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We systematically reviewed the literature to compare the clinical and radiologic outcomes and retear rates of superior capsular reconstruction (SCR) using fascia lata autograft (FLA) versus human dermal allograft (HDA) in cases of massive irreparable rotator cuff tears. Methods: Searches of Pub Med and Cochrane Library identified clinical studies addressing SCR using FLA and HDA. Two reviewers independently screened the titles, abstracts and full texts to extract data from eligible studies. Reported outcome measures were descriptively analyzed. Results: A total of 6 studies with 2 study groups satisfied the inclusion criteria. The number of shoulders in the HDA group was 155, and in the FLA group, the number was 140 shoulders. The mean age at time of surgery for the HDA group and the FLA group was 60.49 years and 65.8 years, respectively, and the mean follow-up was 15.2 months and 44.6 months, respectively. Active elevation improved from of 121-130 to 158-160 in the HDA group and from 74.8-133 to 130.4-146 in the FLA group. Active external rotation improved from 36-45 in the HDA group and from 13-28 to 30-43 in the FLA group. The Visual Analog Scale for pain improved from 4-6.25 to 0.38-1.7 points in the HDA group, whereas in the FLA group, it improved from 6-2.5 points. In the HDA group, American Shoulder and Elbow Surgeons scores improved from 42-52 to 77.5-86.5, whereas in the FLA group scores improved from 35-54.4 to 73.7-94.3. The acromiohumeral distance improved in both groups. The retear rate was 3.4%-55% in the HDA group and 4.5%-29% % in the FLA group. Conclusions: Arthroscopic SCR for massive, irreparable rotator cuff tears using both fascia lata allograft and human dermal allograft leads to improvement in clinical outcomes and radiologic outcomes. There is a lower retear rate in fascia lata allografts. The current literature is heterogeneous and has low levels of evidence. Level of Evidence: Level IV, systematic review of level IV studies.

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Background Femoral tunnel can be drilled through tibial tunnel (TT), or independent of it (TI) by out-in (OI) technique or by anteromedial (AM) technique. No consensus has been reached on which technique achieves more proper femoral aperture position because there have been evolving concepts in the ideal place for femoral aperture placement. This meta-analysis was performed to analyze the current literature comparing femoral aperture placement by TI versus TT techniques in ACL reconstruction. Methods We performed a comprehensive systematic review and meta-analysis of English-language literature in PubMed, Cochrane, and Web of Science databases for articles comparing femoral aperture placement by TI versus TT techniques with aperture position assessed by direct measurement or by postoperative imaging, PXR and/or CT and/or MRI. Results We included 55 articles with study population of 2401 knees of whom 1252 underwent TI and 1149 underwent TT techniques. The relevant baseline characteristics, whenever compared, were comparable between both groups. There was nonsignificant difference between TI and TT techniques in the distance from aperture center to footprint center and both techniques were unable to accurately recreate the anatomic footprint position. TI technique significantly placed aperture at more posterior position than TT technique. TI technique significantly lowered position of placed aperture perpendicular to Blumensaat’s line (BL) than TT technique, and modifications to TT technique had significant effect on this intervention effect. Regarding sagittal plane aperture placement along both AP anatomical axis and BL, there was nonsignificant difference between both techniques. Conclusion Modifications to TT technique could overcome limitations in aperture placement perpendicular to BL. The more anterior placement of femoral aperture by TT technique might be considered, to some extent, a proper position according to recent concept of functional anatomical ACL reconstruction.

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Background: Associated injuries of traumatic anterior shoulder dislocations play an important role in predicting recurrent instability. MRI has proved popular for imaging of suspected abnormalities. MR arthrography (MRA) has been suggested to be more sensitive than MRI in the detection of labral tears and other capsular lesions. In this study, we aimed to assess prospectively the diagnostic effectiveness of MRA in the preoperative planning of traumatic anterior shoulder instability compared with conventional MRI and arthroscopy. Methods: Shoulder MRI and MRA in 100 patients (73 men and 27 women; mean age, 27 yr) with shoulder dislocations were evaluated by two musculoskeletal radiologists who were blinded to arthroscopic findings, which represented the reference standard. An arthroscopic surgeon blinded to the imaging findings evaluated the osseous abnormalities involving the humeral head and glenoid, anterior labroligamentous lesions, and capsular lesions. Sensitivity, specificity, accuracy, and positive and negative predictive values of each imaging study were calculated for each elemental lesion and compared using a paired McNemar test. Results: When comparing the sensitivity and accuracy values of the MRA and MRI for the detection of these elemental lesions, all values of MRA were higher than those of MRI (P<0.01). However, when comparing the specificity values, both MRI and MRA were highly specific (100%) in diagnosing bony Bankart lesions and anterior labroligamentous periosteal sleeve avulsions. MRI missed Perthes lesions, humeral avulsions of the anterior glenohumeral ligament, and glenoid avulsions of the anterior glenohumeral ligament. Conclusions: Despite being invasive, MRA is considerably more useful in the identification and categorization of different elemental lesions of traumatic chronic anterior shoulder instability.

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Background: Double bundle reconstruction of superficial medial collateral (sMCL) and posterior oblique (POL) ligaments with a single femoral tunnel using distally based semitendinosus is a traditional procedure for management of medial knee ligament complex injuries. However, the transferred tendon was always routed in nonanatomical configuration. The author reports the clinical outcomes and complications in a reconstruction technique with anatomical graft routing method. Methods:Fourteen patients with International Knee Documentation Committee (IKDC) grade 3 or 4 valgus instability and anteromedial rotatory instability underwent reconstruction of sMCL and POL by anatomically routed semitendinosus tendon transfer. The average age of the patients was 36.6 yr. Medial-sided knee ligament injury was isolated in two patients and part of multiligament knee injury in 12 patients. The average duration between injury and surgery was 7 wk (range 2 to 25). Patients were evaluated preoperatively and at final follow-up. Results:After a median follow-up of 29.5 mo (range, 24 to 36), the mean Lysholm and IKDC subjective scores improved from 27 (2.95) and 46.8 (8.26) preoperatively to 87.6 (3.44) and 71.7 (3.68) at latest follow-up (P < 0.05), respectively. Nine patients (64.3%) returned at a preinjury Tegner score level at final follow-up. Both medial and posteromedial laxity were significantly improved on physical examination (P < 0.01). No patients had recurrent laxity of medial knee reconstruction or any concurrent cruciate ligament reconstructions. Conclusions:Reconstruction of sMCL and POL using anatomically routed semitendinosus transfer showed favorable clinical outcomes without recurrence of medial or anteromedial instability after midterm follow-up.