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Biomedical subjects

Riley J Williams

Publications and source records attributed to Riley J Williams.

At least 19 recordsLinked to original sources
PubMed2006

Medial ulnar collateral ligament reconstruction of the elbow in throwing athletes.

BACKGROUND: Medial ulnar collateral ligament insufficiency of the elbow can be a devastating injury in the throwing athlete. Reconstruction of the medial ulnar collateral ligament was initially described by Jobe and associates; good clinical results have been described after this procedure. The authors' experience with this technique raised several concerns, and thus the "docking" procedure was developed as an alternative method for medial ulnar collateral ligament reconstruction of the elbow. The early results of the docking technique were good. The authors wish to investigate the intermediate-term clinical results of this method in a large group of athletes. HYPOTHESIS: The docking technique can return overhead-throwing athletes to sport with minimal perioperative morbidity. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: During a 3-year period, 100 consecutive overhead-throwing athletes were treated with surgical reconstruction using the docking technique. The inclusion criteria were as follows: (1) a history of medial elbow pain that prevented throwing, (2) a preoperative standard noncontrast magnetic resonance image demonstrating medial ulnar collateral ligament injury, (3) clinically apparent medial ulnar collateral ligament insufficiency, and (4) an overhead-throwing athlete. At the time of surgery, all patients underwent routine arthroscopic assessment. The ulnar nerve was transposed in 22 cases. The mean follow-up was 36 months (range, 24-60 months). RESULTS: Ninety of 100 (90%) patients were able to compete at the same or a higher level than before medial ulnar collateral ligament injury for more than 12 months as noted at the follow-up interval; 7 patients were able to compete at a lower level. Only 3 patients suffered postoperative complications. CONCLUSION: The docking technique reliably returns athletes to competitive throwing with a low perioperative morbidity.

Adolescent↗
PubMed2006

High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique.

BACKGROUND: Knee articular cartilage injuries in athletes present a therapeutic challenge and have been identified as an important cause of permanent disability because of the high mechanical joint stresses in athletes. PURPOSE: To determine whether microfracture treatment of knee articular cartilage injuries can return athletes to high-impact sports and to identify the factors that affect the ability to return to athletic activity. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty-two athletes who regularly participated in high-impact, pivoting sports before articular cartilage injury were treated with microfracture for single articular cartilage lesions of the knee. Functional outcome was prospectively evaluated with a minimum 2-year follow-up by subjective rating, activity-based outcome scores, and the ability for postoperative participation in high-impact, pivoting sports. RESULTS: At last follow-up, 66% of athletes reported good or excellent results. Activity of daily living, Marx activity rating scale, and Tegner activity scores increased significantly after microfracture. After an initial improvement, score decreases were observed in 47% of athletes. Forty-four percent of athletes were able to regularly participate in high-impact, pivoting sports, 57% of these at the preoperative level. Return to high-impact sports was significantly higher in athletes with age <40 years, lesion size <200 mm(2), preoperative symptoms <12 months, and no prior surgical intervention. CONCLUSION: Microfracture is an effective first-line treatment to return young athletes with short symptomatic intervals and small articular cartilage lesions of the knee back to high-impact athletics.

Activities of Daily Living↗
PubMed2006

Chondral resurfacing of articular cartilage defects in the knee with the microfracture technique. Surgical technique.

