Prevalence of Scapular Dyskinesis in Overhead and Nonoverhead Athletes: A Systematic Review

Background:

Scapular dyskinesis, or abnormal dynamic scapular control, is a condition that is commonly associated with shoulder pathology but is also present in asymptomatic individuals. Literature varies on whether it represents a cause or symptom of shoulder pathology, but it is believed to be a risk factor for further injury. Clinical identification focuses on visual observation and examination maneuvers. Treatment of altered scapular motion has been shown to improve shoulder symptoms. It is thought to be more common in overhead athletes due to their reliance on unilateral upper extremity function but the incidence within nonoverhead athletes is unknown.

Hypothesis:

Overhead athletes will have a greater prevalence of scapular dyskinesis when compared with nonoverhead athletes.

Study Design:

Systematic review; Level of evidence, 3.

Methods:

After PROSPERO registration, a systematic review was performed using PRISMA guidelines through the PubMed database looking for studies published before October 2014. All studies containing the search terms scapular, scapulothoracic, dyskinesis, dyskinesia, shoulder athlete, or overhead athlete were included. Studies that did not include prevalence data for scapular dyskinesis were excluded. Study methodological quality was evaluated using the modified Coleman methodology score. Descriptive statistics and 2-proportion 2-tailed z-tests were used to compare the reported prevalence of scapular dyskinesis between overhead and nonoverhead athletes.

Results:

Twelve studies were analyzed including 1401 athletes (1257 overhead and 144 nonoverhead; mean age, 24.4 ± 7.1 years; 78% men). All the studies were evidence level 2 (33%) or level 3 (67%). The reported prevalence of scapular dyskinesis was significantly (P < .0001) higher in overhead athletes (61%) compared with nonoverhead athletes (33%).

Conclusion:

Scapular dyskinesis was found to have a greater reported prevalence (61%) in overhead athletes compared with nonoverhead athletes (33%).

Clinical Relevance:

Prevalence data for scapular dyskinesis are scarce within the literature. Information on the reported prevalence, laterality, and association with the dominant extremity will allow for better allocation of diagnostic and therapeutic interventions. Recognition and treatment will help athletes to optimize functional performance and decrease the risk of further shoulder injury.

Radiographic Prevalence of Dysplasia, Cam, and Pincer Deformities in Elite Ballet

BACKGROUND

The demands of hip strength and motion in ballet are high. Hip disorders, such as cam and pincer deformities or dysplasia, may affect dance performance. However, the prevalence of these radiographic findings is unknown.

PURPOSE

To determine the prevalence of radiographic cam and pincer deformities, borderline dysplasia, and dysplasia in a professional ballet company.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

An institutional review board-approved cross-sectional investigation of a professional ballet company was undertaken. Male and female adult dancers were eligible for inclusion. Four plain radiographs were obtained (standing anteroposterior pelvis, bilateral false profile, and supine Dunn 45°) and verified for adequacy. Cam and pincer deformities, dysplasia, borderline dysplasia, and osteoarthritis were defined. All plain radiographic parameters were measured and analyzed on available radiographs. Student t test, chi-square test (and Fisher exact test), and Spearman correlation analyses were performed to compare sexes, groups, and the effect of select radiographic criteria.

RESULTS

A total of 47 dancers were analyzed (21 males, 26 females; mean age (±SD), 23.8 ± 5.4 years). Cam deformity was identified in 25.5% (24/94) of hips and 31.9% (15/47) of subjects, with a significantly greater prevalence in male dancers than females (48% hips and 57% subjects vs 8% hips and 12% subjects; P < .001 and P = .001, respectively). Seventy-four percent of subjects had at least 2 of 6 radiographic signs of pincer deformity. Male dancers had a significantly greater prevalence of both prominent ischial spine and posterior wall signs (P = .001 and P < .001, respectively), while female dancers had a significantly greater prevalence of coxa profunda (85% female hips vs 26% male hips; P < .001). Eighty-nine percent of subjects had dysplasia or borderline dysplasia in at least 1 hip (37% dysplastic), with a significantly greater prevalence of dysplasia or borderline dysplasia in female versus male dancers (92% female hips vs 74% male hips; P < .022). Further, in those with dysplasia or borderline dysplasia, 92% of female and 82% of male dancers had bilateral findings.

