Sage Orthopaedics

A hamstring autograft is commonly used in anterior cruciate ligament (ACL) reconstruction (ACLR); however, there is evidence to suggest that the tendons harvested may contribute to medial knee instability. We tested the hypothesis that the gracilis (G) and semitendinosus (ST) tendons significantly contribute to sagittal, coronal, and/or rotational knee stability in the setting of ACLR with a concurrent partial medial collateral ligament (MCL) injury. After ACLR in knees with a concurrent partial MCL injury, the absence of loading on the G/ST did not significantly alter anterior stability. Simulated G/ST harvest did lead to increased valgus motion. These results may have important clinical implications and warrant further investigation to better outline the role of the medial hamstrings, particularly among patients with a concomitant ACL and MCL injury.   Click here to read the article.

Five articles from the December 2017 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are "In Vitro Chondrotoxicity of Nonsteroidal Anti-inflammatory Drugs and Opioid Medications", "The Incidence of Subsequent Meniscal Surgery Is Higher in the Anterior Cruciate Ligament-Reconstructed Knee Than in the Contralateral Knee", "A Comparison of 2-Year Outcomes in Patients Undergoing Tibiofemoral or Patellofemoral Matrix-Induced Autologous Chondrocyte Implantation", "Epidemiology of Posterior Glenohumeral Instability in a Young Athletic Population", and "Rotator Cuff Calcific Tendinitis: Ultrasound-Guided Needling and Lavage Versus Subacromial Corticosteroids: Five-Year Outcomes

Segond fractures may be identified when an anterior cruciate ligament (ACL) tear is diagnosed and likely represent an avulsion of the anterolateral ligament. It is currently unclear whether these fractures can be ignored at the time of ACL reconstruction or if they should be addressed surgically. Patients with a Segond fracture are at no higher risk to require revision ACL reconstruction compared with patients without a Segond fracture. This may be attributable to its high union rate. At the time of primary ACL reconstruction, if a Segond fracture is identified, it can be ignored (not repaired or reconstructed), and this approach does not appear to predispose to early ACL graft failure.   Click here to read the article.

Five articles from the November 2017 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are "Arthroscopic Harvest of Adipose-Derived Mesenchymal Stem Cells From the Infrapatellar Fat Pad", "An Anatomic and Biomechanical Comparison of Bankart Repair Configurations", "Including the Copenhagen Adduction Exercise in the FIFA 11+ Provides Missing Eccentric Hip Adduction Strength Effect in Male Soccer Players: A Randomized Controlled Trial", "Cam Deformities and Limited Hip Range of Motion Are Associated With Early Osteoarthritic Changes in Adolescent Athletes: A Prospective Matched Cohort Study", and "Surgical Treatment of Distal Biceps Tendon Ruptures: An Analysis of Complicat

Distal biceps brachii tendon ruptures lead to substantial deficits in elbow flexion and supination; surgical repair restores muscle strength and endurance. The purpose of this study was to examine clinical and surgical outcomes for distal biceps tendon repairs in a large, multispecialty, integrated health care system. The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, the double-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and reoperation rate. Surgeon’s years of practice, fellowship training, and case volume do not affect the rate of major complications.   Click here to read the article.

Five articles from the October 2017 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are "Professional Athletes’ Return to Play and Performance After Operative Repair of an Achilles Tendon Rupture", "A 20-Year Follow-up After First-Generation Autologous Chondrocyte Implantation", "Pectoralis Major Repair: A Biomechanical Analysis of Modern Repair Configurations Versus Traditional Repair Configuration", "In Vivo Performance of a Novel, Anatomically Shaped, Total Meniscal Prosthesis Made of Polycarbonate Urethane: A 12-Month Evaluation in Goats", and "Risk of Engagement of Bipolar Bone Defects in Posterior Shoulder Instability".   Click here to read the articles.

Transplantation of fresh osteochondral allografts (OCAs) is an attractive treatment option for symptomatic articular cartilage lesions in young, healthy patients. Because the lack of OCA bone integration can be a cause of treatment failure, methods for speeding and enhancing OCA bone integration to mitigate this potential complication are highly desirable. Large femoral condylar OCAs treated with autogenous BMC before implantation showed superior radiographic integration to bone and less sclerosis during the initial 6-month postoperative period. BMC treatment of OCAs may mitigate the failure of OCA bone healing.   Click here to read the article.

