Anatomic Acromioclavicular Joint Reconstruction with and without Acromioclavicular Ligament Reconstruction: A Comparative Biomechanical Study.

Background: The purpose of this study was to determine if adding a reconstructed superior acromioclavicular (AC) joint ligament adds significant biomechanical stability to the AC joint over anatomic coracoclavicular (CC) ligament reconstruction alone.

Methods: Fourteen cadaver shoulders were used for the comparison of biomechanical stability among the anatomic CC ligament reconstruction alone, CC and AC ligament reconstruction, and the intact groups by measuring the displacement under cyclic loads. A load to failure test was then performed in the vertical direction at a loading rate of 2 mm /sec to determine surgical-repair joints' tolerance to the maximum failure load.

Editorial Commentary: Periarticular and Intra-Articular Injections May Do the Right Thing for Patients' Pain but May Be the Wrong Thing for Their Articular Cartilage: Be Careful.

Periarticular and intra-articular injections are regularly used by orthopaedic surgeons both in the clinic and operative setting. These injections include the use of local anesthetics, nonsteroidal anti-inflammatories, steroidal anti-inflammatories, and other classes of pharmaceuticals. Local anesthetics can be injected alone or in conjunction with other pharmaceuticals to maximize pain control and to minimize narcotic use as part of a multimodal pain control algorithm.

Acetaminophen, bupivacaine, Duramorph, and Toradol: A comparison of chondrocyte viability and gene expression changes in osteoarthritic human chondrocytes.

Background: A multitude of chemical agents are currently used intra-articularly to decrease pain after orthopaedic procedures including total knee arthroplasty. However, the possible deleterious effects of these injectable chemicals on chondrocyte viability have not been weighed against their potential benefits. Using a human osteoarthritic chondrocyte model, the purpose of this study was to assess the potential for cartilage damage caused by bupivacaine, Toradol, Duramorph, and acetaminophen from surgical local anesthesia.

Shoulder muscle activation pattern recognition based on sEMG and machine learning algorithms.

Background And Objective: Surface electromyography (sEMG) has been used for robotic rehabilitation engineering for volitional control of hand prostheses or elbow exoskeleton, however, using sEMG for volitional control of an upper limb exoskeleton has not been perfectly developed. The long-term goal of our study is to process shoulder muscle bio-electrical signals for rehabilitative robotic assistive device motion control. The purposes of this study included: 1) to test the feasibility of machine learning algorithms in shoulder motion pattern recognition using sEMG signals from shoulder and upper limb muscles, 2) to investigate the influence of motion speed, individual variability, EMG recording device, and the amount of EMG datasets on the shoulder motion pattern recognition accuracy.

Processing Surface EMG Signals for Exoskeleton Motion Control.

The surface electromyography (sEMG) signal has been used for volitional control of robotic assistive devices. There are still challenges in improving system performance accuracy and signal processing to remove systematic noise. This study presents procedures and a pilot validation of the EMG-driven speed-control of exoskeleton and integrated treadmill with a goal to provide better interaction between a user and the system.

The all-inside all-suture technique demonstrated better biomechanical behaviors in meniscus radial tear repair.

Purpose: The purpose of this study was to evaluate the effectiveness of three constructs and techniques for repair of radial tears of the meniscus.

Methods: Thirty fresh frozen porcine menisci were divided equally into three groups consisting of (1) inside-out repair group, (2) a commonly used all-inside suture with anchor hybrid repair construct (AISAH) (Meniscal Cinch™), and (3) an all-inside all-suture repair construct (AIAS) (Knee Scorpion™). Radial tears were created and repaired and then the menisci were secured to the materials testing machine.

Physeal-sparing posteromedial portal approach reduced distance between guide pin and neurovascular structures.

Purpose: To compare a femoral physeal sparing anterior cruciate ligament (ACL) reconstruction technique utilizing a posteromedial portal to traditional transphyseal techniques with regards to anatomic tunnel positioning and proximity to important neurovascular structures.

