Patellar Tendon Reconstruction Using Semitendinosus Autograft With Preserved Distal Insertion for Treatment of Patellar Tendon Rupture After Bone-Patellar Tendon-Bone ACL Reconstruction: A Case Report

Patellar tendon rupture after bone–patellar tendon–bone (BTB) anterior cruciate ligament (ACL) reconstruction is a rare but known complication. Other complications that are more common include anterior knee pain, pain with kneeling, and peri-incisional numbness. When the extensor mechanism fails after a BTB harvest, it is more commonly in the form of a patellar fracture. The rate of patellar tendon rupture has been reported to be about 0.25%, while patellar fractures are seen at a rate of 1.3%.1,7,18 Patellar tendon rupture can occur either in the early postoperative period, usually attributed to slip and fall–type injuries, or as a late manifestation by forced eccentric contraction in a flexed knee.4,6,8,9 A variety of reconstruction options have been reported in the literature.2,7,10 Much of the traditionally described patellar tendon repair techniques are difficult to apply to a harvested tendon because of the defect within the patella and tendon as well as the different patterns of rupture encountered in harvested tendons. Combined with the risk of patellar fracture after BTB ACL reconstruction, the decision to make additional drill holes through the bone before the defect has filled is met with hesitation.1

Treatment of chronic lateral ankle instability: a modified brostrom technique using three suture anchors

Ankle sprains are very common injuries seen in the athletic and young population. Majority of patients will improve with a course of rest and physical therapy. However, with conservative management about twenty percent of all patients will go on to develop chronic lateral ankle instability. This manuscript describes our detailed surgical technique of a modification to the original Brostrom procedure using three suture anchors to anatomically reconstruct the lateral ankle ligaments to treat high demand patients who have developed chronic lateral ankle instability. The rationale for this modification along with patient selection and workup are discussed. Both the functional outcomes at the two year follow up along with the complications and the detailed postoperative rehabilitation protocol for the high demand athletes are also presented. This modified Brostrom procedure is shown in both illustrative format and intra-operative photos

Treatment of chronic lateral ankle instability: a modified broström technique using three suture anchors

Ankle sprains are very common injuries seen in the athletic and young population. Majority of patients will improve with a course of rest and physical therapy. However, with conservative management about twenty percent of all patients will go on to develop chronic lateral ankle instability. This manuscript describes our detailed surgical technique of a modification to the original Broström procedure using three suture anchors to anatomically reconstruct the lateral ankle ligaments to treat high demand patients who have developed chronic lateral ankle instability. The rationale for this modification along with patient selection and workup are discussed. Both the functional outcomes at the two year follow up along with the complications and the detailed postoperative rehabilitation protocol for the high demand athletes are also presented. This modified Broström procedure is shown in both illustrative format and intra-operative photos

Arthroscopic debridement of the osteoarthritic knee combined with hyaluronic acid (Orthovisc(R)) treatment: A case series and review of the literature

OBJECTIVE: An evaluation of safety and efficacy of high molecular weight hyaluronan (HA) delivered at the time of arthroscopic debridement of the osteoarthritic knee. METHODS: Thirty consecutive patients who met inclusion and exclusion criteria underwent arthroscopic debridement by a single surgeon and concomitant delivery of 6 ml/90 mg HA (Orthovisc(R)). These patients were evaluated preoperatively, at 6 weeks, 3 and 6 months post-operatively. Evaluations consisted of WOMAC pain score, SF-36 Physical Component Summary (PCS) score and complications. RESULTS: No complications occurred during this study. Pre-op average WOMAC pain score was 6.8 +/- 3.5 (n = 30) with a reduction to 3.4 +/- 3.1 at 6 weeks (n = 27). Final average WOMAC pain score improved to 3.2 +/- 3.8 at six months (n = 23). No patients had deterioration of the WOMAC pain score. Mean pre-operative SF-36 PCS score was 39.0 +/- 10.4 with SF-36 PCS score of the bottom 25th percentile at 29.9 (n = 30). Post procedure and HA delivery, mean PCS score at 6 weeks improved to 43.7 +/- 8.0 with the bottom 25th percentile at 37.5 (n = 27). At 6 months, mean PCS score was 48.0 +/- 9.8 with the bottom 25th percentile improved to 45.8 (n = 23). CONCLUSION: The results show that concomitant delivery of high molecular weight hyaluronan (Orthovisc(R) - 6 ml/90 mg) is safe when given at the time of arthroscopic debridement of the osteoarthritic knee. By delivering HA (Orthovisc(R)) at the time of the arthroscopic debridement, there may be a decreased risk of joint infection and/or injection site pain. Furthermore, the combination of both procedures show efficacy in reducing WOMAC pain scores and improving SF-36 PCS scores over a six month period

Management of type II superior labrum anterior posterior lesions: a review of the literature

Superior labrum anterior and posterior lesions were first described in 1985 by Andrews et al. and later classified into four types by Synder et al. The most prevalent is type II which is fraying of the superior glenoid labrum with detachment of the biceps anchor. Superior labrum anterior posterior (SLAP) lesions can also be associated with other shoulder pathology. Both MRI and MRA can be utilized in making the diagnosis with the coronal images being the most sensitive. The mechanism of injury can be either repetitive stress or acute trauma with the superior labrum most vulnerable to injury during the late cocking phase of throwing. A combination of the modified dynamic labral shear and O'Brien test can be used clinically in making the diagnosis of SLAP lesion. However, the most sensitive and specific test used to diagnosis specifically a type II SLAP lesion is the Biceps Load Test II. The management of type II SLAP lesions is controversial and dependent on patient characteristics. In the young high demanding overhead athlete, repair of the type II lesion is recommended to prevent glenohumeral instability. In middle-aged patients (age 25–45), repair of the type II SLAP lesion with concomitant treatment of other shoulder pathology resulted in better functional outcomes and patient satisfaction. Furthermore, patients who had a distinct traumatic event resulting in the type II SLAP tear did better functionally than patients who did not have the traumatic event when the lesion was repaired. In the older patient population (age over 45 years), minimum intervention (debridement, biceps tenodesis/tenotomy) to the type II SLAP lesion results in excellent patient satisfaction and outcomes

S-glutathionylation activates STIM1 and alters mitochondrial homeostasis

Oxidant stress induces constitutive calcium entry by tacking glutathiones onto the Orai CRAC channel activator STIM1

Preface. A state-of-the-art overview on the treatment of hip injuries

Management of sports-related hip injuries is currently one of the fastest growing, challenging, and dynamic fields in sports medicine. Interest in this field has risen due to greater comprehension of the hip’s normal function, biomechanics, and pathologic states. Through research and greater success in the effectiveness of surgical procedures, more physicians have a heightened interest in treating sports-related hip injuries. It was my goal to provide to the sports medical practitioner a complete and state-of-the-art overview from some of the world’s experts on the treatment of hip injuries, from diagnosis to nonoperative treatment to surgical intervention

Assessment and differential diagnosis of the painful hip

Hip pain is a common problem seen by orthopaedic surgeons. The current authors provide an approach to the patient with hip pain, including important information to be gained from the history and physical examination and relevant radiographic studies and laboratory tests. A differential diagnosis for patients presenting with the complaint of hip pain and indications for hip arthroscopy are provided