MRI analysis of tibial position of the anterior cruciate ligament.

This study aimed to establish normal values for the position of the native anterior cruciate ligament (ACL) insertion on the tibia to assist in the evaluation of tunnel placement after primary ACL reconstruction or prior to revision surgery. One hundred consecutive MRI studies performed on patients with a mean age of 29 years (range 20-35) from a single MRI facility were reviewed. Patients with prior surgery, significant osteoarthritis, acute ACL injury, or evidence of ACL reconstruction were excluded.

Platelet-rich plasma: where are we now and where are we going?

Context: Platelet-rich plasma (PRP) may affect soft tissue healing via growth factors released after platelet degranulation. Because of this potential benefit, clinicians have begun to inject PRP for the treatment of tendon, ligament, muscle, and cartilage injuries and early osteoarthritis.

Evidence Acquisition: A PubMed search was performed for studies relating to PRP, growth factors, and soft tissue injuries from 1990 to 2010.

Four-quadrant approach to capsulolabral repair: an arthroscopic road map to the glenoid.

Advancing technology, improved instrumentation, and a desire to address intra-articular pathology with a minimally invasive approach have driven the expansion of arthroscopic shoulder surgery in the past 2 decades. Proponents cite greatly improved visualization, lack of the need to perform a capsulotomy, fewer subscapularis issues postoperatively, and improved access to the entire glenohumeral joint. Our understanding and recognition of glenohumeral joint pathology have improved, and our ability to appropriately treat it has also improved.

Does the literature confirm superior clinical results in radiographically healed rotator cuffs after rotator cuff repair?

Purpose: Because recurrent or persistent defects in the rotator cuff after repair are common, we sought to clarify the correlation between structural integrity of the rotator cuff and clinical outcomes through a systematic review of relevant studies.

Methods: Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Central Register of Controlled Trials were searched for all literature published from January 1966 to December 2008 that used the key words shoulder, rotator cuff, rotator cuff tear, rotator cuff repair, arthroscopic, integrity, healed, magnetic resonance imaging (MRI), computed tomography arthrography (CTA), and ultrasound. The inclusion criteria were studies (Levels I to IV) that reported outcomes after arthroscopic rotator cuff repair in healed and nonhealed repairs based on ultrasound, CTA, and/or MRI.

The kinetic chain in overhand pitching: its potential role for performance enhancement and injury prevention.

The overhead throwing motion is a coordinated effort of muscle units from the entire body, culminating with explosive motion of the upper extremity. The throwing motion occurs at a rapid pace, making analysis difficult in real time. Electromyographic studies and high-speed video recordings have provided invaluable details regarding the involved musculature, the sequence of muscle involvement, and associated kinematic variables.

Does the literature support double-row suture anchor fixation for arthroscopic rotator cuff repair? A systematic review comparing double-row and single-row suture anchor configuration.

Purpose: The purpose of this study was to compare the clinical outcome of single-row (SR) and double-row (DR) suture anchor fixation in arthroscopic rotator cuff repair with a systematic review of the published literature.

Methods: We searched all published literature from January 1966 to December 2008 using Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Central Register of Controlled Trials for the following key words: shoulder, rotator cuff, rotator cuff tear, rotator cuff repair, arthroscopic, arthroscopic-assisted, single row, double row, and transosseous equivalent. The inclusion criteria were cohort studies (Levels I to III) that compared SR and DR suture anchor configuration for the arthroscopic treatment of full-thickness rotator cuff tears.

Bioabsorbable anchors in glenohumeral shoulder surgery.

The use of implants to provide glenohumeral soft tissue fixation has changed dramatically over the past few decades, from point tack fixation to metallic suture anchors to bioabsorbable suture anchors. Bioabsorbable suture anchors have largely replaced metallic anchors because of concerns of implant loosening, migration, and chondral injury. Although the safety and efficacy of bioabsorbable anchors has been well documented, there are numerous reports regarding the early failure related to implant bioabsorbable implant breakage or premature degradation.

Shoulder pain in the overhead throwing athlete.

Treatment of the overhead throwing athlete is among the more challenging aspects of orthopaedic sports medicine. Awareness and understanding of the throwing motion and the supraphysiologic forces to which the structures of the shoulder are subjected are essential to diagnosis and treatment. Pain and dysfunction in the throwing shoulder may be attributed to numerous etiologies, including scapular dysfunction, intrinsic glenohumeral pathology (capsulolabral structures), extrinsic musculature (rotator cuff), or neurovascular structures.

Arthroscopic capsulolabral reconstruction of the type VIII superior labrum anterior posterior lesion: mean 2-year follow-up on 13 shoulders.

Background: A type VIII superior labrum anterior posterior lesion represents pathologic posteroinferior extension of a type II superior labrum anterior posterior lesion with injury to the insertion of the posterior band of the inferior glenohumeral ligament. No reports in the literature describe arthroscopic treatment of a type VIII superior labrum anterior posterior lesion and its associated glenohumeral instability.

Hypothesis: Arthroscopic capsulolabral reconstruction is effective in alleviating pain and restoring stability and function in athletes with glenohumeral instability due to the type VIII superior labrum anterior posterior lesion.

Arthroscopic management of the thrower's shoulder: internal impingement.

Our understanding of internal impingement in the overhand athlete is an evolving body of knowledge. More recent improved understanding of the pathophysiology of events that leads to the spectrum of injury has caused us to refine our techniques of treatment. Improved surgical techniques and instrumentation have made refinement of our approach to treatment possible.