Tunnel Management in Revision Anterior Cruciate Ligament Reconstruction: Current Concepts.

Bone tunnel-related complications are frequently encountered during revision anterior cruciate ligament reconstruction (ACLR). Issues with tunnel positioning, enlargement, containment, and hardware interference may complicate surgery and compromise outcomes. As a result, several strategies have emerged to address these issues and optimize results. However, a systematic, unified approach to tunnel pathology in revision ACLR is lacking. The purpose of this review is to highlight the current state of the literature on bone tunnel complications and, although extensive literature on the subject is lacking, present an updated approach to the evaluation and management of tunnel-related issues in revision ACLR.

Traumatic Leg Fractures in UEFA Football Athletes: A Matched-Cohort Analysis of Return to Play, Reinjury, Player Retention, and Performance Outcomes.

BACKGROUND: The average professional soccer team experiences 1 to 2 traumatic leg fractures per season, with unknown effects on player performance. PURPOSE: To (1) determine the rate and time to return to play (RTP) following leg fracture, (2) investigate the rate of reinjury following RTP, and (3) investigate long-term effects that lower extremity (LE) fracture may have on elite soccer player performance. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Using publicly available records, we identified athletes sustaining a traumatic leg fracture across the 5 major European soccer leagues (English Premier League, Bundesliga, La Liga, Ligue 1, and Serie A) between 2000 and 2016. Athletes with leg fracture (femur, tibia, and/or fibula) were matched 1:2 to controls by demographic characteristics and performance metrics 1 season before the index timepoint. Investigations included the RTP rate, reinjury rate, player characteristics associated with RTP within 2 seasons, long-term player retention, performance metrics during the 4 following seasons, and subgroup analysis by player position. RESULTS: A total of 112 players with LE fracture and 224 controls were identified. Players with LE fractures were absent for a mean of 157 days (range, 24-601 days) and 21 games (range, 2-68 games). The rate of RTP within 1 season was 80%, with 4% experiencing subsequent refracture. Injured players remained active in the league at a higher rate than their uninjured counterparts. As compared with controls, injured athletes played 309 fewer total minutes (P < .05), scored 0.09 more assists per game (P < .01) 1 season after injury, and scored 0.12 more points per game 4 seasons after injury (P < .01). Defenders were most affected by an LE fracture, playing 5.24 fewer games (P < .05), 603 fewer total minutes (P < .01), and recording 0.19 more assists per 90 minutes of play as compared with controls 1 season after injury (P < .001). Attackers and midfielders demonstrated no significant difference in metrics after RTP when compared with controls. CONCLUSION: Most players sustaining an LE fracture returned to elite soccer at the same level after a significant loss of playing time, with a 4% rate of refracture. Player retention was higher for those sustaining an LE fracture versus uninjured controls. Overall, injured players did not experience a decline in performance after recovery from an LE fracture.

Osteochondral Allograft Transplant for Focal Cartilage Defects of the Femoral Condyles: Clinically Significant Outcomes, Failures, and Survival at a Minimum 5-Year Follow-up.

