Clinical outcomes after isolated arthroscopic single-bundle posterior cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to evaluate the clinical outcomes after arthroscopic single-bundle posterior cruciate ligament (PCL) reconstruction in patients with isolated grade III PCL injuries. TYPE OF STUDY: Retrospective review. METHODS: Twenty-one patients who underwent an isolated arthroscopic single-bundle PCL reconstruction for the treatment of a grade III PCL injury between 1989 and 1998 were included in the study. There were 15 male and 6 female patients with an average age of 38 years (range, 20 to 62 years). The length of follow-up was 5.9 years (range, 2.6 to 11 years), and the average time from injury to surgery was 4.5 years (median, 1.3 years; range, 2 weeks to 25 years). All patients completed a subjective evaluation and 14 patients returned for a physical examination and radiographs. One patient underwent an acute reconstruction (<3 weeks), 4 had a subacute (<3 months), and 16 underwent a chronic (>3 months) reconstruction. The anterolateral bundle of the PCL was reconstructed using an Achilles tendon allograft passed through femoral and tibial bone tunnels. RESULTS: The overall average Activities of Daily Living Scale (ADLS), Sports Activities Scale (SAS), and SF-36 scores were 79.3, 71.6, and 98 points, respectively. There was a significant difference identified when the ADLS (91.3 v 75.6) and the SAS (90.4 v 65.8) scores of the subacute/acute group were compared with those of the chronic reconstruction group. Using the International Knee Documentation Committee (IKDC) subjective assessment, 57% of the patients had normal/near normal knee function, and 62% had a normal/near normal activity level. The average extension and flexion losses were 1 degrees and 5 degrees , respectively. Instrumented laxity examination revealed that 62% had less than a 3-mm and 31% had a 3- to 5-mm side-to-side difference in corrected posterior displacement. Radiographs at follow-up showed that 75% had normal/near normal findings according to IKDC guidelines. CONCLUSIONS: The clinical outcomes after arthroscopic single-bundle PCL reconstruction in this study produced a satisfactory return of function and improvement in symptoms. All patients in this study had improved laxity of at least 1 grade. When compared with chronic reconstructions, acute reconstructions had statistically significant better ADLS and SAS scores. LEVEL OF EVIDENCE: IV, case series.

Os acromiale: evaluation and treatment.

Os acromiale is a developmental aberration in which the distal acromion fails to fuse. This aberration is often discovered incidentally but may present with a clinical picture similar to that of subacromial impingement syndrome. Treatment for symptomatic os acromiale is initially nonoperative-activity modification, physical therapy, corticosteroid injection, use of nonsteroidal anti-inflammatory medication. Nonoperative management of clinically significant, radiographically confirmed os acromiale should be pursued for at least 6 months before consideration of surgical intervention. Subacromial decompression is often necessary to address symptoms of impingement. Excision of the os fragment may provide definitive treatment for smaller fragments (<3 cm). Removal of larger fragments remains controversial and should be approached with caution. Surgical fixation of larger fragments with or without supplemental autograft in conjunction with a structured postoperative program of physical therapy can reliably provide relief for symptomatic os acromiale.

Assessment of clavicular translation after arthroscopic Mumford procedure: direct versus indirect resection--a cadaveric study.

PURPOSE: To compare the horizontal stability of the distal clavicle following arthroscopic resection of its lateral end by direct and indirect techniques. TYPE OF STUDY: Biomechanical test of cadaveric specimens. METHODS: We performed arthroscopic distal clavicle resection on 12 fresh-frozen human cadaveric shoulders using direct (group 1, n = 6) or indirect (group 2, n = 6) approaches. In both groups 5 mm of distal clavicle were resected using an arthroscopic burr. The specimens were mounted on a materials testing device that allowed translation of the clavicle along the anteroposterior axis. The degree of posterior translation was measured from maximum anterior displacement of the clavicle. RESULTS: Mean posterior translation was 19.4 mm (range, 18 to 23 mm; SD, 2.2) and 21.3 mm (range, 18 to 25 mm; SD, 3.1) for groups 1 and 2, respectively. This difference was not statistically significant ( P = .27). CONCLUSIONS: This study suggests that there is no significant difference in anteroposterior stability of the clavicle following arthroscopic distal clavicle resection with either a direct or indirect approach. CLINICAL RELEVANCE: Clinically, this study addresses concerns about increased potential instability associated with the indirect technique of distal clavicle resection. From a biomechanical standpoint, based on this study, there is no concern for increased instability with the indirect technique of distal clavicle resection compared to a direct technique.

Arthroscopic management of spinoglenoid cysts associated with SLAP lesions and suprascapular neuropathy.

Suprascapular neuropathy secondary to cyst compression in the spinoglenoid notch may occur in association with SLAP tears. Arthroscopic techniques may be employed for both cyst excision and repair of labral pathology. We describe 3 cases in which preoperative and postoperative electromyograms and magnetic resonance imaging documented cyst resolution and return of suprascapular nerve function after arthroscopic spinoglenoid cyst excision and labral repair.

