Nanoscopic-Assisted Anterior Cruciate Ligament-Posterior Cruciate Ligament Reconstruction.

Knee arthroscopy has allowed us to continue performing surgeries that are minimally invasive and allow patients to have a quick recovery. Multiligamentous knee reconstruction with regards to the anterior cruciate ligament and posterior cruciate ligament can be done in a minimally invasive matter. Visualization is an issue during this surgery, especially looking in the posterior compartment of the knee. The NanoScope (Arthrex, Naples, FL) continues to provide increased possibilities for orthopaedic surgeons. Our technique provides a less-invasive way to observe the posterior compartment to assist the drilling of the tibial tunnel during the posterior cruciate ligament reconstruction. This technique provides distinct advantages over other treatments.

Single-Incision Rotator Cuff Repair With a Needle Arthroscope.

Arthroscopy frequently has been used to treat a variety of shoulder conditions, including rotator cuff tears. Arthroscopic techniques, when compared with open techniques, are associated with less morbidity, leading to lower complication rates, easier recovery, and improved outcomes. As technology improves, we continue to develop less-invasive surgical techniques to treat rotator cuff pathology. With the development of the NanoScope (Arthrex, Naples, FL), we have the opportunity to view through a small cannula without making a standard viewing portal. This technique combines this small viewing portal with standard repair techniques through only a single lateral incision to provide a less-invasive rotator cuff repair technique.

Nanoscopic Single-Incision Anterior Labrum Repair.

Arthroscopy frequently has been used to treat a variety of shoulder conditions, including anterior labrum tears. Anterior labrum repair techniques have progressed from multiple incision techniques to most recently a single anterior working portal with a posterior viewing portal. With the development of the NanoScope (Arthrex, Naples, FL), we do not need to make a standard portal for viewing purposes. In this article, we describe the single-incision anterior labrum repair bypassing the need for a posterior skin incision. The removal of this incision and portal should result in less fluid needed and less swelling. We hope this leads to less pain and improved patient outcomes.

Incisionless Partial Medial Meniscectomy.

Knee arthroscopy has evolved greatly from its inception in the twentieth century. Of the many arthroscopic knee surgeries, meniscectomy is the most commonly performed. Arthroscopic meniscectomy is the most common orthopaedic surgical procedure performed in the United States. We continue to develop more minimally invasive procedures, and the NanoScope has provided a new generation of possibilities. The system does not require the use of a standard incision or portal, and with the use of nanoinstruments, we can perform treatments as well as diagnostic arthroscopy without incisions. This technique provides an updated incisionless option to perform a partial medial meniscectomy.

Closed Reduction of an Irreducible Knee Dislocation: A Case Report.

ADDITION TO ORTHOPEDIC LITERATURE: Posterolateral knee dislocations are extremely rare and generally require open reduction; however, we were able to provide closed reduction by reproducing mechanism of injury with a technique described in the literature. This is the second reported case of such accomplishment. INTRODUCTION: Posterolateral knee dislocation is the most common form of "irreducible" knee dislocations. Buttonholing of the medial femoral condyle through medial soft tissues of the knee results in entrapment. We report the second known case of successful closed reduction. CASE PRESENTATION: A 51-year-old female with morbid obesity sustained a right posterolateral knee dislocation shown on plain radiograph. This was accompanied by lateral patella dislocation and a dimple sign at the medial joint line after a fall from standing height produced a rotational mechanism. CONCLUSION: This is the second reported case of successful closed reduction to an injury that has been generally established to be "irreducible." The technique used closely matches that described in the only other reported case and involves reproduction of the mechanism of injury. This establishes additional evidence to a previously isolated report of successful acute treatment that counters the current narrative.

Smartphone medical applications useful for the rural practitioner.

Like other similarly situated rural states, West Virginia's patients and practitioners often experience access barriers to current medical expertise for multiple disciplines. This article was generated to help bridge this gap and highlights the best-rated mobile medical applications (Apps) for smartphone use. From finding drug interactions and dosing schedules to discussing patients in HIPAA-compliant formats, Apps are becoming integral to the practice of 21st Century medicine. The increased use of these Apps by physicians-in-training and established practitioners highlights the shift from reliance upon the medical library to the easy to use mobile-based technology platforms. This article provides our practitioners, physician extenders, medical trainees, and office staff a guide to access and assess the utility of some of the best rated medical and HIPAA compliant Apps.

Physical education in West Virginia schools: are we doing enough to generate peak bone mass and promote skeletal health?

Peak bone mass (PBM) is attained at 25-35 years of age, followed by a lifelong decline in bone strength. The most rapid increase in bone mass occurs between the ages of 12-17. Daily school physical education (PE) programs have been shown to produce measurable increases in PBM, but are not federally mandated. Increases in PBM can decrease the lifelong risk of osteoporosis and fractures; critical for West Virginia prevention programs. Nationally only 1 in 6 schools require PE three days per week, with 4% of elementary schools, 8% of middle schools and 2% of high schools providing daily PE. In 2005, West Virginia passed the Healthy Lifestyles Act that returned physical education to the K-12 curriculum. This law requires only one credit of PE from grades 9-12 and provides only 35% of the recommended PE for grades K-12. This article highlights the relationship of PE to PBM and discusses the potential impact on West Virginia skeletal health.

Extraskeletal effects of vitamin D: potential impact on WV disease morbidity and mortality.

Vitamin D is an essential nutrient and a secosteroid hormone that regulates many physiologic processes beyond calcium and bone homeostasis. These "extraskeletal" effects are impacted by the circulating levels of the storage form of vitamin D, 25-hydroxyvitamin D3. Levels of vitamin D can be detected after completing a simple 25(OH)D blood test. Vitamin D deficiency (< 30 ng/mL) is associated with a higher risk of many chronic diseases including, but not limited to, fourteen types of cancers, type 1 and 2 diabetes mellitus, obesity, cardiovascular disease, hypertension, stroke, and asthma. This article explores the association between vitamin D deficiency and the burden of chronic diseases in West Virginia.