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Background: Delayed anterior cruciate ligament (ACL) reconstruction (ACLR) is associated with an increased risk of meniscal injury. Limited data are available regarding the relationship between surgical delay and meniscal repairability in the setting of ACLR in young patients. Purpose: To determine whether time from ACL injury to primary ACLR was associated with the incidence of medial and/or lateral meniscal repair in young athletes who underwent meniscal treatment at the time of ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: Records were retrospectively reviewed for patients aged 13 to 25 years who underwent primary ACLR between January 2017 and June 2020 by surgeons from a single academic orthopaedic surgery department. Demographic data were collected, and operative reports were reviewed to document all concomitant pathologies and procedures. Univariable and multivariable logistic regression analyses were used to determine factors associated with meniscal repair, including time elapsed from ACL injury to surgery. Results: Concomitant meniscal tears were identified and treated in 243 of 427 patients; their mean age was 17.9 ± 3.3 years, and approximately half (47.7%) of patients were female. There were 144 (59.3%) medial tears treated and 164 (67.5%) lateral tears treated; 65 (26.7%) patients had both medial and lateral tears treated. Median time from ACL injury to ACLR was 2.4 months (interquartile range, 1.4-4.7 months). Adjusted univariate analysis showed a statistically significant correlation between medial meniscal repair and time to surgery, with a 7% decreased incidence of medial meniscal repair per month elapsed between injury and surgery (odds ratio, 0.93 per month; 95% CI, 0.89-0.98; P =.006). No similar relationship was found between lateral meniscal repair and time to surgery (odds ratio, 1.02; 95% CI, 0.99-1.06; P =.24). Conclusion: In the setting of concomitant ACL and meniscal injuries, surgical delay decreased the incidence of medial meniscal repair in young athletes by 7% per month from time of injury. [ABSTRACT FROM AUTHOR]

Background: Patients with femoroacetabular impingement (FAI) may experience lasting clinical improvement after hip arthroscopy; however, some patients will still eventually undergo early conversion to THA due to unresolved symptoms and progression of arthritis. However, the risk of this has been only incompletely characterized in prior studies.Questions/purposes: Using a large healthcare claims database over a 5-year period (2011-2016), we asked: (1) What is the survivorship free from THA after arthroscopic osteoplasty performed for FAI? (2) What identifiable demographic factors and patient characteristics are associated with early conversion to THA after hip arthroscopy performed for FAI?Methods: We included all patients who underwent hip arthroscopy for FAI, between the ages of 12 years and 63 years, with 3 months of claims data before hip arthroscopy and minimum 2-year follow-up. A total of 4730 hip arthroscopy patients from 2011 to 2014 were retrieved from a US commercial claims database. Hip arthroscopy incidence doubled over time from 1.2 to 2.1 persons per 100,000. Temporal trends, patient demographics, diagnoses at time of arthroscopy, and patient comorbidities were retrieved and logistic regression performed. Survivorship analysis on 11,323 patients (lifting the 2-year follow-up requirement) was also performed to identify independent variables associated with early risk of conversion to THA.Results: In patients undergoing hip arthroscopy for FAI, the overall proportion of conversion to THA within 2 years after hip arthroscopy was 7% (338 of 4730). After controlling for confounding variables such as sex, obesity, and depression, we found the following were independently associated with increased odds of conversion to THA: older age (odds ratio 1.08 [95% CI 1.01 to 1.10]; p < 0.001), osteoarthritis (OR 2.91 [95% CI 2.27 to 3.77]; p < 0.001), joint inflammation (OR 1.89 [95% CI 1.16 to 3.09]; p = 0.01), and a history of opioid use (OR 2.17 [95% CI 1.69 to 2.79]; p < 0.001). Survivorship analysis similarly revealed that older age (hazard ratio 1.08 [95% CI 1.07 to 1.09]; p < 0.001), osteoarthritis (HR 2.53 [95% CI 2.13 to 3.01]; p < 0.001), joint inflammation (HR 1.53 [95% CI 1.10 to 2.11]; p = 0.01), a history of opioid use (HR 2.02 [95% CI 1.71 to 2.38]; p < 0.001), and smoking (HR 1.55 [95% CI 1.14 to 2.11]; p = 0.005), were independently associated with increased odds of conversion to THA within 2 years after hip arthroscopy for FAI.Conclusions: Although the findings of this study are limited and should not be taken in isolation, patients with FAI who are older, carry diagnoses of inflammatory or degenerative articular disease, or who use opioids or smoke should be counseled about a potentially increased risk of undergoing early conversion to THA after hip arthroscopy. Future studies to further examine the effect of these diagnoses in prospectively collected cohorts, incorporating radiographic and patient-reported outcome measures, are needed.Level Of Evidence: Level III, prognostic study. [ABSTRACT FROM AUTHOR]