Five articles from the September 2017 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are "Surgical Predictors of Clinical Outcomes After Revision Anterior Cruciate Ligament Reconstruction", "Changes in Cartilage Biomarker Levels During a Transcontinental Multistage Footrace Over 4486 km", "Risk Factors for Tear Progression in Symptomatic Rotator Cuff Tears: A Prospective Study of 174 Shoulders", "Successful Return to Sport After Arthroscopic Shoulder Stabilization Versus Nonoperative Management in Contact Athletes With Anterior Shoulder Instability: A Prospective Multicenter Study", and "Young Athletes After Anterior Cruciate Ligament Reconstruction With Single-Leg Lan

Advancements in instrumentation and techniques have extended the scope of hip arthroscopic surgery to treat complex osseous deformities that were previously best addressed with an open approach. Global pincer-type femoroacetabular impingement is an example of an abnormality requiring osseous correction with a technically challenging access point. Hip arthroscopic surgery for the management of symptomatic labral tears in patients with combined overcoverage and coxa profunda is associated with improvements in patient outcomes and pain at a minimum 2-year follow-up. However, the degree of improvement is of lower magnitude compared with a matched cohort with normal coverage undergoing the arthroscopic management of symptomatic labral tears. While hips with lateral overcoverage combined with coxa profunda may have a smaller potential for improvement compared with hips with normal coverage, this type of osseous morphology is still repairable with arthroscopic treatment.   Click here to read the article.

Five articles from the August 2017 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are "Return to Play After Shoulder Instability Surgery in National Collegiate Athletic Association Division I Intercollegiate Football Athletes", "Anchored Transosseous-Equivalent Versus Anchorless Transosseous Rotator Cuff Repair: A Biomechanical Analysis in a Cadaveric Model", "Fresh Osteochondral Allograft Transplantation: Is Graft Storage Time Associated With Clinical Outcomes and Graft Survivorship?", "Performance-Based Outcomes After Anterior Cruciate Ligament Reconstruction in Professional Athletes Differ Between Sports", and "Economic Decision Model for First-Time Traumatic Patell

Radial meniscus tears disrupt the circumferential fibers and thereby compromise meniscus integrity. Historically, radial tears were often treated with meniscectomy because of an incomplete understanding of the biomechanical consequences of these tears, limited information regarding the biomechanical performance of repair, and the technical difficulty associated with repair. There is a paucity of studies on the outcomes of the repair of radial meniscus tears. The purpose was to determine the outcomes of 2-tunnel transtibial repair of radial meniscus tears and compare these results to the outcomes of patients who underwent the repair of vertical meniscus tears with a minimum of 2-year follow-up. The hypothesis was that radial and vertical meniscus tear repair outcomes were comparable. The 2-tunnel transtibial pullout technique for the repair of radial meniscus tears produces similar clinical outcomes when compared with the repair of vertical meniscus tears at a mean 3.5 years’ follow-up.   Click here to read th

Five articles from the July 2017 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are "The Effect of Subcritical Bone Loss and Exposure on Recurrent Instability After Arthroscopic Bankart Repair in Intercollegiate American Football", "Femoroacetabular Impingement in Professional Football Players: Return to Play and Predictors of Career Length After Hip Arthroscopy", "High Rate of Osteoarthritis After Osteochondritis Dissecans Fragment Excision Compared With Surgical Restoration at a Mean 16-Year Follow-up", "Objectively Measured Physical Activity in Patients After Anterior Cruciate Ligament Reconstruction", and "Intratendon Delivery of Leukocyte-Poor Platelet-Rich Plasma

Anterior cruciate ligament (ACL) injuries occur commonly in football. Recent work has reported ACL reconstruction (ACLR) as one of several orthopaedic procedures with unfavorable outcomes for professional athletes. The performance impact to defensive players after surgery has not been quantified. Approximately 74% (28/38) of athletes who underwent ACLR returned to play at least 1 NFL game, and 61% (23/38) successfully returned to play at least half a season (ie, 8 games). Players who successfully returned were above-average NFL players before their injury but comparatively average after their return.   Click here to read the article.

