Management of Intraoperative Graft-related Challenges in Anterior Cruciate Ligament Reconstruction.

Anterior cruciate ligament reconstruction (ACLR) is one of the most frequently performed procedures in orthopaedic sports medicine. Intraoperative challenges related to graft procurement, graft preparation, and graft placement are common. Frequently encountered difficulties include insufficient graft diameter and graft-tunnel length mismatches, whereas less frequent challenges may be encountered during graft harvest and handling.

Independent drilling outperforms conventional transtibial drilling in anterior cruciate ligament reconstruction.

Background: Optimal tunnel placement is critical in anterior cruciate ligament reconstructive surgery, yet the method used to drill the tunnels may compromise their placement.

Hypothesis: An independent drilling method versus a conventional transtibial drilling method will place tunnels in different locations and produce reconstructions with different kinematics.

Study Design: Controlled laboratory study.

Ochrobactrum anthropi septic arthritis of the acromioclavicular joint in an immunocompetent 17 year old.

Ochrobactrum anthropi is a ubiquitous, aerobic, gram-negative bacillus of low virulence, most frequently associated with nosocomial infections and infections related to indwelling catheters in immunocompromised hosts. This article presents the first reported case of O anthropi septic arthritis, here occurring at the acromioclavicular joint of an otherwise healthy patient, and provides treatment recommendations based on our experience.

A retrospective comparison of the incidence of bacterial infection following anterior cruciate ligament reconstruction with autograft versus allograft.

Purpose: To compare the incidence of bacterial infection in anterior cruciate ligament (ACL) reconstruction with autograft versus allograft.

Methods: We completed a retrospective medical record review of ACL reconstructions performed at our institutions between 2001 and 2005. These included 170 autograft, 628 allograft, and 3 combined autograft/allograft reconstructions.

Accelerated hypertrophic chondrocyte kinetics in GDF-7 deficient murine tibial growth plates.

The Growth/Differentiation Factors (GDFs) are a subgroup of the Bone Morphogenetic Proteins (BMPs) well known for their role in joint formation and chondrogenesis. Mice deficient in one of these signaling molecules, GDF-5, have recently been shown to exhibit a decreased rate of endochondral bone growth in the proximal tibia due to a significantly longer hypertrophic phase duration. GDF-7 is a related family member, which exhibits a high degree of sequence identity with GDF-5.

An intra-articular knee cyst in a 2-year-old associated with an aberrant anterior cruciate ligament.

Intra-articular ganglia of the knee occur infrequently, with an overall incidence estimated to be from 0.2 to 1.9%.

Increased surgical volume is associated with lower THA dislocation rates.

The presumed correlation between an increasing volume of health care procedures and an improvement in outcomes is sometimes referred to as the practice-makes-perfect effect. Growing interest in outcomes-based research has led to numerous papers examining this relationship for various surgical procedures, including total hip arthroplasty. The results of these studies have important implications for consumers, providers, and healthcare financers.

A cadaveric study comparing standard fluoroscopy with fluoroscopy-based computer navigation for screw fixation of the odontoid.

Although direct osteosynthesis of certain types of odontoid fractures may increase union and decrease the need for prolonged immobilization, screw fixation remains a technically demanding procedure. This study compares radiation exposure, surgical time, and accuracy of hardware placement using standard fluoroscopy versus computer-assisted fluoroscopy-based navigation ("virtual fluoroscopy") to assist with the placement of odontoid screws. Twenty-two cadavers were divided into two groups and underwent placement of a single odontoid screw using either standard fluoroscopic or virtual fluoroscopic guidance.

An anatomical study comparing standard fluoroscopy and virtual fluoroscopy for the placement of C1-2 transarticular screws.

Object: The authors sought to compare radiation exposure, surgical time, and accuracy of screw placement when using either standard fluoroscopy or virtual fluoroscopy for the placement of C1-2 transarticular screws.

Methods: Twenty-two C1-2 transarticular screws were placed in 11 cadavers in a randomized and alternating order by using either standard fluoroscopy or virtual fluoroscopy (fluoronavigation). The radiation time, procedure time, and accuracy of screw placement were recorded and statistically compared.

Management of bony deficiency in revision anterior cruciate ligament reconstruction using allograft bone dowels: surgical technique.

Revision anterior cruciate ligament (ACL) reconstruction surgery has become increasingly common over the past decade and its popularity is likely to rise further as the number of primary ACL reconstructions increases each year. More than 75% of all cases of failed ACL reconstruction are the result of technical error and, of these, more than 70% are attributed specifically to malpositioned tunnels. Management of tunnel malposition in revision surgery often requires innovative approaches for dealing with the resultant bony defects.

Traumatic hemipelvectomy: case report and literature review.

Traumatic hemipelvectomy is a rare but devastating injury involving complete disruption of the hemipelvis from the pubic symphysis to the sacroiliac joints and often results in death. We present an interesting case of traumatic hemipelvectomy caused by a previously undescribed mechanism of injury in which judicious angiography and aggressive surgical treatment contributed to patient survival.

Interposition arthroplasty with bone-tendon allograft: a technique for treatment of the unstable sternoclavicular joint.

Sternoclavicular joint instability is an uncommon but challenging clinical problem for the orthopaedic surgeon. Although most cases can be treated nonoperatively with minimal long-term pain or functional limitation, a small percentage may require surgical intervention. This includes chronic anterior instability associated with persistent pain or functional limitation as well as irreducible or recurrent posterior instability.

Semitendinosus regrowth: biochemical, ultrastructural, and physiological characterization of the regenerate tendon.

Background: Previous studies have suggested that hamstring tendons can regenerate following harvesting for anterior cruciate ligament reconstruction.

Hypothesis: This "neo-tendon" is a true, functional tendon, not scar tissue.

Study Design: Controlled laboratory study.

Ultrastructural determinants of murine achilles tendon strength during healing.

The mechanisms by which tendon strength is established during growth and development and restored following injury are not completely understood and are likely to be complex, multifactorial processes. Several studies examining the relationship between mechanical behavior and ultrastructural characteristics of tendons and ligaments during growth and maturation suggest that collagen fibril diameter is strongly correlated with tendon strength. Because of the similarities between development and repair processes of musculoskeletal tissues, increases in tendon strength during healing may be related to increases in fibril ultrastructural parameters such as fibril size, numerical density, and area fraction.

Ash content modulation of torsionally derived effective material properties in cortical mouse bone.

The purpose of this study was to evaluate the effects of isolated alterations in mineral content on mouse bone torsional properties. The femora and tibiae from 25 eight-week-old male A/J strain mice were divided into five groups and selectively decalcified from 5% to 20%. The right femora were then tested to failure in torsion while the tibiae were ashed to determine final mineral content of the decalcified bones.

Factors affecting forearm compartment pressures in children with supracondylar fractures of the humerus.

This study evaluated forearm compartment pressures in 29 children with supracondylar humerus fractures. Pressures were measured before and after reduction in the dorsal, superficial volar, and deep volar compartments at the proximal 1/6th and proximal 1/3rd forearm. Pressures in the deep volar compartment were significantly elevated compared with pressures in other compartments.