The outcomes and surgical techniques of the latarjet procedure.

PURPOSE: To determine the optimal position and orientation of the coracoid bone graft for the Latarjet procedure for recurrent instability in patients with recurrent anterior instability and high degrees of glenoid bone loss. METHODS: A systematic review of the literature including the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2012), and Medline (1980-2012) was conducted. The following search teams were used: glenoid bone graft, coracoid transfer, glenoid rim fracture, osseous glenoid defect, and Latarjet. Studies deemed appropriate for inclusion were then analyzed. Study data collected included level of evidence, patient demographic characteristics, preoperative variables, intraoperative findings, technique details, and postoperative recovery and complications where available. RESULTS: The original search provided a total of 344 studies. A total of 334 studies were subsequently excluded because they were on an irrelevant topic, used an arthroscopic technique, or were not published in English or because they were review articles, leaving 10 studies eligible for inclusion. Given the different methods used in each of the studies included in the review, descriptive analysis was performed. The duration of follow-up ranged from 6 months to 14.3 years postoperatively. With the exception of 2 studies, all authors reported on recurrent shoulder instability after Latarjet reconstruction; the rate of recurrent anterior shoulder instability ranged from 0% to 8%. Overall patient satisfaction was listed in 4 studies, each of which reported good to excellent satisfaction rates of more than 90% at final follow-up. CONCLUSIONS: As noted in this review, the current literature on Latarjet outcomes consists mostly of retrospective Level IV case series. Although promising outcomes with regard to a low rate of recurrent instability have been seen with these reports, it should be noted that subtle variations in surgical technique, among other factors, may drastically impact the likelihood of glenohumeral degenerative changes arising in these patients. LEVEL OF EVIDENCE: Level IV, systematic review of Level IV studies.

General and disease-specific use of outcomes scores for the shoulder: a survey of AOSSM, AANA, and ISAKOS members.

OBJECTIVE: To report on the knowledge and use of both general and disease-specific shoulder outcomes scores among orthopedic surgeons. METHODS: A 22-question Internet survey was administered to members of the American Orthopaedic Society for Sports Medicine, the Arthroscopy Association of North American, and the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine via voluntary e-mail participation. Questions targeted demographic information, preferred surgical management of shoulder conditions, and the preferred use of shoulder outcomes instruments in clinical practice. RESULTS: Excluding defunct and duplicate e-mails among membership societies, a total of 3892 unique e-mails were sent, from which 1129 surveys were returned and were fully completed (29%). The largest number of respondents were in private practice (52%); 21% were in academia; and 26% were in a mix of settings. As for location, 74% practiced in the United States, 10% in Europe, 8% in Mexico/South America, and 6% in Asia. A total of 31% total respondents used scores all or most of the time, and 30% used scores at least some of the time. Respondents felt that the 3 most commonly utilized shoulder scores were the American Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) score, and the Constant score. The majority of respondents (76%) performed all-arthroscopic instability repairs. The ASES and Western Ontario Shoulder Instability Index (WOSI) scores were the most preferred measures to monitor instability patients, whether or not the scores were actually implemented in their practice. Most perform between 10 and 25 superior labrum anterior-posterior repairs per year and preferred the ASES, UCLA, and Constant scores for these repairs; rotator cuff repair preferred outcomes instruments were similar. When asked to choose 1 score for all shoulder conditions, the ASES was the clear favorite. CONCLUSIONS: This study reports the knowledge and utilization of shoulder scores for both general and disease-specific conditions. Most respondents preferred the ASES score for most shoulder conditions; however, other scores, such as the WOSI, the Constant, and the Short-Form (SF)-36/12, were popular. This information offers insight into the current and future use of shoulder outcomes both for general and disease-specific use.

Articular and meniscal pathology associated with primary anterior cruciate ligament reconstruction.