CONCLUSION

In this professional ballet company, a high prevalence of radiographic abnormalities was found, including cam and pincer deformity and dysplasia. The results also revealed several sex-related differences of these abnormalities in this unique population. The long-term implications of these findings in this group of elite athletes remain unknown, and this issue warrants future investigation.

Incidence and Prevalence of Musculoskeletal Injury in Ballet: A Systematic Review

BACKGROUND

Most published studies on injuries in the ballet dancer focus on the lower extremity. The rigors of this activity require special training and care. By understanding prevalence and injury pattern to the musculoskeletal system, targeted prevention and treatment for this population can be developed.

PURPOSE

To determine the incidence and prevalence of musculoskeletal injuries in ballet.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

A systematic review registered with PROSPERO was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Level 1 through 4 evidence studies reporting incidence of musculoskeletal injuries in male and female ballet dancers were included, with the numbers and types of injuries extracted from each. Injury rates were recorded and calculated based on professional status, sex, and nature of injury. Incidence was defined as number of injuries sustained over a specific time. Prevalence was defined as proportion of subjects with an injury at a given point in time.

RESULTS

The studies analyzed reported injury incidence or prevalence in more than 1365 amateur and 900 professional dancers. The mean age was 16.2 years among amateur and 27.0 years among professional dancers. The incidence of injury among amateur dancers was 0.99 and 1.09 injuries per 1000 dance hours in males and females, respectively; 75% of injuries were overuse, with similar rates among males and females. In professional dancers, the incidence of injury was 1.06 and 1.46 injuries per 1000 dance hours in males and females, respectively, and 64% of female injuries were overuse, compared with 50% in males (P < .001). Only 3 studies provided prevalence data, including 62% prevalence of lumbosacral pain, 58% painful snapping hip, and 29% patellofemoral pain. Lower extremity injuries comprised 66% to 91% of all injuries, with the foot and ankle accounting for 14% to 57%.

CONCLUSION

The overall incidence of injury among amateur and professional ballet dancers is 0.97 and 1.24 injuries per 1000 dance hours, respectively. The majority are overuse in both amateur and professional dancers, with amateur ballet dancers showing a higher proportion of overuse injuries than professionals (P < .001). Male professional dancers show a higher proportion of traumatic injuries, accounting for half of their injuries (P < .001).

Treatment of Anterior Cruciate Ligament Injuries by Major League Soccer Team Physicians

Background:

The treatment and rehabilitation procedures of anterior cruciate ligament (ACL) injuries in elite soccer players are controversial. Points of debate include surgical timing, technique, graft choice, rehabilitation, and return-to-sport criteria and timing.

Purpose:

To identify practice preferences among current Major League Soccer (MLS) team orthopaedic surgeons for ACL injuries.

Study Design:

Cross-sectional study; Level of evidence, 4.

Methods:

The survey was administered at the MLS team physician annual meeting in January 2013. At least 1 orthopaedic surgeon representative from each of the 19 clubs (16 from the United States, 3 from Canada) was in attendance. Teams with more than 1 affiliated orthopaedic surgeon were given an additional survey to be completed either at the meeting or returned via e-mail. Descriptive statistics, Wilcoxon Mann-Whitney (return-to-play parameters, running, and ball drills), and Fisher exact tests (graft selection, bracing, continuous passive motion) were applied to the various data sets from the survey responses.

