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Background: Anatomic total shoulder arthroplasty with a nonspherical humeral head and inlay glenoid replacement has been introduced in the past; however, clinical evidence remains limited. We hypothesized that patients with advanced glenohumeral arthritis demonstrate significant improvements in pain and function. Methods: Prospective patient-reported outcomes (PROs) included the American Shoulder and Elbow Surgeons score, a pain visual analog scale, and satisfaction. Range of motion was compared to the preoperative status. A sensitivity analysis examined responder rates and compared them to literature thresholds using the minimal clinically important difference and substantial clinical benefit. The preoperative glenoid morphology was determined using the Walsh classification. Zone-specific periprosthetic radiolucent lines were quantified at the last follow-up. Results: Thirty-nine shoulders in 36 patients (3 bilateral) with a mean age of 65.9 years (26 males, 13 females) and a mean follow-up of 41.0 months were included. Ninety-three percent had grade III osteoarthritis, and 7% grade II. The glenoid Walsh classification included A1 (25%), A2 (25%), B1 (22%), B2 (25%), and C (3%). All PROs improved significantly (P

Objectives: Rotator cuff tears are rare injuries in professional contact athletes and there is limited data to help guide players and team physicians regarding outcomes after surgical management. The purpose of this study was to report on the clinical outcomes and return to play rates of professional contact athletes that underwent arthroscopic management of rotator cuff tears at our institution. Methods: A retrospective review was performed on 10 rotator cuff tears in 9 professional contact athletes that underwent arthroscopic management of a rotator cuff tear from 2002-2019 at our institution. 8 tears occurred in elite American football players, 7 from the NFL and 1 from the CFL. The remaining 2 rotator cuff tears were identified in professional hockey players from the NHL. The average age of the players was 28.7 ± 4.8 years. Patient information included age, sport, position played, date of injury, date of surgery and length of time from surgery to return to play. Surgical data included tear size, acuity and pattern as well as procedure performed (debridement vs repair). Both intra and post-operative complications were documented. The primary outcome measure was the ability to return to play and the number of games played after surgery was documented. As in other similar studies, return to play was defined as the ability to participate in at least 1 full regular-season game after surgery. Return to play and career length data were collected through publicly available internet sources (NFL, CFL and NHL statistical websites) as well as from the team’s medical staff. Results: 80% of the professional contact athletes that underwent arthroscopic management of a rotator cuff tear in this study were able to return to play at the same professional. The average age of the players that returned to play was 27.3 ± 4.2 years and the average time to return to play was 7.9 ± 1.9 months. 8 of the 10 tears occurred in professional football players and the majority of these injuries (6 of 8) occurred in defensive players. 2 of the 10 tears occurred in professional hockey players from the NHL and both were offensive players. All of these players regained sufficient range of motion, strength and function to pass a pre-participation physical performed by their team’s medical staff and all participated in at least one regular season game. For the football players, the average playing experience after surgery was 32 ± 25 games played. For the hockey players, the average playing experience after surgery was 22 ± 11games played. 9 of the 10 tears were full thickness tears that underwent arthroscopic single row repair while 1 was a partial tear that was debrided. The average tear size was 1.95 ±0.9 cm. The average number of suture anchors used was 1.35 ± 0.7. All tears involved the supraspinatus rotator cuff tendon and 4 were classified as small tears ( 10 years of professional playing experience. One of these players was an NFL player that demonstrated a repair failure at 6 months on post-operative imaging and elected to retire rather than undergo revision surgery. The second was an NHL player that retired for reasons unrelated to his shoulder, despite a good clinical outcome and a healed repair on post-operative imaging. To our knowledge, none of the remaining players have undergone subsequent surgical intervention or revision surgery on their injured shoulder. Conclusions: This is one of only a few studies since 1996 to report on the clinical outcomes after operative management of rotator cuff tears in elite professional contact athletes. The majority (80%) of the professional contact athletes in this series were able to return to play at the same professional level after arthroscopic management of a symptomatic rotator cuff tear. Older players with > 10 years of professional experience and large rotator cuff tears were less likely to return to play after surgical intervention.

