Bone tunnel enlargement has been reported after anterior cruciate ligament (ACL) reconstruction surgery. Although the long-term outcome of this phenomenon is not yet known, tunnel lysis or expansion may be clinically significant in revision surgery because the enlarged tunnels may complicate graft placement and fixation. There any many proposed theories for tunnel lysis. The most accurate statement is that this condition has a multifactorial etiology. Mechanical and biological causes have been reported, and both contribute to enlarged graft tunnels. This article describes the multiple causes of bone tunnel enlargement after ACL surgery. Future techniques and advances in primary ACL surgery must seek to eliminate this phenomenon.

The use of LISS plates appears to stabilize complex fractures of the tibial plateau with a low incidence of complications. The LISS system functioned well in maintaining alignment and obtaining union in these high-energy fractures.

The use of bioabsorbable implants has become commonplace in the treatment of shoulder rotator cuff and labral injuries. These absorbable implants were specifically designed to allow sufficient time for healing to occur before their gradual resorption. First-generation implants were composed of polyglycolic acid (PGA) and found to rapidly absorb and cause significant foreign body reactions. 2 The next generation of implants was made of the homopolymer poly-L-lactic acid (PLLA) and was designed to degrade at a much slower rate. 4,9 Various researchers have observed small areas of osteolysis after repair of shoulder abnormalities with absorbable anchors. Both biological and mechanical theories exist to account for the lytic changes. 4,7-10 We present a case of poly(L-lactide-co-D, Llactide) (PLDLA) suture anchor fixation of both a rotator cuff tear and a superior labral anterior posterior (SLAP) lesion with the development of extensive osteolysis in the humeral head. We propose that the mechanism for the lysis was a mechanical one because no lysis appeared in the glenoid around the other PLDLA implant. CASE REPORTA 20-year-old National Collegiate Athletic Association Division I defensive back complained of pain in his right shoulder for several months after a fall on an outstretched arm. He noted pain in the anterolateral aspect of the shoulder exacerbated with lifting weights and abduction of the shoulder. On examination, he had full range of motion with slight decrease in strength of the supraspinatus muscle. No atrophy of the rotator cuff or surrounding musculature was noted. There was no evidence of instability on examination. In addition, he had a negative active compression test result and positive impingement signs. Treatment with rotator cuff rehabilitation and antiinflammatory drugs was initiated.He continued to play with improved, periodic symptoms. However, he reinjured the shoulder during a game when he fell directly on it and noted a sensation of the shoulder shifting in and out of place. Radiographs were obtained ( Figure 1), and an MRI showed a rotator cuff tear and superior labral abnormality. Based on his ongoing symptoms for nearly 1 year with recent exacerbation and the MRI findings, plans were made to proceed with arthroscopic evaluation and treatment of rotator cuff and labral abnormality.A type II SLAP lesion was arthroscopically repaired with a single Arthrex Bio-Fastack (Naples, Fla) absorbable suture anchor. A small full-thickness tear of the supraspinatus was repaired with a mini-open technique using an Arthrex Bio-Corkscrew suture anchor. Both anchors are molded from PLDLA with an insert-molded eyelet of nonabsorbable polyester suture. The PLDLA implants were placed in standard fashion, using a tap to create the insertion site for the anchor.Postoperatively, he progressed well, and he resumed playing college football the next season. On examination at 8 months after surgery, he had full active and passive range of motion. His shoulder was stable with no evidence of instability. The O'Brie...

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Complete avulsions of the superficial and deep medial collateral ligament from the tibia with disruption of the meniscal coronary ligament should be managed with acute surgical repair for maximum benefit.

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