Surgical treatment of anterior shoulder instability with glenoid bone loss with the Latarjet procedure in active-duty military service members.

INTRODUCTION: The arthroscopic Bankart repair in the setting of glenoid bone loss has high rates of failure. In patients with anterior glenoid bone loss, the Latarjet provides glenohumeral stability through restoration of the glenoid bone, the conjoint tendon acting as a sling on the subscapularis, and anterior capsulolabral repair. Active-duty military personnel are at high risk for glenohumeral instability and have been equated to the contact athlete; most are young, male, and engage in contact sports. The purpose of this study is to assess the return to full-duty rates in active-duty military personnel following the Latarjet for anterior glenohumeral instability with glenoid bone loss. METHODS: A retrospective review of all glenohumeral instability procedures were reviewed at a tertiary training hospital from June 2014 to June 2019. The patient population consisted of active-duty military personnel with glenoid bone loss and anterior glenohumeral instability, who were treated with a Latarjet. The primary outcome was return to full-duty status. RESULTS: There were 50 patients identified for the study. Four patients were lost to follow-up, leaving 46 of 50 patients (92.0%) eligible for this study. The average age at the time of the index procedure was 23.1 years. The average percentage bone loss was 18.4%. Forty-one patients (89.1%) were able to return to full-duty status. Four patients (8.7%) sustained a recurrent dislocation following the Latarjet; all 4 dislocations occurred during a combat deployment. Four patients (8.7%) reported episodes of subluxation without dislocation. Forty-one patients (89.1%) reported that their shoulders felt stable, and we found an average return to full duty at 5.3 months CONCLUSION: In our active-duty military cohort, we found an 8.7% rate of recurrent instability after a Latarjet procedure, and 41 patients (89.1%) were able to return to full-duty status. In conclusion, the Latarjet procedure in the active-duty military population with anterior glenoid bone loss resulted in a high rate of return to duty, excellent functional outcomes, low rate of recurrent instability, and a low overall complication rate.

Editorial Commentary: Uniplane High Tibial Osteotomy Just Below the Metaphyseal Flare Is Preferable to Biplane Opening Wedge High Tibial Osteotomy Distal to the Tuberosity: A Cut Below Our Expectations.

Medial opening wedge high tibial osteotomy (MOWHTO) is indicated to correct coronal plane malalignment in a variety of cases, but it carries a high complication profile. Modifications, such as biplane opening wedge high tibial osteotomy distal to the tibial tuberosity have been developed to mitigate consequences, such as loss of patellar height. Unfortunately, biplane osteotomy, which uses a second anterior osteotomy exiting distal to the tibial tubercle, introduces its own set of complications, such as fractures and nonunion of the tibial tubercle, lateral hinge fracture, and increased posterior tibial slope (PTS). Changes in PTS can have significant consequences for patients undergoing anterior cruciate or posterior cruciate ligament reconstruction. Furthermore, the benefit of maintaining patellar height has not been proven. Given the risk of tuberosity-related complications, significant increases in PTS, and no correlation between decreased patellar height and clinical outcomes, surgeons should consider the use of a uniplane, supra-tubercle MOWHTO rather than a biplane technique to correct varus malalignment in the majority of cases. We prefer a uniplane osteotomy starting on the medial cortex just below the metaphyseal flare, aiming the cut in a proximal and lateral direction toward the fibular head. The cut is finished with an osteotome, ending with a 1-cm hinge laterally, and ∼1.5 cm distal to the articular surface. Our plate is positioned posteromedially to preserve PTS, and we place allograft corticocancellous wedges in the osteotomy site. Why make a complicated procedure more complicated?

Editorial Commentary: Every Cloud Has a Silver Lining but Silver May Not Be the Currency of Choice: The Bioelectric Silver-Zinc Dressing Requires Additional Investigation.

