Limited data exists defining preoperative variables that affect outcomes after osteochondral allograft transplantation (OAT) in the knee. In this retrospective study, we examined 75 patients who underwent OAT for large (≥2 cm) grade IV cartilage defects in the femoral condyle. Patient variables evaluated included the following: smoking, workers compensation, body mass index (BMI), pre-injury activity level, number, and the type of co-morbidities in the operated knee, lesion location and number of grafts placed. OCA donor age and graft storage duration from procurement were also evaluated. Preoperative and postoperative visual analogue scale (VAS) pain scores were the primary outcome measure. Overall, 53 patients (71%) had successful outcomes, with 81% of patients without co-morbidities having successful outcomes. Active patients were significantly ( = 0.023) more likely to have a successful outcome than low activity patients. Patients with BMI <35 were 4 times more likely to have a successful outcome ( = 0.01). There were no significant differences based on donor age. Patients with transplanted grafts stored >28 days were significantly ( = 0.048) and 2.6 times more likely to have an unsuccessful outcome. This study provides new evidence for preoperative patient factors and graft variables that may influence the overall outcome after osteochondral transplantation in the knee.

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Hinged external fixation as a supplement to reconstruction following knee dislocation was associated with fewer failed ligament reconstructions compared with external bracing. Patients presenting with highly unstable knee dislocations should be considered for hinged external fixation to supplement initial reconstructive procedures.

Humeral avulsion of the inferior glenohumeral ligament (HAGL) has recently gained more recognition as a cause of shoulder instability. Posterior HAGL lesions, being much more infrequent than anterior disruptions, have only recently been documented as a notable cause of posterior instability. We detail the treatment of a previously unreported case of a posterior HAGL variant lesion consisting of a bony avulsion with involvement of the teres minor tendon. Arthroscopic fixation was facilitated by use of a "sheathless" arthroscopic approach with a 70 arthroscope and suture anchor.G lenohumeral instability can result from a wide range of factors. Increased recognition has been given to the humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion. The typical HAGL lesion most commonly described is an avulsion of the anterior inferior glenohumeral ligament from its attachment on the humerus. 1,2 This leads to anterior instability, which occurs much more frequently than posterior instability. 3,4 The posterior HAGL lesion, however, has been described as a cause of posterior shoulder instability or pain. 5,6 Diagnosis can be difficult and is often delayed because of nonspecific shoulder pain or multiple potential etiologies for isolated posterior shoulder pain. These may include tears of the labrum, capsule, or rotator cuff or bony insufficiency. Posterior HAGL lesions have been documented in association with anterior and posterior Bankart lesions; anterior, superior, and posterior labral lesions; and anterior labral periosteal sleeve avulsion lesions. Both open repair and arthroscopic repair have subsequently been described. 5,7-9 Teres minor avulsions are rare and, when present, frequently occur in combination with supraspinatus, infraspinatus, or massive rotator cuff tears. [10][11][12] To our knowledge, there is no mention in the literature of a bony posterior HAGL lesion that also involves an isolated teres minor tendon avulsion. We describe the arthroscopic treatment of a traumatic posterior HAGL variant with a bony avulsion and a lesion involving the teres minor tendon. CaseA 16-year-old right handedominant male baseball player sustained a traumatic injury to his left shoulder when he ran into an outfield fence chasing a fly ball. He forcefully struck the wall with a direct blow to the anterior and lateral aspects of the shoulder. He described the sensation of a "slip" of his shoulder but did not sustain a frank dislocation. Radiographs obtained the day of injury yielded negative findings. His examination showed good active motion with minimal rotator cuff weakness. Conservative management for a shoulder strain was subsequently initiated.After 4 weeks of physical therapy, the patient still had persistent shoulder pain, localized anteriorly, with no symptomatic improvement. His physical examination at that time showed diffuse anterior tenderness to palpation. He had full active range of motion with The authors report the following potential conflict of interest or source of funding: P.A.S. rec...

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