Jennifer K. Hayden

Tibiofemoral Contact Mechanics after Serial Medial Meniscectomies in the Human Cadaveric Knee

Background There is no consensus regarding the extent of meniscectomy leading to deleterious effects on tibiofemoral contact mechanics. Hypothesis The meniscus aids in optimizing tibiofemoral contact mechanics, increasing contact area, and decreasing contact stress. Study Design Controlled laboratory study. Methods Twelve fresh-frozen human cadaveric knees each underwent 15 separate testing conditions—5 serial 20-mm posterior medial meniscectomy conditions (intact, 50% radial width, 75% radial width, segmental, and total meniscectomy) at 3 flexion angles (0°, 30°, and 60°)—under an 1800-N axial load. Tekscan sensors were used to measure total force and medial force, contact area, mean contact stress, and peak contact stress. Results All posterior medial meniscectomy conditions resulted in significantly decreased contact areas and increased mean and peak contact stresses compared with the intact state (P < .05). The changes in contact mechanics after segmental and total posterior medial meniscectomies were not statistically different (P > .05). Incremental changes in contact area and mean contact stress increased as more peripheral portions of the medial meniscus were removed, whereas peak contact stresses exhibited similar incremental changes throughout all meniscectomy conditions. Conclusions The meniscus is a crucial load-bearing structure, optimizing contact area and minimizing contact stress. Loss of hoop tension (ie, segmental meniscectomy) is equivalent to total meniscectomy in load-bearing terms. The peripheral portion of the medial meniscus provides a greater contribution to increasing contact areas and decreasing mean contact stresses than does the central portion, whereas peak contact stresses increase proportionally to the amount of meniscus removed. Clinical Relevance Because the degree of meniscectomy leading to clinically significant outcomes is unknown, a prudent strategy is to preserve the greatest amount of meniscus possible.

Arthroscopic Anterior Shoulder Stabilization of Collision and Contact Athletes

Background Repair of the anterior labrum (Bankart lesion) with tightening of the ligaments (capsulorrhaphy) is the recommended treatment for recurrent anterior glenohumeral dislocations. Current evidence suggests that arthroscopic anterior stabilization methods yield similar failure rates for resubluxation and redislocation when compared to open techniques. Study Design Case series; Level of evidence, 4 Purpose To examine the results of arthroscopic anterior shoulder stabilization of high-demand collision and contact athletes. Methods Thirteen collision and 5 contact athletes were identified from the senior surgeons case registry. Analysis was limited to patients younger than 20 years who were involved in collision (football) or contact (wrestling, soccer) athletics. Objective testing included preoperative and postoperative range of motion and stability. Outcome measures included the American Shoulder and Elbow Society shoulder score, Simple Shoulder Test, SF-36, and Rowe scores. The surgical procedure was performed in a consistent manner: suture anchor repair of the displaced labrum, capsulorrhaphy with suture placement supplemented with thermal treatment of the capsule when indicated, and occasional rotator interval closure. Average follow-up was 37 months (range, 24-66 months). Results Two of 18 contact and collision athletes (11%) experienced recurrent dislocations after the procedure; both were collision athletes. One returned to play 3 years of high school football but failed after diving into a pool. One patient failed in his second season after his stabilization (> 2 years) when making a tackle. None of the contact athletes experienced a recurrent dislocation, with all of them returning to high school or college athletics. Conclusions One hundred percent of all collision and contact athletes returned to organized high school or college sports. Fifteen percent of those collision athletes had a recurrence, which has not required treatment. Participation in collision and contact athletics is not a contraindication for arthroscopic anterior shoulder stabilization using suture anchors, proper suture placement, capsulorrhaphy, and occasional rotator interval plication.

Prospective Evaluation of Prolonged Fresh Osteochondral Allograft Transplantation of the Femoral Condyle Minimum 2-Year Follow-Up

Background Focal articular cartilage lesions of the knee in young patients present a therapeutic challenge. Little information is available pertaining to the results after implantation of prolonged fresh grafts. Hypothesis Prolonged fresh osteochondral allografts present a viable option for treating large full-thickness articular cartilage lesions. Study Design Case series; Level of evidence, 4. Methods This study presents the results of 25 consecutive patients who underwent prolonged fresh osteochondral allograft transplantation for defects in the femoral condyle. The average patient age was 35 years (range, 17-49 years). The average length of follow-up was 35 months (range, 24-67 months). Prospective data were collected using several subjective scoring systems, as well as objective and radiographic assessments. Results Statistically significant improvements (P < .05) were seen for the Lysholm (39 to 67), International Knee Documentation Committee scores (29 to 58), all 5 components of the Knee injury and Osteoarthritis Outcome Score (Pain, 43 to 73; Other Disease-Specific Symptoms, 46 to 64; Activities of Daily Living Function, 56 to 83; Sport and Recreation Function, 18 to 46; Knee-Related Quality of Life, 22 to 50), and the Short Form-12 physical component score (36 to 40). Overall, patients reported 84% (range, 25% to 100%) satisfaction with their results and believed that the knee functioned at 79% (range, 35% to 100%) of their unaffected knee. Radiographically, 22 of the grafts (88%) were incorporated into host bone. Conclusion Fresh osteochondral allograft transplantation is an acceptable intermediate procedure for treatment of localized osteochondral defects of the femur. At 2-year follow-up, it is well incorporated and offered consistent improvements in pain and function. Clinical Relevance Prolonged fresh allograft transplantation is a safe and effective technique for addressing symptomatic osteoarticular lesions in the knees of young patients.

