The effectiveness of rhBMP-2 in replacing autograft: an integrated analysis of three human spine studies.

In anterior lumbar spinal fusion, patients treated with rhBMP-2 on a collagen sponge carrier had statistically superior outcomes compared to patients treated with autogenous bone graft. A collagen sponge carrier should replace autogenous bone graft for this patient population.

Anterior lumbar interbody fusion for the management of chronic lower back pain: current strategies and concepts.

In a retrospective analysis of two large multicenter clinical studies, 321 patients with degenerative lumbar disc disease were divided into two groups who underwent anterior lumbar interbody fusion using two threaded titanium fusion cages. To determine whether differences in surgical procedures and cage design affect anterior and posterior annular distraction and clinical outcomes, the authors evaluated the clinical and radiographic outcomes of patients treated with a stand-alone ALIF procedure. End-plate preservation techniques were associated with improved anterior and posterior disc space distraction compared with standard end-plate preparation techniques.

Arthroscopic rotator cuff tear repair.

Rotator cuff injuries or disease can be particularly troubling to patients by causing them pain, weakness, and dysfunction of the shoulder. Surgery of the shoulder and, in particular, of the rotator cuff, has evolved over the years from open surgery to include arthroscopic treatment for many conditions. Although technically demanding, arthroscopic repair of full- and partial-thickness rotator cuff tears has been shown to produce satisfactory results.

Calcific tendinitis of the shoulder.

Calcific tendinitis of the shoulder is a process involving calcium deposition commonly in the rotator cuff tendons. It is a cell-mediated process that is often chronic in nature, but it is usually self-limiting with regard to its acute pain states. Nonoperative management is still the treatment of choice and is successful in up to 90% of patients.

The posteromedial corner of the knee: medial-sided injury patterns revisited.

Background: Medial-sided knee injury patterns have been poorly defined in the available literature. The lack of definition can be attributed to the differing anatomic perspectives of physician authors and the functional significance they assigned to the posteromedial structures of the knee.

Hypothesis: Many so-called medial collateral ligament injuries can involve significant damage to the posteromedial corner structures that may not be appreciated.

Sudden Cardiac Arrest in Athletic Medicine.

OBJECTIVE: To emphasize the importance of decreasing the response time by a trained target responder to increase the survival rate among athletes experiencing sudden cardiac arrest at an athletic event. BACKGROUND: Death due to sudden cardiac arrest that is witnessed is preventable in many cases. However, most people who experience this condition die because of a prolonged response time from onset of the fatal arrhythmia to defibrillation by trained treatment providers.

Is INFUSE bone graft superior to autograft bone? An integrated analysis of clinical trials using the LT-CAGE lumbar tapered fusion device.

Multicenter human clinical studies of patients undergoing anterior lumbar fusion have been conducted using recombinant bone morphogenetic protein or rhBMP-2 on an absorbable collagen sponge, marketed as INFUSE Bone Graft, or autograft implanted in the LT-CAGE Lumbar Tapered Fusion device. An integrated analysis of multiple clinical studies was performed using an analysis of covariance to adjust for preoperative variables in a total of 679 patients. Of these patients, 277 had their cages implanted with rhBMP-2 on an absorbable collagen sponge and 402 received autograft transferred from the iliac crest.

Radiographic assessment of interbody fusion using recombinant human bone morphogenetic protein type 2.

Study Design: A prospective randomized study investigated the radiographic progress of fusion at 6, 12, and 24 months in 42 patients who underwent a single-level anterior lumbar interbody fusion using cylindrical interbody fusion cages.

Objective: To determine the patterns and rates of osteoinduction associated with the use of recombinant human bone morphogenetic protein type 2 (rhBMP-2) and an absorbable collagen sponge carrier in anterior lumbar interbody fusion with a tapered cylindrical fusion device.

Summary Of Background Data: Studies have shown that rhBMP-2 used with allograft dowels increases the rate of interbody fusion by promoting osteoinduction and enhancing incorporation of the allograft.

Clinical and radiographic outcomes of anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2.

Study Design: A prospective, nonblinded, multicenter study of outcomes in patients undergoing single-level anterior lumbar discectomy and interbody fusion with InFUSE Bone Graft.

Objective: To determine the safety and effectiveness of InFUSE Bone Graft applied to an absorbable collagen sponge in anterior lumbar interbody fusion with threaded cortical allografts.

Summary Of Background Data: In primates, InFUSE Bone Graft used with allograft dowels was shown to increase rates of interbody fusion by promoting osteoinduction and enhancing incorporation of the allograft.

Anterior lumbar interbody fusion using rhBMP-2 with tapered interbody cages.

In a multicenter, prospective, randomized, nonblinded, 2-year study, 279 patients with degenerative lumbar disc disease were randomly divided into two groups that underwent interbody fusion using two tapered threaded fusion cages. The investigational group (143 patients) received rhBMP-2 on an absorbable collagen sponge, and a control group (136 patients) received autogenous iliac crest bone graft. Plain radiographs and computed tomographic scans were used to evaluate fusion at 6, 12, and 24 months after surgery.

Intervertebral fixation: clinical results with anterior cages.

Anterior lumbar interbody fusion has several clinical advantages over posterior or posterolateral lumbar fusion. Interbody fusion procedures place bone grafts within the disc space at the center of rotation of the vertebral motion segment. The intervertebral area is highly vascular, and the grafts have a wide contact area in the weight-bearing axis of the spinal motion segment.

