Shoulder Synovial Chondromatosis in an Adolescent Athlete: A Case Report.

Introduction: Synovial chondromatosis refers to a benign proliferative disease of the synovium. Reports in children are rare and reports involving the pediatric shoulder are even more rare. In this review of the literature and case report, we provide a summary of all published cases in children and a report of a case of shoulder synovial chondromatosis in an adolescent female athlete. Case Presentation: A 15-year-old female cheerleader presented to the clinic with gradual onset right shoulder pain with a severity of 5/10. On physician examination, the patient had tenderness over the proximal humerus, limited abduction to 160°, limited forward flexion, and a total arc of motion of <180°. Radiograph of the shoulder demonstrated multiple calcific intra-articular loose bodies consistent with synovial chondromatosis. Arthroscopic removal resulted in resolution of symptoms at the 36-week follow-up. Conclusions: Our literature search revealed only eight case reports on shoulder synovial chondromatosis in children. The location of the chondromatosis within the shoulder joint can be intra-articular, extra-articular, within the biceps sheath, or combined. In general, for chondomatoses confined to the glenohumeral joint space, open surgery is not required. Bony erosions can occur in the setting of chondromatosis though may not need to be addressed surgically. Although rare, this diagnosis should be considered when confronted with shoulder pain that is exacerbated during long athletic events with limited range of motion on physical examination in the adolescent athlete. Arthroscopic treatment in conjunction with physical therapy and early mobilization can lead to a successful outcome.

Hip Arthroscopy in the High-Level Athlete: Does Capsular Closure Make a Difference?

BACKGROUND: Hip arthroscopy has been shown to be effective in athletes who have femoral acetabular impingement and labral tearing. The effect of complete capsular closure versus nonclosure on return to play is unknown. HYPOTHESIS: Complete capsular closure after hip arthroscopy would lead to a higher rate and faster return to sports in high-level athletes. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A nonrandomized retrospective review was performed of high school, collegiate, and professional athletes undergoing hip arthroscopy by a single high-volume hip arthroscopic surgeon. Athletes were divided into those undergoing complete capsular closure (CC group) and non-capsular closure (NC group) after hip arthroscopy. Rate and time to return to play were determined between the 2 groups. Patient-reported outcomes including modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL), and Hip Outcome Score Sport-Specific Subscale (HOS-SSS) were obtained at a minimum of 2 years. RESULTS: A total of 111 athletes with a minimum 2-year follow-up were included in the study. There were 62 in the CC group and 49 in the NC group. A higher percentage of athletes in the CC group returned to play compared with that in the NC group (90.3% vs 75.5%, respectively; P = .03). The CC group returned to play at a mean ± SD of 4.7 ± 1.9 months compared with 5.8 ± 2.6 months in the NC group (P < .001). Patients in the CC group met the minimal clinically important difference for the mHHS, HOS-ADL, and HOS-SSS patient-reported outcomes at higher percentages: mHHS, 98.3% vs 87.7% for CC vs NC, respectively (P = .02); HOS-ADL, 98.3% vs 87.7% (P = .02); and HOS-SSS, 96.7% vs 89.7% (P = .13). The difference between groups was statistically significant for mHHS and HOS-ADL. CONCLUSION: Complete capsular closure after hip arthroscopy was associated with faster return to play and a higher rate of return compared with that of nonclosure of the capsule in this sample population of high-level athletes. At a minimum 2-year follow-up, complete capsular closure was associated with significantly higher patient-reported outcomes compared with those of nonclosure in athletes who underwent hip arthroscopy.

Patellar Instability: When is Trochleoplasty Necessary?

Trochleoplasty is a very effective procedure for correcting trochlear dysplasia and addressing instability of the patella. With an increasing knowledge about the anatomy and biomechanics of the anterior distal femur, a wider array of surgical techniques may be applied to address specific conditions. Patients must be carefully selected to undergo trochleoplasty by use of a thorough history and physical examination as well as basic and advanced imaging. The presence of a "J sign" on physical examination, a history of recurrent instability, patella alta, trochlear dysplasia, and elevated tibial tubercle to trochlear groove are signs and symptoms for which the patient should be evaluated. We attempt to elucidate when trochleoplasty is indicated by means of addressing all aspects of evaluation.

Dynamic versus static analyses of lifting a box from the floor.

Lifting objects from below knee height has been implicated as a source of low back pain and injury. Static models have often been used to assess forces produced in the lumbar region by lifting; however, inertial forces generated by acceleration may be significant. Therefore, the goal of this investigation was to assess differences between static and dynamic analysis methods. Sagittal plane kinematics were collected on 21 men and 22 women of college age while lifting a milk crate (men = 25 kg, women = 15 kg) from the floor to standing knuckle height on level as well as sloped (facing uphill and downhill at 10 degrees and 20 degrees) ground conditions. Both static and dynamic top-down inverse models were utilized to assess net muscular moments at L5/S1 as well as the posture of the person at the time of static max (TSM) and dynamic max (TDM) moments. The TDM moment was significantly later than the TSM in the level through uphill conditions (p < 0.001). The dynamic max moment was significantly greater than the static max moment in all conditions (p < 0.001). Torso angles at TSM exhibited a significantly greater forward lean (by < 2 degrees) in the level through uphill conditions (p < 0.001). Overall low-back curvature, hip angles, knee angles, and ankle angles were not affected by the type of model (p > 0.05), though several minor differences occurred at conditions other than the level (most dramatic in the downhill 20 degrees condition). Therefore, if moments are of interest, a dynamic model should be utilized. However, body position is very similar at TSM and TDM.