BACKGROUND: Microfracture is a frequently used technique for the repair of articular cartilage lesions of the knee. Despite the popularity of the technique, prospective information about the clinical results after microfracture is still limited. The purpose of our study was to identify the factors that affect the clinical outcome from this cartilage repair technique. METHODS: Forty-eight symptomatic patients with isolated full-thickness articular cartilage defects of the femur in a stable knee were treated with the microfracture technique. Prospective evaluation of patient outcome was performed for a minimum follow-up of twenty-four months with a combination of validated outcome scores, subjective clinical rating, and cartilage-sensitive magnetic resonance imaging. RESULTS: At the time of the latest follow-up, knee function was rated good to excellent for thirty-two patients (67%), fair for twelve patients (25%), and poor for four (8%). Significant increases in the activities of daily living scores, International Knee Documentation Committee scores, and the physical component score of the Short Form-36 were demonstrated after microfracture (p < 0.05). A lower body-mass index correlated with higher scores for the activities of daily living and SF-36 physical component, with the worst results for patients with a body-mass index of >30 kg/m(2). Significant improvement in the activities of daily living score was more frequent with a preoperative duration of symptoms of less than twelve months (p < 0.05). Magnetic resonance imaging in twenty-four knees demonstrated good repair-tissue fill in the defect in thirteen patients (54%), moderate fill in seven (29%), and poor fill in four patients (17%). The fill grade correlated with the knee function scores. All knees with good fill demonstrated improved knee function, whereas poor fill grade was associated with limited improvement and decreasing functional scores after twenty-four months. CONCLUSIONS: Microfracture repair of articular cartilage lesions in the knee results in significant functional improvement at a minimum follow-up of two years. The best short-term results are observed with good fill grade, low body-mass index, and a short duration of preoperative symptoms. A high body-mass index adversely affects short-term outcome, and a poor fill grade is associated with limited short-term durability.

Activities of Daily Living↗
PubMed2006

Pigmented villonodular synovitis.

Pigmented villonodular synovitis is a proliferative condition of the synovium. Monoarticular involvement, the most common process, occurs in two forms: localized and diffuse. The localized form is characterized by focal involvement of the synovium, with either nodular or pedunculated masses; the diffuse form affects virtually the entire synovium. The localized form has an excellent prognosis and a low recurrence rate when managed surgically. The more common diffuse form has a reported recurrence rate of up to 46%. Although the condition can present in any joint, the knee is the most commonly affected site. Pigmented villonodular synovitis is often aggressive, with marked extra-articular extension. Open synovectomy is the standard method of management. Arthroscopic synovectomy, which has gained popularity, has several advantages over the open technique, but it is associated with higher recurrence rates in diffuse pigmented villonodular synovitis. Synovectomy by any approach, however, may prevent secondary osteoarthritis and subsequent joint arthroplasty. Radiation-induced synovectomy has shown mixed results. Combined surgical and nonsurgical approaches may be necessary, and in some patients, total joint arthroplasty may be the only effective treatment.

Humans↗
PubMed2005

Anterior cruciate ligament reconstruction with a four-strand hamstring tendon autograft. Surgical technique.

BACKGROUND: In this study, we analyzed the clinical outcomes at a minimum of two years following reconstruction of the anterior cruciate ligament with use of a four-strand hamstring tendon autograft in patients who had presented with a symptomatic torn anterior cruciate ligament. METHODS: One hundred and twenty-two consecutive patients who had an isolated, symptomatic anterior tibial subluxation associated with rupture of the anterior cruciate ligament were treated with reconstruction of the anterior cruciate ligament with a four-strand autologous semitendinosus-gracilis tendon graft. One surgeon performed all of the operations. Prior to surgery and at the follow-up examination, physical findings and functional scores were recorded and knee radiographs were analyzed. Following surgery, a six-month rehabilitation regimen was implemented. RESULTS: Eighty-five patients (70%) were available for follow-up, which included physical examination, scoring of function, KT-1000 arthrometric testing, and radiographs, at a mean of twenty-eight months. Seventy-six (89%) of the patients had negative Lachman and pivot shift tests. The mean Lysholm score improved from 55 points preoperatively to 91 points at the time of follow-up (p < 0.01). The mean Tegner score improved from 5 to 6 points (p < 0.01). Sixty-five patients had <3 mm of knee translation on arthrometric testing, but six patients with marked laxity were not tested. Three patients (4%) had a positive pivot shift test but had no history of additional trauma to the knee. Six patients (7%) had a traumatic rupture of the graft, occurring at a mean of 10.7 months postoperatively. Assessment of the follow-up radiographs demonstrated no evidence of progressive degenerative change compared with the appearance on the preoperative radiographs. However, tunnel expansion was noted in all patients. The tibial tunnel expanded a mean of 17% (range, 0% to 32%), and the femoral tunnel expanded a mean of 29% (range, 0% to 40%). CONCLUSIONS: Reconstruction of the anterior cruciate ligament with use of a four-strand hamstring tendon autograft eliminated anterior tibial subluxation in 89% of patients who were examined at a minimum of two years postoperatively. The overall rate of failure was 11%. The functional knee scores were significantly increased at the time of follow-up, but these results did not correlate with the results of knee arthrometric testing.

