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Double-layered menisci are a rare anatomical variant, with cases identified predominantly in Asian populations. We present a case of Caucasian woman with a double-layered lateral meniscus, in which the accessory lateral meniscus had displaced into the intercondylar notch causing feelings of instability within the right knee. The accessory lateral meniscus was removed through arthroscopic surgery, and the patient had complete resolution of her symptoms postoperatively.Double-layered menisci can present similar to bucket-handled meniscus tears if the accessory meniscus displaces into the intercondylar notch. Arthroscopic debridement can be effective at improving clinical symptoms for these patients.

Background: Glenohumeral internal rotation deficit (GIRD) and total arc of motion difference (TAMD) have been associated with elbow injuries in throwing athletes. Hypothesis: Youth pitchers with elbow pain will have greater GIRD and TAMD compared with youth pitchers without elbow pain. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Glenohumeral range of motion of 25 consecutive throwing athletes presenting with elbow pain and that of a matched control group of 18 asymptomatic throwing athletes were compared. Bilateral glenohumeral internal rotation, external rotation, and horizontal adduction at 90° were measured and GIRD and TAMD were then calculated. An analysis of variance was performed to compare range of motion between throwers with and without elbow pain. Results: The average GIRD of the elbow pain group was 32.7° compared with 14.5° in the control group ( P < 0.05). The average TAMD in the elbow pain group was 28.3° compared with 6.7° in the control group ( P < 0.05). GIRD and TAMD were present in 88% (22 of 25) and 96% (24 of 25) of the elbow pain group versus 33.3% (6 of 18) and 55.6% (10 of 18) of the control group, respectively. Conclusion: Compared with asymptomatic youth pitchers, those presenting with elbow pain have a statistically significant GIRD and TAMD. Clinical Relevance: This study suggests that a GIRD and TAMD may predispose youth pitchers to present with symptomatic elbow pain.

Background: Graft-tunnel mismatch (GTM) is a condition in which the anterior cruciate ligament (ACL) graft is either too long or too short. GTM is particularly problematic when bone–patellar tendon–bone grafts are used because of a potential compromise in fixation of the bone plug on the tibia. Hypothesis: The Blumensaat line (BL), a radiographic landmark representing the roof of the intercondylar fossa, will accurately approximate the native ACL (nACL) length and may aid in the prevention of GTM. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 130 patients (66 males, 64 females) underwent direct measurement of the nACL during knee arthroscopy. The lengths of the nACL and patellar ligament (PL) were measured intraoperatively, and BL length was measured on lateral knee radiographs. The nACL length was compared with PL and BL lengths to calculate the absolute difference (AD). Mean AD was calculated and used to determine mean percentage difference (MPD). Pearson correlation coefficients (CC) between BL, PL, and nACL length were calculated, along with inter- and intraobserver reliability coefficients for the measurement of BL. Results: For male patients, the mean length of the nACL was 32.5 mm, BL was 30.4 mm, and PL was 49.2 mm. The AD between the BL and nACL was 2.4 ± 1.3 mm, MPD was 2.6% ± 1.9%, and CC was 0.88. The CC between the PL and nACL was 0.08. For female patients, the mean length of the nACL was 30.2 mm, BL was 27.5 mm, and PL was 44.4 mm. The AD between the BL and nACL was 2.7 ± 1.7 mm, MPD was 4.5% ± 2.4%, and CC was 0.93. The CC between the PL and nACL was 0.1. The inter- and intraobserver reliability coefficients for the measurement of BL were 0.86 and 0.83, respectively. Conclusion: A strong correlation was found between BL and nACL with a high inter- and intraobserver reliability. This correlation provides a simple and reliable method to closely approximate nACL length before reconstruction and may aid in the prevention of graft-tunnel mismatch.

The throwing athlete represents a very interesting and challenging patient population to treat. Few other athletes require the unique combination of stability combined with inherent laxity to allow them to achieve peak performance. Treatment of them and their injuries necessitates an understanding of this phenomenon, recognition of common pathologies encountered, and experience in the process. In this section, we will review several of the most common entities that we encounter in the care of throwing athletes and the current literature on these topics as well as describing our approach to the decision-making process with regards to their treatment. We will also review our surgical techniques for each of these when nonoperative care has failed or acute intervention is deemed necessary.