Mechanical Analysis of a Novel 3D-printed External Fixator Design Versus Industry-standard External Fixators.

Introduction: External fixation is a critical component of orthopaedic fracture management and is used for various conditions, including trauma and pediatric orthopaedics. However, the availability and high cost of external fixation devices are a concern, especially in rural and developing countries. 3D printing technology has shown promise in reducing manufacturing costs and improving accessibility to external fixation devices.

Effect of Time and Sex on Post-Anterior Cruciate Ligament Reconstruction Psychological Patient-Reported Outcome Measure Scores.

Context: Low scores on psychological patient-reported outcomes measures, including the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) and Injury-Psychological Readiness to Return to Sport (I-PRRS), after anterior cruciate ligament reconstruction (ACLR) have been associated with a maladaptive psychological response to injury and poor prognosis.

Objective: To assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores and generate normative reference curves.

Design: Case series.

Clinical Practice Update: Achilles Tendon Rupture.

Achilles tendon rupture is a common injury. It most often occurs in middle aged men who participate in recreational sports. The injury classically presents with a loud popping noise and immediate pain and weakness of the lower extremity during actions such as jumping or running.

Clinical shoulder measurements related to joint loads in collegiate pitchers.

Background: Pitchers are prone to upper extremity injury due to repetitive high joint loads. Clinical measures of shoulder strength and range of motion (ROM) have shown links to injury risk in pitchers, however, these factors have rarely been studied in relation to throwing joint loads. The purpose of this study was to identify which clinical ROM and isokinetic strength variables were related to peak shoulder and elbow joint torques in collegiate pitchers.

Arthroscopic Repair of the Acetabular Labrum Using an Anchor-First Modified Toggle Suture Technique.

The goal of acetabular labral repair is to restore stable contact between the labrum and acetabular rim while maintaining the anatomic suction seal. One of the challenges of labral repair is achieving proper in-round repair, so that the labrum contacts the femoral head in the native position. This technique article presents a repair method that allows for enhanced inversion of the labrum to assist with anatomic repair.

Design and Development of a Novel 3-D Printed External Fixation Device for Fracture Stabilization.

Background: An external fixator is an orthopaedic device used to stabilize long bone fractures after high energy trauma. These devices are external to the body and fixed to metal pins going into non-injured areas of bone. They serve a mechanical function to maintain length, prevent bending, and resist torque forces about the fracture area.

Prospective Randomized Controlled Clinical Trial Comparing Hyperosmolar Saline to Standard Isotonic Irrigation Fluid for Arthroscopic Knee Surgery: Initial Clinical Outcomes.

Numerous in vitro studies suggest higher osmolarity irrigation fluids potentiate a chondroprotective environment, and a recent clinical study using hyperosmolar saline for shoulder arthroscopy reported potential clinical advantages. This prospective randomized double-blind controlled clinical trial was designed to assess initial clinical outcomes associated with use of a hyperosmolar irrigation solution in patients undergoing arthroscopic knee surgery. With institutional review board approval and informed consent, patients scheduled for arthroscopic knee surgery were randomized to surgery with either isotonic lactated Ringer's (273 mOsm/L) or hyperosmolar saline (593 mOsm/L) irrigation solution.

Return-to-Sport Review for Current Cartilage Treatments.

The return to play outcome is an important measure for orthopaedic sports medicine treatments. This variable is especially important when discussing cartilage treatments because there are many different cartilage options available to athletes with articular injuries and this population is particularly interested in the ability to return to activities. Although many outcome variables are considered in any surgical procedure, the return-to-sport variable is focused on an active population and can be tailored to that patient's sport-specific goals.

Sterility of 3D-Printed Orthopedic Implants Using Fused Deposition Modeling.

The use of 3-dimensional (3D) printing in orthopedics is developing rapidly and impacting the areas of preoperative planning, surgical guides, and simulation. As this technology continues to improve, the greatest impact of 3D printing may be in low- and middle-income countries where surgical items are in short supply. This study investigated sterility of 3D-printed ankle fracture fixation plates and cortical screws.

Eccentric Reaming for B2 Glenoids: History, Preoperative Planning, Surgical Technique, and Outcome.

Background: The biconcave (B2) glenoid is characterized by preservation of the anterior portion of the native glenoid with asymmetric wear of the posterior glenoid. Surgical options for glenoid correction have evolved. The goal of shoulder arthroplasty is to place the implants in such a manner to return the humeral head to a centered position and restore the joint line to a neutral position.

