Eric J. Kropf

Does the lateral intercondylar ridge disappear in ACL deficient patients

The aim of this study was to determine whether there is a difference in the presence of the lateral intercondylar ridge and the lateral bifurcate ridge between patients with sub-acute and chronic ACL injuries. We hypothesized that the ridges would be present less often with chronic ACL deficiency. Twenty-five patients with a chronic ACL injury were matched for age and gender to 25 patients with a sub-acute ACL injury. The lateral intercondylar ridge and lateral bifurcate ridge were scored as either present, absent, or indeterminate due to insufficient visualization by three blinded observers. The kappa for the three observers was .61 for the lateral intercondylar ridge and .58 for the lateral bifurcate ridge. The lateral intercondylar ridge was present in 88% of the sub-acute patients and 88% of the chronic patients. The lateral bifurcate ridge was present in 48% of the sub-acute and 48% of the chronic patients. This matched-pairs case–control study was unable to show a difference in the presence of the femoral bony ridges between patients with acute and chronic ACL injuries. The authors would suggest looking for the ridges as a landmark of the native ACL insertion site during ACL reconstruction in both acute and chronic ACL injuries.

Factors that influence the intra-articular rupture pattern of the ACL graft following single-bundle reconstruction

PurposesThe number of revision anterior cruciate ligament (ACL) surgeries performed annually continues to rise. The purpose of this study was to determine the most common rupture pattern in ACL revision cases after previous single-bundle reconstruction. The second aim was to determine the relationship between rupture pattern and patient-specific factors (age, gender, time between the initial ACL reconstruction and re-injury, and etiology/mechanism of failure) and surgical factors (graft type, tunnel angle).MethodsThis was a cohort study of 60 patients that underwent revision ACL surgery after previous single-bundle ACL reconstruction. Three sports medicine–trained orthopedic surgeons reviewed the arthroscopic videos and determined the rupture pattern of the grafts. The rupture pattern was then correlated to the above-mentioned factors.ResultsThe inter-observer agreement had a kappa of 0.7. The most common rupture pattern after previous single-bundle ACL reconstruction is elongation of the graft. This is different from the native ACL, which displays more proximal ruptures. With the use of autograft tissue and after a longer period of time, the rupture pattern in revision surgery is more similar to that of the native ACL.ConclusionThe most common rupture pattern after previous single-bundle reconstruction was elongation of the graft. Factors that influenced the rupture pattern were months between ACL reconstruction and re-injury and graft type.Level of evidenceCohort study, Level IV.

Management of Recurrent Posterior Shoulder Instability in a Young Contact Athlete Using a Posterior Bone Block Technique With Distal Tibia Osteochondral Allograft

Posterior glenohumeral instability is an uncommon entity that presents a challenging clinical problem. As compared with anterior glenoid bone loss and instability, the treatment of posterior glenoid deficiency with extra-articular bone graft has had mixed results. We present the surgical technique and successful long-term follow-up for the use of distal tibial osteochondral allograft for the treatment of posterior glenoid deficiency in a young male athlete after 2 failed soft tissue repairs. Our case and a review of the early results in the literature demonstrate that distal tibial allograft seems to be an effective bone graft option for posterior glenoid reconstruction in the setting of recurrent posterior glenohumeral instability. Further studies involving more subjects with long-term results are needed to guide future surgical indications.