Simultaneous ipsilateral ruptures of the anterior cruciate ligament and patellar tendon: a case report.

The simultaneous diagnosis of ipsilateral patellar tendon rupture and anterior cruciate ligament tear is rare. Surgical repair is complicated by different rehabilitation regimens as well as anterior cruciate ligament graft choices. We present a case where at the same operative setting, the patellar tendon was repaired, and the anterior cruciate ligament reconstructed with autologous hamstring graft.

Incidence of early radiolucent glenoid lines in patients having total shoulder replacements.

UNLABELLED: Glenoid loosening is the most common long-term complication occurring after total shoulder replacement. Imprecise cement technique and glenoid preparation may result in early radiolucent glenoid line formation. Early radiolucent lines may indicate inadequate initial fixation, which may contribute to early loosening. Improved cement techniques, refined instrumentation, and glenoid component design all may reduce early radiolucent lines. In our study, postoperative anteroposterior and axillary radiographs were obtained after 68 total shoulder replacements done by one surgeon using either an old free-hand, manual packing technique before November 1998 (n = 28) or a new instrument preparation and pressurization technique since November 1998 (n = 40). Three orthopaedic surgeons blindly reviewed the radiographs for the presence and thickness (mm) of radiolucent lines. The newer instrumented pressurization group had a lower incidence of radiolucent lines than the old manually packed group. In the new subgroup, pegged components had a lower incidence of radiolucent lines than keeled components. The incidence of radiolucent lines seems to be reduced using specially designed instruments, new glenoid designs, and modern cement techniques, which may lead to reduced long-term glenoid loosening. LEVEL OF EVIDENCE: Therapeutic study, Level III-2 (retrospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.

Anatomy of the posterior rotator interval: implications for cuff mobilization.

Release of the posterior rotator interval between the supraspinatus and infraspinatus tendons may be necessary to obtain appropriate mobilization for an anatomic rotator cuff repair. Ten cadaver shoulders were dissected to expose the region between the infraspinatus and supraspinatus from the spinoglenoid notch to the greater tuberosity. Measurements were made from the spinoglenoid notch to the glenoid rim, the glenoid rim to the confluence of the supraspinatus and infraspinatus musculotendinous junction, and from the confluence of the tendons to the insertion on the humerus. The histologic features of the posterior rotator interval were examined. The posterior rotator interval is a clear structure, consisting of the glenohumeral capsule medially, which fuses with the supraspinatus and infraspinatus tendons laterally. The average length of the posterior rotator interval was 77.8 mm which includes the distance from the spinoglenoid notch to the glenoid rim (25 mm; standard deviation, 2.89 mm; range, 21-28 mm), from the glenoid to the tendon confluence (25 mm; standard deviation, 1.95 mm; range, 21-28 mm), and from the tendon confluence to insertion (28 mm; standard deviation, 2.36 mm; range, 24-31 mm). Release of the posterior rotator interval can be important to realign the supraspinatus tendon if it is retracted and scarred at its posterior edge.