The pathoanatomy of medial ligamentous disruption in the dislocated and multiple ligament injured knee.

Purpose: To describe the medial-sided pathoanatomy and ligament injuries in acute MLKIs with medial-sided involvement andlook forassociated injury patterns based upon location of ligamentous injury.

Methods: Patients who underwent treatment for MLKI at two level-1 trauma centers were identified between January 2001 and May 2023. Only cases involvingcomplete disruption of the superficial medial collateral ligament (sMCL) were included.

A Novel MRI Mapping Technique for Evaluating Bone Bruising Patterns Associated With Noncontact ACL Ruptures.

Background: Bone bruise patterns in the knee can aid in understanding the mechanism of injury in anterior cruciate ligament (ACL) ruptures. There is no universally accepted magnetic resonance imaging (MRI) mapping technique to describe the specific locations of bone bruises.

Hypothesis: The authors hypothesized that (1) our novel mapping technique would show high interrater and intrarater reliability for the location of bone bruises in noncontact ACL-injured knees and (2) the bone bruise patterns reported from this technique would support the most common mechanisms of noncontact ACL injury, including valgus stress, anterior tibial translation, and internal tibial rotation.

Examining the Bone Bruise Patterns in Multiligament Knee Injuries With Peroneal Nerve Injury.

Background: Tibiofemoral bone bruise patterns seen on magnetic resonance imaging (MRI) are associated with ligamentous injuries in the acutely injured knee. Bone bruise patterns in multiligament knee injuries (MLKIs) and particularly their association with common peroneal nerve (CPN) injuries are not well described.

Purpose: To analyze the tibiofemoral bone bruise patterns in MLKIs with and without peroneal nerve injury.

Injury to the Meniscofemoral Portion of the Deep MCL Is Associated with Medial Femoral Condyle Bone Marrow Edema in ACL Ruptures.

Background: The primary goal of the present study was to investigate injury to the deep medial collateral ligament (MCL), specifically the meniscofemoral ligament (MFL) portion, and its association with medial femoral condyle (MFC) bone marrow edema in acute anterior cruciate ligament (ACL) ruptures. The secondary goal was to examine the association between MFL injury and medial meniscal tears (MMTs) in these same patients.

Methods: Preoperative magnetic resonance imaging (MRI) scans of 55 patients who underwent ACL reconstruction surgery were retrospectively reviewed by 2 board-certified musculoskeletal radiologists.

Isolated avulsion fracture at the medial head of the gastrocnemius muscle.

An isolated avulsion fracture involving the femoral origin of the medial head of the gastrocnemius muscle without an associated muscular, meniscal, or ligamentous injury is extremely rare. We report a case of a 14-year-old male wrestler who presented with a radiographically occult avulsion fracture of the medial gastrocnemius tendon sustained during competition. To our knowledge, this is the first case to describe a mechanism of injury as well as to report a return to competition after non-operative management.

Sex differences in factors influencing recovery from arthroscopic knee surgery.

Background: Many factors affect recovery from arthroscopic partial meniscectomy, including patient sex. However, sex differences in time to maximal recovery of knee function and factors influencing differential rates of recovery are unknown.

Questions/purposes: We determined (1) preoperative sex differences, (2) sex differences in rate and extent of recovery through 1 year postoperatively, and (3) clinical and fitness variables that could explain potential sex differences in recovery from partial meniscectomy.

Surgical stress-induced immune cell redistribution profiles predict short-term and long-term postsurgical recovery. A prospective study.

Background: The experience of undergoing surgery is known to induce a short-term, fight-or-flight physiological stress response. As an optimum immune response at the site of surgery would enhance tissue repair, we examined surgical stress-induced immune cell redistribution profiles as predictors, and potential mediators, of short and long-term postoperative recovery. We tested the a priori hypothesis that predefined adaptive immune cell redistribution profiles observed during surgery will predict enhanced postoperative recovery.

Mood and attitude predict pain outcomes following arthroscopic knee surgery.

Background: Decreased pain represents a clinically important outcome following arthroscopic knee surgery. However, little is known about preoperative mood and attitudinal factors and their potential relationship with pain outcomes.

Purpose: This prospective, longitudinal study investigated the influence of preoperative depression, stress, and optimism on pain severity and interference with functioning, controlling for relevant demographic and clinical factors 1 year postoperatively.

Predictors of short-term recovery differ from those of long-term outcome after arthroscopic partial meniscectomy.

Purpose: The purpose of this study was to determine which patient clinical and demographic factors are associated with the short-term rate of recovery from arthroscopic partial meniscectomy in the year after surgery and how they differ from previously published associations with long-term outcome.

Methods: Depth of meniscal excision, involvement of 1 or both menisci, extent of meniscal tear, and extent of osteoarthritis were determined during surgery, and age, body mass index, and gender were recorded. Mixed-model repeated-measures analyses were used longitudinally to identify independent predictors of recovery, measured by prospectively assessing knee pain, knee function, and overall physical knee status preoperatively and at regular intervals throughout postoperative recovery.

Surgical outcomes after arthroscopic partial meniscectomy.

Much research has been done to determine clinical and demographic variables associated with outcomes from arthroscopic partial meniscectomy for meniscal tears. We undertook a review of the literature to determine trends regarding outcomes from this procedure. Independent variables were analyzed for associations with outcome, and outcome measures and methods of statistical analysis were reviewed.

Hip arthroscopy without a perineal post: a safer technique for hip distraction.

Pudendal nerve palsy is a reported complication of hip arthroscopy. We report a technique using a deflated taped beanbag rather than a perineal post. The patient is placed in the supine or lateral position on a fracture table.

Psychosocial factors and surgical outcomes: an evidence-based literature review.