A 41-year-old man with an unremarkable medical history presented with a painful knee after a sports injury. He was diagnosed with a medial meniscal tear. Symptoms did not abate after 6 months of physical therapy, and he underwent arthroscopic partial medial meniscectomy. A week after beginning physical therapy he experienced a knee effusion, decreased ROM, and inability to flex his quadriceps. His knee was aspirated. Blood tests were ordered and his complete blood count, liver functions tests, and INR/PTT were normal. The patient had recurrent effusions requiring three additional joint aspirations. Ten weeks after the initial surgery, the patient underwent a second arthroscopy, during which a hematoma was removed and a synovectomy performed. The patient continued bleeding from the incisions after portals were sutured, and he was admitted to the hospital. A hematologist was consulted and comprehensive platelet aggregation testing revealed previously undiagnosed Glanzmann’s thrombasthenia. The patient began treatment with platelet infusions and desmopressin and progressed to a full recovery. Clinical suspicion for surgical patients with unusual repetitive postoperative bleeding should include previously undetected rare bleeding disorders even in adults.

Background: There are conflicting reports regarding the association between isokinetic concentric quadriceps and hamstring strength deficits and ratios and risk for hamstring injuries in athletes. Purpose: To determine if isokinetic concentric Cybex data collected during the annual National Football League (NFL) Scouting Combine are predictive of hamstring injury in professional American football players during their first season. Study Design: Case-control study; Level of evidence, 3. Methods: All 32 NFL teams identified players selected during the first 5 rounds of the NFL annual draft who had hamstring injuries during their first professional season. Of these, 164 players with 172 injuries also had Cybex data from the previous year’s Combine. Analyses compared injured legs with contralateral uninjured legs and also injured players with uninjured controls using a database of Cybex data from all players who participated in the NFL Scouting Combine from 2006 to 2011. Results: No Cybex strength variable differentiated the injured legs from the contralateral uninjured legs or injured players from uninjured controls, even after taking into account days lost from activity. Mean ± SD peak torque for the injured and contralateral uninjured sides was as follows: 315.7 ± 70.0 and 313.5 ± 68.3 N·m, respectively ( P = .773, paired t test), for quadriceps and 203.0 ± 42.4 and 205.3 ± 42.5 N·m, respectively ( P = .608, paired t test), for hamstrings. The sensitivity and specificity for the hamstrings-to-quadriceps ratio predicting hamstring injury were 0.513 (95% confidence interval, 0.419-0.607) and 0.524 (0.495-0.554), indicating that the hamstrings-to-quadriceps ratio was not a useful predictor of injury (calculation used the mean ± SD ratio for injured legs, 0.656 ± 0.133). Side-to-side peak torque differences were also not predictive of injury, with more than a 10% difference (plus or minus) occurring commonly in both injured and uninjured players for quadriceps (53% prevalence for both injured and uninjured) and hamstrings (injured, 41% prevalence; uninjured, 43% prevalence). Conclusion: Isokinetic strength data collected from collegiate players at the NFL Scouting Combine were not useful for predicting risk of hamstring injury in subsequent professional NFL competition. These data call into question commonly accepted assumptions about risk factors for hamstring injury, at least for elite collegiate American football players, when the temporal relationship between Cybex testing and actual injury is several months.

Background: Tearing or attenuation of the ulnar collateral ligament (UCL) of the elbow is a common injury in the throwing athlete. Several techniques for reconstruction of the attenuated or torn UCL have been developed.Hypothesis: Ulnar collateral ligament reconstruction based on a hybrid technique, with an ulnar osseous tunnel and suture anchor fixation on the humerus, allows throwing athletes to return to prior activity level and has a low complication rate.Study Design: Case series; Level of evidence, 4.Methods: A retrospective review was performed of the UCL reconstructions performed in 34 throwing athletes, as based on a hybrid technique, over a 6-year period. All elbows were reconstructed with a tendon graft fixed through an osseous tunnel placed at the sublime tubercle and with 2 suture anchors placed into a bony trough at the humeral origin of the native ligament.Results: Average postoperative follow-up was 6.9 years (range, 4.2 to 8.7 years). The average age was 20.2 years, with symptoms present for an average of 22.4 weeks before clinic presentation. Each athlete had pain with valgus stress or milking maneuver in addition to a documented tear of the UCL on magnetic resonance imaging. All experienced pain on the medial aspect of the elbow while throwing. Only 1 patient had new onset of temporary ulnar nerve paresthesia, for a complication rate of 2%. Of 34 athletes, 29 (85%) had an excellent result, defined as the ability to return to play at or above preinjury level. Of the 5 patients who did not return to preinjury level, only 2 were unable to do so secondary to pain.Conclusion: Ulnar collateral ligament reconstruction based on a hybrid fixation technique results in a low complication rate and allows full recovery to preinjury level of performance in the majority (85%) of patients.