Anterior Cruciate Ligament↗
PubMed2005

The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study.

BACKGROUND: Microfracture is a frequently used technique for the repair of articular cartilage lesions of the knee. Despite the popularity of the technique, prospective information about the clinical results after microfracture is still limited. The purpose of our study was to identify the factors that affect the clinical outcome from this cartilage repair technique. METHODS: Forty-eight symptomatic patients with isolated full-thickness articular cartilage defects of the femur in a stable knee were treated with the microfracture technique. Prospective evaluation of patient outcome was performed for a minimum follow-up of twenty-four months with a combination of validated outcome scores, subjective clinical rating, and cartilage-sensitive magnetic resonance imaging. RESULTS: At the time of the latest follow-up, knee function was rated good to excellent for thirty-two patients (67%), fair for twelve patients (25%), and poor for four (8%). Significant increases in the activities of daily living scores, International Knee Documentation Committee scores, and the physical component score of the Short Form-36 were demonstrated after microfracture (p < 0.05). A lower body-mass index correlated with higher scores for the activities of daily living and SF-36 physical component, with the worst results for patients with a body-mass index of >30 kg/m(2). Significant improvement in the activities of daily living score was more frequent with a preoperative duration of symptoms of less than twelve months (p < 0.05). Magnetic resonance imaging in twenty-four knees demonstrated good repair-tissue fill in the defect in thirteen patients (54%), moderate fill in seven (29%), and poor fill in four patients (17%). The fill grade correlated with the knee function scores. All knees with good fill demonstrated improved knee function, whereas poor fill grade was associated with limited improvement and decreasing functional scores after twenty-four months. CONCLUSIONS: Microfracture repair of articular cartilage lesions in the knee results in significant functional improvement at a minimum follow-up of two years. The best short-term results are observed with good fill grade, low body-mass index, and a short duration of preoperative symptoms. A high body-mass index adversely affects short-term outcome, and a poor fill grade is associated with limited short-term durability.

Activities of Daily Living↗
PubMed2004

Anterior cruciate ligament reconstruction with a four-strand hamstring tendon autograft.

BACKGROUND: In this study, we analyzed the clinical outcomes at a minimum of two years following reconstruction of the anterior cruciate ligament with use of a four-strand hamstring tendon autograft in patients who had presented with a symptomatic torn anterior cruciate ligament. METHODS: One hundred and twenty-two consecutive patients who had an isolated, symptomatic anterior tibial subluxation associated with rupture of the anterior cruciate ligament were treated with reconstruction of the anterior cruciate ligament with a four-strand autologous semitendinosus-gracilis tendon graft. One surgeon performed all of the operations. Prior to surgery and at the follow-up examination, physical findings and functional scores were recorded and knee radiographs were analyzed. Following surgery, a six-month rehabilitation regimen was implemented. RESULTS: Eighty-five patients (70%) were available for follow-up, which included physical examination, scoring of function, KT-1000 arthrometric testing, and radiographs, at a mean of twenty-eight months. Seventy-six (89%) of the patients had negative Lachman and pivot shift tests. The mean Lysholm score improved from 55 points preoperatively to 91 points at the time of follow-up (p < 0.01). The mean Tegner score improved from 5 to 6 points (p < 0.01). Sixty-five patients had <3 mm of knee translation on arthrometric testing, but six patients with marked laxity were not tested. Three patients (4%) had a positive pivot shift test but had no history of additional trauma to the knee. Six patients (7%) had a traumatic rupture of the graft, occurring at a mean of 10.7 months postoperatively. Assessment of the follow-up radiographs demonstrated no evidence of progressive degenerative change compared with the appearance on the preoperative radiographs. However, tunnel expansion was noted in all patients. The tibial tunnel expanded a mean of 17% (range, 0% to 32%), and the femoral tunnel expanded a mean of 29% (range, 0% to 40%). CONCLUSIONS: Reconstruction of the anterior cruciate ligament with use of a four-strand hamstring tendon autograft eliminated anterior tibial subluxation in 89% of patients who were examined at a minimum of two years postoperatively. The overall rate of failure was 11%. The functional knee scores were significantly increased at the time of follow-up, but these results did not correlate with the results of knee arthrometric testing.

