Proximal tibial morphology and its correlation with osteochondritis dissecans of the knee.

PURPOSE: The relationship of proximal tibial morphology to the presence of femoral osteochondritis dissecans (OCD) lesions is unknown. This radiographic study tested the null hypothesis that knees with unilateral medial or lateral OCD lesions would have no difference in the slope of their medial, lateral, or posterior tibial plateau compared with unaffected knees. METHODS: There were 72 patients with unilateral OCD lesions of the medial or lateral femoral condyle seen at our institution from 2005 to 2011. On AP and lateral radiographs of the knee, three examiners conducted independent measurements of the tibial plateau posterior slope, as well as medial and lateral slope as measured from the peak of the tibial spine to the edge of the plateau on the side of the corresponding OCD lesion. Measurements were repeated on normal contralateral and matched control knees. RESULTS: Knees with medial femoral condyle OCD lesions had greater medial tibial slope compared with normal contralateral knees (p = 0.007) and normal controls (p < 0.04). Knees with lateral femoral condyle OCD lesions had no significant difference in lateral tibial slope compared with the contralateral knee or matched controls. Posterior slope was greater in knees with medial OCD lesions than matched controls (p = 0.007). Intraclass correlation coefficients demonstrated consistency between observers for all measurements. CONCLUSION: An assessment of proximal tibial morphology demonstrated greater medial and posterior tibial slope in knees with medial OCD lesions compared with normal knees. The technique for measuring medial and lateral tibial slope was reliable among evaluators. The clinical relevance is that proximal tibial morphology may have a relationship with OCD lesions. LEVEL OF EVIDENCE: III.

Part II: The 50°/60° fibular tunnel trajectory for posterolateral corner reconstruction in a cadaver model.

PURPOSE: Using data from our MRI study, we found that a tunnel oriented 50° externally rotated and 60° cephalad would better connect the fibular collateral ligament (FCL) insertion to the popliteofibular ligament (PFL) insertion as compared to a traditional anterior-to-posterior (A-P) fibular tunnel. The purpose of this study was to test that finding in a cadaver model. METHODS: In eight cadaver knee pairs (16 knees), a guide pin was driven from the fibular FCL insertion point in a 50° externally rotated and 60° cephalad trajectory in 8 knees, and in a traditional A-P trajectory in the contralateral 8 knees. Proximity of the pin to the native PFL insertion, the peroneal and tibial nerves was measured, followed by drilling over the guide pin and measuring the remaining fibular bone stock. RESULTS: In comparison with the A-P fibular tunnel technique, the 50°/60° technique resulted in a fibular exit point significantly closer to the native PFL insertion (p < 0.01). Both techniques were safe with regard to the tibial and peroneal nerves. There were no instances of fibular wall blowout in either technique; however, there was less superior bone remaining in the 50°/60° technique (p < 0.04). CONCLUSION: In a cadaveric model, the 50°/60° technique for PLC reconstruction resulted in a more anatomic-based tunnel than an A-P fibular tunnel.

Football injuries: current concepts.

Football is one of the most popular sports in the United States and is the leading cause of sports-related injury. A large focus in recent years has been on concussions, sudden cardiac death, and heat illness, all thought to be largely preventable health issues in the young athlete. Injury prevention through better understanding of injury mechanisms, education, proper equipment, and practice techniques and preseason screening may aid in reducing the number of injuries. Proper management of on-field injuries and health emergencies can reduce the morbidity associated with these injuries and may lead to faster return to play and reduced risk of future injury. This article reviews current concepts surrounding frequently seen football-related injuries.