Iliac crest allograft glenoid reconstruction for recurrent anterior shoulder instability in athletes: Surgical technique and results.

Performing a labral repair alone in patients with recurrent anterior instability and a large glenoid defect has led to poor outcomes. We present a technique involving the use of the iliac crest allograft inserted into the glenoid defect in athletes with recurrent anterior shoulder instability and large bony defects of the glenoid (>25% of glenoid diameter). All athletes with recurrent anterior shoulder instability and a large glenoid defect that underwent open anterior shoulder stabilization and glenoid reconstruction with the iliac crest allograft were followed over a 4-year period. Preoperatively, a detailed history and physical exam were obtained along with standard radiographs and magnetic resonance imaging of the affected shoulder. All patients also completed the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) evaluation forms preoperatively. A computed tomography scan was obtained postoperatively to assess osseous union of the graft and the patient again went through a physical exam in addition to completing the SST, ASES, and Western Ontario Shoulder Instability Index (WOSI) forms. 10 patients (9 males, 1 female) were followed for an average of 16 months (4-36 months) and had a mean age of 24.4 years. All patients exhibited a negative apprehension/relocation test and full shoulder strength at final follow-up. Eight of 10 patients had achieved osseous union at 6 months (80.0%). ASES scores improved from 64.3 to 97.8, and SST scores improved from 66.7 to 100. Average postoperative WOSI scores were 93.8%. The use of the iliac crest allograft provides a safe and clinically useful alternative compared to previously described procedures for recurrent shoulder instability in the face of glenoid deficiency.

Drain clamping in knee arthroplasty, a randomized controlled trial.

BACKGROUND: The purpose of this study was to determine whether repeated clamping of a suction drainage system will result in less external blood loss, blood transfusion and no increase in complications compared to a routine continuous suction drainage system. This was a randomized prospective study on patients undergoing total knee arthroplasty. METHODS: Group A patients' drains were left clamped for all but 5 min (or 100 mL drainage) every 2 h for the first 6 h, then at 12-h and 24-h periods, when the drains were removed. Group B patients had continuous suction drainage. The amount of external blood loss, transfusion requirements and complications were compared between the two groups. The study group comprised 66 patients. RESULTS: The mean external blood loss in the clamped drain group was 296.67 mL (standard deviation 160.28 mL) with a mean drain in situ time of 32 h, significantly less (P < 0.05) than the continuous drain group that had a mean external blood loss of 796 mL (standard deviation 250.34 mL) with a mean drain in situ time of 34 h. There was no difference in the requirements for transfusion between the two groups. CONCLUSION: We conclude that clamping drains intermittently in hybrid total knee arthroplasty results in significantly less external blood loss with no change in morbidity or mortality. This study was a level 1 therapeutic study (i.e. with level of evidence randomized control trial with a significant difference).

A prospective study of the diagnostic potential of the knee tunnel view radiograph in assessing anterior knee pain.

The aim of this comparative study was to examine the potential advantage of the tunnel view radiograph over a series of weight bearing antero-posterior (AP), lateral and skyline radiographs. The study population consisted of 240 subjects with knee pain aged 19 to 93 years. A total of 309 knees had a weight bearing AP in extension, lateral, skyline and tunnel view radiographs. Each radiograph was reported with respect to features related to osteoarthritis, modified from the Ahlback system. Each feature was assessed using the tunnel radiograph alone and then the AP, lateral and skyline views in combination without, and blind to, the information from the tunnel view. On the basis of Bowker's test, the tunnel view was more likely to pick up abnormal intercondylar notch and tibial spine osteophytes but not loose bodies. We conclude that the tunnel view is a valuable addition in the routine assessment of the knee joint in osteoarthritis but not for the diagnosis of loose bodies alone.