Allograft Anterior Cruciate Ligament Reconstruction Fails at a Greater Rate in Patients Younger Than 34 Years.

Purpose: To characterize the secondary anterior cruciate ligament (ACL) injury rates after primary allograft anterior cruciate ligament reconstruction (ACLR) and to identify the age cut-score at which the risk of allograft failure decreases.

Methods: All patients who underwent primary ACLR within a single orthopaedic department between January 2005 and April 2020 were contacted at a minimum of 2 years post-ACLR to complete a survey regarding complications experienced post-surgery, activity level, and perceptions of knee health. Patients were excluded for incidence of previous ACLR (ipsilateral or contralateral) and/or age younger than 14 years.

Glenoid Version Assessment When the CT Field of View Does Not Permit the Friedman Method: The Robertson Method.

Background: To improve spatial resolution, current clinical shoulder cross-sectional imaging studies reduce the field of view of the shoulder, excluding the medial scapula border and preventing glenoid version measurement according to the Friedman method.

Purpose: To evaluate a method to accurately and reliably measure glenoid version on cross-sectional shoulder images when the medial scapula border is not included in the field of view, and to establish measurements equivalent to the Friedman method.

Study Design: Controlled laboratory study.

Factors influencing operative time in arthroscopic rotator cuff repair: a comparison of knotless single-row vs. transosseous equivalent dual-row techniques.

Background: Despite the widespread use of arthroscopic rotator cuff repair (aRCR), there remains considerable debate on the benefits of a dual-row vs. a single-row (SR) repair technique. This study compares operative time of a knotless SR technique with transosseous equivalent (TOE) dual-row technique for aRCR and defines patient-specific factors that affect operative time.

Biceps Tenodesis for Type II SLAP Tears.

Tears of the superior glenoid labrum are a common cause of shoulder pain and disability, especially in overhead athletes such as pitchers, swimmers, and volleyball players. Type II SLAP lesions have been the most clinically important superior labral pathology, and the management of this lesion has been a very controversial topic. Currently, there are no high level studies in the literature to guide treatment.

Two fixation methods for acromioclavicular joint reduction during coracoclavicular ligament reconstruction: a biomechanical analysis.

One specimen from each of six pairs of cadaveric shoulders underwent a semitendinosus coracoclavicular ligament reconstruction with a hook plate used for acromioclavicular joint reduction, while on the other specimen a polydioxanone (PDS) suture braid was utilized. Cyclical loading followed by maximal load-to-failure testing was performed. Displacement during cyclical loading, loads to 50% and 100% displacement, stiffness, and maximal load to failure were determined for all specimens.

Subpectoral biceps tenodesis for the treatment of type II and IV superior labral anterior and posterior lesions.

Background: Surgical repair remains the gold standard for most type II and type IV superior labral anterior and posterior (SLAP) lesions that fail nonoperative management. However, most recently, there have been data demonstrating unacceptably high failure rates with primary repair of type II SLAP lesions. Biceps tenodesis may offer an acceptable, if not better, alternative to primary repair of SLAP lesions.

Comparison of the effect of medical assistants versus certified athletic trainers on patient volumes and revenue generation in a sports medicine practice.

Background: Research has shown increases in efficiency and productivity by using physician extenders (PEs) in medical practices. Certified athletic trainers (ATCs) that work as PEs in primary care sports medicine and orthopaedic practices improve clinic efficiency.

Hypothesis: When compared with a medical assistant (MA), the use of an ATC as a PE in a primary care sports medicine practice will result in an increase in patient volume, charges, and collections.

A biomechanical analysis of point of failure during lateral-row tensioning in transosseous-equivalent rotator cuff repair.

Purpose: The purpose of this study was to determine the maximum load and point of failure of the construct during tensioning of the lateral row of a transosseous-equivalent (TOE) rotator cuff repair.

Methods: In 6 fresh-frozen human shoulders, a TOE rotator cuff repair was performed, with 1 suture from each medial anchor passed through the tendon and tied in a horizontal mattress pattern. One of 2 limbs from each of 2 medial anchors was pulled laterally over the tendon.

Shoulder external rotation fatigue and scapular muscle activation and kinematics in overhead athletes.

Context: Glenohumeral external rotation (GH ER) muscle fatigue might contribute to shoulder injuries in overhead athletes. Few researchers have examined the effect of such fatigue on scapular kinematics and muscle activation during a functional movement pattern.

Objective: To examine the effects of GH ER muscle fatigue on upper trapezius, lower trapezius, serratus anterior, and infraspinatus muscle activation and to examine scapular kinematics during a diagonal movement task in overhead athletes.

Anterior cruciate ligament femoral tunnel drilling through anteromedial portal: axial plane drill angle affects tunnel length.

Purpose: The purpose of this study was to correlate femoral tunnel length with axial drilling angle through the anteromedial portal.

Methods: Ten anatomically correct Sawbones knee models (Pacific Research Laboratories, Vashon, WA) were used for this study. With the knee flexed to 120°, tunnels were drilled through a simulated anterior medial portal with a custom outrigger guide.

Transfer of the latissimus dorsi as a salvage procedure for failed debridement and attempted repair of massive rotator cuff tears.

Seven patients who had a previously failed attempt at debridement and repair of a massive rotator cuff tear were managed with latissimus dorsi transfer. Patient age averaged 63 years and average follow-up was 31 months. All patients were evaluated with shoulder radiographs, Constant and Murley Scores, UCLA Shoulder Score, visual analog pain score, range of motion, and the Short Shoulder Form.

