Suture-Based Debris Behavior in the Draining Lymph Nodes of a Porcine Knee: A Study of Silicone, Polyethylene and Carbon.

Purpose: To determine whether debris from a silicone core suture has an observable intra-articular or extra-articular impact or can be shown to migrate into the lymphatic system.

Methods: Using a porcine stifle joint model, 2 study groups were created: 1 group used silicone-suture particles created by rupturing hand-tied knots of a nonabsorbable suture with an outer sheath of ultrahigh molecular-weight polyethylene, an inner polyester sheath and a medical-grade silicone/sodium chloride-filled core. The second group used a mixture of 3 vitreous carbon particles sizes.

PRP as an Adjunct to Rotator Cuff Tendon Repair.

Arthroscopic rotator cuff repair is a commonly performed repair. Technical developments provide surgeons the tools to create biomechanically robust repairs. How can the biological response mirror the strong and stable surgery? Platelet-rich plasma (PRP) is a supraphysiological platelet concentration which may positively augment rotator cuff healing.

Are the anatomy textbooks wrong? A clinical patho-anatomic study of foveal vessels in the round ligament of the hip.

Background: The foveal vessels of the ligamentum teres are an anterior branch of the posterior division of the obturator artery, providing blood to the capitis of the femoral head. However, the basic anatomic description of foveal vasculature in the ligamentum teres of the hip is widely variable, with some studies reporting that the vessels are not patent in roughly one third of all adults. Therefore, the purpose of this study was to evaluate the status of foveal vessels in primary total hip arthroplasty (THA) patients.

Have the annual trends of total knee arthroplasty in ankylosing spondylitis patients decreased?

Background: Ankylosing spondylitis (AS) is characterized by osteoproliferation-induced structural damage and spinal inflammation, which lead to spinal deformity and functional disability. Though AS commonly affects the axial skeleton and sacroiliac joints, up to 70% of patients have involvement of the knees and other joints. Despite pharmacological efforts, advancing joint involvement may ultimately require surgical intervention.

Does a simple syringe applicator enhance bone cement set up time in knee arthroplasty?

Background: The time required for polymethylmethacrylate (PMMA) cement curing or hardening can be modified by a number of variables including the mixing technique, and the temperature and pressure at which the process is taking place. Therefore, the purpose of this study was to evaluate two different methods of PMMA application in terms of set up time. Specifically, we (I) compared the PMMA set up time of cement that remained in the mixing bowl to cement that was placed in a syringe and (II) extrapolated the associated annual cost difference on the national and individual surgeon levels.

All-Suture Anchors: Biomechanical Analysis of Pullout Strength, Displacement, and Failure Mode.

Purpose: To evaluate the biomechanical and design characteristics of all-suture anchors.

Methods: All-suture anchors were tested in fresh porcine cortical bone and biphasic polyurethane foam blocks by cyclic loading (10-100 N for 200 cycles), followed by destructive testing parallel to the insertion axis at 12.5 mm/s.

Biocomposite Implants Composed of Poly(Lactide-co-Glycolide)/β-Tricalcium Phosphate: Systematic Review of Imaging, Complication, and Performance Outcomes.

Purpose: To determine the degradation and performance outcomes of poly(lactide-co-glycolide)/β-tricalcium phosphate (PLGA/β-TCP) implants.

Methods: A MEDLINE and Embase search for randomized or nonrandomized controlled studies and prospective or retrospective case series that used biocomposite interference screws or suture anchors composed of PLGA/β-TCP was performed. Main outcomes included volume of implant resorption and incidence of osteoconductivity at implant sites, imaging findings, adverse events, and the frequency of reoperations.

Complex Medial Meniscus Tears Are Associated With a Biconcave Medial Tibial Plateau.

Purpose: To determine whether an association exists between a biconcave medial tibial plateau and complex medial meniscus tears.

Methods: A consecutive series of stable knees undergoing arthroscopy were evaluated retrospectively with the use of preoperative magnetic resonance imaging (MRI), radiographs, and arthroscopy documented by intraoperative videos. Investigators independently performed blinded reviews of the MRI or videos.

The results of Oxford unicompartmental knee arthroplasty in the United States: a mean ten-year survival analysis.

