Arthroscopic Minced Cartilage Repair in the Glenohumeral Joint - Short Term Clinical Outcome in a 33-Year-Old Handyman: A Case Report.

Objective: Clinical outcome data for the novel minced cartilage procedure are sparse. While good results have been shown for the knee joint, this is the first report in the current literature regarding this increasingly important procedure in the glenohumeral joint. Case Description: A 33-year-old handyman with a cartilage defect in the humeral head underwent an all arthroscopic one-stage cartilage repair with the AutoCartTM procedure (Arthrex GmbH, Munich, Germany). A senior specialist examined the patient before surgery, five-, 12-and 24-weeks post-surgery. Outcome parameters (Constant-Murley Score, UCLA Shoulder Score and ASES Score) and radiographic imaging were recorded. Results: At six months, follow-up the outcome parameter showed excellent results, the joint pain decreased to numeric rating scale (NRS) 0. The postoperative magnetic resonance imaging (MRI) revealed a thin cartilage layer in the treated area with sufficient integration to the surrounding tissue. The cartilage in the former defect zone presented a homogeneous signal, which was comparable to the intact cartilage. Conclusion: This case report underlines the growing interest in single-stage arthroscopic minced cartilage procedures and shows promising results in the glenohumeral joint. Yet, larger investigations with long-term follow-up are necessary to provide reliable clinical data to determine if comparable results can be achieved over time.

Adjustable-length loop cortical button versus interference screw fixation in quadriceps tendon anterior cruciate ligament reconstruction - A biomechanical in vitro study.

BACKGROUND: This biomechanical cadaveric in vitro study aimed to evaluate and compare the dynamic elongation behavior and ultimate failure strength of tibial adjustable-length loop cortical button versus interference screw fixation in quadriceps tendon-based anterior cruciate ligament reconstruction. METHODS: Sixteen human quadriceps tendons were harvested and fixed into porcine tibiae using either biodegradable interference screw (n = 8) or adjustable loop device (n = 8) fixation. An acrylic block was utilized for femoral adjustable loop device fixation for both groups. All constructs were precycled for 10 times at 0.5 Hz and manually retensioned before tested in position and force control mode each for 1000 cycles at 0.75 Hz according to in vitro loading conditions replicating the in vivo ACL environment. Subsequently, an ultimate failure test at 50 mm/min was performed with mode of failure noted. FINDINGS: Tibial IS fixation showed no statistically significant differences in the initial (-0.46 vs. -0.47 mm; P = 0.9780), dynamic (2.18 mm vs. 2.89 mm; P = 0,0661), and total elongation (1.72 mm vs. 2.42 mm; P = 0,0997) compared to adjustable loop device fixation. The tibial button fixation revealed an increased ultimate failure load (743.3 N vs. 606.3 N; P = 0.0027), while stiffness was decreased in comparison to screw fixation (133.2 N/mm vs. 153.5 N/mm; P = 0,0045). INTERPRETATION: Anterior cruciate ligament reconstruction for quadriceps tendon graft using a tibial adjustable-length loop cortical button provides for comparable dynamic stabilization of the knee with increased ultimate failure load at decreased stiffness compared to screw fixation.