Osteochondral Reconstruction of the Capitellum.

Osteochondritis dissecans (OCD) of the capitellum is a relatively rare condition, with a higher incidence in adolescents who participate in repetitive overhead sports. The surgical treatment approach for this uncommon problem has varied from microfracture, loose body removal, abrasion chrondroplasty, lesion fixation, osteochondral allograft transplantation surgery, and osteochondral autologous transplantation surgery. The purpose of this study is to present the authors' preferred surgical technique for the treatment of unstable OCD lesions of the capitellum with osteochondral autologous transplantation surgery using autograft from the ipsilateral knee.

A biomechanical comparison of 2 hybrid techniques for elbow ulnar collateral ligament reconstruction.

PURPOSE: To compare the valgus laxity and fixation strength of 2 hybrid techniques for elbow ulnar collateral ligament reconstructions. METHODS: Reflective markers were placed near the ligament attachments of the ulnar collateral ligament on the humerus and ulna of 12 fresh-frozen cadaveric upper extremities for tracking displacement with 4 motion analysis cameras. Valgus laxity testing was performed on the intact, disrupted ligament, and reconstructed elbows by applying a 3.0 Nm moment across the joint at 15° intervals throughout elbow motion from 0° to 120°. Two hybrid techniques for ulnar collateral ligament reconstruction were performed: a proximal docking method and a single-point distal fixation method. Failure testing was performed with the elbow at 90° by applying a cyclic valgus load 12 cm distal to the joint that we increased in 10-N intervals. RESULTS: Valgus laxity testing revealed no difference in ligament displacements between the 2 techniques over the entire range of elbow motion. Ligament displacement for the proximal docking hybrid technique was significantly higher than the intact at 0° and 15° of elbow flexion. Failure testing revealed no differences in ligament displacements or failure load between the 2 techniques. CONCLUSIONS: Both the proximal docking and the single-point fixation hybrid reconstructions provided sufficient joint stability and strength compared to the intact elbows, with the exception of the proximal docking method at low flexion angles. The reconstructions were not significantly different with respect to valgus laxity or graft fixation displacement at failure. CLINICAL RELEVANCE: The proximal docking and single-point fixation hybrids tested here are both viable surgical options with sufficient strength and valgus laxity mechanics, warranting clinical evaluation.

Elbow arthroscopy: the basics.

Elbow arthroscopy has become an accepted surgical option for treating numerous conditions of the elbow, including septic, degenerative, or traumatic arthritis; capsular release; removal of loose bodies; synovectomy or plica excision; and chondral lesions of the capitellum. Surgeon experience, knowledge of elbow anatomy, patient positioning, and portal selection and placement are important factors for successful arthroscopy and avoiding complications. This article describes the basic surgical setup and technique for elbow arthroscopy.

Reconstruction of the medial collateral ligament of the elbow.

Since Dr. Frank Jobe initially reported his first series for reconstruction of the medial collateral ligament (MCL) of the elbow in 1986, many modifications have been developed to improve the strength, safety, and efficacy of the procedure. High stresses occur across the anterior bundle of the MCL during the late cocking and early acceleration phases of throwing. Reported failures for reconstruction of the MCL have included stress fractures at the ulnar bone bridge or the distal humerus tunnels. In early techniques, graft placement was not anatomic, and it could not be tensioned appropriately in surgery. Hybrid modifications have arisen to improve patient outcomes and lessen patient morbidity. We propose an alternative, hybrid technique using small bone tunnels in the medial epicondyle and a single, bioabsorbable screw in the ulna for anatomic reconstruction of both bundles of the MCL that can be tensioned before fixation.

Bilateral ruptures of the distal biceps brachii tendon.

BACKGROUND: The purpose of this study was to identify characteristics associated with bilateral ruptures of the distal biceps tendons. METHODS: We present a retrospective case series of 25 patients who sustained non-simultaneous bilateral distal biceps brachii tendon ruptures that were repaired surgically, with follow-up available on 10 patients. The average age of the patients was 50 years (range 28-76). All patients were male. The mean time from the first tendon rupture to the contralateral tendon rupture was 2.7 years (range 0.5 - 6.3). Follow-up averaged 45 months (range 24-85). RESULTS: Patients with bilateral ruptures tended to be middle-aged men, who commonly participated in weight lifting, manual labor, or sports, and who had higher rates of nicotine (50%) and anabolic steroid use (20%) than the general population. After surgical repair of 9 of 10 patients, patients with bilateral distal biceps tendon ruptures had good to excellent outcomes. With the numbers available, outcomes were not statistically associated with manual labor, past medical history, prescription medications, prior tendon injury, body mass index, current activity in sports, use of nutritional supplements, or anabolic steroid use, although worker's compensation claims approached statistical significance (p = 0.059). CONCLUSIONS: Patients who sustained bilateral distal biceps tendon ruptures tended to be middle-aged men with higher rates of nicotine and anabolic steroid use than the general population.