Meniscal Allograft Transplantation Made Simple: Bridge and Slot Technique.

Over recent years, appreciation for the critical role of the meniscus in joint biomechanics has led to an emphasis on meniscal preservation. Meniscal allograft transplant (MAT) is a promising biological solution for the symptomatic young patient with a meniscus-deficient knee that has not developed advanced osteoarthritis. As surgical techniques are refined and outcomes continue to improve, it is vital to consider the utility of such procedures and offer a straightforward approach to MAT. This article and accompanying video provide a step-by-step tutorial on how to perform a MAT using the bridge and slot technique, its key pearls and pitfalls as well as the relevant advantages and disadvantages of MAT.

Chronic Distal Biceps Repair With an Achilles Allograft.

In cases of chronic distal biceps ruptures, the combination of muscle atrophy, distal tendon retraction, and fibrosis makes primary anatomic reattachment of the tendon particularly challenging. To regain tendon length and avoid flexion contractures, reconstruction with graft augmentation has been proposed as an alternative for cases not amenable to primary repair. We describe our technique using an Achilles allograft through a modified Henry approach to reconstruct the distal biceps tendon to regain length as well as restore flexion and supination strength. With proper and detailed exposure, chronic distal biceps injuries can be reconstructed safely and efficaciously using an Achilles allograft.

Coracoid Fracture Following Latarjet Failure A Case Report.

The Latarjet procedure involves the transfer of the coracoid process with its soft tissue attachments, thereby providing both bony and soft tissue articular reinforcement for glenohumeral stabilization. Most studies show positive outcomes with this procedure and complications at rates as low as 1%, predominately secondary to technical error. We present a case of recurrent anterior instability after two attempts at soft tissue stabilization (arthroscopic labral repair followed by open inferior capsular shift) in which an open Latarjet procedure was performed followed by subsequent revision secondary to coracoid autograft fracture. The case presented specifically highlights the need to appropriately identify the "bony margins" of the coracoid prior to drilling to make certain that drill holes are not eccentrically placed.

Modified Jobe Approach With Docking Technique for Ulnar Collateral Ligament Reconstruction.

The ulnar collateral ligament (UCL) of the elbow acts as the primary restraint to valgus force experienced in the late cocking and early acceleration phases of overhead throwing. If the UCL or dynamic flexor-pronator musculature is incompetent, elbow extension and valgus torque, as seen in throwing, can result in posteromedial impingement with subsequent chondromalacia and osteophyte formation. Before the first UCL reconstruction, performed by Frank Jobe in 1974, this injury was considered career ending in overhead athletes. Since the index procedure, further techniques have been developed to minimize dissection of the flexor-pronator mass and improve the biomechanical strength of graft fixation with the goal of increased return to athletic competition. We describe our technique-including pearls and pitfalls, as well as advantages and disadvantages-which combines the docking technique, through a flexor muscle-elevating approach with transposition of the ulnar nerve using a fascial sling. Harvest and preparation of a palmaris longus tendon autograft is also described.

Transosseous-Equivalent Repair for Distal Patellar Tendon Avulsion.

Extensor mechanism disruptions are relatively uncommon injuries involving injury to the quadriceps tendon, patella, or patellar tendon. Patellar tendon avulsions from the tibial tubercle in adults are rare; as such, little technical information has been written regarding surgical management of this injury in the adult. Transosseous-equivalent repairs have been described in the management of several types of tendon ruptures, including rotator cuff and distal triceps tendon ruptures, but not previously in patellar injuries. We present a technique for repairing an avulsion injury of the patellar tendon from the tibial tubercle using suture anchors in a transosseous-equivalent manner. This technique for treating distal patellar tendon avulsion injuries likely increases contact area at the repair site while potentially improving fixation strength.

Monitoring fugitive dust emissions from off-highway vehicles traveling on unpaved roads and trails using passive samplers.

Vehicles traveling on dry, unpaved roads generate copious quantities fugitive dust that contributes to soil erosion, and potentially threatens human health and ecosystems. The purpose of this study was to develop a low-cost technique for monitoring road dust that would enable land managers to estimate soil loss. The "sticky-trap" collectors developed were evaluated at the Turkey Bay off-highway vehicle (OHV) riding area on the Land Between the Lakes National Recreation Area, in western Kentucky. The results showed that the dust plume created by vehicle traffic was heterogeneous: larger particles were in the lower part of the plume and deposited closer to the source, smaller particles were carried higher in the plume and traveled at least 100 m away from the source. Collection of particles parallel to the source was also heterogeneous, suggesting that measurements taken at a single point may not be appropriate for estimating erosion losses. Measurements taken along two trails indicate that when large numbers of riders are present, dust concentrations may reach unhealthful conditions for riders, but that it is unlikely that fugitive dust is harming native vegetation, given frequent rainfall. The study demonstrated that OHV traffic contributes to substantial erosion of roadbeds because of aeolian transport.