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Patellar dislocation is a frequent sports-related knee injury. The primary restraint to lateral translation of patella is medial patellofemoral ligament. Several treatments for patella dislocation have been described in the literature. The purpose of this Technical Note is to describe the surgical technique for medial patellofemoral ligament reconstruction using gracilis tendon and 2 knotless soft anchors, avoiding patella tunneling. [Display omitted] [ABSTRACT FROM AUTHOR]

The anterior cruciate ligament (ACL) tear is one of the most common knee injuries in sports that require side-to-side pivoting movements. While the timeline and specific goals during rehabilitation protocols may vary, ACL reconstruction (ACLR) is the preferred procedure necessary to return these athletes to their respective field of play. However, there are no validated guidelines that define a specific timepoint when it is safe for an athlete to return-to-play, as functional movement deficit may be present much longer than six months post ACLR. A retrospective cross-sectional analysis was conducted on 33 subjects that underwent ACLR. As a part of standard of care, each subject completed a movement screening protocol at a singular timepoint during their rehabilitation process. An innovative three-dimensional markerless motion capture system was used to obtain three algorithm-derived biometric variables: mobility, alignment, and readiness. Significant gradual improvements in mobility and readiness were observed throughout a 3–6-month post ACLR procedure period. When examining the data trends, it was obvious that not all patients responded identically to treatment plans provided by clinical professionals. Therefore, the findings of the present study suggest that the decision regarding when it is safe to return to play needs to be determined on an individual basis. [ABSTRACT FROM AUTHOR]

Recent advancements in orthopaedic devices have instilled a renewed interest in repair of the anterior cruciate ligament. Biological augmentation of the repair has also recently been investigated with the hopes of improving repair outcomes and improving biological healing. The advent of needle arthroscopy allows for potentially decreased recovery times and potentially reduced complication rates compared with traditional arthroscopy. The purpose of this article is to present a percutaneous technique to repair the anterior cruciate ligament with suture tape augmentation while also augmenting with the biological byproducts from the native effusion using needle arthroscopy. Video 1 Surgical technique for repair of the anterior cruciate ligament using suture tape augmentation, needle arthroscopy, and biological augmentation in the right knee with the patient in the supine position. [ABSTRACT FROM AUTHOR]

Background: Professional athletes are reported to be at greater risk of septic arthritis (SA) after anterior cruciate ligament reconstruction (ACLR) than the nonprofessional population. However, this finding has been controversial, and confusion has arisen in the literature owing to the underpowering of previous studies. Purpose/Hypothesis: The purpose was to report the differences in the rate of SA after ACLR in a large series of patients and to perform pooled data analysis including previously published studies. The hypothesis was that professional athletes have a significantly higher risk of SA than nonprofessional athletes. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was performed. Patients who underwent ACLR between January 2009 and July 2017 (with a minimum follow-up of 12 months) were considered for study eligibility. The rate of SA was determined, and multivariate analysis was used to evaluate potentially important risk factors, including participation in professional sport. Furthermore, a literature search was performed, and data were extracted from all identified relevant studies. A pooled data analysis was performed to determine differences in the risk of SA between professional and nonprofessional populations. Results: The current series comprised 4421 anterior cruciate ligament surgical procedures with 265 professional athletes. There were 15 cases of SA diagnosed over the study period (0.34%; 95% CI, 0.19%-0.56%). Ten cases occurred in professional athletes (3.8%; 95% CI, 1.82%-6.83%). The percentage of SA was 0.12% (95% CI, 0.04%-0.28%) in the nonprofessional population. Being a professional athlete was associated with a significantly increased risk of SA after ACLR (odds ratio, 21.038; 95% CI, 6.585-75.789; P <.0001). This finding was confirmed in the pooled data analysis comprising 11,416 patients including 1118 professional athletes (odds ratio, 5.03; 95% CI, 1.17-21.61). Conclusion: Professional athletes are at greater risk of SA after ACLR than nonprofessional athletes. The results of previous studies may have been conflicting owing to underpowering. The current study confirms the elevated risk by using a large clinical series and pooled data analysis to avoid the limitations of previous studies. [ABSTRACT FROM AUTHOR]