Introduction: Assessing readiness of return to sport after procedures such as anterior cruciate ligament (ACL) reconstruction is a complex process, complicated by the pressures that athletes face in returning to sport as quickly as possible. Advances in motion analysis have been able to demonstrate movements that are risk factors for initial ACL injury and subsequent reinjury after reconstruction. An inexpensive, objective measure is needed to determine when athletes are ready to return to sport after ACL reconstruction. Purpose: The aim of this study was to compare the use of a single camera, markerless motion capture technology to 3D motion capture during lower extremity movements that pose as risk factors for ACL injury. Study Design: Cross Sectional Study Methods: This study assessed the validity of the Microsoft Kinect™ against an established 3-dimensional motion analysis system in 20 healthy subjects. Knee kinematics were assessed during impact activity in the coronal and sagittal plane specifically evaluating peak knee valgus and peak knee flexion during single leg hop and jump from box exercises. Intraclass correlation coefficients and 95% limits of agreement (LoA) were determined for each kinematic variable. Results: For the single leg hop, the mean absolute difference in the sagittal plane was 10.4° (95% LoA [-11.7°, 26.8°]), and in the frontal plane was 5.31° (95% LoA [-8°, 13.9°]). Similarly, for the jump from box landing on one leg, there was a difference of 7.96° (95% LoA [-17.7°, 21.3°]) and 4.69° (95% LoA [-6.3°, 12.6°]) respectively. For the jump from box, two-foot land, turn and pivot, the mean absolute difference between the systems was 7.39° (95% LoA [-17.8°, 19.7°]) in the sagittal and 4.22° (95% LoA [-5.9°, 11.6°]) in the frontal plane respectively. Intraclass correlation coefficients for each activity ranged from 0.553 to 0.759. Conclusion: The results from the Microsoft Kinect™ were found to be in poor agreement with those from a standard motion capture system. Measuring complex lower extremity movements with the Microsoft Kinect™ does not provide adequate enough information to use as an assessment tool for injury risk and return to sport timing. Level of Evidence: Level III [ABSTRACT FROM AUTHOR]

The article focuses on update in the field of sports medicine from August 2016 through October 2017. Topics discussed include Anterior Cruciate Ligament (ACL) reconstruction remains the standard treatment for active individuals after ACL disruption, presence of a symptomatic meniscal tear for arthroscopic knee surgical procedures and hip arthroscopy continues to be an expanding area of sports medicine and clinical outcomes. It also mentions sports-related concussions for public interest.

The article focuses on the Walch classification of primary glenohumeral osteoarthritis. The Walch classification may help guide appropriate surgical management, can facilitate communication among surgeons and provide prognostic information. The classification gives an anatomic descriptive characterization of primary glenohumeral osteoarthritis.

The article focuses on Rockwood classification of acromioclavicular (AC) joint separation, a common shoulder injury is noted that the majority of AC injuries are especially numerous in younger patients participating in contact sports and occur in people in their twenties. Imaging modalities defining Rockwood's classification system are also described.

The article reports a study which describes the original Snyder classification of superior labrum anterior and posterior (SLAP) lesions with injury patterns causing pain and instability. It identifies the superior glenoid labral disorders through its injury and biomechanics of labral tears from arthroscopic evaluation. However, the classification of SLAP tears using the original Snyder description lacks adequate reproducibility due to the complex labral anatomy and age-related changes.

