Arthroscopy: The Journal of Arthroscopic and Related Surgery RSS feed: Current Issue. Nowhere is minimally invasive surgery explained better than in Arthroscopy , the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal's expanded website. Online features include full text of all articles, video clips, short reports, and MEDLINE links to related articles. Arthroscopy is ranked 7th of 49 journals in Orthopaedics category on the 2009 Journal Citation Reports®, published by Thomson Reuters, and has an Impact Factor of 2.503.http://www.arthroscopyjournal.org/?rss=yesElsevier Inc.en © 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved. Arthroscopy: The Journal of Arthroscopic and Related Surgery0749-8063262February 2010 © 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.arthroscopyjournal.org/article/PIIS0749806309010767/abstract?rss=yesIt's February, the year-end holidays are now behind us, and our journal is both clinically and academically directed as we energetically continue our 25th anniversary year. The articles in this issue represent a “mini-Fellowship” in the areas of shoulder, hip, knee, and platelet-rich plasma (PRP).Shoulder, Hip, Knee, and PRPJames H. Lubowitz, Gary G. Poehling10.1016/j.arthro.2009.12.005Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0Editorials141142http://www.arthroscopyjournal.org/article/PIIS0749806309009530/abstract?rss=yesSince its inception in 1993, the AANA Masters Program at the Learning Center in Chicago has been the standard by which other surgical skills courses have been measured. Attendees consistently comment on the balance of brief didactics, concentrated hands-on cadaver experience, and guidance from a pool of the world's leaders in arthroscopy. As any good chef will tell you, the secret is in the proportions.What's Cooking at the AANA Learning Center?J.W. Thomas Byrd10.1016/j.arthro.2009.11.009Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0Editorials142143http://www.arthroscopyjournal.org/article/PIIS0749806309010743/abstract?rss=yesTwenty-five years ago, in his editorial for the first issue of Arthroscopy: The Journal of Arthroscopic and Related Surgery, S. Ward Casscells, the Editor-in-Chief, noted that the role of this new journal was to “keep its readers abreast of new knowledge and techniques.” In that first volume, two articles specifically addressed the issue of arthroscopy and osteoarthritis of the knee. Both were looking at the treatment of degenerative meniscal tears in the face of osteoarthritis. The articles reached conflicting conclusions and the debate continues today. The article by Ferkel et al. concluded, “Because degenerative posterior horn tears had such a high percentage of unsatisfactory results, the question remains as to whether all these tears need to be removed.” In contrast to this, Rand concluded, “The results of arthroscopic partial meniscectomy in the older patient with osteoarthritis appears encouraging.”Is There a Role for Arthroscopy in the Treatment of Osteoarthritis?John C. Richmond10.1016/j.arthro.2009.12.003Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0Editorials143144http://www.arthroscopyjournal.org/article/PIIS0749806309010755/abstract?rss=yesIt can be safely said that we all have bias, to some degree or another, stemming largely from what we have been taught, and tempered or reinforced by our own experience. Realizing that, most researchers take great pains to minimize if not eliminate it. The prospective randomized controlled trial (especially when double-blinded) has often been touted as achieving this goal, especially in terms of avoiding selection bias. However, unless randomization is done properly, selection bias may still be present. How this can occur despite overt randomization has been eloquently described by Randelli et al., as have strategies to avoid it. Mathematical methods of randomization before study initiation, as well as statistical manipulations to account for possible bias-related variables after the study conclusion, have their limitations, especially if the bias is more basic, pervasive, and unrecognized.Selection Bias Results in Misinterpretation of Randomized Controlled Trials on Arthroscopic Treatment of Patients With Knee OsteoarthritisOmer A. Ilahi10.1016/j.arthro.2009.12.004Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0Editorials144146http://www.arthroscopyjournal.org/article/PIIS0749806309010974/abstract?rss=yesOn Christmas Eve, the Senate approved health care legislation, HR 3590, by a strict party-line vote of 60 to 39; just enough votes to prevent further debate or filibuster. The bill now heads for reconciliation with the House version with the President hopeful that he will have something to sign before the State of the Union message in January.The Health Care BillLouis F. McIntyre10.1016/j.arthro.2009.12.025Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0Letter to the Editor147148http://www.arthroscopyjournal.org/article/PIIS0749806309007002/abstract?rss=yesPurpose: We described a novel all-arthroscopic technique of coracoclavicular ligament reconstruction and reported the early clinical and radiologic results of this procedure.Methods: We performed all-arthroscopic coracoclavicular ligament reconstruction in 10 consecutive patients (8 men and 2 women; mean age, 41 years) with a symptomatic chronic and complete acromioclavicular (AC) joint dislocation (Rockwood type III or IV). Four patients had undergone surgery previously: two had initial pinning of the acute AC joint separation, and two