Adolescent↗
PubMed2004

Medial collateral ligament tears in the throwing athlete.

Medial collateral ligament (MCL) injuries of the elbow in throwing athletes are part of a spectrum of valgus extension overload injuries. Clinicians should consider reconstruction of the injured MCL in those patients who are unable to return to sports activities or work after an interval of rest and rehabilitation. Surgical treatment of this disorder has continued to evolve from the original technique developed by Jobe and associates. The authors' surgical technique involves reconstruction of the MCL using a single ulnar tunnel and single humeral tunnel that is performed through a muscle-splitting approach that usually obviates the need for ulnar nerve transposition. Knowledge of the biology and biomechanics of MCL function is important in the diagnosis and treatment of MCL injuries of the elbow in the throwing athlete.

Arthroplasty↗
PubMed2003

Arthritis and osteotomies in anterior cruciate ligament reconstruction.

Unfortunately, young patients with active life-styles who present with an ACL-deficient knee and early evidence of arthritis remain a very difficult population to treat. Arthroscopic ACL reconstruction is a proven and effective way to treat patients with anterior knee instability [2]. In addition, numerous authors have demonstrated that knee osteotomies are effective in addressing isolated medial or lateral compartment degenerative disease, even in the presence of anterior knee instability [7, 9, 22, 43]. A comprehensive evaluation of pain, alignment, and stability are necessary in order to formulate the best treatment plan for each patient. Patients with combined chronic instability secondary to ACL insufficiency and unicompartmental arthritis will generally benefit from arthroscopic debridement, ACL reconstruction, knee osteotomy, or any combination thereof. Expectations of patients should be managed according to their underlying pathology, and this is a critical component for the success of the surgery. Most patients will get some degree of symptomatic relief and functional improvement. A return to competitive or high-level sports is an unrealistic goal, however, and should be discouraged.

Anterior Cruciate Ligament↗
PubMed2003

Orbital fractures in sport: a review.

Orbital fractures represent a small proportion of sports-related injuries in the US and abroad. However, the significant functional and cosmetic sequelae of such fractures warrant a comprehensive evaluation of any athlete sustaining facial trauma. Initial evaluation is directed at excluding neurological impairment or the presence of vision-threatening injury. Subsequent examination should ascertain the presence of signs and symptoms consistent with orbital fracture. These include gross bony deformity, limitation of gaze, diplopia and malposition of the globe. The presence of any of the aforementioned symptoms should prompt further investigation using computed tomography to corroborate or refute clinical suspicion. Orbital fracture mandates referral to an ophthalmologist or oculoplastic surgeon; initial management is dictated by the severity of functional symptoms, and may necessitate early surgical intervention. Those patients who are managed conservatively should return for frequent follow-up, as progressive diplopia, enophthalmos, or gaze limitation are indications for late operative repair. The majority of patients who sustain orbital fractures are able to return to sport, however, persistent diplopia is not uncommon, and may persist despite optimal treatment.

Athletic Injuries↗
PubMed2003

The short-term outcome of surgical treatment for painful varus arthritis in association with chronic ACL deficiency.