Objectives: To determine if immobilization of the knee at varying degrees of knee flexion will limit the surface electromygraphical (sEMG) activity of hamstring muscles during crutch-assisted ambulation. Methods: Ten healthy participants walked with crutches with the knee maintained at 0, 30, 60 and 90° of knee flexion, both with and without a brace. The leg was non-weight bearing for all trials except for those with the knee at 0° of flexion, when subjects performed a ‘toe-touch’ gait. sEMG was used to record activity of the biceps femoris and semitendinosus during trials. Results: For the semitendinosus, there were no differences between braced and unbraced conditions at 0° (22.5 vs. 23.2%), 30° (37.5 vs. 28.7%), 60° (47.2 vs. 44.6%), and 90° (32.7 vs. 51.8%) of knee flexion (all, p > 0.05). Similarly, for the biceps femoris, there were no differences between braced and unbraced conditions at 0° (22.5 vs. 23.2%), 30° (44.5 vs. 28.7%), 60° (47.2 vs. 44.6%), and 90° (32.7 vs. 51.8%) of knee flexion (all, p > 0.05). Finally, there were no differences between braced at 90° of knee flexion and unbraced at 0° of knee flexion with regard to semitendinosus (32.7 vs. 23.2%) and biceps femoris (32.6 vs. 23.2%) activity (p > 0.05). Conclusions: The use of a brace to limit knee extension did not decrease activation of the hamstrings during crutch-assisted ambulation in healthy participants. More research is needed to determine if the use of a knee brace is necessary following surgical repair of the hamstring tendon.

Previous studies on the treatment of rotator cuff tears in wheelchair-bound patients have concentrated on nonsurgical management. We conducted a retrospective review to determine the effectiveness of surgical repair of rotator cuff tears in spinal cord-injured patients. Five male patients with rotator cuff tears confirmed by physical examination and magnetic resonance imaging underwent rotator cuff repair. Two of eight shoulders were revisions. The patients were evaluated postoperatively with the American Shoulder and Elbow Surgeons Scoring System. These results were compared with preoperative functional assessment. Patients were given a subjective questionnaire to assess their overall experience. Postoperative range of motion improved in 6 of 8 shoulders. Strength was increased in 6 of 8 shoulders. Patients reported satisfaction with the results in 7 of 8 shoulders, and all 5 patients would recommend the procedure to other spinal cord injury patients. At recent follow-up, 7 of 8 shoulders returned to their preinjury level of function. Surgery for spinal cord injury patients with rotator cuff tears can improve their functional capability and autonomy while reducing their pain. Compliance with the demanding postoperative rehabilitation is essential; therefore proper patient selection is crucial for optimal results.

Purpose: Tears of the anterior cruciate ligament (ACL) are becoming more prevalent in the skeletally immature patient. We report our results with intra-articular transphyseal ACL reconstruction in this patient population. Type of Study: Retrospective analysis. Methods: Ten skeletally immature athletes underwent transphyseal intra-articular ACL reconstruction using patellar tendon allograft. The patients ranged from 9 to 15 years of age. Clinical outcomes were measured using the Lysholm and International Knee Documentation Committee scoring systems, follow-up radiographs, clinical examination, and KT-1000 testing. Results: Mean follow-up was 40 months. The average Lysholm score was 95, and 9 of 10 patients reported normal or nearly normal knee function. There was no clinical or objective evidence of instability, limb-length discrepancy, or early physeal arrest. Nine of 10 patients returned to their preinjury level of athletics. Conclusions: Skeletally immature athletes with symptomatic complete ACL tears who do not want to modify their athletic activity may benefit from intra-articular ACL reconstruction using patellar tendon allografts. Special attention to bone plug and interference screw placement will reduce the risk of early physeal arrest. Key Words: Arthroscopic—Pediatric—ACL—Transphyseal—Patellar tendon allograft—Intra-articular.