Aims: Approved by the Food and Drug Administration in 2004, the Phase III Oxford Medial Partial Knee is used to treat anteromedial osteoarthritis (AMOA) in patients with an intact anterior cruciate ligament. This unicompartmental knee arthroplasty (UKA) is relatively new in the United States, and therefore long-term American results are lacking.

Patients And Methods: This is a single surgeon, retrospective study based on prospectively collected data, analysing a consecutive series of primary UKAs using the Phase III mobile-bearing Oxford Knee and Phase III instrumentation.

No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA.

Background: Opioid analgesics have been a standard modality for postoperative pain management after total knee arthroplasty (TKA) but are also associated with increased risk of nausea, pruritus, vomiting, respiratory depression, prolonged ileus, and cognitive dysfunction. There is still a need for a method of anesthesia that can deliver effective long-term postoperative pain relief without incurring the high cost and health burden of opioids and nerve blocks.

Questions/purposes: (1) Is liposomal bupivacaine-based periarticular injection (PAI) more effective than morphine-based spinal anesthesia or ropivacaine-based PAI in controlling postoperative pain after TKA? (2) Do patients treated with liposomal bupivacaine-based PAI experience fewer opioid-related adverse events compared with patients treated with morphine-based spinal anesthesia or ropivacaine-based PAI in controlling postoperative pain after TKA?

Methods: This multicenter, blind trial randomized 119 patients undergoing TKA with spinal anesthesia to receive spinal anesthesia plus periarticular injection with liposomal bupivacaine (40 patients), spinal anesthesia with bupivacaine plus intrathecal morphine (41 patients) but no liposomal bupivacaine injection, or spinal anesthesia with bupivacaine (38 patients) and no liposomal bupivacaine injection.

Biomechanical Strength and Elongation of the T-Block Modification for Bone-Patella Tendon-Bone Allografts.

Purpose: To assess the biomechanical performance of 2 different T-block modifications of bone-patella tendon-bone (BPTB) allografts.

Methods: The matched knee pairs from 10 human cadavers (mean age 49 years) were fashioned into 30 BPTB allografts and divided into 3 groups (10 each): group 1, standard patella tendon-tibial attachment; group 2, T-block tibial attachment with 10 mm of unattached bone proximal to the patella tendon insertion with 15 mm of tendon attached; group 3, T-block tibial attachment with 15 mm of unattached bone proximal to the patella tendon insertion and 10 mm of tendon attached. A biocomposite interference screw secured each graft into a 10-mm tunnel in 15 pcf polyurethane foam.

Triple-Loaded Single-Row Versus Suture-Bridge Double-Row Rotator Cuff Tendon Repair With Platelet-Rich Plasma Fibrin Membrane: A Randomized Controlled Trial.

Purpose: To compare the structural healing and clinical outcomes of triple-loaded single-row with suture-bridging double-row repairs of full-thickness rotator cuff tendons when both repair constructs are augmented with platelet-rich plasma fibrin membrane.

Methods: A prospective, randomized, consecutive series of patients diagnosed with full-thickness rotator cuff tears no greater than 3 cm in anteroposterior length were treated with a triple-loaded single-row (20) or suture-bridging double-row (20) repair augmented with platelet-rich plasma fibrin membrane. The primary outcome measure was cuff integrity by magnetic resonance imaging (MRI) at 12 months postoperatively.

Long-Term Degradation of Self-Reinforced Poly-Levo (96%)/Dextro (4%)-Lactide/β-Tricalcium Phosphate Biocomposite Interference Screws.

Purpose: To evaluate the long-term in vivo degradation of biocomposite interference screws made with self-reinforced poly-levo (96%)/dextro (4%)-lactide/β-tricalcium phosphate [SR-PL(96)/D(4)LA/β-TCP].

Methods: A study of the in vivo biologic behavior of an SR-PL(96)/D(4)LA/β-TCP biocomposite interference screw was initiated in 2011 using an anterior cruciate ligament (ACL) reconstruction model. Eight patients undergoing a bone-patellar tendon-bone ACL reconstruction fixed at both the femur and tibia with an SR-PL(96)/D(4)LA/β-TCP screw at least 36 months earlier were evaluated by physical, radiographic, and computed tomography (CT) evaluations.

Complications of Biodegradable Materials: Anchors and Interference Screws.

Metal, plastic, and biodegradable implants can all cause problems. The advantage of the biodegradable implant is clarity in postoperative imaging, easier revision, and fewer concerns about associated tissue damage. Although biodegradable implants do degrade over time, this time varies considerably, depends upon the polymer present, and is often measured in years.