BACKGROUND: Osteochondral allograft (OCA) transplant for symptomatic focal cartilage defects in the knee has demonstrated favorable short- to midterm outcomes. However, the reoperation rate is high, and literature on mid- to long-term outcomes is limited. PURPOSE: To analyze clinically significant outcomes (CSOs), failures, and graft survival rates after OCA transplant of the femoral condyles at a minimum 5-year follow-up. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Review of a prospectively maintained database of 205 consecutive patients who had primary OCA transplant was performed to identify patients with a minimum of 5 years of follow-up. Outcomes including patient-reported outcomes (PROs), CSOs, complications, reoperation rate, and failures were evaluated. Failure was defined as revision cartilage procedure, conversion to knee arthroplasty, or macroscopic graft failure confirmed using second-look arthroscopy. Patient preoperative and surgical factors were assessed for their association with outcomes. RESULTS: A total of 160 patients (78.0% follow-up) underwent OCA transplant with a mean follow-up of 7.7 ± 2.7 years (range, 5.0-16.3 years). Mean age at the time of surgery was 31.9 ± 10.7 years, with a mean symptom duration of 5.8 ± 6.3 years. All mean PRO scores significantly improved, with 75.0% of patients achieving minimal clinically important difference (MCID), and 58.9% of patients achieving significant clinical benefit for the International Knee Documentation Committee score at final follow-up. The reoperation rate was 39.4% and was associated with a lower probability of achieving MCID. However, most patients undergoing reoperation did not proceed to failure at final follow-up (63.4% of total reoperations). A total of 34 (21.3%) patients had failures overall, and the 5- and 10-year survival rates were 86.2% and 81.8%, respectively. Failure was independently associated with greater body mass index, longer symptom duration, number of previous procedures, and previous failed cartilage debridement. Athletes were protected against failure. Survival rates over time were not affected by OCA site (P = .154), previous cartilage or meniscal procedure (P = .287 and P = .284, respectively), or concomitant procedures at the time of OCA transplant (P = .140). CONCLUSION: OCA transplant was associated with significant clinical improvement and durability at mid- to long-term follow-up, with 5- and 10-year survival rates of 86.2% and 81.8%, respectively. Maintenance of CSOs can be expected in the majority of patients at a mean of 7.7 years after OCA transplant. Although the reoperation rate was high (39.4%) and could have adversely affected chances of maintaining MCID, most patients did not have failure at long-term follow-up.

Regenerative Potential of Mesenchymal Stem Cells for the Treatment of Knee Osteoarthritis and Chondral Defects: A Systematic Review and Meta-analysis.

PURPOSE: To perform a systematic review and meta-analysis evaluating the effects of mesenchymal stem cells (MSCs) on cartilage regeneration and patient-reported pain and function. METHODS: A systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using a PRISMA checklist. The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008-2019), EMBASE (2008-2019), and MEDLINE (2008-2019) were queried in July 2019 for literature reporting use of stem cells to treat knee osteoarthritis or chondral defects. Data describing administered treatment, subject population, injection type, duration of follow-up, pain and functional outcomes, and radiographic and magnetic resonance imaging findings were extracted. Risk of bias was assessed using the Downs and Black scale. Meta-analyses adjusted for random effects were performed, calculating pooled effect sizes in terms of patient-reported pain and function, cartilage quality, and cartilage volume. RESULTS: Twenty-five studies with 439 subjects were identified. There was no significant difference in pain improvement between MSC treatment and controls (pooled standardized mean difference [SMD] = 0.23, P = .30). However, MSC treatment was significantly favored for functional improvement (SMD = 0.66, P < .001). There was improvement in cartilage volume after MSC treatment (SMD = 0.84, P < .001). Regarding cartilage quality, meta-analysis resulted in a small, nonsignificant effect size of 0.37 (95%, -0.03 to 0.77, P = .07). There was risk for potential bias among included studies, with 17 (68%) receiving either a grade of "poor" or "fair." CONCLUSIONS: The pooled SMD from meta-analyses showed statistically significant effects of MSC on self-reported physical function but not self-reported pain. MSCs provided functional benefit only in patients who underwent concomitant surgery. However, this must be interpreted with caution, as there was substantial variability in MSC composition and mode of delivery. MSC treatment provided significant improvement in cartilage volume but not cartilage quality. Preliminary data regarding therapeutic properties of MSC treatment suggest significant heterogeneity in the current literature, and risk of bias is not negligible. LEVEL OF EVIDENCE: II, Systematic Review and Meta-analysis.

Bone Tunnel Management in Modern Revision Anterior Cruciate Ligament Reconstruction.

Bone tunnel-related issues are frequently encountered during revision anterior cruciate ligament reconstruction. Tunnel malposition, widening, and interference pose unique challenges that may complicate surgery and compromise outcomes. Preoperative planning is critical to identify and characterize bone tunnel pathology. Choice of technique, graft, and implant are influenced by numerous patientrelated and technical factors. Despite this complexity, a variety of strategies are available to help manage and navigate common bone tunnel problems. Among these include alternative techniques for reaming, bone grafting, and fixation. This review provides a modern evidence-based and practical guide to equip the orthopedic surgeon with a systematic approach to the evaluation and management of bone tunnel-related issues encountered during revision anterior cruciate ligament reconstruction.

