Recent literature has shown moderate- to high-quality evidence that PRP can have positive clinical effects in certain conditions such as lateral epicondylitis and rotator cuff tendinopathy. Prospective studies have shown that it can also be useful in the treatment of patella tendinopathy. In summary, we found PRP to have variable success in ligament and tendon pathology; however, it should be considered a viable option in chronic musculoskeletal disease that has failed other treatments. Patient selection, duration of symptoms, and combining with other modalities such as physical therapy should all be taken into consideration in treatment with PRP.
Background: In the past decade, superior capsular reconstruction has emerged as a potential surgical approach in young patients with irreparable posterosuperior rotator cuff tears (RCT) and absence of severe degenerative changes. Recently, the use of locally available and biological viable autografts, such as the long head of the biceps tendon (LHBT) for SCR has emerged, with promising early results. Purpose/Hypothesis: The purpose of this study was to investigate the effect of using the LHBT for reconstruction of the superior capsule on shoulder kinematics, along with different fixation constructs in a dynamic biomechanical model. The authors hypothesized that each of the 3 proposed fixation techniques would restore native joint kinematics, including glenohumeral superior translation (ghST), maximum abduction angle (MAA), maximum cumulative deltoid force (cDF), and subacromial peak contact pressure (sCP). Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric shoulders (mean age, 53.4 ± 14.2 years) were tested using a dynamic shoulder simulator. Each specimen underwent the following 5 conditions: (1) intact, (2) irreparable posterosuperior rotator cuff tear (psRCT), (3) V-shaped LHBT reconstruction, (4) box-shaped LHBT reconstruction, and (5) single-stranded LHBT reconstruction. MAA, ghST, cDF and sCP were assessed in each tested condition. Results: Each of the 3 LHBT techniques for reconstruction of the superior capsule significantly increased MAA while significantly decreasing ghST and cDF compared with the psRCT ( P < .001 and P < .001, respectively). Additionally, the V-shaped and box-shaped techniques significantly decreased sCP ( P = .009 and P = .016, respectively) compared with the psRCT. The V-shaped technique further showed a significantly increased MAA ( P < .001, respectively) and decreased cDF ( P = .042 and P = .039, respectively) when compared with the box-shaped and single-stranded techniques, as well as a significantly decreased ghST ( P = .027) when compared with the box-shaped technique. Conclusion: In a dynamic biomechanical cadaveric model, using the LHBT for reconstruction of the superior capsule improved shoulder function by preventing superior humeral migration, decreasing deltoid forces and sCP. As such, the development of rotator cuff tear arthropathy in patients with irreparable psRCTs could potentially be delayed. Clinical Relevance: Using a biologically viable and locally available LHBT autograft is a cost-effective, potentially time-saving, and technically feasible alternative for reconstruction of the superior capsule, which may result in favorable outcomes in irreparable psRCTs. Moreover, each of the 3 techniques restored native shoulder biomechanics, which may help improve shoulder function by preventing superior humeral head migration and the development of rotator cuff tear arthropathy in young patients with irreparable rotator cuff tears.