Three-dimensional Printing Technology in Orthopaedics.

Three-dimensional (3-D) printing technology is affecting how orthopaedic surgeries are planned and executed. Like many innovations, 3-D printers are becoming smaller, more affordable, and more accessible. Free access to open-source 3-D imaging software has also made clinical implementation of this technology widely feasible.

Direct Visualization of Suspensory Fixation Deployment in Knee Ligament Reconstructions Without Fluoroscopic Imaging.

The authors describe a technique for visualizing the deployment of femoral suspensory fixation during ligament reconstructions that avoids the need for intraoperative fluoroscopic radiographs. Many surgeons currently use intraoperative fluoroscopic radiographs to confirm satisfactory deployment of the suspensory button on the femur; however, this technique involves prolonged surgical time, additional costs, and radiation exposure to the surgical team and patient. The authors' technique uses novel leg and camera positioning to allow for direct visualization of the button deployment.

"In-Round" Labral Repair After Acetabular Recession Using Intermittent Traction.

The prevalence of hip arthroscopy has increased exponentially with the advent of arthroscopic labral repair techniques for femoroacetabular impingement. The goal of arthroscopic labral repair is to re-create the anatomic suction seal of the labrum against the femoral head. This important anatomic relationship has been demonstrated in several biomechanical studies.

Shoulder activity level and progression of degenerative cuff disease.

Background: This study prospectively examined the relationship of direct and indirect measures of shoulder activity with the risks of tear progression and pain development in subjects with an asymptomatic degenerative rotator cuff tear.

Methods: A cohort of asymptomatic degenerative rotator cuff tears was prospectively monitored annually, documenting tear size progression with ultrasound imaging and potential shoulder pain development. Shoulder activity level, self-reported occupational and physical demand level, and hand dominance were compared with risks of tear enlargement and future pain development.

Pilot and Passenger Injuries Associated with Powered Parachutes.

Background: Powered parachutes are becoming a popular form of sport flying. No previous study has reviewed injuries in this sport. The purpose of this study was to describe the injuries associated with powered parachute flying, the flight factors involved in an incident, and the impact an incident has on current sport involvement.

Microstructural and Mechanical Properties of the Posterior Cruciate Ligament: A Comparison of the Anterolateral and Posteromedial Bundles.

Background: The microstructural organization (collagen fiber alignment) of the posterior cruciate ligament (PCL), which likely corresponds with its functional properties, has only been described qualitatively in the literature, to our knowledge. The goal of this study was to quantify the tensile mechanical and microstructural properties of the PCL and compare these qualities between the anterolateral and posteromedial bundles.

Methods: Twenty-two knee specimens from 13 donors (8 male and 5 female; mean age [and standard deviation] at the time of death, 43.

Regional Variation in the Mechanical and Microstructural Properties of the Human Anterior Cruciate Ligament.

Background: The anteromedial (AM) bundle of the anterior cruciate ligament (ACL) has a higher modulus and failure stress than does the posterolateral (PL) bundle. However, it is unknown how these properties vary within each bundle.

Purpose: To quantify mechanical and microstructural properties of samples within ACL bundles to elucidate any regional variation across the ligament.

Microstructural properties and mechanics vary between bundles of the human anterior cruciate ligament during stress-relaxation.

Previous studies have shown different elastic properties between the anteromedial (AM) and posterolateral (PL) bundles of the human anterior cruciate ligament (ACL). However, it is unknown if the two bundles of the ACL exhibit distinct time-dependent properties and microstructural organization, which have important implications for fully understanding the structure-function relationships of this oft-injured ligament. The goal of this study was to quantify the viscoelastic material properties and collagen fiber alignment of the AM and PL bundles in 16 human ACLs during stress-relaxation mechanical tests using the quasi-linear viscoelastic (QLV) model and a quantitative polarization imaging technique.

Differences in the microstructural properties of the anteromedial and posterolateral bundles of the anterior cruciate ligament.

Background: Tissue properties of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) have not been previously characterized with real-time dynamic testing. The current study used a novel polarized light technique to measure the material and microstructural properties of the ACL.

Hypothesis: The AM and PL bundles of the ACL have similar material and microstructural properties.

A novel reduction technique for elbow dislocations.

The purpose of this study was to review a novel reduction maneuver for elbow dislocations. This was a retrospective review comparing a traditional elbow reduction method with a new single-person reduction technique. The reductions were performed during a 3-year period.