Biodegradable Materials: Anchors and Interference Screws.

Biodegradable implants allow clarity in postoperative imaging, easier revision, and fewer concerns about associated tissue damage. It is important to appreciate that different biodegradable materials have different properties and different degradation rates. Faster degradation can be associated with a greater inflammatory response.

Subtle lisfranc subluxation: results of operative and nonoperative treatment.

Subtle Lisfranc instability is typically a low-energy, twisting, axial-loading injury. The present study evaluated the operative treatment of subtle Lisfranc injuries after nonoperative failure. The data from consecutive patients with subtle Lisfranc instabilities were reviewed.

Arthroscopic treatment of calcific tendonitis.

Calcific tendonitis, or calcifying tendonitis, is a common disorder characterized by the multifocal accumulation of basic calcium phosphate crystals within the rotator cuff tendons. In most cases, the multifocal calcifications are located 1 to 2 cm from the insertion of the supraspinatus tendon on the greater tuberosity. The initial treatment should be nonoperative including oral anti-inflammatory medication and physical therapy.

Arthroscopic treatment of iliotibial band syndrome.

Lateral knee pain in athletes is commonly seen in the sports medicine clinic, and the diagnosis of iliotibial band (ITB) syndrome is frequently made. Although conservative management including rest from activity, equipment modification, oral nonsteroidal anti-inflammatory drug use, and physical therapy is the mainstay of treatment initially, refractory cases do exist. Multiple surgical techniques have been described including an arthroscopic technique.

Revision rates after anterior cruciate ligament reconstruction using bone-patellar tendon-bone allograft or autograft in a population 25 years old and younger.

Purpose: To compare clinical outcomes and revision rates for anterior cruciate ligament (ACL) reconstructions using bone-patellar tendon-bone (BPTB) allografts versus BPTB autografts in a population of patients aged 25 years and younger.

Methods: A consecutive series of patients 25 years or younger undergoing ACL reconstruction with either a patient-selected BPTB allograft or BPTB autograft fixed with biocomposite interference screws was retrospectively reviewed. Multiligamentous and posterior cruciate ligament tears were excluded.

Adverse events associated with biodegradable lactide-containing suture anchors.

Purpose: To evaluate the occurrence of adverse events and inflammatory reactions related to the use of biodegradable anchors.

Methods: A retrospective review of a consecutive series of arthroscopic shoulder procedures using biodegradable suture anchors performed by a single surgeon was undertaken. The database was purged of patient identifiers.

Platelet-rich plasma for rotator cuff repair.

Rotator cuff tears are a common cause of shoulder pain and disability. Because they combine both traumatic and degenerative elements, the surgical repair can be challenging. Even after surgical intervention, tendon residual defects or "retears" often develop.

The degradation outcome of biocomposite suture anchors made from poly L-lactide-co-glycolide and β-tricalcium phosphate.

Purpose: The purpose of this study was to evaluate the long-term in vivo degradation of biocomposite suture anchors made of poly L-lactide-co-glycolide (PLLA/PGA) and β-tricalcium phosphate (β-TCP).

Methods: Starting in 2008, the in vivo biological behavior of a biocomposite suture anchor was studied in a consecutive series of rotator cuff tendon repairs. Twenty patients undergoing rotator cuff repair secured with biocomposite PLLA/PGA-β-TCP suture anchors with at least a 36-month follow-up were evaluated by physical, radiographic, and computed tomographic (CT) evaluations of the operated shoulder.

Meniscal cysts: treatment options and algorithm.

Meniscal cysts are commonly seen in the knee. Symptomatic meniscal cysts tend to be located on the lateral side but magnetic resonance imaging studies indicate that medial cysts are more common. Meniscal cysts are commonly associated with horizontal meniscal tears.

Pullout strength of bone-patellar tendon-bone allograft bone plugs: a comparison of cadaver tibia and rigid polyurethane foam.

Purpose: To compare the load-to-failure pullout strength of bone-patellar tendon-bone (BPTB) allografts in human cadaver tibias and rigid polyurethane foam blocks.

Methods: Twenty BPTB allografts were trimmed creating 25 mm × 10 mm × 10 mm tibial plugs. Ten-millimeter tunnels were drilled in 10 human cadaver tibias and 10 rigid polyurethane foam blocks.