ABSTRACT Background To validate the usefulness of subacromial bursa lidocaine for determination of the therapeutic steroid injection site in patients with adhesive capsulitis Methods Ninety-two patients with adhesive capsulitis were randomly divided into the LC (lidocaine test) group (n = 46), in which LC injection was performed at the subacromial bursa prior to therapeutic steroid injection, and GH (glenohumeral) group (n = 46), in which the steroid was injected into the GH. Patients in the LC group received steroid injection at the subacromial bursa or GH according to the result of the LC. Both groups underwent the same exercise protocol. Improvement of the shoulder pain was checked at 2 weeks and 3 months postinjection and expressed on an ordinal scale. Passive range of motion was recorded preinjection, and 2 weeks and 3 months postinjection. Results Two weeks postinjection, 37 patients expressed 'much improved' and 7 patients expressed 'slightly improved' pain levels in the LC group, whereas 18 patients each expressed 'much improved' and 'slightly improved' pain levels in the GH group, which was significantly different ( p < 0.01). This difference was maintained 3 months postinjection ( p < 0.01). Passive range of motion in all directions improved significantly 3 months postinjection in both the LC and GH groups ( p < 0.01). However, there was no significant difference between the LC and GH groups. Conclusions We found that subacromial lidocaine injection prior to steroid injection resulted in better improvement of pain than conventional GH injection for patients with adhesive capsulitis. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:353-360, 2015 [ABSTRACT FROM AUTHOR]

The article discusses a study which determined the efficacy of the Federation Internationale de Football Association (FIFA) 11+ exercise program in reducing the incidence of anterior cruciate ligament (ACL) injury in male soccer players. Topics include the decrease in the overall incidence rate of ACL injuries in the group that used the program, factors identified in the study for a program's success, and the need for prevention programs to target young athletes.

The article discusses a technique of utilizing the posterior transseptal portal to release the posterior capsule in individuals with diseases caused by arthrofibrosis. A historical overview of the transseptal posterior portal for knee arthroscopy is provided, along with indications and contraindications of the procedure. Also included are details of the procedure as well as complications and postoperative management.

Purpose: To determine the normal relative length, girth, and nail width of the pediatric thumb with respect to the index finger in children ages 1 through 18 years. Methods: Measurements of relative thumb length, girth, and nail width were performed on 546 hands in 273 volunteers ages 1 through 18 years. At least 22 hands were included for each age group. The data were analyzed by age, gender, and hand, with the thumb compared with the index finger for all measurements. Results: The adducted thumb tip reached an average of 70% of the length of the index finger proximal phalanx and 32% of the length of the index finger from the metacarpophalangeal joint to its tip. The thumb girth and nail width as a percentage of corresponding levels of the index finger girth and nail width were 133% and 105%, respectively. Relative thumb size remained constant with no significant difference in length, width, or girth between age groups. Conclusions: The relative size of the thumb remains constant during growth. These normative data will allow a more objective assessment of thumb size and appearance. [Copyright &y& Elsevier]

Introduction: More than 75,000 anterior cruciate ligament (ACL) reconstructions are performed annually in the United States. The majority of patients electing to undergo ACL reconstruction are younger, active individuals who demonstrate rotational instability of the knee; however, there are a significant number of patients who are maintaining active lifestyles into the fifth decade of life, necessitating treatment within this cohort as well. The purpose of the present investigation was to determine the outcomes of isolated ACL reconstruction in active patients over the age of 40, and to compare these results with those of a younger patient cohort undergoing the same procedure. Methods: A retrospective review of all patients over 40 years of age who underwent ACL reconstruction at our institution between 2000-2008 was performed. A consecutive series of patients under the age of 25 years during this same period was selected as a control group and served as comparison. Age, gender, graft type, concomitant injuries, complications, and a validated outcome measure (Lysholm) were assessed at final follow-up. Statistical analyses were performed using the Fisher exact t-test (p<0.05). Results: 45 patients in the >40 year group (average age 44.9) were identified (28 male, 17 female) and compared to 48 patients (average age 21) in the <25 year age group (23 males, 25 female) with an average follow-up of 5.7 years and 3.1 years, respectively. Associated injuries in the >40 group included lateral meniscus tears (22 patients), medial meniscus tears (22 patients), collateral ligament sprains (17 patients), articular cartilage degeneration (35 patients), and bone bruises (15 patients). Associated injuries in the younger cohort were not significantly different with the exception of the degree of cartilage degeneration (p = .0001) and lateral collateral ligament sprains (p = .026). Lysholm scores averaged 89.5 in the older cohort compared to 89.2 in the younger, with no statistical difference between groups. Conclusion: Patients undergoing ACL reconstruction in the fifth decade of life demonstrated outcomes comparable to younger patients undergoing the same procedure. Chondral injuries, although present to a greater degree in the older cohort, were not associated with a poorer outcome at intermediate follow-up. [Copyright &y& Elsevier]