Jennifer Hart

All-Inside Meniscal Repair Using a New Flexible, Tensionable Device

Background A new generation of flexible all-inside meniscal repair devices is available, but clinical studies with these devices are lacking. Hypothesis The RapidLoc has an intermediate-term meniscal healing rate that is equivalent to literature reports of inside-out suture technique in patients undergoing concurrent anterior cruciate ligament reconstruction. Study Design Case series; Level of evidence, 4. Methods Retrospective analysis was performed for 75 meniscal tears in 66 consecutive patients undergoing anterior cruciate ligament reconstruction who underwent meniscal repair with the RapidLoc. Patients with at least 2 years’ follow-up were evaluated for symptoms suggestive of a meniscal tear and were assessed with the International Knee Documentation Committee form and the Knee Disorders Subjective History visual analog scale. Subjects were asked to return for a clinical examination to include evaluation for an effusion and joint line tenderness as well as McMurray test and KT-1000 arthrometry readings. Patients with symptoms consistent with meniscal repair failure underwent magnetic resonance arthrography and repeat arthroscopy. Results Twenty patients with 21 meniscal tears were excluded, resulting in 54 meniscal tears in 46 patients. At a mean follow-up of 34.8 months, the clinical success rate for meniscal repair was 90.7% (49/54), with 5 failures requiring meniscectomy. Univariate analysis revealed predictive variables for failure: bucket-handle configuration, multiplanar tears, tear length greater than 2 cm, and chronicity longer than 3 months. Nonpredictive variables included compartment, zone, ligament graft choice, gender, age, follow-up, and visual analog scale score. Analysis of healed patients revealed a negative correlation between chronicity of tear and International Knee Documentation Committee score. Conclusions The RapidLoc has an acceptable intermediate-term clinical healing rate in patients undergoing concurrent anterior cruciate ligament reconstruction. Predictive variables for failure should be considered during operative decision making.

Arthroscopic Rotator Cuff Repair Using the Opus Knotless Suture Anchor Fixation System

Background The reported failure rate of arthroscopic rotator cuff repair varies widely. The influence of repair technique on failure rates and functional outcomes after arthroscopic cuff repair remains controversial. Purpose To determine the functional outcome of arthroscopic knotless fixation using the Opus AutoCuff device for rotator cuff repair and to compare our results with those reported in the literature. Study Design Case series; Level of evidence, 4. Methods Fifty-six consecutive patients underwent arthroscopic rotator cuff repair using an Opus AutoCuff device (Arthrocare, Sunnydale, California) with greater than 2 years’ follow-up. Subjective and objective clinical examinations were performed to include the University of California at Los Angeles (UCLA) shoulder score, the American Shoulder and Elbow Surgeons (ASES) rating scale, the visual analog scale (VAS), and the Tegner Activity Level scale. Results Forty-eight patients were evaluated at a mean follow-up of 26 months (range, 24–35 months). The mean UCLA shoulder score was 33.1 of 35 (SD, 2.89) possible points, and the mean ASES rating scale was 94.2 of 100 (SD, 7.76) compared with a mean preoperative score of 65.7 (P < .001). Postoperative UCLA shoulder scores had 42 of 45 (93.3%) patients with good and excellent results. The mean preoperative ASES pain score was 1.3 (SD, 1.0), and the mean postoperative score was 4.4 (SD, 1.0) (P < .001). The Tegner Activity Level scores demonstrated restoration of function to preinjury status. There were 3 failures (6.3%), 2 by anchor failure (1 with specific trauma), and 1 by rotator cuff retear, all requiring revision surgery. Conclusion Arthroscopic knotless suture fixation with the Opus AutoCuff device results in good to excellent results similar to those reported in the literature with conventional suture anchors.

