Faculty Bibliography

Objectives: The purpose of the current study is to investigate the functional strength outcomes of late distal biceps reconstruction using allograft tissue. Methods: Patients who underwent distal biceps reconstruction with allograft tissue between May 2007 and May 2013 were identified. Charts were retrospectively reviewed for post-operative complications, gross flexion and supination strength, and range of motion (ROM). Isokinetic strength and endurance in elbow flexion and forearm supination were measured in both arms. Tests were conducted using a dynamometer at 60o per second for isokinetic strength and 240o per second for endurance. Isometric strength testing was also measured for elbow flexion and forearm supination. Paired t tests were used for statistical analysis. Results: Ten patients with a mean age of 48 years (range 42 - 61 years) were included in the study. Distal biceps reconstruction was performed using an Achilles tendon allograft in 9 patients and a combination of tibialis anterior allograft and gracilis allograft in 1 patient. Of the reconstructions, 50% involved the dominant arm. Full ROM was observed in all patients at the time of their final follow up assessment. The mean followup for dynamometer strength testing was 34 months (range 13-81 months). No statistical differences were noted between data obtained from operative and contralateral extremities. The average peak torque of the operative limb (38.5+/- 5.9 Nm) was 91.7% of that of the contralateral limb (41.8+/-4.9 Nm) in flexion and 93.4% (operative, 5.7+/-1.3 Nm; contralateral, 6.1+/- 1.0 Nm) in supination. No significant differences were found in fatigue index between operative or contralateral limbs for flexion (operative, 34.1+/-17.1%; contralateral, 30.8+/-17.1%; p = 0.29) or supination (operative, 38.2+/-16.5%; contralateral, 42.1+/-11.9%; p = 0.65). The only complication observed was a transient PIN palsy in one patient which resolved by 3 months post-operatively. All patients reported postoperative cosmetic deformity but found their gross appearance acceptable. Conclusion: Late reconstruction for chronic distal biceps rupture using allograft tissue is a safe and effective solution for symptomatic patients with functional demands in forearm supination and elbow flexion. Dynamometer testing shows near normal return of strength and endurance of both elbow flexion and supination following the procedure

OBJECTIVE: The objectives of the article are to improve the radiologist's understanding of shoulder arthroscopy and see how it correlates with MRI. We review the basic principles of arthroscopy followed by a comparison of its strengths and weaknesses relative to MRI. This discussion is supplemented by a series of cases that show the relationship between arthroscopy and MRI in terms of the visualization of normal and abnormal anatomy in the diagnosis of common shoulder abnormalities. CONCLUSION: By understanding what our orthopedic colleagues are seeing (and not seeing) during arthroscopic shoulder surgery, we can better understand the strengths and weaknesses of MRI, which provides us the opportunity to improve our imaging interpretations and produce valuable management-guiding diagnostic reports.

Bone marrow aspirate, prolotherapy, platelet-rich plasma,and autologous conditioned serum represent alternativetreatment options that have emerged to address variousmusculoskeletal ailments. We have reviewed the basicscience, physiology, and clinical evidence of each of thesemodalities and discovered that each treatment has its individualplace in the management of common orthopaedicpathologies. Bone marrow aspirates are successful intreating early arthritis and cartilage defects. Prolotherapyand platelet-rich plasma have demonstrated good efficacyin treating inflammatory processes and early arthritis. Finally,autologous conditioned serum (Orthokine) representsa promising treatment option for chronic joint arthritis. Theclinical evidence supporting these alternative treatmentmodalities is insufficient and further level 1 evidence isneeded before we can begin to employ these techniques inour daily orthopaedic practice.

Throughout the history of orthopaedics, our understandingof the function and necessity of the meniscus has significantlyevolved, and with it, our techniques of treating,repairing, preserving, and replacing it have progressed inparallel. Currently, it is known that a meniscus deficiencyis a predisposing factor to the development of degenerativechanges of the knee. Thus, it is incumbent upon the surgeonto preserve the meniscus to the extent that biology will allow.Unfortunately, circumstances arise when the meniscus cannotbe preserved, and young patients afflicted by irreparablemeniscus deficiency may be potential candidates for a meniscustransplant. Though its indications are limited and itsexecution technically complex, meniscal allograft transplanthas been shown to provide good subjective outcomes and isa potentially joint preserving surgery. This paper provides acomprehensive and historical review of the meniscus, a briefreview of meniscus anatomy and biomechanics, and commentaryon the role of meniscal allograft transplant for thetreatment of meniscal deficiency, including patient selection,graft selection and sizing, surgical technique, and outcomes.