Results:

A 100% survey participation rate was achieved (22 team orthopaedic surgeons representing 19 MLS teams). A single-incision, arthroscopically assisted, single-bundle reconstruction was the most common technique (91%). Surgeons were split regarding femoral tunnel drilling (50% transtibial, 46% accessory medial). Autograft bone–patellar tendon–bone (BPTB) was the most common preferred graft choice (68%). The biggest concerns about BPTB autograft and hamstring autograft were anterior knee pain (76%) and hamstring weakness (46%), respectively. Most surgeons did not recommend postoperative continuous passive motion (64%) or functional bracing (68%). Most surgeons permitted return to sport without restrictions at 6 to 8 months following surgery (82%). Surgeons who routinely used functional bracing after ACL surgery more frequently used hamstring autograft than those who used BPTB autograft (P = .04).

Conclusion:

This article successfully describes current management of ACL injuries among MLS team orthopaedic surgeons. The preference for single-bundle BPTB autograft is similar to published data in the National Football League and National Basketball Association.

Return to play after treatment of superior labral tears in professional baseball players

BACKGROUND

The published return-to-play (RTP) rates for athletes who have undergone surgical repair of superior labrum anterior-posterior (SLAP) tears vary widely and are generally accepted to be lower in the subset of competitive throwers. The efficacy of nonsurgical treatment for this group is unknown.

HYPOTHESIS

Nonsurgical treatment of SLAP tears in professional baseball players leads to RTP before consideration of surgical treatment. Incorporating performance statistics and level of competition will result in lower calculated RTP rates than have been previously reported.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

A retrospective review of 119 consecutive patients in a single professional baseball organization with persistent shoulder pain that limited the ability to compete was performed. Sixty-eight patients had magnetic resonance imaging-documented SLAP lesions. All patients had failed 1 attempt at rehabilitation but had continued with supervised physical therapy. Treatment was according to an algorithm focusing on the correction of scapular dyskinesia and posterior capsular contracture with glenohumeral internal rotation deficit (GIRD), followed by pain-free return to throwing. Those who failed 2 cycles of nonsurgical treatment were treated surgically. Success was defined by 2 different standards: (1) RTP, in accordance with previous studies; and (2) a more stringent standard of return to the same level/quality of professional competition (A, AA, AAA, etc) with the incorporation of a return to preinjury individual performance statistics (earned run average, walks plus hits per inning pitched), termed "return to prior performance" (RPP).

RESULTS

Sixty-eight athletes were identified with SLAP lesions. Twenty-one pitchers successfully completed the nonsurgical algorithm and attempted a return. Their RTP rate was 40%, and their RPP rate was 22%. The RTP rate for 27 pitchers who underwent 30 procedures was 48%, and the RPP rate was 7%. For 10 position players treated nonsurgically, the RTP rate was 39%, and the RPP rate was 26%. The RTP rate for 13 position players who underwent 15 procedures was 85%, with an RPP rate of 54%.

CONCLUSION

Nonsurgical treatment correcting scapular dyskinesia and GIRD had a reasonable success rate in professional baseball players with painful shoulders and documented SLAP lesions. The rate of return after surgical treatment of SLAP lesions was low for pitchers. The RTP and RPP rates were higher for position players than for pitchers. Nonsurgical treatment should be considered for professional baseball players with documented SLAP lesions, as it can lead to acceptable RTP and RPP rates.