Outcome measurement in the treatment of extensor mechanism difficulties of the knee.

The authors' underlying philosophy is to use a standardized data package to collect information prospectively. This allows for the clinical evaluation and research of extensor mechanism disabilities. The use of a system of data management allows meaningful follow-up comparisons.

Prevalence of negative-pressure pulmonary edema at an orthopaedic hospital.

Negative-pressure pulmonary edema (NPPE) occurs when a large, negative intrathoracic pressure is generated against an obstructed upper airway, causing fluid to shift into the lung interstitium. Young, healthy, athletic male patients appear to be at increased risk for this disorder, but the prevalence in orthopaedic surgery patients has been unknown. We retrospectively reviewed the charts of 14 patients (11 male, 3 female) with NPPE at our institution over a 15-year period.

Initial biomechanical properties of anterior cruciate ligament reconstruction autografts.

To provide more information to consider when selecting a reconstruction technique, we did a side-by-side comparison of some of the initial biomechanical properties of currently accepted reconstruction methods. Our research hypotheses were that a quadrupled, woven semitendinosus and gracilis graft is as strong as any of the other commonly used graft materials and that quadrupling and weaving the hamstring graft may increase the stiffness of the overall construct Using lower extremity cadaveric specimens harvested from young donors, we fashioned seven each of seven types of graft: 9-mm, 10-mm, and 11-mm-wide patellar tendon graft (PTG); 10-mm-wide central quadriceps tendon graft; doubled semitendinosus graft; tripled semitendinosus graft; and quadrupled, woven semitendinosus and gracilis graft. Specimens were stripped of remaining soft tissue, and anterior cruciate ligament (ACL) constructs were created for biomechanical testing.

Nonunion of the fractured clavicle: evaluation, etiology, and treatment.

Although often viewed as benign injuries, clavicular fractures can lead to complications, particularly nonunions. The nonunion rate has been reported to be between 0.1% and 15%.

On field evaluation and management of head and neck injured athletes.

Cervical spine injuries, although relatively uncommon, can be devastating. Proper and prompt management is absolutely essential, even though the complexity of the brain and the lack of objective signs and symptoms make injury assessment difficult. Being prepared for head and neck injury is key to its on-field management.

Lateral epicondylitis.

Satisfactory treatment of lateral epicondylitis results from correct diagnosis followed by a well-controlled operative or nonoperative treatment program. Many options for nonoperative and operative treatment exist for lateral epicondylitis. More study is needed on outcomes of both nonoperative treatment and operative treatment so that each patient can attain maximal improvement.

Pronator syndrome.

Although pronator syndrome is often misdiagnosed and does not occur as frequently as carpal tunnel syndrome, its clinical features are well described, and the diagnosis should be made if the clinical features are understood and reasonable suspicion exists. The differentiating features between carpal tunnel syndrome and pronator syndrome should be understood, and evaluation for one site of compressive neuropathy of the median nerve always should include the other potential sites. When the correct diagnosis is made, pronator syndrome can be successfully treated nonoperatively or surgically, if necessary.

Biceps tendinitis and subluxation.

Since the 17th century, the long head of the biceps tendon as a source of shoulder pain and its functional significance has been a source of debate. Although the term tendinitis is commonly used, overuse tendon injuries infrequently demonstrate inflammatory cells; instead, degenerative changes resulting from the failure of self-repair usually are found. Bicipital tendinitis or bicipital tenosynovitis is most often secondary to impingement beneath the coracoacromical arch.

Arthroscopic classification and treatment of lateral epicondylitis: two-year clinical results.

We assessed the clinical utility of 42 arthroscopic releases for lateral epicondylitis in 40 patients (average age, 43 years) with an average of 14 months of symptomatic history before surgery. At arthroscopy, we found 15 type I lesions (intact capsule), 15 type II lesions (linear capsular tear), and 12 type III lesions (complete capsular tear), and associated disorders were found in 69% of the patients. At an average follow-up of 2.

Lumbosacral epidural steroid injections.

Epidural steroid injections for the treatment of low back pain and associated leg pain have been used for half a century. Initial use was empirical and not without controversy. An abundant literature has accumulated describing their use and potential benefit.

A comparison of plate and pin fixation for arthrodesis of the rheumatoid wrist.

This retrospective study compared plate fixation versus pin fixation in 57 patients with rheumatoid arthritis who underwent wrist arthrodesis. Fixation was achieved by using plates in 32 patients and longitudinal pins in 25 patients. Clinical follow-up averaged 29 months (range: 12-57 months) and radiographic follow-up averaged 16 months (range 12-39 months).

Technical pitfalls of collateral ligament surgery.

The technical pitfalls of collateral ligament surgery include: Failure to properly diagnose and appropriately recommend surgery; posterolateral instability is the most commonly missed acute associated instability pattern Failure to correct all components of the injury (see Table 1): lateral meniscus, arcuate ligament, and popliteus, lateral gastrocnemius, and biceps muscles Failure to properly reattach and repair the damaged structures Peroneal nerve damage during the surgical approach and repair Wound problems: breakdown, hematoma Loss of motion This article presented a concise introduction to the anatomy of the collateral and capsular ligaments of the knee. This information should prove valuable in avoiding pitfalls in the diagnostic and surgical approach to the knee. To fully appreciate the anatomy, one must study it in the anatomy laboratory by performing repeated dissections.