Five articles from the June 2017 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are "Intra-articular Recombinant Human Proteoglycan 4 Mitigates Cartilage Damage After Destabilization of the Medial Meniscus in the Yucatan Minipig", "Return to Sport and Recreational Activity After Osteochondral Allograft Transplantation in the Knee", "Arthroscopic Versus Open Latarjet in the Treatment of Recurrent Anterior Shoulder Dislocation With Marked Glenoid Bone Loss: A Prospective Comparative Study", "Risk Factors for Revision Surgery After Superior Labral Anterior-Posterior Repair: A National Perspective", and "Anatomic Reconstruction of the Anterior Cruciate Ligament of the Knee

Graft failure and low rates of return to sport are major concerns after anterior cruciate ligament (ACL) reconstruction, particularly in a population at risk. The purpose of this study was to evaluate the association between reconstruction techniques and subsequent graft rupture and return-to-sport rates in patients aged 16 to 30 years participating in pivoting sports. In conclusion, in a high-risk population of young patients participating in pivoting sports, the rate of graft failure with HT+ALL grafts was 2.5 times less than with B-PT-B grafts and 3.1 times less than with 4HT grafts. The HT+ALL graft is also associated with greater odds of returning to preinjury levels of sport when compared with the 4HT graft.   Click here to read the article.

Five articles from the May 2017 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are "Outcomes After Biologically Augmented Isolated Meniscal Repair With Marrow Venting Are Comparable With Those After Meniscal Repair With Concomitant Anterior Cruciate Ligament Reconstruction", "Long-term Effects of Adolescent Sport Concussion Across the Age Spectrum", "Interposition Dermal Matrix Xenografts: A Successful Alternative to Traditional Treatment of Massive Rotator Cuff Tears", "The Association of Sport Specialization and Training Volume With Injury History in Youth Athletes", and "Traumatic Patellar Dislocation and Cartilage Injury: A Follow-up Study of Long-Term Cartilage De

The use of allograft tissue for anterior cruciate ligament reconstruction (ACLR) remains controversial. The purpose of this study is to compare the risk of aseptic revision between bone–patellar tendon–bone (BPTB) autografts and BPTB allografts. In conclusion, when BPTB allograft tissue was used for ACLR, an overall 4.54 times adjusted higher risk of revision was observed compared with surgery performed with a BPTB autograft. Whether the tissue was irradiated with either high- or low-dose radiation, chemically processed, or not processed at all made little difference in the risk of revision. The differences in the revision risk were also consistent in younger and older patients. Surgeons and patients should be aware of the increased risk of revision when a BPTB allograft is used for ACLR.   Click here to read the article.

Five articles from the April 2017 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are "Prospective Evaluation of Surgical Treatment of Humeral Avulsions of the Glenohumeral Ligament", "The Tibial Tubercle–Trochlear Groove Distance Is Greater in Patients With Patellofemoral Pain: Implications for the Origin of Pain and Clinical Interventions", "Morphological Distribution of the Anterior Inferior Iliac Spine in Patients With and Without Hip Impingement: Reliability, Validity, and Relationship to the Intraoperative Assessment", "Long-term Outcomes of Autologous Chondrocyte Implantation in Adolescent Patients", and "Body Mass and Weekly Training Distance Influence the Pain

Quantitative magnetic resonance (qMR) can be used to measure macromolecules in tissues and is a potential method of observing early cartilage changes in the development of posttraumatic osteoarthritis. We hypothesized that specific patient and surgical factors affecting cartilage matrix composition after anterior cruciate ligament (ACL) reconstruction (ACLR) can be detected using T1ρ and T2 relaxation times. Our purpose was to demonstrate this ability in a multicenter feasibility study. We concluded that prolonged relaxation times in multiple regions demonstrate how the injury affects the entire joint after an ACL tear. Changes observed in the uninjured knee may be caused by increased loading during rehabilitation, especially in the patellofemoral articular cartilage and distal femur. Relaxation times in the tibial regions may be predictive of patient symptoms at 6 months. These same regions are affected by surgical timing as early as 30 days after injury, but this may partially be reflective of the severity

Patient selection is critical when choosing between arthroscopic joint preservation and total shoulder arthroplasty in young patients with glenohumeral osteoarthritis (GHOA). The purpose of this study was to identify prognostic factors predictive of early failure in patients undergoing comprehensive arthroscopic management (CAM) for GHOA. The CAM procedure has been shown to reliably improve pain and function in active patients with advanced GHOA; however, it is important to inform patients about the limitations of the procedure. Patients with less joint space and abnormal posterior glenoid shape were significantly more likely to progress to early failure.   Click here to read the article.