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This study examined the time-dependent course of the minimally clinically important difference (MCID) and the substantial clinical benefit (SCB) achievement for International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales following anterior cruciate ligament reconstruction (ACLR). A prospective institutional registry was queried for patients receiving ACLR. The patient-reported outcome measures (PROMs) of interest included the IKDC score and KOOS sub-scales. One hundred forty-three patients (mean±SD age, 30.86±12.78 years; mean±SD body mass index, 25.51±4.64 kg/m 2 ) were included in the analysis. Threshold values for the MCID/SCB were 18.9 of 29.6 on IKDC score, 15.7 of 25.3 on KOOS Symptom, 11.9 of 15.5 on KOOS Pain, 13.3 of 20.0 on KOOS ADL, 25.9 of 35.8 on KOOS Quality of Life (QoL), and 27.0 of 43.0 on KOOS Sport (area under the curve, 0.74–0.91). Overall, MCID achievement rates increased from 28.0% to 42.7% at 6 months to 41.9% to 70.8% at 12 months. Achievement rates of SCB increased from 16.1% to 30.4% at 6 months to 29.3% to 51.8% at 12 months. Statistically significant increases in MCID achievement (chi-square=47.95–79.36, all P P P Orthopedics . 2021;44(5):299–305.]

Knee extensor mechanism rupture is an uncommon, but significant, injury. The inability to actively extend the knee precludes normal gait. Quadriceps tendon injuries usually result from a simple fall in middle-aged men.1 Although low-energy fall mechanism of injury is most common, spontaneous rupture tends to occur in a subset of medical conditions (Table).2,3 Patients with quadriceps tendon ruptures are typically older (>40 years) than those who sustain patellar tendon injuries (

The number of primary anterior cruciate ligament (ACL) tears is rapidly increasing. In patients who wish to return to their preoperative level of function, specifically as it pertains to participation in sports, the gold standard of treatment following an ACL tear remains an anterior cruciate ligament (ACL) reconstruction. Despite a majority of good/excellent results following primary ACL reconstruction, there is a growing subset of patients with persistent or recurrent functional instability who require revision ACL reconstruction. Preoperative planning for revision ACL reconstruction requires a careful understanding of the root cause of ACL failure, including possible technical causes of primary ACL failure and the presence of combined knee pathology that was not addressed at the index ACL reconstruction. The decision to perform 2-stage revision ACL reconstruction is multifactorial and is reached by technical considerations that may make a 1-stage revision less optimal, including tunnel widening, arthrofibrosis, active infection, and others. Concomitant knee pathology such as meniscal deficiency, malalignment (including an increase in posterior tibial slope), chondral lesions, and other ligamentous laxity may also require a staged approach to treatment. This evidence-based review covers the indications for 2-stage revision ACL reconstruction, surgical techniques, evidence for and technique of bone grafting prior ACL tunnels, and outcomes of 2-stage revision stratified by initial cause of ACL reconstruction failure. With proper preoperative planning and an understanding of the cause of failure following the primary ACL reconstruction, revision ACL reconstruction can offer excellent outcomes in the motivated patient. [ Orthopedics. 2016; 39(3):e456–e464.]

Knee pain is one of the most frequent complaints evaluated by orthopedic surgeons. It encompasses a broad range of pathology and can present in a variety of ways. Most of this pain can be attributed to essential structures of the knee, including the menisci, cruciate or collateral ligaments, and articular cartilage. However, there are underrecognized structures in and around the knee that can frequently be a cause of knee pathology and pain. Knee pain stemming from these structures may be missed or incorrectly diagnosed, and these patients often present for second and third opinions because of failure to diagnose and treat the underlying pathology. The synovial plica, suprapatellar pouch, lateral retinaculum, infrapatellar fat pad, and infrapatellar branch of the saphenous nerve are less common but still significant causes of knee pain. Although initial treatment involves various nonoperative modalities, operative treatment is often warranted. Operative and nonoperative management of these soft tissue structures may occur in isolation or with concomitant procedures, including knee ligament reconstruction, total knee arthroplasty, tibial tuberosity osteotomy, or lysis of adhesions. With proper recognition of the role of these structures in knee pain, the orthopedic surgeon can offer a valuable primary or adjunctive treatment option for patients with knee pain, especially those without localizing signs of meniscal, ligamentous, or cartilage damage. [ Orthopedics. 2016; 39(1):32–42.]