The use of silver in various forms has been advocated for its antibacterial properties for centuries, because its toxicity to human cells is considerably lower than its toxicity to bacteria. The Greek historian Herodotus recounted how the king of Persia, before going to war, among his provisions included boiled water stored in flagons of silver, ostensibly to mitigate the risk of foodborne infections in his troops. Additionally, recent studies support the use of silver to generate an electrical stimulation for promotion of wound healing. These concepts have been combined in a proprietary postoperative dressing that is promoted to mitigate the risk of postoperative infections.

High frequency of posterior and combined shoulder instability in young active patients.

OBJECTIVE: The purpose of this study was to describe the epidemiology and demographics of surgically treated shoulder instability stratified by direction. We hypothesized that there would be an increased frequency of posterior and combined shoulder instability in our population compared with published literature. Secondarily, we assessed preoperative magnetic resonance imaging (MRI) reports to determine how accurately they detected the pathology addressed at surgery. MATERIALS AND METHODS: A retrospective review was conducted at a single facility during a 46-month period. The study included all patients who underwent an operative intervention for shoulder instability. The instability in each case was characterized as isolated anterior, isolated posterior, or combined, according to pathologic findings confirmed at arthroscopy. The findings were retrospectively compared with official MRI reports to determine the accuracy of MRI in characterizing the clinically and operatively confirmed diagnosis. RESULTS: A consecutive series of 231 patients (221 men, 10 women) underwent stabilization for shoulder instability over 46 months. Patients were a mean age of 26.0 years. There were 132 patients (57.1%) with isolated anterior instability, 56 (24.2%) with isolated posterior instability, and 43 (18.6%) with combined instability. Overall, MRI findings completely characterized the clinical diagnosis and arthroscopic pathology in 149 of 219 patients (68.0%). CONCLUSION: The rate of posterior and combined instability in an active population is more common than has been previously reported, making up more than 40% of operatively treated instability, including a previously unreported incidence of 19% for combined instabilities. In addition, MRI was often incomplete or inaccurate in detecting the pathology eventually treated at surgery.

Utility of computed tomography arthrograms in evaluating osteochondral allograft transplants of the distal femur.

Postsurgical evaluation of osteochondral allograft transplant surgery (OATS) of the distal femur most commonly utilizes radiographs or magnetic resonance imaging. This article proposes the utilization of computed tomography (CT) arthrography as an additional option, which allows clear assessment of articular congruity and osseous integration. A retrospective review was performed of 18 patients who underwent an OATS for distal femoral chondral lesions and obtained CT arthrograms postoperatively. CT arthrograms were evaluated for osseous integration and articular congruity. The average age and follow-up were 30.9 years and 4.3 years, respectively. Only 60% of patients were able to remain in the military postoperatively. The articular cartilage was smooth in eight (44.4%); complete bony integration was noted in eight (44.4%) patients. Neither articular congruity nor bony integration was associated with duty status at final follow-up. Although it allows excellent evaluation, similar to other modalities, CT arthrogram does not appear predictive of functional outcome.

Pectoralis Major Tendon Reconstruction With Achilles Tendon Allografts Utilizing Combined Pulvertaft Weave and Onlay Techniques.

Surgical treatment of chronic pectoralis major tears presents a technical challenge, as injury chronicity may preclude the ability to perform a direct repair. Many techniques have been described to repair an acute pectoralis tendon rupture, including utilization of unicortical buttons within the humeral footprint. In the chronic setting when direct repair is not possible, reconstruction with allograft tissue can restore strength, improve cosmesis, and yield high functional outcomes; however, literature is limited to small case series. We describe a combined Pulvertaft Weave and onlay technique with dual Achilles tendon allograft in the management of an active duty infantryman with a chronic pectoralis major injury.

Glenoid bare area: arthroscopic characterization and its implications on measurement of bone loss.

