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BACKGROUND: The risk of tear of the intact anterior cruciate ligament in the contralateral knee after anterior cruciate ligament reconstruction of the opposite knee and the incidence of rupturing the anterior cruciate ligament graft during the first 2 years after surgery have not been extensively studied in a prospective manner. Clinicians have hypothesized that the opposite normal knee is at equal or increased risk compared with the risk of anterior cruciate ligament graft rupture in the operated knee. HYPOTHESIS: The risk of anterior cruciate ligament graft rupture and contralateral normal knee anterior cruciate ligament rupture at 2-year follow-up is equal. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: The Multicenter Orthopaedic Outcome Network (MOON) database of a prospective longitudinal cohort of anterior cruciate ligament reconstructions was used to determine the number of anterior cruciate ligament graft ruptures and tears of the intact anterior cruciate ligament in the contralateral knee at 2-year follow-up. Two-year follow-up consisted of a phone interview and review of operative reports. RESULTS: Two-year data were obtained for 235 of 273 patients (86%). There were 14 ligament disruptions. Of these, 7 were tears of the intact anterior cruciate ligament in the contralateral knee (3.0%) and 7 were anterior cruciate ligament graft failures (3.0%). CONCLUSION: The contralateral normal knee anterior cruciate ligament is at a similar risk of anterior cruciate ligament tear (3.0%) as the anterior cruciate ligament graft after primary anterior cruciate ligament reconstruction (3.0%). [ABSTRACT FROM AUTHOR]

BACKGROUND: Six classification systems have been proposed for describing rotator cuff tears designed to help understand their natural history and make treatment decisions. PURPOSE: To assess the interobserver variation for these classification systems and identify the method with the best interobserver agreement. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Six rotator cuff tear classification systems were identified in a literature search. The components of these systems included partial-thickness rotator cuff tears and classification by size, shape, configuration, number of tendons involved, and by extent, topography, and nature of the biceps. Twelve fellowship-trained orthopaedic surgeons who each perform at least 30 rotator cuff repairs per year reviewed arthroscopy videos from 30 patients with a random assortment of rotator cuff tears and classified them by the 6 classification systems. Interobserver variation was determined by a kappa analysis. RESULTS: Interobserver agreement was high when distinguishing between full-thickness and partial-thickness tears (0.95, kappa = 0.85). The investigators agreed on the side (articular vs bursal) of involvement for partial-thickness tears (observed agreement 0.92, kappa = 0.85) but could not agree when classifying the depth of the partial-thickness tear (observed agreement 0.49, kappa = 0.19). The best agreement for full-thickness tears was seen when the tear was classified by topography (degree of retraction) in the frontal plane (observed agreement 0.70, kappa = 0.54). CONCLUSION: With the exception of distinguishing partial-thickness from full-thickness rotator cuff tears and identifying the side (articular vs bursal) of involvement with partial-thickness tears, currently described rotator cuff classification systems have little interobserver agreement among experienced shoulder surgeons. Researchers should consider describing full-thickness rotator cuff tears by topography (degree of retraction) in the frontal plane. [ABSTRACT FROM AUTHOR]

We studied five fresh-frozen lower extremity cadaveric specimens to assess the effect of knee effusions on KT-1000 arthrometry. Part 1 consisted of serial 10-ml injections (up to 100 ml) of saline into each knee and measurements of midpatellar knee circumference and anterior displacement using the KT-1000 arthrometer at 67, 89, and 134 N after each 10-ml increment. Part 2 consisted of evacuation of the saline and transection of the anterior cruciate ligament through a 2-cm medial parapatellar arthrotomy. Each knee again underwent the part 1 protocol. Sequential injections in parts 1 and 2 showed incremental increases in knee circumference and KT-1000 arthrometer measurements for all three force levels. A 3-mm increase in anterior translation compared with the value at 0-ml injection was obtained by the 70-ml injection point in both groups. At the 70-ml injection point, the patella was ballottable, thereby affecting anterior measurements-despite posterior force on the patella sensor pad-because of the KT-1000 arthrometer reference level at midpatella. This increase in KT-1000 arthrometer readings could erroneously imply anterior cruciate ligament disruption in the clinical situation of right-to-left comparison. We conclude that clinicians using the KT-1000 arthrometer should aspirate knees that have effusions and a ballottable patella to minimize false-positive readings. [ABSTRACT FROM AUTHOR]

BACKGROUND: The meniscal flounce sign is a fold in the free, nonanchored inner edge of the medial meniscus that can be noted during routine arthroscopy of the knee. HYPOTHESIS: The meniscal flounce sign can be a significant indicator of the presence or absence of medial meniscus injury. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 4. METHODS: One hundred sixty-eight patients were prospectively evaluated at the time of the arthroscopy for the presence or absence of the arthroscopic meniscal flounce sign. These results were then correlated with the presence of medial meniscus tears. RESULTS: The presence of the meniscal flounce sign has a positive predictive value of a normal meniscus of 0.97 (63/65). The absence of the meniscal flounce sign has a positive predictive value of an abnormal meniscus of 0.98 (101/103). Specificity is 98%, and sensitivity is 97%. CONCLUSION: The absence of the arthroscopic meniscal flounce sign is a sensitive and specific predictor of the presence of medial meniscus tears that should alert the surgeon to probe carefully for an occult medial meniscus tear. [ABSTRACT FROM AUTHOR]