Prospective Evaluation of Allograft Meniscus Transplantation A Minimum 2-Year Follow-up

Background Clinical and biomechanical studies have demonstrated the increase in contact pressure and progressive deterioration of the tibiofemoral compartments that occur after partial or complete meniscectomy. Meniscus transplantation has been indicated for the symptomatic postmeniscectomy patient to alleviate symptoms and potentially prevent the progression of articular degeneration. Purpose To report the early-term results after allograft meniscus transplantations from a single institution performed by a single surgeon. Study Design Case series; Level of evidence, 4. Methods Forty-four meniscus transplants in 39 patients were evaluated at minimum 2-year follow-up using the Lysholm, Tegner, International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, Noyes symptom rating and sports activity, and SF-12 scoring systems; visual analog pain scales; patient satisfaction; and physical examination. Four transplants failed early, leaving 40 transplants in 36 patients for review. Patients were grouped into medial and lateral transplant groups as well as those with isolated and combined procedures. Twenty-one menisci were transplanted in isolation (52.5%), and 19 were combined with other procedures (47.5%) to address concomitant articular cartilage injury. Results Patients demonstrated statistically significant improvements in standardized outcomes surveys and visual analog pain and satisfaction scales. In 7 patients, treatment had failed at final follow-up. Overall, 77.5% of patients reported they were completely or mostly satisfied with the procedure, and 90% of patients were classified as normal or nearly normal using the International Knee Documentation Committee knee examination score at final follow-up. There were no significant differences in the medial and lateral subgroups, although the lateral subgroup did demonstrate a trend toward greater improvement. No significant differences were noted in the isolated and combined subgroups. Conclusion Meniscus transplantation alone or in combination with other reconstructive procedures results in reliable improvements in knee pain and function at minimum 2-year follow-up. Longer term studies are necessary to determine if transplantation can prevent the articular degeneration associated with meniscectomy.

Primary anterior cruciate ligament reconstruction using fresh-frozen, nonirradiated patellar tendon allograft: minimum 2-year follow-up.

Background There are conflicting reports of allograft performance, immune response, tissue incorporation, and rerupture rates when used for anterior cruciate ligament reconstruction. Purpose To evaluate the clinical outcome of a fresh-frozen, nonirradiated, patellar tendon allograft for primary anterior cruciate ligament reconstruction surgery. Study Design Case series; Level of evidence, 4. Methods Patients who underwent endoscopic primary anterior cruciate ligament reconstruction with allograft tissue a minimum of 2 years ago were evaluated with physical examinations, the KT-1000 arthrometer, functional testing, radiographic evaluation, subjective assessment, and outcomes tools. Results Fifty-nine patients (60 knees) were evaluated at an average of 51 months after surgery. Ninety-four percent of patients were mostly or completely satisfied. A negative pivot shift test result was noted in 90% of subjects. The KT-1000 arthrometer side-to-side differences were = 3 mm in 95% of patients, and no patient exceeded 5 mm. The mean International Knee Documentation Committee score was 78 (SD = 19), and the mean Lysholm score was 82 (SD = 17). There were no clinical symptoms consistent with graft rejection or infection. Radiographic evaluation demonstrated infrequent significant tunnel widening. Conclusions Use of a fresh-frozen, nonirradiated allograft for primary reconstruction of the anterior cruciate ligament is a successful procedure both subjectively and functionally for restoring stability in patients selected for allograft reconstruction. In the patients selected for this surgical procedure, clinical, arthrometric stability testing, and subjective satisfaction were comparable to our previously published cohort studies using patellar tendon autograft at similar postoperative follow-up.

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.

Internal fixation of unstable Cahill Type-2C osteochondritis dissecans lesions of the knee in adolescent patients

The treatment of osteochondritis dissecans lesions remains controversial. Twelve adolescent patients, with average 6-year follow-up, underwent compression screw fixation of unstable Cahill Type-2C osteochondritis dissecans lesions. Postoperatively, patients were evaluated with several functional tests and scoring systems, including Lysholm, IKDC, and KOOS. All lesions healed, and no clinical or radiographic evidence of degenerative disease was noted. No significant differences in thigh girth, range of motion, stability, or single-leg-hop distance was observed when compared to the unaffected, contralateral extremity. This technique is appropriate and efficacious for the treatment of unstable osteochondritis dissecans lesions.

The Effectiveness of a Pain Wrap Compared to a Standard Dressing on the Reduction of Postoperative Morbidity Following Routine Knee Arthroscopy: A Prospective Randomized Single-Blind Study

A pain wrap dressing in patients undergoing routine knee arthroscopy was evaluated to determine its ability to decrease postoperative pain and swelling. Bilateral knee examinations were performed pre- and postoperatively. Patients recorded narcotic usage and pain levels for 10 postoperative days. Twenty-four patients completed the study. The pain wrap group had lower pain ratings (2.2 versus 4.6 [P=.03]) and demonstrated lower skin temperatures (1.1 degrees F versus 3.9 degrees F [P=.02]). Less postoperative swelling was noted in the treatment patients, whereas postoperative arc of motion and narcotic usage was similar in both groups.

Prospective Randomized Single-blinded Controlled Clinical Trial of Percutaneous Neuromodulation Pain Therapy Device Versus Sham for the Osteoarthritic Knee: A Pilot Study

This pilot study presents the initial results for a percutaneous neuromodulation pain therapy device (Deepwave) that is associated with no morbidity, good pain relief, and increased function in patients with knee osteoarthritis.