James Bicos

Current Concepts Review The Medial Patellofemoral Ligament

Awareness of the medial patellofemoral ligament has increased markedly over the past decade. Previously, this structure, which was delineated in anatomical studies, had been little recognized and underestimated with regard to its importance in stabilizing the patella. The goal of this review of the medial patellofemoral ligament is to develop a current understanding of how this ligament functions in patellofemoral stability and to review the current treatment options for medial patellofemoral ligament disruption.

Evaluation and Treatment of Acromioclavicular Joint Injuries

Acromioclavicular joint injuries and, more specifically, separations are commonplace both in general practice and during athletic participation. This article reviews the traditional classification as well as the clinical evaluation of patients with acute and chronic acromioclavicular joint separations. It also highlights many recent advances, principally in the anatomy and biomechanics of the acromioclavicular joint ligamentous complex. The concept of increases in superior translation as well as disturbances in horizontal translation with injuries to this joint and ligaments are discussed. This information, coupled with the unpredictable longterm results with the Weaver-Dunn procedure and its modifications, have prompted many recent biomechanical studies evaluating potential improvements in the surgical management of acute and chronic injuries. The authors present these recent works investigating cyclic loading and ultimate failure of traditional reconstructions, augmentations, use of free graft, and the more recent anatomic reconstruction of the conoid and trapezoid ligaments. The clinical results (largely retrospective), including acromioclavicular joint repair, reconstruction and augmentation with the coracoclavicular ligament, supplemental sutures, and the use of free autogenous grafts, are summarized. Finally, complications and the concept of the failed distal clavicle resection and reconstruction are addressed. The intent is to provide a current, in-depth treatise on all aspects of acromioclavicular joint complex injuries to include anatomy, biomechanics, benchmark studies on instability and reconstruction, clinical and radiographic evaluation, and to present the most recent clinical research on surgical outcomes.

Novel approach for reconstruction of the posterolateral corner using a free tendon graft technique.

Injuries to the lateral collateral ligament (LCL) and posterolateral corner of the knee, particularly when combined with anterior cruciate or posterior cruciate ligament injuries, can result in profound symptomatic knee instability. Although many surgical improvements have been made in the reconstruction of anterior and posterior cruciate ligament injuries, reconstruction of the posterolateral corner has had less predictable results, with residual pathologic laxity especially in the chronic situation. This has stimulated many surgeons to recommend acute repair of posterolateral knee injuries. This article will briefly review the relevant surgical anatomy, present a summary of current reconstructive techniques for the posterolateral corner, and describe our preferred method for anatomic reconstruction of the posterolateral corner for chronic instability of the knee by recreating the LCL and popliteofibular ligament using either autogenous or allograft soft tissue and an interference screw technique.We do not use a transtibial tunnel but re-orientate the transfibular tunnel and utilize 2 femoral tunnels an the attempt to recreate the LCL and popliteus tendon. In a small clinical series, this has proven to restore varus rotation and external rotation patholaxities with a high degree of predictability.

Articular Cartilage Thickness of the Humeral Head: An Anatomic Study

This study determined the thickness of normal humeral head articular cartilage by anatomic cross section using computer-aided image analysis software. Sixteen adult cadaveric humeral heads were analyzed. Our findings reveal that the thickness of humeral articular cartilage is substantially thinner than articular cartilage found in the knee. The cartilage is thickest in the central portion of the head and becomes progressively thinner towards the periphery. Surgical techniques used to treat pathology in the glenohumeral joint, specifically thermal energy or mechanical debridement, may have deleterious effects on the relatively thin humeral articular cartilage.

The Glenoid Center Line

This study sought to define a point on the anterior glenoid surface to serve as a marker for glenoid orientation and to present the concept of a glenoacromial version angle. Twenty fresh-frozen cadaver scapulas were examined. A line perpendicular to the glenoid surface exited the anterior scapular cortex in all specimens at an average distance of 29.3 +/- 3.9 mm. The average glenoacromial version angle was 60 degrees +/- 110 degrees. These numbers may allow better intraoperative assessment of glenoid version.

Repair of Distal Biceps Tendon Ruptures Using a Combined Anatomic Interference Screw and Cortical Button

Complete and partial ruptures of the distal biceps tendonseem to be occurring with an increased frequency. Thistrend is probably the result of increased demands placedon the upper extremities, as well as increased activity inthe middle-aged population. Treatment options have ex-panded in an effort to use modern fixation methods toreturn patients to work or athletics more quickly.Originally, a single extensile anterior exposure wasused to reinsert the avulsed tendon. Boyd and Andersonsubsequently described a 2-incision technique designedtominimizeanteriorexposureandlimittherisk toneuro-vascular structures in proximity to the tuberosity.

Biomechanics and anatomy of the proximal biceps tendon.

With the role of the biceps tendon being the source of considerable controversy, the treatment of its disease has been even more confusing. Our understanding of its role in shoulder pathology has ranged from describing it as a vestigial structure, to a vital structure of shoulder function with distinct disease pathology. This chapter analyzes the anatomic and biomechanical functions of the proximal biceps tendon.

The Multi-suture Technique for Rotator Cuff Repair: A Biomechanical Evaluation

Multi-suture fixation of supraspinatus rotator cuff tears provides excellent fixation and biomechanical failure characteristics.