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Full article available online at Healio.com/Orthopedics. Search: 20131120-19 The purposes of this 2-part study were to determine whether reduced distal femoral component geometry allows for routinely larger component sizes to be used and whether clinical or radiographic outcomes differ between total hip arthroplasty (THA) patients treated with either standard-length or short femoral components. Femoral component size and ongrowth surface area were retrospectively compared in a group of bilateral THA patients that had both a standard-length component and a contra-lateral short component. Then, clinical and radiographic outcomes were compared between matched groups of THA patients that had either a standard-length or short femoral component. The use of the short component resulted in a significantly larger femoral component size being used (P=.01), and the potential ongrowth surface area was significantly larger for the short component than for the standard component (median, 36.69 vs 35.55 cm[sup 2]; P=.02). In the matched-pairs analysis, no group differences were noted in modified Harris Hip Scores (P=.43) or femoral component subsidence (P=.35), but there was a significantly greater prevalence of radiolucent lines in Gruen zone 8 with the short component (P=.008). The use of a short femoral component was associated with consistently larger component sizes being used, which corresponded with a larger potential ongrowth surface area. Short-term clinical and radiographic outcomes did not differ between standard-length and short femoral components. Studies are necessary to determine whether the increased proximal ongrowth surface area may result in improved long-term fixation or, on the contrary, may increase the risk of periprosthetic fracture. [ABSTRACT FROM AUTHOR]

The Sonoma CRx device (Sonoma Orthopedic Products, Santa Rosa, California) is a recently introduced intramedullary device with a flexible shaft that becomes rigid once actuated to allow deployment within the sigmoidal contour of the clavicular shaft. Medial intramedullary cortical purchase is obtained by grippers and lateral purchase through a locking bicortical buttressing screw. This article describes 2 cases of early hardware failure using this device. In both cases, early postoperative radiographs demonstrate adequate initial fracture reduction and implant position. Both patients sustained repeat injuries, one under low physiologic load and the other after returning to mixed martial arts 4 months postoperatively. Implant failure was noted after reinjury in both cases. Complete healing and full return to function was documented for both patients at 2 years. Proper patient selection and counseling regarding the limitations of this intramedullary fixation device are important. Biomechanical comparison of this implant to plate fixation under physiologic loads of combined axial compression and torsion may shed light on differences in fixation stability. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the short-term changes in quality of life for patients younger than 80 years with those 80 years and older undergoing total knee arthroplasty (TKA). It was hypothesized that patients 80 years and older had a similar quality of life after TKA compared with those younger than 80 years. All consecutive patients undergoing primary TKA were enrolled in this prospective, comparative, prognostic (level I evidence) study and were stratified into 2 groups based on their age (younger than 80 years and 80 years and older). Data on quality of life assessed using the Short Form 36 health survey were obtained preoperatively and 1 year postoperatively (short-term follow-up) and were compared between groups. A total of 328 (83.89%) patients younger than 80 years (mean age, 70.7 years) and 63 (16.11%) patients 80 years and older (mean age, 82.1 years) were included. No significant differences in preoperative quality of life were observed between groups. Postoperative physical function, vitality, social function, and physical component summary were lower in patients 80 years and older. Older patients had a lower difference between pre- and postoperative values in Short Form 36 physical function and role-emotional scores. Patients 80 years and older had a similar improvement in quality of life 1 year after TKA compared with patients younger than 80 years. Therefore, changes in quality of life justify TKA as a treatment option for elderly patients with end-stage knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Lamina osteotomy and replantation with miniplate fixation is often used to treat benign intradural tumors, effectively preventing nerve entrapment and postoperative spinal deformities. However, no studies report using this technique to treat thoracic myelopathy due to ossification of the ligamentum flavum (OLF). This article reports the clinical outcome of a series of 18 cases of contiguous multilevel OLF treated by lamina osteotomy and replantation with miniplate fixation. Eighteen consecutive patients at the authors' institution were treated between 2008 and 2010 for contiguous multilevel OLF. Clinical efficacy, operative time, blood loss, sagittal alignment, and complications were investigated. Japanese Orthopaedic Association scale scores improved from 4.7±1.4 preoperatively to 7.9±1.3 three months postoperatively and 8.8±1.3 at final follow-up (P<.01), with a mean recovery rate of 67.8%±13.1%. No significant kyphotic deformity occurred postoperatively, and local kyphosis in the treated area increased by a mean of only 1.9°±1.0° at final follow-up. No patient required additional surgery due to spinal canal reobstruction and progressive spinal deformity. Cerebrospinal fluid leakage occurred in 4 patients and resolved after repair. Pulmonary infection and deep venous thrombosis occurred in 1 patient who was discharged with no complications after routine treatment. Lamina osteotomy and replantation with miniplate fixation is an effective therapeutic option for thoracic myelopathy due to contiguous multilevel OLF compression. The technique provides adequate decompression and stabilized sagittal alignment and avoids invasion of the spinal canal by scar tissue. [ABSTRACT FROM AUTHOR]

