The incidence of ACLR increased between 1994 and 2006, particularly in females as well as those younger than 20 years and those 40 years or older. Research efforts as well as cost-saving measures may be best served by targeting prevention and outcomes measures in these groups. Surgeons should be aware that concomitant injury is common.

To define the biomechanical effects of total lateral meniscectomy and of subsequent lateral meniscal allograft replacement on load transmission and distribution across the human knee, we mounted 10 fresh-frozen young human cadaveric knees on a mechanical testing system. Peak pressure and contact area profiles were determined at 0 degrees, 30 degrees, and 60 degrees of knee flexion using pressure-sensitive film and a densitometer. Load transmission profiles were determined for each knee in a sequential test order: 1) intact knee, 2) after lateral meniscectomy, 3) after implantation of size-matched meniscal allograft fixed with bone plugs, and 4) after release of the anterior and posterior horn attachments of the allograft. Total lateral meniscectomy resulted in a 45% to 50% decrease in total contact area. Allograft replacement increased total contact area by 42% to 65% as compared with total meniscectomy at all flexion angles. After release of the anterior and posterior horn attachments, contact area was identical to that after total meniscectomy. Total lateral meniscectomy resulted in a 235% to 335% increase in peak local contact pressure. Allograft replacement decreased these pressures by 55% to 65% at all flexion angles, but they remained significantly greater than those in the intact state. After release of the anterior and posterior horn attachments, contact pressures were identical to those after total meniscectomy. Compared with total meniscectomy, meniscal allograft transplantation significantly increases contact area and decreases peak local contact pressures, but any biomechanical advantages are lost without bone plug fixation of the anterior and posterior horns.

T1-weighted FS 3D FLASH imaging is accurate for the detection and grading of articular cartilage abnormalities of the patellofemoral joint.

No abstract

Several studies have noted that increasing age is a significant factor for diminished rotator cuff healing, while biomechanical studies have suggested the reason for this may be an inferior healing environment in older patients. Larger tears and fatty infiltration or atrophy negatively affect rotator cuff healing. Arthroscopic rotator cuff repair, double-row repairs, performing a concomitant acromioplasty, and the use of platelet-rich plasma (PRP) do not demonstrate an improvement in structural healing over mini-open rotator cuff repairs, single-row repairs, not performing an acromioplasty, or not using PRP. There is conflicting evidence to support postoperative rehabilitation protocols using early motion over immobilization following rotator cuff repair.

The modified docking technique yields highly successful return to preinjury level of competition rates (92%) in a select group of elite baseball players.

Successful outcomes were achieved for the management of effort thrombosis in a series of 32 competitive athletes using a multidisciplinary approach based on (1) early diagnostic venography, thrombolysis, and tertiary referral; (2) paraclavicular thoracic outlet decompression with external venolysis and frequent use of subclavian vein reconstruction; and (3) temporary postoperative anticoagulation, with or without an adjunctive arteriovenous fistula. Optimal outcomes for venous thoracic outlet syndrome depend on early recognition by treating physicians and prompt referral for comprehensive surgical management.

Acute patellar dislocation and relocation produces major forces at the articular surfaces. Articular injury was assessed in 48 patients, 24 boys and 24 girls (mean age, 14 years), with acute, initial, noncontact patellar dislocations. Correlation of the findings of radiographic and arthroscopic examinations was done. Eleven of the 48 patients (23%) had radiologic diagnoses of articular injuries. Thirty-four of the 48 patients (71%) had arthroscopic evidence of articular damage, 32 osteochondral and 2 chondral injuries. Eight of the 28 (29%) arthroscopically identified osteochondral loose bodies (4 to 20 mm) were identified radiologically. Overall, only 11 of the 34 (32%) arthroscopically documented articular injuries were defined by preoperative radiographs. These standard radiographs provided limited information for management decisions. Poor results after patellar dislocation treatment may involve nonrecognition of articular compromise.