Management Strategies for Rotator Cuff Defects After Calcific Tendinitis Debridement.

Management of rotator cuff defects that are created in the process of excising calcific deposits for patients undergoing surgical intervention for symptomatic calcific tendinitis is not well defined. Such defects can vary considerably in depth, size, and location, and surgical treatment of these rotator cuff lesions depends on a number of factors. Accurately identifying the location and extent of these calcific deposits is important in ensuring their complete removal, and techniques designed to consistently localize these calcific deposits are also described.

Quadriceps augmentation of undersized hamstrings during ACL reconstruction.

BACKGROUND: Double hamstring autograft for anterior cruciate ligament (ACL) reconstruction is a well-established graft option; however, a major concern with this method arises when the prepared graft is too small. Resorting to allograft can be a solution to this problem, but some surgeons prefer to use autograft in particular situations and some patients may refuse allograft. We investigate the merits of using autogenous quadriceps tendons to augment the insufficient hamstrings and compare the autograft composite graft to a standard hamstrings graft of equal size. METHODS: Semitendinosus, gracilis, and quadriceps tendons were harvested from 10 matched pairs of human cadaver lower extremities. Within each pair, a routine hamstring ACL graft (control) consisting of the semitendinosus and gracilis tendons, and an quadriceps augmented hamstrings graft of equal size comprised of the semitendinosus and quadriceps tendons, were prepared. A freeze-clamp mount was used to biomechanically test each graft construct. Tensile failure load, displacement, energy absorbed, and stiffness were determined and statistically compared within each pair and mode of graft failure was established. RESULTS: No statistically significant differences were found between the quadriceps augmented hamstrings graft versus standard control grafts. Average values for peak failure load and graft displacement at the point of first failure were nearly identical. All ACL graft constructs failed at the mid-substance. CONCLUSIONS: This study demonstrates no statistical difference in the biomechanical properties of an isolated hamstring ACL autograft versus a quadriceps augmented ACL autograft of equal size at time zero. CLINICAL RELEVANCE: This is a potentially new and reliable method for quadriceps tendon autograft augmentation of hamstring autograft for ACL reconstruction.