Heber C. Crockett

Osseous Adaptation and Range of Motion at the Glenohumeral Joint in Professional Baseball Pitchers

The throwing shoulder in pitchers frequently exhibits a paradox of glenohumeral joint motion, in which excessive external rotation is present at the expense of decreased internal rotation. The object of this study was to determine the role of humeral head retroversion in relation to increased glenohumeral external rotation. Glenohumeral joint range of motion and laxity along with humeral head and glenoid version of the dominant versus nondominant shoulders were studied in 25 professional pitchers and 25 nonthrowing subjects. Each subject underwent a computed tomography scan to determine bilateral humeral head and glenoid version. The throwing group demonstrated a significant increase in the dominant shoulder versus the nondominant shoulder in humeral head retroversion, glenoid retroversion, external rotation at 90°, and external rotation in the scapular plane. Internal rotation was decreased in the dominant shoulder. Total range of motion, anterior glenohumeral laxity, and posterior glenohumeral laxity were found to be equal bilaterally. The nonthrowing group demonstrated no significant difference in humeral head retroversion, glenoid retroversion, external rotation at 90° or external rotation in the scapular plane between shoulders, and no difference in internal rotation at 90°, total motion, or laxity. A comparison of the dominant shoulders of the two groups indicated that both external rotation at 90° and humeral head retroversion were significantly greater in the throwing group.

High tibial osteotomy.

Abstract High tibial osteotomy is effective for managing a variety of knee conditions, including gonarthrosis with varus or valgus malalignment, osteochondritis dissecans, osteonecrosis, posterolateral instability, and chondral resurfacing. The fundamental goals of the procedure are to unload diseased articular surfaces and to correct angular deformity at the tibiofemoral articulation. Although the clinical success of total knee arthroplasty has resulted in fewer high tibial osteotomies being done during the past decade, the procedure remains useful in appropriately selected patients with unicompartmental knee disease. Renewed interest in high tibial osteotomy has occurred for a number of reasons. These include the prevalence of physiologically young active patients presenting with medial compartment osteoarthritis; the advent of new techniques for performing the procedure (ie, improved instrumentation and fixation plates for medial opening wedge osteotomy, dynamic external fixation for medial opening wedge osteotomy, and improved instrumentation for lateral closing wedge osteotomy); and the need to concomitantly correct malalignment when performing chondral resurfacing procedures (ie, autologous chondrocyte transplantation, mosaicplasty, and microfracture).

Local Anesthesia for Knee Arthroscopy Efficacy and Cost Benefits

We performed a retrospective review of a series of knee arthroscopic procedures that were completed using lo cal, general, or regional anesthesia to evaluate the ef ficacy of these anesthetic techniques. Operative time, complications or failures, procedures successfully per formed, recovery room time and postoperative stay, and patient satisfaction were recorded. Local anesthesia with intravenous sedation compared favorably with the other techniques: operative time was not increased, a large variety of operative procedures were successfully completed, recovery time was significantly shortened, and patient satisfaction remained high. This technique offers several advantages over other types of anesthe sia for knee arthroscopy, including improved cost ef fectiveness.

Repair of SLAP Lesions Associated With a Buford Complex: A Novel Surgical Technique

PURPOSE The purpose of this study was to analyze outcomes of a novel arthroscopic repair technique for type II SLAP lesions associated with a Buford complex. METHODS Patients selected for study enrollment had a symptomatic, isolated type II SLAP lesion and the Buford complex anatomic variant. Excluded were patients undergoing any concomitant shoulder procedure (e.g., subacromial decompression) or with any history of shoulder surgery. In addition to standard type II SLAP repair using suture anchors, the described technique also transects the cordlike middle glenohumeral ligament (MGHL) at the equator of the glenoid. This decreases postoperative stress on the repair and allows incorporation of the proximal MGHL segment for repair augmentation. The stout proximal MGHL segment is fixed to the anterosuperior glenoid rim, which is devoid of labral tissue, to enhance fixation of the SLAP repair anterior to the biceps anchor. The distal MGHL segment is left free so as to not impair external rotation. A single surgeon performed all procedures using the same surgical technique. Outcomes were assessed by University of California, Los Angeles (UCLA) and Constant shoulder scoring indexes. RESULTS Twenty-one patients were evaluated. Both UCLA and Constant shoulder scores showed a statistically significant improvement after surgery. The mean UCLA score increased from 14.3 preoperatively to 32.1 postoperatively (P < .0001). The mean Constant score improved from 39.7 to 85.0 (P < .0001). Follow-up examination was performed at a mean of 44 months after surgery (range, 23 to 75 months). No patients had evidence of postoperative instability. CONCLUSIONS For patients with a symptomatic type II SLAP tear and an associated Buford complex, using the proximal Buford MGHL to enhance repair and releasing the distal Buford MGHL segment resulted in significant improvement in outcomes at intermediate follow-up. LEVEL OF EVIDENCE Level IV, therapeutic case series.

Ulnar collateral ligament tear with concommitant extensor pollicis brevis and extensor pollicis longus disruptions: A case report

A patient with a tear of the thumb ulnar collateral ligament and simultaneous extensor pollicis brevis and extensor pollicis longus disruptions is reported. No report of a similar constellation of injuries was found in the literature.