PURPOSE: The purpose of this study was to characterize arthroscopically the frequency and location of the glenoid bare area. METHODS: Three fellowship-trained orthopaedic sports surgeons evaluated and characterized the bare area of the glenoid in 52 consecutive patients undergoing arthroscopic surgery of the shoulder without a diagnosis of instability. Among the patients with a visible bare area, the position was measured, and when eccentrically located, an apparent bone loss or gain was calculated. RESULTS: The bare area of the glenoid was observed in only 48% of patients undergoing arthroscopic surgery, and when observed, it was at the center only 37% of the time. Of the glenoids with visible bare areas, 8% were located anteriorly enough to result in an apparent bone loss calculation of greater than 20%. An additional 25% of visible bare areas were posteriorly located, resulting in an apparent bone gain. CONCLUSIONS: The glenoid bare area is a variably visible and eccentric landmark on the glenoid and thus should not be used as the sole reference point to measure glenoid bone loss.

Anterior Cruciate Ligament Reconstruction Using Femoral Cortical Button Fixation: A Case Series of Intraoperative Malpositioning.

Background: Malpositioning of the femoral button is a known technical complication after anterior cruciate ligament (ACL) reconstruction with cortical suspensory fixation. The incidence of malpositioning, as well as the efficacy of methods to prevent malpositioning of cortical suspensory fixation devices, has not been reported. Purpose: To determine the rate of malpositioned cortical suspensory fixation devices after ACL reconstruction, investigate which intraoperative technique yields the lowest rate of malpositioning, and determine the return-to-duty rate for active-duty service members with malpositioned buttons and the revision rate for malpositioned buttons. Study Design: Case series; Level of evidence, 4. Methods: The records of patients who underwent primary ACL reconstruction with a cortical suspensory fixation device between 2008 and 2018 were reviewed at our institution. Postoperative radiographs were reviewed for evidence of malpositioned femoral buttons. Malpositioned buttons were classified as (1) fully positioned in the bone tunnel, (2) partially positioned in the bone tunnel, (3) >2 mm from cortical bone, or (4) deployed over the iliotibial band. Operative reports were reviewed to determine the intraoperative methods undertaken to verify the button position. The rate of malpositioned cases with subjective instability and revision surgery performed were determined. The ability of patients to return to full military duty was reviewed for active-duty personnel. Results: A total of 1214 patients met the inclusion criteria. A 3.5% rate (42 cases) of malpositioned cortical suspensory fixation devices (femoral buttons) was identified. For patients with malpositioned buttons, 7 (16.7%) patients underwent revision surgery in the immediate postoperative period. Techniques used to avoid malpositioning included direct arthroscopic visualization, direct open visualization, intraoperative fluoroscopy, and first passing the button through the skin before positioning on the femoral cortex. There was a 4.6% malposition rate using direct arthroscopic visualization and a 5.1% malposition rate using passage of the button through the skin, while no malpositioning occurred with intraoperative fluoroscopy or direct open visualization (P < .05). Overall, 12 (28.6%) patients with malpositioned buttons ultimately underwent revision surgery. Despite having been diagnosed with malpositioned buttons, 21 (63.6%) active-duty members were able to return to full duty. Conclusion: Malpositioning of femoral buttons during ACL reconstruction occurred in 3.5% of patients in this series. The techniques of intraoperative fluoroscopy and direct open visualization are encouraged to prevent malpositioning.

Failure Rates After Anterior Cruciate Ligament Repair With Suture Tape Augmentation in an Active-Duty Military Population.

