Arthroscopic Superior Capsule Reconstruction Technique in the Setting of a Massive, Irreparable Rotator Cuff Tear.

Massive, irreparable rotator cuff tears are challenging to treat and associated with pain and severe limitation in shoulder elevation due to the proximal migration of the humeral head and, consequently, subacromial impingement. Furthermore, retraction of the tendons in combination with fat infiltration and muscular weakness results in unpredictable treatment outcomes. While conservative treatment may be warranted for low-demand patients, surgical treatment is often indicated for a successful return to activities of daily living as well as an improved quality of life.

Epidemiology of Injuries Identified at the NFL Scouting Combine and Their Impact on Performance in the National Football League: Evaluation of 2203 Athletes From 2009 to 2015.

Background: At the annual National Football League (NFL) Scouting Combine, the medical staff of each NFL franchise performs a comprehensive medical evaluation of all athletes potentially entering the NFL. Currently, little is known regarding the overall epidemiology of injuries identified at the combine and their impact on NFL performance.

Purpose: To determine the epidemiology of injuries identified at the combine and their impact on initial NFL performance.

Latarjet Technique for Treatment of Anterior Shoulder Instability With Glenoid Bone Loss.

Anterior glenohumeral instability is a common clinical entity, particularly among young athletic patient populations. Nonoperative management and arthroscopic treatment of glenohumeral instability have been associated with high rates of recurrence, particularly in the setting of glenohumeral osseous defects. Coracoid transfer, particularly the Latarjet procedure, has become the treatment of choice for recurrent anterior glenohumeral instability in the setting of osseous deficiencies greater than 20% to 30% of the glenoid surface area and may also be considered for the primary treatment of recurrent instability in the high-risk contact athlete, even in the setting of limited osseous deficiency.

Mini-Open Posterior Compartment Release for Chronic Exertional Compartment Syndrome of the Leg.

Chronic exertional compartment syndrome (CECS) is a well-recognized cause of leg pain in endurance athletes. Surgical fasciotomy for posterior leg CECS historically has inferior clinical results compared with anterior and lateral compartment release. Poor surgical technique with inadequate release may contribute to less reliable outcomes.

Ankle impingement.

Ankle impingement is a syndrome that encompasses a wide range of anterior and posterior joint pathology involving both osseous and soft tissue abnormalities. In this review, the etiology, pathoanatomy, diagnostic workup, and treatment options for both anterior and posterior ankle impingement syndromes are discussed.

Posterior Tibial Arterial System Deficiency Mimicking Chronic Exertional Compartment Syndrome: A Case Report.

Case: A 15-year-old female competitive high school basketball player presented as an outpatient with a 3-month history of bilateral exertional calf pain. Patient history and compartment pressure measurements were consistent with the diagnosis of chronic exertional compartment syndrome, and the patient underwent bilateral fasciotomies. Postoperatively, her symptoms recurred and she was found to have a deficient posterior tibial arterial system bilaterally, as confirmed on advanced imaging.

Suture Anchor Biomechanics After Rotator Cuff Footprint Decortication.

Purpose: To identify the biomechanical consequences of violating the cortical shelf when preparing the greater tuberosity for suture anchor repair.

Methods: Demographic information and bone mineral density were obtained for 20 fresh-frozen human humeri (10 matched pairs). Suture anchors were placed at a predetermined location in decorticated and non-decorticated settings after randomization.

Five-strand hamstring autograft for anterior cruciate ligament reconstruction.

Four-strand hamstring autograft is a common choice for anterior cruciate ligament reconstruction. A potential disadvantage of hamstring autograft for anterior cruciate ligament reconstruction is the inherent variability in graft diameter. Multiple studies have shown increased revision rates when using an undersized hamstring graft.

Surgical treatment of symptomatic superior labrum anterior-posterior tears in patients older than 40 years: a systematic review.

Background: Successful arthroscopic repair of symptomatic superior labral tears in young athletes has been well documented. Superior labral repair in patients older than 40 years is controversial, with concerns for residual postoperative pain, stiffness, and higher rates of revision surgery.

Purpose: To analyze the published data on the surgical treatment of superior labral injuries in patients aged ≥40 years, including those with concomitant injuries to the rotator cuff.

Anatomic anterior cruciate ligament reconstruction with a flexible reamer system and 70° arthroscope.

Anterior cruciate ligament (ACL) reconstruction techniques continue to evolve as surgeons seek to improve surgical process and outcome measures. On the basis of published data showing improved biomechanics, many surgeons now attempt to better re-create native ACL anatomy in reconstruction. Use of flexible reamer technology and a 70° arthroscope allows for excellent visualization of the native ACL anatomy, as well as precise and independent drilling of the tibial and femoral reconstruction tunnels, while offering several surgical and technical advantages compared with other drilling techniques.

Arthroscopic transosseous-equivalent rotator cuff repair.

Rotator cuff repair techniques continue to evolve in an effort to improve repair biomechanics, maximize the biologic environment for tendon healing, and ultimately improve patient outcomes. The arthroscopic transosseous-equivalent technique was developed to replicate the favorable tendon-bone contact area for healing seen in open transosseous tunnel repair. In this technical note and accompanying video, we present our all-arthroscopic transosseous-equivalent rotator cuff repair technique with a focus on technical pearls.

Clinical success of biceps tenodesis with and without release of the transverse humeral ligament.

Background: Multiple methods for biceps tenodesis exist, but long-term studies have demonstrated high failure rates. We hypothesized that tenodesis techniques that do not release the biceps sheath are associated with a higher surgical revision rate than those that do.

Methods: A retrospective study was conducted of 127 biceps surgeries over a 2-year period.

Acromioclavicular joint injuries: diagnosis and management.

Acromioclavicular joint injuries represent nearly half of all athletic shoulder injuries, often resulting from a fall onto the tip of the shoulder with the arm in adduction. Stability of this joint depends on the integrity of the acromioclavicular ligaments and capsule as well as the coracoclavicular ligaments and the trapezius and deltoid muscles. Along with clinical examination for tenderness and instability, radiographic examination is critical in the evaluation of acromioclavicular joint injuries.

Acromionectomy and deltoid deficiency: a solution.

Unlabelled: Deltoid insufficiency after iatrogenic or traumatic acromionectomy results from separation of the deltoid from its origin and mechanical fulcrum. Subsequent retraction of the tendon and formation of subdeltoid adhesions to the cuff and humerus result in stiffness and pain. We evaluated clinical outcomes of patients treated with autogenous tricortical iliac crest bone graft combined with deltoid reconstruction or deltoidplasty for deltoid insufficiency after acromionectomy.

Analysis of interobserver and intraobserver variability in the diagnosis and treatment of SLAP tears using the Snyder classification.

Background: Superior labral anterior posterior lesions are a relatively rare entity, and classification as a basis for selection of treatment has remained a point of controversy.

Hypothesis: There will be substantial interobserver and intraobserver variability in the diagnosis and treatment of superior labral anterior posterior tears by experienced arthroscopic specialists.

Study Design: Cohort study (diagnosis), Level of evidence, 2.