A review of patients with anterior cruciate ligament (ACL) insufficiency, symptomatic medial compartment osteoarthritis, and varus malalignment of the knee was performed. Twenty-six patients met the inclusion criteria. Twelve patients were treated with a valgus closing-wedge high tibial osteotomy (group 1). Fourteen patients were treated with a valgus closing-wedge high tibial osteotomy combined with arthroscopic ACL reconstruction (group 2). Twenty-five patients were available for follow-up at a minimum of 2 years. For group 1 patients, high tibial osteotomy alone had no effect on the Lachman test or pivot shift phenomena. For group 2 patients, combined high tibial osteotomy/ACL reconstruction resulted in a grade 1 Lachman test in 11 of 13 patients, and a negative pivot shift in 12 of 13 patients. No deficits in range of motion were noted in either group. Prior to surgery, 14 (56%) patients participated in recreational sports; 23 (92%) patients were able to participate in recreational sports at follow-up. Radiographs demonstrated osteoarthritic progression in group 1 and 2 patients (P<.05). The results of this study suggest that high tibial osteotomy alone and combined high tibial osteotomy/ACL reconstructions are effective in the surgical treatment of varus, ACL-deficient knees with symptomatic medial compartment arthritis; however, good or excellent results were more often seen after the combined procedure.

Adult↗
PubMedDate not supplied

Open posterior stabilization for recurrent posterior glenohumeral instability.

Open posterior capsular shift is used for posterior glenohumeral instability that has failed nonoperative treatment. Few series have fully evaluated the outcome after open posterior stabilization. The purpose of this series was to evaluate the clinical and radiographic outcome after open posterior stabilization of the shoulder. Preoperative and intraoperative factors were analyzed with regard to their impact on results. Forty-eight consecutive shoulders were identified that had undergone primary open shoulder stabilization by use of open posterior capsular shift. Of the shoulders, 4 were lost to follow-up, resulting in a study group of 44 shoulders in 41 patients. Shoulders were evaluated at a range of 1.8 to 22.5 years after surgery by use of the L'Insalata shoulder form, Short Form-36 (SF-36), and a subjective shoulder rating in 44 shoulders. Thirty-nine shoulders were evaluated by physical examination, and thirty-seven underwent radiographic examination. A recurrence of posterior instability occurred in 8 shoulders (19%). Of the patients, 84% were satisfied with the current status of their shoulder. The mean L'Insalata score was 81.25+/-17.8 points, the mean SF-36 physical component score was 50.81+/-7.87, and the mean mental component score was 53.82+/-7.55. Significantly poorer satisfaction and outcome scores were seen in shoulders found to have a chondral defect at the time of stabilization and in patients aged greater than 37 years at the time of surgery. No progressive radiographic signs of glenohumeral arthritis were seen up to 22 years after surgery. Open posterior shoulder stabilization is a reliable procedure for treating significant posterior instability without causing arthritic changes. Patients found to have chondral damage within the shoulder and older patients were found to have less success after stabilization.

Adolescent↗
PubMedDate not supplied

Differential patterns of muscle activation in patients with symptomatic and asymptomatic rotator cuff tears.

Patients with rotator cuff tears have varying degrees of symptom expression. Our purpose was to evaluate the differential firing patterns of the rotator cuff, deltoid, and scapular stabilizer muscle groups in normal control subjects and in patients with symptomatic and asymptomatic 2-tendon rotator cuff tears. Eighteen subjects were evaluated: six normal subjects and twelve with 2-tendon cuff tears (six asymptomatic and six symptomatic). All cuff tear patients had magnetic resonance imaging (MRI) scans documenting superoposterior tear configurations involving the supraspinatus and infraspinatus tendons; all normal subjects had an ultrasound examination confirming the absence of cuff pathology. Subjects were grouped based on shoulder examination and outcomes questionnaires. Asymptomatic patients had minimal pain (<3 on the visual analog scale and no loss of active range of motion compared with the contralateral side); symptomatic patients had pain greater than 3 on the visual analog scale and decreased range of motion compared with the contralateral side (>10 degrees of motion loss). Electromyographic activity from 12 muscles and kinematic data were collected simultaneously during 10 functional tasks. Both symptomatic and asymptomatic cuff subjects demonstrated a trend toward increased muscle activation during all tasks compared with normal subjects. During the internal rotation tasks, asymptomatic patients had significantly greater (P<.05) subscapularis activity than symptomatic patients (65% maximal voluntary contraction [MVC] vs 42% MVC). During the carrying task, asymptomatic patients demonstrated significantly less (P<.03) upper trapezius muscle activation than symptomatic patients (16% MVC vs 50% MVC). During shoulder elevation tasks, symptomatic patients had significantly greater supraspinatus (52% MVC vs 28% MVC, P<.03), infraspinatus (32% MVC vs 16% MVC, P<.05), and upper trapezius (39% MVC vs 20% MVC, P<.04) muscle activation compared with asymptomatic patients. During heavy elevation (8 lb), asymptomatic patients showed a trend toward increased activation (P<.06) of the subscapularis compared with symptomatic patients (34% MVC vs 21% MVC). Differential shoulder muscle firing patterns in patients with rotator cuff pathology may play a role in the presence or absence of symptoms. Asymptomatic subjects demonstrated increased firing of the intact subscapularis, whereas symptomatic subjects continued to rely on torn rotator cuff tendons and periscapular muscle substitution, resulting in compromised function.

