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The subscapularis tendon, coracohumeral ligament, and transverse humeral ligament are all believed to contribute to biceps tendon stability within the bicipital groove. In order to examine the relative contribution of these soft tissue structures to proximal biceps tendon stability, 11 fresh frozen cadaveric shoulder specimens were prepared and mounted onto a custom jig. A three-dimensional digitizer was utilized to record biceps tendon excursion in various shoulder positions. In sequential order, these structures were then sectioned, and biceps tendon excursion was again recorded. We found that sectioning of the subscapularis tendon significantly increased biceps tendon excursion, compared to intact specimens (8.1 +/- 4.1 mm vs. 4.3 +/- 3.6 mm; p < 0.006). In contrast, isolated sectioning of the transverse humeral ligament or the coracohumeral ligament did not significantly increase biceps excursion (5.4 +/- 2.5 mm, p = 0.26; 5.6 +/- 1.3 mm, p = 0.24). When two structures were sectioned, significant excursion in the biceps tendon only occurred in specimens where the subscapularis tendon was one of the sectioned structures. The preliminary data suggest that, of the three tested soft tissue structures, the subscapularis tendon is the most important stabilizer of the proximal biceps and that clinically significant lesions of the proximal biceps tendon may be associated with a defect in the subscapularis tendon.

The purpose of this study was to evaluate any differences in the accuracy of knee MRI interpretation between radiology and orthopaedic surgery residents as well as to evaluate differences in quality of interpretation relative to resident training level. In this study, 20 MRI scans demonstrating specific pathology of the knee were identified. From one institution, two radiology residents and two orthopaedic surgery residents of each postgraduate year (PGY) of training (2 to 5) were recruited. Each resident was asked to interpret all the studies and choose up to 16 diagnoses for each scan from the list provided. Orthopaedic surgery residents showed improvement in overall accuracy and specificity with each year of additional training. Level of training did not correspond with increased sensitivity in the orthopaedic residents tested. Radiology residents did not demonstrate a consistent trend toward improved accuracy, sensitivity, or specificity with additional years of training. The only statistically significant differences in specificity observed between the two groups were seen in the readings of ACL tears, lateral femoral condyle chondromalacia, and chondromalacia patella. This study found that the accuracy of knee MRI interpretations between radiology and orthopaedic surgery residents did not demonstrate any differences. Level of training had no effect on the interpretation of the MRIs by radiology residents. Orthopaedic surgery residents did show an improvement with each year of additional training.

Acute distal clavicular osteolysis was first described in 1936. Since then, distal clavicular osteolysis (DCO) has been separated into traumatic and atraumatic pathogeneses. In 1982 the first series of male weight trainers who developed ADCO was reported. The association of weightlifting and ADCO is especially important considering how routine a component weights are to the male athlete's training. The pathogenesis of DCO has often been debated. The most widely accepted etiology involves a connection between microfractures of the subchondral bone and subsequent attempts at repair, which is consistent with repetitive microtrauma. Symptoms usually begin with an insidious aching pain in the AC region that is exacerbated by weight training. On examination, patients have point tenderness over the affected AC joint and pain with a cross-body adduction maneuver. Although DCO may seem like an easy and quick diagnosis, one must rule out other possibilities. Avoidance of provocative maneuvers, modification of weight training techniques, ice massage, and nonsteroidal anti-inflammatory drugs (NSAID) constitute the basis of initial treatment. Much of the literature supports the same general indications for surgery. These include point tenderness of the AC joint, evident abnormal signs with AC joint scintigraphy and AC radiographs, lack of response to conservative treatment, and an unwillingness to give up or modify weight training or manual labor. Distal clavicle resection has provided good results. Distal clavicle osteolysis is a unique disease most likely due to an overuse phenomenon.

This study was performed to determine if a meniscal al- lograft with attached bone plug and suture offers superior ixation when compared to allograft afixed with suture alone through a bony tunnel. Seven pairs of human cadaver proximal tibia specimens were obtained. The specimens were then randomly assigned to either Group 1 (suture alone) or Group 2 (bone plug plus suture). All Group 1 specimens had the meniscus detached at the bony insertion of the anterior and posterior horns, with two No. 2 Ethibond sutures placed at the posterior root insertion. All Group 2 specimens had a posterior horn with a bone plug and two No. 2 Ethibond sutures. Both groups had their respective sutures passed through a 7 mm tibial tunnel and secured over a screw and post on the proximal tibia. The specimens were then loaded to failure. The mean failure load for Group 1 was 111.8 N (SD: 21 N) and for Group 2 was 112 N (SD: 32 N). Based on the Wilcoxon Rank-Sum analysis, the two groups were not signiicantly different. This study demonstrated no difference in the mean pullout strength of medial meniscal allograft posterior horn ixation between the two groups. This biome- chanical cadaveric study demonstrated that it may not be necessary to use an attached bone plug for medial meniscal transplant ixation, as using suture alone will sufice. The choice of using suture alone for the posterior horn meniscal attachment eases the technique of surgery when compared to using a bone plug plus suture.

Sliding knots are commonly used in arthroscopic surgery and can be problematic in terms of strength and loop security. A new sliding knot for arthroscopic surgery, a modified racking hitch (MRH) knot, is described. The knot is essentially a modified cow's hitch knot that includes two self-locking loops. By tensioning the loop strands, a snug knot is created without backward sliding and provides excellent knot and loop security. In laboratory testing, the MRH knot provided comparable strength and security to other sliding knots. Experience gained from approximately 5 years of clinical use has added to the promise of the useful application of the MRH knot in arthroscopy.