Graft Choice in Isolated Medial Patellofemoral Ligament Reconstruction: A Systematic Review With Meta-analysis of Rates of Recurrent Instability and Patient-Reported Outcomes for Autograft, Allograft, and Synthetic Options.

PURPOSE: To determine whether graft selection or patient age affects the following after isolated medial patellofemoral ligament (MPFL) reconstruction: (1) rates of recurrent instability, (2) rates of postoperative complications (other than instability), and (3) subjective symptom improvement. METHODS: A systematic search identified studies reporting outcomes for isolated MPFL reconstruction. Rates of recurrent instability, subjective Kujala knee function scores, and complications were tabulated. Symptom improvement was defined as change in Kujala score (preoperative evaluation to final follow-up). RESULTS: Forty-five studies were included with 27 documented cases of recurrent instability among 1,504 patients (1.8%); instability rates ranged from 0% to 20.0% overall; among autograft in adults, 0% to 11.1% (1.4%, 18/1,260); among autograft in adolescents, 0% to 20% (10.0%, 8/80); among allograft, 0% (0/65 cases); and among synthetic, 0% to 3.3% (1.3%, 1/76). Among autograft choices in adults, rates of recurrent instability were low; recurrence with gracilis ranged from 0% to 11.1% (0.9%, 1/116); with semitendinosus, 0% to 6.3% (0.6%, 4/676); with quad or patellar tendon, 0% (0/65); and with adductor tendon, 5.6% to 8.3% (6.7%, 2/30). Complication rates ranged from 0% to 34.4%. All included studies reported significant improvement in Kujala scores after surgery (P < .01). There was significant heterogeneity in effect size and evidence of reporting bias among small studies, precluding reliable pooled analysis of treatment effect. CONCLUSIONS: Autograft is not superior to allograft or synthetic grafts for isolated reconstruction of the MPFL, and rates of recurrent instability are generally low. Isolated MPFL reconstruction can provide significant symptom relief regardless of graft selection, although there is a bias toward reporting better than expected results among smaller studies. Pediatric patients and patients treated with adductor tendon autograft have higher recurrent instability rates. While caution should be used in making definitive recommendations secondary to the small number of allograft and synthetic studies, selection of graft type based on surgeon preference, comfort, and prior experience remains appropriate. LEVEL OF EVIDENCE: Level IV, systematic review of Level I to IV studies.

Use of a Bicortical Button to Safely Repair the Distal Biceps in a Two-Incision Approach: A Cadaveric Analysis.

PURPOSE: No consensus has been reached on the most effective anatomic approach or fixation method for distal biceps repair. It is our hypothesis that, using a cortical biceps button through a 2-incision technique, the distal biceps can be safely and anatomically repaired. METHODS: A 2-incision biceps button distal biceps repair was completed on 10 fresh-frozen cadavers. The proximity of the guide pin to the critical structures of the forearm, including the posterior interosseous nerve and recurrent radial artery, was measured. The location of repair was mapped and compared with anatomic insertion. RESULTS: The average distance from the tip of the guide pin to the posterior interosseous nerve was 11.4 mm (range, 8-14 mm). The average distance from the tip of the guide pin to the recurrent radial artery was 12.5 mm (range, 8-19 mm). The distal biceps tendon was repaired to the anatomic insertion site on the tuberosity using the biceps button technique in all specimens. CONCLUSIONS: The 2-incision biceps button repair described here allows safe and accurate repair of the tendon to the radial tuberosity in this cadaveric study. CLINICAL RELEVANCE: The goal of distal biceps repair is to safely, securely, and anatomically repair the torn biceps tendon to the radial tuberosity. The most commonly performed techniques (single anterior incision with cortical button and the double-incision procedure with bone tunnels and trough) have limitations. A 2-incision button repair safely and anatomically repairs the distal biceps tendon.

Open Repair of Acute Proximal Adductor Magnus Avulsion.

Hip adduction is accomplished through coordinated effort of the adductor magnus, brevis, and longus and the obturator externus and pectineus muscles. Each of these muscles may be injured at its proximal or distal insertion or in its midsubstance. The incidence of injuries to the adductor complex is difficult to determine in sport because of players' underreporting and playing through minor strains. The most commonly injured adductor muscle is the adductor longus muscle. The injury most frequently occurs at the proximal or distal musculotendinous junction, but several case reports of origin and insertional ruptures of the adductor longus exist in the literature. Successful outcomes have been obtained with both operative and nonoperative approaches in these cases. Reports of isolated proximal avulsion of the adductor magnus are less common. This article describes our surgical technique for management of a rare acute proximal adductor magnus avulsion.

Isolated Tear of the Pectoralis Minor Tendon in a Professional American Football Quarterback: A Case Report.

CASE: A 27-year-old right-hand-dominant National Football League (NFL) quarterback injured his right shoulder after falling with the elbow flexed and the shoulder flexed and slightly abducted. He noted an immediate onset of right anterior shoulder pain, but was able to continue playing and throwing without notable deficit. Magnetic resonance imaging of the chest revealed an isolated tear of the pectoralis minor tendon. The patient received nonoperative local treatment and was able to start as quarterback at the next game. CONCLUSION: An isolated pectoralis minor tear in the dominant arm of a professional throwing athlete may be successfully treated with nonoperative local treatment and shoulder strengthening and stabilization exercises, allowing an early return to competition.

Randomized controlled trial of the effects of a trunk stabilization program on trunk control and knee loading.

BACKGROUND: Many athletic maneuvers involve coordination of movement between the lower and upper extremities, suggesting that better core muscle use may lead to improved athletic performance and reduced injury risk. PURPOSE: To determine to what extent a training program with quasistatic trunk stabilization (TS) exercises would improve measures of core performance, leg strength, agility, and dynamic knee loading compared with a program incorporating only resistance training (RT). METHODS: Thirty-seven male subjects were randomly assigned to either an RT-only or a resistance and TS training program, each lasting 6 wk. Core strength and endurance, trunk control, knee loading during unanticipated cutting, leg strength, and agility were collected pre- and posttraining. RESULTS: Between-group analyses showed that the TS group significantly improved only core endurance when compared with the RT group (side bridge, P = 0.050). Within-group analyses showed that the TS group improved lateral core strength (maximum pull, cable on nondominant side; 44.5 ± 61.3 N, P = 0.037). Both groups increased leg strength (deadlift 1 repetition maximum; TS: 55.1 ± 46.5 lb, P = 0.003; RT: 33.4 ± 17.5 lb, P < 0.001) and decreased sagittal plane trunk control (sudden force release test; cable in front; TS: 2.54° ± 3.68°, P = 0.045; RT: 3.47° ± 2.83°, P = 0.004), but only the RT group decreased lateral trunk control (sudden force release; cable on dominant side; 1.36° ± 1.65°, P = 0.029). The RT group improved standing broad jump (73.2 ± 108.4 mm, P = 0.049) but also showed increased knee abduction moment during unanticipated cutting (1.503-fold increase (percentage body weight × height), P = 0.012). CONCLUSIONS: Quasistatic TS exercises did not improve core strength, trunk control, or knee loading relative to RT potentially because of a lack of exercises, including unexpected perturbations and dynamic movement. Together, these results suggest the potential importance of targeted trunk control training to address these known anterior cruciate ligament injury risk factors.