The influence of psychosocial factors on clinical outcomes after surgery has been investigated in several studies. This review is limited to surgical outcomes studies published between 1990 and 2004 that include (1) psychosocial variables (eg, depression, social support) as predictors of outcome and that focus on (2) clinical outcomes (eg, postoperative pain, functional recovery) using (3) specific multivariate analytic techniques with (4) relevant clinical variables (eg, presurgical health status) included as covariates. Twenty-nine studies met these criteria.

Implications of the pivot shift in the ACL-deficient knee.

Unlabelled: The Losee repair controls rotational subluxation of the lateral femoral condyle, or pivot shift, but does not reliably eliminate Lachman laxity. Despite this surgical limitation, many patients who were operated on continued to do high-demand activities at the last followup. We hypothesized that Lachman findings alone did not predict poor surgical outcome or progression to osteoarthritis.

Shared decision making, preoperative expectations, and postoperative reality: differences in physician and patient predictions and ratings of knee surgery outcomes.

Purpose: The present study was performed to determine the extent to which physicians and patients rate preoperative and postoperative knee pain and function differently, and to determine whether physicians or patients more accurately predict postoperative knee pain and function.

Type Of Study: Longitudinal, prospective study.

Methods: Ninety-eight patients requiring either anterior cruciate ligament reconstruction surgery or meniscectomy and related surgery were interviewed 1 week before surgery, as well as 3 and 24 weeks postoperatively.

Master's performance in the New York City Marathon 1983-1999.

Background: Physical activity in older people is believed to slow down the natural aging process through its effects on disuse atrophy.

Objectives: To show that elite master (age above 50) male and female athletes, as a group, have improved their running times over the last two decades at a greater rate than their younger counterparts.

Methods: Running time, age, and sex of all 415,000 runners in the New York City Marathon from 1983 to 1999 were examined using linear regression analysis.

MR arthrography of anterior cruciate ligament reconstruction grafts.

Objective: Our objective was to determine the accuracy of MR arthrography for identification of tears of anterior cruciate ligament reconstruction grafts and for detection of localized anterior arthrofibrosis and impingement.

Materials And Methods: We retrospectively identified 27 patients (mean age, 31 years; range, 18-45 years) with anterior cruciate ligament reconstruction who had undergone MR arthrography followed by arthroscopy within 1 year. Three radiologists independently reviewed the MR arthrograms for the presence or absence of graft tear, localized anterior arthrofibrosis, and impingement.

Technical tips in orthopaedics: meniscal repair with use of an in situ fibrin clot.

The importance of meniscal preservation has become increasingly clear, and many authors advocate repair of the meniscus whenever possible, forgoing patient age and tear location. In accordance with the common goal of preserving meniscal tissue, we describe a simple technique to augment meniscal repairs with the use of an in situ fibrin clot. The site is prepared accordingly: the synovium directly above the tear site is abraded with a shaver, rasp, or small intra-articular banana blade.

Vascular leiomyoma presenting as medial joint line pain of the knee.

We present the case of a 27-year-old woman with a subcutaneous vascular leiomyoma occurring around the knee. The patient presented with a several-year history of medial-sided knee pain with an unknown etiology. The clinical presentation, magnetic resonance imaging, and histopathologic features are reported, and the literature pertaining to the clinicopathologic characteristics is reviewed.

Muscle contusion injury and myositis ossificans traumatica.

In athletic competition, muscle contusion injury is a frequent and debilitating condition. Found in traditional contact and noncontact sports, contusions also can occur to the nonathlete by simple falls and accidents. The injury consists of a well-defined sequence of events involving microscopic rupture and damage to muscle cells, macroscopic defects in muscle bellies, infiltrative bleeding, and inflammation.

Grade 2C signal in the meniscus [correction of mensicus] on MR imaging of the knee.

Objective: The objective of our study was to evaluate the clinical significance of grade 2C meniscal [corrected] signal (an extensive triangular or wedge-shaped signal that does not reach the surface on more than one image) on MR imaging of the knee.

Materials And Methods: Review of 1106 MR imaging reports over 2 years revealed 88 patients with menisci described as containing triangular, wedge-shaped, extensive, or grade 2C signal. Image review by consensus of two radiologists found 34 menisci in 29 patients that fit criteria for grade 2C signal.

Effect of aging on male and female master athletes' performance in strength versus endurance activities.

Aging has traditionally been associated with several functional declines within the musculoskeletal system. In this study, we characterized and compared age-related changes in performance in power and endurance activities (ie, power-lifting, stationary rowing). From age 25 to age 85, men's and women's rowing performance decreases 29%; from age 25 to age 55, men's rowing performance decreases 0.

Muscle contusion injuries: current treatment options.

Muscle contusion is second only to strain as the leading cause of morbidity from sports-related injuries. Severity depends on the site of impact, the activation status of the muscles involved, the age of the patient, and the presence of fatigue. The diagnosis has traditionally been one of clinical judgment; however, newer modalities, including ultrasonography, magnetic resonance imaging, and spectroscopy, are becoming increasingly important in both identifying and delineating the extent of injury.

Aging successfully: the importance of physical activity in maintaining health and function.

Physicians caring for middle-aged and older patients frequently overlook the importance of regular physical activity. Exercise on a routine basis is an important component of successful aging. It has been shown that many age-related declines in musculoskeletal function can be markedly reduced by participation in some form of regular exercise.

Endometriosis of the pelvis presenting as hip pain. A case report.

Endometriosis is a disorder resulting from the presence of actively growing and functioning endometrial tissue in aberrant sites outside the uterus. Ectopic implantation of the endometrium can be located throughout the pelvic cavity. Depending on the location of the endometriosis, it can mimic common musculoskeletal problems, especially in young women who are menstruating.