Background: Anterior cruciate ligament (ACL) repair had previously been considered the standard of care for a ruptured ACL; however, ACL reconstruction has became the standard of care because of poor midterm outcomes after ACL repair. Recently, studies have suggested that the treatment paradigm should shift back to ACL repair. Purpose/Hypothesis: The purpose of this study was to evaluate the outcomes of ACL repair augmented with suture tape in a high-demand military population. We hypothesized that for proximal ACL avulsions, ACL repair with suture tape augmentation would lead to acceptable failure rates, satisfactory knee stability, excellent functional outcomes, and high rates of return to preinjury activity levels. Study Design: Case series; Level of evidence, 2. Methods: Patients who were treated with ACL repair by a single surgeon between March 2017 and June 2019 and who had a minimum of 2 years of follow-up were included. Intraoperatively, all patients first underwent an arthroscopic examination. If an ACL avulsion of the proximal insertion with adequate remaining tissue was visualized, then ACL repair was performed. The primary outcome assessed was ACL repair failure, defined as reruptures or clinical instability requiring revision to ACL reconstruction. Analysis of the risk factors for ACL repair failure was conducted, with age at surgery, sex, body mass index, level of competition, and tobacco use evaluated. Results: Included were 46 patients (32 male and 14 female; mean age, 28.3 ± 8.4 years) who underwent ACL repair with suture tape augmentation. There were 12 cases of failure (26.1%; 8 male and 4 female). The mean time from injury to surgery in the failure group was 164.1 ± 59.4 days compared to 107.3 ± 98.0 days in the nonfailure group (P = .02). According to multivariate regression analysis, patients aged ≤17 and ≥35 years, elite/competitive/operational patients, and current smokers had a higher chance of ACL repair failure. The mean time to pass a military physical fitness test was 5.0 months. There were no complications other than ACL repair failure. Conclusion: Primary arthroscopic ACL repair with suture tape augmentation resulted in unacceptably high failure rates at a minimum of 2 years of follow-up in a highly active military population. Age ≤17 and ≥35 years, elite level of competition, time from injury to surgery, and active tobacco use were independent risk factors for ACL repair failure.

Early failures with single clavicular transosseous coracoclavicular ligament reconstruction.

INTRODUCTION: Coracoclavicular (CC) ligament reconstruction remains a challenging procedure. The ideal reconstruction is biomechanically strong, allows direct visualization of passage around the coracoid, and is minimally invasive. Few published reports have evaluated arthroscopic techniques with a single clavicular tunnel and transcoracoid reconstruction. One such report noted early excellent results, but without specific outcome measures. This study reports the clinical and radiographic results of a minimally invasive, arthroscopically assisted technique of CC ligament reconstruction using a transcoracoid and single clavicular tunnel technique. MATERIALS AND METHODS: A retrospective review was performed of 10 consecutive repairs in 9 active duty patients who underwent CC ligament reconstruction with the GraftRope (Arthrex, Naples FL, USA). All reconstructions were performed according to the manufacturer's technique by a single, fellowship-trained surgeon. Medical records and radiographs were evaluated for demographics, operative details, loss of reduction, and return to duty. RESULTS: In 8 of 10 repairs (80%) intraoperative reduction was lost at an average of 7.0 weeks (range, 3-12 weeks). Four patients (40%) required revision. Subjective patient outcomes included 5 excellent/good results, 1 fair result, and 4 poor results. Tunnel widening was universally noted, and the failure mode in most patients appeared to be at the holding suture. CONCLUSION: This transcoracoid, single clavicular tunnel technique was not a reliable approach to CC ligament reconstruction. We noted a high percentage of radiographic redisplacement and clinical failure. This technique, in its current form, cannot be recommended to treat AC joint injuries in our population.

Distal Biceps Femoris Tendon Tear in an Active-Duty Soldier: A Case Report and Review of the Literature.

Distal hamstring injuries and tendon ruptures are rarer than their proximal counterparts, and literature on the management of these injuries is limited. We present a case report of an active-duty soldier who sustained an intratendinous rupture isolated to the long head of the biceps femoris, as well as a summary of the available evidence on this subject matter. A combined end-to-end repair with partial tenodesis to the intact short head allowed the patient a near-full return to military duties at 5 months postoperatively. Surgery combined with diligent, supervised rehabilitation may be effective in returning patients with intratendinous distal biceps femoris tendon tears to athletic lifestyles.

Management Considerations for Unicompartmental Osteoarthritis in Athletic Populations: A Review of the Literature.

