Acromioclavicular joint injuries and, more specifically, separations are commonplace both in general practice and during athletic participation. This article reviews the traditional classification as well as the clinical evaluation of patients with acute and chronic acromioclavicular joint separations. It also highlights many recent advances, principally in the anatomy and biomechanics of the acromioclavicular joint ligamentous complex. The concept of increases in superior translation as well as disturbances in horizontal translation with injuries to this joint and ligaments are discussed. This information, coupled with the unpredictable long-term results with the Weaver-Dunn procedure and its modifications, have prompted many recent biomechanical studies evaluating potential improvements in the surgical management of acute and chronic injuries. The authors present these recent works investigating cyclic loading and ultimate failure of traditional reconstructions, augmentations, use of free graft, and the more recent anatomic reconstruction of the conoid and trapezoid ligaments. The clinical results (largely retrospective), including acromioclavicular joint repair, reconstruction and augmentation with the coracoclavicular ligament, supplemental sutures, and the use of free autogenous grafts, are summarized. Finally, complications and the concept of the failed distal clavicle resection and reconstruction are addressed. The intent is to provide a current, in-depth treatise on all aspects of acromioclavicular joint complex injuries to include anatomy, biomechanics, benchmark studies on instability and reconstruction, clinical and radiographic evaluation, and to present the most recent clinical research on surgical outcomes.
Awareness of the medial patellofemoral ligament has increased markedly over the past decade. Previously, this structure, which was delineated in anatomical studies, had been little recognized and underestimated with regard to its importance in stabilizing the patella. The goal of this review of the medial patellofemoral ligament is to develop a current understanding of how this ligament functions in patellofemoral stability and to review the current treatment options for medial patellofemoral ligament disruption.
We have established the kinematic and kinetic parameters of the adolescent baseball pitch. These measured parameters and the differences between adolescent pitchers and their adult counterparts can be used to examine and help determine the causes of the rapid increase in adolescent pitching injuries.
This study determined the thickness of normal humeral head articular cartilage by anatomic cross section using computer-aided image analysis software. Sixteen adult cadaveric humeral heads were analyzed. Our fi ndings reveal that the thickness of humeral articular cartilage is substantially thinner than articular cartilage found in the knee. The cartilage is thickest in the central portion of the head and becomes progressively thinner towards the periphery. Surgical techniques used to treat pathology in the glenohumeral joint, specifi cally thermal energy or mechanical debridement, may have deleterious effects on the relatively thin humeral articular cartilage.A rticular cartilage thickness has been extensively studied in the knee. 1-7 However, there is a paucity of data regarding the thickness of articular cartilage of the humeral head. Most characterizations of humeral head articular cartilage have been performed using radiographic imaging studies, specifi cally magnetic resonance imaging with and without the use of intraarticular contrast. [8][9][10] The radiographic data obtained in two of these studies were compared to the corresponding data obtained by direct measurement of the articular surface. In both studies, only limited areas of the humeral head were analyzed, and direct measurements of the articular surface were performed by observers using loupe magnifi cation. The diffi culty in accurately imaging the highly spherical humeral head and the substantially thinner articular cartilage found on the hu-meral head as compared to the knee were the reasons given for the inferior results. According to Eckstein 2 , magnetic resonance imaging (MRI) of strongly curved surfaces can overestimate cartilage thickness without appropriate derivations. Soslowsky et al 11 used stereophotogrammetry to defi ne the geometry of the glenohumeral articulation and reported on surface area and cartilage thickness of both the humeral head and the glenoid.The purpose of this study was to determine the thickness of humeral head articular cartilage via anatomic measurements from multiple cross sections of cadaveric humeral heads using computeraided image analysis software. From this data a topographical map of humeral head articular cartilage was developed. This information may serve as a standardization of normal articular cartilage thickness of the humeral head. MATERIALS AND METHODSEighteen adult cadaveric humeri (8 left and 10 right) were obtained through the anatomic gift association at Rush University Medical Center. The age of the specimens ranged from 53 to 91 years. Overlying muscle and soft tissue were sharply dissected away with a scalpel and scissors with care taken to avoid injury to the articular surface. Two right humeral heads were eliminated: one head demonstrated evidence of degenerative changes, and the second head had developed subchondral cysts. Thus, 16 humeral heads were analyzed. Humeral heads were cut at the anatomical neck with a band saw. The heads were then placed in a plastic container and potted in Iso...
Injuries to the lateral collateral ligament (LCL) and posterolateral corner of the knee, particularly when combined with anterior cruciate or posterior cruciate ligament injuries, can result in profound symptomatic knee instability. Although many surgical improvements have been made in the reconstruction of anterior and posterior cruciate ligament injuries, reconstruction of the posterolateral corner has had less predictable results, with residual pathologic laxity especially in the chronic situation. This has stimulated many surgeons to recommend acute repair of posterolateral knee injuries. This article will briefly review the relevant surgical anatomy, present a summary of current reconstructive techniques for the posterolateral corner, and describe our preferred method for anatomic reconstruction of the posterolateral corner for chronic instability of the knee by recreating the LCL and popliteofibular ligament using either autogenous or allograft soft tissue and an interference screw technique. We do not use a transtibial tunnel but re-orientate the transfibular tunnel and utilize 2 femoral tunnels an the attempt to recreate the LCL and popliteus tendon. In a small clinical series, this has proven to restore varus rotation and external rotation patholaxities with a high degree of predictability.
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