William F. Bennett

Specificity of the Speed's test: Arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove

A positive Speeds test result is usually thought to suggest inflammation or lesions related to the biceps/labral complex. The specificity, sensitivity, and positive and negative predictive values are determined for the Speeds test. A prospective study design was developed for all patients with shoulder pain who presented between October 1, 1994 and February 28, 1995. The clinical results of the Speeds test were correlated with biceps/labral pathology by direct arthroscopic visualization. A neuroprobe is used to pull the biceps tendon into the articular portion of the glenohumeral joint so as to visualize the biceps tendon at the level of the bicipital groove. Forty-six shoulders in 45 patients, 31 men (average age, 53 years; range, 16 to 76 years) and 14 women (average age, 64 years; range, 30 to 80 years) with 26 dominant and 20 nondominant extremities were operated on during this time interval. The clinical evaluation showed that the speeds test was positive in 40 shoulders. Biceps/labral complex pathology was present in 10 of these patients. A specificity of 13.8%, a sensitivity of 90%, a positive predictive value of 23%, and a negative predictive value of 83% were calculated. Thus, it is concluded that the Speeds test is a nonspecific but sensitive test for macroscopic biceps/labral pathology. This clinical examination is positive with a various number of other pathological shoulder problems.

Addressing Glenohumeral Stiffness While Treating the Painful and Stiff Shoulder Arthroscopically

The shoulder can be primarily or secondarily stiff. Cadaveric cutting studies have shown increases in passive range of glenohumeral motion when certain portions of the capsule are released. This study has recorded the intraoperative gains made in passive range of motion for external rotation, flexion, abduction, and internal rotation with sequential release of the rotator interval, inferior capsule, and posterosuperior capsule, regardless of initial etiology, and followed-up over time. Thirty one of 60 shoulders, found clinically to have a loss of passive range of motion and having failed a nonoperative approach, underwent a capsular release. Eighteen patients underwent a partial capsular release (group 1) and 13 patients (group 2) underwent a complete capsular release. Thirty of 31 shoulders had statistically significant gains in passive range of motion with sequential release. In general, resection of the rotator interval contributed to gains in external rotation; resection of the inferior capsule (anteroinferior and posteroinferior) contributed gains to external rotation, forward flexion, and internal rotation; and resection of the posterosuperior capsule contributed to gains only in internal rotation. At a minimum of 18 months follow-up, 30 of 31 shoulders retained their intraoperative gains. There was no difference in the results between primarily and secondarily stiff shoulders for motion gains (P >.05). Arthroscopically addressing capsular tightness is beneficial in returning shoulders with a loss of passive glenohumeral motion to normal regardless of the etiology.

Arthroscopic Subscapularis Repair: A Look at Primacy From a Historical Perspective

important message of our study was that the ACL midsubstance is band-like, with a thickness of about 5 mm in a very narrow space between the lateral femoral condyle and the PCL in extension. We have to take into consideration that an oversized graft can cause impingement to the PCL. We agree with the authors of the letter that, as Harner published, the ACL fans out in the tibial attachment and is 3 times thicker (Fig 6, D and F in our article). Figure 8 is based on our measurements shown in Table 2 in our article. For the measurements, we used a stereo microscope (Leica MZ75; Leica Microsystems, Heerbrugg, Switzerland). The image information was

Circumferential Arthroscopic Capsular Release: Reflections and a Historical Perspective

At this point, we want to explain to Dr. Karahan where he lost his flow of reasoning. According to the winner of the 2008 American Journal of Sports Medicine Systematic Review Competition, long-term studies on the occurrence of osteoarthritis after ACL injury should feature clear inclusion and exclusion criteria.1 For this reason, we focused on a very selected but ompletely homogeneous group of patients, consisting of athetes after ACL reconstruction after isolated ACL injury returnng to their previous sports. Maybe the inclusion criteria were ot stated clearly enough, and one may misunderstand them. e did not exclude athletes with poor results being unable to eturn to their sports after ACL reconstruction. In this limited ut highly selected case series, most patients played at a cometitive or professional level according to the Tegner score at he time of injury. At the time of surgery, the mean age of the atients was very young, at 22 years. This means that all of hese patients had maximum interest in a full return to their port, and this was possible for all of them. Thus absolutely no election of only patients with good results was performed, hich was the complaint of Dr. Karahan. Accompanying injuies involving the meniscus, posterior cruciate ligament, cartiage, and collateral ligaments, as well as any injury to the ontralateral knee at the time of ACL replacement, have been xcluded not to create a good study population but to maximize he homogeneity of the study population. This strict selection llowed focusing the interest specifically on the ACL and the nee’s fate after isolated ACL reconstruction. Thus the primary oal of the study was to analyze whether ACL reconstruction in solated ACL tears without any accompanying lesions is able to estore normal anatomy, biology, and biomechanics. As “noral,” the status of the unaffected knee was taken for comparson, which seems to be absolutely representative and reasonble. The argument that the unaffected knee should not be ccepted as a control because it was not exposed to ACL upture is not valid in our opinion. In contrast, ACL recon-