Arthroscopic Anterior Cruciate Ligament Femoral Tunnel Visualization for Button Fixation.

Arthroscopic reconstruction of the anterior cruciate ligament (ACL) remains one of the most commonly performed procedures in orthopaedic surgery. We describe a technique to visualize the button being advanced through the femoral tunnel using an arthroscope placed in the anteromedial portal. Looking into the femoral tunnel in line with the sutures, this technique allows the surgeon to directly visualize the femoral button as it traverses the femoral tunnel and confirms that it is engaged over the femoral cortex.

Immortalized Mouse Achilles Tenocytes Demonstrate Long-Term Proliferative Capacity While Retaining Tenogenic Properties.

Investigating the cellular processes underlying tendon healing can allow researchers to improve long-term outcomes after injury. However, conducting meaningful studies to uncover the injury healing mechanism at cellular and molecular levels remains challenging. This is due to the inherent difficulty in isolating, culturing, and expanding sufficient primary tenocytes, due to their limited proliferative capacity and short lifespan.

Pectoralis major repair with cortical button technique.

Pectoralis major tendon ruptures can lead to significant functional deficits that affect high-level athletic and labor-intensive activities. In active populations operative repair of the ruptured pectoralis major tendon has shown significant advantages over nonoperative treatment. We describe a novel surgical technique for pectoralis major repair with tension button fixation.

Posterior instability caused by batter's shoulder.

In summary, batter’s shoulder is a rare and only recently recognized entity. This condition is posterior shoulder instability caused by a missed attempt at hitting a pitch, especially with an outside pitch. The lack of counterforce from hitting a ball produces increased forces imparted on the posterior capsulolabral complex of the lead shoulder during batting.

Age-related differences in radiographic parameters for femoroacetabular impingement in hip arthroplasty patients.

Purpose: To compare the prevalence of femoroacetabular impingement (FAI) radiographic findings between patients aged younger than 50 years and those aged 50 years or older who underwent total hip arthroplasty.

Methods: Total hip arthroplasty patients aged younger than 50 years and those aged 50 years or older were identified retrospectively from a facility medical record database. Fifty patients from each group were randomly selected, and preoperative radiographs were collected.

The biomechanical effects of 1.0 to 1.2 Mrad of γ irradiation on human bone-patellar tendon-bone allografts.

Background: Recent data suggest that anterior cruciate ligament (ACL) reconstruction with irradiated allograft tissue may lead to increased failure rates.

Hypothesis: Low-dose (1.0-1.

Emerging ideas: Novel 3-D quantification and classification of cam lesions in patients with femoroacetabular impingement.

Background: Femoroacetabular impingement (FAI) can lead to labral injury, osseous changes, and even osteoarthritis. The literature contains inconsistent definitions of the alpha angle and other nonthree-dimensional (3-D) radiographic measures. We present a novel approach to quantifying cam lesions in 3-D terms.

Allograft meniscus transplantation.

Menisci function to manage load transmission, provide secondary mechanical stability as well as nutrition, and lubricate the joint. Meniscus transplantation techniques continue to evolve and include: free soft tissue allograft implantation; separate anterior and posterior bone plugs; and bone bridges including key hole, trough, dovetail, and bridge-in-slot variations. The senior author's preference is for the bridge-in-slot technique for lateral and medial menisci, owing to its simplicity and secure bony fixation, flexibility in allowing concomitant procedures as osteotomy and ligament reconstruction, and the ability to maintain the native anterior and posterior meniscal horn attachments.

Effect of donor age on bone mineral density in irradiated bone-patellar tendon-bone allografts of the anterior cruciate ligament.

Background: Allograft tissue remains a valuable alternative for anterior cruciate ligament reconstruction. No study to date has correlated the effect of donor age to bone mineral density (BMD) in a large series of irradiated bone-patellar tendon-bone (BPTB) allograft tissue. Hypothesis/

Purpose: The authors attempted to correlate donor age with BMD in a large group of BPTB allograft specimens treated with low-dose gamma irradiation (1.

Osteochondral Tissue Cell Viability Is Affected by Total Impulse during Impaction Grafting.

Objective: Osteochondral graft transplantation has garnered significant attention because of its ability to replace the lesion with true hyaline cartilage. However, surgical impaction of the graft to anchor it into the defect site can be traumatic and lead to cell death and cartilage degeneration. This study aimed to test the hypothesis that increasing impulse magnitude during impaction of osteochondral plugs has a direct effect on loss of cell viability.

Effect of impaction sequence on osteochondral graft damage: the role of repeated and varying loads.

Background: Osteochondral autografts and allografts require mechanical force for proper graft placement into the defect site; however, impaction compromises the tissue. This study aimed to determine the effect of impaction force and number of hits to seat the graft on cartilage integrity.

