The Prevalence of Cam Morphology: A Cross-Sectional Evaluation of 3,558 Cadaveric Femora.

Purpose: We sought to determine (1) the prevalence of cam deformity in the population and that of bilateral cam deformity, (2) the typical location of a cam lesion, and (3) the typical size of a cam lesion by direct visualization in cadaveric femora. Methods: Two observers inspected 3,558 human cadaveric femora from the Hamann-Todd Osteological Collection from the Cleveland Museum of Natural History. Any asphericity >2 mm from the anterior femoral neck line was classified as a cam lesion. Once lesions had been inspected, the prevalence in the population, prevalence by gender, and prevalence of bilateral deformity were determined. Additionally, each lesion was measured and localized to a specific quadrant on the femoral neck based upon location of maximal deformity. Results: Cam lesions were noted in 33% of males and 20% of females. Eighty percent of patients with a cam lesion had bilateral lesions. When stratified by location of maximal deformity, 90.9% of lesions were in the anterosuperior quadrant and 9.1% were in the anteroinferior quadrants. The average lesion measured 17 mm long × 24 mm wide × 6 mm thick in men and 14 mm × 22 mm × 4 mm in women (p < 0.05). Conclusions: The population prevalence of cam deformity determined by direct visualization in cadavers may be higher than has been suggested in studies utilizing imaging modalities. Level of Evidence : Level II, diagnostic study.

Excision and Reimplantation of the Proximal Humerus After Fracture-Dislocation.

Fractures of the proximal humerus are common and the treatment for both displaced and comminuted variants remains controversial. Treatment options initially consisted of closed reduction, traction, casting, and abduction splints. In the early 1930s, operative treatment for displaced fractures gained popularity, which continued in the 1940s and 1950s. Humeral head replacement for severely displaced fractures of the proximal humerus was introduced in the 1950s. In the 1970s, the Association for Osteosynthesis/Association for the Study of Internal Fixation popularized plates and screws for fracture fixation, and humeral head prostheses were redesigned. The traditional management of severely displaced proximal humerus fractures has been with arthroplasty because of the significant risk of osteonecrosis of the humeral head following open reduction and internal fixation. The authors present a case of a 51-year-old right-hand-dominant man who sustained a seizure along with a posteriorly displaced proximal humerus fracture-dislocation of the right upper extremity. This was treated with surgical extrusion of the entire humeral head and subsequent open reduction and internal fixation. During the surgical procedure, the patient's humeral head was completely extruded from the body through a posterior incision and then reduced back to the proximal humerus through the standard anterior deltopectoral approach. After 4 years of follow-up, the patient remains pain free, has functional range of motion, and is without signs of osteonecrosis on plain radiographs. This case illustrates that even with complete disruption of the vascular supply to the humeral head, revascularization after osteosynthesis is possible. [Orthopedics. 2016; 39(4):e779-e782.].

Arthroscopic Reverse Remplissage for Posterior Instability.

Posterior shoulder dislocation is an unusual injury often associated with electrical shock or seizure. As with anterior instability, patients frequently present with an impaction injury to the anterior aspect of the humeral head known as a "reverse Hill-Sachs lesion." The treatment of this bony defect is controversial, and multiple surgical procedures to fill the defect in an effort to decrease recurrence have been described. Most of the reports have focused on an open approach using variations of lesser tuberosity and subscapularis transfers, bone allograft, and even arthroplasty to assist with persistent instability. We advocate an arthroscopic technique that involves a suture anchor-based distal tenodesis of the subscapularis tendon or a reverse remplissage procedure.

Transosseous Medial Meniscal Root Repair Using a Modified Mason-Allen Suture Configuration.

Medial meniscal tears are among the most common injuries to the knee joint. Loss of the meniscus has been linked to increased contact pressures on the adjacent articular cartilage and progression of degenerative changes in the knee. A subset of tears known as "root tears" involves the insertion of the posterior horn of the meniscus to the bone. Arthroscopic partial meniscectomy for root tears led to undesirable outcomes, which prompted surgeons to explore restorative procedures. Multiple repair techniques have been presented with an emphasis placed on initial secure fixation and stimulation of potential healing. We present an arthroscopic-assisted technique for medial meniscal root repair with these goals in mind.

Levels of evidence in research published in The Journal of Bone and Joint Surgery (American Volume) over the last thirty years.

BACKGROUND: The recent emphasis on evidence-based medicine has led to increasing levels of evidence being published in surgical journals. The purpose of the present study was to review the levels of evidence in reports published in The Journal of Bone and Joint Surgery (American Volume) over the last thirty years. METHODS: We reviewed all of the articles published in The Journal in the years 1975, 1985, 1995, and 2005. Cadaver studies, animal studies, basic-science studies, review articles, Instructional Course Lectures, and correspondence were excluded. Articles were scored according to The Journal's levels of evidence for a primary research question. RESULTS: A total of 1058 articles were reviewed. Of these, 134, 123, 120, and 174 articles met the inclusion criteria for the years 1975, 1985, 1995, and 2005, respectively, and were ranked according to level of evidence. The number of articles for each level of evidence rating was then expressed as a percentage of the total number of articles meeting the inclusion criteria for that year. There was a significant trend toward higher levels of evidence, with the combined percentage of Level-I, II, and III studies increasing from 17% to 52% (p < 0.01). The percentage of Level-I studies increased from 4% in 1975 to 21% in 2005. The average level of evidence rating improved from 3.72 to 2.90 during the study period. CONCLUSIONS: The level of evidence in The Journal has improved significantly over the last thirty years.

Salicylic acid inhibits gibberellin-induced alpha-amylase expression and seed germination via a pathway involving an abscisic-acid-inducible WRKY gene.

It is well known that abscisic acid (ABA) antagonizes gibberellin (GA)-promoted seed germination. Recent circumstantial evidence suggests that salicylic acid (SA) also inhibits seed germination in maize and Arabidopsis. Our study shows that SA blocks barley seed germination in a dosage dependent manner. As an initial effort to addressing the mechanism controlling the crosstalk of SA, GA and ABA signaling in barley, we studied the regulation of alpha-amylases by SA and a WRKY gene whose expression is modulated by these hormones. Assays of alpha-amylase activity reveal that GA-induced alpha-amylase production in aleurone cells is inhibited by bioactive SA, but not its analogs, 3-hydroxybenzoic acid and 4-hydroxybenzoic acid. This inhibitory effect is unlikely due to repressing alpha-amylase secretion or inhibiting alpha-amylase enzyme activities. Northern blot analyses indicate that SA suppresses GA-induced expression of a barley low pI alpha-amylase gene (Amy32b). Because our previous data indicate that ABA-inducible and GA-suppressible WRKY genes inhibit the expression of alpha-amylase genes in rice, we studied the steady state mRNA levels of a barley WRKY gene, HvWRKY38. The expression of HvWRKY38 in barley aleurone cells is down-regulated by GA, but up-regulated by SA and ABA. However, the regulation of HvWRKY38 by SA appears to be different from that of ABA in term of the kinetics and levels of induction. Over-expression of HvWRKY38 in aleurone cells by particle bombardment blocks GA induction of the Amy32b promoter reporter construct (Amy32b-GUS). Therefore, HvWRKY38 might serve as a converging node of SA and ABA signal pathways involved in suppressing GA-induced seed germination.