Rehabilitation following total knee arthroplasty (TKA) is a costly, cumbersome, and often painful process. Physical therapy contributes to the successful outcome of TKA but can be expensive. Alternative methods of obtaining good functional results that help minimize costs are desirable. Neuromuscular electrical stimulation (NMES) is a potential option. Neuromuscular electrical stimulation has been shown to increase quadriceps muscle strength and activation following TKA. Functional scores also improve following TKA when NMES is added to conventional therapy protocols vs therapy alone. The authors hypothesized that rehabilitation managed by a physical therapist would not result in a functional advantage for patients undergoing TKA when compared with NMES and an unsupervised at-home range of motion exercise program and that patient satisfaction would not differ between the 2 groups. Seventy patients were randomized into a postoperative protocol of conventional physical therapy with a licensed therapist, including range of motion exercises and strengthening exercises, or into a program of NMES and range of motion exercises performed at home without therapist supervision. Noninferiority of the NMES program was obtained 6 weeks postoperatively (Knee Society pain/function scores, Western Ontario and McMaster Universities Osteoarthritis Index, flexion). Noninferiority was shown 6 months postoperatively for all parameters. The results suggest that rehabilitation managed by a physical therapist results in no functional advantage or difference in patient satisfaction when compared with NMES and an unsupervised at-home range of motion program. Neuromuscular electrical stimulation and unsupervised at-home range of motion exercises may provide an option for reducing the cost of the postoperative TKA recovery process without compromising quadriceps strength or patient satisfaction. [ABSTRACT FROM AUTHOR]

Tablets are becoming commonplace in the health care setting. Patients often request to view their radiographs after sustaining trauma. This can be challenging, especially if patients are immobile. The authors performed a prospective, questionnaire-based study to assess inpatient desire to view radiographs on tablets and whether viewing images affected patient-rated outcomes of understanding and satisfaction. Enabling trauma patients to view their images on a tablet is a worthwhile practice because it improves patient involvement in decision making, satisfaction, perceived understanding, and overall experience. [ABSTRACT FROM AUTHOR]

