Background The labral complex plays a crucial role in shaping the glenoid fossa morphology, thereby enhancing passive joint stability. This study aimed to investigate the influence of the labrum on glenoid inclination, a key determinant for load distribution within the joint. In addition, the labral influence on glenoid concavity depth and radius of curvature in the supero-inferior plane was evaluated. Methods Forty-three patients (mean age: 42 years [range 21-64 years]; 35 males, 8 females) with acromioclavicular (AC)-joint dislocation and no glenohumeral pathologies, who received a full series of magnetic resonance imaging or magnetic resonance arthrography, were retrospectively included. For each patient, the glenoid surface inclination, concavity depth, and radius of curvature was measured and compared to their respective values of the bony glenoid. In addition, the bony humeral head radius was measured to evaluate the influence of the labrum on joint congruency. Paired t-tests were used to assess the differences between bony and glenoid surface inclination and concavity depth. Repeated measures analysis of variance and pairwise comparisons were made to compare radius of curvature measurements. The correlation between the bony glenoid inclination and its difference to glenoid surface inclination, as well as between the bony glenoid radius and its difference to glenoid surface radius, was analyzed. Results The bony glenoid inclination measured 7.1° ( ± 4.1° standard deviation [SD]), the glenoid surface inclination 1.6° ( ± 3.2° SD); the bony glenoid concavity depth measured 4.0 mm ( ± 0.8 mm SD), the glenoid surface concavity depth 7.1 mm ( ± 0.9 mm SD). The bony glenoid radius of curvature measured 33.4 mm ( ± 3.3 mm SD), the glenoid surface radius 25 mm ( ± 2.1 mm SD) and the humeral head radius 24.1 mm ( ± 1.7 mm SD). The labrum significantly decreased the glenoid fossa inclination by 5.5° (P < .001), significantly decreased the glenoid fossa radius by 8.4 mm (P < .001) and significantly increased the concavity depth by 3.2 mm (P < .001). There was a positive correlation between the bony glenoid inclination and its respective difference to the glenoid surface inclination (r = 0.71, P < .001). Also, there was a positive correlation between bony glenoid radius of curvature and its respective difference to the glenoid surface radius (r = 0.77, P < .001). Conclusion The labral complex decreases glenoid inclination and increases joint concavity and congruency in the supero-inferior plane. Differences between bony and surface glenoid measures were higher in individuals with increased superior bony inclination and larger bony radii, suggesting a compensatory role to the labrum for the underlying bony morphology.

BACKGROUND:Free bone graft transfer (FBGT) and the Latarjet procedure are 2 competing techniques for the treatment of anterior shoulder instability with glenoid bone loss. In the current literature, there are no mid- to long-term prospective randomized comparative studies comparing both surgical methods. METHODS:This prospective, twin-center, randomized study enrolled 60 patients with anterior shoulder instability and more than 15% glenoid bone loss. The study cohort was randomly assigned in a 1:1 ratio to either an open FBGT surgery (J-bone graft technique) or an open Latarjet procedure. Clinical data, including Western Ontario Shoulder Index (WOSI), Rowe Score, Subjective Shoulder Value, visual analog scale, satisfaction with the operation, sports and work limitations, range of motion and strength, as well as the extent of instability arthropathy were collected preoperatively and at 6, 12, 24, and 60 months postoperatively. The 5-year follow-up rate was 63.3% for the FBGT group and 66.6% for the Latarjet group. RESULTS:The primary outcome parameter (ie, WOSI) showed no significant differences at the 5-year follow-up (J-Span 221 ± 186, Latarjet 201 ± 239; P = .529) and other time points. The secondary clinical scores also showed no significant differences between the 2 groups (Rowe Score, P = .596; Subjective Shoulder Value, P = .368; visual analog scale, P = .238; and Athletic Shoulder Outcome Scoring System, P = .594). Comparable results were observed regarding strength and motion, except for significantly better internal rotation in the FBGT group at all time points, including the 5-year follow-up (P = .004). A single recurrence of instability was observed in 3 patients of the FBGT group and 1 patient of the Latarjet group (P = .342). Postoperative hypesthesia at the iliac crest was reported in 3.3% of the FBGT patients. The degree of instability arthropathy showed a comparable increase in both cohorts (P = .154). CONCLUSION:Neither of the 2 surgical methods showed clinical superiority at the 5-year follow-up, except for statistically better internal rotation in the FBGT group. Both cohorts showed comparable success in joint stabilization, but neither could prevent the progression of instability arthropathy.