Cervical Spine Alignment in the Youth Football Athlete Recommendations for Emergency Transportation

Background Substantial literature exists regarding recommendations for the on-field treatment and subsequent transportation of adult collision-sport athletes with a suspected injury to the cervical spine. Purpose To develop an evidence-based recommendation for transportation of suspected spine-injured youth football players. Study Design Descriptive laboratory study. Methods Three lateral radiographs were obtained in supine to include the occiput to the cervical thoracic junction from 31 youth football players (8-14 years). Each child was imaged while wearing helmet and shoulder pads, without equipment, and with shoulder pads only. Two independent observers measured cervical spine angulation as Cobb angle from C1 to C7 and subaxial angulation from C2 to C7. We calculated intraclass correlation coefficients for intraobserver reliability analysis and compared Cobb and C2 to C7 angles between equipment conditions with t tests. Results Interobserver analysis showed excellent reliability among measurements. Cobb and subaxial angle measurements indicated significantly greater cervical lordosis while children wore shoulder pads only, compared with the other 2 conditions (no equipment and helmet and shoulder pads) (P < .001). There was no statistically significant difference in either Cobb or C2-C7 angles between fully equipped (helmet + shoulder pads) and no-equipment conditions (P >.05). Conclusions Equipment removal for the youth football athlete with suspected cervical spine injury should abide by the “all or none” policy that has been widely accepted for adult athletes. Helmet and shoulder pads should be left in place during emergency transport of the suspected spine-injured youth athlete. Clinical Relevance Despite differences in head to torso size ratios between youth and adult players, helmet removal alone is not recommended for either during emergency transportation.

Physical examination of the knee

Even with the rapid advancement in technology and medical imaging, there is still no substitute for the history and physical examination that can be obtained from a patient. With a well-performed history and physical, the majority of pathology can be determined prior to any expensive imaging or surgical procedures. The knee is one of the most commonly injured joints, and its function is critical to basic ambulation and participation in sports, work, and activities of daily living. This article reviews the key concepts to a complete evaluation of the knee and highlights aspects of the physical examination and radiographie imaging that best aid in diagnosing knee pathology.

Prospective, Randomized, Double Blind Evaluation of the Efficacy of a Single Dose Hyaluronic Acid for the Treatment of Patellofemoral Chondromalacia

Objectives: Introduction: Patellofemoral pain is common and is often diagnosed as chondromalacia patella in the absence of radiographic evidence of osteoarthritis. Chondromalacia patella is often painful and debilitating, affecting patients’ function, activity level and quality of life. Non-operative management is limited and focuses on physical therapy and modalities. Hyaluronic acid (HA) is an injectable device that has been used for the treatment of knee osteoarthritis. We hypothesize that a single injection of HA will reduce pain, improve function and improve muscle strength in patients who have previously failed conservative management. Methods: Methods: This was a prospective, randomized, double-blind, sham-controlled, parallel group clinical trial to compare outcomes for 6-months after a single injection of HA (Synvisc One) in the knees of patients with a diagnosis of chondromalacia patella. A total of 86 patients with a clinical diagnosis of chondromalacia (65F/21 M, 27.0±7.7years, 168.6±8.9 cm, 74.6±17.0 kg, BMI 26.0±5.2) including no radiographic evidence of tibiofemoral or patellofemoral osteoarthritis were recruited and enrolled in this study. All patients failed at least 1 month of conservative management including a program of therapeutic quadriceps strengthening exercises under a physical therapist’s direction. Patients were evaluated by blinded observers. Outcome assessments included patellofemoral pain assessment using a visual analog scale during a single leg squat, knee osteoarthritis outcome score (KOOS), Tegner activity rating and normalized isometric knee extension strength. After baseline measurements, patients were randomly allocated to either 6 cc of HA or a sham injection (needle stick) and visually shielded during injection for blinding. All patients were prescribed an additional home exercise program including lower extremity strengthening and flexibility exercises and followed at 1, 3 and 6 months. Group assignment was revealed to the patients after the 6 month outcome assessment and crossover treatment offered to patients receiving the sham injection who were still symptomatic. Repeated measures ANOVA was used to compare outcomes between groups and across time. Results: Results: 45 patients were randomized to HA injection, 41 to sham, and 5 patients were lost to follow up (93% follow up rate). Patients in both groups experienced a significant reduction in visual analog pain ratings and significant increases in all domains of the KOOS at the 6 months compared to baseline measurement (P<0.05); however, there was no significant difference between groups. There were no differences observed over time or between groups for normalized knee extension strength or Tegner activity rating (P<0.05). Conclusion: Conclusion: We observed improvements in patient reported pain and function with no change in quadriceps strength or activity rating. HA injections did not have an effect at 6 months after injection. HA injection had no effect on pain or functional outcomes in patients with a clinical diagnosis of chondromalacia patella.