Jon K. Sekiya

Comparison of Tibial Graft Fixation Between Simulated Arthroscopic and Open Inlay Techniques for Posterior Cruciate Ligament Reconstruction

Background Techniques for reconstruction of the posterior cruciate ligament continue to evolve to improve clinical results. Recent arthroscopic reconstruction methods using tibial inlay grafts require suture fixation to avoid a posterior approach to the knee. Hypothesis Early strength of the tibial fixation of posterior cruciate ligament inlay grafts, designed for an arthroscopic approach and using suture fixation, is not significantly different than that of open technique grafts using screw fixation. Study Design Controlled laboratory study. Methods Six paired human tibias were randomized to a reconstruction using an open inlay technique with two 4.0-mm cancellous lag screws or an instrumented technique suitable for an all-arthroscopic approach using 2 No. 5 Ethibond sutures tied over a button on the anterior tibial cortex. Cyclic testing of each construct was done before loading to failure. Results The loads for each group at 3-mm displacement and at 5-mm displacement were not found to be significantly different. Ultimate load for the screw group was 762 N and for the suture group was 582 N (P = .31). Stiffness was 89.8 N/mm for the screw inlays and 85.1 N/mm for the suture inlays (P = .68). Cyclic testing demonstrated no advantages of screw fixation over sutures. No suture failure was noted. Conclusion The suture fixation technique for tibial inlay posterior cruciate ligament reconstruction appears to approximate the early strength of screw fixation. Clinical Relevance Arthroscopic techniques for tibial inlay reconstruction of the posterior cruciate ligament requiring suture fixation may offer similar initial biomechanical fixation as current open inlay techniques without the need for an open posterior knee approach.

Arthroscopic Treatment of Multidirectional Instability: Thermal Technique

Multidirectional instability of the shoulder can be a difficult management problem. It usually presents in adolescents and young adults with hyperlaxity of several joints. Initial management of multidirectional instability is directed at a supervised exercise program consisting of rotator cuff, deltoid, and periscapular strengthening exercises. While conservative therapy is the mainstay of treatment and often successful, a subset of patients fails to improve, and surgical intervention is necessary to effectively restore shoulder stability.

Effect of Cortical Bone Thickness on the Magnitude and Classification of Hill Sachs Lesions Verses Glenoid Lesions

The shoulder is the most dislocated major joint in the body; approximately 2% of the population will dislocate their glenohumeral joint between the ages of 18 and 70 [1]. Hill-Sachs lesions, compression fractures resulting from the impaction of the posteroloateral humeral head against the solid anterior rim of the glenoid, occur in roughly 30–40% of all anterior dislocations. Humeral head defects have been linked to postoperative recurrent dislocations and overall instability of the shoulder following stabilization procedures for the capsule [2]. However, the forces and deformations required to create these lesions during shoulder dislocation should be identified to properly develop injury models and new repair techniques. Therefore, the objective of this study was to determine the forces required to create bony lesions on the humeral head and quantify the size of the resulting lesions. In order to achieve this objective, a repeatable testing protocol was developed to consistently produce Hill Sachs lesions.Copyright