Meniscus allograft transplantation has demonstrated promising clinical outcomes in the management of total meniscal deficiency. Magnetic resonance imaging (MRI) is commonly used to assess graft integrity and position, particularly meniscus extrusion; however, MRI has limitations, including high cost, limited accessibility, and inability to provide dynamic, real-time assessments. Furthermore, static MRI findings often show poor correlation with clinical outcomes, underscoring the need for complementary methods. This Technical Note presents a standardized knee ultrasound protocol for dynamic evaluation of meniscus extrusion after meniscus allograft transplantation. Ultrasonography provides a cost-effective, accessible, and in-office modality that enables real-time assessment of graft function under axial loading, offering a valuable alternative to MRI for postoperative monitoring.

Background:Evidence for the superiority of surgical versus nonsurgical treatment of Rockwood type 3 acromioclavicular joint (ACJ) dislocation is still lacking. Hypothesis:It was hypothesized that surgical treatment will outperform nonsurgical treatment. Study Design:Randomized controlled trial; Level of evidence, 1. Methods:A prospective randomized trial involving 4 study centers was performed from January 1, 2011, to March 31, 2016. A total of 85 patients with acute Rockwood type 3 ACJ dislocations were allocated randomly to receive either nonsurgical or surgical treatment. A total of 70 patients were treated as allocated, and 8 patients made an early crossover from nonsurgical to surgical treatment, leaving 47 patients treated surgically and 31 patients nonsurgically. All patients were followed up longitudinally, including clinical evaluation using the Constant score and standardized radiographic evaluation, with final follow-up after 2 years. Results:At no follow-up time point was there a significant difference in Constant score between the surgically and nonsurgically treated patients. Radiographic analysis showed not only an inferior coracoclavicular distance at all follow-up points for surgical treatment but also a higher incidence of posttraumatic osteoarthritis and heterotopic ossifications, without any negative clinical correlation. With regard to complications, 1 patient (3%) in the nonsurgical group underwent secondary surgical ACJ stabilization. The revision rate after surgical treatment was 17% (P < .001). Neither primary horizontal instability nor younger age were associated with inferior clinical outcomes after nonsurgical treatment. Conclusion:Surgical treatment of ACJ Rockwood type 3 injuries did not lead to superior functional outcomes. Neither younger age nor horizontal instability were associated with inferior outcomes after nonsurgical treatment. Surgical treatment led to a slower recovery and to higher complication and revision rates. Registration:ISRCTN registry (study ID: ISRCTN92265154).

Background: This study aimed to assess long-term progression of osteoarthritis (OA) after isolated anterior cruciate ligament (ACL) reconstruction in athletes compared to the healthy contralateral side. Methods: The study included 15 patients and 30 knees with a mean age of 40 years (range, 35–46) years, none of whom had had revision surgery or an injury to the contralateral side. The mean follow-up period was 16.4 years (range, 13–22). Clinical and radiographic assessment included the Tegner activity scale (TAS), International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Kellgren and Lawrence (KL) grade. The long-term results of the injured knees were compared with the status of the healthy contralateral side and compared with previously published mid-term results of the same cohort of patients. Results: Patients generally remained clinically asymptomatic or mildly symptomatic at final follow-up, which is reflected by a KOOS pain score of 33 points (maximum 36 points) and an IKDC total subjective score of 87% (maximum 100%). There was a significant difference between mid-term and final follow-up in terms of the function score of the IKDC subjective questionnaire (p = 0.031), compartment findings and donor site morbidity of the IKDC functional examination (both p = 0.034), and the total KOOS score (p = 0.047). The KL score indicated significant progression of OA from mid-term to final follow-up in the injured knees (p = 0.004) and healthy contralateral knees (p = 0.014). Mean OA grades of the injured knees were significantly higher compared with the healthy contralateral side (p = 0.006) at final follow-up, and two patients showed moderate to severe signs of OA in the injured knee. Conclusions: Although most patients remained clinically asymptomatic or mildly symptomatic, long-term progression of OA after isolated ACL reconstruction in athletes was significantly higher compared with the healthy contralateral knee.

