The American journal of sports medicine
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Generally, a glenoid bone loss greater than 20% to 25% is considered critical for poor surgical outcomes after a soft tissue repair. However, recent studies have suggested that the critical value should be lower. ⋯ An anterior glenoid bone loss of 17.3% or more with respect to the longest anteroposterior glenoid width should be considered as the critical amount of bone loss that may result in recurrent glenohumeral instability after arthroscopic Bankart repair.
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Previous studies have reported variable rates of recurrent lateral patellar instability mainly because of limited cohort sizes. In addition, there is currently a lack of information on contralateral patellar instability. ⋯ At 20 years after a first-time lateral patellar dislocation, the cumulative incidence of recurrent ipsilateral patellar dislocations was 36.0%, compared with 5.4% for contralateral dislocations. Trochlear dysplasia, elevated TT-TG distance, patella alta, age <18 years at the time of the first dislocation, and female sex were associated with ipsilateral recurrence. Trochlear dysplasia, elevated TT-TG distance, patella alta, and age <18 years at the time of the first dislocation were predictive of a statistically significant decrease in time to recurrence.
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Effective postoperative pain management after shoulder arthroscopy is a critical component to recovery, rehabilitation, and patient satisfaction. ⋯ On the basis of the evidence in this review, we recommend the use of ISBs as the most effective analgesic for outpatient arthroscopic shoulder surgery.
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Reconstruction of the medial patellofemoral ligament (MPFL) for recurrent lateral patellar dislocation is gaining popularity. However, the morphological changes in the femoral tunnel after MPFL reconstruction are still not fully documented. ⋯ The CSA of the femoral tunnel aperture enlarged, and the tunnel aperture migrated anteriorly with time after MPFL reconstruction. Risk factors for patellar dislocation other than patella alta did not influence morphological changes of the femoral tunnel.
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The treatment of symptomatic cartilage defects of the patella is particularly challenging, and no gold standard is currently available. ⋯ The implantation of a cell-free collagen-hydroxyapatite osteochondral scaffold provided a clinical improvement at short-term follow-up for the treatment of patellar cartilage defects. Women had lower outcomes, and the need for realignment procedures led to a slower recovery. MRI evaluation showed some abnormal findings with the presence of bone overgrowth, but no correlation has been found with the clinical outcome.