Unicompartmental osteoarthritis in the young athlete poses a challenge for both patients and providers. Coronal plane malalignment is frequently a concomitant finding that adds to the complexity of management. Military surgeons are presented unique challenges, in that they must consider optimal joint-preservation methods while returning patients to a high-demand occupational function. Management options range from lifestyle changes to surgical interventions. We present a concise review of the available literature on this subject, with a specific focus on indications and outcomes within the military and young athletic population.

Outcomes of Patellar Stabilization Utilizing a Combined Arthroscopic and Open Technique: A Retrospective Review With 5-Year Follow-up.

BACKGROUND: Few studies have reported the long-term outcomes of patellar stabilization surgery in an active duty military cohort. PURPOSE: To evaluate the long-term results of a combined open and arthroscopic patellar stabilization technique for the treatment of recurrent lateral patellar instability in members of a military population. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We performed a retrospective review of a consecutive series of 63 patients who underwent operative management for patellar instability at a tertiary military medical center between 2003 and 2017. All cases were performed by a single sports medicine fellowship-trained orthopaedic surgeon. Patients with recurrent lateral patellar instability whose nonoperative management failed were included. All patients underwent arthroscopic imbrication of the medial patellar retinaculum, an open lateral retinacular release, and an Elmslie-Trillat tibial tubercle osteotomy. Outcome measures at final follow-up included recurrent instability, need for surgical revision, subjective assessments, and military-specific metrics. We also analyzed anatomic risk factors for failure: patella alta, coronal plane alignment, trochlear dysplasia, and tibial tubercle-trochlear groove distance. RESULTS: A total of 51 patients were included (34 men, 17 women; mean ± SD age at surgery, 27.2 ± 5.8 years; mean follow-up, 5.3 years). The mean postoperative SANE score (Single Assessment Numeric Evaluation) was 75.0 ± 17.7, and the mean visual analog scale pain score was 2.5 ± 2.1. Four patients (7.8%) reported redislocation events, and 4 underwent revision surgery. Twenty-five patients (49.0%) reported a decrease in activity level as compared with preinjury, while 10 (19.6%) cited restrictions in activities of daily living. Of the 21 patients remaining on active duty, 6 (28.6%) required an activity-limiting medical profile. Of the 48 active duty patients, 12 (25.0%) underwent evaluation by a medical board for separation from the military. Differences in the Caton-Deschamps Index and tibial tubercle-trochlear groove distance between surgical success and failure were not statistically significant. CONCLUSION: Surgical management of patellar instability utilizing a multifaceted technique resulted in low recurrence rates and may be independent of predisposing anatomic risk factors for instability. At 5-year follow-up, most patients retained their active duty status, although nearly half experienced a decrease in activity level.

There is No Difference in Return to Duty Following the Latarjet With Subscapularis Split Versus Tenotomy Technique in the Military Population.

Purpose: To evaluate the return to duty rates between subscapularis split versus subscapularis tenotomy approach to the Latarjet procedure in an active-duty military population. Methods: A total of 46 patients were identified. Thirty-six (87.8%) were able to be contacted and included in the study. Operative technique, time to return to duty, and postoperative range of motion were collected. Patients were contacted telephonically to collect information on recurrent dislocation and time to pass first physical fitness test postoperatively. The primary outcome was time to return to full-duty status designated by passing a Physical Fitness Test. Secondary outcomes were redislocations and final range of motion. Results: In total, 36 of 41 (87.8%) patients were able to be contacted. There was no difference in return to duty rates designated by completion of first Physical Fitness Test for both groups (P = .23). In the subscapularis split group, 22 of 23 patients returned to full-duty at an average of 8.0 months versus the tenotomy group, with 12 of 13 patients returned to full-duty at an average of 8.7 months. There was also no difference with re-dislocation incidence for both groups of 0.08 (P = .45). Both groups had one patient each who was unable to return to full duty. There were no differences in postoperative forward flexion and external rotation, but abduction was 9° higher in the split compared to the tenotomy group (P = .03). Conclusions: In the military patient with anterior glenohumeral instability, the Latarjet using the subscapularis split and subscapularis tenotomy approach demonstrate similar return to duty rates and similar duration to pass a standardized fitness assessment. There was no clinically significant difference in postoperative range of motion. Both approaches produce similar results clinically; and should be chosen based on surgeon preference. Level of Evidence: III, retrospective cohort study.