Adult↗
PubMedDate not supplied

Chondrocyte survival and material properties of hypothermically stored cartilage: an evaluation of tissue used for osteochondral allograft transplantation.

BACKGROUND: There is little information available on the material properties of hypothermically stored allograft specimens used to repair osteochondral defects. PURPOSE: To analyze the effect of hypothermic storage on the material properties of fresh knee specimens over a 60-day interval. STUDY DESIGN: Controlled laboratory study. METHODS: Twelve sheep knee condyles were isolated. The femoral and tibial condyles and the patella were stored in a nutritive medium containing Dulbecco's Modified Eagle's Medium for 1, 8, 15, 29, 45, or 60 days. Total chondrocyte density, chondrocyte viability, matrix proteoglycan content, matrix water content, and matrix dynamic modulus of elasticity were determined. RESULTS: Mean chondrocyte viability decreased significantly over the storage interval: 100% (day 1), 98.2% (day 8), *80.2% (day 15), *80.6% (day 29), *64.6% (day 45), and *51.6% (day 60) (* P < 0.05). Qualitative analysis demonstrated a preponderance of nonviable chondrocytes in the superficial cartilage layer. Significant decreases in matrix proteoglycan were observed in day 15 through day 60 specimens (P < 0.05). The matrix dynamic modulus significantly decreased from day 1 through day 60 (P < 0.05). CONCLUSION: The material properties of hypothermically stored knee condyles progressively decline over 60 days. CLINICAL RELEVANCE: This observed decline may have significant ramifications on long-term graft survival following stored-allograft implantation.

Analysis of Variance↗
PubMedDate not supplied

Medial collateral ligament reconstruction of the elbow using the docking technique.

BACKGROUND: Medial collateral ligament insufficiency of the elbow with resultant valgus instability in throwing athletes is typically treated with free tendon graft reconstruction as described by Jobe. HYPOTHESIS: Improved results could be obtained with the use of the docking technique. STUDY DESIGN: Uncontrolled retrospective review. METHODS: The study group consisted of 36 athletes who had symptomatic insufficiency of the medial collateral ligament confirmed by magnetic resonance imaging and by surgical findings. Average follow-up was 3.3 years. Key elements of the docking technique included a muscle-splitting approach without routine transposition of the ulnar nerve, routine arthroscopic assessment, treatment of associated lesions, and docking the two ends of the tendon graft into a single humeral tunnel. RESULTS: Thirty-three of 36 patients (92%) returned to or exceeded their previous level of competition for at least 1 year, meeting the Conway-Jobe classification criteria of "excellent." All 22 professional or collegiate athletes returned to or exceeded their previous competition level. CONCLUSIONS: The docking technique allowed simplified graft tensioning and improved graft fixation.

Adolescent↗
PubMedDate not supplied

Electromyographic analysis and phase definition of the overhead football throw.