The purpose of this study was to evaluate the outcomes of patients undergoing subpectoral biceps tenodesis for bicipital tendonitis with a superior labral anterior-posterior (SLAP) tear. Patients undergoing primary subpectoral biceps tenodesis for arthroscopically confirmed SLAP tears with signs or findings of bicipital tendonitis were included. An independent observer collected data prospectively as part of a data repository, which was then analyzed retrospectively. Primary outcome measures were the American Shoulder and Elbow Surgeons (ASES) score and pain relief via visual analog scale (VAS). Secondary outcome measures included the Simple Shoulder Test (SST), Constant, Single Assessment Numeric Evaluation (SANE), and Short Form 12 (SF-12) scores. Twenty-eight patients with a mean±SD age of 43.7±13.4 years and a mean±SD follow-up of 2.0±1.0 years met inclusion criteria. Workers’ compensation was involved with 43% of cases, and 46% of the included patients were manual laborers. Eight (32%) patients were athletes, and 88% of the athletes were overhead athletes. Intraoperatively, 15 (54%) patients had type I SLAP tears, 10 (36%) had type II SLAP tears, 1 (3%) had a type III SLAP tear, and 2 (7%) had type IV SLAP tears. Significant improvements were seen in the following outcome measures pre- vs postoperatively: ASES score (58±23 vs 89±18; P =.001), SST score (6.3±3.6 vs 10.6±3.3; P =.001), SANE score (54±24 vs 88±25; P =.003), VAS score (3.8±2.0 vs 1.1±1.8; P =.001), SF-12 overall score (35±6 vs 42±6; P =.001), and SF-12 physical component score (39±6 vs 50±10; P =.001). Overall satisfaction was excellent in 80% of patients. Subpectoral biceps tenodesis demonstrates excellent clinical outcomes in select patients with SLAP tears. [ Orthopedics. 2015; 38(1):e48–e53.]

Anterior cruciate ligament (ACL) rupture is a significant injury in National Football League (NFL) quarterbacks. The purpose of this study was to determine (1) return-to-sport (RTS) rate in NFL quarterbacks following ACL reconstruction, (2) performance upon RTS, and (3) the difference in RTS and performance between players who underwent ACL reconstruction and controls. Thirteen quarterbacks (14 knees) who met inclusion criteria underwent ACL reconstruction while in the NFL. Matched controls were selected from the NFL during the same time span to compare and analyze age, body mass index (BMI), position, performance, and NFL experience. Student t tests were performed for analysis of within- and between-group variables. Bonferroni correction was used in the setting of multiple comparisons. Twelve quarterbacks (13 knees; 92%) were able to RTS in the NFL. Mean player age was 27.2±2.39 years. Mean career length in the NFL following ACL reconstruction was 4.85±2.7 years. Only 1 player needed revision ACL reconstruction. In both cases and controls, player performance was not significantly different from preinjury performance after ACL reconstruction (or index year in controls). There was also no significant performance difference between case and control quarterbacks following ACL reconstruction (or index year in controls). There is a high rate of RTS in the NFL following ACL reconstruction. In-game performance following ACL reconstruction was not significantly different from preinjury or from controls.

