Biceps Tenodesis for Type II SLAP Tears.

Tears of the superior glenoid labrum are a common cause of shoulder pain and disability, especially in overhead athletes such as pitchers, swimmers, and volleyball players. Type II SLAP lesions have been the most clinically important superior labral pathology, and the management of this lesion has been a very controversial topic. Currently, there are no high level studies in the literature to guide treatment. While the few level 3 and level 4 evidence studies that are available following arthroscopic repair of type II SLAP lesions all report reasonable overall patient satisfaction, persistent postoperative pain is common and associated with a low return to pre-injury level of sports participation. There has been a recent school of thought that biceps tenodesis, which maintains the length-tension relationship of the long head of biceps, should be the procedure of choice for patients with isolated type II SLAP lesions. The current paper reviews the role biceps tenodesis plays in the management of type II SLAP tears.

The Masters Athlete: A Review of Current Exercise and Treatment Recommendations.

CONTEXT: With the ever-increasing number of masters athletes, it is necessary to understand how to best provide medical support to this expanding population using a multidisciplinary approach. EVIDENCE ACQUISITION: Relevant articles published between 2000 and 2013 using the search terms masters athlete and aging and exercise were identified using MEDLINE. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 3. RESULTS: Preparticipation screening should assess a variety of medical comorbidities, with emphasis on cardiovascular health in high-risk patients. The masters athlete should partake in moderate aerobic exercise and also incorporate resistance and flexibility training. A basic understanding of physiology and age-related changes in muscle composition and declines in performance are prerequisites for providing appropriate care. Osteoarthritis and joint arthroplasty are not contraindications to exercise, and analgesia has an appropriate role in the setting of acute or chronic injuries. Masters athletes should follow regular training regimens to maximize their potential while minimizing their likelihood of injuries. CONCLUSION: Overall, masters athletes represent a unique population and should be cared for utilizing a multidisciplinary approach. This care should be implemented not only during competitions but also between events when training and injury are more likely to occur. STRENGTH OF RECOMMENDATION TAXONOMY SORT: B.

Costal cartilage autografts to simulated degenerative intervertebral discs in the rat.

STUDY DESIGN: An autograft of costal cartilage was transplanted into the rat intervertebral space in the proximal tail following 2 weeks of simulated degeneration by chondroitinase ABC (CABC). OBJECTIVES: The purpose of this study was to evaluate costal cartilage transplantation into a degenerated disc as a possible therapy. SUMMARY OF BACKGROUND DATA: Reversal of degenerative disc dehydration is an attractive goal. Costal cartilage is plentiful, hydrophilic, and avascular, leading us to speculate that it would survive transplantation into the degenerated disc, increase proteoglycan content, and restore disc height. MATERIALS AND METHODS: Costal cartilage fragments were transplanted into a single proximal intervertebral disc in each of the rats' tails following a 2-week period of simulated degeneration. The intervertebral space was measured on radiographs under 2.5x magnification taken pretreatment and 21 days posttreatment. Each specimen was sagittally sectioned, mounted, and stained. The slides were graded for proteoglycan content. RESULTS: A 64% increase in intervertebral disc height was observed in the implant group compared with a 4% increase in sham operated group and a 39% increase in the CABC only group. Histology demonstrated a viable implant in 7 of 9 rats. The transplant group had significantly more proteoglycan staining than either the CABC group or sham group (P < 0.05). CONCLUSIONS: Costal cartilage transplantation may rehydrate degenerated intervertebral discs and might serve as a promising model for understanding and perhaps modifying this complex degenerative disease.

The effect of levodopa or levodopa-carbidopa (sinemet) on fracture healing.

OBJECTIVES: Levodopa (L-dopa) and L-dopa/carbidopa were evaluated to determine their effectiveness in the stimulation of bone healing of fractures at risk for nonunions. METHODS: Forty-two retired breeder female Sprague-Dawley rats were divided into 2 experimental groups and 1 control. Thirty-six rats were evaluated for results. The right femur of each rat was fractured and an intramedullary omega pin was inserted to create a 2 mm bone gap. The rats were administered either 0.2 g/kg/d of L-dopa, 0.2/0.02 g/kg/d L-dopa/carbidopa in their feed, or plain powdered chow (Sham control group). The rats were killed at 5 weeks postsurgery. The femurs were excised, radiographed, and mechanically tested. Bone healing was assessed. Bone stiffness, ultimate load, and energy to failure were determined under 3 point bending using an Instron materials testing system. RESULTS: The femurs of 30% of the Sham rats healed compared with 50% of the L-dopa/carbidopa and 84% of the L-dopa treated femurs. The healed L-dopa rat femurs had significantly greater ultimate load (P = 0.037) and energy to failure (P = 0.004) than the healed Sham rats. There were no significant differences between the L-dopa/carbidopa group and either the Sham or L-dopa group. CONCLUSIONS: These results confirm that L-dopa administration increases the healing in nonunion fractures. The combination of L-dopa/carbidopa did not significantly increase fracture healing.