Introduction: Recently, a new minimally invasive single bundle technique for anatomic ACL reconstruction has been described, called the 'All-Inside graft-link technique'. One of the advantages of this procedure is the reduced morbidity at the donor site as the graft choice is the quadrupled semitendinosus, thus sparing the gracilis tendon. The aim of this study was to evaluate isokinetic flexion strength recovery in patients who underwent a gracilis sparing technique compared to those with a full-tibial tunnel technique using a doubled gracilis and semitendinosus tendons (DGST) graft. Methods: Patients were divided into two groups: Group A (22 patients) who underwent ACL reconstruction performed with an All-Inside graft-link technique; Group B (22 patients) who underwent ACL reconstruction with an Out-In technique and DGST graft. At a mean follow-up of 13 months, quadriceps and hamstring isokinetic peak torque deficits were recorded. Results: In group A, the mean side to side peak torque flexion difference between the operated and non-operated limbs was −3% and the mean torque at 30° was −7.5% at high angular velocity (180°/sec); the mean peak flexion torque was 7.2% and the mean torque at 30° was 3.1% at low angular velocity (60°/sec). In group B, the mean side to side peak flexion torque was −3.5% and the mean torque at 30° was −7.6% at high angular velocity (180°/sec); the mean peak flexion torque was −7.2% and the mean torque at 30° was −11% at low angular velocity (60°/sec). A statistically significant difference was found between the two groups at lower angular velocity both for the mean peak flexion torque and the mean torque at 30° (p = 0.009), with better results in the study group. Discussion/conclusion: Gracilis sparing technique is a minimally invasive technique for ACL reconstruction and yielded a significantly better flexion strength recovery at lower angular velocity compared to a full tibial tunnel technique with DGST for ACL reconstruction. [ABSTRACT FROM AUTHOR]

Background The β-angle, formed by the intersection of a line on the floor of the supraspinatus fossa and glenoid fossa line, has been described as a reliable measurement tool in the clinical setting to analyze glenoid inclination on the anteroposterior (AP) view of the shoulder. The purpose of this study was to compare the accuracy of the β-angle measurement using different imaging modalities with a validated 3-dimensional (3D) software tool. Materials and methods The β-angle was measured on AP radiographs, unformatted 2-dimensional (2D) computed tomography (CT) scan, and reformatted 2D CT scan in the scapular plane for 51 shoulders of 49 patients undergoing primary total shoulder arthroplasty. Comparison to the glenoid inclination angle calculated by the 3D software was performed. Results The β-angle measured on reformatted CT scan was found to be the most accurate measurement method, with a mean difference of 1° (standard deviation [SD], 0.5°) with respect to 3D measurement. On AP radiographs, the β-angle was not as accurate, with a mean difference of 3° (SD, 0.7°; P < .006). The β-angle on unformatted 2D CT scan was not a reliable method to measure glenoid inclination, with a mean difference of 10° (SD, 0.9°; P < .0001). Conclusion The β-angle measured with 2D CT scan formatted in the scapular plane was the most accurate method for measuring glenoid inclination. The β-angle on the AP radiograph is less accurate and reliable. Measurement of the β-angle on an unformatted 2D CT scan is not an acceptable method to determine glenoid inclination. [ABSTRACT FROM AUTHOR]