had a subsequent Mumford procedure. The surgical technique, performed entirely by arthroscopy, consisted of (1) rerouting the coracoacromial ligament with a bone block harvested from the tip of the acromion in a socket created in the distal clavicle (Chuinard's modification of the Weaver-Dunn procedure) and (2) augmenting the reconstruction with 2 titanium buttons connected by a heavy suture in a 4-strand configuration (Double-Button fixation; Smith & Nephew Endoscopy, Andover, MA). Patients were prospectively followed up for a mean of 12.8 months (range, 6 to 20 months).Results: One patient had a superficial infection of the superior (clavicular) portal, which resolved with oral antibiotics. At the most recent review, all patients were satisfied or very satisfied with the cosmesis, and 9 of 10 returned to previous sports, including contact and overhead sports. All symptoms resolved (pain, shoulder weakness, paresthesia). The mean postoperative University of California, Los Angeles modified AC rating score was 16.5 points (range, 13 to 18 points) out of 20 points. The mean Subjective Shoulder Value improved from 36% (range, 0% to 70%) preoperatively to 82.5% (range, 70% to 100%) postoperatively (P = .005). The bone block was totally healed in the medullary canal in 8 cases and partially healed in 2. No loss of reduction was observed in any of the patients.Conclusions: Our study shows that severe chronic symptomatic AC joint separations, defined as Rockwood types III through V, can be repaired entirely by arthroscopy safely and effectively by transferring the coracoacromial ligament with a bone block in the distal clavicle. The bone block transfer (Weaver-Dunn-Chuinard procedure) has the advantage of making the repair easier and stronger, and it provides bone-to-bone healing by use of free, autologous vascularized tissue. Double-Button fixation has the advantage of maintaining the reduction during the biological healing process. Although the durability of the reconstruction remains unproven, in our short-term follow-up we observed no loss of reduction and the functional and cosmetic results were uniformly good.Level of Evidence: Level IV, therapeutic case series.All-Arthroscopic Weaver-Dunn-Chuinard Procedure With Double-Button Fixation for Chronic Acromioclavicular Joint DislocationPascal Boileau, Jason Old, Olivier Gastaud, Nicolas Brassart, Yannick Roussanne10.1016/j.arthro.2009.08.008Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2009-12-31Arthroscopy: The Journal of Arthroscopic and Related Surgery2009-12-31262S0749-8063(10)X0002-0Original Articles149160http://www.arthroscopyjournal.org/article/PIIS0749806309006148/abstract?rss=yesPurpose: The purpose of this study was to systematically evaluate the technique and tests used in the physical examination of the adult hip performed by multiple clinicians who regularly treat patients with hip problems and identify common physical examination patterns.Methods: The subjects included 5 men and 6 women with a mean age (±SD) of 29.8 ± 9.4 years. They underwent physical examination of the hip by 6 hip specialists with a strong interest in hip-related problems. All examiners were blind to patient radiographs and diagnoses. Patient examinations were video recorded and reviewed.Results: It was determined that 18 tests were most frequently performed (≥40%) by the examiners, 3 standing, 11 supine, 3 lateral, and 1 prone. Of the most frequently performed tests, 10 were performed more than 50% of the time. The tests performed in the supine position were as follows: flexion range of motion (ROM) (percentage of use, 98%), flexion internal rotation ROM (98%), flexion external rotation ROM (86%), passive supine rotation test (76%), flexion/adduction/internal rotation test (70%), straight leg raise against resistance test (61%), and flexion/abduction/external rotation test (52%). The tests performed in the standing position were the gait test (86%) and the single-leg stance phase test (77%). The 1 test in the prone position was the femoral anteversion test (58%).Conclusions: There are variations in the testing that hip specialists perform to examine and evaluate their patients, but there is enough commonality to form the basis to recommend a battery of physical examination maneuvers that should be considered for use in evaluating the hip.Clinical Relevance: Patients presenting with groin, abdominal, back, and/or hip pain need to have a basic examination to ensure that the hip is not overlooked. A comprehensive physical examination of the hip will benefit the patient and the physician and serve as the foundation for future multicenter clinical studies.The Pattern and Technique in the Clinical Evaluation of the Adult Hip: The Common Physical Examination Tests of Hip SpecialistsHal D. Martin, Bryan T. Kelly, Michael Leunig, Marc J. Philippon, John C. Clohisy, RobRoy L. Martin, Jon K. Sekiya, Ricardo Pietrobon, Nicholas G. Mohtadi, Thomas G. Sampson, Marc R. Safran10.1016/j.arthro.2009.07.015Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0Original Articles161172http://www.arthroscopyjournal.org/article/PIIS0749806309009414/abstract?rss=yesPurpose: The aim of this study was to compare the results of meniscal repair of the medial meniscus with or without decompression of the posterior segment of the medial meniscus for the treatment of posteromedial tibiofemoral incongruence at full flexion (PMTFI), which induces deformation of the posterior segment on sagittal magnetic resonance imaging (MRI).Methods: For more than 2 