Biceps Tenodesis as an Attractive Alternative to Superior Labral Anterior-Posterior (SLAP) Repair for Type II SLAP Lesions in Active-Duty Military Patients Younger Than 35 Years.

Background: Biceps tenodesis has been suggested as a superior surgical technique compared with isolated labral repair for superior labral anterior-posterior (SLAP) tears in patients older than 35 years. The superiority of this procedure in younger patients, however, is yet to be determined.

Purpose: To compare the outcomes of arthroscopic SLAP repair with those of arthroscopic-assisted subpectoral biceps tenodesis for type II SLAP tears in active-duty military patients younger than 35 years.

Outcomes of Simultaneous Arthroscopic Rotator Cuff Repair and Inferior Labral Repair Among Active Patients Younger Than 40 Years.

Rotator cuff tears as a consequence of shoulder instability, which are uncommon among patients younger than 40 years, have been found to be more prevalent in active duty service members in this age group. As a result, this population provides a unique opportunity to study concurrent arthroscopic treatment of rotator cuff and inferior labrum tears in young, active patients, a topic that has not been studied extensively. The goal of this study was to report clinical outcomes of rotator cuff and inferior labral tears managed concurrently with all-arthroscopic repair for military patients younger than 40 years.

Direct repair of chronic pectoralis major tears in active duty military patients.

Objective: To express the significance and report the clinical outcomes of active duty military patients who underwent direct pectoralis major repairs in a chronic setting.

Methods: Retrospective review of data collected on 16 active duty military patients who underwent direct repair of a chronic pectoralis major tear. Pre-operative and post-operative evaluations (minimum 2 year follow up; mean, 53.

Risk of Iatrogenic Axillary Nerve Injury During Acromioclavicular Joint Reconstruction.

Anatomical reconstruction of the coracoclavicular ligaments involves drilling the base of the coracoid or looping a graft around it, placing the axillary nerve at risk for injury. Rockwood type V acromioclavicular (AC) separation injuries involve disruption of the AC joint capsule and coracoclavicular ligaments, resulting in inferomedial displacement of the scapulohumeral complex and alteration of the normal anatomical relations of the shoulder girdle structures. This study evaluated the effect of Rockwood type V AC separation on the anatomical relation of the axillary nerve to the coracoid base.

Outpatient Orthopedic Rehabilitation in New York State During the COVID-19 Pandemic: Therapist Perspectives.

The COVID-19 pandemic has had a strong impact on the care of orthopedic patients. This impact has been particularly difficult in New York State, which experienced the largest number of COVID-19 cases and led to a state- mandated pause on all elective surgeries. As a result, physical and occupational therapists became the principal providers of care and had to adjust their workflow to ensure quality care.

Arthroscopic Repair of Full-Thickness Rotator Cuff Tears in Active Patients Younger Than 40 Years: 2- to 5-Year Clinical Outcomes.

This study characterized injury patterns and reported clinical outcomes of all-arthroscopic management of full-thickness rotator cuff tears among military patients younger than 40 years. A retrospective review was performed of prospective data for 42 patients younger than 40 years who underwent arthroscopic rotator cuff repair and, in some cases, concomitant labral repair. Preoperative and postoperative evaluations (minimum follow-up, 2 years; mean, 41 months; range, 24-66 months) included range of motion, visual analog scale (VAS) score, Subjective Shoulder Value (SSV), and American Shoulder and Elbow Surgeons (ASES) Shoulder Score.

Elastic Intramedullary Nailing of a Medial Clavicle Fracture in a Pediatric Patient.

Introduction: Injuries to the medial clavicle in pediatric patients typically involve the physis and/or sternoclavicular joint. Clavicle fractures are one of the most common injuries in children, but ones at its medial end are rare. Most medial clavicle fractures are treated nonoperatively, but surgery is indicated in some cases.

Effect of highly purified capsaicin on articular cartilage and rotator cuff tendon healing: An in vivo rabbit study.

Highly purified capsaicin has emerged as a promising injectable compound capable of providing sustained pain relief following a single localized treatment during orthopedic surgical procedures. To further assess its reliability for clinical use, the potential effect of highly purified capsaicin on articular cartilage metabolism as well as tendon structure and function warrants clarification. In the current study, rabbits received unilateral supraspinatus transection and repair with a single 1 ml injection of capsaicin (R+C), PEG-only placebo (R+P), or saline (R+S) into the glenohumeral joint (GHJ).

The teres minor muscle in rotator cuff tendon tears.