Hypothesis: Under constant impulse conditions, higher impaction load magnitudes are more detrimental to cell viability, matrix integrity, and collagen network organization and will result in proteoglycan loss and nitric oxide release.

Complications associated with anterior shoulder instability repair.

Anterior shoulder instability is a common orthopaedic problem, and the surgical treatment, both open and arthroscopic, has been shown to effectively restore stability and prevent recurrence. However, despite success with these surgical techniques, there are several clinically relevant complications associated with both open and arthroscopic techniques for anterior shoulder stabilization. These complications can be subdivided into preoperative, intraoperative, and postoperative and include entities such as nerve injury, chondrolysis, incomplete treatment of associated lesions, and subscapularis dysfunction.

Triad of cartilage restoration for unicompartmental arthritis treatment in young patients: meniscus allograft transplantation, cartilage repair and osteotomy.

Arthritis treatment in young patients remains a challenge. Joint replacement surgery offers excellent pain relief but is controversial with this age group because of long-term wear and loosening. Recently, biological reconstructive techniques have become available to improve traditional treatment methods such as osteotomies.

A randomized, prospective, double-blind study to investigate the effectiveness of adding DepoMedrol to a local anesthetic injection in postmeniscectomy patients with osteoarthritis of the knee.

Background: Patients with osteoarthritis of the knee are at risk for poorer outcomes after arthroscopic meniscectomy. Intra-articular corticosteroid injections have been shown to be efficacious both in patients with osteoarthritis and postarthroscopy patients.

Hypothesis: A postoperative, intra-articular methylprednisolone and lidocaine injection in patients with chondromalacia undergoing meniscectomy will improve patient-rated pain and function compared with control patients.

Long-term effects of bupivacaine on cartilage in a rabbit shoulder model.

Background: Previous investigations have reported on the chondrotoxicity of bupivacaine in short-term in vivo and in vitro models. This study was designed to provide additional information on the long-term effects of bupivacaine infusion on articular cartilage in an established rabbit shoulder model.

Hypothesis: Infusion of bupivacaine into the rabbit shoulder will have long-term deleterious effects on articular cartilage.

Biceps tendinitis in chronic rotator cuff tears: a histologic perspective.

Patients with chronic rotator cuff tears frequently have anterior shoulder pain attributed to the long head of the biceps brachii (LHBB) tendon. In this study, tenodesis or tenotomy samples and cadaveric controls were assessed by use of immunohistochemical and histologic methods to quantify inflammation, vascularity, and neuronal plasticity. Patients had moderate pain and positive results on at least 1 clinical test of shoulder function.

Outcomes of mechanical debridement and radiofrequency ablation in the treatment of chondral defects: a prospective randomized study.

This study compared the clinical and biomechanical outcomes of mechanical debridement with and without monopolar radiofrequency energy in treating chondral defects. Patients who were scheduled for arthroscopic procedures (diagnostic, debridement and lavage, and meniscectomy) and consented to biomechanical cartilage stiffness testing comprised the study population. Patients were randomized into 2 groups.

Abnormal findings on knee magnetic resonance imaging in asymptomatic NBA players.

The purpose of this study was to evaluate the knees of asymptomatic National Basketball Association (NBA) players via magnetic resonance imaging (MRI) and confirm or dispute findings reported in the previous literature. It is thought that a variety of significant abnormalities affecting the knee exist in asymptomatic patients and that these findings can be accurately identified on MRI. Two months prior to the 2005 season, bilateral knee MRI examinations of 14 asymptomatic NBA players (28 knees) were evaluated for abnormalities of the articular cartilage, menisci, and patellar and quadriceps tendons.

Arthroscopic rotator cuff repair: prospective functional outcome and repair integrity at minimum 2-year follow-up.

The purpose of this study was to assess arthroscopic repair of rotator cuff tears at a minimum of 2 years postoperatively with both patient-derived and objective outcome measures, including the use of magnetic resonance imaging (MRI), to evaluate repair status. Evaluated were 49 shoulders in 47 consecutive patients. The American Shoulder and Elbow Surgeons score, Constant and Murley score, Simple Shoulder Test, Rowe score, Visual Analog Pain Scale, and the Medical Outcomes Study Short Form-12 Mental Component Scale all improved significantly (P < .

Prospective evaluation of prolonged fresh osteochondral allograft transplantation of the femoral condyle: minimum 2-year follow-up.

Background: Focal articular cartilage lesions of the knee in young patients present a therapeutic challenge. Little information is available pertaining to the results after implantation of prolonged fresh grafts.

Hypothesis: Prolonged fresh osteochondral allografts present a viable option for treating large full-thickness articular cartilage lesions.