Mark D. Miller

The Natural History of Bone Bruises A Prospective Study of Magnetic Resonance Imaging-Detected Trabecular Microfractures in Patients with Isolated Medial Collateral Ligament Injuries

We conducted a prospective study to evaluate bone bruises, or trabecular microfractures, associated with isolated medial collateral ligament injuries. Magnetic resonance imaging was performed on 65 patients with isolated medial collateral ligament injuries determined by physical examination and imaging studies. Of these 65 patients, 29 (45%) had associated trabecular microfractures. Follow-up images were completed at various intervals on 24 of these 29 patients (83%). Complete resolution of these lesions was observed in all cases. This process appears to occur as a result of gradual diffusion over a period of 2 to 4 months. Bone bruises associated with medial collateral ligament injuries are approximately one-half as common as bone bruises associated with anterior cruciate ligament injuries. However, medial collateral ligament-associated trabecular microfractures may be a better natural history model because these injuries are treated nonoperatively.

Thawing the Frozen Shoulder: The "Patient" Patient

Many different modalities have been advocated for the treatment of frozen shoulder (adhesive capsulitis), some of which can be associated with complications and morbidity. We retrospectively reviewed 50 patients with adhesive capsulitis treated by the senior author over a 10-year period. Treatment consisted of closely monitored home therapy using moist heat and antiinflammatory medication, and a physician-directed rehabilitation program. Without exception, every patient regained a significant amount of motion and returned to activities of daily living without pain.

Revision Anterior Cruciate Ligament Surgery

Anterior cruciate ligament (ACL) reconstruction has become one of the most popular orthopedic procedures in the United States.1 Although this operation is usually successful, failure rates can be as high as 25%.2 As the operation continues to gain popularity, the numbers of revision ACL reconstructions required will increase as well. It is imperative, therefore, for knee surgeons to be prepared to perform revision ACL surgery. It is perhaps equally important for surgeons to have a variety of treatment options and techniques at their disposal.

Arthroscopically assisted reduction and fixation of an adult tillaux fracture of the ankle

We describe the first report of arthroscopically-assisted reduction and fixation of an adult Tillaux fracture. Anatomic reduction of the fracture was possible with arthroscopic visualization. Adjunctive use of the arthroscope for accurate reduction of intraarticular fractures, which has been successful in the management of distal radius and tibial plateau fractures, can also be used for adult Tillaux fractures of the ankle.

Meniscus surgery: Indications for repair

Abstract Several basic sciences studies have laid the foundation for successful meniscal repair. There are currently four techniques for meniscal repair that are popular: open, “inside-out,” “outside-in,” and “all-inside.” Because of near universal development of late osteoarthritis after total and even partial meniscectomy, there has been increased emphasis on preserving the meniscus whenever possible, and greater interest in expanding the indications for meniscal repair. This article suggests several indications for repair and summarizes the key components of each technique. The use of “enhancing” techniques, such as fibrin clot, fibrin glue, and various grafting techniques, may expand future indications for meniscal repair.

Arthroscopic allograft anteriorcruciate ligament reconstruction

Abstract The use of allograft tissue for anterior cruciate ligament (ACL) reconstruction has several advantages. It is readily available, has no associated donor site morbidity, shortens operative time, produces less postoperative pain, has improved cosmesis, and has a lower incidence of postoperative knee stiffness. Despite these advantages, the risk of disease transmission and possible longer graft incorporation times are worthy of consideration. Initial reports of allograft use are encouraging; however, some caution is appropriate. The surgical technique of endoscopic ACL reconstruction using allograft is presented in detail.Allograft use is perhaps most suitable when other graft sources are not availble.

Management of the Stiff Knee After Trauma and Ligament Reconstruction

The “stiff knee,” which has been referred to as “arthrofibrosis,” “infrapatellar contracture syndrome,” “patella infera,” “ankylosis,” and various other names, is unfortunately an all too common complication of both fracture management and knee ligament surgery. The etiology of this difficult problem is as diverse as the terms used to describe it. It can be related to inadequate reduction or fixation of intraarticular fractures, prolonged traction or immobilization, infection, and ligament surgery (both intra- and extraarticular) to highlight only a few associated risk factors.

Management of anterior cruciateligament deficiency in the skeletally immature individual

Abstract Anterior cruciate ligament deficiency can be a significant problem in skeletally immature individuals, becausereconstructive procedures normally done in adults can risk injury to the growth plate. A systematic approach to the problem will help rule out physiological laxity and congenital deficiency, which may not require operative treatment. Avulsion fractures can be successfully repaired primarily. Some individuals may do well with rehabilitation or extra-articular procedures until they reach skeletal maturity. The rare child with significant laxity that can not be adequately managed otherwise, may benefit from an intraarticular procedure specifically designed to avoid damage to the growth plates.