years, we followed up 27 patients with PMTFI who were classified into the following 2 groups. Group 1 included 8 patients (5 male joints and 3 female joints) with a medial meniscal tear with instability at the site of the tear who underwent meniscal repair. The mean age was 23.6 years. Group 2 included 19 patients (16 male joints and 3 female joints) who had a meniscal tear with instability at the site of the tear and underwent meniscal repair and decompression. The mean age was 26.5 years. In decompression of the posterior segment, redundant bone tissue on the most proximal part of the medial femoral condyle was excised. The patients were assessed by use of the Lysholm score, sagittal MRI at full flexion, and arthroscopic examination.Results: There were no statistical differences in mean Lysholm score between the 2 groups before surgery, but the mean score in group 2 was significantly higher than that in group 1 after surgery. Meniscal deformation of the posterior segment at full flexion on MRI disappeared in all cases after decompression. On second-look arthroscopy, the rate of complete healing at the site of the tear was 0% in group 1 but 57% in group 2, and it was significantly different between these groups.Conclusions: The addition of decompression of the posterior segment of the medial meniscus to meniscal repair of knee joints with PMTFI allowed more room for the medial meniscus to accommodate and improved both function of the knee joint and the rate of success of repair of isolated medial meniscal tears in patients who regularly performed full knee flexion.Level of Evidence: Level III, therapeutic case-control study.Cam Impingement of the Posterior Femoral Condyle in Medial Meniscal TearsJun Suganuma, Ryuta Mochizuki, Kenji Yamaguchi, Yutaka Inoue, Eikou Yamabe, Yoshiyuki Ueda, Tarou Fujinaka10.1016/j.arthro.2009.11.002Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0Original Articles173183http://www.arthroscopyjournal.org/article/PIIS0749806309006112/abstract?rss=yesPurpose: To explore whether changes in the starting point of separation affect the morphology of the 2 bundles of the anterior cruciate ligament (ACL) at insertion.Methods: Ten cadaveric knees were used to separate the ACL fibers into 2 bundles from 3 different starting points that were located at the proximal one fifth, two fifths, and three fifths of the inter-bundle mark line. The dividing lines between the 2 bundles at insertion and the area of the anteromedial (AM) bundle resulting from these different separations were compared, with data collected in groups I, II, and III, respectively.Results: The angle of the dividing line and the long axis of the femoral footprint was 67.24° ± 11.94°, 91.01° ± 11.16°, and 116.03° ± 9.01° in groups I, II, and III, respectively, and the percentage of the AM bundle area in the whole femoral footprint was 38.64% ± 5.55%, 52.22% ± 6.76%, and 65.09% ± 4.53%, respectively. At the tibial insertion sites, the angle between the dividing line and the sagittal plane was 110.17° ± 13.26°, 127.72° ± 8.94°, and 149.28° ± 18.80° in groups I, II, and III, respectively, and the percentage of the AM bundle area in the whole footprint was 25.72% ± 3.82%, 40.41% ± 3.73%, and 60.56% ± 6.59%, respectively. There were statistical differences between the angle and the area data of each of the 2 groups at either the tibial or femoral insertion site.Conclusions: In an anatomic study of the ACL, changes in the point from which separation started resulted in noticeably different bundle morphology at the insertion.Clinical Relevance: Proper separation will lead to a more accurate bundle description and, thus, a more accurate location of the tunnels in ACL reconstruction.Arbitrary Starting Point of Separation Affects Morphology of the 2 Bundles of Anterior Cruciate Ligament at Insertion SitesJinzhong Zhao, Xiaoqiao Huangfu10.1016/j.arthro.2009.07.012Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2009-12-21Arthroscopy: The Journal of Arthroscopic and Related Surgery2009-12-21262S0749-8063(10)X0002-0Original Articles184191http://www.arthroscopyjournal.org/article/PIIS0749806309009529/abstract?rss=yesPurpose: Our purpose was to evaluate the effect of meniscectomy and meniscal allograft transplant on anterior cruciate ligament (ACL) and knee biomechanics.Methods: A differential variable reluctance transducer was placed in the ACL of 10 human cadaveric knees to record strain. Tibial displacement from a neutral reference was recorded relative to the position of the femur. Testing was performed at 30°, 60°, and 90° of knee flexion. Six cycles of anterior-posterior loads were applied to the limit of 150 N. After a testing cycle, a medial meniscectomy was performed and the testing cycle was repeated. A meniscal allograft transplant was performed, and a final testing cycle was conducted. ACL strain and tibial displacement in the meniscectomy and meniscal allograft states were compared with the intact-knee state.Results: Tibial displacement after meniscectomy significantly increased at all angles. The meniscal allograft transplant restored tibial displacement to normal values at 30° and 90°. ACL strain increased significantly after meniscectomy at 60° and 90° of flexion, and meniscal allograft transplant returned the strain values to normal at 60° and 90°.Conclusions: In most cases medial meniscectomy produced a significant increase in tibial displacement relative to the femur, and meniscal allograft transplantation restored displacement values to normal. Meniscectomy increased