Full-thickness focal chondral defects in the knee are more common in athletes than among the general population. More than one-half of asymptomatic athletes have a full-thickness defect. Further study is needed to define more precisely the prevalence of these lesions in this population.

Recurrent patellar dislocation is associated with an increased prevalence of patella alta, increased TT-TG distance, rotational deformity, and trochlear dysplasia compared with patients with no histories of patellar dislocation. Multiple anatomic factors were identified in the majority of patients with recurrent dislocation. Further research may identify which factors play a greater role in patellar stability and may allow physicians to predict which first-time dislocation patients are more likely to sustain recurrence.

Background: Treatment for displaced proximal humeral fractures is still under debate. Poor rota-tor cuff status and non-union of the tubercles in elderly patients has caused reversed total shoulder prosthesis growing popularity and showed promising results, even in comparison to angular stable plates fixation. The purpose of this study is to report clinical and radiological results of proximal humerus fractures treated with rTSA or ORIF in elderly. Materials and methods: The study has investigated retrospectively a consecutive series of 73 patients over 65 years old (range 65-91) with proxi-mal humeral three-and four-parts fractures, operated from January 2009 to June 2014 with a reversed total shoulder prosthetic replacement or open reduction and internal fixation using an angular stable plate, with at least 1 year follow-up. Participants are admitted in our hospital with a displaced proximal humeral fracture according to AO-OTA type 11-B2 or 11-C2. The primary outcomes are active ROM and shoulder function (Constant score). Secondary outcomes have been patient self-assessment form (Simple shoulder test) and radiographical details. Follow-up takes place at the moment of clinical observation with rx control. Results: We analyzed a group of 23 patients treated by plate and screws and 21 patients treated by rTSA with these average results. ORIF: Flexion 112.8°, Abduction 99.6°, External rotation at 90° 47.4°, modal Internal rotation hand at Sacroiliac joint, Constant Score 52.9 and Simple Shoulder Test 8.0. RSA: Flexion 133.3°, Abduction 101.4°, External rotation at 90° of abduction 35.5°, modal Internal rotation hand at waist (L3), Constant Score 65.9 and Simple Shoulder Test 9.2. No nerve injuries were reported. No cases of pseudo-arthrosis or plate fractures. No arthroplasty implant loosening, infection or dislocation was documented and revision required. Conclusion: Our study shows good clinical outcomes and fewer complications in both treatment options. Better clinical and daily living results are reported in RSA compared with ORIF, confirming that rTSA is one of the best treatment in proximal humeral fractures in the elderly patients, which rotator cuff status frequently is poor and degenerating. The few radiological complications do not seem to have influence on active ROM and Constant Score, both the first and the second group of patients. Level of evidence: Level IV, Case Series, Surgical.

No abstract

Treatment for an initial incidence of patellar dislocation is usually conservative management; however, almost half of patients experience a subsequent, or multiple, dislocation(s). Patients often undergo multiple procedures which fail to treat the underlying anatomic abnormalities. The objective of this study was to evaluate interactions between key predisposing anatomic factors to patellar dislocation and identify combinations of abnormal factors which increase the risk of recurrent lateral dislocation. Four factors associated with lateral patellar dislocation were identified (sulcus angle, Insall-Salvati ratio, tibial tubercle-trochlear groove distance, and femoral anteversion). A finite element model of the patellofemoral joint was developed and parameterized so that a value for each factor could be applied and the model geometry/alignment would be modified accordingly. 100 combinations of the four factors were generated in separate computational simulations and resulting kinematics and forces of the patellofemoral joint were recorded. Sulcus angle was the most impactful factor on constraint. Multiple abnormal factors were generally required to produce the extremes of patellar alignment observed in this analysis. Understanding the underlying anatomic factors, and their effect on joint mechanics, for patients with recurrent lateral patellar dislocation will aid in determining optimal treatment pathways on a patient-specific basis.

IV.

