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The very nature of sport is that it can occasion harm and involves various degrees of risk, which is perhaps one of the reasons that it is so compelling for both participants and spectators. However, there is often an adversarial relationship between sporting performance and patient welfare1. As a doctor, one of the primary tenets governing clinical practice is primum non nocere (first, do no harm). This raises challenging ethical dilemmas in the context of sports medicine, in which orthopaedic surgeons are frequently called upon to treat patients injured playing sport with the explicit goal of returning these patients to the same sport and, thus, back into harm’s way. Players participate in sport of their …

Background: The clock face has been employed to define the position of labral pathology in relation to identifiable arthroscopically relevant acetabular landmarks. The purpose of this study was to qualitatively and quantitatively describe arthroscopically relevant anatomy of the acetabulum. We aimed to present a surgical landmark that is located in close proximity to the usual location of labral pathology as an alternative to the midpoint of the transverse acetabular ligament as a reference point. Methods: Fourteen fresh-frozen cadaveric hemipelves were dissected to evaluate osseous landmarks and relevant surrounding soft-tissue structures of the acetabulum. With use of a coordinate-measuring device, we determined the location, orientation, and relationship of key arthroscopic landmarks and the footprint areas formed by the insertions of the rectus femoris, capsule, and labrum. Results: An analysis of variability of reference points around the acetabulum in relation to the anterior inferior iliac spine (AIIS) revealed that the superior margin of the anterior labral sulcus (psoas-u) was the most consistent anatomic landmark. The AIIS comprised superior and inferior facets, demarcated by the origins of the direct head of the rectus femoris and the iliocapsularis. The inferolateral corner of the footprint of the direct head of the rectus femoris was located 19.2 mm (95% confidence interval [CI], 18.0 to 20.4 mm) from the acetabular rim and the inferolateral aspect of the iliocapsularis footprint, 12.5 mm (95% CI, 10.1 to 15.0 mm) from the rim. Conclusions: The superior margin of the anterior labral sulcus (psoas-u) was a reliable landmark for reference of the clock face on the acetabulum. We propose that this point, denoting 3:00, be adopted as the new standard clock-face reference for intra-articular hip structures because of its universal presence and reliable arthroscopic visualization. This marker is also beneficial because of its proximity to the typical location of labral pathology. The data presented provide a comprehensive analysis of pertinent arthroscopically relevant acetabular anatomy. Clinical Relevance: The establishment of a new standard reference point within the acetabulum will enhance the consistency of interpretation of the location of labral pathology and improve arthroscopic orientation and navigation.

“Quis custodiet ipsos custodes?” (“Who will guard the guards themselves?”) (Juvenal, Roman poet and satirist [55 to 127 a.d.], Satire VI 1) The decision about which thromboprophylactic measure to use with patients undergoing total joint arthroplasty has always been contentious. The choice is made no easier by the myriad of pharmacological and mechanical prophylactic options that currently exist. Consequently, reaching a consensus on which method of prophylaxis is optimal is extremely challenging and, at best, highly controversial. The argument is most heated regarding high-risk patients or patients with bleeding risks. In an attempt to provide some direction in this area, the American Academy of Orthopaedic Surgeons (AAOS), as the preeminent provider of musculoskeletal education, has produced guidelines on the prophylaxis of venous thromboembolic events in patients undergoing total joint arthroplasty2. These guidelines are based on the interpolation of results reported in the literature. However, it is one thing to promulgate guidelines and another thing entirely to validate their utility for an unselected patient population. In this study, Lewis et al. demonstrated the clinical effectiveness of the AAOS clinical guidelines by reporting on a large, prospective series of patients, utilizing risk stratification as well as pharmacological and/or mechanical prophylaxis. In doing so, they highlighted a number of unresolved dilemmas that surgeons face in using thromboprophylaxis in an elective setting, particularly with the high-risk patient or in cases …

“Too much of a good thing can be taxing.” —Mae West It is well known that an insufficiency of meniscal tissue predisposes to arthritic changes of the knee1. Meniscal resection in adolescents has been reported to cause three times as many radiographic changes that are consistent with osteoarthritis after thirty years as compared with the findings in the contralateral, unaffected knee2. However, it is questionable whether meniscal injury in adolescent or younger patients truly poses the same treatment dilemma as it does when found in middle-aged patients. An appreciation of the essential role that the meniscus plays in prolonging the longevity of the knee has persuaded surgeons to preserve this important tissue, insofar as possible, rather than to resect it. As such, meniscal transplantation has gradually evolved to become a standard procedure for the treatment of the meniscus-deficient knee, although it is seldom a reliable solution for middle-aged patients. The artificial meniscus has been suggested as a viable alternative. However, unconvincing long-term data and restrictive inclusion criteria make this procedure unfeasible for the majority of patients requiring additional meniscal tissue. So, why is it that too much of a good thing can actually be a bad thing? The discoid …