Complications in anterior cruciate ligament surgery.

There are many potential problems associated with ACL surgery; however, careful attention to detail can prevent problems from occurring or provide corrective options in the event they do occur. Multiple backup options are not only desirable but also essential to a successful outcome. By following these guidelines, ACL surgery can have good long-term results and return the recreational or higher-level athlete to sports participation.

Imaging of the elbow in the overhead throwing athlete.

Elbow injuries in athletes who perform overhead throwing motions often present diagnostic challenges because of the undue stresses and often chronic, repetitive patterns of injury. Accurate and efficient assessment of the injured elbow is essential to maximize functional recovery and expedite return to play. Radiographic evaluation should be tailored to the specific injury suspected and requires a thorough understanding of normal anatomic relationships as well as familiarity with common injuries affecting these athletes.

Thermal capsulorrhaphy for shoulder instability.

Although thermal capsulorrhaphy is a useful tool in the arthroscopic management of shoulder instability, there are limits to the amount of capsular tissue that can be shortened before collagen is significantly weakened and denatured to a point that would be detrimental to healing. The real goal of thermal capsulorrhaphy, therefore, is to enhance other arthroscopically performed stabilization procedures, further improving the results that could be obtained with either procedure alone. When used in the proper manner for the correct indications, thermal capsulorrhaphy can be an effective adjunct in treating shoulder instability arthroscopically.

Orthopedic issues after cerebrovascular accident.

Patients who have had a cerebrovascular accident with resultant hemiplegia often present to the orthopedic surgeon with characteristic complaints and deformities. The most common of these include muscle spasticity and contracture, shoulder pain, hip fracture, and heterotopic ossification. Although some of these disorders are clinically evident, others may be easily overlooked. The purpose of this article is to summarize the most common orthopedic aspects of hemiplegic patients who have had a cerebrovascular accident.

A simple method for construction of an articulating antibiotic-loaded cement spacer.

A 2-stage exchange protocol has been used widely in North America for management of infected total hip arthroplasties. Many surgeons choose to use an antibiotic-loaded cement spacer in the interval before reimplantation of the final prosthesis. We propose a simple technique for the construction of an articulating antibiotic-loaded spacer for use as part of 2-stage exchange protocol for the treatment of infected total hip arthroplasties.

Unipolar versus bipolar hemiarthroplasty: functional outcome after femoral neck fracture at a minimum of thirty-six months of follow-up.

OBJECTIVES: This investigation was undertaken to compare a series of elderly individuals who sustained a displaced femoral neck fracture treated with either a cemented bipolar prosthesis or a cemented modular unipolar prosthesis. DESIGN: A retrospective review of prospectively collected data. SETTING: Hospital-based tertiary care orthopaedic trauma practice. PATIENTS AND PARTICIPANTS: Two hundred eighty-one community dwelling elderly patients sixty-five years of age or older who sustained a displaced femoral neck fracture (Garden Types III-IV) and underwent primary prosthetic replacement. INTERVENTION: One hundred one patients received a cemented bipolar prosthesis and 180 received a cemented modular unipolar prosthesis. MAIN OUTCOME MEASUREMENTS: The study was designed to determine whether there were any significant differences in: (a) the rate of prosthetic dislocation, postoperative medical and wound complications, or need for revision surgery, and (b) the functional outcome, including the incidence of hip pain and recovery of preinjury levels of ambulatory status and activities of daily living, at a minimum of thirty-six months of follow-up. RESULTS: The two groups of patients did not differ in preinjury characteristics (age, sex, American Society of Anesthesiologist rating of operative risk, number of comorbidities, fracture type, activities of daily living, ambulatory status). There were no significant differences in the rates of postoperative medical or wound complications or dislocation. Ninety-two patients died during the period of study. Forty patients were lost to follow-up or refused to participate. Consequently, 149 patients were followed for a minimum of thirty-six months. Functional ability was compared between both groups with regard to recovery of ambulatory status and activities of daily living, as well as the incidence of hip pain at a minimum of thirty-six months of follow-up. No significant differences were found between the unipolar and bipolar groups. CONCLUSION: Based on the results of this study, there does not appear to be any advantage to the use of a bipolar endoprosthesis in the management of displaced femoral neck fractures in the elderly. Furthermore, the extra cost of bipolar endoprostheses does not seem to warrant its use.

Shoulder injuries in the athlete.

Shoulder injuries are common in the athletic population. Injuries can be a result of repetitive overhead use or from direct trauma. Common injury sites include the rotator cuff, glenohumeral joint, acromioclavicular joint, biceps tendon, scapulothoracic articulation, and sternoclavicular joint. The identification, physical exam, and treatment options of these conditions will be discussed.