Recently, gender-specific designs of total knee replacement have been developed to accommodate anatomical differences between males and females. We examined a group of male and female distal femora matched for age and height, to determine if there was a difference in the aspect ratio (mediolateral distance versus anteroposterior distance) and the height of the anterior flange between the genders. The Hamann-Todd Collection provided 1207 skeletally mature cadaver femora. The femoral length, the anteroposterior height, height of the lateral and medial flanges and the mediolateral width were measured in all the specimens. The mechanical axis of the femur, the cut articular width and the aspect ratio were assessed. Statistical analysis of the effect of gender upon the aspect ratio and the lateral and medial flanges was undertaken, controlling for age, height and race. The mean aspect ratio of male femora was 1.21 (SD 0.07) and of female femora it was 1.16 (SD 0.06) (p < 0.001). There was no significant difference between male and female specimens in the mean size of the lateral flange (6.57 mm (SD 2.57) and 7.02 mm (SD 2.36), respectively; p = 0.099) or of the medial flange (3.03 mm (SD 2.47) and 3.56 mm (SD 2.32), respectively; p = 0.67). Future work in the design of knee prostheses should take into account the overall variability of the anatomy of the distal femur.

Background and objectivePrimary patellar dislocations can concomitantly involve osteochondral injuries for which prompt recognition is paramount for joint preservation. These injuries can be missed on radiographs, necessitating MRI examinations. In this study, we aimed to identify patient parameters that correlate with occult osteochondral injuries. MethodsPatients were retrospectively identified between 2015 and 2020 through a chart review. The inclusion criteria were as follows: patients diagnosed with a primary patellar dislocation with three radiographic views and an MRI of the injured knee. Demographic and radiographic data were evaluated. ResultsA total of 61 patients met the inclusion criteria. There were no statistically significant demographic differences between patients with osteochondral injuries and those without (p>0.05). Seven knees (88%) with an osteochondral lesion and 20 (38%) without had an effusion (p=0.02). There was no association in terms of ligamentous laxity (p=0.49), Caton-Deschamps index (CDI) (p=0.68), sulcus angle (SA) (p=0.68), congruence angle (CA) (p=0.56), and lateral patellofemoral angle (LPFA) (p=0.25) between patients with and without an occult osteochondral injury. ConclusionAmong the parameter examined, the presence of an effusion was the only one that correlated with the presence of occult osteochondral injury in our cohort.

Background: Superior labral anterior to posterior (SLAP) tears are one of the most common injuries to the shoulder, with the type II variant representing the most frequently encountered subtype. Purpose: To systematically review the literature to better understand outcomes after arthroscopic repair of isolated type II SLAP lesions using knotted versus knotless anchors based on implant number, implant location, patient position, and portal position. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review investigating all studies in the literature between January 2000 and June 2019 reporting on patients undergoing arthroscopic repair for isolated type II SLAP lesions using knotted versus knotless suture anchors was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the PubMed, BIOSIS Previews, SPORTDiscus, PEDro, and Embase databases. Results: A total of 234 patients undergoing isolated arthroscopic repair of type II SLAP lesions using suture anchors were identified, with 76% (179/234) treated using knotted anchors versus 24% (55/234) treated using knotless anchors. Complications were reported in 12% of patients treated using knotted anchors versus no patients treated using knotless anchors ( P = .008). The incidence of complications for knotted anchor repair was not significantly affected by patient position ( P = .22) or portal position ( P = .19). Using multiple regression analysis, we found no significant association with the incidence of complications when analyzing for anchor design ( R 2 = 0.02; P = .06) or anchor position ( R 2 = 0.02; P = .92). No significant difference in return-to-activity timing was appreciated based on anchor type ( P = .28), patient position ( P = .98), or portal position ( P = .97) in patients treated using knotted anchors. Conclusion: Patients treated using knotted anchors were significantly more likely to experience a postoperative complication compared with patients treated using knotless anchors after arthroscopic repair of isolated type II SLAP lesions. Despite the increased incidence of a postoperative complication after knotted anchor fixation compared with knotless anchor fixation, multiple regression analysis showed that anchor design and anchor position were not significantly predictive of the incidence of complications. Given the increasing popularity of knotless anchor fixation, further study on the long-term outcomes after knotless repair for isolated type II SLAP lesions is warranted.