BACKGROUND: The abnormal kinematics, contact pressures, and repeated episodes of instability observed in chronic anterior cruciate ligament (ACL) deficiency suggest that these patients may be predisposed to early degenerative changes and associated pathologies such as meniscal tears and chondral injury. Injury to the cartilage and associated structures at the time of ACL rupture, in combination with the inflammatory mediators released at the time of injury, may create irreversible damage to the knee despite restoration of normal knee kinematics with an ACL reconstruction. HYPOTHESIS: Patients undergoing acute ACL reconstruction have a higher incidence of lateral meniscal tears and less severe chondral changes when compared with patients undergoing late ACL reconstruction. Older patients likely have a higher incidence of chondral and meniscal pathology compared with younger patients. METHODS: A retrospective chart review of a single surgeon's ACL practice over 20 years was performed. A surgical data packet was used to record patient demographics, location, grade, and number of chondral injuries as well as location and pattern of meniscal injuries at the time of ACL reconstruction. Patients (N = 709) were divided into three subgroups according to their time from injury to surgery; acute (less than 4 weeks, N = 121), subacute (4 to 8 weeks, N = 146), and chronic (8 weeks or more, N = 442). RESULTS: Older patients had a higher incidence of more severe chondral grade and number of chondral injuries at the time of ACL reconstruction. Patients undergoing surgery more than 8 weeks after injury had a statistically significant more severe chondral grade in the medial compartment when compared with those that had surgery less than 8 weeks after injury. A similar observation was not found in the lateral compartment. With regard to meniscal pathology, full-thickness medial meniscal tears were likely to be bucket-type tears regardless of the chronicity of the injury. Similarly, full-thickness lateral meniscal tears were more often flap-type tears independent of the time interval between injury and surgery. Partial-thickness tears were common both medially and laterally. CONCLUSIONS: Patient's age and chronicity of ACL tear greater than 8 weeks are both significant factors in medial compartment chondral pathology. Patients with delayed reconstruction may have greater associated pathology.

Nontraditional modification to articular cartilage.

Biomechanical imbalance, trauma, and age-related degeneration often result in chondral lesions, which may lead to overt osteoarthritis over time. Such cartilage pathology is frequently accompanied by persistent pain and loss of normal joint function. As a result, patients who suffer from biologically active articular cartilage lesions are often unable to function in both high level activities and exhibit compromised activities of daily living. The limited potential for self-regeneration of hyaline cartilage has led to the emergence of new technologies to solve this difficult clinical problem. Treatment of arthritis and chondral lesions includes alleviation of pain and return of function through pharmacologic intervention and/or attempts at cartilage reparative, restorative and reconstructive options.

An analysis of shoulder outcomes scores in 275 consecutive patients: disease-specific correlation across multiple shoulder conditions.

OBJECTIVES: To determine the outcomes scores of military patients who initially present with a variety of shoulder conditions, identify which scores demonstrate the highest correlation per diagnosis, and determine if a difference exists for patients who went onto surgery. METHODS: Two-hundred and seventy five consecutive patients with mean age of 36.5 +/- 12.9 at presentation completed baseline outcomes assessments that included Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) Score, Western Ontario Shoulder Instability Index (WOSI), Western Ontario Rotator Cuff Index (WORC), the Simple Shoulder Test (SST), and the Disabilities of the Arm, Shoulder, and Hand Index (DASH). The patients were grouped by clinical, radiographic, and surgical findings into 10 diagnostic categories. OUTCOMES: The initial mean outcomes scores were SANE 48.8, ASES 50.1, WOSI 1279 (40% normal), WORC 1122.4 (47% normal), SST 6.7, and DASH 33.1. Patients with superior labrum anterior-posterior tears demonstrated the lowest mean scores, followed by instability and rotator cuff tear patients. For all conditions, scores were lower for patients who went onto surgery compared with those managed nonoperatively (p = 0.008). CONCLUSIONS: Our findings may be utilized as a baseline to compare and track patient-derived disability across multiple shoulder conditions and serve to define mean diagnosis-specific shoulder patient preoperative scores.

Biceps tenotomy versus tenodesis: a review of clinical outcomes and biomechanical results.

HYPOTHESIS: There are significant differences in incidence of cosmetic deformity and load to tendon failure between biceps tenotomy versus tenodesis for the treatment of long head of the biceps brachii (LHB) tendon lesions which are supported by the evidence-based strengths and weaknesses of each procedure in the literature. MATERIALS AND METHODS: PubMed, Embase, and Cochrane databases were searched for eligible clinical and biomechanical articles relating to biceps tenotomy or tenodesis from 1966 to 2010. Keywords were biceps tenotomy, biceps tenodesis, long head of the biceps brachii, and Popeye sign. All relevant studies were included based on study objectives, and excluded studies consisted of abstracts, case reports, letters to the editor, and articles without outcome measures. RESULTS: All articles reviewed were of level IV evidence. Combined results from reviewed papers on the differences between LHB tenotomy vs tenodesis demonstrated a higher incidence of cosmetic deformity in patients treated with biceps tenotomy. Complications were similar for each treatment, with a higher likelihood of bicipital pain associated with tenodesis. Lack of high levels of evidence from prospective randomized trials limits our ability to recommend one technique over another. DISCUSSION: This review demonstrated a higher incidence of cosmetic deformity in patients treated with biceps tenotomy compared with tenodesis, with an associated lower load to tendon failure. However, there was no consensus in the literature regarding the use of tenotomy vs. tenodesis for LHB tendon lesions due to variable results and methodology of published studies. Individual patient factors and needs should guide surgeons on whether to use tenotomy or tenodesis. CONCLUSIONS: There is a great need for future studies with high levels of evidence, control, randomization, and power, with well-defined study variables, to compare biceps tenotomy and tenodesis for the treatment of LHB tendon lesions.

