Faculty Bibliography

The gender disparity of anterior cruciate ligament injury has recently been demonstrated and is striking. Numerous etiological factors have been implicated but definitive causation has not yet been determined. An overview of the various hypotheses has been presented and it appears that the etiology is multifactorial. The intrinsic factors are primarily anatomical and cannot be altered in an effort to reduce injury rate. Presently, neuromuscular factors appear to be the most contributory to female ACL injury. Physicians, trainers, and coaches participating in the care of female athletes should encourage proper conditioning. A particular emphasis should be placed on hamstring and gastrocnemius strengthening, as female athletes tend to be quadriceps dominant. Movement training that encourages landing and pivoting with increased knee flexion should also be emphasized. Structured plyometric and jump training programs have been documented to significantly reduce the rate of female ACL injury and continued research in this area may provide more explanation to the gender disparity of ACL injury rates.

A 75-year-old male patient had an unexplained transient ischemic attack. Transesophageal echocardiography revealed a large, unruptured Sinus of Valsalva aneurysm which contained spontaneous echo contrast. This finding represents a potential source of embolism

The authors determined the outcomes of 18 consecutive Volz total wrist arthroplasties that were followed for an average of 8.6 years. Nine of these wrists were followed for 10 or more years. Fourteen wrists were replaced for rheumatoid arthritis and four for post-traumatic degenerative joint disease. Forty-nine degrees of combined flexion and extension and 25 degrees of combined ulnar and radial deviation were maintained. The balance of wrist motion was dependent upon the design and location of the metacarpal prosthesis. A 24% loss in carpal height (subsidence) occurred during the study period. Four metacarpal components were loose (22%), three of which were placed in patients with degenerative joint disease. One radial component (6%) was loose. Fifteen of 18 wrists (83%) had little or no pain. The three wrists with moderate or severe pain were in patients with degenerative joint disease. There were five (28%) complications. One revision was performed and another was recommended. Overall, the long-term outcome of total wrist arthroplasty was favorable in patients with rheumatoid arthritis

Ninety-four high-modulus total hip arthroplasties (THAs) were performed from 1977 to 1982 using the Computer Assist Design (CAD) and HD-2 prostheses. Eighty-six hips were followed for an average of 6.7 years. The cement gun was used throughout the study period, and distal bone or cement plug use was begun in 1979. The results of these arthroplasties were evaluated retrospectively using both survivorship analysis and observed success rates. Using a standard hip rating system, 19 hips were rated as excellent, 44 as good, 15 as fair, and 11 as poor. Failure was defined as definitely visible radiographic migration of either component, or reoperation for revision of one or both components. There was no significant difference between the HD-2 and CAD prostheses. There were five hips revised for aseptic loosening and revision was advised in an additional three hips. One hip with late sepsis required removal of both components. The five- and ten-year survivorships of the acetabular components were 97% +/- 3 and 58% +/- 17, respectively. Those of the femoral components were 93% +/- 5 and 78% +/- 13, respectively. For the components combined, the survivorship at five years was 91% +/- 6 but only 50% +/- 17 at ten years. Survivorship analysis provided a different and more realistic appraisal of the long-term results of the arthroplasties in this series than did the observed success rates. The contemporary cement techniques of the late 1970s and early 1980s may not be sufficient for the long-term survival of high-modulus THAs. Additional techniques may be necessary for improved long-term survival

A case of femoral component loosening secondary to impingement on an extended-lip acetabular cup liner is presented. This impingement led to the accelerated creation of particulate polyethylene wear debris. The particulate polyethylene induced an osteolytic response about the femoral component, which contributed to the failure of this component. It is recommended that intraoperative examination for impingement, especially in extension, be performed when using liners of this design