The American journal of sports medicine
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Rotational knee stability provided by the anterior cruciate ligament (ACL) in the pivot-shift phenomena involves analysis of more complex robotic testing profiles and resulting tibiofemoral compartment kinematics and subluxations. ⋯ Surgeons should be cautious in interpreting conclusions on ACL function and graft reconstructions without knowing the resulting tibiofemoral subluxations or loading conditions that may limit maximum anterior tibial femoral subluxations.
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Multicenter Study
Novel radiographic feature classification of knee osteochondritis dissecans: a multicenter reliability study.
Osteochondritis dissecans (OCD) is a vexing condition for patients, parents, and physicians because of the frequent slow healing and nonhealing that leads to prolonged treatment. Several features on plain radiographs have been identified as predictors of healing, but the reliability of their measurement has not been established. ⋯ Many diagnostic features of femoral condyle OCD lesions can be reliably classified on plain radiographs, supporting their future testing in multifactorial classification systems and multicenter research to develop prognostic algorithms. Other radiographic features should be excluded, however, because of poor reliability.
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Identifying predictors of contralateral anterior cruciate ligament (ACL) reconstruction is important to focus preventive strategies and related research on high-risk groups. ⋯ In both male and female participants, age <20 years predicted an almost 3 times higher 5-year risk of contralateral ACL reconstruction. Among female participants undergoing reconstruction with autograft hamstring, a contralateral harvest predicted a more than 3 times higher 5-year risk of contralateral ACL reconstruction. Patient sex, activity at the time of index injury, graft selection, meniscal injury, and chondral injury were not predictors of contralateral ACL reconstruction.
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Capsular laxity is a main contributing factor in recurrent shoulder instability and is suggested to be correlated with increased capsular volume. Arthroscopic capsular shift combined with Bankart repair can reduce the capsular volume and reinforce the redundant capsule; however, as the capsuloligamentous structure has viscoelastic properties, it is possible for the shifted and tensioned capsule of the glenohumeral joint to slowly stretch out again over time, resulting in an increase in capsular volume. ⋯ Surgeons should be aware of the re-increase in anterior capsular volume or restretching trait of the anterior capsule over time, even after successful arthroscopic Bankart repair and capsular shift. In this study, women, elite athletes, and those with frequent dislocations were at high risk of capsular restretching. An increase in capsular volume was related to redislocation and positive apprehension sign as well as with Rowe score.
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Postoperative knee chondrolysis caused by continuous intra-articular pain pumps infusing bupivacaine with epinephrine is a rare but serious complication. ⋯ The development of knee chondrolysis was associated with the intra-articular infusion of bupivacaine with epinephrine postoperatively. Furthermore, the presented evidence suggests that this occurs in a dose-dependent manner. The risk of knee chondrolysis might be reduced by avoidance of intra-articular infusion of bupivacaine with epinephrine. We recommend against continuous intra-articular infusion of local anesthetic postoperatively.