Collegiate female soccer athletes have a high initial return-to-play rate. Undergoing ACL reconstruction earlier in the college career as well as the presence of a scholarship had a positive effect on return to play. Surgical factors including graft type, fixation method, tunnel placement technique, concomitant knee surgeries, and revision status demonstrated no significant effect on the return-to-play rate.
Two-incision anterior cruciate ligament reconstruction uses an outside-in femoral drilling technique. Advantages include anatomic femoral tunnel placement and increased versatility with regard to graft position and fixation in the femoral tunnel or distal femur. The authors believe that transtibial femoral tunnel drilling is inferior because of nonanatomic femoral tunnel placement and the requirement of the posterior footprint placement of the tibial tunnel. Indications for outside-in femoral drilling include revision anterior cruciate ligament reconstruction, drilling an all-epiphyseal tunnel in skeletally immature patients, long bone-patellar tendon-bone autografts when using more than 45 mm of tendon, and cases in which the leg cannot be hyperflexed for accessory anteromedial portal drilling.
Distal tibiofibular syndesmosis injuries are complex injuries that often result in extended loss of playing time for athletes. Unstable syndesmosis injuries are uniformly reduced and stabilized by numerous methods. Controversy arises from syndesmosis injuries that are stable on stress radiographs but functionally unstable with loading of the ankle during athletic activity. The authors present a case of operative fixation of a dynamically unstable syndesmosis and detail the postoperative course.
Articular cartilage injuries to the patella are frequent after patellar dislocation. The management of these acute cartilage injuries in the acute setting can be challenging. It is well documented that acute fixation is the optimal choice for treatment of osteochondral injuries. This article discusses the challenges and potential treatment options for acute chondral/osteochondral injuries to the patella after acute patellar dislocation.
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