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Bipartite patella is a relatively rare phenomenon. This anomaly is typically asymptomatic but can become painful with overuse, strenuous activities, or trauma, which is why it is typically seen in a young, athletic population. Although nonsurgical management is the initial treatment, if symptoms persist, surgical intervention may be necessary. Multiple surgical options exist, such as excision or fixation of the fragment or release of lateral soft tissue structures. The authors report the efficacy of various surgical interventions on a symptomatic bipartite patella, with outcomes related to symptom relief and ability to return to preoperative levels of activity. A systematic review was performed using multiple databases. Studies reporting outcomes of symptom relief or ability to return to activity following surgical intervention for a bipartite patella were included. Surgical technique, type of bipartite, and complications were recorded. Twenty-four articles with a total of 122 patients and 127 knees were included and reviewed. Relief of pain was achieved in 84.1% of patients, with 98.3% able to return to their preoperative activity levels after surgery. For patients with a symptomatic bipartite patella, return to preoperative activity levels with zero to minimal pain can be achieved with excellent results using any of the reported surgical methods., (Copyright 2014, SLACK Incorporated.)

The purpose of this study was to determine the sensitivity and positive predictive value of magnetic resonance imaging (MRI) in the identification of full-thickness articular cartilage defects in the porcine knee. Seventy-two full-thickness chondral defects (small or large; circular, oval, or triangular) were created in 12 porcine knees. The authors used 3.0-T MRI with 3-dimensional gradient echo water-selective/fluid (WATSf) sequences acquired in axial, coronal, and sagittal planes. Sensitivity and positive predictive value parameters were calculated for 2 readers. Magnetic resonance imaging was highly sensitive for detection of full-thickness defects in the knee (85%). The highest sensitivity was observed at the medial femoral condyle (93%), while the lowest was observed at the medial patella (71%). The sensitivities for detecting different shapes were unique to each shape, with oval lesions identified with greatest sensitivity (93%). Small lesions (86%) were detected at a similar sensitivity as large lesions (83%). The positive predictive values for accurate true-positive reads were low for all lesion shapes (18%-57%) and moderate for small (69%) and large (59%) sizes, with significant differences observed between the 2 readers. Magnetic resonance imaging has a high sensitivity in the detection of full-thickness articular cartilage defects in the porcine knee. Variability in defect shape and intra-articular location affects MRI sensitivity, while size does not. Magnetic resonance imaging was not effective in describing lesion shape or size. Further, there was subjectivity in reading defect shape and size between 2 radiologists., (Copyright 2014, SLACK Incorporated.)

We evaluated the biomechanical properties of FiberWire (Arthrex, Inc, Naples, Florida), a new suture material, for both repair and augmentation as compared to standard Ethibond suture (Ethicon, Inc, Somerville, New Jersey), hypothesizing that primary repair and cerclage augmentation with the new suture material would have similar biomechanical properties as a standard repair with wire augmentation. Forty-five fresh bovine knees were placed in 3 groups of equal size: (1) #5 Ethibond tendon repair plus 18-gauge wire augmentation; (2) #5 FiberWire repair plus #5 FiberWire augmentation; and (3) #5 Ethibond repair plus #5 FiberWire augmentation. A straight static pullout test was performed, randomly alternating between the different groups. Gap formation was measured at the center of the repair by a metric ruler, with the examiner blinded to the developing force-tension readout. For each millimeter of gap formation (1-10 mm), the force on the repair was recorded, as well as the force at the ultimate failure of the repair, designated by breakage of any repair material. Analysis showed no significant difference between the standard Ethibond/wire repair and the FiberWire/FiberWire repair. The Ethibond/FiberWire repair was shown to be significantly weaker than the other 2 groups. Ultimate failure data indicated that the Ethibond/wire repair was significantly stronger than both other groups. No significant differences were found between the FiberWire/FiberWire repair and the Ethibond/FiberWire repair. Newer, stronger suture material for both primary repair and augmentation may provide equivalent biomechanical strength at clinically significant levels., (Copyright 2011, SLACK Incorporated.)

Osteochondral autograft transfer is an accepted treatment for chondral and osteochondral defects of the knee. Synthetic plugs may eventually be used for primary treatment of defects. Currently they are largely used for osteochondral donor site backfill. Placement of osteochondral or synthetic plugs proud leads to articulating surface incongruity, increases in contact pressure, and potential for both plug and opposing surface degenerative change. We conducted a biomechanical study of human cadaver knees to determine whether differences exist in the contact pressure of osteochondral autograft plugs placed proud versus synthetic plugs placed proud. Ten human cadaveric knees were used (20 condyles). Contact pressure was measured with Tekscan sensor technology (South Boston, Massachusetts) with both static and cyclical loads (of 250 and 500 cycles) created by an MTS Bionix system (Eden Prairie, Minnesota) under the following conditions: native articular cartilage, surgically created defect (7-mm diameter), 1-mm proud osteochondral autograft, and 1-mm proud synthetic graft. Proud osteochondral autograft plugs resulted in a 21.4% increase in peak contact pressure over surrounding native articular cartilage versus a 4.9% increase with proud synthetic plugs. Synthetic plugs compressed their structure and subsided versus subchondral bone collapse with compressive load in osteochondral autograft plugs. Proud osteochondral autograft plugs have significantly higher peak contact pressures than proud synthetic plugs when placed for treatment of chondral and osteochondral defects in the knee., (Copyright 2011, SLACK Incorporated.)

