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Patellar crepitus and clunk (PCC) is a known complication in total knee arthroplasty (TKA) and the cause of dissatisfaction. Patellofemoral articulations have reportedly been optimized in newer TKAs. This study compared the incidence of PCC between a historical and modern TKA design. A single-surgeon retrospective review of primary PFC Sigma (DePuy Synthes, Warsaw, Indiana) or Attune TKA (DePuy Synthes) was performed. A total of 114 PFC Sigma and 103 Attune implants were analyzed at a mean 3.2 years follow-up for overall PCC, painful PCC, anterior knee pain (regardless of crepitus), and PCC necessitating revision. Similar rates of overall PCC (14.6% vs 20.2%, Patellar crepitus and clunk (PCC) is a known complication in total knee arthroplasty (TKA) and the cause of dissatisfaction. Patellofemoral articulations have reportedly been optimized in newer TKAs. This study compared the incidence of PCC between a historical and modern TKA design. A single-surgeon retrospective review of primary PFC Sigma (DePuy Synthes, Warsaw, Indiana) or Attune TKA (DePuy Synthes) was performed. A total of 114 PFC Sigma and 103 Attune implants were analyzed at a mean 3.2 years follow-up for overall PCC, painful PCC, anterior knee pain (regardless of crepitus), and PCC necessitating revision. Similar rates of overall PCC (14.6% vs 20.2%, P=.803), painful PCC (8.7% vs 6.1%, P=.605), and anterior knee pain (15.5% vs 9.7%, P=.219) were observed in the Attune and PFC Sigma groups, respectively. No clinically significant differences in range of motion, pain, or Knee Society Scores were found between groups. Subgroup analyses of mobile vs fixed bearing PFC Sigma implants demonstrated higher rates of overall PCC (32.4% vs 15.0%, P=.043), painful PCC (20.6% vs 5.0%, P=.016), anterior knee pain (17.6% vs 1.3%, P=.003), and crepitus requiring revision surgery (17.6% vs 1.3%, P=.003) for mobile bearing PFC Sigma implants. No difference was found in the rates of anterior knee pain or PCC between the PFC Sigma and Attune implants. Subgroup analysis suggests that a mobile bearing PFC Sigma implant results in higher PCC. The authors believe the true incidence of anterior knee pain and PCC is underreported in the literature because many outcome measures do not capture these complications. [Orthopedics. 2020;43(6):e508–e514.]

Extensor mechanism (EM) insufficiency after knee arthroplasty is a rare but devastating complication resulting in severe disability. To date, primary repair and allograft reconstructive options have produced suboptimal results. A synthetic mesh allograft reconstruction technique has recently been introduced with promising outcomes. A retrospective chart review was performed to identify all patients who experienced EM failure after total or unicompartmental knee arthroplasty and subsequently underwent synthetic mesh EM reconstruction using a previously described technique. Patient demographics, pre- and postoperative knee range of motion and residual extensor lag, pre- and postoperative pain and functional outcome scores, and complications were extracted during the chart review. Twelve patients met inclusion criteria: 3 with patellar tendon and 9 with quadriceps tendon defects. At mean follow-up of 27.0 months, all patients were ambulatory, with a mean residual extensor lag of 12.9° (range, 0°–30°). Mean visual analog scale pain score decreased significantly after EM reconstruction: 4.6±2.3 (range, 1–8) preoperatively vs 1.8±2.4 (range, 0–7) postoperatively (Extensor mechanism (EM) insufficiency after knee arthroplasty is a rare but devastating complication resulting in severe disability. To date, primary repair and allograft reconstructive options have produced suboptimal results. A synthetic mesh allograft reconstruction technique has recently been introduced with promising outcomes. A retrospective chart review was performed to identify all patients who experienced EM failure after total or unicompartmental knee arthroplasty and subsequently underwent synthetic mesh EM reconstruction using a previously described technique. Patient demographics, pre- and postoperative knee range of motion and residual extensor lag, pre- and postoperative pain and functional outcome scores, and complications were extracted during the chart review. Twelve patients met inclusion criteria: 3 with patellar tendon and 9 with quadriceps tendon defects. At mean follow-up of 27.0 months, all patients were ambulatory, with a mean residual extensor lag of 12.9° (range, 0°–30°). Mean visual analog scale pain score decreased significantly after EM reconstruction: 4.6±2.3 (range, 1–8) preoperatively vs 1.8±2.4 (range, 0–7) postoperatively (P=.01). The mean Knee Society knee score improved from 41.5±11.1 (range, 21–57) preoperatively to 79.5±13.8 (range, 54–90) postoperatively (P<.0001). The mean Knee Society function score improved from 14.6±12.3 (range, 0–40) preoperatively to 64.2±27.1 (range, 5–95) postoperatively (P<.0001). One clinical failure occurred as a result of prosthetic joint infection. Synthetic mesh EM reconstruction effectively restores knee function for a variety of EM deficiencies following knee arthroplasty. [Orthopedics.2019; 42(4):e385–e390.]

Bicruciate retaining total knee arthroplasty dates back to the 1980s. The earliest of the prostheses saved all of the ligaments but included constraint in the surface design that led to a kinematic conflict and early failures. Townley and Cloutier developed successful designs that had good midterm results but they did not develop a significant following among the orthopedic surgeons of their time. With the introduction of minimally invasive surgery for total knee arthroplasty, the concept of sparing the anatomy brought surgeons back to the concept of saving all of the ligaments. In the past 5 years at least 2 new designs for the bicruciate ligament retaining TKA have been introduced. The new prostheses have improved anatomy and more sophisticated instrumentation for the surgical procedure. The clinical results are short-term, but they are encouraging. The operation can be performed routinely, the prosthesis is reliable, and patients are reporting improved KOOS scores. The future will show added technology for the operation with robotic assistance, pressure sensing devices for balancing, and smart instruments to assist in alignment. Hopefully, the more anatomic design will help the 15% of patients who are not satisfied with their TKA.