ACL strain and meniscal allograft transplant restored strain values to normal in 2 of 3 tested flexion angles.Clinical Relevance: The absence of the medial meniscus exposes the ACL to increased strain, whereas meniscal allograft lowered the strain on the native ACL. This could have implications for those patients undergoing ACL reconstruction who have concomitant removal of the medial meniscus.The Effect of Medial Meniscectomy and Meniscal Allograft Transplantation on Knee and Anterior Cruciate Ligament BiomechanicsJeffrey T. Spang, Alan B.C. Dang, Augustus Mazzocca, Lina Rincon, Elifho Obopilwe, Bruce Beynnon, Robert A. Arciero10.1016/j.arthro.2009.11.008Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0Original Articles192201http://www.arthroscopyjournal.org/article/PIIS0749806309006136/abstract?rss=yesPurpose: The purpose of this study was to compare the bundle tension curves and resultant knee kinematics between 2 tensioning protocols in anatomic double-bundle anterior cruciate ligament (ACL) reconstruction.Methods: Anatomic double-bundle ACL reconstruction was performed in 7 male cadaveric knees. Each graft was tensioned to 22 N under 2 conditions: (1) both bundles tensioned at 20° of knee flexion (20/20 protocol) or (2) posterolateral (PL) bundle tensioned at 15° and anteromedial (AM) bundle at 45° (45/15 protocol). Knee kinematics were recorded in response to anterior and combined rotatory loads in the intact, ACL-deficient, and reconstructed states. Bundle tension was recorded dynamically with knee motion and during each loading test.Results: Tensioning both bundles at 20° of knee flexion resulted in a reciprocal bundle tension pattern that was not statistically different; the PL bundle tension was greater than the AM bundle tension in full extension, and the AM bundle tension was greater than the PL bundle tension from 25° to 120°. In the second tensioning protocol, the AM bundle tension was significantly greater than the PL bundle tension at all flexion angles. Both tensioning protocols restored normal knee kinematics.Conclusions: Bundle-tensioning protocol is a variable that has a significant effect on the bundle-loading patterns in double-bundle ACL reconstruction. The 20/20 protocol resulted in AM and PL bundle–loading patterns that were equivalent during dynamic testing, whereas the 45/15 protocol led to excessive tension in the AM bundle in full extension. We recommend equal tensioning of both bundles with the knee at 20° of flexion to restore relatively normal tension curves in each bundle and to avoid excessive stress on the AM bundle.Clinical Relevance: In double-bundle ACL reconstruction, there is no consensus regarding bundle-tensioning protocols. This study provides data on the individual bundle tension curves that result from 2 commonly used tensioning protocols. These data will assist clinicians as the technique and application of double-bundle ACL reconstruction move forward.Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: Kinematics and Knee Flexion Angle–Graft Tension RelationPatrick J. Murray, Jerry W. Alexander, Jonathan E. Gold, Kurt D. Icenogle, Philip C. Noble, Walter R. Lowe10.1016/j.arthro.2009.07.014Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-01-11Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-01-11262S0749-8063(10)X0002-0Original Articles202213http://www.arthroscopyjournal.org/article/PIIS074980630900615X/abstract?rss=yesPurpose: The purpose of this study was to measure graft tension in vivo in anatomic double-bundle anterior cruciate ligament (ACL) reconstruction during active knee extension, as well as to investigate the effect of loading a weight around the ankle on graft tension.Methods: Seven patients with chronic ACL injury underwent anatomic double-bundle ACL reconstruction. Two grafts were temporarily fixed to the 2 tension-adjustable force gauges on the anterior tibial cortex, after they were fixed on the femur. After the creep within the femur–ACL graft–tibia construct was removed, 10 N of the initial tension was applied to each graft at 20°. First, tension to the anteromedial (AM) and posterolateral (PL) grafts was continuously measured during passive extension from 90° to 0° with the patient under general anesthesia. Then, after the patient was awoken from anesthesia, graft tension was again recorded while the knee was actively extended by the patient in the same manner. Finally, after a 2-kg weight was placed around the ankle, the tension of each graft was measured again during active knee extension by the patient himself or herself.Results: During passive extension motion, the tension of the AM graft was 19.3 ± 4.7 N, whereas that of the PL graft was 24.5 ± 5.9 N at 0°. The tension of each graft increased when approaching full extension. During active knee extension motion, the tension of the AM graft was 24.0 ± 6.1 N, whereas that of the PL graft was 30.8 ± 7.3 N at 0°. When the 2-kg weight was placed around the ankle during active motion, the tension was significantly higher than that with no weight at all flexion angles.Conclusions: Graft tension was greater during active motion than that during passive motion, and graft tension during active motion increased with a weight placed around the ankle. The highest graft tension was 62.8 N at 0° of flexion with a 2-kg weight placed around the ankle, when 20 N of initial tension was applied at 20° of flexion in anatomic double-bundle ACL reconstruction. Thus care must be taken during active extension exercise with weights, especially