Faculty Bibliography

Femoroacetabular impingement results from an abnormal contact between the femur and the pelvis. This abnormal contact leads to developmental changes in the femoral neck, labrum, and acetabulum. Secondary to the altered hip joint mechanics, chondral damage occurs and initiates the degenerative process, eventually leading to osteoarthritis. Numerous etiologies have been implicated in femoroacetabular impingement, and a variety of treatment algorithms have been established, with no definitive gold standard. However, the treatment of this disorder with joint preserving techniques offers a viable option between the extremes of nonoperative treatment and total joint arthroplasty

Purpose: There are many options for arthroscopic knots including the type of knot and suture material used. The current investigation evaluated knot properties using 3 high-strength suture materials tied in 5 common arthroscopic knot configurations. Methods: Four arthroscopic sliding knots including the Roeder, Weston, SMC, and Tennessee Slider and an arthroscopic nonsliding Surgeon's knot were evaluated. Each knot was tied with each of 3 No. 2 polyblended suture types (Fiberwire [Arthrex, Naples, FL], Ultrabraid [Smith & Nephew, Andover, MA], and Orthocord [Mitek, Raynham, MA]). Each configuration was tied 8 times, for a total of 120 samples. Loop security and knot security were then evaluated by using a previously described protocol comparing the different knot types and suture material. Results: With respect to loop security, Orthocord performed better than the other tested suture materials, producing on average smaller knot loops. For the nonsliding Surgeon's knot, there was no difference in loop security observed between suture types. For the Roeder knot, Fiberwire had superior knot security compared with Ultrabraid and Orthocord (P < .001). For the Weston knot, Ultrabraid showed superior knot security compared with Orthocord (P < .02). Knot security for the Tenessee slider knot was better for both Fiberwire and Ultrabraid compared with Orthocord (P < .001, respectively). Similar results were seen with the SMC knot, with Fiberwire and Ultrabraid outperforming Orthocord (P < .001, respectively). The nonsliding Surgeon's knot had significantly lower mean loads to failure compared with arthroscopic sliding knots for each tested suture material (P < .02 for all comparisons). Conclusions: Loop security and knot security varied depending on the type of knot tied and suture material used. Arthroscopic sliding knots performed better than the nonsliding Surgeon's knot. Clinical Relevance: Surgeons should try to use sliding knots instead of Surgeon's knots when using polyblend suture material. Differences between the brands in this suture category will change the characteristics of the knots thrown and may ultimately affect tissue fixation

Articular cartilage defects are common and play a significant role in degenerative joint disease. Cartilage is unable to regenerate, secondary to an inherent lack of vascular supply, thus, various techniques have been described in an attempt to treat and potentially restore these defects. Treatment decisions should be based on appropriate evaluation and classification of the pathology. Only then can the surgeon choose to perform a repair or a restoration of the articular surface. Current literature and techniques for the treatment of articular cartilage defects are reviewed, with an algorithm developed for the management of articular cartilage defects by orthopaedic surgeons.

OBJECTIVE: To assess outcome after hip fracture in patients ninety years of age and older, as compared with a population of the same age and sex in the United States and younger patients with hip fractures. DESIGN: Prospective, consecutive. SETTING: University teaching hospital. METHODS: Eight hundred fifty community-dwelling elderly people who sustained an operatively treated hip fracture were prospectively followed up. MAIN OUTCOME MEASUREMENTS: The outcomes examined in this study were the patients' in-hospital mortality and postoperative complication rates, hospital length of stay, discharge status, mortality rate, place of residence, ambulatory ability, and independence in basic and instrumental activities of daily living twelve months after surgery. RESULTS AND CONCLUSIONS: The mean patient age was 79.7 years (range 65 to 105 years). Seventy-six (8.9 percent) patients were ninety years of age and older. Patients who were ninety years of age and older had significantly longer mean hospital lengths of stay than younger individuals (p = 0.01). People ninety years of age and older were more likely to die during the hospital stay (p = 0.001) and within one year of surgery (p = 0.001). Patients who were ninety years of age and older were more likely to have a decrease in their basic activities of daily living status (p = 0.03) and ambulation level (p = 0.01). Younger individuals had a higher standard mortality ratio (1.48) than did patients who were ninety years of age and older (1.24). Being ninety years of age and older was not predictive of having a postoperative complication, of being placed in a skilled nursing facility at discharge or at one-year follow-up, or recovering of prefracture independence in instrumental activities of daily living