Faculty Bibliography

BACKGROUND: Allograft tissue remains a valuable alternative for anterior cruciate ligament reconstruction. No study to date has correlated the effect of donor age to bone mineral density (BMD) in a large series of irradiated bone-patellar tendon-bone (BPTB) allograft tissue. Hypothesis/ PURPOSE: The authors attempted to correlate donor age with BMD in a large group of BPTB allograft specimens treated with low-dose gamma irradiation (1.0-1.3 Mrad) collected over a 4-year period. They hypothesized there would be no effect of donor age on the BMD of irradiated BPTB allografts. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 110 BPTB allograft specimens from 44 male and 66 female donors with a mean age of 46 years (range, 21-58 years) were analyzed. Bone mineral density data were obtained from both the patellar and tibial bone plugs of the BPTB complex. Statistical analyses were conducted using linear regression for correlations and 2-tailed Student t tests for comparisons between groups. RESULTS: The mean BMD of the patellar bone plug (0.471 g/cm(2)) was significantly greater than the mean BMD of the tibial bone plug (0.328 g/cm(2)) (P < .001). No correlation was identified between donor age and BMD for either the patella or tibial bone plugs (R(2) = .014 and .011, respectively). Both patellar and tibial BMD was significantly greater for the male grafts than the female ones. CONCLUSION: No correlation was found between donor age and BMD for irradiated BPTB allograft tissue. The patellar bone plugs were noted to have a greater BMD than the tibial bone plugs. Allograft tissue from male donors had higher BMD values than that harvested from female donors.

CONTEXT: Lateral meniscus tears are a common entity seen in sports medicine. Although lateral-side knee pain is often the result of a meniscus injury, several extra-articular pathologies share signs and symptoms with a meniscus tear. It is critical for the clinician to be able to identify and understand extra-articular pathologies that can present similar to a lateral meniscus tear. EVIDENCE ACQUISITION: Data were collected through a thorough review of the literature conducted through a MEDLINE search for all relevant articles between 1980 and February 2010. STUDY TYPE: Clinical review. RESULTS: Common extra-articular pathologies that can mimic lateral meniscal tears include iliotibial band syndrome, proximal tibiofibular joint instability, snapping biceps femoris or popliteus tendons, and peroneal nerve compression syndrome or neuritis. The patient history, physical examination features, and radiographic findings can be used to separate these entities from the more common intra-articular knee pathologies. CONCLUSIONS: In treating patients who present with lateral-sided knee pain, clinicians should be able to recognize and treat extra-articular pathologies that can present in a similar fashion as lateral meniscus tears.

Injuries to the articular cartilage of the knee are common. They alter the normal distribution of weightbearing forces and predispose patients to the development of degenerative joint disease. The management of focal chondral lesions continues to be problematic for the treating orthopaedic surgeon. Although many treatment options are currently available, none fulfill the criteria for an ideal repair solution: a hyaline repair tissue that completely fills the defect and integrates well with the surrounding normal cartilage. Autologous chondrocyte implantation (ACI) is a relatively new cell-based treatment method for full-thickness cartilage injuries that in recent years has increased in popularity, with early studies showing promising results. The current article reviews the nature of cartilage lesions in the knee and the treatment modalities utilized in their management, focusing on the role ACI plays in the surgical treatment of these complex injuries

Background Negative pressure wound dressings have revolutionized the treatment of open wounds by stimulating the formation of granulation tissue and hastening wound closure. We hypothesized that negative pressure therapy in the immediate postoperative period after total knee arthroplasty (TKA) in high-risk patients would also hasten the time to a dry wound. Methods This prospective, randomized trial compared the number of days to a dry wound after TKA with application of a negative pressure dressing compared with sterile gauze dressing in 51 patients undergoing 60 TKA surgeries (9 bilateral). Patients undergoing primary TKA who were obese (BMIZ30) and received enoxaparin were randomized to receive either a negative pressure dressing or sterile gauze for 48 hours postoperatively. The days to a dry wound, total weight of drainage, number of gauze dressings used, duration of hospital stay and infection rate were recorded. Results Twenty-four knees received negative pressure therapy and 36 knees had sterile gauze placed. There was no significant difference in the primary endpoint of days to a dry wound (4.3 days with negative pressure and 4.1 days with sterile gauze). There were two postoperative infections, one in each arm of the study. The study was stopped prematurely when 15 of 24 knees (63%) treated with the negative pressure wound dressing developed skin blisters. Conclusions Negative pressure wound therapy did not appear to hasten wound closure and was associated with blisters. There does not appear to be a benefit to the routine use of negative pressure wound dressings in the immediate postoperative TKA period. 2011 Wolters Kluwer Health | Lippincott Williams &Wilkins