in the first few weeks after ACL reconstruction, because graft tension increases with an increase in initial tension and easily reaches a critical level.Clinical Relevance: Our findings suggest that active knee extension exercise should be performed in moderation in the early phase after ACL reconstruction.Graft Tension During Active Knee Extension Exercise in Anatomic Double-Bundle Anterior Cruciate Ligament ReconstructionTatsuo Mae, Konsei Shino, Norinao Matsumoto, Akira Maeda, Ken Nakata, Minoru Yoneda10.1016/j.arthro.2009.07.016Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2009-12-21Arthroscopy: The Journal of Arthroscopic and Related Surgery2009-12-21262S0749-8063(10)X0002-0Original Articles214222http://www.arthroscopyjournal.org/article/PIIS0749806309006495/abstract?rss=yesPurpose: To evaluate the results of a remnant posterior cruciate ligament (PCL)–augmenting stent procedure for acute- or subacute-stage PCL injuries in terms of stability and clinical results.Methods: Between September 2003 and March 2006, 32 patients with a PCL tear underwent a reconstructive stent procedure with an autogenous hamstring tendon graft to augment the remains of the injured PCL. Of these patients, 20 who satisfied our inclusion criteria and could be followed up for a minimum duration of 24 months were enrolled in our study. The remnant PCL and synovium were preserved, and augmentation was performed by use of the transtibial technique. A femoral tunnel was created near the footprint of the anterolateral bundle. Stability was measured on posterior stress radiographs and by use of a maximum manual displacement test performed with a KT-1000 arthrometer (MEDmetric, San Diego, CA). The International Knee Documentation Committee (IKDC) and Orthopädische Arbeitsgruppe Knie scoring systems were used for clinical evaluation.Results: Stress radiographs showed that the mean side-to-side differences in displacement were reduced from 9.9 ± 4.0 mm preoperatively to 3.0 ± 2.6 mm at the last follow-up, whereas KT-1000 tests showed that these differences were reduced from 6.9 ± 2.1 mm preoperatively to 2.7 ± 1.5 mm. The final IKDC score was A in 7 patients (35%), B in 10 (50%), C in 2 (10%), and D in 1 (5%). The mean Orthopädische Arbeitsgruppe Knie score improved from 61.6 ± 13.1 to 88.2 ± 9.5.Conclusions: Of the patients, 90% showed satisfactory posterior stability and 85% had a normal or nearly normal rating based on the IKDC score at a mean of 3 years after the remnant PCL–augmenting stent procedure in the acute or subacute stage of PCL injuries.Level of Evidence: Level IV, therapeutic case series.Remnant Posterior Cruciate Ligament–Augmenting Stent Procedure for Injuries in the Acute or Subacute StageYoung-Bok Jung, Ho-Joong Jung, Kwang-Sup Song, Jae Yoon Kim, Han Jun Lee, Jae-Sung Lee10.1016/j.arthro.2009.07.017Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2009-12-21Arthroscopy: The Journal of Arthroscopic and Related Surgery2009-12-21262S0749-8063(10)X0002-0Original Articles223229http://www.arthroscopyjournal.org/article/PIIS0749806309006070/abstract?rss=yesPurpose: The purpose of this study was to evaluate the results of posterior arthroscopic subtalar arthrodesis (ASTA) by use of a posterior 2-portal approach in the prone position and to describe the surgical technique.Methods: Between September 2004 and December 2006, posterior ASTA was performed in 16 patients (all men) with post-traumatic subtalar arthritis after an intra-articular fracture of the calcaneus. The mean age was 44 years (range, 20 to 64 years). The mean follow-up period was 30 months (range, 20 to 46 months). According to the Sanders classification of calcaneal fractures, 2 patients had type IIA fractures, 3 had type IIIB fractures, 6 had type IIIAC fractures, and 5 had type IIIBC fractures. The technique involved using posteromedial and posterolateral portals in the prone position, posterior talocalcaneal facet debridement, and percutaneous posterior fixation with 2 cannulated screws. Clinical results were evaluated by use of the ankle-hindfoot scale of the American Orthopaedic Foot & Ankle Society (AOFAS), the Angus and Cowell scoring system, and postoperative complications. To assess union rate and time to union, radiographic evaluations were also performed.Results: The mean modified AOFAS score (maximum, 94 points) improved from 35 points (range, 24 to 45 points) preoperatively to 84 points (range, 71 to 94 points) at final follow-up. According to the Angus and Cowell criteria, 13 patients had a good rating, 2 had a fair rating, and 1 had a poor rating because of nonunion. The union rate was 94% at a mean of 11 weeks, and nonunion occurred in 1 case. No other postoperative complications occurred.Conclusions: ASTA in the prone position through a posterior 2-portal approach provided safe access and superior visualization of the posterior talocalcaneal facet and easy fixation of posterior screws. This technique also provided good clinical outcomes (good results in 81% of patients according to the Angus and Cowell scoring system and a mean modified AOFAS score of 84 points) and a 94% union rate at a mean of 11 weeks.Level of Evidence: Level IV, therapeutic study.Arthroscopic Subtalar Arthrodesis Using a Posterior 2-Portal Approach in the Prone PositionKeun-Bae Lee, Chan-Hee Park, Jong-Keun Seon, Myung-Sun Kim10.1016/j.arthro.2009.07.008Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2009-12-21Arthroscopy: The Journal of Arthroscopic and Related Surgery2009-12-21262S0749-8063(10)X0002-0Original