Total Knee Arthroplasty Is Safe in Jehovah's Witness Patients-A 12-Year Perspective.

Despite the evolution of blood management protocols, total knee arthroplasty (TKA) occasionally requires allogeneic blood transfusion. This poses a particular challenge for Jehovah's Witnesses (JW) who believe that the Bible strictly prohibits the use of blood products. The aim of this study was to compare JW and a matched-control cohort of non-JW candidates undergoing TKA to assess the safety using modern blood management protocols. Fifty-five JW patients (63 knees) who underwent TKA at our institution between 2005 and 2017 were matched to 63 non-JW patients (63 knees). Patient demographics, intraoperative details, and postoperative complications including in-hospital complications, revisions, and 90-day readmissions were collected and compared between the groups. Additionally, subgroup analysis was performed comparing JW patients who were administered tranexamic acid (TXA) between the two groups. Baseline demographics did not vary significantly between the study cohorts. The mean follow-up was 3.1 years in both the JW and non-JW cohorts. Postoperative complications, including in-hospital complications (7.9 vs. 4.8%; p = 0.47), revision TKA (1.6 vs. 1.6%; p = 1.00), and 90-day readmission (1.6 vs. 4.8%; p = 0.31) were not significantly different between the JW and non-JW groups. Subgroup analysis demonstrated JW patients who received TXA had a significantly lower decline in postoperative hemoglobin (Hgb) (8.6 vs. 14.0%; p < 0.01). At a follow-up of up to 12 years, JW patients who underwent TKA have outcomes equivalent to non-JW patients without the need for transfusion. Our findings support that surgeons are more likely to optimize JW patients preoperatively with iron and folate supplementation. Despite these variations in preoperative optimization efforts, no significant difference with regard to Hgb or hematocrit levels was demonstrated. Level of evidence is III, retrospective observational study.

Outcome Trends After Hip Arthroscopy for Femoroacetabular Impingement: When Do Patients Improve?

PURPOSE: To determine when patients reach critical thresholds of clinical improvement after hip arthroscopy for femoroacetabular impingement (FAI) using previously defined cutoffs for the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) and to identify risk factors for prolonged recovery. METHODS: Consecutive patients with a diagnosis of FAI who underwent unilateral hip arthroscopy between January 2010 and January 2015 with at least 2 years of clinical follow-up were studied. The modified Harris Hip Score was collected prospectively at 6 consecutive time points. The number of patients reaching the MCID and PASS at each time point was determined. RESULTS: During the study period, 340 consecutive hip arthroscopies were performed in 316 patients with a mean final follow-up period of 50 months (range, 29-84 months). The mean modified Harris Hip Score and percentage of patients reaching the MCID and PASS increased at each time point. At 2 years, 271 patients (93%) surpassed the MCID and 212 patients (73%) achieved the PASS. Female sex, age of 40 years or older, and body mass index of 30 or greater were associated with lower rates of achieving the MCID and PASS at set time points. Patients undergoing labral repair had superior PASS rates at 3 months and beyond than patients undergoing labral debridement alone. Patients who did not achieve the PASS by 3 months were more likely to require reoperation. CONCLUSIONS: Hip arthroscopy for FAI results in increased patient-reported outcome measures at interval follow-up. Most patients reach critical thresholds of minimal and satisfactory clinical improvement. Patients who are female, older, or obese or who undergo labral debridement alone are less likely to reach these milestones at major time intervals. Patients who do not reach the PASS by 3 months are more likely to require reoperation. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Capitellum Fracture Open Reduction and Internal Fixation With Headless Screws.

