A multicenter study investigating factors that influence initiation of return to sport functional testing following ACL reconstruction

Despite advances in surgical technique and rehabilitation following anterior cruciate ligament (ACL) reconstruction, re-injury rates after return to play (RTP) are high. There remains controversy over the most effective criteria utilized to initiate RTP functional testing following ACL reconstruction. The purpose of this study is to investigate factors that influence provider decision to initiate RTP functional testing

Treatment of Glenoid Chondral Defect Using Micronized Allogeneic Cartilage Matrix Implantation

Abstract: Focal chondral lesions of the glenohumeral joint, though less common than chondral defects in the knee or ankle, can be a significant source of pain in an active population. For patients in whom nonsurgical management fails, promising results have been reported after arthroscopic microfracture surgery to treat such lesions. However, microfracture leads to growth of fibrocartilage tissue and is biomechanically less durable than native hyaline cartilage. Recently, augmentation of the microfractured defect with micronized allogeneic cartilage and platelet-rich plasma has been described to restore hyaline-like cartilage and potentially protect the subchondral bone from postsurgical fracture biology within the base of the defect. We present a simple arthroscopic technique of implanting dehydrated, micronized allogeneic cartilage scaffold to treat an isolated chondral lesion of the glenoid. C artilage injury in the shoulder may be caused by trauma, shoulder instability, osteonecrosis, infection, chondrolysis, osteochondritis dissecans, inflammatory arthritis, rotator cuff arthropathy, and osteoarthritis. Although symptomatic glenohumeral chondral lesions in elderly and less active patients can be successfully treated with shoulder arthroplasty, focal chondral lesions in the younger, active patient population demand alternative treatment strategies that preserve the joint because of the high rate of glenoid component failure and need for revision surgery in younger patients treated with shoulder arthroplasty

Approach to the Patient With Failed Hip Arthroscopy for Labral Tears and Femoroacetabular Impingement

There has been an exponential increase in the diagnosis and treatment of patients with femoroacetabular impingement, leading to a rise in the number of hip arthroscopies done annually. Despite reliable pain relief and functional improvements after hip arthroscopy in properly indicated patients, and due to these increased numbers, there is a growing number of patients who have persistent pain after surgery. The etiology of these continued symptoms is multifactorial, and clinicians must have a fundamental understanding of these causes to properly diagnose and manage these patients. Factors contributing to failure after surgery include those related to the patient, the surgeon, and the postoperative physical therapy. This review highlights common causes of failure, including those related to residual bony deformity as well as capsular deficiency, and provides a framework for diagnosis and treatment of these patients

Arthroscopic Saucerization and All-Inside Repair of a Delaminated Discoid Lateral Meniscus

Preservation of the meniscus has been shown to influence the progression of degenerative changes of the knee. As more meniscus is preserved, the propensity for development of osteoarthritis is lessened. Surgical treatment of a torn discoid meniscus has typically been a subtotal meniscectomy or partial meniscectomy. Similar to tears of a normal meniscus, partial meniscectomy compared with subtotal meniscectomy of the discoid meniscus confers better long-term results. With the abnormal morphology predisposing the discoid meniscus to tearing, several characteristic tear patterns can be observed—the horizontal tear being commonly encountered. We present a technique that not only creates a more normal morphology of a discoid meniscus but also preserves the tissue by using an all-inside, intrameniscal repair technique. This technique restores the central rim of the meniscus in the setting of a horizontal cleavage plane, thus restoring a more normal meniscus morphology