Objectives: Although the teres minor has received little attention in the literature compared to the other musculotendinous units of the rotator cuff, it is an important component of shoulder function. Our purpose was to study the appearance of the teres minor muscle on CT and MRI images in various patterns of rotator cuff tears.

Materials And Methods: We analyzed the appearance of the teres minor according to the Walch classification (normal, hypertrophic, atrophic, or absent) in 1,332 CT and in 240 MRI images of rotator cuff tears and we correlated it with the type of rotator cuff tears, time period between initial onset of symptoms and diagnostic imaging, age of the patient at the time of imaging, and degree of fatty infiltration of other rotator cuff muscles.

Subscapularis management in open shoulder surgery.

Management of the subscapularis in open shoulder surgery is a controversial topic. Subscapularis tenotomy has been the traditional approach, but other techniques have recently been developed to preserve the integrity of the subscapularis tendon. These include subscapularis peel, subscapularis split, and lesser tuberosity osteotomy.

Natural history of fatty infiltration and atrophy of the supraspinatus muscle in rotator cuff tears.

Background: In some patients nonoperative treatment of a rotator cuff tear is sufficient, while in others it is only the first stage of treatment prior to surgery. Fatty infiltration progresses throughout the nonoperative treatment although it is not known at what point fatty infiltration contributes to poor functional outcomes, absence of healing, or increased rerupture rates.

Questions/purposes: We therefore identified factors related to the appearance of supraspinatus muscle fatty infiltration, determined the speed of appearance and progression of this phenomenon, and correlated fatty infiltration with muscular atrophy.

Current perspectives on rotator cuff anatomy.

Understanding the anatomy of the rotator cuff and the surrounding structures that influence its function is essential to treating rotator cuff disease. During the past decade, advances in basic science and surgical technology have improved our knowledge of this anatomy. This review article presents the current concepts on rotator cuff anatomy and how they should be used in the surgical management of rotator cuff tears.

A comprehensive review of partial anterior cruciate ligament tears.

A partial tear of the anterior cruciate ligament is characterized by an asymmetric Lachman-test result, a negative pivot-shift test, a low-grade KT-1000 arthrometer measurement (< or =3 mm), and arthroscopic evidence of anterior cruciate ligament injury. The pivot shift test is the most important test in determining anterior cruciate ligament insufficiency. A positive test, independent of the grade, is indicative of a functionally deficient anterior cruciate ligament.

Environmental issues for team physicians.

As outdoor sports continue to gain popularity, understanding the environmental factors that may influence athletes is becoming a more important aspect of medical care for team physicians. Temperature, ultraviolet light, lightning, and altitude are some of the most common elements that cause illness. Understanding how to prevent, diagnose, and promptly treat conditions caused by environmental factors is essential to optimizing athletic performance in outdoor sports and avoiding morbidity.

The floating shoulder.

The floating shoulder is an uncommon but important injury pattern. Although it is frequently defined as an ipsilateral fracture of the clavicle and scapular neck, recent studies suggest that ligament disruption associated with a scapular neck fracture contributes to the functional equivalent of this injury pattern, with or without an associated clavicle fracture. Determining the specific injury patterns indicates the potential for significant instability, and correlating these patterns with clinical outcome is a challenge.

Radial nerve injuries associated with humeral fractures.

A radial nerve injury associated with a humeral shaft fracture is an important injury pattern among trauma patients. It is the most common peripheral nerve injury associated with this fracture. Although treatment for this injury pattern is a controversial subject among upper-extremity surgeons, certain principles of management need to be applied in all cases.

Evaluation and management of valgus impacted four-part proximal humerus fractures.

Unlabelled: A valgus impacted, four-part humerus fracture is an uncommon but important injury to recognize in patients with orthopaedic trauma. Recognizing this fracture pattern and understanding the pathoanatomy of it are essential to providing appropriate care. The treatment options for valgus impacted, four-part humerus fractures range from nonoperative care to hemiarthroplasty.

Stress fractures of the femur in athletes.

Femoral stress fractures represent an uncommon but important lower-extremity injury in athletes and soldiers. Careful assessment of the involved and contralateral lower extremity and the spine is required to make the diagnosis. Based on a review of the literature, specific treatment is based on individual patient assessment.

New therapies in tendon reconstruction.

Despite the use of various types of grafts, no surgical treatment currently exists to restore a tendon to its normal condition. Tissue engineering techniques are being used to develop therapies for tendon reconstruction. Biologic and synthetic scaffolds can both repair tendon defects and improve healing by allowing for the regeneration of the tendon's natural biologic composition to restore its mechanical capacity.