Graft options for ACL reconstruction.

Once the decision for anterior cruciate ligament (ACL) reconstruction has been made, the orthopedist has to decide which graft substitute will best restore normal anterior knee stability. This article will present an overview of graft options as well as fixation options most commonly used in ACL reconstructions.

Newborn clavicle fractures.

A prospective screening program of 9106 newborns identified 43 infants with clavicle fractures for a prevalence of 1 fracture in every 213 live births (0.5%). The fractures were equally distributed by right and left side involvement, and male and female sex. All fractures occurred during vaginal deliveries. None were breech presentation. Risk factors for fracture included large birth-weight, shoulder dystocia, mechanically assisted delivery, and prolonged gestational age. One in 11 newborns with a clavicle fracture also had a brachial plexus palsy.

Assessment of failed arthroscopic anterior labral repairs. Findings at open surgery.

To assess capsulolabral lesions present in patients after unsuccessful arthroscopic procedures, we reviewed the records of 20 patients who had undergone open shoulder procedures after unsuccessful arthroscopic Bankart procedures for chronic shoulder instability. The Bankart lesion had initially been repaired arthroscopically by transglenoid sutures (N = 10), bioabsorbable tacks (N = 7), suture anchors (N = 2), or arthroscopic screws (N = 1). Five of the 20 patients (25%) had reinjuries to the shoulder after the arthroscopic procedure. The average time from the arthroscopic to the open procedure was 17.9 months. Overall, 12 of the 20 patients (60%) had healed Bankart lesions at the time of open surgery. Eight of the 20 patients (40%) were found to have persistent Bankart lesions, and 15 of the 20 patients (75%) were found to have redundant anterior capsules. The presence of a persistent Bankart lesion significantly correlated with postarthroscopic dislocation, and the presence of capsular laxity significantly correlated with postarthroscopic subluxation. We concluded that capsular laxity is difficult to quantify arthroscopically and is present in a significant percentage of patients with chronic traumatic shoulder instability. Failure to successfully treat either the Bankart lesion or capsular laxity at the time of an arthroscopic Bankart procedure may lead to postoperative instability.

Arthroscopic anterior labral reconstruction using a transglenoid suture technique. Results in active-duty military patients.

We report the clinical outcome of arthroscopic labral reconstruction using a transglenoid suture technique in a young, active-duty military population. Forty-eight patients (49 shoulders) with varying degrees of glenohumeral instability underwent arthroscopic labral reconstruction using a transglenoid suture technique. All patients had traumatic injuries to their shoulders and all patients had magnetic resonance imaging scans demonstrating anterior labral tears. Postoperatively, the patients' shoulders were immobilized for up to 6 weeks. At a mean followup of 30 months (range, 12 to 49), 17 of the 41 patients (41%) with preoperative dislocation or subluxation had recurrent instability. Nine of these patients subsequently underwent open reconstruction procedures for recurrent instability. On the basis of the Rowe rating system, 53% had excellent or good results and 47% had fair or poor results. The overall perioperative complication rate was 14%. Suprascapular nerve palsy occurred in three cases (6%). Using the Fisher exact test, we determined that immobilization for 6 weeks postoperatively correlated with a lower recurrence rate in the patients with a history of glenohumeral dislocation (P = 0.007). The results of arthroscopic labral reconstruction using transglenoid sutures in the military patient are inferior to the reported 3% to 5% recurrence rate with open Bankart procedures, and the transglenoid pin technique jeopardizes the suprascapular nerve.