Empty Sunrise Sign: An Arthroscopic Finding in Recurrent Patellar Dislocation.

Patellar dislocation is a relatively common knee injury and can be challenging to diagnose. We describe an arthroscopic finding we noted in recurrent patellar dislocation. Arthroscopic photos were evaluated from 50 knees with a history patellar dislocation and 100 control patients. We quantified the amount of patellar subluxation seen on a single arthroscopic view and coined it Empty Sunrise Sign if the patella did not overlap the trochlea. Empty Sunrise Sign was found in 82% of 50 cases with recurrent patellar dislocation and none of the 100 control cases. The finding was 100% specific for identifying a recurrent patellar dislocator. High interobserver agreement was noted. Empty Sunrise Sign suggests significant capsular laxity. This may need to be considered in the surgical treatment of recurrent patellar dislocation.

Treatment of Madelung Deformity With Vicker Ligament Release and Radial Physiolyses: A Case Series.

PURPOSE: To evaluate the surgical outcomes in a series of Madelung wrists treated with a Vicker ligament release at a young age. We hypothesize that early treatment of Madelung deformity with Vicker ligament release is safe and may minimize progression of deformity. METHODS: A retrospective review was performed at a single large pediatric institution from 2013 to 2016 of patients with a diagnosis of Madelung deformity treated with Vicker ligament release and radial physiolysis. Exclusion criteria included patients who were skeletally mature, who underwent osteotomy procedures, or who had incomplete follow-up. Patient demographics were collected, concomitant surgeries were recorded, and outcomes including range of motion and pain were documented. Measurements of standard anteroposterior and lateral radiographs were calculated before and after surgery to monitor radiographic deformity and progression. RESULTS: Six girls with bilateral Madelung deformity who underwent bilateral Vicker ligament resection and radial physiolysis (12 total wrists) were included. The average age at presentation was 7.5 years (range, 7-9 years), with an average follow-up of 30 months. Reasons for presentation included sports injuries (2), ulnar-sided wrist pain (2), and mild deformity (2). Additional radial and ulnar epiphysiodeses were performed in 2 wrists each. There were no intraoperative complications. Although pain resolved within the first month after surgery for all patients, 2 patients had intermittent unilateral ulnar-sided wrist pain at final follow-up. All patients returned to their presurgery activities. There was no loss of range of motion, and 4 wrists with preoperative supination deficits improved by an average of 17°. Radiographic measurements demonstrated improvement in the radial physeal angle in 10 out of 12 wrists (83%). No patients displayed worsening deformity after surgery. Two patients underwent subsequent procedures. CONCLUSIONS: In patients with early Madelung deformity, Vicker ligament release with radial physiolysis is a safe treatment option that theoretically has the potential to minimize the progression of radiographic deformity. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.

Intrawound Vancomycin Powder Reduces Early Prosthetic Joint Infections in Revision Hip and Knee Arthroplasty.

Intrawound vancomycin powder has shown efficacy and safety in decreasing postoperative spine infections, but its use in arthroplasty has not been well established. The purpose of this study was to compare the rate of early prosthetic joint infections (PJI) with and without the use of intrawound vancomycin powder during joint arthroplasty. A retrospective cohort of all patients who underwent primary or revision hip or knee arthroplasty by two surgeons over a two-year period at a single hospital system was evaluated. The control group received standard systemic prophylaxis only, whereas the treatment group received 1 g of vancomycin powder in the surgical wound in addition to systemic prophylaxis. A statistically significant decrease in the overall PJI rate was found in the treatment group (4/816=0.49%) compared to the control group (13/824=1.57%; p=0.0479). Subgroup analysis demonstrated a trend toward fewer PJIs in the vancomycin group, however, only the revision procedures showed a statistically significant reduction in early PJIs after the initiation of vancomycin (7/180=3.89% to 0/134=0%; p=0.0217). The use of intrawound vancomycin powder was associated with a significant reduction in the overall incidence of early PJIs following joint arthroplasty, however, only the revision procedures demonstrated a significant reduction in the rate of early PJIs.

Subcutaneous adipose tissue thickness alters cooling time during cryotherapy.

OBJECTIVE: To determine if differing subcutaneous adipose thickness alters the treatment duration required to produce a standard cooling effect during cryotherapy. DESIGN: A 4-group, between-groups comparison in which the independent variable was skinfold thickness (0-10mm, 11-20mm, 21-30mm, 31-40mm) and the dependent variable was cooling time, defined as the treatment duration required to decrease intramuscular (IM) temperature 7 degrees C from baseline. SETTING: A sports injury research laboratory. PARTICIPANTS: Forty-seven volunteers with anterior thigh skinfold measurement of less than 40mm. INTERVENTION: Topical cryotherapy (750g crushed-ice bag) to the anterior thigh to produce a typical cooling effect, defined as IM temperature at 1cm subadipose declining by 7 degrees C. MAIN OUTCOME MEASURE: Cryotherapy treatment duration required to produce a standardized cooling effect in subjects with differing subcutaneous adipose thickness. RESULTS: Analysis of variance revealed that mean time to cool IM tissues by 7 degrees C differed across all groups, with cooling time increasing as adipose thickness increased. The mean +/- standard deviation cooling times were as follows: 31-40mm (58.6+/-11.7min), 21-30mm (37.8+/-9.6min), 11-20mm (23.3+/-6.7min), and 0-10mm (8.0+/-3.4min). CONCLUSIONS: During cold application, there is a clinically important direct relationship between adipose thickness and required cooling time. This relationship necessitates dramatic adjustments to cryotherapy duration to produce similar IM temperature changes. A 25-minute treatment may be adequate for a patient with a skinfold of 20mm or less; however, a 40-minute application is required to produce similar results in a patients with skinfolds between 21 and 30mm, whereas a 60-minute application is required for patients with skinfolds of 30 to 40mm.