Groin pain is a common complaint in athletes that use themusculature of the lower abdomen and proximal thigh. Thecomplex anatomy of the groin region and broad differentialdiagnosis presents the sports medicine specialist with uniquediagnostic and treatment challenges. Sports hernia, osteitispubis, and adductor dysfunction are common extra-articularmusculoskeletal causes of groin pain in athletes. The currentpaper reviews the pathogenesis, history and physicalexamination, imaging, non-operative treatment, surgicaltechniques, and outcomes for these conditions. Treatmentalgorithms are presented for management of patients withsports hernia, osteitis pubis, and adductor dysfunction.

INTRODUCTION: We hypothesized that resident participation in a hands-on fracture fixation course leads to significant improvement in their performance as assessed in a simulated fracture fixation model. METHODS: Twenty-three junior orthopaedic surgery residents were tasked to treat radial shaft fractures with standard fixation techniques in a sawbones fracture fixation simulation twice during the year. Before the first simulation, 6 of the residents participated in a fraction fixation skills course. The simulation repeated 6 months later after all residents attended the course. Residents also completed a 15-question written examination. Assessment included evaluation of each step of the procedure, a score based on the objective structured assessment of technical skill (OSATS) system, and grade on the examination. Comparisons were made between the two cohorts and the two testing time points. RESULTS: Significant improvements were present in the percentage of tasks completed correctly (64.1% vs 84.3%) the overall OSATS score (13.8 vs 17.1) and examination correct answers (8.6 vs 12.5) for the overall cohort between the two testing time points (p<0.001, p<0.03, p<0.04 respectively). Residents who had not participated in the surgical skills course at the time of their initial simulation demonstrated significant improvements in percentage of tasks completed correctly (61.3% vs 81.2%) and OSATS score (12.4 vs 17.0) (p<0.002, p<0.01 respectively). No significant difference was noted in performance for the cohort who had already participated in the course (p=0.87 and p=0.68). The cohort that had taken the course prior to the initial simulation showed significantly higher scores at initial evaluation (88.5% vs 58.5% percentage of tasks completed correctly, 17.3 vs 12.0 OSATS score, 12.5 vs 8.6 correct answers on the examination). At the second simulation, no significant difference was seen with task completion or examination grade, but a significant difference still existed with respect to the OSATS score (20.0 vs 17.0; p<0.03). CONCLUSION: Participation in a formal surgical skills course significantly improved practical operative skills as assessed by the simulation. The benefits of the course were maintained to 6 months with residents who completed the training earlier continuing to demonstrate an advantage in skills. Such courses are a valuable training resource which directly impact resident performance.

Cyclops lesion was previously described as a fibrous lesion with a granulation tissue core originating from the tibial insertion of the anterior cruciate ligament (ACL) graft. 1 Recently, two case reports described inverted cyclops le - sions, which originated from the femoral aspect of the ACL. 2,3 Both cyclops and inverted cyclops lesions are usually associated with a block to knee extension. Here we present a case of an 18-year-old female who developed a painful inverted cyclops lesion originating from the femoral notch above hamstring autograft without restriction to knee range of motion 20 months after arthroscopically assisted ACL reconstruction. The case is followed by literature review on presentation, diagnosis, and treatment of cyclops and inverted cyclops lesions.

Ice hockey is a fast paced sport with unique injury potential. There are no studies in the literature that examine the shoulder strength and range of motion in this population. Players on a single professional ice hockey team underwent a comprehensive examination of shoulder motion and strength. Shoulder motion and strength between right and left extremities were compared within athletes. Comparisons were made between right and left handed players, players that shoot right versus left handed, and by position. Within individual athletes, there was no difference in motion or strength between right and left shoulders. There was no difference in motion or strength between the dominant and non-dominant shoulder and players that shoot right versus left handed. Defensemen had a statistically significant increase in external rotation with the arm at the side for the left shoulder (66 degrees versus 55 degrees , p = 0.02) and a trend towards increased external rotation with the arm at the side for the right shoulder (65 degrees versus 56 degrees , p = 0.07). In professional ice hockey players, there is no difference in shoulder motion and strength between the right and left upper extremity. Ice hockey defensemen may have more external rotation with the arm at the side than forward.