The bony apprehension test for instability of the shoulder: a prospective pilot analysis.

PURPOSE: We performed a prospective pilot study of the "bony apprehension test," in which apprehension is experienced at or below 45 degrees of abduction and 45 degrees of external rotation, as a means of screening for a significant bony lesion causing instability of the shoulder. METHODS: Over a 1-year period, 29 consecutive cases of symptomatic shoulder instability were examined with the bony apprehension test and treated with surgery. Findings at arthroscopy were used as the definitive diagnostic data point. This information was compared with the results of the test and with the results of the preoperative plain radiographs. RESULTS: There were 8 cases involving significant bony lesions and 21 cases involving only soft-tissue lesions. The bony apprehension test was positive in all 8 patients in the bony lesion group and in 3 of 21 patients in the soft-tissue lesion group, representing a sensitivity of 100%, specificity of 86%, positive predictive value of 73%, and negative predictive value of 100%. Preoperative radiographs were positive in 4 patients in the bony lesion group only, representing a sensitivity of 50%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 84%. CONCLUSIONS: The bony apprehension test can reliably screen for significant osseous lesions. In this study it was more sensitive than plain radiographs, as shown by a higher sensitivity for the test (100%) than for preoperative plain radiographs (50%). LEVEL OF EVIDENCE: Level II, development of diagnostic criteria based on consecutive patients with universally applied gold standard.

The use of suture anchors in repair of the ruptured patellar tendon: a biomechanical study.

BACKGROUND: Rupture of the patellar tendon is a disabling injury that usually requires surgical treatment. The standard method of repair involves placing suture loops through transpatellar tunnels. The use of suture anchors in patellar tendon repair has not been previously described. HYPOTHESIS: No difference exists in the amount of gap formation during cyclic loading or in ultimate load-to-failure strength between repairs performed with anchors and those performed with 2 types of transpatellar sutures. STUDY DESIGN: Controlled laboratory study. METHODS: Six matched pairs of cadaveric knees were tested in a custom biomechanical apparatus based on an established model. Repairs were performed using either suture anchors with No. 2 FiberWire or transpatellar suture tunnels using 2 different types of suture-No. 5 Ethibond and No. 2 FiberWire. Gap formation across the repair site during 250 cycles of extension as well as ramp-up load to failure were measured for each repair. RESULTS: The mean total gap formation across the repair site at 250 cycles was 4.1 +/- 1.9 mm for the suture anchor group, 6.7 +/- 1.8 mm for the FiberWire tunnel group, and 8.5 +/- 2.7 mm for the Ethibond tunnel group. Mean load to failure was 779 +/- 183 N, 730 +/- 83 N, and 763 +/- 231 N, respectively. CONCLUSION: Significantly less gap formation throughout 250 cycles (P = .009) and no difference in load to failure occurred with patellar tendon repairs performed with suture anchors as compared with repairs performed with transpatellar tunnels. CLINICAL RELEVANCE: The newly described method, using suture anchors for repair of patellar tendon ruptures, may be clinically equal or superior to the established method of using transpatellar tunnels.