Methods: Eight cadaveric knees were obtained for the study. Femoral tunnel guide pins were placed utilizing four different techniques: accessory anterior medial portal, posteromedial portal, trans-tibial, and figure-4 methods.

Analysis of Non-Game Injuries in Major League Baseball.

Background: Numerous studies have investigated injuries and treatments in the baseball athlete. The majority of these studies have focused on the throwing shoulder and elbow. However, more recent literature is reporting injuries to other regions in this cohort, including the knee, head, hip, and hamstring.

Radial Tears of the Lateral Meniscus-Two Novel Repair Techniques: A Biomechanical Study.

Background: A common treatment for radial tears of the meniscus has historically been partial meniscectomy. Owing to the poor outcomes associated with partial meniscectomy, repair of the meniscus is an important treatment option. It is important to evaluate different repair techniques for radial tears of the meniscus.

Proximity of Lateral Critical Structures to the All-Epiphyseal Outside-In Femoral Tunnels in Pediatric Anterior Cruciate Ligament Reconstruction.

Purpose: To describe the proximity of the lateral critical structures (peroneal nerve [PN], popliteus tendon [PT], lateral collateral ligament [LCL], and articular cartilage [AC]) to the femoral tunnel for outside-in all-epiphyseal anterior cruciate ligament (ACL) reconstruction in reference to knee flexion angle.

Methods: All-epiphyseal ACL reconstructions were performed in 12 human cadaveric knees using arthroscopy and outside-in drilling for anatomic femoral tunnel placement that was ensured by identifying the center of the total ACL footprint. Fluoroscopy was used to confirm tunnel position and reconstructions were performed with quadrupled semitendinosus and gracilis autograft with Xtendobutton (Smith & Nephew, Andover, MA) fixation on the femoral side.

The Interaction of Intramuscular Ketorolac (Toradol) and Concussion in a Rat Model.

The purpose of this study was to examine the interaction of a single dose of Toradol and head impact in an in vivo rat model for sport-related concussion using a validated rat concussion model. Thirty-five Sprague-Dawley rats were placed into one of four groups: (1) Control, (2) Impact Only, (3) Toradol Only, (4) Impact and Toradol. Animals in the impact groups were subjected to a single head impact.

Comparison of ACL Strain in the MCL-Deficient and MCL-Reconstructed Knee During Simulated Landing in a Cadaveric Model.

Background: Noncontact anterior cruciate ligament (ACL) injury after valgus landing has been reported and studied biomechanically. However, the role of the medial collateral ligament (MCL) in dissipating these forces has not been fully elucidated. Purpose/Hypothesis: The purpose of this study was to investigate the role that the MCL plays in ACL strain during simulated landing.

Biomechanical properties of tenotomy versus biceps knot in a cadaver model.

Background: Biceps tenotomy and biceps tenodesis are the primary methods of treating biceps pathology. This study describes a new technique of tenotomy with the goal of autotenodesis to give the biceps a higher load to failure and decreased chance of a Popeye deformity.

Purpose: The purpose of this study was to evaluate the strength of the "biceps knot", which is an outlet tenodesis of the biceps tendon and compare the biomechanical properties of this technique to tenotomy.

Load to Failure and Stiffness: Anchor Placement and Suture Pattern Effects on Load to Failure in Rotator Cuff Repairs.

Background: Rotator cuff tendinopathy is a frequent cause of shoulder pain that can lead to decreased strength and range of motion. Failures after using the single-row technique of rotator cuff repair have led to the development of the double-row technique, which is said to allow for more anatomical restoration of the footprint.

Purpose: To compare 5 different types of suture patterns while maintaining equality in number of anchors.

A Biomechanical Comparison of Isometric and Anatomic Medial Patellofemoral Ligament Reconstruction.

The purpose of this study was to compare two different methods of medial patellar femoral ligament (MPFL) reconstructions: isometric and anatomic. These were then compared with the native MPFL. Fourteen fresh frozen cadaveric knees were carefully dissected to expose the MPFL.

