Background: Supracondylar humerus (SCH) fractures are the most common elbow fractures in children. Historically, displaced (Gartland type 3) SCH fractures have been treated with closed reduction and percutaneous pinning. Fluoroscopic imaging is used intraoperatively in order to assess adequate reduction of the fracture fragments before pinning. On lateral fluoroscopic and radiographic images, a lateral rotation percentage (LRP) can be estimated in order to assess rotational deformity. The purpose of this study was to determine the true rotational deformity of distal humerus fracture fragments in SCH fractures based upon the LRP using a clinically relevant laterally based pinning technique. Methods: In this study, a sawbones model was used to examine the correlation between calculated LRP and the true degree of rotational deformity with 3 of the most common extension-type SCH fracture types (low transverse, high transverse, and lateral oblique). Because fracture stability was not the focus of this study, a single pin was used to hold the construct and allow for fragment rotation along a fixed axis. In this study, 2 of the authors independently measured rotational deformity and compared this with LRP on fluoroscopic lateral imaging of a sawbones model at 0 to 45 degrees of rotational deformity. Results:The LRP of all 3 patterns demonstrated a near linear increase from 0 to 45 degrees with maximum LRP measured at 45 degrees for each of the 3 patterns. Univariate linear regression demonstrated an increase in LRP for the low transverse pattern of 2.02% for every degree of rotation deformity (R 2 = 0.97), 2.29% for the lateral oblique pattern (R 2 = 0.986), and 1.17% for the high transverse pattern (R 2 = 0.971). Maximum LRP was measured at 45 degrees for all 3 patterns with a mean of 53.5% for the high transverse pattern, 93.5% for the low transverse pattern, and 111.2% for the lateral oblique pattern. A higher LRP was measured with increasing degrees of rotational displacement in the low transverse and lateral oblique patterns for all degrees of rotational deformity compared to the high transverse pattern. Conclusion: There is a near linear correlation between the degree of malrotation and the LRP with more superior metaphyseal fracture patterns demonstrating a lower LRP than inferior fracture patterns. Clinical Relevance: Using our data one can estimate the degree of malrotation based on the LRP on radiographs in the clinical setting. Level of Evidence: Not applicable (basic-science article).

Arthroscopy frequently has been used to treat a variety of shoulder conditions, including rotator cuff tears. Arthroscopic techniques, when compared with open techniques, are associated with less morbidity, leading to lower complication rates, easier recovery, and improved outcomes. As technology improves, we continue to develop lessinvasive surgical techniques to treat rotator cuff pathology. With the development of the NanoScope (Arthrex, Naples, FL), we have the opportunity to view through a small cannula without making a standard viewing portal. This technique combines this small viewing portal with standard repair techniques through only a single lateral incision to provide a lessinvasive rotator cuff repair technique.

The use of biologics in sports medicine is increasing rapidly. An osteochondral defect in a young active patient remains a difficult issue to treat. Autograft cartilage has tremendous advantages for the treatment of full-thickness defects, but harvesting and preparation have been difficult in the past. Disadvantages have included donor-site morbidity and the need for further surgery. With the recent development of the GraftNet device (Arthrex, Naples, FL), harvesting and delivery of autograft have become easier and can be performed arthroscopically in a single surgical procedure. Bone marrow concentrate has recently increased in popularity owing to the presence of mesenchymal stem cells. These stem cells combined with autograft cartilage and BioCartilage (Arthrex) could lead to better incorporation and healing. In this article, we show how this unique biological composite is obtained and then added in the cartilage defect during a singlestage arthroscopic procedure.

Arthroscopic meniscus repair is one of the commonly used arthroscopic surgical procedures. Open treatment was the standard for meniscus repairs and recently arthroscopic all-inside treatment has become popular. Novel and more minimally invasive techniques to common arthroscopic procedures are paving the foundation to better patient outcomes. With the use of the NanoScope and nanoinstruments, we continue to develop new minimally invasive diagnostic and treatment techniques that do not require standard portals. The nanoscopic medial meniscus repair technique described here uses a less-invasive approach to a meniscus repair.

