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Previous studies report professional athletes return to play following arthroscopic microfracture of the hip for chondral defects. Our hypothesis is that professional hockey players undergoing arthroscopic microfracture for chondral defects of the hip achieve the same performance they had pre-injury and compared to matched controls. Seventeen professional hockey players underwent arthroscopic microfracture for an Outerbridge grade IV chondral lesion. Concomitant procedures for labral pathology or FAI were included. Performance data for the full season preceding and following index procedure were analysed, in addition to two matched control players per subject. Data were collected at two points, 2 years apart. Eighty-two per cent (14/17) of players who underwent arthroscopic microfracture returned to play. The year prior to injury for the 14 players who returned was compared to the average of their individual controls. There was no statistical difference between the groups for age, number of seasons in the league, games played, time on ice, points, save percentage, and shots against goal. Post-operatively, there was no statistical difference between the treatment and control groups regarding performance measures. There was a trend towards a decrease in games played and points post-operatively compared with controls. The treatment group decreased 11 games played, while the controls decreased five games. The treatment group also decreased 14 points, while the controls decreased three points for the season. Professional hockey players with a discrete, full-thickness chondral defect of the hip are able to return to elite performance level following an arthroscopic microfracture procedure when compared to pre-injury outcomes and controls. III.

Multiligament knee injuries pose a challenging clinical situation to even experienced orthopedic surgeons. Although nonoperative treatment of mild varus instability without a cruciate injury has been shown to have acceptable outcomes, it is now accepted that operative management of multiligament inj

Deep venous thrombosis and septic pulmonary embolism are known to occur in association with pediatric musculoskeletal infections. The authors of recent studies have reported an apparent increase in the incidence of this phenomenon, which appears to be related to the rising occurrence of infections caused by methicillin-resistant Staphylococcus aureus 1. Some authors have suggested that the Panton-Valentine leukocidin gene, which may be expressed by methicillin-resistant Staphylococcus aureus , is responsible for severe consequences of infection including necrotizing pneumonia, deep venous thrombosis, septic pulmonary embolism, and an enhanced local inflammatory response leading to abscess formation in tissues adjacent to the site of infection2-5. We previously reported on thirteen children with deep venous thrombosis that occurred in association with osteomyelitis (eleven), septic arthritis (one), or pyomyositis (one), and we identified characteristics of these children that may help to guide clinicians in assessing the relative propensity of a child with musculoskeletal infection to develop deep venous thrombosis6. In that report, 25% of the children above the age of eight years who had osteomyelitis caused by methicillin-resistant Staphylococcus aureus and who presented with a C-reactive protein level of >6 mg/dL were noted to have deep venous thrombosis, but none of the children with deep venous thrombosis in that report had an upper-extremity infection. The majority of the infections occurred adjacent to the knee, involving either the proximal part of the tibia or the distal part of the femur, with the deep venous thrombosis located in the popliteal or femoral vein. We present here the case of a child with acute osteomyelitis of the humerus associated with a deep venous thrombosis in the ipsilateral upper extremity and septic pulmonary embolism. The parents of the patient were informed that data concerning the case would be submitted for publication, and …

Purpose of review Total hip replacement is one of the safest and most clinically efficacious operations in orthopedic surgery. It has been extended to more and more patient populations over the past four decades. The purpose of this review is to present the contemporary data of total hip replacement in two unique patient populations: obese patients and geriatric patients older than 75 years of age. Recent findings There are unique clinical challenges in these patients. In addition, the clinical outcome and complications are different from more routine total hip replacement populations. Summary The recent research has shown that total hip replacement in the obese and elderly populations can be successful, and should not be denied solely based on these two criteria. There is a need for more research to investigate postoperative instability in the obese patient population, and perioperative mental confusion and cognitive function deterioration in the elderly patient population.

Background [Pro 11 D -Ala 12 ] angiotensin I is an ACE-resistant substrate specific for chymase. We used this peptide to determine whether a functionally significant non-ACE angiotensin (Ang) II–generating pathway exists in human dorsal hand veins. Methods and Results Using a modified Aellig technique, we studied the response to Ang I and [Pro 11 D -Ala 12 ] Ang I in dorsal hand veins in vivo in patients with coronary heart disease. We measured the venoconstrictor effect of each peptide given before and after a 6.25-mg oral dose of the ACE inhibitor captopril or matching placebo. Placebo or captopril was given in a double-blind, randomized fashion. Ang I induced a mean±SEM venoconstrictor response of 45±11%, 40±10%, 55±8%, and 4±4% before placebo, after placebo, before captopril, and after captopril, respectively. Hence, the response to Ang I was reproducible and was reduced significantly only after treatment with captopril ( P =0.002). [Pro 11 D -Ala 12 ] Ang I induced a mean venoconstrictor response of 42±9%, 49±9%, 48±10%, and 54±11% before placebo, after placebo, before captopril, and after captopril, respectively. Hence, captopril had no significant effect on the response to [Pro 11 D -Ala 12 ] Ang I. Conclusions We have demonstrated that [Pro 11 D -Ala 12 ] Ang I is able to induce venoconstriction in humans in vivo. With this specific pharmacological probe, we have shown that a non-ACE pathway capable of generating Ang II exists in human veins in vivo and is potentially functionally important. This pathway is likely to involve the enzyme chymase.