Increased posterior tibial slope is an independent risk factor of anterior cruciate ligament reconstruction graft rupture irrespective of graft choice.

INTRODUCTION: Anterior cruciate ligament (ACL) reconstruction failure remains a commonly seen complication despite advances in technique and graft options. Recently, several studies have shown that the inclination of the tibial plateau in the sagittal plane affects the stability of the knee joint. The purpose of this study was to determine if an increased posterior slope of the tibia is associated with failure of ACL reconstruction irrespective of the graft used. METHODS: From June 2002 to August 2003, a total of 100 patients with a symptomatic ACL-deficient knee were randomised to receive either a hamstring autograft or posterior tibialis allograft. All allografts were from a single tissue bank, aseptically processed, and fresh-frozen without terminal irradiation. ACL graft failures requiring reoperation with a minimum of 10-year follow-up were identified via telephone survey. Lateral radiographs of the knee of all patients were reviewed, and the slope of the tibia was measured using a standardised technique. Two fellowship-trained orthopaedic sports medicine specialists, one board-certified general orthopaedic surgeon, and two fellowship-trained musculoskeletal radiologists measured the tibial slope in all patients. RESULTS: At a minimum of 10-year follow-up, there were four (8.3%) autograft and 13 (26.5%) allograft failures that required revision reconstruction. The overall average tibial slope of the nonfailure cohort was 9.4°. The overall average tibial slope of the failure cohort was 11.9° (P â€‹= â€‹0.0002). The average slope of the allograft failures was 11.5°compared with an average slope of 9.6° in the nonfailures (P â€‹= â€‹0.01). The average slope of the autograft failures was 13.1° compared with 9.3° in the nonfailures (P â€‹= â€‹0.011). The mean difference in tibial slope measurements was 0.665 (95% confidence interval: 0.569-0.750). The interrater reliability, as measured by the intraclass correlation coefficient, for tibial slope was 0.898 (95% confidence interval: 0.859-0.928). The Cronbach α was 0.904. CONCLUSION: In a prospective, randomised trial of ACL reconstructions using either autograft or allograft, failures were associated with a significantly increased slope of the tibia compared with the nonfailures at 10-year follow-up.

Tenosynovial Giant-Cell Tumor Presenting as Septic Arthritis of the Knee.

Tenosynovial giant-cell tumor (TGCT) is an intraarticular giant-cell tumor of the synovial tissue and tendon sheaths which often mimics multiple conditions on presentation. This case report describes a previously asymptomatic 67-year-old man with preliminary clinical and laboratory evaluation suggestive of septic arthritis; however, arthroscopy revealed diffuse synovitis, and biopsy confirmed TGCT. To our knowledge, this is the first report of TGCT presenting as septic arthritis in an adult patient. This diagnosis should be considered in evaluation of acute, atraumatic knee pain with associated inflammatory marker elevation.

Tibial Tubercle-Sparing Anterior Closing Wedge Osteotomy With Cross-Screw Fixation to Correct Pathologic Posterior Tibial Slope.

Anterior cruciate ligament reconstruction failure remains a commonly seen outcome despite advances in technique and graft options. Recent studies have shown that the declination of the tibial plateau slope in the sagittal plane affects the in situ stress on the anterior cruciate ligament. The native posterior tibial slope has been described to range from 7° to 10°. However, several authors have suggested that a posterior tibial slope >12° should be considered pathologic. Given the recent evidence, our institution has begun performing a tibial tubercle-sparing anterior closing wedge proximal tibial osteotomy with cross screw fixation to decrease sagittal plane tibial slope.