Articles230238http://www.arthroscopyjournal.org/article/PIIS0749806309005180/abstract?rss=yesPurpose: The purpose of this study was to systematically review the evidence on the outcomes of arthroscopic repair for anterior shoulder instability in first-time dislocators when compared with patients with recurrent instability.Methods: We designed a systematic review with a specific methodology to investigate the outcomes of surgery for those with only a first-time dislocation versus those who underwent surgery after multiple instability events. We performed a literature search from January 1966 to December 2008 using Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Central Register of Controlled Trials. Key words included the following: first time, primary shoulder, or recurrent shoulder instability, shoulder dislocation, Bankart repair, arthroscopic Bankart repair, and labral repair. The inclusion criteria were cohort studies (Level I to II) that evaluated the outcomes of patients undergoing arthroscopic stabilization after the first dislocation or multiple recurrent episodes. Studies that lacked a comparison group or were retrospective (Level III studies or higher) were excluded.Results: There were 15 studies that met the inclusion criteria and were included in the final analysis: 5 in the first-time dislocation group and 10 in the recurrent instability group. Study design, patient demographics, mean number of dislocations, surgical technique, and rehabilitation protocol, as well as subjective and objective outcome measures, were recorded.Conclusions: There were no differences in recurrence or complication rate among patients undergoing surgery after the primary dislocation when compared with those undergoing surgery after multiple recurrent episodes. Clinical outcome measures significantly improved within all independent studies from preoperatively to postoperatively. However, because of variation in the outcome measurement tools used, no direct comparison between the study groups could be performed. Additional randomized controlled studies are needed to compare the functional outcome, quality of life, and ability to return to preinjury activity level among patients undergoing early versus delayed repair for anterior shoulder instability.Level of Evidence: Level II, systematic review of Level I and II studies.Arthroscopic Stabilization for First-Time Versus Recurrent Shoulder InstabilityRobert C. Grumet, Bernard R. Bach, Matthew T. Provencher10.1016/j.arthro.2009.06.006Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2009-12-07Arthroscopy: The Journal of Arthroscopic and Related Surgery2009-12-07262S0749-8063(10)X0002-0Systematic Review239248http://www.arthroscopyjournal.org/article/PIIS0749806309005672/abstract?rss=yesAbstract: The understanding and treatment of shoulder instability comprise a rapidly evolving area of interest in orthopaedics. Evaluation methods are becoming more specific in showing the exact pathologies causing the symptoms. Magnetic resonance arthrography and arthroscopy have contributed to this development. The patient with an unstable shoulder should be thoroughly evaluated through their history and specific clinical tests of the shoulder as well as the scapulothoracic joint. Often, shoulder instability can be classified after this primary evaluation. Magnetic resonance arthrography and arthroscopy are the gold standards in soft-tissue evaluation, whereas specialized radiographic examinations and computed tomography scans are used to assess bony defects. Patients are treated according to the pathology found on preoperative or pretreatment evaluation. Multiple factors need to be considered before the treatment program is instituted, including the patient's age, activity demands, associated pathology and dysfunction, soft-tissue pathology, degree of instability, direction, frequency, and etiology. Treatment can be nonoperative or arthroscopic or open repair. Soft-tissue pathology and bony defects should be addressed, and the surgeon's preferred method and skills are important in choosing the right treatment for the patient. The patient should be informed about possible complications, restrictions during the treatment period, and the prognosis for the particular type of instability. To improve progress in shoulder orthopaedics, one of the most important factors can be a universal agreement on an outcome measurement tool that is well designed and validated.Consensus Statement on Shoulder InstabilityKlaus Bak, Ethan R. Wiesler, Gary G. Poehling, ISAKOS Upper Extremity Committee10.1016/j.arthro.2009.06.022Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2009-12-14Arthroscopy: The Journal of Arthroscopic and Related Surgery2009-12-14262S0749-8063(10)X0002-0ISAKOS Committee Report249255http://www.arthroscopyjournal.org/article/PIIS0749806309009566/abstract?rss=yesSummary: Twenty fresh frozen cadaver shoulders were dissected in order to study the rotator cable-crescent complex. The rotator crescent is a term that we have used to describe the thin, crescent-shaped sheet of rotator cuff comprising the distal portions of the supraspinatus and infraspinatus insertions. The crescent was found to be bounded on its proximal margin by a thick bundle of fibers that we have called the rotator cable. This cable-crescent configuration was found to consistently span the insertions of supraspinatus and infraspinatus tendons. The dimensions of the rotator cable and crescent were measured by a digital micrometer. The rotator cable was found to be