Aims Adrenomedullin is a newly described peptide that has widespread tissue distribution. Its presence in cardiovascular (including vascular endothelial cells, smooth muscle cells, and cardiac atria and ventricles) and renal tissues, together with its vasodilatory and natriuretic properties, suggest a role in blood pressure regulation and fluid and electrolyte balance. Methods Nine normal volunteers were studied to determine whether or not adrenomedullin influenced plasma atrial natriuretic peptide and arginine vasopressin concentrations during systemic angiotensin II infusion. Results A significant (P = 0.02) augmentation of atrial natriuretic peptide concentrations, but no suppression of arginine vasopressin concentrations, was found with coinfusion of adrenomedullin and angiotensin II when compared with vehicle and angiotensin II. Conclusions Despite its vasodilator and natriuretic action, adrenomedullin significantly augmented angiotensin II-stimulated plasma atrial natriuretic peptide concentrations in healthy humans. This provides further evidence of a synergistic interaction between adrenomedullin and atrial natriuretic peptide and suggests that adrenomedullin may have a role in fluid and electrolyte balance and blood pressure regulation.

Laryngeal hemangiomas in adults are uncommon. We report four such cases seen at our clinic during an 18-month period in 1996 and 1997. All masses were detected by endoscopy, and all were biopsied and ablated uneventfully with a CO2 laser. All four patients recovered without incident. We feel that laryngeal hemangiomas that affect only the glottic area can be treated endoscopically with a CO2 laser without consequences.

Rhinophyma is an acne rosacea which primarily affects the midface of elderly men, and causes disfigurement as well as obstruction. There are numerous ways of treating this condition and, in our institution, a CO2 laser is the treatment of choice.

Purpose The purpose of this study was to compare elite athletes who underwent hip arthroscopy with and without microfracture with respect to their ability to return to sport at the professional level. Methods All elite male athletes who underwent hip arthroscopy between 1999 and 2010 were identified. Inclusion criteria were hip arthroscopy with treatment of labrum, femoroacetabular impingement, cartilage, ligamentum teres, capsule, and/or loose body removal. Exclusion criteria were diffuse degenerative joint disease, previous surgery, plans to retire, labral reconstruction, soft tissue release, and concomitant lower extremity injury. Thirty-nine athletes underwent hip arthroscopy with microfracture and were assigned to the microfracture treatment group. Eighty-one elite athletes (94 hips) underwent hip arthroscopy without microfracture and were assigned to the control group. Sports played included hockey, soccer, football, baseball, tennis, and golf. Results Seventy-seven percent (30 of 39) of athletes in the microfracture treatment group and 84% (79 of 94) in the control group returned to play. There was no statistical difference in rate of return to play between groups (odds ratio = 1.6; 95% confidence interval, 0.633 to 4.049). Those players who did return were followed for an average of 3 years (range, 2 to 12). Athletes in the microfracture treatment group who returned have averaged 3 seasons thus far, and 73% are still playing. We found no significant difference in the microfracture group in age, time from injury to surgery, number of seasons played preoperatively, or size of lesion for return versus no return. We also found no increased risk of not returning because of contact sport, multiple lesions, or lesion on weightbearing surface. Conclusions There was no detectable statistically significant difference in return to play rate after hip arthroscopy with microfracture and hip arthroscopy without microfracture. Professional athletes who underwent hip arthroscopy with microfracture procedure were able to return to the same high level of competition after surgery at a high rate. Level of Evidence Level III, retrospective comparative study.

A medial meniscal tear is a common diagnosis for an orthopaedic surgeon, and a partial meniscectomy is commonly performed to treat these tears. However, because of recent literature supporting increased tibiofemoral contact and increased contact stress after a partial or subtotal meniscectomy1, there has been a heightened interest in repairing meniscal tears. However, the biomechanical effects of complex repairs are poorly understood. Muriuki and colleagues evaluated both a vertically oriented medial meniscus tear that extended to the posterior horn as well as a radial tear that extended only to the peripheral one-third of the meniscus and assessed their subsequent repairs. It is intriguing to note that although the repair potential of inner margin, radial tears is extremely poor and that most orthopaedic surgeons would perform a saucerization of this tear, leaving as much native meniscus as possible, there is little change in the maximum tibiofemoral …

This is case report of extramedullary plasmacytoma occurring in the nasal cavity. These are unusual tumors especially in the nasal area. Patients present mainly with nasal symptoms on the same side of the tumors. The treatment consists of surgery resection, or, radiation, or both. There is a fifty percent survival rate in five years.

