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Objectives There are limited data on Western Ontario Rotator Cuff (WORC) Index scores in a population without shoulder pathology. The primary purpose was to provide normative reference values for the WORC in an adult population with healthy shoulders. The secondary purpose was to identify demographic factors and comorbidities that may impact WORC scores. Methods The WORC survey was completed by patients and family members at a suburban outpatient orthopaedic centre. Patients with current shoulder injury or former upper extremity surgery were excluded. Percentage scores were calculated for total and subscale measures. Demographic factors and comorbidities were evaluated to identify possible risk factors for an abnormal baseline score (less than 100). Results There were 988 participants (434 men, 554 women). Overall WORC median (IQR) was 98.64 (94.3 to 100). Each subscale was greater than 96 for all sex-based and age-based subgroups. Median WORC scores were greater than those reported in previous literature following surgery for shoulder pathology. Demographic risk factors for poor WORC scores included body mass index (BMI) greater than 30 (p Conclusions This study provides baseline values for the WORC survey in a US suburban population across a range of age groups, demonstrating that surgery for shoulder pathology often results in improved WORC scores, but may not return patients to baseline. Demographic risk factors for lower scores include smoking, BMI above 30, history of shoulder problems or history of shoulder injection. Level of evidence Descriptive epidemiology study; Level of evidence: III.

Objective Investigate the patellar force-displacement profile (ligament stiffness) of patellofemoral disorders. Methods Fifty-two knees from 34 consecutive patients (mean 31.6 years and 53% male) were analysed including 24 knees with patellofemoral pain (PFP), 19 with potential patellofemoral instability (PPI) and 9 with objective patellofemoral instability (OPI). Physical examination, patient-reported outcome measures (Kujala and Lysholm Scores), standard radiography and MRI or CT were performed in all patients. Instrumented stress testing (Porto Patella testing device) concomitantly with imaging (MRI or CT) was performed to calculate ligament stiffness. Results The force-displacement curves in patients with PPI and OPI displayed a similar pattern, which was different from that of the PFP group. Patients with PPI showed higher ligament stiffness (a higher force was required to displace the patella) than the patients in the OPI group. Patients with OPI had a statistically significant shallower trochlear groove and increased lateral tilt. More than half of the PPI and OPI population presented with at least one classic risk factor (patella alta, trochlear dysplasia, increased quadriceps vector, lateral tilt). In the PPI group, at least two risk factors were found in 37% of patients, whereas at least 33% of patients in the OPI group had three risk factors present. None of the patients presented with all four anatomical risk factors. Conclusion Patients presenting with patellofemoral instability (PPI and OPI) display similar ligament stiffness patterns (force-displacement curve). Patients with PFP and PPI showed higher ligament stiffness as compared with patients with OPI. Level of evidence Level V, case series.

Rationale and Objectives In this retrospective case series, we utilize arthroscopy as the gold standard to determine if magnetic resonance imaging (MRI) of the knee can predict osteochondritis dissecans (OCD) lesion stability, the most important information to guide patient treatment decisions. It is hypothesized that the classification system of the International Cartilage Repair Society (ICRS) will allow for improved assessment of lesion grade and stability in OCD. Materials and Methods Routine MRI studies of 46 consecutive patients with arthroscopically proven OCD lesions (mean age: 23.7 years; 26 male, 16 female) were assessed by three radiologists who were blinded to arthroscopic results. Arthroscopic images were evaluated by two orthopedic surgeons in consensus. The OCD criteria of the ICRS were applied to arthroscopy and imaging interpretations. Inter-rater correlation statistics and accuracy of magnetic resonance (MR) grading with respect to arthroscopy were determined. Results Only 56% of the available MR reports assigned a label of stable or unstable to the lesion description. Of these, 58% of the lesions were deemed unstable and 42% were stable. Accuracy was 53% when reports addressed stability. Utilizing the ICRS classification system, for all three readers combined, the respective sensitivity, specificity, and accuracy of MR imaging to determine lesion stability were 70%, 81%, and 76%. When compared to the original MRI report, the overall accuracy increased from 53% to 76% when readers were given the specific criteria of the OCD ICRS classification. However, inter-reader variability remained high, with Krippendorf's alpha ranging from 0.48 to 0.57. Conclusions In this paper, we utilize arthroscopy as the gold standard to determine if MRI can predict OCD lesion stability, the most important information to guide patient treatment decisions. To our surprise, the analysis of the existing radiology reports that addressed stability revealed an overall accuracy in defining OCD lesion stability of about 53%. The classification system of the ICRS, created by an international multidisciplinary, multi-expert consortium, did markedly improve the accuracy, but consistency among different readers was lacking. This retrospective study on OCD reporting and classification highlights the inadequacy of existing classification schemes, and emphasizes the critical need for improved diagnostic MRI protocols in musculoskeletal radiology in order to propel it toward evidence-based medicine.

Purpose The purpose of this study was to identify the relationship between the common peroneal nerve (CPN) and the fibular head. Methods Sixteen cadaveric dissections were performed. The distance from the fibular head to the center of the CPN as it exits beneath the biceps femoris (BF) was measured in 0°, 30°, 60°, and 90° of flexion and was averaged on the first 8 specimens. Based on those measurements, a needle was placed on the second 8 dissections before the fascial incision was made to assess reliability. All measurements were repeated after needle removal, distances were recorded, and 95% confidence interval (CI) and correlation coefficients were calculated. Results The distance from the posterior border of the fibular head to where the CPN nerve center emerges from the BF was 62.3 mm (95% confidence interval [CI], 58.2 to 66.4), 56.3 mm (95% CI, 51.9 to 60.8), 46.8 mm (95% CI, 43.6 to 50.0), and 45.3 mm (95% CI, 43.2 to 47.3) in 0°, 30°, 60°, and 90° of knee flexion, respectively. The correlation coefficient between knee flexion and measured distance was nearly linear: r = −0.97. The correlation coefficients were 0.62, 0.32, and 0.01 for height, weight, and body mass index (BMI), respectively. The CPN crossed the posterior border of the fibula 21.9 mm (95% CI, 20.2 to 23.7) from the fibular styloid at 90° of flexion. Conclusions With the knee in 90° of flexion, the CPN center crosses the long head of the BF (LHBF) tendon 45.3 mm from the posterior border of the fibula, where the direct arm of the BF inserts, and the posterior border of the fibula 21.9 mm from the tip of the fibular styloid. There is a near linear correlation between knee flexion and the distance to the CPN as it exits the BF. No correlation exists between the distance to the CPN and weight or BMI, whereas a moderate correlation with height exists. Clinical Relevance These relationships allow for efficient and safe identification of the CPN proximal to the zone of injury when operating around the posterior lateral corner (PLC) of the knee.

There are many ways to perform stabilization of unstable acromioclavicular injuries, and there are generally good results with all surgical techniques. Unfortunately, the literature is weak on comparing surgical results with nonsurgical management, so we still have not defined which patients need surgery and which patients do not.

There are currently many techniques for performing articular cartilage repair. The Denovo NT Allograft is a one-stage cartilage repair technique that utilizes particulate juvenile cartilage allograft. Having an understanding of this technique would add to the armamentarium of the surgeons performing articular cartilage repair. The purpose of this article, therefore, is to explain the basic science of the Denovo NT allograft and the rationale for its use, discuss the indications, describe the surgical techniques, and examine the early clinical literature that is available.