Full article available online at Healio.com/Orthopedics. Search: 20130122-12 The purpose of this study was to compare the effectiveness of 2 surgical approaches for femoral neck fractures in young adults: internal fixation with or without a vascularized iliac graft. Between January 1998 and December 2008, seventy-eight patients presented with a Garden type III (n=38) or IV (n=40) femoral neck fracture. Thirty-eight patients were women and 40 were men, with an average age of 28 years (range, 16-38 years). Fractures were caused by fall injury (n=24), motor vehicle accident (n=36), and heavy weight lifting (n=18). Patients were randomly divided into 2 groups. Group A underwent internal fixation with 2 cannulated compression screws combined with an iliac graft supported by the ascending branch of the lateral femoral circumflex artery (n=44), and group B underwent internal fixation with 3 cannulated compression screws (n=34). Average follow-up was 4.5 years (range, 2-8 years), and mean Harris Hip Score was 92 (range, 62-100) in group A and 84 (range, 40-100) in group B. Average fracture healing time at final follow-up was 4.4 months in group A and 6 months in group B.Two (4.5%) cases of osteonecrosis of the femoral head occurred in group A, and 8 (23.5%) cases occurred in group B. Internal fixation with 2 cannulated compression screws combined with an iliac graft supported by the ascending branch of the lateral femoral circumflex artery is an effective surgical approach for treating femoral neck fractures in young adults to minimize the occurrence of fracture nonunion and osteonecrosis of the femoral head and to facilitate bone healing and functional recovery of the hip. [ABSTRACT FROM AUTHOR]

Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) has been recognized as a public health concern since the mid-1990s. Because of the increase in reports of this pathogen, it has become increasingly tempting for clinicians to provide prophylaxis against this entity using antibiotics known to be effective against MRSA. The goal of this study was to assess the use of MRSA prophylaxis to determine whether it is safe and effective. A systematic search of the literature was performed to identify articles that examined the use of vancomycin in clean orthopedic surgery. Infection rates and adverse events were extracted, and the data were aggregated and analyzed using a DerSimonian and Laird random effects model. Publication bias and study quality were also assessed. No benefit of parenteral administration of vancomycin was identified. Local, vancomycin-impregnated cement and powder are associated with lower infection rates. Few adverse events occurred, and most of those that occurred involved infusion rate. Cost, resistance, and side effects are concerns in using vancomycin therapy in addition to standard antibiotic prophylaxis. Given the lack of efficacy of intravenous vancomycin, the authors do not recommend its routine use in clean orthopedic surgery. However, local administration appears to be safe and effective. The data are most compelling in orthopedic spine surgery in which a patient without prophylaxis is more than 4 times as likely to have a deep postoperative wound infection compared with a patient who received local vancomycin. The authors recommend the use of local antibiotics when possible in clean orthopedic surgery. [ABSTRACT FROM AUTHOR]

Full article available online at Healio.com/Orthopedics. Search: 20121218-30 Injury to the distal triceps tendon is uncommon and can be difficult to diagnose, especially when a partial rupture or tear occurs. In situations where an incomplete disruption to the musculotendinous unit occurs, a palpable defect or clear functional loss may not be present. Advanced imaging techniques, such as magnetic resonance imaging or ultrasound, can be used to confirm the diagnosis and define the extent of injury. The treatment of a complete rupture of the distal triceps tendon is repair or reconstruction, whereas the management of a patient with a partial triceps rupture is related to the pain, functional deficit, and expectations of the patient. This article presents 2 patients with chronic, near complete disruptions of the distal triceps tendon. In both patients, surgical reconstruction of the injured tendon was accomplished using ipsilateral palmaris longus autograft. This technique allows the treating surgeon to harvest the graft from the ipsilateral upper extremity. The palmaris autograft is then used to reconstruct the injured portion of the triceps tendon using a Pulvertaft weave technique through the intact triceps tendon and osseous tunnels within the proximal ulna. This technique allows for easy surgical setup and harvest of autograft tendon and provides a structurally sound technique for a tension-free reconstruction of the injured tendon. It also permits early postoperative elbow range of motion, with active elbow extension allowed at 6 weeks. The authors have used this technique successfully in the treatment of chronic partial tears of the distal triceps tendon. [ABSTRACT FROM AUTHOR]

Given the high percentage of persistent rotator cuff defects, investigators have begun exploring techniques that use biologic adjuvants to recreate a biomechanically equivalent layer of connective tissue. To evaluate the efficacy of a mesenchymal stem cell, platelet-rich plasma, and dermal al-lograft construct, a histological comparison of native rotator cuff tissue and biologically enhanced rotator cuff tissue was performed. The evaluation indicated that this treatment modality in conjunction with an adjusted rehabilitation protocol may successfully recreate a transition zone and restore a synovial lining similar to native tissue. [ABSTRACT FROM AUTHOR]

