Hyperflexion and Femoral Interference Screw Insertion in ACL Reconstruction.

Background: In anatomic anterior cruciate ligament (ACL) reconstructions produced with flexible reamers and no knee hyperflexion, it is unknown whether knee hyperflexion is necessary for femoral interference screw insertion.

Purpose: To compare femoral screw-graft divergence in anatomic ACL reconstructions with endoscopic interference screws placed without knee hyperflexion and with the use of flexible versus rigid screwdrivers.

Study Design: Controlled laboratory study.

Editorial Commentary: Size Does Matter-Anterior Cruciate Ligament Graft Diameter Affects Biomechanical and Clinical Outcomes.

Anterior cruciate ligament (ACL) graft strength is related to graft diameter and how ACL grafts heal. All grafts appear to lose strength during healing. Clinical studies have documented that hamstring grafts less than 8 mm wide are more vulnerable to failure.

Height and Depth Guidelines for Anatomic Femoral Tunnels in Anterior Cruciate Ligament Reconstruction: A Cadaveric Study.

Purpose: To develop guidelines for femoral tunnel placement based on height and depth on the lateral wall of the notch and to apply these guidelines arthroscopically to show tunnel placements within the anterior cruciate ligament (ACL) femoral insertion site.

Methods: Twelve cadaveric knees were dissected to define the centers of the femoral ACL attachment and its anteromedial (AM) and posterolateral (PL) bundles. In 90° of flexion, the height and depth of each center were determined relative to the low point on the lateral intercondylar notch.

Full-Contact Practice and Injuries in College Football.

Background: Despite recent restrictions being placed on practice in college football, there are little data to correlate such changes with injuries.

Hypothesis: Football injuries will correlate with a team's exposure to full-contact practice, total practice, and total games.

Study Design: Descriptive epidemiological study.

Flexible instruments outperform rigid instruments to place anatomic anterior cruciate ligament femoral tunnels without hyperflexion.

Purpose: This study evaluated the ability of flexible instruments compared with rigid instruments to place anatomic femoral tunnels in anterior cruciate ligament reconstructions by use of both transtibial drilling and anteromedial drilling without hyperflexion.

Methods: Rigid and flexible pins were placed in 12 matched pairs of cadaveric knees with transtibial drilling (6 pairs) and anteromedial drilling (6 pairs) at 110° of flexion. Intraosseous pin lengths, femoral exit locations, and tunnel alignment were measured.

Anatomic single-bundle ACL reconstruction.

A critical evaluation of anterior cruciate ligament (ACL) reconstruction techniques has revealed that single-bundle grafts placed by conventional transtibial drilling do not provide adequate restraint to translational and rotatory forces. In some knees, this will affect function and possibly contribute to chondral injuries. The method of 2-bundle ACL reconstruction has evolved partly to address these concerns with the premise that greater rotational stability will be provided by 2-bundle grafts.

Independent drilling outperforms conventional transtibial drilling in anterior cruciate ligament reconstruction.

Background: Optimal tunnel placement is critical in anterior cruciate ligament reconstructive surgery, yet the method used to drill the tunnels may compromise their placement.

Hypothesis: An independent drilling method versus a conventional transtibial drilling method will place tunnels in different locations and produce reconstructions with different kinematics.

Study Design: Controlled laboratory study.

Osteotomies about the knee for tibiofemoral malalignment in the athletic patient.

Osteotomies have a role in the active patient with degenerative joint disease of the medial or lateral knee who, for reasons of age or activity level, is not yet a good candidate for prosthetic arthroplasty. Recognition and treatment of malalignment associated with ligamentous instability is essential if long-term good outcomes are to be expected from ligamentous reconstruction. Also, treatment of concomitant malalignment and the unloading of the operative site is now recognized as an important adjunct to any cartilage-preserving surgery.

Independent drilling of tibial and femoral tunnels in anterior cruciate ligament reconstruction.

Anterior cruciate ligament (ACL) reconstruction can be optimized when single-bundle grafts are centered within the native ligament's tibial and femoral insertions. An understanding of ACL anatomy, including surgical landmarks for tunnel placement, is critical to accomplish this task. The best method for placing the femoral tunnel requires the independent, rather than a transtibial, drilling of the femoral tunnel.

Equal kinematics between central anatomic single-bundle and double-bundle anterior cruciate ligament reconstructions.

Purpose: The purpose of this study was to compare the kinematics of a central anatomic single-bundle anterior cruciate ligament (ACL) reconstruction with a double-bundle ACL reconstruction by use of hamstring grafts and anatomic tunnel placement.

Methods: Anterior tibial translation and rotation were measured with a computer navigation system in 8 pairs of fresh-frozen cadaveric knees by use of a 133-N anterior force, an internal and external torque of 10 Nm, and an anterior force (133 N) combined with an internal rotation torque (10 Nm). Tests were performed at 30 degrees and 60 degrees of flexion with the ACL intact, the ACL transected, and after reconstruction of one side of a pair with either a single or a double-bundle construct.

Strategies to improve anterior cruciate ligament healing and graft placement.

Recent improvements in anterior cruciate ligament (ACL) reconstruction have been notable for strategies to improve ACL healing and to improve graft placements. The controversial choice of 1-bundle or 2-bundle grafts requires an advanced knowledge of native ACL insertional anatomy and an appreciation for the kinematic effects of graft placements. Understanding the limitations of surgical techniques to place tunnels is important.

Anatomical limitations of transtibial drilling in anterior cruciate ligament reconstruction.

Background: Recommended techniques for transtibial drilling in anterior cruciate ligament reconstruction are based on strategies to prevent graft impingement and preserve tibial tunnel length. The limitations of this drilling technique may restrict the ability to centralize tunnels in the anterior cruciate ligament footprints.

Hypothesis: A transtibial drilling starting point to centralize the tibial and femoral tunnels in their respective footprints can be identified, but it will result in a short tibial tunnel.

Complete embolization of a left atrial myxoma resulting in acute lower extremity ischemia.

Atrial myxoma is the most common benign tumor of the heart. Patients who have atrial myoxmas usually present with cardiac obstruction, arrhythmias, or peripheral embolization. A tumor originating in the left atrium most often embolizes to the cerebrovascular system.

Team physicians in college athletics.

Background: There has been little documentation of what constitutes the clinical work of intercollegiate team physicians. Team physicians could be recruited based on the needs of athletes.

Hypothesis: A multidisciplinary team of physicians is necessary to treat college athletes.

The biomechanical effects of low-dose irradiation on bone-patellar tendon-bone allografts.

Background: Despite evidence that low-dose irradiation of 2 Mrad (20 kGy) is not virucidal for patellar tendon allografts and reduces tissue strength, many tissue bank protocols include low-dose irradiation.

Hypothesis: Maintaining tissue mechanical integrity may be particularly relevant toward accelerated rehabilitation of the injured knee, where the cyclic function of patellar tendon allografts is critical.

Study Design: Controlled laboratory study.

Acute renal artery thrombosis treated by percutaneous rheolytic thrombectomy.

Renal artery thrombosis or embolus is a rare condition that may lead to hypertension and renal failure. Treatment options in the past have had limited success. We present a case which demonstrates the use of percutaneous rheolytic therapy with the Angiojet atherectomy catheter to treat this condition in the acute setting.