Temperature Change When Drilling Near the Distal Femoral Physis in a Skeletally Immature Ovine Model.

Background: The possibility of physeal injury during anterior cruciate ligament reconstruction in the pediatric population is a concern. The purpose of this study was to determine whether drilling at or near the physis could cause a temperature increase that could trigger chondrolysis.

Methods: Skeletally immature cadaveric lamb distal femurs were used for this study and randomly placed in 1 of 6 groups (n=10 in each group).

The effect of continuous interscalene brachial plexus block with 0.125% bupivacaine vs 0.2% ropivacaine on pain relief, diaphragmatic motility, and ventilatory function.

Study Objective: Outpatient continuous interscalene brachial plexus blocks containing bupivacaine or ropivacaine are commonly used to control pain after shoulder surgery. Interscalene blocks cause hemidiaphragmatic paresis. Because ropivacaine preferentially blocks sensory fibers, it may cause less blockade of the phrenic nerve.

Soccer-Related Injuries in Children and Adults Aged 5 to 49 Years in US Emergency Departments From 2000 to 2012.

Background: An increase in soccer-related injuries occurred in the United States between 2000 and 2012; however, most studies of soccer-related injuries have only examined the pediatric population and not adults.

Hypothesis: The number of soccer injuries is increasing in both the pediatric and adult populations. There are differences in injury types and counts when comparing male and female players within various age groups.

Biomechanical properties of labral repair: simple versus vertical suture pattern.

The goal of this study was to evaluate contact area and surface pressure as a result of different suture patterns in the treatment of anterior shoulder instability caused by a Bankart lesion. Loads were applied through the humeral head to the glenoid surface in the intact shoulder and after simple suture labral repair (n=10) and vertical mattress labral repair (n=9). Peak contact pressure, mean contact pressure, and contact area were recorded for 0°, 45°, and 90° shoulder abduction, and then the repair was loaded to failure.

Physeal-sparing technique for femoral tunnel drilling in pediatric anterior cruciate ligament reconstruction using a posteromedial portal.

Pediatric anterior cruciate ligament (ACL) tears present a technical dilemma for orthopaedic surgeons. Multiple surgical techniques have been described to protect the distal femoral and proximal tibial physes. We present an ACL reconstruction technique performed on a 12-year-old girl with open physes who sustained an ACL tear after a noncontact twisting injury while playing soccer.

Concussion Management, Education, and Return-to-Play Policies in High Schools: A Survey of Athletic Directors, Athletic Trainers, and Coaches.

Background: Concussions represent 8.9% to 13.2% of all high school athletic injuries.

Anatomical evaluation of a cortical button for distal biceps tendon repairs.

Background: The posterior interosseous nerve (PIN) is at risk for injury during one-incision distal biceps tendon repair using a cortical button. The purpose of this study was to evaluate the proximity of a cortical button to the PIN during one-incision repairs of the distal biceps tendon using human cadaveric models.

Methods: In ten cadaveric elbows the biceps tendon was identified, traced to its insertion, and transected.

Biomechanical evaluation of anatomical double-bundle coracoclavicular ligament reconstruction secured with knot fixation versus screw fixation.

Methods to reconstruct the coracoclavicular ligaments anatomically have been described. No clear advantage of 1 technique has been elucidated. The authors' hypothesis was that the biomechanical properties of a modified knot fixation technique would be similar to the anatomical double-bundle technique.

Outlet biceps tenodesis: a new technique for treatment of biceps long head tendon injury.

Degeneration and tearing of the long head of the biceps brachii tendon (LHBT) are common intra-articular findings, and surgical intervention including tenodesis or tenotomy is beneficial. A new arthroscopic shoulder technique may be performed through an anterior portal while one is viewing from a posterior portal: (1) Visualize the intra-articular biceps tendon. (2) Identify the segment of the LHBT to be enlarged.