BACKGROUND: The phases of the football throw need definition so that muscle activation patterns during the overhead football throw can be fully described. HYPOTHESIS: Electromyographic analysis of shoulder musculature can better define muscle activation patterns during the football throw. STUDY DESIGN: Descriptive anatomic study. METHODS: Videos of 20 elite-level quarterbacks were reviewed to define phases of the overhead football throw; 14 recreational male athletes underwent electromyography and motion analysis testing. RESULTS: Four sequential phases of the football throw were consistently observed. Early cocking (49% +/- 11% of throw) was initiated at rear foot plant and continued to maximal shoulder abduction and internal rotation. Late cocking (20% +/- 6%) started at maximal shoulder abduction and internal rotation and ended with maximal shoulder external rotation. The acceleration phase (15% +/- 4%) began with maximal shoulder external rotation and ended with ball release. Follow-through (16% +/- 5%) was defined as the phase from ball release to maximal horizontal adduction (across the body). CONCLUSION: The four phases demonstrated little variation in motion analysis and electromyographic activation between subjects and were associated with muscle activation patterns consistent with upper extremity movements. CLINICAL RELEVANCE: A clearer understanding of muscle activation patterns may help to explain patterns of muscle injury and improve rehabilitation protocols in football-throwing athletes.

Adult↗
PubMedDate not supplied

Arthroscopic repair for traumatic posterior shoulder instability.

BACKGROUND: The role of arthroscopic repair in the treatment of posterior shoulder instability remains poorly defined. PURPOSE: To evaluate the results of arthroscopic repair of posterior Bankart lesions. STUDY DESIGN: Retrospective review. METHODS: Records were reviewed of 27 shoulders (26 patients). All of the patients were male with a mean age of 28.7 years; in all cases symptoms were preceded by a traumatic event. Fourteen of the patients had 2+ to 3+ posterior translation noted under preoperative anesthesia. The posterior capsulolabral complex was found to be detached from the glenoid rim in all cases; bioabsorbable tack fixation was used for repair. RESULTS: At a mean follow-up of 5.1 years, no patients demonstrated a range of motion deficit. Muscle weakness (grade 4/5) in external rotation was noted in two patients (8%). There was no instability greater than 1+ in the anterior, posterior, or inferior directions. The mean L'Insalata shoulder score was 90.0 +/- 13.9. The mean SF-36 physical and mental component scores were 50.4 +/- 7 and 53.9 +/- 9, respectively. Symptoms of pain and instability were eliminated in 24 patients (92%). Two patients (8%) required additional surgery after arthroscopic repair of the posterior Bankart lesion. Radiographs demonstrated that there had been no progressive glenohumeral joint degeneration. CONCLUSIONS: Arthroscopic repair of the posterior capsulolabral complex is an effective means of eliminating symptoms of pain and instability associated with posterior Bankart lesions of traumatic origin.

Absorbable Implants↗
PubMedDate not supplied

Hip arthroscopy: current indications, treatment options, and management issues.

The management of hip injuries in athletes has evolved significantly in the past few years with the advancement of arthroscopic techniques. The application of minimally invasive surgical techniques has facilitated relatively rapid returns to sporting activity in both recreational and elite athletes. Recent advancements in both hip arthroscopy and magnetic resonance imaging have elucidated several sources of intraarticular abnormalities that result in chronic and disabling hip symptoms. Many of these conditions were previously unrecognized and, thus, left untreated. Current indications for hip arthroscopy include the presence of symptomatic acetabular labral tears, hip capsule laxity and instability, chondral lesions, osteochondritis dissecans, ligamentum teres injuries, snapping hip syndrome, iliopsoas bursitis, and loose bodies (for example, synovial chondromatosis). Less common indications include management of osteonecrosis of the femoral head, bony impingment, synovial abnormalities, crystalline hip arthropathy (gout and pseudogout), infection, and posttraumatic intraarticular debris. In rare cases, hip arthroscopy can be used to temporize the symptoms of mild-to-moderate hip osteoarthritis with associated mechanical symptoms. This article discusses the current clinical and radiographic methods to detect early hip joint disease and the current indications and surgical techniques of hip arthroscopy.

Arthroscopy↗