a very substantial structure, averaging 2.59 times the thickness of the rotator crescent that it surrounded. This anatomic study supports the concepts of stress shielding of the rotator crescent by the stout rotator cable and stress transfer by this loaded cable system.The Rotator Crescent and Rotator Cable: An Anatomic Description of the Shoulder's “Suspension Bridge”Stephen S. Burkhart, James C. Esch, R. Scott Jolson10.1016/j.arthro.2009.11.012Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0Arthroscopy Classics256257http://www.arthroscopyjournal.org/article/PIIS0749806309006549/abstract?rss=yesAnatomy is the foundation of orthopaedic surgery, and the advancing knowledge of the anterior cruciate ligament (ACL) anatomy has led to the development of improved modern reconstruction techniques that approach the anatomy of the native ACL. Current literature on the anatomy of the ACL and its reconstruction techniques, as well as our surgical experience, was used to develop a flowchart that can aid the surgeon in performing anatomic ACL reconstruction. We define anatomic ACL reconstruction as the functional restoration of the ACL to its native dimensions, collagen orientation, and insertion sites. A guideline was written to accompany this flowchart with more detailed information on anatomic ACL reconstruction and its pitfalls, all accompanied by relevant literature and helpful figures. Although there is still much to learn about anatomic ACL reconstruction methods, we believe this is a helpful document for surgeons. We continue to modify the flowchart as more information about the anatomy of the ACL, and how to more closely reproduce it, becomes available.Anatomic Single- and Double-Bundle Anterior Cruciate Ligament Reconstruction FlowchartCarola F. van Eck, Bryson P. Lesniak, Verena M. Schreiber, Freddie H. Fu10.1016/j.arthro.2009.07.027Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0Level V Evidence258268http://www.arthroscopyjournal.org/article/PIIS0749806309009931/abstract?rss=yesAbstract: Platelet-rich plasma (PRP) is a new technology focused on enhancing the healing response after injury of different tissue types. PRP is prepared by withdrawal of patients' peripheral blood and centrifugation to obtain a highly concentrated sample of platelets, which undergo degranulation to release growth factors with healing properties. It also contains plasma, cytokines, thrombin, and other growth factors that are implicated in wound healing and have inherent biological and adhesive properties. The prepared concentrate is then injected back into the patient at the site of morbidity. This may be intralesional, intra-articular, or surrounding the involved tissue bed. PRP preparations have been used therapeutically in various medical fields from implantology to vascular ulcers, with a more recent evolution and promising results in the field of sports medicine and arthroscopy. Sports medicine patients desire a rapid return to their preinjury level of function, and PRP may have certain applications that will speed recovery in cases of tendon, ligament, muscle, and cartilage disorders. In particular, anterior cruciate ligament reconstruction has shown better autograft maturation, improved donor site morbidity, and pain control, in addition to improved allograft incorporation. By acceleration of the biological integration of the graft by use of PRP, patients may undergo faster, more intensive rehabilitation programs and return to sports more rapidly. Because of its autogenous origin, easy preparation, and excellent safety profile, the advent of PRP has opened another therapeutic door for sports medicine physicians and orthopaedic surgeons. Future directions of PRP include improving the results of arthroscopic and related surgery, in addition to delineating correct dosage, timing, and quantification, as well as ideal techniques of PRP application.The Use of Platelet-Rich Plasma in Arthroscopy and Sports Medicine: Optimizing the Healing EnvironmentEmilio Lopez-Vidriero, Krista A. Goulding, David A. Simon, Mikel Sanchez, Donald H. Johnson10.1016/j.arthro.2009.11.015Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0Current Concepts269278http://www.arthroscopyjournal.org/article/PIIS0749806309008317/abstract?rss=yesAbstract: Femoroacetabular impingement (FAI) has been recently established as a risk factor in the development of osteoarthritis of the hip. Intraosseous cysts are commonly seen on imaging of FAI. In most cases these cysts are incidental and do not require specific treatment at the time of surgical treatment of hip impingement. However, in some cases the cysts may mechanically compromise the acetabular rim or femoral neck. We present a technique for treating such cysts with an all-arthroscopic technique using a commercially available bone graft substitute composed of cancellous bone and demineralized bone matrix placed within an arthroscopic cannula for direct delivery into the cysts. This technique may be of benefit to surgeons treating FAI with an all-arthroscopic technique.Minimally Invasive Bone Grafting of Cysts of the Femoral Head and Acetabulum in Femoroacetabular Impingement: Arthroscopic Technique and Case PresentationAmir A. Jamali, Anto T. Fritz, Deepak Reddy, John P. Meehan10.1016/j.arthro.2009.09.016Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0Technical Note279285http://www.arthroscopyjournal.org/article/PIIS0749806309004368/abstract?rss=yesAbstract: The advent of new arthroscopic devices has led to the development of novel techniques of