Biomechanical evaluation of a high tibial osteotomy with a meniscal transplant.

This study determines the biomechanical advantage and the optimal configuration of a high tibial osteotomy (HTO) and meniscus transplantation performed concurrently. Six cadaver knees were placed in a spatial frame, and an HTO was completed. Loading points between a mechanical 6 degrees of varus and 8 degrees ofvalgus were loaded to 800 N for medial meniscal intact, meniscectomized, and transplanted states. Posterior slope was also increased by 3 degrees in these specimens. Contact data was recorded. Peak pressures significantly increased in the meniscectomized state in every degree of varus/valgus (p < 0.05). For both peak and total medial compartment pressures, there was a significant drop (p < 0.001) between neutral and 3 degrees of valgus. Lateral compartment pressures linearly increased from varus to valgus orientation. There was no significant change in the pressure profile of the knee with a 3-degree increase in posterior slope. This biomechanical study confirms the hypothesis that an HTO improves the peak pressures in the medial compartment at all degrees of varus/valgus alignment in the setting of meniscal transplantation. Furthermore, the largest decrease in medial pressures was between neutral and 3 degrees of valgus, suggesting that perhaps neutral aligned knees could benefit from an HTO.

Avoiding mismatch in allograft anterior cruciate ligament reconstruction: correlation between patient height and patellar tendon length.

PURPOSE: The purpose of this study was to evaluate whether a correlation exists between patient height and soft-tissue patellar tendon length. METHODS: Magnetic resonance imaging (1.5 T) was performed for knee pathology on 403 patients. The patellar tendon length was measured in the midsagittal plane by a board-certified musculoskeletal radiologist. Patient height was recorded to the nearest inch. Patients were grouped into 6 subgroups with 4-inch range intervals based on height. The entire study group was analyzed. Subgroup analysis and gender analysis were performed to determine statistical significance. RESULTS: The mean patellar tendon length was 45 +/- 7 mm (range, 30 to 66 mm). Wide ranges were noted among each height subgroup irrespective of gender. Significant differences were noted between most height subgroups independent of gender. CONCLUSIONS: This study showed that a correlation exists between patient height, gender, and patellar tendon length. Although variation occurs among patients of the same height, significant differences in mean patellar tendon lengths do exist between patients in different height subgroups. CLINICAL RELEVANCE: Parameters are provided using patient gender and height to reduce the potential for graft-construct mismatch when ordering bone-patellar tendon-bone allografts for anterior cruciate ligament reconstruction.

Arthroscopic suprascapular nerve decompression: indications and surgical technique.

BACKGROUND: Although entrapment of the suprascapular nerve (SSN) is an infrequent presentation of shoulder pain, proper diagnosis and treatment are critical to prevent chronic supraspinatus and infraspinatus atrophy. MATERIALS AND METHODS: We present a technique that allows SSN decompression at the spinoglenoid notch or suprascapular notch through the subacromial space. RESULTS AND CONCLUSIONS: This method allows for facile decompression of the SSN after repair of concomitant shoulder pathology and allows direct visualization of the medial neck of the glenoid to avoid complications of iatrogenic SSN nerve injury from aggressive medial capsule dissection. The purpose of this article is to provide surgeons with a safe, reliable method to decompress the SSN at the suprascapular or spinoglenoid notch.

Anatomic osteochondral glenoid reconstruction for recurrent glenohumeral instability with glenoid deficiency using a distal tibia allograft.