Purpose of this study was to evaluate the mid- to long-term outcome after conservatively treated first-time posterior shoulder dislocations and to determine structural defects associated with failure. In this multi-centric retrospective study, 29 shoulders in 28 patients with first-time acute posterior shoulder dislocation (Type A1 or A2 according to the ABC classification) and available cross-sectional imaging were included. Outcome scores as well as radiological and magnetic resonance imaging were obtained at a mean follow-up of 8.3 ± 2.7 years (minimum: 5 years). The association of structural defects with redislocation, need for secondary surgery, and inferior clinical outcomes were analysed. Redislocation occurred in six (21%) shoulders and nine shoulders (31%) underwent secondary surgery due to persistent symptoms. The posttraumatic posterior glenohumeral subluxation was higher in the redislocation group compared to the no redislocation group; however, statistical significance was not reached (61.9 ± 12.5% vs. 50.6 ± 6.4%). Furthermore, a higher adapted gamma angle was observed in the failed conservative treatment group versus the conservative treatment group, similarly without statistically significant difference (97.8° ± 7.2°, vs. 93.3° ± 9.7°). The adapted gamma angle was higher than 90° in all patients of failed conservative therapy and the redislocation group. An older age at the time of dislocation showed a significant correlation with better clinical outcomes (SSV: r = 0.543, p = 0.02; ROWE: r = 0.418, p = 0.035 and WOSI: r = 0.478, p = 0.045). Posterior glenohumeral subluxation after trauma correlated with a worse WOSI (r = − 0.59, p = 0.02) and follow-up posterior glenohumeral decentring (r = 0.68, p = 0.007). The gamma angle (r = 0.396, p = 0.039) and depth of the reverse Hill–Sachs lesion (r = 0.437, p = 0.023) correlated significantly with the grade of osteoarthritis at follow-up. Conservative treatment is a viable option in patients with an acute traumatic posterior shoulder dislocation with good outcome after mid- and long-term follow-up especially in patients with centred joint, low gamma angle, and middle or old age. IV.

Introduction: Subcapital fractures of the 5th metacarpal bone (MCV) represent a common injury. Volar angulation measurement is essential for treatment decision-making and therefore needs a reliable and valid method. The purpose of the present study was to investigate a new technique for volar angulation measurement, called the "Trigonometric Technique" (TT), and to compare the TT with the reference standard based on computed tomography (CT). Hypothesis: Quantifying volar angulation in MCV neck fractures with the TT shows no difference compared to the angle measured on CT scans. Material and methods: Fifteen patients (14 men and 1 woman) with a mean age of 37 16 years (range, from 16 to 72 years) who suffered MCV neck fracture and met the inclusion and exclusion criteria were selected for this prospective cohort study. Radiologic investigation included simple dorsopalmar (DP) radiographs and CT scans from the injured hand. Volar angulation measurements were performed by three observers at two time points comparing the TT to measurements obtained on CT scans. Intraclass correlation coefficients (ICC) were determined to assess interand intra-observer reliability. Results: The TT showed a mean volar angulation of 39 5 degrees (range, from 26 to 46 degrees) compared to 41 7 degrees (range, from 28 to 54 degrees) on CT measurement, which revealed a significant correlation between the two measurement techniques (R = 0.922, p < 0.001). Overall, the inter-rater (R = 0.977; 95% CI 0.945-0.992) as well as intra-rater (R = 0.857; 95% CI 0.739-0.941) reliability for the volar angulation using the TT was excellent. Conclusion: The TT presented in this study uses plain radiography and trigonometric identities to precisely determine volar angulation in MCV neck fractures. The TT correlates excellently with the obtained volar angulation angles measured on CT scans. We recommend the TT for volar angulation measurement in boxer's fracture as a reliable alternative to the conventional techniques. However, rotational abnormalities may remain undetected and should therefore be ruled out during clinical examination. (C) 2020 Elsevier Masson SAS. All rights reserved.