Purpose: To examine the early clinical outcomes as well as safety of the Fertilized anterior cruciate ligament (ACL) reconstruction procedure. Methods: A total of 16 consecutive patients with a mean age of 24 years (range, 16-45 years), who had been treated with the fertilized ACL were evaluated and followed over 2 years. Four patients underwent reconstruction using an FGL GRAFTLINK allograft (LifeNet Virginia Beach, VA) and 12 using quadriceps autografts. All patients received the fertilized ACL as previously described using bone marrow composite, demineralized bone matrix, and an internal brace (Arthrex, Largo, FL). Clinical outcomes at 2 years including International Knee Documentation Committee and Marx scores were evaluated. Complication rates, including return to operating room, arthrofibrosis, infection, and rerupture rates, were also assessed. Results: All patients were followed for 6 months and all were released to full activity. In total, 11 of 16 patients were available for 2-year follow-up after the fertilized ACL reconstruction. At 2 years, the average International Knee Documentation Committee and Marx scores were 81 (standard deviation, 5.9) and 9 (standard deviation, 5.7), respectively. One patient required a return trip to the operating room for manipulation under anesthesia. No reruptures were observed at the 2-year mark. Nine of 11 patients had returned to their preinjury activity status at 2 years. Conclusions: The fertilized ACL, which adds biology and an internal brace to an ACL reconstruction, is a reliable and safe option when performing an ACL reconstruction. Very low complication risks were seen in this consecutive series followed for 2 years. Patients consistently returned to their preinjury activity status. Level of Evidence: Level IV, therapeutic case series.

Total knee arthroplasty remains the definitive treatment for end-stage osteoarthritis of the knee. Despite being a very successful intervention in terms of relieving pain and returning a patient's function, it is not without complications. Post-operative stiffness after total knee arthroplasty is one of those complications that can be puzzling for physicians and debilitating for patients. While the etiology of stiffness is multifactorial, the treatment options are essentially limited to manipulation under anesthesia, removal of adhesions and revision total knee arthroplasty. With patient outcomes directly related to relief of pain and post-operative range of motion, it is paramount that surgeons do all that is necessary to minimize risk of post-operative stiffness.

No abstract

Cup-cage constructs are one of several methods commonly used to treat severe acetabular bone loss during contemporary revision total hip arthroplasty. The purpose of this study was to provide a long-term results of the technique with emphasis on implant survivorship, radiographic results, and clinical outcomes for both full and half cup-cage reconstructions.We identified 57 patients treated with a cup-cage reconstruction for major acetabular bone loss between 2002–2012. All patients had Paprosky Type 2B through 3B bone loss, with 60% having an associated pelvic discontinuity. Thirty-one patients received a full cup-cage construct, and 26 a half cup-cage. Mean age at reconstruction was 66 years, 75% were female, and the mean BMI was 27 kg/m2. Mean follow-up was 10 years.The 10-year cumulative incidences of any revision were 14% and 12% for the full and half cup-cage construct groups, respectively. Of the 9 revisions, 3 were for dislocation, 2 for aseptic loosening and construct failure (both were pelvic discontinuities), 1 for adverse local tissue reaction, and 1 for infection with persistent pelvic discontinuity. The 10-year cumulative incidences of revision for aseptic loosening were 4.5% and 5% for the full and half cup-cage constructs, respectively. Of the unrevised cases, incomplete and non-progressive zone 3 radiolucent lines were observed in 10% of patients in each group. Three patients experienced partial motor and sensory sciatic nerve palsies (2 in the full and 1 in the half cup-cage group). Both the full and half cup-cage cohorts demonstrated significantly improved Harris hip scores.Full and half cup-cage reconstructions for major acetabular defects were successful at 10 years in regards to acetabular fixation without appreciable differences between the two techniques. However, zone 3 radiolucent lines were not uncommon in association with discontinuities, and dislocation continues to be a problem.