Female athletes after menarche increase their quadriceps strength greater than their hamstring strength, putting them at risk for anterior cruciate ligament injury. Anterior cruciate ligament-prevention programs based on improving dynamic control of the knee by emphasizing hamstring strengthening should be instituted for girls after menarche.

espite the paucity of long-term supportive studies, the use of thermal energy for the treatment of shoulder instability has become increasingly popular during the last decade. Axillary nerve injury, recurrent instability, capsular obliteration, and adhesive capsulitis are known complications of thermal capsulorrhaphy that have been documented in the literature 1-5 . A recent report highlighted the complication of chondrolysis following shoulder arthroscopy in three patients 6 ; however, none of these patients had chondrolysis severe enough to warrant arthroplasty. We present the cases of two young athletes who had severe chondrolysis following thermal capsulorrhaphy for the treatment of shoulder instability. Our patients were informed that data concerning each case would be submitted for publication.Case Reports ASE 1. A nineteen-year-old right-hand-dominant competitive gymnast and diver presented with symptoms of left-sided shoulder instability, which had first developed when he was fifteen years of age and had been treated conservatively for three years; he had no dislocations. Physical examination demonstrated 2+ anterior load and shift, 2+ posterior load and shift, a 2+ sulcus sign 7 , positive apprehension and relocation tests, and no signs of generalized ligamentous laxity. A magnetic resonance imaging-arthrogram demonstrated a normal glenohumeral joint and a patulous capsule (Fig. 1). Despite nonoperative management, including activity modification, physical therapy, and treatment with anti-inflammatory medications, the instability pattern persisted and the patient elected to proceed with arthroscopic surgery. The intraoperative findings demonstrated a patulous capsular pouch. The treating surgeon believed that thermal capsulorrhaphy was indicated on the basis of the preoperative examination and the intraoperative findings and treated the capsule thermally with the "zebra-striping" technique, which is designed to leave normal strips of capsular tissue intertwined with the thermally altered tissue. A monopolar radiofrequency device (Oratec ORA-50; Oratec Interventions, Menlo Park, California) was used with the standard settings of 67°C and a power of 40 W. Irrigation flow was set on low during the procedure, and the fluid was at room temperature. The chondral surfaces were normal, and no thermal treatment of the chondral surfaces was performed.The shoulder was placed in a sling immediately postoperatively, and a progressive range-of-motion exercise program was begun at two weeks. By eight weeks after surgery, the pa-D C Fig. 1 Figs. 1 through 5 Case 1. Fig. 1 A fat-suppressed, T1-weighted magnetic resonance imaging-arthrogram demonstrating a normal glenohumeral articulation and a patulous capsule.

Controlling pain after total joint arthroplasty (TJA) is critical to minimizing complications, decreasing costs, and expediting patients' return to function. We implemented a TJA multimodal pain management protocol at a Level III trauma center in a small, rural community in New York. We retrospectively reviewed 266 patient charts and collected patient demographics, pain management information, and discharge data. Our primary goals were to quantify the total number of narcotic medication doses used and length of hospital stay. The multimodal pain management protocol significantly reduced the number of narcotic doses used (P < .01). Hospital length of stay decreased slightly; although not statistically significant (P = .25), this may be clinically significant. Gender, age, and type of arthroplasty (ie, knee, hip) were not significant factors. A multimodal approach to pain management after TJA can reduce narcotic use and hospital length of stay, thereby also reducing the incidence of side effects from narcotics.

Postoperative surgical site infections (SSIs) are the most common cause of expensive and debilitating revision surgeries. The Institute for Healthcare Improvement has introduced a three-intervention package, titled Project JOINTS, which attempts to control preoperative and perioperative factors contributing to postoperative SSI in patients undergoing total joint arthroplasty (TJA). The three interventions are preoperative screening for Staphylococcus aureus, decolonizing the skin and nares, and intraoperative administration of combined antimicrobial and alcohol agents to the skin. Canton-Potsdam Hospital was an early adopter of the Project JOINTS protocol, and this quality improvement project has demonstrated a reduced SSI rate throughout the two years of implementation. Before implementation, 596 TJAs were performed with an S aureus SSI rate of 1.8%. During Project JOINTS, 305 TJAs were conducted with a significantly (P = .050) lower S aureus SSI rate of 0.66%. Thus, Project JOINTS is effective at reducing the postoperative incidence of S aureus SSIs in patients undergoing TJA.

Animal models for orthopaedic implant testing are well-established but morphologically dissimilar to human tibiae; notably, most are shorter. The purpose of this study was to quantitatively evaluate the morphology and mechanical properties of the cervine tibia, particularly with regard to its suitability for testing orthopaedic implants. Two endosteal and eleven periosteal measurements were made on 15 cervine tibiae. The mechanical strength in axial compression and torsion was measured using 11 tibiae. The cervine tibia is morphologically similar to the human tibia and more closely matches the length of the human tibia than current tibia models (ovine, porcine, and caprine). The distal epiphysis dimensions are notably different, but no more so than the current tibia models. The torsional stiffness of the cervine tibia is within the range of previously reported values for human tibiae. Furthermore, in many regions, cervine tibiae are abundant and locally available at a low cost. Given these mechanical and morphological data, coupled with potential cost savings if regionally available, the cervine tibia may be an appropriate model for orthopaedic implant testing.

No abstract

Animal joints are valuable proxies for those of humans in biomechanical studies, however commonly used quadruped knees differ greatly from human knees in scale and morphometry. To test the suitability of the cervine stifle joint (deer knee) as a laboratory model, gross morphometry, ACL cross section, and ACL rupture strength were measured and compared to values previously reported for the knees of humans and commonly studied animals. Twelve knee joints from wild white-tailed deer were tested. Several morphometry parameters, including bicondylar width (53.5 ± 3.0 mm) and notch width (14.7 ± 2.5 mm), showed a high degree of similarity to those of the human knee, while both medial (16.7 ± 2.1°) and lateral (17.6 ± 4.7°) tibial slopes were steeper than in humans but less steep than other quadrupeds. The median ACL rupture force (2054 N, 95% CI 2017-2256 N), mean stiffness (260 ± 166 N/mm), mean length (33 ± 7 mm), and mean cross sectional area (44.8 ± 18.3 mm) were also comparable to previously reported values for human knees. In our limited sample size, no significant sexual dimorphism in strength or morphometry was observed (p ≥ 0.05 for all parameters), though female specimens generally had steeper tibial slopes (lateral: p = 0.52, medial: p = 0.07). Our results suggest that the deer knee may be a suitable model for ex vivo studies of ACL rupture and repair.

Intramedullary nails are the gold standard of fracture fixation, yet problems can still arise due to their manufacture in discrete lengths. Patient outcomes are less favorable when implanted with an improper length nail, and the wide range of discrete length options can increase the size hospital inventory. Prototypes of adjustable-length intramedullary nails were developed and tested in axial compression, torsion, and four-point bending. These prototypes are comparable to conventional nails in axial and bending stiffness. The torsional stiffness of the prototypes is less than that of conventional nails, but may be sufficient for clinical use.