Meniscal repair and reconstruction.

Meniscus injuries are one of the most commonly encountered problems by orthopaedic surgeons today. Surgical techniques for the treatment of meniscal tears are evolving. While many tears can only be treated with partial menisectomy, there are an increasing number of surgical techniques to repair or reconstruct the meniscus. Because of the large increases in contact pressures across the articular cartilage due to loss of meniscal tissue, there has been increased focus on preventing the development of degenerative joint disease from meniscal injuries requiring partial or subtotal menisectomy. Some of these newer techniques include allografts, scaffolds, collagen implants, and repair enhancements. The common goal of these newer techniques is to preserve or restore as much normal, functioning meniscal tissue as possible. This review aims to review the various techniques and history of meniscus repair as well as examine of the newer techniques being introduced to reconstruct or replace the meniscus.

Fixation systems of greater trochanteric osteotomies: biomechanical and clinical outcomes.

The development of cerclage systems for fixation of greater trochanteric osteotomies has progressed from monofilament wires to multifilament cables to cable grip and cable plate systems. Cerclage wires and cables have various clinical indications, including fixation for fractures and for trochanteric osteotomy in hip arthroplasty. To achieve stable fixation and eventual union of the trochanteric osteotomy, the implant must counteract the destabilizing forces associated with pull of the peritrochanteric musculature. The material properties of cables and cable grip systems are superior to those of monofilament wires; however, potential complications with the use of cables include debris generation and third-body polyethylene wear. Nevertheless, the cable grip system provides the strongest fixation and results in lower rates of nonunion and trochanteric migration. Cable plate constructs show promise but require further clinical studies to validate their efficacy and safety.

Lower extremity injuries in the skeletally immature athlete.

The heightened intensity of training and competition among young athletes places them at increased risk for both acute and chronic injuries. Prompt recognition and treatment of such injuries are critical to prevent long-term functional disability and deformity. These injuries occur in patterns unique to the skeletally immature athlete, given their developing epiphyses and ossification centers and supporting ligamentous structures. Children and adolescents who participate in recreational and organized sports are particularly susceptible to a broad spectrum of lower extremity injuries involving both the osseous and soft-tissue structures. Fundamental knowledge of the pathophysiology of injury helps the clinician in determining management. Early recognition of acute traumatic injuries, along with preventive regimens and knowledge of both nonsurgical and surgical treatment protocols, has helped to restore and maintain normal lower extremity function in the skeletally immature athlete.

A mechanical evaluation of two fixation methods using cancellous screws for coronal fractures of the lateral condyle of the distal femur (OTA type 33B).

PURPOSE: To compare the relative strength and stability of 2 fixation methods for displaced coronal shear fractures of the lateral femoral condyle (Hoffa fractures, OTA Type 33B3). SETTING: University Biomechanics laboratory. DESIGN: Eight matched pairs of embalmed femurs were divided into 2 groups and simulated Hoffa fractures were created. In each pair, 1 of the fractures was fixed with 2 screws placed in an anteroposterior direction, and in the other, the fracture was fixed with 2 screws placed in a posteroanterior direction. METHODS: All specimens were cyclically tested with simulated physiologic loading. Displacement of the femoral condyle was continuously measured to 10 cycles. The specimens were then loaded to failure. RESULTS: Fixation with posterior to anteriorly placed cancellous lag screws was significantly more stable than that with anterior to posteriorly placed screws at 10 cycles (P = 0.05), with 0.67 mm displacement compared to 1.36 mm, respectively. They were also more stable at 10, 100, and 1000 cycles; however, these displacements were not statistically significant. Fixation with posteriorly placed cancellous screws also had significantly higher ultimate strength (P = 0.04), 1700 N compared to 1025 N for anterior placement. CONCLUSION AND SIGNIFICANCE: Lag screws placed posterior to anterior provided more stable fixation of Hoffa fractures in embalmed femurs than anteroposteriorly placed lag screws. This finding may apply in the clinical setting; however, this technique requires that the screw heads be recessed beneath the articular surface. The effects of the cartilage defects so created are not known. The choice of technique is also determined by concomitant fractures and the exposure required for their fixation.

The effects of home interferential therapy on post-operative pain, edema, and range of motion of the knee.

OBJECTIVE: We studied the effects of home interferential current therapy (IFC) on postoperative pain, range of motion, and edema in subjects undergoing anterior cruciate ligament (ACL) reconstruction, menisectomy, or knee chondroplasty. DESIGN: Randomized, double-blind, placebo-controlled prospective study. SETTING: A tertiary care outpatient orthopaedic clinic/ambulatory surgery center. SUBJECTS OR PARTICIPANTS: Eighty-seven subjects were separated into three groups based on their type of knee surgery and within each group randomized into a treatment or placebo group. INTERVENTIONS: All subjects received home IFC units. Subjects randomized to treatment group received a working IFC unit. Placebo subjects received units that were previously set to deliver no current. MAIN OUTCOME MEASUREMENTS: Post-operative edema at 24, 48, and 72 hours, and weeks 1-8; range of motion at 1, 3, 6, and 9 weeks; pain immediately after surgery, at 24, 48, and 72 hours, and weeks 1-7; and amount of pain medication taken at days 1-10 were compared between treatment and placebo groups. RESULTS: All IFC subjects reported significantly less pain and had significantly greater range of motion at all post-operative time points. ACL and menisectomy IFC subjects experienced significantly less edema at all time points, while chondroplasty subjects experienced significantly less edema until 4 weeks postoperatively. CONCLUSIONS: These findings indicate that home IFC may help reduce pain, pain medication taken, and swelling while increasing range of motion in patients undergoing knee surgery. This could result in quicker return to activities of daily living and athletic activities.