arthroscopic rotator cuff repair. However, failure to recognize specific technical aspects and improper application of these devices can lead to complications. We report a case of intra-articular protrusion of knotless anchors (PEEK PushLock SP, 4.5 × 18.5 mm; Arthrex, Naples, FL), used in the lateral row of a suture-bridging technique for arthroscopic rotator cuff repair. This case draws attention to the increased length of such devices when compared with traditional suture anchors, the technical aspects of proper device use, the possible patient-related factors such as implant-patient size mismatch, and the importance of additional imaging for the investigation of failure to progress postoperatively.Proper Insertion Angle Is Essential to Prevent Intra-Articular Protrusion of a Knotless Suture Anchor in Shoulder Rotator Cuff RepairAndrew S. Wong, Zinon T. Kokkalis, Christopher C. Schmidt10.1016/j.arthro.2009.05.006Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2009-12-07Arthroscopy: The Journal of Arthroscopic and Related Surgery2009-12-07262S0749-8063(10)X0002-0Case Report286290http://www.arthroscopyjournal.org/article/PIIS0749806309010330/abstract?rss=yesPrimum non nocere, or to do no harm, is a key component of the Hippocratic Oath taken by all medical students and fundamental to all medical practice. In orthopaedic surgery, and medicine in general, physicians strive to minimize complications. While not all complications can be avoided, those that can are often dependent on surgeon knowledge, preparation, patient selection, operative execution, and postoperative care.John B. Reid10.1016/j.arthro.2009.11.020Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0Book Review291291http://www.arthroscopyjournal.org/article/PIIS0749806310000095/abstract?rss=yesArthroscopy Journal Video Prize. At the recommendation of the Journal Board of Trustees and with the approval of the AANA Board, we are pleased to announce that the annual Journal prize in 2010 will be the Arthroscopy Journal Video Prize. Recognizing the value and taking advantage of what the Internet has to offer, we have exhorted our authors to “Go to the Video” in our effort to provide our readers with the highest quality, most instructive video supplements to published articles possible. And so, we will award a prize of $5,000 to the best video with narration to accompany an article published in Arthroscopy in 2010. The award will be judged by the Journal's Editors and Associate Editors, who have recused themselves from the competition. Please see the Instructions for Authors for file type, length, and file size limits.Announcements10.1016/S0749-8063(10)00009-5Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0Book Review291291http://www.arthroscopyjournal.org/article/PIIS0749806310000460/abstract?rss=yesSpanish Translated Abstracts10.1016/S0749-8063(10)00046-0Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0Translated Abstractse17e31http://www.arthroscopyjournal.org/article/PIIS0749806310000046/abstract?rss=yesArthroscopy: The Journal of Arthroscopic and Related Surgery (ISSN 0749-8063) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010-1710. (For Post Office use only: Volume 26 issue 2 of 12.) Periodicals postage paid at New York, NY and additional mailing offices.Masthead10.1016/S0749-8063(10)00004-6Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0FrontmatterA2A2http://www.arthroscopyjournal.org/article/PIIS0749806310000058/abstract?rss=yesEditorial Board10.1016/S0749-8063(10)00005-8Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0FrontmatterA6A6http://www.arthroscopyjournal.org/article/PIIS074980631000006X/abstract?rss=yesTable of Contents10.1016/S0749-8063(10)00006-XArthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0FrontmatterA9A9http://www.arthroscopyjournal.org/article/PIIS0749806310000071/abstract?rss=yesArthroscopy: The Journal of Arthroscopic and Related Surgery seeks to provide readers with current information by publishing the best papers on clinical and basic research, review articles, technical notes, case reports, and editorials about the latest developments in arthroscopic surgery, knee surgery, and orthopaedic sports surgery. All articles are subject to peer review. Letters to the Editor and comments on the Journal's content or policies are always welcome.Instructions for Authors10.1016/S0749-8063(10)00007-1Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0FrontmatterA16A16http://www.arthroscopyjournal.org/article/PIIS0749806310000083/abstract?rss=yesThis statement was prepared by the Committee on Ethics and Standards and the Board of Directors of the Arthroscopy Association of North America. The decision to grant and renew privileges in diagnostic arthroscopy and or arthroscopic surgery is typically made by individual hospitals with input from medical staff committees and appropriate department chairpersons, in accordance with individual hospital and medical staff bylaws, rules and regulations. In situations where arthroscopic surgical privileges are requested, a Board Certified orthopedic surgeon or equivalent specialist, with considerable experience in the field of arthroscopic surgery should be involved in the decision making process to grant these privileges.Suggested Guidelines for the Practice of Arthroscopic Surgery10.1016/S0749-8063(10)00008-3Arthroscopy: The Journal of Arthroscopic and Related Surgery 26, 2 (2010)2010-02-01Arthroscopy: The Journal of Arthroscopic and Related Surgery2010-02-01262S0749-8063(10)X0002-0FrontmatterA28A28