The menisci have an essential function in force transmission across the knee. Injuries to the menisci are common. The indications for repair should be expanded, as the results of partial meniscectomy may deteriorate over time. Tears in younger, higher demand patients should be prepared to optimize the healing environment and be meticulously repaired, particularly in the setting of concurrent anterior cruciate ligament reconstruction. For complex, recurrent, or avascular zone tears, particularly when surgery is limited to meniscal work, consideration can be given to augmenting the repair with a fibrin clot or platelet rich plasma. Partial meniscectomy is a suitable option for lower demand or older patients. Meniscal allograft transplantation is a salvage procedure

Spontaneous osteonecrosis of the knee (SPONK) and osteo necrosis in the postoperative knee (ONPK) are two clinical entities that have the potential to cause significant morbidity in affected patients. In addition to the knowledge of the patient population at risk and the classic presentation and imaging characteristics of SPONK and ONPK, the treating orthopaedic surgeon needs to maintain a high index of suspicion for these disorders since early diagnosis and treatment may allow for an improved clinical outcome. The following review presents the current knowledge regarding these two pathological processes of the knee.

Treating glenohumeral arthritis in the young adult remains a significant challenge. There are a variety of etiologies that can lead to this condition, and the diagnosis is often not straightforward. With advances in both surgical techniques and biologic options, the treatment algorithm for patients with glenohumeral arthritis is constantly evolving. When nonsurgical treatment fails, there are a variety of possible surgical options, each with potential benefits. It is helpful to review the diagnostic challenges presented by these patients and understand the palliative, reparative, restorative, and reconstructive surgical options and their associated clinical outcomes, which provide a framework for clinical and surgical decision making.

Tendinopathy of the long head of the biceps brachii encompasses a spectrum of pathology ranging from inflammatory tendinitis to degenerative tendinosis. Disorders of the long head of the biceps often occur in conjunction with other shoulder pathology. A thorough patient history, physical examination, and radiographic evaluation are necessary for diagnosis. Nonsurgical management, including rest, nonsteroidal anti-inflammatory drugs, physical therapy, and injections, is attempted first in patients with mild disease. Surgical management is indicated for refractory or severe disease. In addition to simple biceps tenotomy, a variety of tenodesis techniques has been described. Open biceps tenodesis has been used historically. However, promising results have recently been reported with arthroscopic tenodesis.

Excision of the distal clavicle (DCE) is a commonly carried out surgical procedure used in the management of acromioclavicular joint pathology. Although successful outcomes after both open and arthroscopic distal clavicle excision occur in a high percentage of patients, treatment failures have been reported, creating a difficult clinical scenario for the treating orthopedic surgeon. The most common mode of failure after DCE is persistent pain and potential etiologies include under-resection, over-resection leading to joint instability, postoperative stiffness, heterotopic ossification, untreated concomitant shoulder pathology, and postoperative infection. Less common causes of failure include distal clavicle fracture, reossification or fusion across the acromioclavicular joint, suprascapular neuropathy, and psychiatric illness. Persistent symptoms and disability after distal clavicle excision require a careful assessment of these potential causes of treatment failure and the formulation of a treatment plan, which may include conservative care, revision surgery, or coracoclavicular ligament reconstruction. Although careful patient selection, preoperative planning, proper surgical technique, and appropriate rehabilitation during the index procedure can minimize the likelihood of poor outcome, this paper reviews the work-up and management of cases of failed distal clavicle excision

Originally defined as 'tenderness to palpation over the greater trochanter with the patient in the side-lying position,' greater trochanteric pain syndrome (GTPS) as a clinical entity, has expanded to include a number of disorders of the lateral, peritrochanteric space of the hip, including trochanteric bursitis, tears of the gluteus medius and minimus and external coxa saltans (snapping hip). Typically presenting with pain and reproducible tenderness in the region of the greater trochanter, buttock, or lateral thigh, GTPS is relatively common, reported to affect between 10% and 25% of the general population. Secondary to the relative paucity of information available on the diagnosis and management of components of GTPS, the presence of these pathologic entities may be underrecognized, leading to extensive workups and delays in appropriate treatment. This article aims to review the present understanding of the lesions that comprise GTPS, discussing the relevant anatomy, diagnostic workup and recommended treatment for trochanteric bursitis, gluteus medius and minimus tears, and external coxa saltans