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Revision anterior cruciate ligament reconstruction is an increasingly common procedure, with 2-stage surgery often required to address large bone defects and malpositioned tunnels. The arthroscopic bone grafting technique described herein uses morselized allograft bone to provide reproducible fill of asymmetrical bone defects without autograft harvest or additional loss of native bone. The second stage of the anterior cruciate ligament reconstruction can typically proceed 6 months following bone grafting.

Valgus malalignment can be corrected with a biplanar lateral opening wedge distal femoral osteotomy (bLOWDFO) in patients with symptomatic lateral compartment disease. Advantages of a lateral opening wedge technique over the medial closing wedge technique include avoidance of vascular structures and theoretically better control of the amount of correction. The advantages of a bLOWDFO over a uniplanar osteotomy are that it creates a larger surface area for healing, and provides inherent stability to control the osteotomy intraoperatively. The purpose of this article is to present a reproducible technique for bLOWDFO and review the indications, preoperative planning, rationale, and clinical outcomes.

Hamstring injuries commonly occur at the musculotendinous junction; however, they can occur as proximal avulsion injuries. A lack of recognition can lead to proximal hamstring injuries being frequently misdiagnosed, resulting in delayed treatment. Chronic proximal hamstring tears are often retracted and scarred to the surrounding soft tissues. Owing to the poor quality of tissue at the torn ends of the tendon, an augmented reconstruction using an allograft may be required. In cases with poor visualization of the ischial tuberosity and proximal hamstring footprint, an Achilles tendon allograft can be secured directly to the tuberosity with suture anchors. However, visualization of the footprint can be optimized using an arthroscope. This report describes a technique for endoscopic-assisted anatomic reconstruction using an Achilles allograft with both knotless and knotted suture anchors for chronic complete avulsions of the proximal hamstring.

In orthopedic sports medicine, amniotic-derived products have demonstrated promising preclinical and early clinical results for the treatment of tendon/ligament injuries, cartilage defects, and osteoarthritis. The amniotic membrane is a metabolically active tissue that has demonstrated anti-inflammatory, antimicrobial, antifibrotic, and epithelialization-promoting features that make it uniquely suited for several clinical applications. Although the existing clinical literature is limited, there are several ongoing clinical trials aiming to elucidate the specific applications and benefits of these products. This article reviews the current amniotic-derived treatment options and the existing literature on outcomes, complications, and safety profile of these products for use in sports medicine.

Posterior glenohumeral capsular rupture is a rare cause of posterior glenohumeral instability. With advances in imaging and arthroscopic techniques, diagnosis and treatment of posterior glenohumeral instability are becoming more common in practice. We present a technique for arthroscopic repair of a posterior glenohumeral capsular rupture with concomitant anterior and posterior labrum detachment. Arthroscopic fixation was facilitated by use of a 70° arthroscope through an anterior viewing portal to allow accurate placement of the posterior portal in preparation for knot tying. This arthroscopic technique resulted in a successful outcome.

There is considerable controversy as to whether quantitative coronary angioplasty is a meaningful surrogate index for clinical outcomes after coronary intervention. If a larger MLD reduces the incidence of restenosis, this in turn should be associated with a decrease in the incidence of subsequent clinical events. To study this phenomenon, we analyzed 6 major randomized trials evaluating a variety of approaches to reduce restenosis following percutaneous revascularization. In 3 of the 6 trials compared to the control arm, treatment was associated with significant decrease in the incidence of clinical events secondary to restenosis (myocardial infarction, death and need for repeat revascularization) and an improvement in the MLD at the time of follow-up catheterization. However, a similar or greater absolute MLD improvement did not yield clinical benefit in 2 trials, and 1 trial showed only clinical benefit. MLD (mm) Event Rate p Difference Treatment Control Angiopeptin 0.01 22% 30% 0.03 CAVEAT I 0.11 28% 30% NS BENESTENT 0.12 23% 33% l0.05 ACCORD 0.16 32% 32% NS CAVEAT II 0.17 22% 33% 0.04 STRESS 0.20 20% 27% 0.08 The magnitude of the difference in MLD between the control and treatment arms of each group is small in comparison with the difference in clinical events detected, and there is no correlation between the magnitude of MLD benefit and outcomes. Conclusion While in some individual trials there is concordance in angio-clinical results, there is little evidence for this with inter trial comparison. This suggests a treatment (medical or device) or trial specific relationship rather than a direct linkage between MLD and clinical outcomes.