Full article available online at Healio.com/Orthopedics. Search: 20121120-25 Implants currently used for reconstruction of a burst vertebral body are associated with complications, including subsidence, nonunion, and substantial intraoperative blood loss. A new reconstruction device, the U-Cage (Double Engine Medical Material Ltd, Xiamen, Fujian, China), was designed to minimize complications. Six intact adult cadaver thoracolumbar (T11-L3) spines were collected and scanned by dual-energy X-ray absorptiometry (DEXA). The stiffness of the burst spine was subsequently compared with its previous intact state during flexion/extension, lateral bending, and rotation, and then subjected to a cyclic test to predict cage subsidence and device loosening. Axial load was applied continuously until failure to test the peak load that the specimen could withstand during the cyclic test. The correlation of bone mineral density and peak load was also analyzed. The instrumented specimens were found to be equivalent to intact bone in all directions (P>.05), with the exception of left rotation (P<.05). All specimens could withstand the cyclic test, and no subsidence or loosening of the device was detected. Average peak load for the instrumented specimens was 4137.5 N, which correlated with the average bone mineral density (r=0.915; P=.011). Thoracolumbar burst fractures instrumented with a U-Cage and anterolateral D-rod fixation achieved a stiffness similar to that of intact spines. This procedure may avoid the subsidence of the cage in vivo and serve as a better option for treating thoracolumbar burst fractures. [ABSTRACT FROM AUTHOR]

Full article available online at Healio.com/Orthopedics. Search: 20121120-22 Intramedullary nailing, which is preferred in tibial diaphyseal fractures, is also frequently used in distal third tibial fractures. Various angular deformities, including varus/valgus deformity, may be observed during postintramedullary nailing. Orthopedic surgeons use several methods to prevent this problem. In this study, at least 2 static locking screws were placed proximal and distal to the nail during intramedullary nailing of distal third tibial fractures. No additional supportive methods were used. The efficacy of this technique in the prevention of postoperative angular deformities was retrospectively investigated. Thirty-four patients with distal third tibial fractures who were treated with intramedullary nailing were included in the study. Angulations were measured in the anteroposterior and lateral planes on plain radiographs obtained preoperatively, on postoperative day 1, and after fracture union. Angulations measured on postoperative day 1 were compared with those measured after fracture union, and an increase was observed. Based on statistical analyses, the increase in the angulations was not significant. In distal third tibial fractures, when fixation was performed by placing 2 static screws distal and proximal to the intramedullary nail following adequate reduction, the angulations that developed during the period until union were not significant in terms of causing deformity, although additional fixation methods are not used. [ABSTRACT FROM AUTHOR]

Full article available online at Healio.com/Orthopedics. Search: 20121120-21 The carpometacarpal joint of the thumb is a common site of degenerative arthritis. Several surgical treatments exist, but arthroscopic management offers the potential benefit of earlier recovery. The current study evaluated the early clinical outcomes of a procedure involving arthroscopic hemitrapeziectomy with Artelon spacer (Artimplant, Västra Frölunda, Sweden) interposition arthroplasty into the newly created carpometacarpal space. A chart review of 9 patients treated with thumb carpometacarpal arthroscopic hemitrapeziectomy and Artelon spacer interposition arthroplasty between September 2005 and January 2009 was performed for postoperative complications, range of motion, and pinch strength (percentage of the contralateral limb). Subjective outcomes were analyzed by the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and the Patient-rated Wrist Evaluation. Mean follow-up was 23.4 months (range, 13-33 months). All patients maintained full range of motion. By the 1-year follow-up, mean pinch strength returned to 59%±19.1% of the contralateral limb strength. The Quick Disabilities of the Arm, Shoulder, and Hand and the Patient-rated Wrist Evaluation scores were 12.3±7.6 and 26.8±23.5, respectively. No significant complications occurred, and 1 patient with symptoms of synovitis was successfully treated with a corticosteroid injection. This study revealed excellent short-term results at the minimum 1-year follow-up for a less invasive treatment option that is appropriate for select patients with moderate thumb carpometacarpal arthritis (Eaton stages 2 and 3). The authors demonstrated a comparably good outcome of arthroscopic hemitrapeziectomy with Artelon spacer interposition arthroplasty with no evidence of foreign-body reaction. The authors also demonstrated the potential role of corticosteroid injections in the setting of a postoperative inflammatory reaction. [ABSTRACT FROM AUTHOR]

