Patellar tendon has been widely used to reconstruct the anterior cruciate deficient knee. The technique involvesharvesting the central third of the patellar tendon, or using a patellar tendon allograft. Attention to detail regarding appropriate tunnel placement is essential. Interference screw fixation provides an immediately stable and rigidly fixed graft. It is necessary to avoid lateral wall or roof encroachment on the patellar tendon graft and to avoid the pitfalls of excessive anterior placement of the femoral and tibial tunnels in order to achieve an optimum result. Rigid fixation of the graft allows immediate aggressive rehabilitation.

The purpose of this study was to quantitate the effect of inferior capsular shift on shoulder volume. Four fresh frozen cadaveric shoulders were analyzed. Volume before and after shift was determined using 3 techniques: (1) Magnetic resonance imaging sequences were digitized to computer and analyzed for volume via a 35-mm camera using Cue 2 software. The capsule was delineated by contrast between light and dark regions. Volume was calculated by summing the total area of respective slices. (2) Ultrasound images, obtained after surgical exposure of the capsule, were digitized. Volume was calculated using the formula for a prolate ellipsoid. (3) An 18-gauge needle was used to inject and evacuate saline via an anterior approach. Quantity of aspirated fluid provided a direct measure of volume. Inferior capsular shift was performed. After the operation, measurements were repeated. Inferior capsular shift reduced volume in all shoulders with each technique. On average, inferior capsular shift reduced joint volume by 57 %). A measurable reduction in shoulder joint volume is an effect of capsular shift. This measurement may have clinical application if volume is an indicator of instability or laxity.

Eastlack, M.; Snyder-Mackler, L.; Gillespie, M.; Axe, M.; Bartolozzi, A. Author Information

Objective: To investigate the accuracy of diagnosing anterior cruciate ligament (ACL) tears with axial MR imaging.Materials and Methods: Two blinded independent observers retrospectively reviewed axial T2 weighted or FSE fat suppressed imaging of the knee from 47 patients, Arthroscopy had demonstrated a complete tear of the ACL in 25 patients and a normal ACL in 22 patients. The two criteria used to diagnose ACL tears on sequential axial imaging were (a) lack of visualization of the ACL in its expected course or (b) focal increased signal in the expected course of the ACL.Results: Observer 1 demonstrated a sensitivity of 92% (23 of 25) and a specificity of 100% (22 of 22) in diagnosing ACL tears (chi(2) = 39.6, P < 0.001). Observer 2 demonstrated a sensitivity of 92% (23 of 25) and a specificity of 82% (18 of 22) in diagnosing ACL tears (chi(2) = 26.1, p < 0.001). The Kappa value was 0.75 (agreement in 41 of 47 cases), indicating a high degree of intraobserver agreement.Conclusion: Axial T2 weighted or FSE fat suppressed imaging provides an accurate means of confirming the diagnosis of ACL tears.

One hundred thirty-six patients with impingement syndrome and rotator cuff disease who were treated nonoperatively from 1987 to 1991 were reviewed to identify findings at initial presentation that correlated with final outcome. Mean followup was 20 months (range, 6-41 months). All patients received initial conservative treatment. The results were analyzed in 2 groups. Group I consisted of the entire 136 patients with a minimum 6-month followup. Group II consisted of a subgroup of 68 patients with at least an 18-month followup. The overall results in Group I were 66% excellent and good and 34% fair and poor. For Group II, the overall results were 76% excellent and good and 24% fair and poor. For the Group II patients, a distribution of clinical findings at the 6-month followup demonstrated only 46% excellent and good results, indicating that the clinical result improves significantly as followup duration increased. Patient characteristics and prognostic factors that were associated with an unfavorable clinical outcome included a rotator cuff tear > 1 cm2, a history of pretreatment clinical symptoms for > 1-year duration, and significant functional impairment at initial presentation. Factors not associated with clinical outcome included patient age, occupation, gender, associated instability, dominance, chronicity of onset, active range of motion, or specific treatment modalities. Early operative intervention is recommended for patients with poor prognostic factors to avoid a protracted clinical course.

Neglected tears of the patellar tendon due to loss of active extension remain a difficult therapeutic endeavor. The goals in the approach to this diagnosis include restoration of both structural and functional integrity of the extensor mechanism. A procedure has been developed utilizing Z-shortening of the patellar tendon, Z-lengthening of the quadriceps tendon, and the semitendinosis gracilis as a biologic splint. This technique allows establishment of preoperative goals, including restoration of the muscle-tendon complex in its anatomic position, restoration of quadriceps function, preservation of vascularity of the reconstructed tendon, and splinting of the patellar tendon. This reconstruction allows early mobilization and rehabilitation.