A Technique for Endoscopic in Situ Repair of Undersurface Hip Abductor Tears.

Endoscopic repair of hip abductor tendons has been shown to have equivalent outcomes and lower complication rates compared with open repair. First reported in 2007, endoscopic repair has become more frequent, with multiple techniques previously described. Frequently, hip abductor tears involve a partial-thickness undersurface component that has been previously addressed endoscopically by making a longitudinal split in the tendon to access the diseased tissue. However, we present a technique for addressing these undersurface tears in situ, accessing the undersurface of the tear by coming under the distal anterior edge of the gluteus medius tendon.

Physical examination and imaging of medial collateral ligament and posteromedial corner of the knee.

The medial collateral ligament (MCL) is the most commonly injured knee ligament. Most will heal well with nonoperative treatment. However, not all medial knee injuries are the same. A detailed physical examination can help determine the severity of the medial-sided injury. When combined with advanced imaging, the examination will delineate damage to associated medial knee structures, including the location of MCL damage, posteromedial capsule injuries, and combined cruciate injuries. Failure to recognize MCL injuries that may be prone to chronic laxity can lead to significant disability, joint damage, and failure of concomitant cruciate ligament reconstructions. Magnetic resonance imaging is the mainstay of diagnostic imaging, with coronal sequences allowing full assessment of the MCL complex. Tangential views aid in the diagnosis of concomitant injuries. Stress radiography can play a role in evaluating MCL healing and subtle chronic laxity. Ultrasonography is also gaining acceptance as a means to assess MCL injuries. Use of a detailed examination and advanced imaging will allow optimal treatment of medial knee injuries and improve clinical outcomes.

Anterior cruciate ligament graft failure: a comparison of graft type based on age and Tegner activity level.

BACKGROUND: When reviewing anterior cruciate ligament instability, age, gender, activity level, associated injury, and type of graft should all be considered. HYPOTHESIS: The authors hypothesized that patients under 25 years of age will have higher failure rates with anterior cruciate ligament reconstruction than those older than 25 years, and that in the patients younger than 25 years, bone-patellar tendon-bone autograft will have the lowest failure rate. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: With use of a computerized relational database, all patients having primary anterior cruciate ligament reconstruction at 1 institution between January 2000 and July 2007 with allograft, bone-patellar tendon-bone, and hamstring grafts were evaluated. RESULTS: A significant association was found between age group and graft failure (P = .012). Patients 25 years and younger had a significantly higher failure rate (16.5%) than patients older than 25 years (8.3%). Pairwise comparisons indicated that both allograft (29.2%) and semitendinosus/gracilis (25.0%) grafts resulted in significantly higher failure rates than bone-patellar tendon-bone grafts (11.8%) in the age group of patients 25 years and younger. CONCLUSION: Autograft hamstrings and allografts had a significantly higher failure rate in the age group of patients 25 years and younger compared with the bone-patellar tendon-bone autograft. These data suggest that bone-patellar tendon-bone autografts may be a better graft source for young, active individuals.

Treatment of osteoporotic ankle fractures in the elderly: surgical strategies.

The goal of displaced ankle fracture treatment is to restore congruity and stability to the ankle mortise. However, adequate fixation in patients with osteoporosis is difficult due to poorly mineralized bone. This article presents alternative fixation strategies that can helpachieve ankle stability in this patient population.