Although the results of arthroscopic management of posterior labral pathology in young athletes have been reported extensively in the literature, the clinical outcomes in older patients are unknown. This retrospective review included patients older than 35 years who underwent arthroscopic posterior labral repair. Functional outcome scores were collected, and subgroup analyses were performed to evaluate the impact of patient-specific factors. Forty-three patients met the inclusion criteria; average follow-up was 36.9 months (range, 24–54 months). Mean patient age at the time of surgery was 40.9 years (range, 35–57 years). Average outcome scores at final follow-up were Quick Disabilities of the Arm, Shoulder and Hand Scale (QuickDASH), 19±22; Simple Shoulder Test (SST), 9.9±3; Western Ontario Shoulder Instability Index (WOSI), 601±546; and Single Assessment Numeric Evaluation (SANE), 79.6%±23.4%. No significant differences in outcomes were observed in patients with preoperative symptomatic instability, active workers' compensation claims, or traumatic injury (Although the results of arthroscopic management of posterior labral pathology in young athletes have been reported extensively in the literature, the clinical outcomes in older patients are unknown. This retrospective review included patients older than 35 years who underwent arthroscopic posterior labral repair. Functional outcome scores were collected, and subgroup analyses were performed to evaluate the impact of patient-specific factors. Forty-three patients met the inclusion criteria; average follow-up was 36.9 months (range, 24–54 months). Mean patient age at the time of surgery was 40.9 years (range, 35–57 years). Average outcome scores at final follow-up were Quick Disabilities of the Arm, Shoulder and Hand Scale (QuickDASH), 19±22; Simple Shoulder Test (SST), 9.9±3; Western Ontario Shoulder Instability Index (WOSI), 601±546; and Single Assessment Numeric Evaluation (SANE), 79.6%±23.4%. No significant differences in outcomes were observed in patients with preoperative symptomatic instability, active workers' compensation claims, or traumatic injury (P>.05). The presence of intraoperatively definable chondral damage (Outerbridge grade III or higher) was associated with significantly worse final functional outcomes (QuickDASH: 29 vs 11.9, P=.03; SST: 8.5 vs 10.9, P=.02; WOSI: 875 vs 407, P=.01; and SANE: 70.6% vs 86%, P=.05). One patient (2%) experienced a minor postoperative complication, and 3 patients (7%) required subsequent procedures: 2 total shoulder arthroplasties and 1 revision labral repair. The results of arthroscopic posterior labral repair in patients older than 35 years were variable and worse than those previously reported in younger patients. The presence of chondral damage at the time of the index procedure was a negative predictive factor. [Orthopedics.2017; 40(2):e305–e311.]

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Metastatic tumors to the oral cavity are relatively uncommon and account for about 1 % of all oral cancers. Distant metastases to the jawbone are associated with a poor prognosis and a survival rate that is usually less than one year. The leading common primary sites for these lesions are the breast in females and the lung in males followed by the adrenals, kidneys, prostate, thyroid and colon. In 30% of all cancers, a metastatic lesion could be the first sign of a primary tumor elsewhere in the body. Metastatic lesions to the jaws are known to simulate periodontal and pulpal disease and other radiolucent lesions that can occur in the jaws. Microscopic evaluation with concurrent radiographic skeletal survey is warranted in patients where a metastatic lesion is suspected.

The deposition of PLZT thin films by cluster magnetron techniques is described. X-ray photoelectron spectroscopy has been used to determine film composition over a range of substrate temperatures. As-deposited films have been studied by X-ray diffraction techniques and the role of post deposition annealing has been assessed. The morphology and growth rates have been determined.

A method for attenuating a laser beam based on the excitation of a surface plasmon is described. This attenuator is continuously variable, has a dynamic range of 10^2, has a spectral range covering the visible, does not steer the beam or distort its profile, and can handle powers of at least 1-W cw. Some preliminary results obtained on a crude prototype are presented; final device design and predicted performance are discussed.

Several letters to the editor are presented in response to topics discussed in previous issues including computerized systems for railroads, railroad traffic, and proposed railroad policies in Great Britain.

The article deals on the preservation program of the Sonoran pronghorn in the Cabeza Prieta National Wildlife Refuge in Arizona. In an effort to preserve these most endangered creatures, the state government has created an electrified five-foot-high wire mesh fence that keeps these creatures along the Cabeza refuge. Being a subspecies from the American pronghorn antelopes, the pronghorn has been protected by the Endangered Species Act since 1967.

Describes the behavior, habitat and life of the grasshopper mice. Species of grasshopper mouse found in Arizona; Diet of the mouse; Description of the mouse's digestive system; Manner of catching food, building nests and providing refuge for their young; Purpose and meaning of their cries.

Current/voltage, current/brightness and capacitance values have been monitored as d.c. electroluminescent ZnS:Cu,Mn powder panels have been ‘formed’ to a series of voltages. Bulk effects are seen to be at least as important as junction effects to the generation of electroluminescence.

Presents a description of a hiking trail in the Escudilla Wilderness located in the Apache-Sitgreaves National Forest, Arizona. Description of flora and fauna along the trail; Terrain conditions; Weather; Author's experiences on different hikes; Travel details; Contact information.

Presents information on a rescue mission to bring the black-footed Ferret back to Arizona. How the ferret was brought back to Arizona; Mention of the efforts to save the species and repopulate the region.

Describes the author's hiking trip on Charlie Bell Pass in Arizona's Cabeza Prieta National Wildlife Refuge. Requirements for gaining access to the Refuge; Best times for visiting the Pass; Duration of the hike.