Background: The goal of this longitudinal study was to investigate the fate of the lateral ferm-oral notch (LFN), which is frequently seen as an impaction fracture of the lateral femoral condyle in patients with anterior cruciate ligament (ACL) tears. Methods: Patients who underwent early ACL reconstruction between 2006 and 2010 were reviewed. If post-injury magnetic resonance images showed an LFN greater than 1.5 min in depth, patients with untreated LFN were followed. Two blinded observers performed quantitative and qualitative imaging analysis. Results: Sixteen patients (five women, 11 men) were available for follow-up nine years (six to 10 years) post-injury. The median defect area of the LFN significantly decreased from 23 cm(2) (range: 0.9-3.8 cm(2)) to 1.6 cm(2) (range: 0.4-32 cm(2)) (P < .001). The defect depth did not significantly change from 2.3 mm (range: 2.0-3.6 mm) to 2.5 mm (range: 13-3.6 mm) (P > .05). The International Cartilage Repair Society (ICRS) score increased from 1.5 (range: 0-3) post-injury to 2.0 (range: 0-4) at follow-up (P < .01). The Lysholm score was 93 (72-100), the Tegner activity level was 6 (3-9) and the knee injury and osteoarthritis outcome score (KOOS) score was 97 (91-100). Conclusions: The defect area of the LFN decreased overtime, whereas the depth of the impression remained. Focal cartilage lesions were found in all except two patients post-injury and progressed during follow-up. However, patient-reported outcome scores were satisfying. (C) 2020 Elsevier B.V. All rights reserved.

Subcapital fractures of the 5th metacarpal bone (MCV) represent a common injury. Volar angulation measurement is essential for treatment decision-making and therefore needs a reliable and valid method. The purpose of the present study was to investigate a new technique for volar angulation measurement, called the ‘Trigonometric Technique’ (TT), and to compare the TT with the reference standard based on computed tomography (CT). Quantifying volar angulation in MCV neck fractures with the TT shows no difference compared to the angle measured on CT scans. Fifteen patients (14 men and 1 woman) with a mean age of 37 ± 16 years (range, from 16 to 72 years) who suffered MCV neck fracture and met the inclusion and exclusion criteria were selected for this prospective cohort study. Radiologic investigation included simple dorsopalmar (DP) radiographs and CT scans from the injured hand. Volar angulation measurements were performed by three observers at two time points comparing the TT to measurements obtained on CT scans. Intraclass correlation coefficients (ICC) were determined to assess inter- and intra-observer reliability. The TT showed a mean volar angulation of 39 ± 5 degrees (range, from 26 to 46 degrees) compared to 41 ± 7 degrees (range, from 28 to 54 degrees) on CT measurement, which revealed a significant correlation between the two measurement techniques (R = 0.922, p < 0.001). Overall, the inter-rater (R = 0.977; 95 % CI: 0.945–0.992) as well as intra-rater (R = 0.857; 95 % CI: 0.739–0.941) reliability for the volar angulation using the TT was excellent. The TT presented in this study uses plain radiography and trigonometric identities to precisely determine volar angulation in MCV neck fractures. The TT correlates excellently with the obtained volar angulation angles measured on CT scans. We recommend the TT for volar angulation measurement in boxer's fracture as a reliable alternative to the conventional techniques. However, rotational abnormalities may remain undetected and should therefore be ruled out during clinical examination. Study of diagnostic test.