Purpose: Evaluation of an arthroscopically assisted ankle arthrodesis technique for clinical and radiographic union, function, and patient satisfaction. Type of Study: Retrospective analysis and review of the literature. Methods: Twenty-one patients with a mean age of 52.7 years who underwent arthroscopic ankle arthrodesis were examined at an average follow-up time of 34 months. The mean duration of symptoms was 4.4 years. The most common diagnosis for patients who underwent arthrodesis was post-traumatic arthritis (19 of 21) with 1 patient having a diagnosis of avascular necrosis of the talus and the other patient having rheumatoid arthritis. All patients described severe mechanical pain as the most important reason for undergoing the procedure. Results: Fusion occurred in 20 of 21 patients. The average time to clinical and radiographic union was 8.9 weeks. Nine patients were graded as excellent; no pain, limp, or occupational restriction, and a stable fusion. Eleven were graded as good; mild pain, occasional limp, or occupational restriction with a stable fusion. One was graded as poor; failed union and pain. The failure had extensive avascular necrosis involving approximately 50% of the talus as a preoperative diagnosis. Conclusions: The advantages of the arthroscopic technique include a high fusion rate, decreased time to fusion, and decreased cost. There are considerable advantages to the arthroscopic technique in appropriately selected patients with no or mild angular deformity and no avascular necrosis greater than 30% of the talus. There is a substantial reduction in time to fusion in the arthroscopic procedure compared with published reports on open procedures for ankle arthrodesis. While this procedure is not indicated in all instances, selected patients with disabling ankle arthrosis may be more appropriately treated with an arthroscopic arthrodesis than by open surgery. Key Words: Arthroscopy—Ankle—Arthrodesis— Fusion—Osteoarthritis.

Summary: To determine whether the results of arthroscopically assisted rotator cuff repair deteriorate with time, 60 shoulders were evaluated on 2 separate occasions. There were 7 small, 16 medium, 20 large, and 17 massive tears. Patients were evaluated with a detailed questionnaire that included the UCLA shoulder scale and physical examination. Average initial follow-up was at 21 months (range, 12 to 68 months), and the second follow-up was at an average of 62 months (range, 24 to 103 months); only 4 patients had a change of more than 3 points on the UCLA scoring scale. No statistically significant difference was found in pain, function, range of motion, strength score, satisfactory results (80% on both occasions), and UCLA score (30.8 v 31.4) at second follow-up. The results of our study indicate that there is no significant deterioration over time of results of rotator cuff repair using the mini‐deltoid splitting technique. Key Words: Arthroscopic-assisted rotator cuff repair—Results—Short-term follow-up—Long-term follow-up.

Pigmented villonodular synovitis (PVNS) is a rare disease, with multiple forms, anatomic sites, and treatment methods having been described. During a 10-year period, 14 patients, 7 male and 7 female, average age 35 years (range, 19 to 64 years) were treated for PVNS with arthroscopic partial or total synovectomy. Average follow-up was 42 months (range, 8 to 83 months). Twelve patients had diffuse and 2 had a localized form. Results were assessed subjectively, clinically, and radiographically, and were rated as excellent, good, fair, or poor. There were no complications and 10 patients (72%) were rated as excellent or good, 2 patients (14%) as fair, and 2 patients (14%) as poor. The recurrence rate was 14% and occurred in the group with diffuse PVNS. Radiographs did not show any bone erosion. The most widely accepted treatment for PVNS is synovectomy, and both open and arthroscopic synovectomy have been advocated as treatment. Advantages of arthroscopic treatment include accurate evaluation of the knee joint, treatment of other pathology, more rapid rehabilitation, decreased risk of joint stiffness, and less pain. In our experience, it appears that arthroscopic synovectomy is an effective method of treatment of this disorder.

Isokinetic concentric quadriceps and hamstring strength data using a Cybex dynamometer are collected for elite collegiate American football players invited to the annual National Football League Scouting Combine. We constructed a normative (reference) database of the Cybex strength data for the purpose of allowing comparison of an individual's values to his peers. Data reduction was performed to construct frequency distributions of hamstring/quadriceps (H/Q) ratios and side-to-side strength differences. For the cohort (n = 1,252 players), a statistically significant but very small (1.9%) mean quadriceps strength preference existed for dominant side vs. nondominant side. Peak torque (Newton meters, best repetition) for quadriceps and hamstrings was significantly correlated to player body mass (weight) (the same relationship was found for other variables using peak torque in the calculation). Peak torque varied by player position, being greatest for offensive linemen and lowest for kickers (p0.0001). Adjusting for body weight overcorrected these differences. The H/Q ratios and frequency distributions were similar across positions, with a mean of 0.6837 ± 0.137 for the cohort dominant side vs. 0.6940 ± 0.145 for the nondominant side (p = 0.021, n = 1,252). Considerable variation was seen for dominant-to-nondominant side difference for peak torque. For quadriceps, 47.2% of players had differences between -10% and +10%, 21.0% had a peak torque dominant-side deficit of 10% or greater compared to nondominant side, and for 31.8% of players, dominant-side peak torque was greater than 10% compared to nondominant side. For hamstrings, 57.0% of players had differences between -10% and +10%, 19.6% had a peak torque dominant-side deficit of 10% or greater compared to nondominant side, and 23.4% of players, dominant-side peak torque was greater than 10% compared to nondominant side. We observed that isokinetic absolute strength variables are dependent on body weight and vary across player position. The H/Q ratios vary only within a relatively narrow range. Side-to-side differences in strength variables10% are common, not the exception.