Partial articular fractures involving the capitellum represent an injury to the lateral column of the distal humerus. Capitellum open reduction and internal fixation restores this portion of the distal humerus articular surface and biomechanical integrity to the lateral column. This video demonstrates open reduction and internal fixation of a type I capitellar fracture with headless compression screws through an extensile lateral approach.

Total Hip Arthroplasty in Human Immunodeficiency Virus-Positive Patients: A Concise Follow-Up at 10 to 14 Years.

BACKGROUND: Advancements in the management of human immunodeficiency virus (HIV) now permit HIV-positive patients to have longer life spans, increasing their cumulative risk of developing an advanced degenerative joint disease, necessitating total hip arthroplasty (THA). The purpose of this study was to provide an extended follow-up on a previously published study on a cohort of HIV-positive THA recipients in an effort to confirm the safety and longevity of THA in this population. METHODS: This study is a follow-up on a previous study comprised of 41 hips in 31 HIV-positive THA recipients. At this follow-up, 5 patients from the original cohort required contralateral THA. Postoperative complications were recorded up to the patient's last follow-up date. A survivorship analysis was performed using the Kaplan-Meier method with revision THA as the end point. RESULTS: Since the last report, 2 additional hips were revised (one for aseptic loosening and one for a periprosthetic fracture), and 5 patients underwent contralateral THA. This resulted in a total of 5 (13.8%) hips requiring revision THA at the latest follow-up. The mean follow-up interval for the original cohort and for the contralateral 5 hips was 78.9 ± 50.2 months and 54.6 ± 45.3 months, respectively. Kaplan-Meier survivorship analysis with revision THA for any reason as the end point demonstrated survivorship of 93% (2 years), 90% (5 years), and 81% (10 and 14 years) after primary THA, respectively. CONCLUSION: Our study suggests that it is possible to achieve a low incidence of postoperative infection in HIV-positive THA recipients. In addition, our study demonstrates that non-hemophiliac HIV-positive patients have comparable revision rates to previously published reports on HIV-negative patients of similar age, underscoring the clinical efficacy of highly active antiretroviral therapy.

Performance outcomes after medial ulnar collateral ligament reconstruction in Major League Baseball positional players.

BACKGROUND: We sought to determine whether professional baseball positional players who underwent medial ulnar collateral ligament (MUCL) reconstruction demonstrate decreases in performance on return to competition compared with preoperative performance metrics and their control-matched peers. METHODS: Data for 35 Major League Baseball positional players who underwent MUCL reconstruction during 31 seasons were obtained. Twenty-six players met inclusion criteria. Individual statistics for the 2 seasons immediately before injury and the 2 seasons after injury included wins above replacement (WAR), on-base plus slugging (OPS), and isolated power (ISO). Twenty-six controls matched by player position, age, plate appearances, and performance statistics were identified. RESULTS: Of the 35 athletes who underwent surgery, 7 did not return to their preinjury level of competition (return to play rate of 80%). In comparing preinjury with postinjury statistics, players exhibited a significant decrease in plate appearances, at-bats, and WAR 2 seasons after injury but did not demonstrate declines in WAR 1 season after injury. Compared with matched controls, athletes who underwent MUCL reconstruction did not demonstrate significant decline in statistical performance, including OPS, WAR, and ISO, after return to play from surgery. Of all positional players, catchers undergoing surgery demonstrated lowest rates of return to play (56%) along with statistically significant decreases in home run rate, runs batted in, and ISO. CONCLUSION: Major League Baseball positional players undergoing MUCL reconstruction can reasonably expect to return to their preinjury level of competition and performance after surgery compared with their peers. Positional players return to play at a rate comparable to that of pitchers; catchers may experience more difficultly in returning to preinjury levels of play.

Closed-Loop Double Endobutton Technique for Repair of Unstable Distal Clavicle Fractures.

