Faculty Bibliography

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.

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

Platelet-rich plasma is defined as autologous blood with a concentration of platelets above baseline values. Platelet-rich plasma has been used in maxillofacial and plastic surgery since the 1990s; its use in sports medicine is growing given its potential to enhance muscle and tendon healing. In vitro studies suggest that growth factors released by platelets recruit reparative cells and may augment soft-tissue repair. Although minimal clinical evidence is currently available, the use of platelet-rich plasma has increased, given its safety as well as the availability of new devices for outpatient preparation and delivery. Its use in surgery to augment rotator cuff and Achilles tendon repair has also been reported. As the marketing of platelet-rich plasma increases, orthopaedic surgeons must be informed regarding the available preparation devices and their differences. Many controlled clinical trials are under way, but clinical use should be approached cautiously until high-level clinical evidence supporting platelet-rich plasma efficacy is available

BACKGROUND: To date, repair of the lacertus in distal biceps tendon ruptures, recommended by some, has not been evaluated. The goal of these biomechanical experiments was to evaluate the degree to which its repair increases the strength of a distal biceps tendon repair. HYPOTHESIS: An intact or repaired lacertus fibrosus will increase the strength of a distal biceps tendon repair. STUDY DESIGN: Controlled laboratory study. METHODS: Four matched pairs of fresh-frozen human cadaveric upper extremities were prepared by isolating the lacertus fibrosus and the distal biceps tendon. The extremity was placed in a custom-built rig with the distal biceps brachii clamped and affixed to a stepper motor assembly. The distal biceps tendon was sharply removed directly from the radial tuberosity and repaired through a bony tunnel in all specimens. One side of each pair was randomized to also receive repair of the lacertus. The specimens were pulled at a constant rate until failure. RESULTS: The mean failure strength, defined as maximal strength to 15 mm of displacement, was higher in specimens with a repaired lacertus (250.2 N vs 158.2 N; P =.012), as was mean maximum strength (256.8 N v. 164.5 N; P =.0058). Mean stiffness was not significantly different (16.36 N/mm vs 13.8 N/mm; P =.58). All specimens failed due to fracture at the bony bridge. CONCLUSION: Repair of the lacertus strengthened distal biceps tendon repair in a controlled laboratory setting. CLINICAL RELEVANCE: Repair of the lacertus fibrosus as an adjunct to distal biceps tendon repair strengthens the repair in the laboratory setting. Clinical testing is needed to verify that this increased strength improves clinical results. Surgeons should be cautioned to protect the underlying neurovascular structures during repair of the lacertus fibrosus and to avoid an overly tight repair

Posterior cruciate ligament injuries occur much less frequently than anterior cruciate ligament injuries. We review the important physical examination and radiographic findings, as well as provide the indications for nonoperative and operative treatment