Comparison of Curved and Straight Anchor Insertion for Bankart Repair.

The quality of Bankart repair may be compromised by the presence of glenoid perforation during suture anchor placement. The purpose of this study was to compare the rate of glenoid perforation and biomechanical strength of antero-inferior suture anchors placed with a curved vs a traditional straight technique through an anteroinferior portal. Ten bilateral pairs of fresh human cadaveric shoulders were randomized to either a curved or a straight suture anchor insertion technique. An anteroinferior portal was used to place a 1.5-mm soft anchor in the anteroinferior glenoid (5:30 position for right shoulders). Anatomic dissection was performed, and the maximum load of each anchor was measured using a materials testing system. The overall rate of glenoid perforation by the anteroinferior anchor was 50%. The rate of glenoid perforation was 40% in the straight group and 60% in the curved group (P=.41). The median maximum load was 86 N in the straight group and 137 N in the curved group (P=.23). The median maximum load of the anchors that did perforate the glenoid was 102 N and of those that did not was 118 N (P=.72). The mode of failure was suture anchor pullout in all except one specimen. The curved guide was not superior to the traditional straight guide in terms of the rate of glenoid perforation or the maximum load of the suture anchors. Anterior cortical perforation of the glenoid during anteroinferior suture anchor placement is common with both techniques. [Orthopedics. 2019; 42(2):e242-e246.].

Comparison of Curved and Straight Anchor Insertion for SLAP Repair: A Cadaveric Study.

PURPOSE: To compare a curved drill guide with a straight guide for suture anchor placement into the posterosuperior glenoid from an anterolateral portal with respect to glenoid perforation, drill contact with the suprascapular nerve, and maximum load. METHODS: Ten bilateral pairs of fresh human cadaveric shoulders were randomized to the curved technique on 1 side and the straight technique on the contralateral side. An anterolateral trans-rotator cuff portal was used for placement of anchors at the posterior (11 o'clock right shoulder) and far posterior (10 o'clock right shoulder) positions on the glenoid with a 24-mm drill stop, and the drill tip was marked with ink. Specimens were dissected for glenoid perforation and drill contact with the suprascapular nerve. The maximum load of each anchor was measured using a material testing system. RESULTS: Glenoid perforation occurred in 30% in the curved group and 60% in the straight group overall (P = .01). Ink markings demonstrated a direct hit on the suprascapular nerve in most of the penetrations (13 of 18) but was not significantly different between the curved and straight guides (P = .25). Maximum load of the posterior anchor was greater in the curved group than that in the straight group (199.5 vs 146.7 N, respectively; P = .01). CONCLUSIONS: The curved technique has a lower rate of glenoid perforation and greater maximum load than the straight technique. However, the curved technique can result in glenoid perforation and injury to the suprascapular nerve, and we do not recommend it. CLINICAL RELEVANCE: Placing suture anchors through an anterolateral portal with a curved guide provides a more optimal trajectory with decreased risk of glenoid perforation and superior biomechanical strength than that with the straight guide, but it is not safe.

Vitamin D Insufficiency Among Professional Basketball Players: A Relationship to Fracture Risk and Athletic Performance.

