The purpose of this report is to describe an arthroscopic technique using a semitendinosus allograft to reconstruct chronic grade III, IV, or V acromioclavicular joint separations. Indications for arthroscopic surgery include pain, functional limitation, severe cosmetic deformity, and failure of nonoperative treatment. Twelve patients were managed by this technique during a 2-year period. All 12 were reevaluated 2 to 4 years postoperatively. Of the 12 patients, 10 had satisfactory to excellent results. Two patients lost reduction: 1 was subsequently repaired with an excellent result and 1 loss of approximately 5 mm of reduction with no consent for follow-up procedure at this time. There was a 25% complication rate. The arthroscopic technique for reconstruction of the dislocated acromioclavicular joint is still evolving but shows much promise for the future management of these problematic injuries.
Anterior cruciate ligament (ACL) injuries are relatively common and can lead to knee dysfunction. The classic presentation is a non-contact twisting injury with an audible pop and the rapid onset of swelling. Prompt evaluation and diagnosis of ACL injuries are important. Acute treatment consists of cessation of the sporting activity, ice, compression, and elevation with evaluation by a physician familiar with ACL injuries and their management. The diagnosis is made with the use of patient history and physical examination as well as imaging studies. Radiographs may show evidence of a bony injury. MRI confirms the diagnosis and evaluates the knee for concomitant injuries to the cartilage, menisci and other knee ligaments. For active patients, operative treatment is often recommended while less-active patients may not require surgery. The goal of this review is to discuss the diagnosis of an ACL injury and provide clear management strategies for the primary-care sports medicine physician.
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