The American journal of sports medicine
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Various approaches have been proposed to treat articular cartilage lesions, which are plagued by inherent limited healing potential. ⋯ Both methods have shown satisfactory clinical outcome at medium-term follow-up. Better clinical results and sport activity resumption were noted in the group treated with second-generation autologous chondrocyte transplantation.
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Several techniques are published for the treatment of peroneal tendon instability. ⋯ Groove impaction offers a simple, quickly done procedure with low morbidity, relatively quick return to sports, and successful elimination of peroneal tendon instability.
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Traumatic acromioclavicular (AC) joint dislocations are common injuries among the active population. The injury mechanism requires excessive force delivered by a fall or blow to the shoulder. Associated injuries may occur and remain undetected if they are masked by the painful and prominent AC joint injury. ⋯ Concomitant injuries to the shoulder girdle obtained during traumatic AC joint separation may be more frequent than previously thought. Clinical diagnosis may be difficult in the setting of an acute and painful dislocated AC joint. Shoulder arthroscopy during arthroscopic AC joint stabilization may aid in detecting associated injuries.
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Previous investigations have reported on the chondrotoxicity of bupivacaine in short-term in vivo and in vitro models. This study was designed to provide additional information on the long-term effects of bupivacaine infusion on articular cartilage in an established rabbit shoulder model. ⋯ No permanent impairment of cartilage function was detected 3 months after intra-articular infusion of bupivacaine. Cartilage metabolism was increased, indicating a possible reparative response. This suggests that, at least in the model used, articular cartilage has the ability to recover from the chondrotoxic effects of bupivacaine infusion. Before extrapolating these results to human cartilage, other factors including underlying cartilage injury or disease, decreased chondrocyte density, and increased bupivacaine dosing need to be taken into account. Clinical Relevance Bupivacaine toxicity has recently been implicated in the development of chondrolysis after arthroscopic shoulder procedures, but these findings suggest that additional noxious stimuli might be required before permanent damage ensues.
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Effective soft tissue graft fixation to the tibial tunnel in all-inside anterior cruciate ligament reconstructions has been reported to be a problem and may lead to retrograde pullout at ultimate load testing. ⋯ These findings may prove useful in providing additional stability when using an all-inside technique in a difficult case, or in a patient with poor bone stock, and may also be useful as an alternative to more commonly used tibial tunnel soft tissue fixation techniques.