Objectives: Hypertropic lingual tonsils are a known obstruction in the upper airway. Enlarged linguals are responsible for obstructive sleep apnea, potential infections, and difficult intubations for routine surgeries. In our institution all patients were treated with protection of the airway, and ablation of lingual tonsils with a CO 2 laser. Methods: The patients were diagnosed with direct visualization and a CT scan of the neck. All patients were intubated with a laser reinforced endotracheal tube and fire precautions were taken when draping patient. One patient had a tracheotmy performed before being treated for hypertrophic lingual tonsils. A wide funnell larynscope was suspended. The CO 2 laser was used at 15 watts continuous along with an operating microscope to ablate the tissue. Results: All patients were admitted for a 23-hour stay. Postoperatively, no patient required intubation to protect the airway. Three of the 50 patients required a revision surgery to completely ablate all the lingual tonsils. The patient with the tracheotomy was decannulated. All patients were relieved and asymptomatic after surgery. Conclusion: CO 2 laser is a safe and acceptable method for lingual tonsillectomy. All patients in our institution had no complications and were free of all symptoms. The laser compleletly ablated the lingual tonsils removing the obstruction in the airway.

(Editorial Comment: The authors describe a rare entity that may mimic a common benign parotid neoplasm. The clinical presentation, work-up, and treatment are summarized.) Preauricular masses are usually parotid tumors. Rarely, they are temporomandibular joint cysts. These cysts are divided between ganglion cysts and synovial cysts. Twelve temporomandibular joint cysts have been reported. Eight have been ganglion cysts and 4 have been synovial cysts. 1 This is the 5th synovial cyst reported as a temporomandibular joint cyst. Treatment is uncertain; however, surgical excision of the temporomandibular joint cyst has the highest success rate. CASE REPORT A 47-year-old woman presented to the Ear, Nose, and Throat Clinic with a preauricular mass. She admitted to the mass growing slowly and being present for approximately 1 year. She had left preauricular pain and discomfort when chewing. The pain had become worse before her visit. She had a history of temporomandibular joint dysfunction and was being treated by her dentist. Her past medical history was basically unremarkable. Her physical examination showed a 2-cm mass in the left preauricular region. The mass was tender to the touch and mobile. There was no facial nerve paralysis or paresis. The rest of her head and neck examination was unremarkable. A fine-needle aspiration was performed. The results were nondiagnostic. Epithelial cells were obtained, but we could not make a diagnosis. She was offered an additional fine-needle aspiration, even with the use of ultrasound needle-guided aspiration, but she refused. Therefore, a computed tomography (CT) scan was obtained, which showed a cystic lesion near the parotid gland but did not involve the parotid gland (Fig 1). Because the pain was becoming unbearable and there was no diagnosis of this cystic lesion, she was offered surgery. She was taken to the operating room where a superficial parotidectomy was performed for exposure. The cystic lesion involved the left temporomandibular joint. The cystic lesion was removed, and the entire joint and capsule of the temporomandibular joint was reconstructed at the time of surgery. Pathological examination showed that this was a synovial ganglion cyst of the left temporomandibular joint. She was followed up in 1 week with no complications. She admitted her pain was gone. Postoperatively, she had no pain on chewing. Six months postoperatively, she only complained of occasional temporomandibular joint problems, which were very mild compared with her past history.

Introduction Microfracture technique has become increasingly popular among orthopaedic surgeons for the treatment of chondral defects in several joints due to its effectiveness, low cost, and ease of performance. Arthroscopic microfracture for full thickness chondral defects of the knee has been reported in elite athletes with good clinical outcomes and adequate return to sport percentages. Very few data have been reported regarding return to sport following arthroscopic microfracture in the hip in elite level athletes. Methods Forty-one elite level athletes were initially identified who underwent arthroscopic microfracture performed by a single surgeon (MJP) between 1999 and 2008. Thirty-four elite level athletes met the inclusion criteria of a discrete Outerbridge grade IV chondral lesion either on the femoral head (N=3), acetabulum (N=27), or both (N=4), which was amenable to microfracture, and had a desire to return to a professional career. Sports played at the elite level included hockey, soccer, football, baseball, tennis, and golf. All patients underwent concomitant labral debridement (N=8), repair (N=23), or reconstruction (N=3). Data were obtained including number of games played and number of seasons played at an elite level following arthroscopic microfracture. Results Seventy-nine percent (27 of 34) of elite athletes who underwent microfracture surgery returned to play at an elite level. Twenty-seven athletes returned to play for an average of 4 seasons following the index procedure (range: 1-11 seasons). Twenty-six (96%) athletes returned to play the same season or the season following the index procedure. The six of the seven athletes (2 soccer, 3 hockey, 1 baseball, 1 football) who did not return to play underwent a concomitant labral repair, and one underwent a labral reconstruction. Conclusion Professional athletes with a discrete, full thickness chondral defect of the hip are able to return to the elite level following an arthroscopic microfracture procedure.