Full article available online at Healio.com/Orthopedics. Search: 20121120-14 Although 2-dimensional assessments using postoperative plain radiographs have been used after total knee arthroplasty (TKA) in previous studies, a strong possibility exists that deviation can occur when assessing 3-dimensional (3-D) objects. The purpose of this study was to test the hypothesis that novel 3-D image-matching software could accurately assess the positioning of implants and could be a useful tool in postoperative evaluation after TKA. Total knee arthroplasty was performed in 30 consecutive patients. Intraoperatively, the thickness of each bone cut was measured. Postoperatively, the thickness of each part of the bone cut was measured using Athena Knee (SoftCube Co, Ltd, Osaka, Japan) 3-D image-matching software. The results revealed no significant differences in the medial compartment and significant differences of approximately 1 mm in the lateral compartment. The difference was possibly caused by the remaining cartilage in the lateral compartment. Linear regression analysis revealed a statistically excellent correlation between intra- and postoperative values in all parts of the bone cuts. Although the 3-D image-matching software used in this study was originally developed for preoperative planning in TKA, it is considered accurate enough to assess the positioning of implants with respect to the bone after TKA. [ABSTRACT FROM AUTHOR]

This study assessed the accuracy of preoperative digital templating for a second-generation cementless stem compared with its first-generation design. A prospective cohort of 100 consecutive patients who had undergone a primary total hip arthroplasty using a new second-generation cementless stem was compared with the prior 100 hips that had received the first-generation stem. The authors believe that the second-generation stem may allow equal or more accurate digital templating compared with its predicate design. [ABSTRACT FROM AUTHOR]

Outpatient use of anticoagulants to prevent venous thromboembolism after total hip or knee arthroplasty may be hampered either by requirements for parenteral administration or high variability and frequent monitoring of anticoagulant activity. Trials of the new oral direct factor Xa inhibitors rivaroxaban and apixaban and the direct thrombin inhibitor dabigatran indicate that they can be administered in fixed doses without monitoring and that they generally have efficacy at least equivalent to enoxaparin, although with potential minor differences in the balance of efficacy vs risk for bleeding. This article reviews the results and pharmacokinetic properties that may influence their use in clinical practice. [ABSTRACT FROM AUTHOR]

In total knee arthroplasty (TKA), intramedullary and extramedullary tibial alignment guides are not proven to be highly accurate in obtaining alignment perpendicular to the mechanical axis in the coronal plane. The objective of this study was to determine the accuracy of an accelerometer-based, handheld surgical navigation system in obtaining a postoperative tibial component alignment within 2° of the intraoperative goal in both the coronal and sagittal planes. A total of 151 TKAs were performed by 2 surgeons using a handheld surgical navigation system to perform the tibial resection. Postoperatively, standing anteroposterior hip-to-ankle radiographs and lateral knee-toankle radiographs were performed to determine the varus/valgus alignment and the posterior slope of the tibial components relative to the mechanical axis in both the coronal and sagittal planes. Findings showed that 95.3% of the tibial components were placed within 2° of the intraoperative goal in the coronal plane and 96.1% of the components were placed within 2° of the intraoperative goal in the sagittal plane. Overall, mean postoperative lower-extremity alignment was -0.3°±2.1°, with 97% of patients having an alignment within 3° of a neutral mechanical axis. The handheld surgical navigation system improves the accuracy of the tibial resection and subsequent tibial component alignment in TKA. It is able to combine the accuracy of computer-assisted surgery systems with the ease of use and familiarity of conventional, extramedullary alignment systems, and the ability to adjust both the coronal and sagittal alignments intraoperatively may prove clinically useful in TKA. [ABSTRACT FROM AUTHOR]