Aims and Objectives: With current trends towards individualized anterior cruciate ligament (ACL) surgery, especially in younger patients performing high pivoting sports and patients with hyperlaxity, the bone-patellar tendon-bone (BPTB) autograft and its advantages in primary ACL reconstruction, have been brought into focus. Still concern remains about donor site morbidity, especially kneeling pain, due to bone block harvesting at the distal patella and tibial tuberosity. There is ongoing scientific effort to reduce this weakness of BPTB-harvesting techniques, without satisfying results so far. This study compares anterior knee pain (AKP) in patients receiving hamstring tendon (HS) and those patients treated with BPTB autograft ACL reconstruction, respectively. In the latter group harvest sites were refilled with autologous bone material from an oscillating hollow saw used to create the tibial tunnel. The aim of this study was, to compare both techniques that there is no significant difference in postoperative knee pain and kneeling pain in the early follow up period. Materials and Methods: Forty-two patients with primary ACL reconstruction (21 BPTB, group A; 21 HS, group B) were retrospectively analyzed obtaining matched pairs based on age (±5 years), length of follow up (18 ± 6 months) and gender.Preoperative radiological analysis of patellofemoral cartilage defects were recorded using MRI scans and arthroscopic images (modified Outerbridge grading). Additionally clinical and patient-reported outcome measures were obtained, assessing range-of-motion, knee-laxity (Lachman, anterior-drawer test), activities of daily living and sports activity scale (KOS-ADL and SAS score) and graft or contralateral ACL tear occurring during follow up. Results: At short term follow up clinical parameters were similar between patients treated either with hamstring or BPTB autograft. Scores showed higher values for daily living (KOS-ADLS) in the short term in group A (P<0,05), in contrary group B showed higher scores for the KOS-SAS (P<0,05). More patients avoid kneeling on the operated knee after BPTB-autograft reconstruction, without impairing activities of daily living or sports participation. No significant difference existed between clinical stability measures or range of motion at follow up. Conclusion: Our study showed that ACL reconstruction with HS or BPTB autograft has successful short term outcome, with high probability of returning to unimpaired activities of daily living. This study shows that refilling of harvest sites with autologous bone material taken from an hollow saw used for creation of the tibial tunnel leads to acceptable donor site morbidity, without restriction in daily activities and sports participation, respectively. It can therefore be assumed that BPTB autograft without leaving bony defects at the harvest sites is a safe procedure with low donor site morbidity, being relevant in individualized ACL reconstruction.

Background: The subscapularis musculotendinous unit provides a stabilizing effect on the glenohumeral joint and thus, enables normal active range of motion. As pathologies of the subscapularis tendon (SSC) are diagnosed with increased regularity, treatment strategies and their long-term consequences are of relevant interest. Therefore, the primary objective of this retrospective case series was to evaluate clinical and radiological long-term results after open repair of large SSC tears. Hypothesis: Repair failure negatively influences clinical outcomes and the progression of secondary glenohumeral osteoarthritis (OA). Methods: Between 1998 and 2007, 24 patients with traumatic large (Lafosse III and IV) SSC tears were treated with an open transosseous repair technique. Of those, 20 patients (83%) with a mean age of 55 +/- 8 years (range, from 31 to 68 years) at the time of surgery were subjected to a long-term follow-up after a mean of 14 +/- 3 years (range, from 10 to 18 years). The Subjective Shoulder Value (SSV), the Constant Score (CS), the University of California at Los Angeles (UCLA) Shoulder Score, and the American Society for Shoulder and Elbow Surgeons (ASES) Score were obtained. Magnetic resonance imaging (MRI) was performed to evaluate tendon integrity. The progression of secondary glenohumeral OA from pre- to postoperative was analyzed using the collective instability arthropathy (CIA) score. Results: One patient (5%) had to undergo revision surgery due to a symptomatic re-tear of the SSC tendon. Besides that, the mean SSV of the affected shoulder was 83% +/- 12, the CS 78 +/- 10, the UCLA 32 +/- 2, and the ASES 89 +/- 14 points, respectively. MRI revealed a re-tear of the SSC tendon in 4 patients (29%). On the affected shoulder, glenohumeral OA progressed significantly from pre-(CIA, 0.3 +/- 0.5) to postoperative (CIA, 1.7 + 0.9; p = 0.003) and was significantly associated with repair failure (p = 0.040). Conclusion: Open repair of large SSC tears yielded good clinical long-term results. Nevertheless, repair failure was common and, in the further course, negatively affected clinical outcomes and the progression of secondary glenohumeral OA. (C) 2019 Elsevier Masson SAS. All rights reserved.