The treatment of glenoid bone loss in the setting of recurrent shoulder instability remains a challenge. This is because of the nonanatomic nature and resultant incongruous joint resulting from most bony augmentation procedures. We present a novel technique for the management of glenoid bone deficiency by using a fresh osteochondral distal tibial allograft. We have found that the distal tibia has excellent articular conformity to unmatched humeral heads, fits nearly anatomically on the distal two thirds of the glenoid, is composed of dense weight-bearing cortical and metaphyseal distal tibia bone, and provides for a cartilaginous surface for which the humeral head to articulate. This article describes the technique, initial results, and postoperative findings with the use of a distal tibia allograft (the lateral portion of the distal tibia) for the treatment of glenoid bone deficiency (mean loss of 30%) in a series of 3 patients.

The snapping scapula: diagnosis and treatment.

As a largely under-recognized problem, snapping scapula stems from the disruption of normal mechanics in scapulothoracic articulation. It is especially common in the young, active patient population, and symptoms are frequently seen with overhead and throwing motions. Understanding the anatomy of the scapula and surrounding neurovascular structures is crucial in making a differential diagnosis and providing both nonoperative and surgical treatments. Common causes of snapping scapula include bursitis, muscle abnormality, and bony or soft-tissue abnormalities. Anatomic variations, such as excessive forward curvature of the superomedial border of the scapula, may also be a cause for snapping. Benign tumor conditions of the scapula can also predispose one to snapping scapula syndrome and should be thoroughly investigated during the course of treatment. Patients with snapping scapula syndrome typically present with a history of pain with overhead activities. Snapping scapula is associated with audible and palpable crepitus near the superomedial border of the scapula. Various imaging studies may be used to rule out soft-tissue and bony masses, which may cause impingement at the scapulothoracic articulation. In most cases nonoperative treatment is curative and includes physical therapy for scapular muscle strengthening and nonsteroidal anti-inflammatory medications. Corticosteroid injections may also be used for therapeutic and diagnostic purposes. In most cases overuse injuries and repetitive strains respond well to nonoperative treatments. When nonoperative measures fail, surgery is a proven modality, especially if a soft-tissue or bony mass is implicated. Both open and arthroscopic techniques have been described with predictable results.

Anatomic reduction and next-generation fixation constructs for arthroscopic repair of crescent, L-shaped, and U-shaped rotator cuff tears.

Emerging techniques and instrumentation have allowed orthopaedic surgeons to achieve rotator cuff repair through an all-arthroscopic technique. The most critical steps in rotator cuff repair consist of proper identification of the cuff tear pattern and anatomic restoration of the torn tendon footprint. With anatomic reduction of the rotator cuff tendons, a sound fixation construct can help restore rotator cuff contact pressure and kinematics, allowing for decreased repair tension and optimal healing potential. We provide surgical methods to recognize tear patterns and present a repair construct that will restore the anatomic footprint of the torn rotator cuff tendon. The key, initial maneuver to restore the anatomic footprint of the cuff includes placement of a suture anchor at the anterolateral corner for L-shaped tears and at the posterolateral corner for reverse L-shaped and U-shaped tears. After insertion of the medial-row anchors, the tendon stitches should be planned by use of a grasper to hold the tendon in a reduced position and guide location of the stitch. The lateral row with suture bridge can be visualized, and the final repair construct should produce an anatomic restoration of the rotator cuff footprint.

Distal clavicle fracture as a complication of arthroscopic distal clavicle resection.

Arthroscopic resection of the distal clavicle has been advocated as a surgical treatment option for acromioclavicular (AC) joint pathology. To our knowledge, iatrogenic fracture of the distal clavicle during distal clavicle resection has never been reported. This report describes distal clavicle fracture as a complication of misidentification of the AC joint and subsequent aggressive burring of the distal clavicle during shoulder arthroscopy. This case is further complicated by the development of symptomatic delayed union and adhesive capsulitis. Ultimately, a revision distal clavicle resection was performed, underscoring the fact that special care must be taken to properly identify the AC joint and rule out pre-existing distal clavicle stress fracture or osteolysis before performing the arthroscopic Mumford procedure.

Arthroscopic decompression of the suprascapular nerve at the spinoglenoid notch and suprascapular notch through the subacromial space.

