Faculty Bibliography

The treatment of massive irreparable rotator cuff tears has been a controversial topic with multiple procedures described. Research trends have been growing rapidly over the past decade resulting in a greater understanding of its natural evolution. No singular superior procedure has been described. Rather, treatment options should be weighed in the setting of patient expectations, comorbidities, and the findings from clinical examinations. Based on the current literature, practitioners should be aware of the available treatment options and the most appropriate settings for employing each option. This review discusses the history of massive irreparable rotator cuff tears and evaluates each treatment option based on the highest quality of research available.

BACKGROUND:Several methods are available for fixing the femoral side of a hamstring autograft in ACL reconstruction and the best method is unclear. Biomechanical studies have shown varying results with regard to fixation failure. QUESTIONS/PURPOSES/OBJECTIVE:We asked whether there were any differences with regard to graft failures and functional outcome measures with differing methods of femoral fixation of hamstring autografts in ACL reconstruction. METHODS:We systematically reviewed the literature using PubMed, MEDLINE, Scopus, and Cochrane Controlled Trial Register databases with regard to interference screw fixation (aperture fixation) versus noninterference screw fixation (fixation away from the joint line). A meta-analysis was performed of those studies reporting on surgical failures and postoperative International Knee Documentation Committee score. Eight studies met our inclusion criteria of Level I or II evidence. RESULTS:Use of interference screws for femoral fixation resulted in a trend toward decreased risk of surgical failure (relative risk = 0.57; confidence interval, 0.1678-1.0918). When only Level I trials were evaluated, the same trend was noted toward a decreased risk of surgical failures using femoral interference screws (relative risk = 0.52; confidence interval, 0.1794-1.3122). There was no difference in postoperative International Knee Documentation Committee score with Level I and II studies (relative risk = 0.9940; confidence interval, 0.6230-1.5860) or only Level I studies (relative risk = 1.0380; confidence interval, 0.6381-1.6886). CONCLUSIONS:The literature suggests a trend toward decreased surgical failures with femoral fixation at the joint line with an interference screw. However, there is no difference when postoperative functional outcomes are compared. Future studies are needed with standardized fixation methods and outcomes assessment to determine the importance of femoral fixation.

We report a case of giant cell tumor that occurred in the proximal tibia of a 52-year-old man 13 years after bone-patella-bone anterior cruciate ligament reconstruction. The tumor was at the site of the metal interference screw. We discuss the differential diagnosis of proximal tibia lesions that occur after anterior cruciate ligament reconstruction and the importance of recognizing potentially life-threatening sports tumors.