As physician involvement in health policy grows, there will be an increasing need for future leaders in orthopedics. Interested orthopedic residents may be unaware of opportunities for leadership involvement in professional and subspecialty organizations. This article investigates whether national and subspecialty organizations offer membership to residents, allow residents to participate in committees, and provide opportunities for scholarly activity and mentorship. The authors surveyed 20 national orthopedic professional and subspecialty societies to evaluate the availability and cost of resident membership, meeting attendance and participation, research funding, committee membership, and mentorship opportunities. Each society's Web site was reviewed, and societies were contacted by phone if further inquiry was needed. Of the 20 orthopedic societies surveyed, 11 allowed resident membership. Five of 20 societies allowed residents to serve on committees, with a total of 14 total positions for residents. Four organizations provided formalized mentorship programs to residents. Although opportunities for resident involvement in subspecialty and professional societies are available in the majority of groups surveyed, the Orthopaedic Trauma Association and American Society for Surgery of the Hand provided the most comprehensive collection of opportunities. Residents should also pursue involvement in other organizations that may be more readily accessible, such as local, state, and regional orthopedic and medical societies. Increased resident participation in these organizations may help in increasing the 14 nationally available committee positions for orthopedic residents. Our orthopedic profession and societies should encourage motivated residents to pursue involvement and leadership at the national level. [ABSTRACT FROM AUTHOR]

Limited data exist regarding the long-term results of labral debridement and the effect of coexisting pathology on outcomes. Our hypothesis was that untreated coexisting hip pathologies such as femoroacetabular impingement and arthritis significantly affect the outcomes of arthroscopic labral debridement. Between 1996 and 2003, fifty consecutive patients who underwent hip arthroscopy and labral debridement with a mean follow-up of 8.4 years were included in our study. Patients' preoperative Harris Hip Scores and coexisting pathologies such as femoroacetabular impingement, dysplasia, or arthritis were recorded as variables. Postoperative Harris Hip Score and satisfaction at final follow-up were recorded as outcomes. Good or excellent results were achieved in 62% of cases (58% in patients with untreated femoroacetabular impingement and 19% in patients with arthritis). Failures included 2 cases that were converted to total hip replacement (4.5 and 5.2 years after index procedure) due to advancement of arthritis and 1 case of repeat arthroscopy for cam decompression. Patients with no coexisting pathology had significantly higher satisfaction and Harris Hip Scores. Almost all of the patients with low postoperative Harris Hip Scores had arthritic changes. Arthritis had a significant correlation with low postoperative Harris Hip Scores and satisfaction. Coexisting pathology, especially arthritis and untreated femoroacetabular impingement, can result in inferior outcomes. Arthroscopic labral debridement of symptomatic tears in selected patients with no coexisting pathology can result in favorable longterm results. Arthritis is the strongest independent predictor of poor outcomes. [ABSTRACT FROM AUTHOR]

Patients with diabetes mellitus have a higher risk of complications after sustaining an ankle fracture, including fracture displacement, superficial and deep infection, hardware failure, and neuropathic arthropathy. With the increased incidence of diabetes among the aged, the increased incidence of complications due to diabetes mellitus and its sequelae are important to keep in mind when treating ankle fractures. [ABSTRACT FROM AUTHOR]