BACKGROUND: Vitamin D is believed to play a role in influencing fracture risk and athletic performance. Insufficiency of vitamin D affects an estimated three-quarters of the United States population. Hypovitaminosis D has also been demonstrated to be quite common among professional basketball players in the National Basketball Association (NBA). PURPOSE: To determine whether a relationship exists between vitamin D levels and fracture risk and athletic performance (as measured by NBA draft status) among elite basketball players. STUDY DESIGN: Descriptive epidemiology study. METHODS: Data were obtained from the NBA regarding combine participants from 2009 through 2013. This information included vitamin D level, demographic information, fracture history, and NBA draft status. The data were analyzed to determine associations between vitamin D level and fracture risk and NBA draft status. RESULTS: Vitamin D levels were measured for 279 players at the NBA Combine from 2009 through 2013. Vitamin D deficiency (<20 ng/mL) was seen in 32.3% of athletes, vitamin D insufficiency (20-30 ng/mL) was seen in 41.2%, and sufficient levels of vitamin D (>30 ng/mL) were present in only 26.5%. A total of 118 players had a history of at least 1 fracture. Vitamin D level was not predictive of fracture risk. Contrary to our hypothesis, players with a history of stress fracture had a significantly greater mean vitamin D level than those without such history (30.7 vs 25.1 ng/mL; P = .04). A majority (79.6%) of participants were selected in the NBA draft. Players with deficient vitamin D levels had a significantly lower rate of being drafted into the NBA (P = .027). The NBA draft rate was found to increase with increasing levels of vitamin D (P = .007). CONCLUSION: Hypovitaminosis D is quite common among NBA Combine participants, affecting 73.5%. While no significant relationship was found between vitamin D level and fracture history, patients with a history of stress fracture had significantly greater mean vitamin D levels. Additionally, participants with greater vitamin D levels were more likely to be drafted into the NBA. This information supports the potential role of vitamin D in influencing athletic performance.

Evaluation of Risk to the Suprascapular Nerve During Arthroscopic SLAP Repair: Is a Posterior Portal Safer?

PURPOSE: The purpose of this study was to compare the risk of glenoid perforation during SLAP repair for suture anchors placed through an anterolateral portal versus a posterolateral portal of Wilmington. METHODS: Ten bilateral cadaveric shoulders were randomized to suture anchor placement through an anterolateral portal on one shoulder and a posterolateral portal on the contralateral shoulder. Anchors were placed into anterior, posterior, and far posterior positions on the glenoid rim (1 o'clock, 11 o'clock, and 10 o'clock positions for right shoulders). The shoulder was then dissected, and the distance from the suture anchor tip to the nerve was measured if perforation occurred. The maximum load and failure mechanism of each anchor was assessed with a materials testing system machine. RESULTS: Only 2 of 20 anchors placed in the posterosuperior glenoid through the posterolateral portal perforated compared with 16 of 20 of the anchors placed through the anterolateral portal (P < .05). The mean distance from the perforated anchor tip to the suprascapular nerve was 2.5 ± 1.4 mm for the anterolateral portal and 4.4 ± 0.6 mm for the posterolateral portal (P = .18). We did not observe a significant difference in biomechanical strength (P > .05). CONCLUSIONS: There is a high rate of glenoid perforation in close proximity to the suprascapular nerve when placing anchors in the posterosuperior glenoid through an anterolateral portal. Use of the posterolateral portal results in a much lower incidence of glenoid perforation for anchors placed in the posterosuperior glenoid, but there is a higher risk of glenoid perforation for an anchor placed in the anterosuperior glenoid from the posterolateral portal. CLINICAL RELEVANCE: There is a higher risk of injury to the suprascapular nerve when suture anchors are placed in the posterosuperior glenoid through an anterolateral portal compared with a posterolateral portal for SLAP repair.

Debridement of Articular Cartilage: The Natural Course.

Chondral defects of the knee are quite common, affecting an estimated 10% to 12% of the population. Symptomatic chondral defects are thought to be persistent and possibly progressive. Less is known about the natural history of asymptomatic chondral lesions. Traditional treatment of chondral lesions has involved arthroscopic debridement with a mechanical shaver. Radiofrequency chondroplasty has been explored as a possible alternative or adjuvant to mechanical chondroplasty. The role of chondroplasty in the setting of knee osteoarthritis is more controversial. Early studies demonstrated promising results of arthroscopic debridement in the context of knee arthritis. However, publications in the last 10 to 15 years have brought into question the role of arthroscopic debridement in the setting of knee osteoarthritis. The purpose of this chapter is to explore the role of arthroscopic debridement in the treatment of chondral defects.