Rotator Cuff Augmentation: Its Role and Best Practices.

Rotator cuff tears are a common source of pain and impairment in the shoulder. Healing of the rotator cuff tendons following repair has been associated with improved patient outcomes. While there have been many technical improvements in surgical techniques for rotator cuff repair, failure rates are still surprisingly high. Augmentation of these repairs has been shown to help with fixation biomechanics as well as healing rates. The described types of augments include autograft, allograft, xenograft, and synthetic options. This report reviews the commonly available types of augments and some of the outcomes associated with their use.

Chronic Midsubstance Patellar Tendon and Retinacular Rupture: Primary Repair Enhancement Using Bioinductive Implant Augmentation.

Midsubstance tears of the patellar tendon are uncommon and present a difficult injury to treat. If left untreated, these can be debilitating injuries for patients and leave them with an overall lack of function in the injured extremity. Compared to a proximal or distal patellar tendon rupture, midsubstance tears rely on tendon-to-tendon healing instead of bone to tendon healing. Given this situation, specific preoperative planning and the use of a bioinductive scaffolding allows surgeons to enhance the overall construct, while promoting a beneficial healing environment. Although the addition of bioinductive implants has grown in popularity for upper extremity injuries, few cases describe its use in the lower extremity setting. Here, we present a case of midsubstance patellar tendon repair, as well as a medial and lateral retinacular repair using a structural biological implant with Type I collagen for augmentation to enhance our overall final construct.

Isolated Posterior Medial Ankle Dislocation with Associated Os Trigonum Dislocation after Low-Energy Mechanism.

We describe a case of an isolated posteromedial ankle dislocation, without malleolar fracture, with associated dislocation of an os trigonal process after a low-energy tennis injury. We demonstrate that nonoperative treatment results in excellent functional outcome scores with minimal arthritic progression at 2 years of follow-up. We discuss pathoanatomic risk factors of pure dislocations and propose that an os trigonum is a risk factor for isolated dislocations of the ankle.

The Relationship Between Vertical Ground Reaction Force, Loading Rate, and Sound Characteristics During a Single-Leg Landing.

CONTEXT: Landing kinetic outcomes are associated with injury risk and may be persistently altered after anterior cruciate ligament injury or reconstruction. However, it is challenging to assess kinetics clinically. The relationship between sound characteristics and kinetics during a limited number of functional tasks has been supported as a potential clinical alternative. OBJECTIVE: To assess the relationship between kinetics and sound characteristics during a single-leg landing task. DESIGN: Observational Setting: Laboratory. PARTICIPANTS: There was total of 26 healthy participants (15 males/11 females, age = 24.8 [3.6] y, height = 176.0 [9.1] cm, mass = 74.9 [14.4] kg, Tegner Activity Scale = 6.1 [1.1]). INTERVENTION: Participants completed single-leg landings onto a force plate while audio characteristics were recorded. MAIN OUTCOME MEASURES: Peak vertical ground reaction force, linear loading rate, instantaneous loading rate, peak sound magnitude, sound frequency were measured. Means and SDs were calculated for each participant's individual limbs. Spearman rho correlations were used to assess the relationships between audio characteristics and kinetic outcomes. RESULTS: Peak sound magnitude was positively correlated with normalized peak vertical ground reaction force (ρ = .486, P = .001); linear loading rate (ρ = .491, P = .001); and instantaneous loading rate (ρ = .298, P = .03). Sound frequency was negatively correlated with instantaneous loading rate (ρ = -.444, P = .001). CONCLUSIONS: Peak sound magnitude may be more helpful in providing feedback about an individual's normalized vertical ground reaction force and linear loading rate, and sound frequency may be more helpful in providing feedback about instantaneous loading rate. Further refinement in sound measurement techniques may be required before these findings can be applied in a clinical population.

Reactive Strength Index and Knee Extension Strength Characteristics Are Predictive of Single-Leg Hop Performance After Anterior Cruciate Ligament Reconstruction.

Birchmeier, T, Lisee, C, Geers, B, and Kuenze, C. Reactive strength index and knee extension strength characteristics are predictive of single-leg hop performance after anterior cruciate ligament reconstruction. J Strength Cond Res 33(5): 1201-1207, 2019-Single-leg hop distance is incorporated into return to sport criteria after anterior cruciate ligament reconstruction (ACLR) because of its relationship with knee extension strength; however, it may be related to other strength and plyometric characteristics. The purpose of this study was to assess the association between isometric knee extension strength and plyometric characteristics, including amortization and reactive strength index (RSI), measured during a single-leg drop vertical jump and single-leg hop performance in individuals with unilateral ACLR. Participants attended 2 testing sessions. During the first session, a biomechanical analysis using a 3D motion capture system was performed to measure RSI and amortization during a single-leg drop vertical jump for maximal height. Participants completed a single hop and a triple hop for maximal distance. During the second session, isometric knee extension strength was measured during a maximal voluntary isometric contraction. Strength characteristics included peak torque, rate of torque development (RTD), RTD 0-100 ms (RTD 100), and RTD 100-200 ms (RTD 200). Fifty-two individuals (17 men/35 women) participated. Multivariable regression models revealed jump height, peak torque, and RTD 200 explained 60.9% of the variance in normalized single-leg hop distance (p < 0.001). Reactive strength index, peak torque, RTD 200, and RTD 100 significantly explained 61.8% of the variance in normalized triple hop distance (p < 0.001). Single hop distance may indicate improved knee extension strength, whereas triple hop distance may indicate improvement in reactive strength. Training to improve RSI may improve triple hop performance and clinical outcomes in this population.