Background: Ski touring is an outdoor sport with growing popularity in alpine countries. Information about injuries in ski touring is limited. Purpose: To determine injury rates, mechanisms, causes, and risk factors in ski touring. Study Design: Descriptive epidemiology study. Methods: Between November 2015 and May 2016, a total of 191 participants from the Alps region were prospectively tracked via personalized online questionnaires. Injury rates were calculated per 1000 hours of sports exposure. Risk factors were assessed per multivariate logistic regression analysis. Results: A total of 3900 ski tours were performed, with 10,955 hours and 4,108,503 m in height ascension (uphill) recorded. The overall injury rate was 2.5 injuries per 1000 hours of ski touring. A total of 27 injury-events were reported, of which 18 (67%) were classified as mild, 7 (26%) as moderate, and 2 (7%) as severe. Hands (28%) and knees (16%) were the most commonly involved anatomic regions. Most injuries were limited to the soft tissue, such as bruises (31%) and abrasions (18%). Significantly more injuries happened during the descent (n = 17; 63%) than during the ascent (n = 6; 22%) (odds ratio, 5.96; P = .004), while poor weather conditions, icy surface, and inattentiveness were the most often reported reasons for injury. Sidecountry ski touring was identified as the only significant independent risk factor for injury (P < .001). Conclusion: In this prospective injury surveillance study, the majority of ski touring injuries were mild and limited to the soft tissue. Ski touring injuries were more likely to happen during the descent of a tour, and sidecountry ski touring was the only significant independent risk factor for injury. Bad weather, icy surface, and inattentiveness were found to be the leading causes for an injury-event in this study.

The subscapularis musculotendinous unit provides a stabilizing effect on the glenohumeral joint and thus, enables normal active range of motion. As pathologies of the subscapularis tendon (SSC) are diagnosed with increased regularity, treatment strategies and their long-term consequences are of relevant interest. Therefore, the primary objective of this retrospective case series was to evaluate clinical and radiological long-term results after open repair of large SSC tears. Repair failure negatively influences clinical outcomes and the progression of secondary glenohumeral osteoarthritis (OA). Between 1998 and 2007, 24 patients with traumatic large (Lafosse III and IV) SSC tears were treated with an open transosseous repair technique. Of those, 20 patients (83%) with a mean age of 55 ± 8 years (range, from 31 to 68 years) at the time of surgery were subjected to a long-term follow-up after a mean of 14 ± 3 years (range, from 10 to 18 years). The Subjective Shoulder Value (SSV), the Constant Score (CS), the University of California at Los Angeles (UCLA) Shoulder Score, and the American Society for Shoulder and Elbow Surgeons (ASES) Score were obtained. Magnetic resonance imaging (MRI) was performed to evaluate tendon integrity. The progression of secondary glenohumeral OA from pre- to postoperative was analyzed using the collective instability arthropathy (CIA) score. One patient (5%) had to undergo revision surgery due to a symptomatic re-tear of the SSC tendon. Besides that, the mean SSV of the affected shoulder was 83% ± 12, the CS 78 ± 10, the UCLA 32 ± 2, and the ASES 89 ± 14 points, respectively. MRI revealed a re-tear of the SSC tendon in 4 patients (29%). On the affected shoulder, glenohumeral OA progressed significantly from pre- (CIA, 0.3 ± 0.5) to postoperative (CIA, 1.7 ± 0.9; p = 0.003) and was significantly associated with repair failure (p = 0.040). Open repair of large SSC tears yielded good clinical long-term results. Nevertheless, repair failure was common and, in the further course, negatively affected clinical outcomes and the progression of secondary glenohumeral OA. IV; retrospective case series.