BACKGROUND: Displaced fractures of the distal clavicle are inherently unstable and lead to nonunion in a high percentage of cases. The optimal surgical management remains controversial. HYPOTHESIS: Indirect osteosynthesis with a closed-loop double endobutton construct would result in reliable fracture union and obviate the need for additional surgery. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Eight patients with an acute unstable Neer type IIB distal clavicle fracture were treated with a closed-loop double endobutton implant. Mean follow-up averaged 3.4 years (range, 1-9 years). Two patients were lost to follow-up. The remaining 6 patients underwent a detailed functional and radiologic evaluation. RESULTS: Definitive fracture healing was achieved in all patients. There were no complications, and no patients required additional surgery related to the index procedure. The mean Constant score was 97 at final follow-up. CONCLUSION: The closed-loop double endobutton technique was reliable and effective in achieving fracture union in all patients with unstable Neer type IIB fractures of the distal clavicle. This technique obviates the need for late hardware removal that is often necessary when direct osteosynthesis is used and avoids potential complications associated with coracoclavicular cerclage constructs that require knot fixation.

Axial-Plane Biomechanical Evaluation of 2 Suspensory Cortical Button Fixation Constructs for Acromioclavicular Joint Reconstruction.

BACKGROUND: Although numerous suture-button fixation techniques for acromioclavicular (AC) joint reconstruction have been validated with biomechanical testing in the superior direction, clinical reports continue to demonstrate high rates of construct slippage and breakage. PURPOSE: To compare the stability of a novel closed-loop double Endobutton construct with a commercially available cortical button system in both the axial and superior directions. STUDY DESIGN: Controlled laboratory study. METHODS: Six matched pairs of fresh-frozen cadaveric upper extremities were anatomically dissected and prepared to simulate a complete AC joint dislocation. One side of each pair was reconstructed with the double Endobutton (DE) construct and other side with the dog bone button (DB) construct. The specimens were then tested using a materials testing machine, determining initial superior and axial displacements with a preload, and then cyclically loaded in the axial direction with 70 N for 5000 cycles. Displacement was again measured with the same preloads at fixed cycle intervals. The specimens were then loaded superiorly to failure. RESULTS: At 5000 cycles, the mean axial displacement was 1.7 mm for the DB group and 1.2 mm for the DE group (P = .19), and the mean superior displacement was 1.1 mm for the DB group and 0.7 mm for the DE group (P = .32). Load at failure was similar (558 N for DE, 552 N for DB; P = .96). There was no statistically significant difference in the modes of failure. CONCLUSION: Biomechanical testing of both constructs showed similar fixation stability after cyclical axial loading and similar loads to failure. CLINICAL RELEVANCE: The strength of both constructs after cyclical loading in the axial plane and load-to-failure testing in the superior plane validate their continued clinical use for achieving stability in AC joint reconstruction procedures.

The Importance of Tear Edge Fixation in Modified Transosseous-Equivalent Rotator Cuff Repair: A Biomechanical Study.

PURPOSE: The purpose of this study was to evaluate the impact of dog ear fixation with peripheral sutures on the biomechanical properties of transosseous-equivalent rotator cuff repair. METHODS: Eight matched-pairs of fresh-frozen cadaveric shoulders were dissected to create an isolated, full thickness supraspinatus tear. One shoulder in each matched pair was randomly selected for repair with a standard transosseous-equivalent suture-bridge technique (TOE), and the contralateral shoulder underwent TOE repair with additional tear edge fixation (TEF). Unidirectional tensile testing was conducted to determine cyclic displacement, linear stiffness, yield load, ultimate load, and mode of failure for each specimen. RESULTS: The ultimate load and yield load were significantly higher for the TEF group (460 ± 104 N and 455 ± 97 N) than the TOE group (409 ± 111 N and 356 ± 143 N) (p = 0.020, p = 0.019, respectively). No statistical difference was noted in stiffness or displacement. Seven of eight TOE specimens versus two of eight TEF specimens failed by medial row tendon rupture, while one of eight TOE specimens versus five of eight TEF specimens failed by lateral row anchor pullout. CONCLUSIONS: The addition of peripheral tear edge fixation to transosseous-equivalent rotator cuff repair improves the initial load to failure properties of the construct. However, dog ear fixation has no significant impact on cyclical displacement or stiffness. CLINICAL RELEVANCE: Tear edge fixation with peripheral sutures should be considered to increase the initial strength of transosseous-equivalent rotator cuff repair while restoring the anatomic footprint. The addition of dog ear fixation may promote healing and minimize the risk of construct failure during the immediate postoperative period.

