The original MR interpretations correctly identified 35 of the 36 unstable lesions and all 4 stable lesions, giving a sensitivity of 0.97 and specificity of 1.0. There was a 98% agreement between the original and retrospective diagnoses. A high-signal-intensity line was seen beneath 72% of the 36 unstable lesions. The other three signs were noted in 22-31% of the unstable lesions. Fifty-six percent of the unstable lesions showed only one sign of instability. MR imaging is a highly sensitive method for detection of unstable osteochondritis dissecans. The presence of any one sign indicates instability, the most frequent sign being an underlying high-signal-intensity line. Because we examined only four stable lesions, our 95% confidence interval of 0.40-1.0 for a specificity of 1.0 gives only a limited estimate of the specificity of MR.

Three of five patients with an open femoral growth plate and one of nine patients with a closed growth plate had a good clinical outcome. Both patients with lesions smaller than 160 mm2 in area had a good outcome and ten of 12 patients with larger lesions had a poor outcome. Both patients with stable lesions by MR imaging had a good outcome while ten of 12 patients with a lesion unstable by MR imaging had poor outcomes. All six patients with a cartilage fracture or articular defect had poor outcomes. The results of this study should be considered preliminary since only 14 patients were followed. However, it appears that a good clinical outcome is likely when the femoral growth plate is open, when the osteochondritis dissecans is small, and when the lesion is stable by MR imaging. When a cartilage fracture or articular defect is found on MR imaging, the patient is likely to have a poor outcome.

No abstract

Blunt-threaded interference screws used for fixation of hamstring tendons in anterior cruciate ligament reconstructions provide aperture fixation and may provide a biomechanically more stable graft than a graft fixed further from the articular surface. It is unknown if soft tissue fixation strength using interference screws is affected by screw length. We compared the cyclic and time-zero pull-out forces of 7 x 25 mm and 7 x 40 mm blunt-threaded metal interference screws for hamstring graft tibial fixation in eight paired human cadaveric specimens. A four-stranded autologous hamstring tendon graft was secured by a blunt-threaded interference screw into a proximal tibial tunnel with a diameter corresponding to the graft width. Eight grafts were secured with a 25-mm length screw while the other eight paired grafts were secured with a 40-mm length screw. During cyclic testing, slippage of the graft occurred as the force of pull became greater with each cycle until the graft-screw complex ultimately failed. All grafts failed at the fixation site, with the tendon being pulled past the screw. There were no measurable differences in the mean cyclic failure strength, pull-out strength, or stiffness between the two sizes of screws. Although use of the longer screw would make removal technically easier should revision surgery be necessary, it did not provide stronger fixation strength than the shorter, standard screw as had been postulated.

The 5-throw openly tied square knot remains the gold standard, although the openly tied SAK offers similar security when tying in a hole. Arthroscopic knots, whether complex knots backed up by 3 RHAPs, the 6-throw surgeon's knot, or the 5-throw SAK, give security similar to the standard. Square knots tied with the newer sutures in open fashion are more secure than if tied with braided polyester. Using lower profile knots may be especially important when employing Fiberwire or Ultrabraid, as these sutures tend to result in bulkier knots than those tied with Ethibond or Orthocord.

No abstract

No abstract

To evaluate the effect of surgical timing on the formation of heterotopic ossification about the elbow, 71 consecutive patients with elbow trauma requiring operative management were evaluated. Fourteen patients were excluded because they suffered from head injury, burns, or severe open injuries requiring surgery on two or more occasions. Sixteen patients were lost to follow-up, leaving a group of 41 patients. The average age of patients was 35 years. The fractures involved the olecranon in 19, distal humerus in 12, and radial head/neck in 10 patients. Six of these fractures were accompanied by a dislocation. Eleven were open injuries; the remaining 30 were closed. Bone grafting was performed in nine patients. The interval between injury and surgical intervention averaged 57 hours. None (0%) of 17 patients treated within 48 hours developed grade II, III, or IV heterotopic ossification, whereas 8 (33%) of 24 patients treated after 48 hours developed grade II, III, or IV heterotopic ossification. There were no significant differences in demographic or injury parameters between these two groups. These findings suggest that fixation of unstable elbow fractures within 48 hours of injury may reduce the formation of ectopic bone.