Athletes with superior labral tear from anterior to posterior (SLAP) lesions place large demands on their rotator cuff and often have partial articular-sided rotator cuff tears as part of an internal impingement process. A percutaneous technique that facilitates SLAP repair may decrease the rotator cuff morbidity associated with establishment of the standard Wilmington portal. The current study reports the clinical outcome of patients with SLAP lesions treated with a percutaneous repair technique. Twenty-two patients with SLAP lesions underwent percutaneous repair. Mean patient age was 26.9 years. Standard posterior viewing and anterior working portals were used. Anchor placement and suture passing were performed with a 3-mm percutaneous and transtendinous approach to the superior labrum. Knot tying was performed via the standard anterior working portal. Clinical outcomes were assessed with validated shoulder evaluation instruments. Mean follow-up was 31.1 months (6.6 months). Improvement of shoulder evaluation scores from pre- to postoperative were as follows: American Shoulder and Elbow Surgeons score improved from 49.5 to 83.6, visual analog scale improved from 5.4 to 1.5, and Simple Shoulder Score improved from 6.4 to 11.0. All were significant improvements (P.05). There was no signifi cant difference in functional scores between Type II lesions versus combined lesions, or between patients with or without a concurrent low-grade rotator cuff tear. Ninety percent of athletes were able to return to sport at pre-injury level of function. Percutaneously-assisted arthroscopic SLAP lesion repair may minimize surgical morbidity to the rotator cuff and provides excellent results. [ABSTRACT FROM AUTHOR]

Lumbosacral pain is common in the general population and among athletes. Many athletes are diagnosed with low back strain and treated with nonsteroidal anti-inflammatories, rest, and muscle relaxers. However, the differential for low back pain in athletes is broad and includes many potential etiologies such as: lumbar disk disease, facet arthropathy, spondylolysis, sacroiliitis, tendinopathies, ligament sprains, hip pathology, bursitis, intraabdominal processes, and neoplasm. Sacral stress fractures are included among the many possibilities.Stress fractures are rare in the general population, with a 1% incidence over a lifetime, but up to 20% of runners may experience a stress fracture while participating in their sport. Athletes are unique as they engage in prolonged strenuous activities, both in practice and competition. Sports activities have the potential of placing extreme amounts of repetitive loading on bones, articular surfaces, and soft tissues throughout the body, including the sacrum. Hockey players place considerable demands on their pelvis during training and competition given the physical demands of the sport. This article presents a case of a delayed diagnosis of a sacral stress fracture in a professional hockey player. This is the first known report of a hockey-related sacral stress fracture. [ABSTRACT FROM AUTHOR]

This study evaluated and compared the intraoperative stabilities using the low and high femoral tunnel techniques in ACL reconstruction. Seventy patients who underwent ACL reconstruction were equally allocated to low or high femoral tunnel groups (35 in the low femoral tunnel group and 35 in the high femoral tunnel group) for this study. The authors compared intraoperative anterior, internal rotational, and external rotational stabilities at 0°, 30°, 60°, and 90° of knee flexion using a navigation system after reconstruction. The low femoral tunnel group showed significantly better intraoperative internal rotational stability at 0° and 30° of flexion than the high tunnel group; however, no significant intergroup differences were found for anterior and external rotational stabilities at any flexion angle. These findings suggested that the low femoral tunnel group showed better internal rotational stability at time zero condition during ACL reconstruction than the high femoral tunnel group, but anterior and external rotational stabilities were similar. However, to determine whether these results may affect clinical results, further studies based on more accurate measurement of rotational stability in clinical settings are needed. [ABSTRACT FROM AUTHOR]

