anterior glenohumeral joint instability in which significant glenoid bone loss is present, and numerous techniques have been proposed for capsular management after the bony augmentation component of the procedure. These techniques for capsular management include excision of the capsule and labrum, 2-flap elevation, T-capsulotomy, or an L-shaped incision into the capsule. Capsular management during open shoulder procedures may vary among surgeons and may or may not include capsulolabral repair after the Bristow-Latarjet procedure.

Comprehensive review of the physical exam for glenohumeral instability.

Glenohumeral instability is a common pathology of the shoulder joint, especially among young athletes. Despite advancements in technology and the widespread use of diagnostic imaging, a careful history and physical examination still remain the cornerstone of diagnosing patients with shoulder instability. Due to the involvement of many static and dynamic stabilizers, proficient physical examination can be challenging.

Patellar Fresh Osteochondral Allograft Transplantation.

Chondral defects of the patellofemoral joint remain a difficult-to-treat pathology with limited long-term results. Currently available techniques to treat large or unipolar chondral defects of the patella include autologous chondrocyte implantation and osteochondral allograft transplantation. Despite the recent advances in orthobiologic adjuncts, there is no single gold-standard surgical approach to this difficult-to-treat pathology in patients who are frequently young, active, and demanding on their bodies.

Incidence and Healing Rates of Meniscal Tears in Patients Undergoing Repair During the First Stage of 2-Stage Revision Anterior Cruciate Ligament Reconstruction.

Background: Meniscal tears, including tears at the root attachment, have been associated with tears of the anterior cruciate ligament (ACL) in both primary and revision settings. However, there is a paucity of literature reporting the healing rates of meniscal repair during 2-stage revision ACL reconstruction (ACLR).

Purpose: To evaluate the healing rates of meniscal repairs performed during 2-stage revision ACLR in ACL-deficient knees and to report the incidence of meniscus root tears in patients undergoing primary ACLR as compared with revision ACLR.

Rotator Cuff Sparing Arthroscopic SLAP Repair With Knotless All-Suture Anchors.

Arthroscopic repair of SLAP tears is a common shoulder procedure, especially in overhead athletes. Repair techniques have evolved over the last 20 years, and the optimal technique remains elusive. In many cases, a transrotator cuff portal placed lateral to the acromion is used to access the superior glenoid.

Etiology and Pathomechanics of Femoroacetabular Impingement.

Purpose Of Review: Femoroacetabular impingement is a common cause of hip pain in young patients and has been shown to progress to osteoarthritis. The purpose of this review is to better understand the development of femoroacetabular impingement.

Recent Findings: Recent literature shows little genetic transmission of FAI.

Anterior Closing Wedge Proximal Tibial Osteotomy for Slope Correction in Failed ACL Reconstructions.

Increased sagittal plane posterior tibial slope has been identified as a risk factor for primary anterior cruciate ligament reconstruction (ACLR) failure. Although ACLR failure is multifactorial, correction of sagittal plane posterior tibial slope should be evaluated in patients with an ACLR graft rupture. There are limited technical descriptions of proposed decreasing tibial slope osteotomy procedures; therefore, the purpose of this Technical Note is to describe the current senior author's technique of performing an anterior closing wedge proximal tibial osteotomy to decrease sagittal plane tibial slope in patients requiring a revision ACLR.

Lateral Posterior Tibial Slope in Male and Female Athletes Sustaining Contact Versus Noncontact Anterior Cruciate Ligament Tears: A Prospective Study.

Background: Lateral posterior tibial slope (PTS) has been identified as a risk factor for primary anterior cruciate ligament (ACL) tears.

Purpose/hypothesis: The purpose was to prospectively determine if there was a difference in lateral PTS between male and female athletes sustaining contact ACL tears as compared with a group of sex-, age-, and activity-matched athletes who sustained noncontact ACL tears. It was hypothesized that there would be no difference in degree of lateral PTS between contact and noncontact mechanisms among patients sustaining primary ACL tears in sports.

Medial Clavicle Osseous Dimensions with Implication on Plate Fixation.

Significantly displaced medial clavicle fractures are associated with high rates of painful nonunion. Operative fixation can be challenging due to limited medial bone stock and adjacent vital vascular structures. Twenty-one consecutive chest computer topography (CT) scans were analyzed to measure anterior-posterior and superior-inferior dimensions of the medial clavicle.

Retrospective Review of Air Transportation Use for Upper Extremity Amputations at a Level-1 Trauma Center.

Introduction: Air transportation to tertiary care centers of patients with upper extremity amputations has been utilized in hopes of reducing the time to potential replantation; however, this mode of transportation is expensive and not all patients will undergo replantation. The purpose of this study is to review the appropriateness and cost of air transportation in upper extremity amputations.

Materials And Methods: Consecutive patients transported by aircraft with upper extremity amputations in a 7-year period at a level-1 trauma center were retrospectively reviewed.

Leclercia adecarboxylata Musculoskeletal Infection in an Immune Competent Pediatric Patient: An Emerging Pathogen?

Case. An immune competent pediatric patient presented with a persistent lower extremity infection with Leclercia adecarboxylata after a penetrating injury. This case report details the presentation, clinical course, and treatment.

Articular Sinus Tract with Mycobacterium fortuitum Osteomyelitis After Anterior Cruciate Ligament Reconstruction: A Case Report.

Case: Three weeks after transphyseal anterior cruciate ligament reconstruction with a hamstring autograft, a fourteen-year-old boy presented with fevers, joint effusion, and elevated inflammatory markers. Cultures from an operative debridement grew Mycobacterium fortuitum, for which he received six months of antibiotics. Continued drainage prompted magnetic resonance imaging, which revealed osteomyelitis of the tibial tunnel.