Faculty Bibliography

Purpose: There are many options for arthroscopic knots including the type of knot and suture material used. The current investigation evaluated knot properties using 3 high-strength suture materials tied in 5 common arthroscopic knot configurations. Methods: Four arthroscopic sliding knots including the Roeder, Weston, SMC, and Tennessee Slider and an arthroscopic nonsliding Surgeon's knot were evaluated. Each knot was tied with each of 3 No. 2 polyblended suture types (Fiberwire [Arthrex, Naples, FL], Ultrabraid [Smith & Nephew, Andover, MA], and Orthocord [Mitek, Raynham, MA]). Each configuration was tied 8 times, for a total of 120 samples. Loop security and knot security were then evaluated by using a previously described protocol comparing the different knot types and suture material. Results: With respect to loop security, Orthocord performed better than the other tested suture materials, producing on average smaller knot loops. For the nonsliding Surgeon's knot, there was no difference in loop security observed between suture types. For the Roeder knot, Fiberwire had superior knot security compared with Ultrabraid and Orthocord (P < .001). For the Weston knot, Ultrabraid showed superior knot security compared with Orthocord (P < .02). Knot security for the Tenessee slider knot was better for both Fiberwire and Ultrabraid compared with Orthocord (P < .001, respectively). Similar results were seen with the SMC knot, with Fiberwire and Ultrabraid outperforming Orthocord (P < .001, respectively). The nonsliding Surgeon's knot had significantly lower mean loads to failure compared with arthroscopic sliding knots for each tested suture material (P < .02 for all comparisons). Conclusions: Loop security and knot security varied depending on the type of knot tied and suture material used. Arthroscopic sliding knots performed better than the nonsliding Surgeon's knot. Clinical Relevance: Surgeons should try to use sliding knots instead of Surgeon's knots when using polyblend suture material. Differences between the brands in this suture category will change the characteristics of the knots thrown and may ultimately affect tissue fixation

PURPOSE: Surgeons have noticed an increased incidence of finger lacerations associated with arthroscopic knot tying with solid-core suture material. This study examines glove perforations and finger lacerations during arthroscopic shoulder surgery. METHODS: We collected 400 surgical gloves from 50 consecutive arthroscopic shoulder repair procedures using No. 2 solid-core sutures. Two surgeons using double gloves were involved in every case, with one being responsible for tying all knots. Powder-free latex gloves were worn in all cases. Knots consisted of a sliding stitch of the surgeon's preference followed by 3 half-hitches via a knot-pusher instrument. All gloves were inspected grossly and then tested for tears with an electroconductivity meter. RESULTS: The knot-tying surgeon had significantly more glove tears than the control (P < .01). Tears were localized to the radial side of the index finger of the glove at the distal interphalangeal joint in all cases. Of the tying surgeon's gloves, 68 (34%) were found to have tears. These included 17 inner gloves (17%) and 51 outer gloves (51%). If an inner glove was torn, the corresponding outer glove was torn in all cases. A mean of 3.96 knots were tied in each case. There was a significantly higher incidence of inner glove tears when more than 3 knots were tied (P < .03). There was no significant difference in glove tears between suture types. Finger lacerations did occur in the absence of glove tears. However, in the presence of an inner glove tear, there was a statistically significant association with a finger laceration at the corresponding level (P < .03). CONCLUSIONS: Intraoperative glove tears and subsequent finger lacerations occur with a high frequency when arthroscopic knots are tied with solid-core suture material. Risk can potentially be minimized by frequent glove changes or use of more durable, less penetrable gloves. CLINICAL RELEVANCE: This study addresses surgeon and patient safety during arthroscopic shoulder surgery

Articular cartilage defects are common and play a significant role in degenerative joint disease. Cartilage is unable to regenerate, secondary to an inherent lack of vascular supply, thus, various techniques have been described in an attempt to treat and potentially restore these defects. Treatment decisions should be based on appropriate evaluation and classification of the pathology. Only then can the surgeon choose to perform a repair or a restoration of the articular surface. Current literature and techniques for the treatment of articular cartilage defects are reviewed, with an algorithm developed for the management of articular cartilage defects by orthopaedic surgeons.

Total hip arthroplasty has evolved in regard to surgical technique, implant design, and long-term survivorship over the last several decades with excellent clinical results. Owing to these improvements, indications for surgery have expanded to include a greater variety of patients. We present the case of a 62-year-old man who underwent total hip arthroplasty 39 years after contralateral hemipelvectomy. The importance of an appropriate preoperative plan in regard to patient positioning and postoperative protocol is addressed. Our patient was informed that data concerning his case would be submitted for publication

A case of a 26-year-old male with symptoms resulting from loose bodies residing in a sublabral recess is presented. Operative intervention using the standard arthroscopic portals in addition to an accessory posterior portal was successful in removing the loose bodies and approximating the edges of the sublabral foramen. The shoulder is a complex region made up of numerous anatomic structures, which if damaged may be responsible for a patient's pathology. Normal anatomic variations also exist, which in certain situations, may contribute to a patient's presentation. One example of a normal anatomic variation is the sublabral foramen, which represents an unattached anterosuperior labrum

BACKGROUND CONTEXT: The spine is a complex and vital structure. Its function includes not only structural support of the body as a whole, but it also serves as a conduit for safe passage of the neural elements while allowing proper interaction with the brain. Anatomically, a variety of tissue types are represented in the spine. Embryologically, a detailed cascade of events must occur to result in the proper formation of both the musculoskeletal and neural elements of the spine. Alterations in these embryologic steps can result in one or more congenital abnormalities of the spine. Other body systems forming at the same time embryologically can be affected as well, resulting in associated defects in the cardiopulmonary system and the gastrointestinal and genitourinary tracts. PURPOSE: This article is to serve as a review of the basic embryonic development of the spine. We will discuss the common congenital anomalies of the spine, including their clinical presentation, as examples of errors of this basic embryologic process. STUDY DESIGN/SETTING: Review of the current literature on the embryology of the spine and associated congenital abnormalities. METHODS: A literature search was performed on the embryology of the spine and associated congenital abnormalities. RESULTS: Development of the spine is a complex event involving genes, signaling pathways and numerous metabolic processes. Various abnormalities are associated with errors in this process. CONCLUSION: Physicians treating patients with congenital spinal deformities should have an understanding of normal embryologic development as well as common associated abnormalities

One hundred twenty-three consecutive primary total hip arthroplasties in 107 patients were performed with the insertion of a cemented, all polyethylene, flanged acetabular component. At a minimum of 20 years, 66 patients had died (75 hips) and 8 patients (8 hips) were lost to follow-up evaluation, leaving 40 hips in 33 patients. At a mean of 21.1 years, 2 cups had been revised for aseptic loosening, one well-fixed cup was revised at the time of femoral component revision, and 4 additional cups had definite evidence of radiographic loosening. Survivorship analysis revealed a 77.3% survivorship for the component at 21 years, with revision or definite loosening as an endpoint (95% confidence interval, 67.8%-86.8%).

Allergy to polymethyl methacrylate bone-cement or its components is unusual. Because of the potential for an inflammatory response in an allergic patient and the possibility of pain and loosening if a cemented implant is used, it is imperative to identify patients with this allergy to modify their treatment. We report the case of an otherwise healthy 60-year-old woman who needed a total knee arthroplasty and who had an allergy to methyl methacrylate bone-cement identified preoperatively. The appropriate evaluation for a patient who is suspected to have an allergy to bone-cement or its components is reviewed