We evaluated the clinical evidence of using continuous passive motion postoperatively after treating articular cartilage lesions of the knee. We hypothesized that postoperatively, the use of continuous passive motion improves the outcomes of cartilage restoration procedures. Multiple medical databases (MEDLINE, EMBASE, CINAHL, PubMed, Sport-Discus, and Cochrane) were searched for Level I through IV evidence with specific study inclusion and exclusion criteria. The following key words were searched: microfracture, mosaicplasty, OATS, ACI, osteochondral autograft, osteochondral allograft, autologous chondrocyte implantation, autologous chondrocyte transplantation, CPM, continuous passive motion, motion therapy, postoperative knee rehabilitation, cartilage, knee. All studies were independently reviewed by the authors and the references were checked for any missed articles. Four Level III studies were identified that met inclusion criteria for our hypothesis. No randomized, controlled studies were identified. A meta-analysis could not be performed as a result of the heterogeneity of the procedures and outcome measures. Definitive conclusions regarding the benefits of continuous passive motion postoperatively in knee cartilage surgery could not be made secondary to this heterogeneity. Continuous passive motion is commonly used postoperatively following cartilage surgery. Unfortunately, the clinical evidence (only 4 studies) to support the use of continuous passive motion is lacking despite an overwhelming abundance of basic science support and the common clinical practice of continuous passive motion implementation postoperatively in knee cartilage restoration procedures. There is a great need for well-conducted, high-level evidence studies to address this void in our literature., (Copyright 2010, SLACK Incorporated.)

Lemierre's syndrome is a severe complication of Fusobacterium necrophorum oropharyngeal infection associated with metastatic foci of infection, internal jugular vein thrombosis, and septicemia. Musculoskeletal manifestations include isolated or multifocal septic arthritis, soft tissue abscesses, pyomyositis, and osteomyelitis. This article describes a case of a variant of Lemierre's syndrome in a 17-year-old girl, demonstrating a relentless case of limb infection refractory to multiple surgical debridements and broad-spectrum and targeted antibiotics. The patient had F. necrophorum within a peritonsillar abscess and multiple foci within her right lower extremity. Overall, she required 12 surgical procedures and 14 weeks of antibiotic therapy to resolve the infection. Further unique findings in this case include the presence of a recent lateral meniscus tear with associated hemarthrosis treated with a short course of oral steroids prior to the diagnosis of septic arthritis. Knee arthroscopy with lysis of adhesions and manipulation at 6 months postinfection demonstrated significant chondral damage. Outcome at >2-year follow-up revealed pain-free activities of daily living and the ability to return to competitive, club-level collegiate softball. Clinically relevant findings illustrated in this case include potential development of antibiotic resistance within Fusobacterium genus with little to no response to several surgical debridements and broad-spectrum and targeted antibiotics, and development of multifocal, ipsilateral septic arthritis and soft tissue abscesses and pyomyositis in the context of steroid use and recent intra-articular knee injury., (Copyright 2010, SLACK Incorporated.)

Articular cartilage injury can occur after meniscal repair with biodegradable implants. Previous contact pressure analyses of the knee have been based on the tibial side of the meniscus at limited knee flexion angles. We investigated articular contact pressures on the posterior femoral condyle with different knee flexion angles and surgical repair techniques. Medial meniscus tears were repaired in 30 fresh bovine knees. Knees were mounted on a 6-degrees-of-freedom jig and statically loaded to 200 N at 45 degrees, 70 degrees, 90 degrees, and 110 degrees of knee flexion under 3 conditions: intact meniscus, torn meniscus, and meniscus after repair. For each repair, 3 sutures or biodegradable implants were used. A pressure sensor was used to determine the contact area and peak pressure. Peak pressures over each implant position were measured. Peak pressure increased significantly as knee flexion increased in normal, injured, and repaired knees. The change in peak pressure in knees with implant repairs was significantly higher than suture repairs at all knee flexion angles. Articular contact pressure on the posterior femoral condyle increased with knee flexion. Avoidance of deep knee flexion angles postoperatively may limit increases in articular contact pressures and potential chondral injury., (Copyright 2010, SLACK Incorporated.)

Anticoagulation is commonly needed for multiple medical conditions. The indications to discontinue anticoagulation for a simple procedure are controversial. Other surgical subspecialties have shown that keeping patients on warfarin during a simple procedure is safe. The purpose of this retrospective study was to evaluate the postoperative complications encountered for patients undergoing simple arthroscopic procedures while on warfarin. We hypothesized that anticoagulated patients undergoing simple arthroscopic procedures would have few surgical bleeding complications.Arthroscopic procedures performed over a 10-year period on warfarin-anticoagulated patients were retrospectively evaluated. Data collected included the procedure and orthopedic problem, the type of anesthesia, the medical condition requiring anticoagulation, the international normalized ratio (INR) at surgery, and all postoperative complications (bleeding, hematoma, delayed healing, prolonged postoperative course, infection, and medical complication). Twenty-four patients met the inclusion criteria. All had abnormal INR levels at time of surgery. Four patients were operated on emergently for septic joints, and 20 patients had elective arthroscopic procedures (10 knees, 10 shoulders). There were no major intraoperative bleeding problems. Seven patients had minor postoperative surgical complications: 2 prolonged effusions and 5 prolonged ecchymosis. No medical complications were seen. Oral warfarin appeared to be a safe alternative to manipulating anticoagulation during the preoperative period for simple arthroscopic procedures. Minor bleeding complications consisting of ecchymosis were seen, but no medical complications were identified., (Copyright 2010, SLACK Incorporated.)