Faculty Bibliography

Meniscus injuries are one of the most commonly encountered problems by orthopaedic surgeons today. Surgical techniques for the treatment of meniscal tears are evolving. While many tears can only be treated with partial menisectomy, there are an increasing number of surgical techniques to repair or reconstruct the meniscus. Because of the large increases in contact pressures across the articular cartilage due to loss of meniscal tissue, there has been increased focus on preventing the development of degenerative joint disease from meniscal injuries requiring partial or subtotal menisectomy. Some of these newer techniques include allografts, scaffolds, collagen implants, and repair enhancements. The common goal of these newer techniques is to preserve or restore as much normal, functioning meniscal tissue as possible. This review aims to review the various techniques and history of meniscus repair as well as examine of the newer techniques being introduced to reconstruct or replace the meniscus

We investigated the effects of implementation of an institution-wide screening and decolonization protocol on the rates of deep surgical site infections (SSIs) in patients undergoing primary knee and hip arthroplasties. 2058 patients were enrolled in this study: 1644 patients in the treatment group and 414 in the control group. The treatment group attended preoperative admission testing (PAT) clinic where they were screened for MSSA and MRSA colonization. All patients were provided a 5-day course of nasal mupirocin and a single preoperative chlorhexidine shower. Additionally, patients colonized with MRSA received Vancomycin perioperative prophylaxis. The control group did not attend PAT nor receive mupirocin treatment and received either Ancef or Clindamycin for perioperative antibiotic prophylaxis. There were a total of 6 deep infections in the control group (1.45%) and 21 in the treatment group (1.28%); this represented a decrease of 13% (P = .809) in the treatment versus control group. This decrease represented a positive trend in favor of staphylococcus screening, decolonization with mupirocin, and perioperative Vancomycin for known MRSA carriers

The medial collateral ligament is the most frequently injured ligament of the knee. The anatomy and biomechanical role of this ligament and the associated posteromedial structures of the knee continue to be explored. Prophylactic knee bracing has shown promise in preventing injury to the medial collateral ligament, although perhaps at the cost of functional performance. Most isolated injuries are treated nonsurgically. Recent studies have investigated ligament-healing variables, including modalities such as ultrasound and nonsteroidal anti-inflammatory drugs. Concomitant damage to the anterior or posterior cruciate ligaments is a common indication to surgically address the high-grade medial collateral ligament injury. The optimal treatment of multiligamentous knee injuries continues to evolve, and controversy exists surrounding the role of medial collateral ligament repair/reconstruction, with data supporting both conservative and surgical management

Patellofemoral joint arthritis is a common condition which can be extremely debilitating. Although it is a common condition, the treatment of isolated patellofemoral arthritis varies and remains controversial. The objective of this review is to provide an overview of the current understanding of patellofemoral arthritis and various different surgical options, indications, and their respective outcomes

The subscapularis tendon, coracohumeral ligament, and transverse humeral ligament are all believed to contribute to biceps tendon stability within the bicipital groove. In order to examine the relative contribution of these soft tissue structures to proximal biceps tendon stability, 11 fresh frozen cadaveric shoulder specimens were prepared and mounted onto a custom jig. A three-dimensional digitizer was utilized to record biceps tendon excursion in various shoulder positions. In sequential order, these structures were then sectioned, and biceps tendon excursion was again recorded. We found that sectioning of the subscapularis tendon significantly increased biceps tendon excursion, compared to intact specimens (8.1 +/- 4.1 mm vs. 4.3 +/- 3.6 mm; p < 0.006). In contrast, isolated sectioning of the transverse humeral ligament or the coracohumeral ligament did not significantly increase biceps excursion (5.4 +/- 2.5 mm, p = 0.26; 5.6 +/- 1.3 mm, p = 0.24). When two structures were sectioned, significant excursion in the biceps tendon only occurred in specimens where the subscapularis tendon was one of the sectioned structures. The preliminary data suggest that, of the three tested soft tissue structures, the subscapularis tendon is the most important stabilizer of the proximal biceps and that clinically significant lesions of the proximal biceps tendon may be associated with a defect in the subscapularis tendon

In this review of prospectively collected data, representing the largest series of its kind, we identified 25 stress injuries of the diaphyseal femur in 20 athletes at an NCAA (National Collegiate Athletic Association) Division I university. All 20 patients successfully completed rehabilitation and returned to activity without limitations. Seventeen of these patients (representing 22 injuries) were female, and all 5 patients who sustained 2 stress injuries were female. The higher proportion of injured females in this study, and the histories of menstrual irregularities and disordered eating, raised the concern that the female athlete triad may be a factor. It is important to consider the diagnosis of stress injuries of the diaphyseal femur when evaluating thigh pain in running athletes, especially females, as early diagnosis and treatment lead to excellent outcomes and full return to activity. Magnetic resonance imaging should be considered the gold standard in the diagnostic evaluation of these injuries. Further, as stress fractures may be the first presentation of the female athlete triad, it is also important for orthopedic surgeons to identify the presence of risk factors that may predispose athletes to recurrent stress injuries and other health problems

Clavicle fractures are common skeletal injuries that are typically managed nonoperatively, which results in a high rate of fracture union with few or no long-term sequelae. Type II distal clavicle fractures are an exception, with reported rates of nonunion ranging from 22% to 44%. This high rate of nonunion has led to controversy regarding the appropriate treatment of type II injuries. The following case report describes a type IIB distal clavicle fracture, in which nonoperative management was complicated by the breakdown of skin over the fracture site and the subsequent development of infection. This is a rare complication of conservative management. Thorough operative debridement, fracture stabilization via external fixation, and identification of the causative organism allowed for successful outcome in the management of this complex presentation

BACKGROUND: Strain injury to the adductor longus muscle is a common cause of groin pain in athletes and generally occurs in the proximal portion of the muscle, near its origin from the anterior aspect of the pubis. The composition and cross-sectional anatomy of this muscle's origin has not been previously described. HYPOTHESIS: We hypothesize that the adductor longus muscle origin is composed mainly of muscle fibers and that the tendon composes only a small part of the cross section at the origin of the muscle. STUDY DESIGN: Descriptive laboratory study. METHODS: We harvested 42 adductor longus muscles from 28 cadavers and measured the cross-sectional dimensions of the tendon with microcalipers. Next, we determined the relative contributions of the tendon and muscle fibers to the cross-sectional anatomy of the muscle using optical scanning. These 2 sets of measurements were obtained at 3 locations: at the muscle origin and 1.0 and 2.0 cm distal to the origin. RESULTS: The average length and width of the tendon was 11.6 and 3.7 mm, respectively, at the origin. The average cross-sectional areas of the tendon were 49.3, 27.9, and 25.7 mm(2) at points 0.0, 1.0, and 2.0 cm from its origin, respectively. The origin of the adductor longus muscle was composed of 37.9% tendon and 62.1% muscle tissue. At 1.0 cm from the origin, the percentage of tendon decreased to 34%. At 2.0 cm from the origin, the tendon composed 26.7% of the cross section. CONCLUSION: The cross-sectional area of the tendon of the adductor longus muscle is relatively small. The muscle origin is composed predominantly of direct attachment of muscle fibers. CLINICAL RELEVANCE: Knowledge of the cross-sectional anatomy of the adductor longus muscle at its origin may help clinicians better understand the complex nature of injuries in this area