Faculty Bibliography

Bone and tissue adhesives are common and beneficial supplements to standard methods of musculoskeletal tissue suture repair. Knowledge and development of biologically derived or inspired adhesives useful in orthopedic surgery are rapidly advancing. Recent literature demonstrates the increased adjunct or primary use of biological adhesives in the repair of musculoskeletal soft tissues, chondral fractures, and osteochondral fractures. Adhesives offer more benefits and enhancements to tissue healing than current fixation methods afford, including improved biocompatibility, resorbability, and nonimmunogenicity. Further investigation is required to determine the extent of the role that these bioadhesives can play in orthopedic surgery. The largest group of biologically derived adhesives and sealants is fibrin sealants, which include first- and second-generation commercially available fibrin sealants, autologous fibrin sealants, and variants. Other groups include gelatin-resorcin aldehydes, protein-aldehyde systems, collagen-based adhesives, polysaccharide-based adhesives, mussel adhesive proteins, and various biologically inspired or biomimetic glues. Potential uses include applications in orthopedic-related blood conservation, arthroplasty, articular cartilage disorders, sports medicine, spine surgery, trauma, and tumors. The development of an adhesive with universal application is likely unfeasible, given the unique characteristics of various musculoskeletal tissues. However, the literature demonstrates the overall underuse of adhesives and indicates the rising probability of the development of a successful variety of bioadhesives for use in orthopedic surgery. C1 [Shah, Neil V.; Meislin, Robert] NYU, Hosp Joint Dis, Dept Orthopaed Surg, New York, NY 10016 USA

Anatomic reconstruction of the humeral head with osteochondral allograft has been reported as a solution for large Hill-Sachs lesions with or without glenoid bone loss. However, to date, varying techniques have been used. This technical note describes an arthroscopic reconstruction technique using fresh-frozen, side- and size-matched osteochondral humeral head allograft. Allograft plugs are press fit into the defect without internal fixation and seated flush with the surrounding articular surface. This technique restores the native articular contour of the humeral head without compromising shoulder range of motion. Potential benefits of this all-arthroscopic approach include minimal trauma to the soft tissue and articular surface without the need for hardware or staged reoperation.

BACKGROUND: Because current instrumentation makes it possible to perform an arthroscopic transosseous rotator cuff repair, we performed a biomechanical comparison of a double-row transosseous equivalent rotator cuff repair using suture anchors to an arthroscopic, transosseous rotator cuff repair to determine if they provided similar fixation stability. METHODS: Six pairs of shoulders were used. One of each pair had a standard double row, transosseous equivalent arthroscopic rotator cuff repair using a suture-bridge technique with suture anchors, and the other had an arthroscopic transosseous repair using an Xbox technique. The repairs were cycled at 150 N for 10,000 cycles with movement of the lateral cuff edge recorded and then tested to failure. RESULTS: The total cuff edge displacement at 10,000 cycles in the anchor group (transosseous equivalent repair) was 7.9 mm and 6.3 mm for the bone tunnel group (transosseous repair); these were not significantly different (p=0.19). The anchor group failed at an average of 309 N and the bone tunnel group at an average of 339 N (p=0.22). DISCUSSION: Biomechanical testing suggests that arthroscopic, transosseous rotator cuff repair using a Xbox suture configuration is similar in strength and stability to an arthroscopic transosseous equivalent suture-bridge repair. Both techniques demonstrated difficulty in maintaining the lateral position of the tendon.

Background: Allografts offer potential advantages over autografts in anterior cruciate ligament reconstruction (ACLR), including the absence of donor site morbidity, shorter operative times, improved cosmesis, and easier rehabilitation. There is limited and conflicting outcome data for ACLR with tibialis anterior allograft. The purpose of this study was to evaluate the functional outcomes of ACLR with tibialis anterior allograft. Methods:We retrospectively evaluated primary ACL reconstructions using tibialis anterior allograft between January 2004 and December 2006. Clinical outcomes were measured by KT-1000 arthrometry, and International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores. Results: 19 patients were available for follow-up at a mean of 2.7 years (range: 2.0 to 3.2). One patient experienced a traumatic re-rupture that required revision and another patient was advised to undergo revision reconstruction for a failed graft. Based on IKDC and Lysholm scoring, 12 patients (63%) had good or excellent results, 4 (21%) patients had fair results, and 3 (16%) patients had poor results. The mean side-to-side difference was 2.7mm (0 to 8.2) and the mean decrease in Tegner activity level was 1.4 (0 to 6). Conclusion:An alarming number of patients demonstrated residual laxity after ACL reconstruction with tibialis anterior allograft. We recommend against using tibialis anterior allograft as a first choice graft for high demand patients.