Background: Injuries to the Kaplan fiber complex (KFC) are not routinely assessed for in the anterior cruciate ligament (ACL)-deficient knee during preoperative magnetic resonance imaging (MRI). As injuries to the KFC lead to anterolateral rotatory instability (ALRI) in the ACL-deficient knee, preoperative detection of these injuries on MRI scans may help surgeons to individualize treatment and improve outcomes, as well as to reduce failure rates. Purpose: To retrospectively determine the rate of initially overlooked KFC injuries on routine MRI in knees with isolated primary ACL deficiency. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent isolated ACL reconstruction between August 2013 and December 2019 were identified. No patient had had Kaplan fiber (KF) injury identified on the initial reading of the MRI scan or at the time of surgery. Preoperative knee MRI scans (minimum 1.5 T) were reviewed and injuries to the proximal and distal KFs were recorded by 3 independent reviewers. KF length and distance to nearby anatomic landmarks (the lateral joint line and the lateral femoral epicondyle) were measured. Additional radiological findings, including bleeding, lateral femoral notch sign, and bone marrow edema (BME), were identified to detect correlations with KFC injury. Results: The intact KFC could reliably be identified by all 3 reviewers (85.9% agreement; Kappa, 0.716). Also, 53% to 56% of the patients with initially diagnosed isolated ACL ruptures showed initially overlooked injuries to the KFC. Injuries to the distal KFs were more frequent (48.1%, 53.8%, and 43.3% by the first, second, and third reviewers, respectively) than injuries to the proximal KFs (35.6%, 47.1%, and 45.2% by the first, second, and third reviewers, respectively). Bleeding in the lateral supracondylar region was associated with KFC injuries ( P = .023). Additionally, there was a positive correlation between distal KF injuries and lateral tibial plateau BME ( P = .035), but no associations were found with the lateral femoral notch sign or other patterns of BME, including pivot-shift BME. Conclusion: KF integrity and injury can be reliably detected on routine knee MRI scans. Also, 53% to 56% of the patients presenting with initially diagnosed isolated ACL ruptures had concomitant injuries to the KFC. This is of clinical relevance, as ACL injuries diagnosed by current routine MRI examination protocols may come with a high number of occult or hidden KFC injuries. As injuries to the KFC contribute to persistent ALRI, which may influence ACL graft failure or reoperation rates, significant improvements in preoperative diagnostic imaging are required to determine the exact injury pattern and to assist in surgical decision making.
Background: Lateral opening wedge distal femoral osteotomy (DFO) unloads a diseased lateral compartment of the knee in patients with genu valgum. To the best of our knowledge, there are no biomechanical studies investigating the effect of knee flexion on contact pressure and area after DFO. Hypothesis: As knee flexion angles increase, DFO will be less effective at unloading the lateral compartment of the knee. Study Design: Controlled laboratory study. Methods: Lateral opening wedge DFO was performed, correcting a mean of 7°, in 10 cadaveric knees using plate fixation. Tibiofemoral contact pressure was measured in 0°, 15°, 30°, 45°, 60°, and 75° of knee flexion before and after osteotomy using electronic sensors. Peak contact pressure (PCP), mean contact pressure (MCP), and contact area were measured for each condition. Anatomic dissection quantified the tibiofemoral contact position on the distal femur in all degrees of flexion. Mixed-effects regression analyses were used to compare the change in variables before and after osteotomy and between flexion angles. Results: One sample had to be excluded because of tibiofemoral arthritis. MCP decreased in the lateral compartment after DFO throughout all degrees of flexion (all P < .05) but to the greatest extent in 0° of flexion. When examining the percentage of MCP in the lateral compartment, this decreased after DFO at 0° (70.4% to 40.0%; P < .001), 15° (65.1% to 52.1%; P < .001), 30° (60.7% to 52.0%; P = .003), 45° (55.8% to 49.7%; P = .033), and 60° (51.9% to 44.2%; P = .010) but not at 75° (50.2% to 45.3%; P = .112). PCP decreased in the lateral compartment after DFO at 0° (2.41 to 1.34 MPa; P < .001), 15° (2.50 to 1.81 MPa; P < .001), 30° (2.28 to 1.93 MPa; P = .039), 45° (2.21 to 1.73 MPa; P = .005), 60° (2.15 to 1.71 MPa; P = .009), and 75° (1.95 to 1.49 MPa; P = .012). The percentage of contact area decreased in the lateral compartment in full extension (68.7% to 48.1%; P = .007) but not at any other degree of flexion (all P > .05). Conclusion: DFO decreased lateral compartment pressure. However, it had the greatest effect in full knee extension. Clinical Relevance: DFO decreased contact pressure in the lateral compartment but more effectively decreased contact pressure in the more anterior aspects of the femoral articular cartilage.
The posterolateral corner (PLC) is an important stabilizer of the knee. This complex of ligaments and tendons functions as the primary restraint to varus and posterolateral rotation of the knee. Injury to the PLC can result in chronic instability, a varus-thrust gait, and early arthrosis of the medial compartment of the knee if left untreated. Several techniques have been designed to address injuries of the PLC. Over the last 30 years, our understanding of the posterolateral corner as well as its operative reconstruction evolved. This evolution has attempted to refine what is an "anatomic" reconstruction. With more improved techniques and new, innovative fixation devices, we hope to make a more favorable repair for recreating the native stability of the posterolateral corner.
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