Acetabular paralabral cyst: an unusual cause of femoral vein compression.

Acetabular labral tears are a known cause of hip pain in the young, active patient. Labral tears can be due to trauma, femoroacetabular impingement, capsular laxity, dysplasia, and degenerative pathology. Paralabral cysts are relatively common in association with labral tears of the hip, with cysts seen on magnetic resonance imaging studies in as many as 50% to 70% of patients with labral tears. In some cases the cysts can become sizeable and cause neurovascular compression. Nonoperative interventions for the management of paralabral cysts in the shoulder and knee have shown high recurrence rates. In the shoulder and knee, arthroscopic debridement of paralabral cysts has shown good results with lower recurrence rates and resolution of neurovascular function. In the hip there is limited literature regarding surgical management of paralabral cysts. We present a surgical technique for arthroscopic decompression of acetabular paralabral cysts combined with labral repair.

MPFL reconstruction: technique and results.

Patellar instability is a common problem, and medial patellofemoral ligament (MPFL) injury is inherent with traumatic patellar dislocations. Initial nonoperative management is focused on reconditioning and strengthening the dynamic stabilizers of the patella. For those patients who progress to recurrent instability, further investigation into the predisposing factors is required. MPFL reconstruction is indicated in patients with recurrent instability and insufficient medial restraint due to MPFL injury. A technique of MPFL reconstruction is outlined. This procedure may also be performed in combination with other realignment procedures.

Suture placement near the musculotendinous junction in the supraspinatus: implications for rotator cuff repair.

BACKGROUND: Transosseous-equivalent rotator cuff repair has an increased incidence of medial rotator cuff failure compared with single-row repair. No studies have evaluated the influence of the proximity of the suture row to the musculotendinous junction (MTJ) on cyclic gapping and failure properties. HYPOTHESIS: A single row of horizontal mattress sutures placed within the supraspinatus tendon lateral to the MTJ will experience less gap formation and higher failure loads than a similar suture row placed at the MTJ. STUDY DESIGN: Controlled laboratory study. METHODS: Paired supraspinatus tendons were isolated from human cadaveric specimens and resected at the tendon insertion to the humerus. Randomized within a pair, a single row of 4 horizontal mattress sutures was placed either in the tendon 5 mm lateral to the MTJ or at the MTJ. The tied sutures secured the tendon to a fixture that ensured consistent placement of the suture row in the tendon and static fixation of the row. The muscle belly was gripped in a cryoclamp, and a servohydraulic materials testing machine was used to provide uniaxial tensile deformation for 500 cycles at 1 Hz, followed by load to failure at 1 mm/s. Fiducial markers with video tracking were used to quantify gap formation at the suture line, while the materials testing machine recorded loading for the cyclic and failure tests. RESULTS: During cyclic loading, both constructs experienced gross initial gap formation, followed by progressive gap formation that plateaued after cycle 200. The MTJ specimens had significantly higher mean cumulative gapping than the tendon specimens: 3.6±1.0 mm versus 2.4±0.6 mm, respectively (P=.012). The tendon specimens had significantly higher mean loads to failure than did the MTJ specimens: 567.1±121.8 N versus 434.2±148.1 N, respectively (P=.013). The mean failure displacement did not differ between groups for the tendon and MTJ: 5.7±2.5 mm versus 4.5±2.0 mm, respectively (P=.144). CONCLUSION: A horizontal suture row placed at the MTJ has inferior mechanical properties (increased gapping, decreased load support) as compared with a suture row placed 5 mm laterally within the tendon. CLINICAL RELEVANCE: The integrity of rotator cuff repair may be compromised if sutures are placed too close to the MTJ.

MPFL reconstruction: technique and results.

MPFL reconstruction is a viable option for treating patients with recurrent patellar instability, in whom nonoperative methods have failed to provide relief. It is important to evaluate patients for predisposing factors for patellar instability. This technique of MPFL reconstruction uses a reliable method to obtain anatomic tunnel position. Rigid fixation with interference fit in bone tunnels allows early range of motion and rehabilitation and minimizes concern for graft failure.

The effect of delay time between primary melanoma biopsy and sentinel lymph node dissection on sentinel node status, recurrence, and survival.

For primary melanoma, there is a delay between the initial skin biopsy and sentinel lymph node dissection, which may cause anxiety for the patient. The consequences of this delay on disease progression are unknown. The goal of this study was to determine whether delay time for sentinel node dissection from the initial cutaneous melanoma biopsy affects patient outcomes. A retrospective analysis of 492 patients with melanoma who underwent a sentinel node dissection between 1993 and 1999 was carried out. The endpoints assessed were sentinel node tumor status, recurrence, and mortality. Time to sentinel node dissection was compared between patients with positive and negative sentinel nodes. Long-term survival and recurrence were evaluated in relation to the time between the cutaneous biopsy and the sentinel node dissection (delay time), comparing less than 40 days with at least 40 days. In total, 15.9% of patients had positive sentinel nodes. The median follow-up was 11.7 years. Positive sentinel node patients had a median delay of 35 days between the primary melanoma biopsy and the sentinel node dissection compared with 41 days for negative sentinel node patients (P=0.5). Kaplan-Meier survival curves showed that a delay time of less than 40 days versus at least 40 days was not related to recurrence of melanoma (log-rank P=0.13) or overall survival (log-rank P=0.14). On multivariate analysis of age, thickness, ulceration, and sentinel node status, there was no difference in disease-free survival (P=0.58) or overall survival (P=0.53) between the less than 40 days and the at least 40 days groups. A modest delay in sentinel node dissection from the initial melanoma biopsy does not adversely affect sentinel node status, recurrence, nor survival.