Background Increased critical shoulder angles consist of both the acromial cover and glenoid inclination and have been found in patients with rotator cuff pathology. The purpose of this study was to determine the correlation of the critical shoulder angle and glenoid inclination and to determine the difference in glenoid inclination between patients with osteoarthritis and massive rotator cuff tears. Methods The critical shoulder angle and glenoid inclination were measured on anteroposterior radiographs, and glenoid inclination was also measured on a validated 3-dimensional computer software program of 50 shoulders undergoing primary total shoulder arthroplasty. Twenty-five shoulders had osteoarthritis and A1 glenoids, as defined by the Walch classification, and were undergoing anatomic shoulder arthroplasty. The other 25 shoulders had massive rotator cuff tears and E0 glenoids, as defined by the Favard classification. The 2 groups were compared. Results Critical shoulder angle and glenoid inclination were significantly correlated ( R 2 = 0.7426, P < .001). Shoulders with massive rotator cuff tears (E0) demonstrated increased glenoid inclination measurements than shoulders with osteoarthritis (A1). As measured by the 3-dimensional software, the massive rotator cuff group had a glenoid inclination of 13.6° ± 4.3° and the osteoarthritis group had a glenoid inclination of 4.7° ± 5.6°. When measured by anteroposterior radiographs, the average glenoid inclination was 13.6° ± 4.6° in the massive rotator cuff group and was 7.6° ± 5.01° in the osteoarthritic group . Conclusion Glenoid inclination is linearly correlated with the critical shoulder angle and is significantly increased in patients with massive rotator cuff tears. [ABSTRACT FROM AUTHOR]

The authors discuss a report on the potential for collision between the femoral tunnels for Lemaire procedures and femoral anterior cruciate ligament tunnels drilled through an anteromedial portal. Topics mentioned include the use of a MacIntosh femoral tunnel position instead of Lemaire, location of a lateral extra-articular tenodesis femoral tunnel based on anatomic and biomechanical considerations, and studies that aid in the selection of the optimum femoral tunnel location.

The Anatomy of the lateral aspect of the knee has been increasingly debated in recent literature, the morphology and function of anterolateral ligament (ALL) are not clearly understood even today (1, 2). The aim of present study was to provide for the first time a detailed ultrastructural characterization of the ALL and its ultrastructure collagen arrangement using the light microscopy (LM), the transmission electron microscopy (TEM) and variable pressure scanning electron microscopy (VP-SEM). Eight paired samples from four fresh-frozen males cadavers were used for the study. Samples were harvested from the ALL, from the anterolateral capsule and from the medial collateral ligament (MCL). All samples were treated for microscopy techniques. Histological analysis showed similar morphology features between ALL and MCL sectioning, but clear differences are evident in comparison to the knee capsule. At TEM the collagen fibers of ALL and MCL showed similarity in the ultrastructural morphology, both collagen fibers have parallel alignment mainly orientated longitudinally. Significant structural difference of the tissue of the fibrous capsule compared to the ligaments may be observed. The VP-SEM highlighted that ALL and MCL morphology has shown aligned arrangements of fiber bundles densely packed, completely different assembling organization of the fibers were observed in fibrous capsule. Data from this study demonstrate that the ALL and MCL have comparable ultrastructural properties. It can further lead us to speculate that the ALL is a ligamentous structure distinct from the knee capsule. [ABSTRACT FROM AUTHOR]

Background: Normative data for passive range of motion are well established, but daily living is comprised of active motion. The purpose of this study was to establish normative values for active range of motion of the shoulder across age, sex, and arm. Our hypotheses were that active range of motion of the shoulder (1) decreases with age group, (2) differs between males and females, and (3) differs between the right arm and left arm., Methods: Shoulder active range of motion was captured with an eight-camera markerless motion capture system. Data were collected for a heterogenous sample of 6635 males and females of all ages. For each subject, 6 shoulder motions were collected with maximum values measured: external rotation, internal rotation, flexion, extension, abduction, and horizontal abduction. Three-way repeated measures analyses were performed, with 2 between-subject factors (age group and sex) and 1 within-subject factor (arm). The unadjusted threshold for statistical significance was α = 0.05., Results: External rotation decreased with age (approximately 10° decrease from below 30 years to above 60 years). External rotation was approximately 5° greater in the right arm, whereas internal rotation was approximately 5° greater in the left arm. Flexion decreased with age (approximately 15° decrease from below 20 years to above 60 years). For age groups from 10 to 59 years, extension and horizontal abduction were approximately 5° to 10° greater in females than males. Abduction was greater for females than males. Abduction was also greater in younger people (aged 10-29 years) than older people., Conclusion: In general, active range of motion of the shoulder decreases with age. Sex (male/female) and arm side (right/left) also influence shoulder range of motion., (© 2022 The Authors.)