Characterization of a consistent radiographic finding in chronic anterior cruciate ligament deficiency: the posteromedial osteophyte.

Often found in patients undergoing total knee arthroplasty (TKA) is an osteophyte, at the posterior lateral corner of the medial tibial plateau, that prevents anterior translation. This osteophyte does not occur in the presence of an entirely normal anterior cruciate ligament (ACL) with normal vascularity. Although similar findings have been reported in animal studies, to our knowledge this has never been documented in humans.

Electrothermal arthroscopic shoulder capsulorrhaphy: a minimum 2-year follow-up.

Background: Few studies have documented the outcomes of thermal capsulorrhaphy for shoulder instability.

Purpose: To examine prospective evaluate outcomes of the first 100 patients with glenohumeral instability treated with thermal capsulorrhaphy.

Study Design: Case series; Level of evidence, 4.

A biomechanical comparison of EndoButton versus suture anchor repair of distal biceps tendon injuries.

The purpose of this study was to compare suture anchor and EndoButton repair of distal biceps injuries in a human bone-tendon model. Right and left arm repairs were alternately performed with either the EndoButton or 2 single-loaded 5-mm suture anchors. Each construct was cyclically loaded by use of a servohydraulic materials testing machine.

The repeatability of scapular rotations across three planes of humeral elevation.

Measurement of scapular kinematics is an important component in the assessment of shoulder function; however, repeatability of these measurements has not been established. The purpose of this study, therefore, was to determine the repeatability of scapular rotation measures for different humeral elevation planes between trials, sessions, and days. Three-dimensional scapular rotations were collected using an electromagnetic tracking system in three planes of humeral elevation.

Scapular kinematics during supraspinatus rehabilitation exercise: a comparison of full-can versus empty-can techniques.

Background: Supraspinatus strengthening is an important component of shoulder rehabilitation. Previous work has determined that the full-can and empty-can exercises elicit the greatest amount of supraspinatus activity. However, scapular kinematics has not been considered when prescribing supraspinatus exercises.

Suture plication, thermal shrinkage, and sclerosing agents: effects on rat patellar tendon length and biomechanical strength.

Background: Shortening or tightening of dense, collagenous tissues is often desirable in the treatment of laxity.

Purpose: To compare the effect of stress-protection suture, radiofrequency thermal shrinkage combined with stress-protection suture, and a 5% sodium morrhuate sclerosing injection on the length and biomechanical strength of the rat patellar tendon.

Hypothesis: Sclerosing agents will increase tendon mechanical strength.

The HAGL lesion: an arthroscopic technique for repair of humeral avulsion of the glenohumeral ligaments.

Glenoid avulsion of the capsulolabral complex and associated capsular laxity are well-described results of traumatic anterior dislocation. A less common consequence of traumatic anterior instability is the humeral avulsion of the glenohumeral ligaments (HAGL) lesion. An understanding of the arthroscopic pathoanatomy of the HAGL lesion will assist the surgeon in recognizing this uncommon entity.

Thermal microdebridement does not affect the time zero biomechanical properties of human patellar tendons.

Background: Thermal microdebridement for the treatment of chronic tendinopathy has recently been introduced. The effect of thermal microdebridement on the biomechanical properties of human tendons, however, remains unknown.

Hypothesis: Thermal microdebridement does not affect the biomechanical properties of human patellar tendons in a cadaveric model at the time of initial treatment.

Nandrolone decanoate and load increase remodeling and strength in human supraspinatus bioartificial tendons.

Background: To date, no studies document the effect of anabolic steroids on rotator cuff tendons.

Study Design: Controlled laboratory study.

Hypothesis: Anabolic steroids enhance remodeling and improve the biomechanical properties of bioartificially engineered human supraspinatus tendons.

Volumetric change in the shoulder capsule after open inferior capsular shift versus arthroscopic thermal capsular shrinkage: a cadaveric model.

The purpose of this study was to compare the percentage of glenohumeral intracapsular volume reduction after open inferior capsular shift and arthroscopic thermal capsulorrhaphy. Twelve matched, fresh-frozen cadaveric shoulders were used for the study. Intraarticular glenohumeral volume measurements were obtained by injecting a viscous fatty acid sulfate solution into the joint.

Glenohumeral volume reduction in arthroscopic shoulder reconstruction: a cadaveric analysis of suture plication and thermal capsulorrhaphy.

Purpose: The purpose of this study was to objectively assess glenohumeral volume changes after arthroscopic suture plication, arthroscopic thermal capsulorrhaphy, and combined suture and thermal treatment.

Type Of Study: Cadaveric study.

Methods: Five matched pairs of cadaver shoulders were treated with either thermal capsulorrhaphy (n = 5) or arthroscopic suture plication (n = 5).

Relationship of the axillary nerve to the proximal screws of a flexible humeral nail system: an anatomic study.

Objective: To investigate the risk of axillary nerve injury during placement of the proximal interlock and tension screws of the Synthes Titanium Flexible Humeral Nail System (Synthes, Paoli, PA).

Design: Cadaver study.

Main Outcome Measure: Anatomic relationships.

The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players.

Between 1986 and 1997, 25 active National Football League (NFL) players underwent microfracture to treat full-thickness chondral lesions. Average follow-up was 4.5 years (range: 2-13 years).