Computer-assisted surgery has focused on alignment of implants and soft tissue balancing but the end results during surgery as they pertain to long-term function of the implants are not yet realized. One parameter that continues to be variable despite the use of computer navigation is the placement of the implants in the transverse plane. The objective of this study was to determine whether implant and anatomic registrations could be used in a computer model (LifeMOD/KneeSIM, LifeModeler, Inc., San Clemente, California) to show differences in the resulting contact patterns of the medial and lateral condyles of the polyethylene insert. The simulations included tibiofemoral and patellofemoral contact, passive soft tissue (medial and lateral collateral, and posterior cruciate ligaments, as well as the capsular tissues), and active muscle elements (quadriceps and hamstrings). Components of a fixed-bearing cruciate-retaining total knee (Columbus knee system; B. Braun Aesculap, Tuttlingen, Germany) were imported into the model. The systems were subjected to one 60-second cycle of a lunge. Both the femoral and the tibial components were positioned in 5° of internal or external rotation in varying combinations and the resulting kinematics analyzed. The resulting kinematics showed variations in anteroposterior translation of the lateral and medial femoral condyles that resembled several of those reported in the literature for individual patients with a cruciate-retaining knee implant system. [ABSTRACT FROM AUTHOR]

This study was conducted (1) to document discrepancies between preoperative and postoperative radiographic measurements and postregistration and postimplantation intraoperative navigational measurements of coronal limb alignments, and (2) to identify predictors of discrepancies between radiographic and navigational measures. In addition, we propose the use of a novel radiographic measuring method, and we demonstrate that this method reduces discrepancies. For 107 total knee arthroplasties performed using a navigation system, coronal alignment were assessed using preoperative and postoperative whole limb radiographs using the standard and novel radiographic methods. During surgery, coronal limb alignment was measured using the navigation system postregistration and postprosthesis implantation. Strengths of correlations and discrepancies between radiographic and navigational assessments were compared between the standard and novel methods. Multivariate regression was performed to identify predictors of discrepancies. Differences between radiographic and navigational measurements were observed for both preoperative and postoperative assessments, but discrepancies were greater for preoperative assessments, despite their stronger correlations. Extent of preoperative varus deformity was identified as the strongest predictor of discrepancy in preoperative radiographic and navigational measurements, and varus malalignment was identified as the strongest predictor of discrepancy in postoperative measurements. Strengths of correlations between radiographic and navigational measurements were similar for the standard and novel radiographic methods, but discrepancies between the 2 were significantly smaller for the novel method for both preoperative and postoperative assessments. The authors propose the use of the described novel radiographic method that reduces discrepancies between radiographic and navigational measurements. [ABSTRACT FROM AUTHOR]

We selected 86 cases for the study: 50 navigated revision total knee replacements (TKRs) and 36 conventional revision TKRs. We hypothesized that the rate of satisfactory implantation would be higher for navigated revision TKR than for conventional revision TKR. The primary criterion was the rate of optimally implanted prostheses on postoperative anteroposterior and lateral long leg radiographs. Thirty-one navigated cases (62%) and 14 conventional cases (39%) had an optimal global implantation (P<.05). The use of a standard navigation software for revision TKR allows a significant improvement of the accuracy of implantation. However, development of dedicated software will allow addressing more precisely the specific features of a revision TKR, such as stem extension navigation, defects filling, and joint line reconstruction. [ABSTRACT FROM AUTHOR]

Shoulder arthroscopy is generally a safe and effective method for treating a wide variety of shoulder pathology. Fortunately, complications following shoulder arthroscopy are rare, with reported rates between 4.6% and 10.6%.¹⁻⁷ These rates may be underestimated, as underreporting of complications and varying definitions of the term complication are likely. During shoulder arthroscopy, complications may occur at numerous points. The surgeon must be aware of potential problems and take necessary measures to prevent them. This article describes common complications after arthroscopic shoulder surgery. Although failure of treatment and postoperative stiffness are undesirable outcomes, they are not described. [ABSTRACT FROM AUTHOR]

By healing most forefoot ulcerations and lowering their recurrence rate, tendon lengthening should lower the incidence of metatarsal ulceration progression to infection and subsequent amputation. [ABSTRACT FROM AUTHOR]