Suprascapular nerve entrapment can cause disabling shoulder pain. Suprascapular nerve release is often performed for compression neuropathy and to release pressure on the nerve associated with arthroscopic labral repair. This report describes a novel all-arthroscopic technique for decompression of the suprascapular nerve at the suprascapular notch or spinoglenoid notch through a subacromial approach. Through the subacromial space, spinoglenoid notch cysts can be visualized between the supraspinatus and infraspinatus at the base of the scapular spine. While viewing the subacromial space through the lateral portal, the surgeon can use a shaver through the posterior portal to decompress a spinoglenoid notch cyst at the base of the scapular spine. To decompress the suprascapular nerve at the suprascapular notch, a shaver through the posterior portal removes the soft tissue on the acromion and distal clavicle to expose the coracoclavicular ligaments. The medial border of the conoid ligament is identified and followed to its coracoid attachment. The supraspinatus muscle is retracted with a blunt trocar placed through an accessory Neviaser portal. The transverse scapular ligament, which courses inferior to the suprascapular artery, is sectioned with arthroscopic scissors, and the suprascapular nerve is decompressed.

A new arthroscopic technique to determine anterior-inferior glenoid bone loss: validation of the secant chord theory in a cadaveric model.

PURPOSE: The accuracy of a previously described method using the glenoid bare spot (GBS) as a reference point was compared with a new method using the secant chord theory (SCT), which relies on the circular geometry of the inferior glenoid to calculate bone loss. METHODS: In 7 embalmed cadaveric shoulders a digital image of the glenoid face was used to calculate the area of the best-fit circle of the inferior glenoid. Osteotomy templates from the 3-o'clock to 6-o'clock position were created to make a simulated anterior-inferior bone defect of 12.5% and 25% of the area of the circle. Measurements were taken with an arthroscopic probe from 2 simulated posterior portal positions (9 and 10 o'clock) by use of 2 techniques-SCT and GBS-in the intact, 12.5% loss, and 25% loss states. RESULTS: In the intact state, measurements showed a mean SCT loss of 4.1% and GBS loss of 4.4%. In the 12.5% loss state, mean percent bone loss with GBS was 23.1% compared with 14.8% with SCT (P = .0001) at the 10-o'clock portal and 22.2% compared with 15.9% (P = .006) at the 9-o'clock portal. In the 25% loss state, mean percent bone loss with GBS was 31.5% compared with 26.6% with SCT (P = .002) at the 10-o'clock portal and 30.4% compared with 28.9% (P = .48) at the 9-o'clock portal. CONCLUSIONS: The SCT is shown to be a more accurate method of determining glenoid bone loss in an arthroscopic model; however, additional mathematic calculations are necessary. As shown in the intact state, there is an inherent small error of approximately 4% when arthroscopically determining bone loss. CLINICAL RELEVANCE: The technique may aid the clinician in quantifying glenoid bone loss and help determine when bone augmentation may be advisable.

Complications associated with anterior shoulder instability repair.

Anterior shoulder instability is a common orthopaedic problem, and the surgical treatment, both open and arthroscopic, has been shown to effectively restore stability and prevent recurrence. However, despite success with these surgical techniques, there are several clinically relevant complications associated with both open and arthroscopic techniques for anterior shoulder stabilization. These complications can be subdivided into preoperative, intraoperative, and postoperative and include entities such as nerve injury, chondrolysis, incomplete treatment of associated lesions, and subscapularis dysfunction. When they occur, complications may significantly impact patient outcomes and function. Therefore, surgeon awareness and identification of the factors associated with these complications may help prevent occurrence. Although failure of instability repair can be classified as a complication of surgery, it requires an entirely separate discussion and is therefore not addressed in this article. Because most of the previously published studies on anterior shoulder instability have emphasized surgical technique and clinical outcomes, the purpose of this article is to define the complications associated with anterior instability repair and provide recommendations on techniques that may be used to help avoid them.

Open, mini-open, and all-arthroscopic rotator cuff repair surgery: indications and implications for rehabilitation.

UNLABELLED: Rotator cuff tears lead to debilitating shoulder dysfunction and impairment. The goal of rotator cuff repair is to eliminate pain and improve function with increased shoulder strength and range of motion. The clinical outcomes of the surgical methods of rotator cuff repair (open, mini-open, and all-arthroscopic cuff repair) vary, as each method provides an array of advantages and disadvantages. Although the open surgical technique has long been considered the gold standard of rotator cuff repair, surgeons are becoming more adept at decreasing patient morbidity through decreased surgical trauma from an all-arthroscopic approach. In addition to a surgery-specific rotator cuff rehabilitation program, effective communication, and coordination of care by the physical therapist and surgeon are essential in optimal patient education and outcomes. In the ideal situation, a very well-educated therapist who has great communication with the treating surgeon can mobilize the shoulder early, re-establish scapulothoracic function safely and minimize the risk of stiffness and retear, while facilitating return to function. Treatment options can be individualized according to patient age, size and chronicity of tear, surgical approach, and fixation method. We recommend that patients who have undergone an all-arthroscopic rotator cuff repair undergo an accelerated postoperative rehabilitation program. A rational approach to therapy involves early, safe motion to allow optimal tendon healing, yet maintenance of joint mobility with minimal stress. As the field of orthopedics and, particularly, rotator cuff repair continues to develop with new technologies, the patient, physical therapist, and doctor need to work together to ensure optimal outcomes and patient satisfaction. LEVEL OF EVIDENCE: Therapy, Level 5.