INTRODUCTION:Little is known about injuries in canyoning. It was the purpose of this study to determine injury rates, patterns, causes and risk factors in canyoning; and to identify targets for future injury prevention strategies.METHODS:From May to October 2015, 109 participants from 17 different countries were prospectively followed via a monthly e-mail-based questionnaire.RESULTS:During 13,690 h of canyoning, 57 injury-events occurred. The overall injury-rate was 4.2 injuries/1000 h of canyoning. The hand (23%) and lower leg and foot (25%) were most frequently involved. Most of the injuries were mild (n = 27, 49%) and limited to the soft-tissue. There were seven severe injuries (12%) with two lateral malleolar fractures, both necessitating surgery. The majority of injuries were due to material failure (44%) and significantly more injury-events were reported when the tour included rappelling (p = 0.037). Canyoning guides suffered from significantly less injuries compared to beginners and advanced canyoneers (p < 0.001).CONCLUSIONS:The majority of canyoning injuries are mild. On the other side, roughly one-tenth suffered from severe injury. Canyoning guides are less prone to injury-events and beginners should consider performing tours with experienced guides. Notwithstanding, rappelling was the most common activity associated with an injury and the material used was deemed causative for an injury-event in almost half of all cases. Further improvement in canyoning equipment, frequent equipment service, and instructional courses to ensure adequate employment of equipment might minimize the risk of getting injured.

BACKGROUND:Instability arthropathy (IA) is a major long-term concern in patients with anterior shoulder instability. This study investigated the association of glenoid morphology with the development of IA. METHODS:The study included 118 patients with unilateral anterior shoulder instability and available bilateral computed tomography scans. Instability-specific information was obtained from all patients. The glenoid morphology of the affected shoulder was compared with the nonaffected contralateral side resembling the constitutional preinjury glenoid shape. Both shoulders were evaluated independently by 3 observers to assess the grade of IA according to a Comprehensive Arthropathy Rating (CAR) system. Associations between IA and the glenoid morphology parameters were investigated. RESULTS:The average glenoid retroversion (P < .001), glenoid depth (P < .001), glenoid diameter (P < .001), and the bony shoulder stability ratio (P < .001) of the affected shoulder were significantly reduced compared with the contralateral side due to bony defects in 79.6% of the patients. The CAR of the affected side was significantly higher (P < .001), with more osteophytes (P = .001) and more sclerosis and cysts (P < .001). Differences in CAR (Δ-CAR) correlated positively with the age at the time of the computed tomography scan (P < .001), age at the initial dislocation (P = .001), size of the glenoid defect (P = .005), and the contralateral glenoid depth (P = .011), glenoid diameter (P = .016), and bony shoulder stability (P = .029), and negatively with glenoid retroversion of the affected side (P = .027). CONCLUSION:Development of IA arthropathy is associated not only with the age of the patients but also with morphologic parameters of the glenoid, including glenoid defect size and the constitutional glenoid concavity shape.

Recurrence rates after primary traumatic shoulder dislocation are distinctly high. We hypothesized that concomitant isolated fractures of the greater tuberosity are associated with low rates of persistent instability but decreased range of motion.