Background: Multiple surgical procedures exist for the treatment of osteitis pubis: curettage of the symphysis joint, wedge resection, complete resection of the joint, placement of extraperitoneal retropubic synthetic mesh, and arthrodesis of the joint. However, a paucity of literature has reported long-term successful outcomes with the aforementioned approaches. Patients treated operatively have reported recalcitrant pain resulting from iatrogenic instability. The article presents the results of a conservative operative technique that avoids disruption of adjacent ligaments. Hypothesis: Preserving the adjacent ligamentous structures will allow competitive athletes to return to competition and activities of daily living free of iatrogenic pelvic instability and pain. Study Design: Case series. Methods: Four competitive athletes (2 professional and 2 collegiate football players) diagnosed with osteitis pubis were treated conservatively for a minimum of 6 months. Patients underwent surgical intervention upon failure to respond to nonoperative management. The degenerative tissue was resected, allowing only bleeding cancellous bone to remain while preserving the adjacent ligaments. An arthroscope was used to assist in curettage, allowing the debridement to be performed through a small incision in the anterior capsule. Results: The symptoms of all 4 patients resolved, and they returned to competitive athletics. This ligament-sparing technique provided a solid, stable repair and pain relief. Conclusion: This surgical technique preserves the adjacent ligamentous structures and allows competitive athletes to return to competition and activities of daily living free of pain and void of pelvic instability. Clinical Relevance: This technique is a surgical treatment option for athletes with osteitis pubis who fail conservative treatment.

This article presents our surgical technique for reestablishing acromioclavicular stability after overzealous distal clavicular resection. Two cases are presented in which the clavicle of the affected acromioclavicular joint was unstable, causing pain with range of motion (ROM). To address the pathology, reconstruction of the coracoclavicular ligament and reattachment of the trapezius and deltoid to the clavicle were required. We reconstructed the coracoclavicular ligaments using an Achilles tendon calcaneal allograft. The bony end of the Achilles tendon allograft was used as an extension to lengthen the clavicle and the tendinous portion to reconstruct the coracoacromial ligament, thus stabilizing the clavicle. Once allograft reconstruction and stability had been achieved, a 1.5-cm gap remained between the acromion and the new allograft end of the clavicle. There was no evidence of acromioclavicular impingement. Supplemental fixation was not required. The trapezius, pectoralis, and deltoids were all reefed over the clavicle using Vicryl sutures (Ethicon, Inc, West Somerville, New Jersey) to reinforce the reduction and restore the natural contour of the shoulder girdle. Fifteen months postoperatively, both patients had maintained a reduced acromioclavicular joint. They had no pain with ROM, and full muscular strength was evident in all planes. Radiographs of their shoulders revealed a completely incorporated graft and a reduced clavicle. We recommend this novel technique for reestablishing acromiclavicular stability, as it provides good functional and subjective results.

Background Controversy exists in the diagnosis and treatment of pectoralis major tear patterns. Hypothesis Magnetic resonance imaging is useful in determining the grade and the location of pectoralis major tears and in guiding toward an appropriate treatment plan. Study Design Case series; Level of evidence, 4. Methods Between January 1998 and December 2002, 27 patients were treated for pectoralis major tears. All patients were evaluated by history and physical examination. A clinical impression was formed regarding the location and grade of injury, and a treatment plan was established. All patients underwent magnetic resonance imaging, and images were reviewed by an orthopaedic surgeon and a board-certified musculoskeletal radiologist, resulting in a final treatment plan. The mean follow-up was 12 months. All patients were evaluated by questionnaire and clinical examination to assess pain, function, deformity, and overall satisfaction. Results In 19 of 27 patients, the clinical impression and magnetic resonance imaging agreed regarding the location and the grade of the injury. A total of 19 patients underwent surgical repair, and 8 patients were treated nonoperatively. The magnetic resonance imaging result changed the treatment plan in 3 patients from operative to nonoperative. Conclusion The clinical impression appeared to overestimate the severity, the location, and the grade of the injury. Magnetic resonance imaging provided a more accurate assessment and, in conjunction with the clinical examination, helped to identify those patients who would benefit most from surgical repair.