Continuous Loop Double Endobutton Reconstruction for Acromioclavicular Joint Dislocation.

BACKGROUND: Current anatomic methods for reconstruction of the dislocated acromioclavicular (AC) joint show improved clinical results but continue to be associated with significant rates of fixation loss and complications, limiting more widespread use. PURPOSE: To determine the long-term clinical and radiologic outcomes of a novel surgical technique using a closed-loop double Endobutton device to reconstruct both acute and chronic dislocations. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 2003 and 2012, a total of 35 patients (31 men, 4 women) at a mean age of 42 years (range, 25-70 years) were surgically treated for a Rockwood type III or greater AC joint dislocation with the described technique (26 chronic, 9 acute). Imbrication of the AC joint capsule and deltotrapezial fascia was performed in all patients. Biological bridging across the coracoclavicular (CC) interval was performed in all patients by use of coracoacromial (CA) ligament transfer in 28 patients and primary repair of the CC ligament in 7 patients. Complete follow-up information was obtained for 31 of 35 patients. RESULTS: At a mean follow-up of 5.2 years (range, 27-144 months), the construct remained stable in all but 1 patient. The mean CC interval difference was 1.1 mm (range, -2.5 to 4.0 mm) and was <2 mm in 87% of patients. The mean Constant score was 98; the mean University of California, Los Angeles Shoulder Rating Scale score was 34; and the mean American Shoulder and Elbow Surgeons Shoulder Score was 98. Follow-up MRI evaluation in 10 patients consistently demonstrated a wide band of dense scar tissue between the coracoid and clavicle. No infections, fractures, or perioperative complications occurred. CONCLUSION: Excellent results were obtained and maintained over long-term follow-up. The continuous loop device eliminated the possibility of knot slippage or breakage. MRI confirmed a robust healing response. The described technique resulted in outcomes that were significantly superior to historical reports of nonsurgical outcomes, and the technique can be recommended both for acute and chronic dislocations.

Outcomes of total hip arthroplasty in human immunodeficiency virus-positive patients.

Today, patients with human immunodeficiency virus (HIV) live long enough to develop chronic degenerative and HIV-associated joint disease. There is a growing population of patients infected with HIV who are candidates for total hip arthroplasty (THA). A total of 31 HIV-positive, non-hemophilic patients undergoing 41 THAs at our institution between 2000 and 2012 were identified. In-hospital medical complications were reported in 5 of 41 hips, all of which resolved prior to discharge. Deep infection developed in 1 of 41 hips and revision was required in 3 of 41 hips. These results suggest that low rates of complications and revision can be achieved in the HIV-positive, non-hemophilic population. We believe that with careful patient selection, THA may improve the quality of life in the HIV-positive population.

10-year follow-up wear analysis of first-generation highly crosslinked polyethylene in primary total hip arthroplasty.

Our goal was to report a 10-year follow up of linear penetration rates for HCLPE, and to determine whether a difference exists between penetrations measured on pelvis or hip anterior-posterior radiographs. We reviewed 48 total hip arthroplasties where a first-generation HCLPE liner was used. Femoral head penetration was measured on both AP pelvis and hip radiographs. Total wear and wear rate at 10 years were 1.26 mm and 0.122 mm/y, respectively. The rate decreased significantly after the first 2-3 years, plateauing at a wear rate of 0.05 mm/y for the last 5 years. The AP hip total wear and wear rate were 1.38 mm and 0.133 mm/y respectively, while rates were 1.13 mm and 0.109 mm/y respectively for the pelvis radiographs (P<.05). We found a significant difference in measurements of linear penetration when comparing AP pelvis vs. hip radiographs with lower rates recorded using an AP pelvis.

Outcomes of anterior cruciate ligament reconstruction in patients older than 50 years of age.

BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) has traditionally been reserved for young patients with functional instability. As the aging population continues to grow and embrace a more active lifestyle, it is important to determine if favorable outcomes of ACLR can be achieved in older adults. METHODS: Patients greater than 50 years of age undergoing ACLR between January 2001 and September 2006 were identified. Charts were retrospectively reviewed for clinical, pathologic, and radiographic findings. Prospective data was collected at follow-up, including Lysholm Knee Score, Tegner Activity Level Score, International Knee Documentation Committee (IKDC) Subjective Knee Form Score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Anteroposterior (AP) instability was assessed with use of a KT-2000 arthrometer (MEDmetric, San Diego, CA). RESULTS: Forty-seven patients underwent ACLR with 32 (16 males and 16 females) available at a mean follow-up of 5.0 years (range: 2.2 to 9.0 years). The mean age at the time of operation was 58.4 years (range: 51 to 65 years). At time of final follow-up, the mean side-to-side difference measured by KT-2000 was 1.2 ± 1.3 mm (range: 0 to 4.5 mm). Mean postoperative subjective IKDC score was 80.1 (range: 33 to 100) and Lysholm score was 86.7 (range: 45 to 95). There was no change in Tegner score from pre-injury (range: 0 to 3) to postoperative (range: 0 to 3). Twelve patients (38%) underwent subsequent knee surgery. All patients were satisfied with the final outcome of their ACLR surgery. Only patellofemoral Outerbridge cartilage grade was associated with worse outcome. CONCLUSION: ACLR provides symptomatic relief and restoration of function for patients greater than 50 years of age. ACLR should be considered in active older patients with subjective functional instability.

Impact of diabetes mellitus on surgical outcomes in sports medicine.

Diabetes mellitus (DM) affects a significant proportion of the patients evaluated and treated by orthopedic surgeons who specialize in sports medicine. Sports-medicine-related conditions associated with DM include tendinopathy, adhesive capsulitis of the shoulder, and articular cartilage disease. This article reviews the current literature adressing the effect of DM on surgical outcomes in sports medicine. In general, patients with DM undergo operations more frequently and experience inferior surgical outcomes compared with patients without DM. Diabetes mellitus is associated with increased rates of complications from sports medicine procedures, such as infection, delayed healing, and failure of the operation. However, additional research is needed to determine the full impact of DM on patient outcomes in sports medicine. Surgeons should be cognizant of special considerations in the population of patients with DM and aim to tailor the surgical management of this growing patient population.

Arthroscopic anatomic humeral head reconstruction with osteochondral allograft transplantation for large hill-sachs lesions.

Anatomic reconstruction of the humeral head with osteochondral allograft has been reported as a solution for large Hill-Sachs lesions with or without glenoid bone loss. However, to date, varying techniques have been used. This technical note describes an arthroscopic reconstruction technique using fresh-frozen, side- and size-matched osteochondral humeral head allograft. Allograft plugs are press fit into the defect without internal fixation and seated flush with the surrounding articular surface. This technique restores the native articular contour of the humeral head without compromising shoulder range of motion. Potential benefits of this all-arthroscopic approach include minimal trauma to the soft tissue and articular surface without the need for hardware or staged reoperation.

Arthroscopic treatment of labral tears and concurrent avascular necrosis of the femoral head in young adults.

Avascular necrosis (AVN) of the femoral head is a progressive disease affecting young adults that results in collapse of the femoral head and subsequent degenerative joint disease. Although precollapse stages of AVN can be successfully treated with core decompression, making the diagnosis is often difficult given alternative sources of hip pain in this age group. We propose that arthroscopic-assisted core decompression of the femoral head offers an effective method of addressing AVN of the femoral head as well as coexistent hip disorders in the same operation. This article describes in detail the technique used to perform an arthroscopic-assisted core decompression of the femoral head, and a companion video demonstrating the procedure is included. Our experience suggests that arthroscopic-assisted core decompression can be used as an alternative to open core decompression, while simultaneously addressing other sources of hip pain, with successful outcomes.