BACKGROUND:Anatomic graft tunnel placement is recommended in anterior cruciate ligament (ACL) reconstruction to restore knee joint stability and function. Transtibial (TT), anteromedial portal (AMP), and outside-in (OI) retrograde drilling surgical techniques have been described for tibial and femoral bone tunnel preparation.PURPOSE/HYPOTHESIS:The purpose of this study was to evaluate the bone tunnel parameters and compare the ability of 3 different surgical techniques to achieve placement of the ACL femoral and tibial bone tunnels at the center of the native ACL femoral and tibial attachment sites. The hypothesis was that tunnel placement using an AMP or OI technique would result in optimized tunnel parameters and more closely reconstruct the center of the native ACL femoral attachment site.STUDY DESIGN:Cohort study; Level of evidence, 3.METHODS:The study population consisted of 100 patients undergoing anatomic single-bundle ACL reconstruction using multiple-stranded hamstring tendon grafts. In group 1 (n = 36), the femoral tunnel was drilled using a TT surgical technique; in group 2 (n = 32), the femoral tunnel was drilled through an AMP; and in group 3 (n = 32), the femoral tunnel was created by use of an OI technique with retrograde drilling. Computed tomography (CT) scans were obtained postoperatively, and characteristics of femoral and tibial tunnel apertures were correlated to femoral and tibial measurement grid systems. The position of the resulting tibial and femoral bone tunnels for each group was compared with the center of the native ACL attachment sites.RESULTS:There were statistically significant differences (P < .05) for the ACL femoral tunnel between the 3 groups with respect to intercondylar height, total tunnel length, graft fixation length, tunnel axis, and tunnel entry angle. Statistically significant differences (P < .05) were found for the ACL tibial tunnel with respect to anteroposterior tunnel position and sagittal tunnel axis between the TT and both the OI and AMP techniques. The OI surgical technique produced more oblique and anatomically correct femoral tunnel apertures and longer femoral tunnel lengths compared with the AMP technique. Both AMP and OI techniques resulted in a more precise replication of intercondylar tunnel depth and height. There was no statistically significant difference for graft fixation length between the AMP and OI techniques.CONCLUSION:The AMP and OI surgical techniques were superior in positioning the ACL femoral tunnel at the center of the native ACL attachment site compared with the TT technique. An acceptable graft fixation length was obtained for all 3 surgical techniques.

PURPOSE:Biomechanical reports have advocated anatomic graft tunnel placement for reconstruction of the posterior cruciate ligament (PCL) to restore knee joint stability and facilitate optimal functional outcome. However, in vivo investigations that correlate tunnel position to functional results are lacking so far. This study evaluates the anatomic accuracy of femoral and tibial tunnel apertures on postoperative computed tomography (CT) scans and compares these findings to subjective and objective clinical outcome parameters.METHODS:After single-bundle PCL reconstruction, 29 patients were stratified into several subgroups according to the anatomic accuracy of femoral and tibial tunnel apertures measured on postoperative CT scans. A threshold value for the centres of the tunnel apertures was determined using a measurement grid system as a radiographic reference. To evaluate the functional and radiological results, visual analogue scale, International Knee Documentation Committee (IKDC), Tegner, Lysholm, Knee Injury and Osteoarthritis Outcome Score and osteoarthritis scores were obtained.RESULTS:Comparison between functional outcome and tunnel position yielded a statistically significant difference for subjective IKDC score and angle segment α and for objective stability and tunnel position P3 but no statistically significant difference with respect to intercondylar depth, intercondylar height and tibial tunnel position P2. No correlation was found between anatomic tunnel position and present or progressive osteoarthritis on follow-up. Of the patients, 72 % classified their result as excellent and good and 90 % would repeat surgical treatment.CONCLUSIONS:Despite a small sample size and subject to the threshold values we used, our data indicate a potentially minor effect of anatomic tunnel placement on midterm functional outcome following PCL reconstruction.

Purpose Tibial bone destruction during primary graft tunnel placement and tibial bone loss following tunnel enlargement represent major challenges in revision reconstruction of the anterior cruciate ligament (ACL). Initial all-inside ACL reconstruction facilitates the preparation of tibial bone sockets rather than full tunnels that potentially preserve tibial bone stock. The purpose of this study was to comparatively assess length, diameter and volume of tibial graft tunnels following all-inside and conventional ACL reconstruction. Methods Postoperative computed tomography (CT) scans of 59 patients were assessed following ACL reconstruction. In 35 patients we used conventional antegrade tibial tunnel drilling and in 24 all-inside retrograde tibial bone sockets. Imaging analysis included total, minimal and maximal tunnel length and tunnel diameter. Tunnel volumes were calculated corresponding to these parameters. Results Statistically significant group differences ( p < 0.01) could be detected for tibial tunnel volume, length and diameter between conventional antegrade and all-inside retrograde tibial bone tunnels and sockets, respectively. Conclusions Compared with conventional techniques, all-inside retrograde drilling of tibial bone sockets is effective in preserving significant bone stock, which might be beneficial for revision reconstruction in cases of eventual primary graft failure.