The purpose of this study was to evaluate 4 cases in which bioabsorbable polymerized lactic acid tacks failed after arthroscopic shoulder surgery. Four male elite athletes with recurrent shoulder pain were seen a mean of 7.5 months (range, 3-10 months) after initial arthroscopy. Three of the cases involved superior labrum anterior-to-posterior (SLAP) lesion stabilization, and the fourth case was a rotator cuff (RTC) repair. In the three labral repairs, the implant had broken and the unabsorbed fragments were visible with magnetic resonance imaging. The device used in the RTC repair showed no signs of absorption. All 4 patients underwent arthroscopic removal of the polymer tack fragments to alleviate their symptoms, 2 of whom had foreign-body reactions that required synovectomy. On the basis of clinical examination and magnetic resonance imaging, 2 of the SLAP lesions and the RTC tear had healed. The third patient with a SLAP lesion required arthroscopic debridement of a portion of the labrum. The intact RTC implant had backed out of its insertion point. In all 3 labral repairs, the polymerized lactic acid implant experienced a mechanical failure near the head-shaft junction. We theorize that the labral implants failed because of the variable rate of degradation along the shaft of the devices from the intraarticular to intraosseous regions.

Arthroscopic subacromial decompression has become an accepted treatment for patients with impingement syndrome; however, its use for full thickness rotator cuff tears continues to be controversial. The purpose of this study is to determine if the results of arthroscopic subacromial decompression alone for full thickness rotator cuff tears deteriorate at long-term follow-up. We reevaluated all 25 patients with full thickness rotator cuff tears who underwent arthroscopic subacromial decompression from our original study group. Based on the University of California at Los Angeles shoulder rating, 68% of patients were rated as excellent or good at the present mean follow-up of 45.8 months (range 36-72 months). This represents a significant decrease from our initial report of 84% satisfactory results at a mean follow-up of 24.6 months. There was a significant decrease in ratings with regard to pain and function; however, no significant deterioration was noted with regard to motion and strength. Two additional patients required open rotator cuff repair since the time of initial follow-up for a total of six. Large and massive rotator cuff tears fared worse over time as compared with small and moderate size tears. Although 1- to 3-year results of arthroscopic subacromial decompression and rotator cuff debridement were favorable, the long-term follow-up demonstrates deterioration of results. We therefore cannot support the use of decompression and debridement alone in the treatment of repairable full thickness rotator cuff tears.

Thirty-six patients with a total of 50 symptomatic tailor's bunions were evaluated clinically, radiographically, and subjectively, both before and after a distal oblique osteotomy procedure was performed.Thirty-four of 36 patients were satisfied with pain relief. Radiographic measurements derived from this study were consistent with those of other studies.Avascular necrosis, nonunions, or neuroma formation were not encountered in this study. The significant advantages of this procedure are its simplicity, safety, and predictability. The procedure does not require internal fixation or postoperative immobilization.

A 19-year-old female college student complained of inability to extend the thumb of her left, nondominant hand. The patient stated that she was turning the steering wheel of her car when she felt pain, which was short lived, in the dorsal aspect of her left wrist. Immediately thereafter she noted the loss of extensor power in her thumb metacarpophalangeal joint. She was seen one day later. The patient had no history of repetitive motions with the hand and denied any previous wrist trauma. Physical examination showed fullness and tenderness to palpation over the dorsal aspect of the left wrist. No effusion was evident in the wrist joint. There was diminished extensor power at the thumb metacarpophalangeal and interphalangeal joints, and the extensor pollicis longus tendon could not be palpated. At surgery the extensor pollicis longus tendon was found to be disrupted at Lister’s tubercle. There was no evidence of inflammation or synovitis. The tendon was rerouted through the subcutaneous tissue radial to Lister’s tubercle and was easily reapproximated. The tendon was primarily repaired with a nonabsorbable 3-O suture and a modified Bunnell suturing technique. The wrist was then placed in a cast in slight extension and radial deviation, with the thumb metacarpophalangeal and interphalangeal joints in extension. The cast was removed at 4 weeks, and therapy was begun. At 2 months after the surgical procedure full thumb motion