BACKGROUND: Chronic ruptures of the distal biceps are often complicated by tendon retraction and fibrosis, precluding primary repair. Reconstruction with allograft augmentation has been proposed as an alternative for cases not amenable to primary repair. PURPOSE: To investigate the clinical outcomes of late distal biceps reconstruction using allograft tissue. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 20 patients who underwent distal biceps reconstruction with allograft tissue between May 2007 and May 2012 were identified. Charts were retrospectively reviewed for postoperative complications, gross flexion and supination strength, and range of motion. Subjective functional outcomes were assessed prospectively with the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: Eighteen patients with adequate follow-up were included in the study. All had undergone late distal biceps reconstruction with allografts (Achilles [n = 15], semitendinosus [n = 1], gracilis [n = 1], or anterior tibialis [n = 1]) for symptomatic chronic ruptures of the distal biceps. At a mean office follow-up of 9.3 months (range, 4-14 months), all patients had full range of motion and mean gross strength of 4.7 of 5 (range, 4-5) in flexion and supination. After a mean out-of-office follow-up at 21 months (range, 7-68.8 months), the mean DASH score was 7.5 +/- 17.9, and the mean MEPS increased from 43.1 preoperatively to 94.2 postoperatively (P < .001). The only complication observed was transient posterior interosseous nerve palsy in 2 patients. Additionally, all but 1 patient reported a cosmetic deformity. However, all patients found it acceptable. CONCLUSION: Late reconstruction for chronic ruptures of the distal biceps using allograft tissue is a safe and effective solution for symptomatic patients with functional demands in forearm supination and elbow flexion. While there are several graft options, the literature supports good results with Achilles tendon allografts. Further studies are needed to evaluate the clinical outcomes of other allograft options.

Distal biceps tendon rupture is a relatively uncommon occurrence in the general female population, and to our knowledge, has not been reported in association with a supinator muscle tear. We report a case of 51-year-old woman who experienced sharp pain in her forearm and elbow after lifting a heavy object. History and physical examination raised suspicion for a distal biceps tendon rupture. MRI imaging determined a combined distal biceps tendon tear with a supinator muscle tear with subsequent confirmation at surgery. Surgical repair was performed for the distal biceps tendon only through a single incision approach using the Endobutton technique.

Surgical repair of the anterior cruciate ligament is a fairly common necessity in knee injuries, usually with good to excellent outcomes. However a successful repair and return to activities for a subpopulation of patients, 10% to 30%, remain elusive. Additionally, some athletes have arthritic changes, even with ligament repair. These issues are likely multi-factorial in nature but the debate continues even over which primary operative technique will produce the most favorable outcome. This review examines and discusses the anatomic and historical rationale of double-bundle ACL reconstruction techniques, the published kinematics of double-bundle reconstructions, and the clinical literature comparing double-bundle outcomes to those of the more traditional single-bundle constructs. Conclusions regarding surgical care include a need for more standardization of measuring parameters and the future application of advanced technologies that would inform more correct models of knee kinematics for comparison to various ACL construction approaches, potentially allowing improvement in the techniques of ACL reconstruction

The acceptance and rates of hip arthroscopy are increasing in the United States and abroad and the literature describing it is expanding. Indications for hip arthroscopy include labral tears, loose bodies, femoroacetabular impingement, ruptured ligamentum teres, chondral injuries, adhesive capsulitis, instability, synovial disease, disorders of the iliopsoas tendon, external coxa saltans, tears of the hip abductors, and diagnosis of unresolved intra-articular hip pain. Current techniques in the central and peripheral compartments include, but are not limited to, labral debridement, labral repair, chondroplasty, microfracture, synovectomy, loose body removal, acetabuloplasty, proximal femoral osteoplasty, and iliopsoas release, with other procedures possible in the peritrochanteric space. Long-term outcomes are limited, but early data shows good results for many arthroscopic procedures in the hip when they are performed in the absence of degenerative disease. Improved techniques and technology are allowing for more advanced procedures to become popularized, but long-term outcome data about hip arthroscopy is still relatively sparse