Arthroscopic Versus Open Anterior Shoulder Stabilization: A Prospective Randomized Clinical Trial With 15-Year Follow-up With an Assessment of the Glenoid Being "On-Track" and "Off-Track" as a Predictor of Failure.

BACKGROUND: Recent studies have demonstrated equivalent short-term results when comparing arthroscopic versus open anterior shoulder stabilization. However, none have evaluated the long-term clinical outcomes of patients after arthroscopic or open anterior shoulder stabilization, with inclusion of an assessment of preoperative glenoid tracking. PURPOSE: To compare long-term clinical outcomes of patients with recurrent anterior shoulder instability randomized to open and arthroscopic stabilization groups. Additionally, preoperative magnetic resonance imaging (MRI) studies were used to assess whether the shoulders were "on-track" or "off-track" to ascertain a prediction of increased failure risk. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A consecutive series of 64 patients with recurrent anterior shoulder instability were randomized to receive either arthroscopic or open stabilization by a single surgeon. Follow-up assessments were performed at minimum 15-year follow-up using established postoperative evaluations. Clinical failure was defined as any recurrent dislocation postoperatively or subjective instability. Preoperative MRI scans were obtained to calculate the glenoid track and designate shoulders as on-track or off-track. These results were then correlated with the patients' clinical results at their latest follow-up. RESULTS: Of 64 patients, 60 (28 arthroscopic and 32 open) were contacted or examined for follow-up (range, 15-17 years). The mean age at the time of surgery was 25 years (range, 19-42 years), while the mean age at the time of this assessment was 40 years (range, 34-57 years). The rates of arthroscopic and open long-term failure were 14.3% (4/28) and 12.5% (4/32), respectively. There were no differences in subjective shoulder outcome scores between the treatment groups. Of the 56 shoulders, with available MRI studies, 8 (14.3%) were determined to be off-track. Of these 8 shoulders, there were 2 surgical failures (25.0%; 1 treated arthroscopically, 1 treated open). In the on-track group, 6 of 48 had failed surgery (12.5%; 3 open, 3 arthroscopic [P = .280]). CONCLUSION: Long-term clinical outcomes were comparable at 15 years postoperatively between the arthroscopic and open stabilization groups. The presence of an off-track lesion may be associated with a higher rate of recurrent instability in both cohorts at long-term follow-up; however, this study was underpowered to verify this situation.

Anatomic Double Bundle Posterior Cruciate Ligament Reconstruction Using an Internal Splint.

Techniques for reconstruction of posterior cruciate ligament (PCL) tears are rapidly evolving. One problem with current techniques is that laxity may develop early in the postoperative period, leading to relapsed posterior translation of the tibia. Therefore, maintaining tibial reduction during graft incorporation is a target for improvement. We describe using an internal splint to optimize the 4-tunnel, double-bundle allograft PCL reconstruction.

Anterior Cruciate Ligament Repair: Historical Perspective, Indications, Techniques, and Outcomes.

Anterior cruciate ligament (ACL) repair was first reported in 1895 by Sir Arthur Mayo-Robson. Open primary ACL repair was performed throughout the 1970s and 1980s; however, rerupture rates were as high as 50% at mid-term follow-up. Throughout the 1980s and 1990s, synthetic graft materials received consideration; however, the outcomes were abysmal. Recently, with a better understanding of ACL healing and improvement in technique, there has been renewed interest in ACL repair. The potential advantages of ACL repair include improvements in knee kinematics and proprioception, avoiding graft harvest, and preserving bone stock. Although recent data on short-term outcomes suggest potential in properly indicated patients, medium- and long-term outcomes are largely unknown. ACL repair has the greatest potential in cases of proximal ACL rupture (modified Sherman type I and II proximal tears). Repair of midsubstance tears (modified Sherman type III tears) should be avoided. Caution is advised in athletes and younger patients because of higher failure rates. Today, ACL repair remains controversial and should be performed with caution because of limited medium- and long-term outcomes.