Faculty Bibliography

The simultaneous diagnosis of ipsilateral patellar tendon rupture and anterior cruciate ligament tear is rare. Surgical repair is complicated by different rehabilitation regimens as well as anterior cruciate ligament graft choices. We present a case where at the same operative setting, the patellar tendon was repaired, and the anterior cruciate ligament reconstructed with autologous hamstring graft

Suprascapular neuropathy secondary to cyst compression in the spinoglenoid notch may occur in association with SLAP tears. Arthroscopic techniques may be employed for both cyst excision and repair of labral pathology. We describe 3 cases in which preoperative and postoperative electromyograms and magnetic resonance imaging documented cyst resolution and return of suprascapular nerve function after arthroscopic spinoglenoid cyst excision and labral repair

BACKGROUND: Professional dancers experience high rates of musculoskeletal injuries. OBJECTIVE: To analyze the effect of comprehensive management (case management and intervention) on injury incidence, time loss, and patterns of musculoskeletal injury in a modern dance organization. STUDY DESIGN: Retrospective/prospective cohort study. METHODS: Injury data were analyzed over a 5-year period, 2 years without intervention and 3 years with intervention, in a modern dance organization (42 dancers). The number of workers' compensation cases and number of dance days missed because of injury were compared across a 5-year period in a factorial design. RESULTS: Comprehensive management significantly reduced the annual number of new workers' compensation cases from a high of 81% to a low of 17% and decreased the number of days lost from work by 60%. The majority of new injuries occurred in younger dancers before the implementation of this program. Most injuries involved overuse of the lower extremity, similar to patterns reported in ballet companies. Benefits of comprehensive management included early and effective management of overuse problems before they became serious injuries and triage to prevent overutilization of medical services. CONCLUSIONS: This comprehensive management program effectively decreased the incidence of new cases and lost time. Both dancers and management strongly support its continuance

In this article, we report the case of a healthy young woman who sustained an anterior hip dislocation while participating in a noncontact activity (ballet dancing). The patient's atraumatic dislocation failed closed reduction secondary to interposition of anterior capsule and rectus femoris muscle. Open reduction using a Smith-Petersen approach was concentric and stable. Postinjury femoral nerve neuropraxia resolved within 6 weeks. At 2-year follow-up, the patient was without complications of the injury-including avascular necrosis and posttraumatic arthritis. She returned to dancing and is now asymptomatic

Ochronotic arthropathy is a progressive joint disorder resulting from the deposition of a derivative of homogentisic acid into connective tissues, especially meniscal and articular cartilage. Patients may present with symptoms, physical examination results, and radiographic changes consistent with degenerative joint disease. We present a case in which an operative arthroscopy of the knee was highly suggestive of ochronotic arthropathy. The definitive diagnosis of ochronosis was subsequently confirmed by laboratory and pathologic evaluation

Intra-articular lipoma is an exceedingly rare diagnosis. There have been less than 15 documented cases of an intra-articular lipoma of the knee joint. This report presents the first description of an intra-articular knee lipoma treated entirely by arthroscopic methods. Preoperative history, examination, and imaging studies are reviewed. Intraoperative findings, treatment, and postoperative evaluation are discussed as well. Symptomatic intra-articular lipoma of the knee joint can be successfully treated by arthroscopic resection. Differentiating intra-articular lipoma from lipoma arborescens, a similar but more common condition, is important with regards to optimal treatment

Synovial chondromatosis is an uncommon disorder with rare occurrence in the elbow. Case reports in the literature for elbow synovial chondromatosis have described presenting symptoms secondary to peripheral nerve compressions or localized bursitis. We discuss a case of synovial chondromatosis of the elbow that presented as an isolated soft-tissue mass over the radial head-more suggestive of a soft-tissue tumor than of synovial chondromatosis

A case of arthroscopic removal of a bullet fragment from the subtalar joint and the calcaneus is presented. The bullet fragments impinged on the fibula, limiting eversion and causing pain. The fragments were removed both arthroscopically and through open incision. The patient noted complete relief of pain and improved range of motion within 1 week, and complete recovery soon thereafter

The role of arthroscopic procedures in the management of glenohumeral stability continues to evolve. Arthroscopic transglenoid suture capsulorrhaphy, as described, is an effective alternative for correcting the pathology of anterior and anteroinferior shoulder instability. The procedure avoids the morbidity associated with open repairs as a result of anterior soft tissue dissection and division of the subscapularis. The procedure, however, is technically demanding. To achieve predictable and reproducible results that approach those seen in comparable patient populations undergoing open Bankart stabilization, recognition of, and addressing, the responsible pathology is essential, as is appropriate patient selection. Based upon experience to date, arthroscopic transglenoid suture capsulorraphy is best indicated for traumatic anterior dislocators with a Bankart lesion and good quality glenohumeral ligaments. Arthroscopic suture capsulorrhaphy is not recommended for patients involved in upper extremity collision sports, those with a large glenoid rim defect, habitual luxators, patients younger than 18 years of age, and for surgeons whose experience with operative arthroscopy of the shoulder is limited. The procedure has an unresolved role, due to lack of sufficient long-term data in acute dislocations, multidirectional instability, those with previously failed open or arthroscopic repairs, and those with generalized joint hyperlaxity. The eventual role of arthroscopic transglenoid suture capsulorrhaphy in the treatment of anterior shoulder instability awaits further studies and technological innovation

Twenty-nine cases of operative arthroscopy of the ankle were done between 1985 and 1989 for synovial impingement of the ankle. The average age of the patients was 37 years. All patients (17 men, 12 women) reported an earlier history of injury, with 24 of the patients (83%) noting chronic ankle pain after an inversion injury and 5 of the patients (17%) reporting a previous ankle fracture. Physical examination elicited anterolateral tenderness at the ankle in all cases with associated anteromedial pain in 4 patients. A demonstrable 'click' was evident in 6 of the patients (21%) on forced dorsiflexion of the ankle. All patients failed conservative treatment including physical therapy and nonsteroidal antiinflammatory drugs. Surgery was performed at an average of 36 months postinjury. Ankle arthroscopy revealed extensive hypertrophic synovial thickening and scar tissue anterolaterally, indicating synovial impingement in all patients. Associated chondromalacia of the distal tibia was seen in 21% of the patients. Operative arthroscopy included partial synovectomy and debridement of the hypertrophic tissue and partial shaving chondroplasty of the tibia when indicated. Postoperatively, patients were weightbearing as tolerated. Results were assessed subjectively and objectively. At 25-month followup 26 patients had excellent or good results and 3 had fair results; there were no poor results. There were no major complications, including infection or neurovascular compromise. The 3 patients with associated ankle instability comprised the 'fair' result group and eventually required lateral ankle reconstruction. Thus, chronic ankle pain due to synovial impingement can be safely, predictably, and effectively treated by operative ankle arthroscopy