Patellofemoral kinematics after limited resurfacing of the trochlea.

Patellofemoral kinematics after a limited resurfacing of the trochlea was investigated. Patellofemoral contact pressure, area, and force were measured for intact state; after creation of a 20-mm full-thickness trochlear defect; and after trochlear resurfacing implant (Arthrosurface) in serial flexion positions (45 degrees, 60 degrees, 75 degrees). In the defect state, edge loading and peak contact forces were highest at the periphery. The chondral defect increased peak contact force (13 to 18 N, P < .01) and peak contact pressure (23 to 31 kg/cm2, P < .02) compared with the intact state. Peak contact pressure and force were restored to 90% (P < .01) and 88% (P < .01). Implantation of the device restored contact area to 85% of the intact state. Limited resurfacing of the trochlea restores contact area, peak pressure, and peak force to the intact state. These findings highlight the potential clinical use of limited patellofemoral resurfacing in trochlear chondral defects.

In vivo profile of ICA-27243 [N-(6-chloro-pyridin-3-yl)-3,4-difluoro-benzamide], a potent and selective KCNQ2/Q3 (Kv7.2/Kv7.3) activator in rodent anticonvulsant models.

Openers or activators of neuronal KCNQ2/Q3 potassium channels decrease neuronal excitability and may provide benefit in the treatment of disorders of neuronal excitability such as epilepsy. In the present study, we evaluate the effects of ICA-27243 [N-(6-chloro-pyridin-3-yl)-3,4-difluoro-benzamide], an orally bioavailable, potent, and selective KCNQ2/Q3 opener, in a broad range of rodent seizure models. ICA-27243 was effective against maximal electroshock (MES) and pentylenetetrazole (PTZ)-induced seizures in both rats (MES, ED(50) = 1.5 mg/kg p.o.; PTZ, ED(50) = 2.2 mg/kg p.o.) and mice (MES, ED(50) = 8.6 mg/kg p.o.; PTZ, ED(50) = 3.9 mg/kg p.o.) in the rat amygdala kindling model of partial seizures (full protection from seizure at 9 mg/kg p.o.) and in the 6-Hz model of psychomotor seizures in mice (active at 10 mg/kg i.p.). Antiseizure efficacy in all models was observed at doses significantly less than those shown to effect open-field locomotor activity (rat ED(50) = 40 mg/kg p.o.) or ability to remain on a Rotorod (no effect in rat at doses up to 100 mg/kg p.o.). There was no evidence of cognition impairment as measured in the Morris water maze in the rat (10 and 30 mg/kg p.o.), nor was there evidence of the development of tolerance after multiple doses of ICA-27243. Our findings suggest that selective KCNQ2/Q3 opening activity in the absence of effects on KCNQ3/Q5 or GABA-activated channels may be sufficient for broad-spectrum antiepileptic activity in rodents.

Femoral and tibial tunnel position using a transtibial drilled anterior cruciate ligament reconstruction technique.

This study evaluates the position of the femoral tunnel, which is achieved using a transtibial, single-bundle anterior cruciate ligament (ACL) reconstruction technique. The radiographs of 50 consecutive, primary single-bundle ACL reconstructed knees using this technique were reviewed. The angle between the femoral tunnel and the apex of the intercondylar notch was recorded. The average angle from the 12-o'clock vertical position to the femoral tunnel was 49 degrees (range, 39 degrees-59.2 degrees; SD = 3.9), corresponding to the 10:20 position on a clock face for a right knee. These results demonstrate that it is technically possible to create an obliquely oriented single-bundle femoral tunnel at approximately the 10:20 position through a tibial tunnel angled approximately 60 degrees from the proximal tibial joint surface. This correlates to a femoral tunnel approximately midway between the anteromedial and posterolateral bundle origins of the ACL.