Background: Rotator cuff muscle atrophy and fatty infiltration are predictors of negative outcomes after rotator cuff repair. However, the impact of muscle degeneration on nonsurgical treatment is unknown. Hypothesis: Rotator cuff muscle atrophy and fatty infiltration will reduce the outcomes of operative repair while having a minimal effect on nonsurgical treatment. Additionally, in the setting of atrophy and fatty infiltration, surgical and nonsurgical treatment will produce equivalent outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing operative and nonoperative treatment of full-thickness rotator cuff tears were prospectively enrolled into a nonrandomized cohort study. Muscle quality was assessed on magnetic resonance imaging by use of the supraspinatus tangent sign, Warner atrophy, and Goutallier fatty infiltration classifications. Grading was performed by 2 independent observers who were blinded to patient treatment and outcomes. Normalized Western Ontario Rotator Cuff (WORC) index was the primary patient-reported outcome. Multivariate linear regression analysis was used to determine the impact of muscle quality on treatment outcomes. Results: The cohort consisted of 157 patients, 89 (57%) surgical and 68 (43%) nonsurgical, with a mean follow-up of 2.4 years (range, 1-5 years). Tangent sign had the best inter- and intrarater reliability, with kappa statistics of 0.81 and 0.86, respectively. Reliability for Warner atrophy was 0.69 to 0.76 and for Goutallier classification was 0.54 to 0.64. Overall, improvement in WORC scores was higher in the surgical group than the nonsurgical group (39.3 vs 21.2; P < .001). A positive tangent sign was the only independent predictor ( P < .01) of worse outcomes in the surgical group, accounting for an estimated 22-point lower improvement in WORC scores. Conclusion: A positive tangent sign was predictive of worse operative outcomes, resulting in equivalent improvements between surgical and nonsurgical treatment. The tangent sign is a reliable, prognostic indicator that clinicians can use when counseling patients on the optimal treatment of rotator cuff tears.

Background: Traumatic anterior shoulder instability is a common condition affecting sports participation among young athletes. Clinical outcomes after surgical management may vary according to patient activity level and sport involvement. Overhead athletes may experience a higher rate of recurrent instability and difficulty returning to sport postoperatively with limited previous literature to guide treatment. Purpose: To report the clinical outcomes of patients undergoing primary arthroscopic anterior shoulder stabilization within the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Consortium and to identify prognostic factors associated with successful return to sport at 2 years postoperatively. Study Design: Case series; Level of evidence, 4. Methods: Overhead athletes undergoing primary arthroscopic anterior shoulder stabilization as part of the MOON Shoulder Instability Consortium were identified for analysis. Primary outcomes included the rate of recurrent instability, defined as any patient reporting recurrent dislocation or reoperation attributed to persistent instability, and return to sport at 2 years postoperatively. Secondary outcomes included the Western Ontario Shoulder Instability Index and Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow questionnaire score. Univariate regression analysis was performed to identify patient and surgical factors predictive of return to sport at short-term follow-up. Results: A total of 49 athletes were identified for inclusion. At 2-year follow-up, 31 (63%) athletes reported returning to sport. Of those returning to sport, 22 athletes (45% of the study population) were able to return to their previous levels of competition (nonrefereed, refereed, or professional) in at least 1 overhead sport. Two patients (4.1%) underwent revision stabilization, although 14 (28.6%) reported subjective apprehension or looseness. Age ( P = .87), sex ( P = .82), and baseline level of competition ( P = .37) were not predictive of return to sport. No difference in range of motion in all planes ( P > .05) and Western Ontario Shoulder Instability Index scores (78.0 vs 80.1, P = .73) was noted between those who reported returning to sport and those who did not. Conclusion: Primary arthroscopic anterior shoulder stabilization in overhead athletes is associated with a low rate of recurrent stabilization surgery. Return to overhead athletics at short-term follow-up is lower than that previously reported for the general athletic population.