The purpose of this article was to review current literature on peri-operative pain management in hip arthroscopy. A systematic review of the literature on pain control in hip arthroscopy published January 2008 to December 2018 was performed. Inclusion criteria consisted of English language or articles with English translations, subjects undergoing hip arthroscopy with documented peri-operative pain control protocols in studies reporting Level I to IV evidence. Exclusion criteria were non-English articles, animal studies, prior systematic review or meta-analyses, studies not reporting peri-operative pain control protocols, studies documenting only pediatric (&lt;18 years of age) patients, studies with Level V evidence and studies including less than five subjects. Statistical analysis was performed to assess pain protocols on narcotic consumption in PACU, VAS score on discharge, time to discharge from PACU and incidence of complications. Seventeen studies were included, comprising 1674 patients. Nerve blocks were administered in 50% of patients (n = 838 of 1674), of which 88% (n = 740 of 838) received a pre-operative block while 12% (n = 98 of 838) post-operative block. Sixty-eight complications were recorded: falls (54%, n = 37), peripheral neuritis (41%, n = 28), seizure (1.5%, n = 1), oxygen desaturation and nausea (1.5%, n = 1) and epidural spread resulting in urinary retention (1.5%, n = 1). No significant differences in narcotic consumption, VAS score at discharge, time until discharge or incidence of complication was found based on pain control modality utilized. No statistically significant difference in PACU narcotic utilization, VAS pain scores at discharge, time to discharge or incidence of complications was found between peri-operative pain regimens in hip arthroscopy.

The purpose of this article is to determine normative values for the length of the acetabular rim and detect differences between gender, age, ethnicity, height and leg length. Six measurements were taken on the acetabular rim of 143 cadaveric skeleton specimens (286 acetabula) using a coordinate-measuring device: circumferential (excluding acetabular notch), anterior inferior iliac spine (AIIS)-anterior, AIIS-posterior, 12–3 o’clock, 12–9 o’clock and 11–5 o’clock. Museum specimen height data and leg length data from a previous study were recorded for 109 of 143 specimens. Intraclass correlation coefficients were calculated. Student t-tests compared mean values. Multiple regression analysis was used to determine the relationship between acetabular rim length and gender, age, ethnicity, height and leg length. The average acetabular rim length in males for circumferential, AIIS-anterior, AIIS-posterior, 12–3, 12–9 and 11–5 o’clock were 15.8, 4.2, 11.7, 4.9, 4.7 and 9.5 cm, respectively; and for females: 13.7, 3.7, 10.0, 4.3, 4.1 and 8.3 cm, respectively. Intraclass correlation coefficients were 0.953, 0.930, 0.958, 0.857, 0.913 and 0.951, respectively, for each measurement. All six measurements were significantly larger for males (P < 0.001). Multiple regression analysis demonstrated a significant relationship between gender and rim length for all six measurements (P < 0.001) and between height and leg length and acetabular rim length for five of the six measurements exclusive of AIIS-anterior (P < 0.001). No significant trends between age or ethnicity and rim length were found. Average acetabular rim lengths were established. The acetabular rim is significantly longer in males and correlates with height and leg length. Age and ethnicity do not appear to be significant predictors of acetabular rim length. Normative values for acetabular rim lengths may assist in hip preservation surgery.

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» Rotator cuff tear arthropathy (RCTA) describes a pattern of glenohumeral degenerative changes following chronic rotator cuff tears that is characterized by superior humeral head migration, erosion of the greater tuberosity of the humeral head, contouring of the coracoacromial arch to create a socket for the humeral head, and eventual glenohumeral arthritis.» Acute and chronic inflammatory changes following rotator cuff tears are thought to contribute to cartilage damage, muscle fibrosis, and fatty infiltration in the glenohumeral joint.» In vitro animal studies targeting various inflammatory modulators, including macrophages, insulin-like growth factor-I, and transforming growth factor-beta pathways, provide promising therapeutic targets to improve healing after rotator cuff tears.» The role of platelet-rich plasma in the treatment and prevention of RCTA has been investigated, with conflicting results.

The aim of this study is to assess the efficacy of a three-phase, multimodal, perioperative pain protocol for primary hip arthroscopy based on pain scores, narcotic use, time to discharge, hospital admission and complications. A retrospective study of patients undergoing primary hip arthroscopy over a 48-month time period was conducted. Patients were separated into a multimodal group consisting of non-narcotic medication, local analgesia and a peripheral nerve block (PNB) versus patients receiving only a PNB. Differences in post-anesthesia care unit (PACU) visual analog scores, PACU time to discharge, PACU opioid consumption, hospital admission and complications between protocols were recorded and analyzed. There were 422 patients who underwent 484 surgeries, with 15 patients crossing over pain protocol groups for surgery on the contralateral hip. One hundred and ninety-six patients underwent 213 procedures in the multimodal group and 241 patients underwent 271 procedures in the PNB group. No differences in baseline characteristics were appreciated between groups. Mean time to discharge was significantly shorter in the multimodal group (137.4 ± 49.3 min versus 176.3 ± 6.5 min; P &lt; 0.001) which also had less post-operative admissions (0 versus 9; P = 0.006) than the PNB group. In patients who crossed over protocol groups, a statistically shorter time to discharge was appreciated with the multimodal protocol compared with the PNB protocol (119.9 ± 32.1 min versus 187.9 ± 9.2; P = 0.012). The three-phase, multimodal pain protocol led to significantly faster discharge times and fewer hospital admissions when compared with isolated PNB in patients undergoing primary hip arthroscopy.