Editorial Commentary: Both Bristow and Latarjet Procedures Result in Low Rates of Recurrent Shoulder Instability Despite Potential for Bone Resorption and Lack of Graft Healing.

Anterior shoulder instability surgery has evolved over the decades, including both anatomic and nonanatomic repairs and reconstructions. Surgeons are continually advancing their skills and performing more of these procedures using arthroscopic as opposed to open techniques in patients with and without glenoid bone loss. However, there is a steep learning curve and increased technical demands when performing these procedures arthroscopically.

The effect of graft tissue on anterior cruciate ligament outcomes: a multicenter, prospective, randomized controlled trial comparing autograft hamstrings with fresh-frozen anterior tibialis allograft.

Purpose: To compare the results and outcome of anterior cruciate ligament (ACL) reconstruction using autogenous hamstring tendon versus fresh-frozen allograft anterior tibialis tendon.

Methods: A prospective randomized study was conducted from September 2002 to October 2006. We randomized 147 patients to undergo ACL reconstruction with either autogenous hamstring or fresh-frozen allograft anterior tibialis tendon.

Controversies in soft-tissue anterior cruciate ligament reconstruction: grafts, bundles, tunnels, fixation, and harvest.

Increased stability has been reported with both autografts and allografts for anterior cruciate ligament (ACL) reconstruction. However, meta-analysis has shown significantly lower overall knee stability rates and more than double the abnormal stability rate with allografts. Some issues surrounding allograft sterilization (ie, risk of disease transmission) are unresolved, and cost is also a concern.

Principles for using hamstring tendons for anterior cruciate ligament reconstruction.

The use of autogenous hamstring tendon as a graft source for anterior cruciate ligament (ACL) reconstruction continues to gain in popularity. The low harvest morbidity and excellent biomechanical graft properties coupled with improved fixation of soft tissue grafts are all reasons for excellent clinical outcomes of ACL reconstruction using hamstring tendons. In addition, surgeon awareness of the complications associated with poor tunnel placement and more exacting tunnel placement techniques help prevent roof and posterior cruciate ligament impingement and contribute to the successful outcomes of hamstring ACL constructs.

Gravity reduces the tibia when using a tibial guide that targets the intercondylar roof.

Background: Reduction of the tibia relative to the femur with the knee in maximum extension is required to correctly position the tibial tunnel in the sagittal plane when using a guide that targets the intercondylar roof. The authors found no studies that determined (1) whether gravity reduces the tibia and (2) whether roof impingement is prevented without a roofplasty and without positioning the tibial tunnel too posteriorly.

Methods: The position of the tibia relative to the femur was measured from a lateral radiograph of the treated knee in maximum extension with and without the tibial guide and of the contralateral normal knee in extension in single-leg stance (control).

Scientific justification and technique for anterior cruciate ligament reconstruction using autogenous and allogeneic soft-tissue grafts.

The DLSTG is the strongest and stiffest autogenous graft source available for reconstruction of the torn anterior cruciate ligament. Harvest morbidity is low compared with other autogenous graft sources, such as the patellar bone-tendon-bone graft. Soft-tissue allografts provide an excellent alternative for patients requiring revision surgery or for patients who want to avoid any morbidity associated with autogenous graft harvest.

How four weeks of implantation affect the strength and stiffness of a tendon graft in a bone tunnel: a study of two fixation devices in an extraarticular model in ovine.

Background: For a tendon graft to function as an anterior cruciate ligament, the tendon must heal to the bone tunnel. We studied the effect of 4 weeks of implantation on the strength and stiffness of a tendon in a bone tunnel using two different fixation devices in an ovine model.

Hypothesis: The type of fixation device in anterior cruciate ligament reconstruction may affect early healing, which can be measured as the strength and stiffness of a tendon in a bone tunnel.