Objective guidelines permitting safe return to sport following anterior cruciate ligament (ACL) reconstruction are infrequently used. The purpose of this study was to determine the published return to sport guidelines following ACL reconstruction in Level I randomized controlled trials. A systematic review was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Level I randomized controlled trials were included if they reported a minimum 2-year follow-up after ACL reconstruction and return to sport criteria. Outcomes analyzed were the timing of initiation of return to sport, follow-up duration, and use of quantitative/qualitative criteria to determine return to sport. Forty-nine studies were included (N=4178; 68% male; mean patient age, 27.5±3.2 years; mean follow-up, 3.0±1.9 years; mean time from injury to reconstruction, 379±321 days). Ninety-six percent of reconstructions used autograft and 87% were single-bundle reconstructions. Lysholm score, single-leg hop, isokinetic strength, and KT-1000 or KT-2000 arthrometer (MEDmetric, San Diego, California) testing were performed in 67%, 31%, 31%, and 82% of studies, respectively. Only 5 studies reported whether patients were able to successfully return to sport. Ninety percent and 65% of studies failed to use objective criteria or any criteria, respectively, to permit return to sport. Description of permission/allowance to return to sport was highly variable and poor. Twenty-four percent of studies failed to report when patients were allowed return to sport without restrictions. Overall, 39%, 45%, and 51% of studies permitted running at 3 months, return to cutting/pivoting sports at 6 months, and return to sport without restrictions at 6 months, respectively. Further research into validated return to sport guidelines is necessary to fill the existing void in contemporary literature and to guide clinical practice.

The arthroscopic treatment of a humeral avulsion of the glenohumeral ligaments lesion allows for a safe, reproducible, and effective way to reestablish the inferior glenohumeral ligament and capsular complex to the humerus.

Multi-suture fixation of supraspinatus rotator cuff tears provides excellent fixation and biomechanical failure characteristics.

Using an anterior portal for a labral elevator and shaver instrument, with the arthroscope in the anterosuperior portal, allows the posterior and posteroinferior chondrolabral junction to be safely prepared.

The treatment of osteochondritis dissecans lesions remains controversial. Twelve adolescent patients, with average 6-year follow-up, underwent compression screw fixation of unstable Cahill Type-2C osteochondritis dissecans lesions. Postoperatively, patients were evaluated with several functional tests and scoring systems, including Lysholm, IKDC, and KOOS. All lesions healed, and no clinical or radiographic evidence of degenerative disease was noted. No significant differences in thigh girth, range of motion, stability, or single-leg-hop distance was observed when compared to the unaffected, contralateral extremity. This technique is appropriate and efficacious for the treatment of unstable osteochondritis dissecans lesions.

Drs Creighton and Bach and Mr Kinder are from the Division of Sports Medicine, Rush University Medical Center, Chicago, Ill. Reprint requests: Bernard R. Bach, Jr, MD, 1725 W Harrison St, Ste 1063, Chicago, IL 60612. Compartment syndrome is an elevation of the interstitial pressure in a closed osseofascial compartment that results in microvascular compromise. The condition may be further classifi ed as either acute or chronic. Common causes of acute compartment syndrome include fractures, severe blunt soft tissue trauma, arterial injury, limb compression, and burns. Chronic compartment syndrome is caused by increased muscle volume most commonly occurring during exercise. The diagnosis of an acute compartment syndrome is made by clinical signs and can be further confi rmed by compartment pressure measurements.1-6 Measurements of compartment pressure are used for the evaluation of a compartment in which the diagnosis of compartment syndrome cannot be made or ruled out with certainty, as in a patient with altered mental status or in chronic exertional compartment syndrome.3 Signs and symptoms of acute compartment syndrome include pain out of proportion, increased use of analgesics, pain with passive muscle stretching, paresis, paresthesia, and diminished pulses. Pulses usually remain intact due to arterial pulses remaining higher than the pressure of the compartment compressing the artery. The following case report describes the clinical presentation and treatment of compartment syndrome following an inversion injury of the ankle.

This prospective randomized clinical trial evaluated whether the use of radiofrequency energy (RFE) devices for soft-tissue ablation and coagulation cause thermal injury to bone. Fifty patients underwent one of three treatment modalities: electrocautery, monopolar RFE, or bipolar RFE. Preoperative and postoperative magnetic resonance imaging was compared to evaluate for evidence of osteonecrosis. Postoperative MRI of all patients did not reveal any osteonecrosis or subchondral edema. These findings indicate electrocautery, monopolar RFE, and bipolar RFE devices can be used safely for soft-tissue ablation and hemostasis.