Strain within the native and reconstructed MPFL during knee flexion

There is little published data on the strain within the medial patellofemoral ligament (MPFL) and medial retinaculum through knee motion. This study was undertaken to evaluate the three-dimensional strain across the MPFL in the native state, using a proprietary visible-light stereophotogrammetry (VLS) system, and to compare the findings to the strain in a MPFL injury model and in two different reconstructed states. This is a controlled laboratory study. Eight cadaveric knees were marked along the MPFL and medial retinaculum, placed in an activity simulator, and taken through a range a motion. A proprietary VLS system was used to calculate the strain across the medial retinaculum and MPFL at 10 different degrees of knee flexion. This process was repeated in an MPFL injury model, as well as after standardized reconstruction of the MPFL using hamstring autograft performed in both 20 and 45 degrees of flexion. Averaged over all the measurement sites, the maximum principal strain (ε1) within the native MPFL increased rapidly from full extension to 120 degrees of flexion. The highest value of ε1 (87%) was observed at 120 degrees of knee flexion in the MPFL region. The largest change in strain occurred between 25 and 30 degrees (10% increase). The strain patterns in the knees reconstructed at 45 degrees of flexion more closely resembled the strain in the native state than did the strain in the knees reconstructed at 20 degrees. Strain within the native MPFL increases as the knee flexion angle increases, with the largest change occurring between 25 and 30 degrees. Reconstruction of the MPFL at 45 degrees is preferable to reconstruction at 20 degrees as the strain across the medial retinaculum more closely resembles the strain in the native state. Knowledge of the strain across the MPFL should allow for more accurate reconstruction of the MPFL, potentially reducing the risk of patellar maltracking or cartilage overload. The proprietary VLS system used in this study has many potential uses for experimental analysis of strain in the human body.

Asymmetric Hip Rotation in Professional Baseball Pitchers

Background:

There is a renewed interest in examining the association between hip range of motion and injury in athletes, and the data on baseball players are conflicting. Understanding whether asymmetrical hip rotation is a normal adaptation or a risk factor for injury will help therapists, trainers, and physicians develop rehabilitation programs to improve kinetic energy transfer and prevent injury. As our knowledge of hip pathology among baseball pitchers improves, establishing baselines for hip motion is critical in the further assessment of injury.

Hypothesis:

Because of the repetitive nature of throwing sports and the adaptive changes documented in the shoulder, elite baseball pitchers would have characteristic patterns of hip internal and external rotations on their dominant throwing side (stance) and their nondominant side (stride) in extension.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Computer software was used to measure passive internal and external rotations on digital photographs of 111 professional baseball pitchers.

Results:

In right-handed pitchers, there was significantly more internal rotation in the stance hip than the stride hip (32.2° ± 8.2° vs 30.8° ± 8.4°; P = .0349) and significantly more external rotation in the stride hip than the stance hip (36.3° ± 7.7° vs 30.8° ± 9.7°; P < .0001). While the mean difference in external rotation was 4.7°, 32% of the subjects had a >10° increase in external rotation on the stride hip relative to the stance hip. This population was statistically different from the remaining group for older age (P = .0053), lower body mass index (P = .0379), and more years in professional baseball (P = .0328). In the smaller number of left-handed pitchers, side-to-side differences in hip rotation were found but were not statistically significant.

Conclusion:

Pitchers showed more internal rotation on their stance hip and more external rotation on their stride hip. Although the mean differences are small, there is a subset of pitchers with defined characteristics in whom larger differences exist.

The effect of progressive degrees of medial meniscal loss on stability after anterior cruciate ligament reconstruction

Previous studies report conflicting results on whether loss of the medial meniscus compromises knee stability after reconstruction of the anterior cruciate ligament (ACL). The purpose of this study was to determine whether the degree of medial meniscus deficiency affects the stability of the ACL-reconstructed knee. Six cadaveric knees were arthroscopically reconstructed with bone-patellar tendon-bone autografts using an anatomic "footprint" technique. Knees tested were ACL-deficient and after reconstruction under three different meniscal states: with partial medial meniscectomy, subtotal meniscectomy, and meniscal root transection. Biomechanical testing was performed at 30 and 60 degrees of flexion under two loading conditions: (1) 134-N anterior tibial load termed anterior tibial translation (ATT) and (2) 10-Nm valgus load combined with 5 Nm of internal tibial torque termed provocative pivot maneuver (PPM). Knee kinematics was measured using a custom activity simulator, motion analysis system, and three-dimensional CT reconstructions. During both ATT and PPM loading, ACL deficiency resulted in a significant increase in anterior translation compared with knees with an intact ACL or those that had undergone ACL reconstruction (p < 0.05). Neither the addition of a partial nor subtotal medial meniscectomy led to increased instability. Only after medial meniscal root transection was increased instability of the ACL-deficient knee detected compared with intact, partial, or subtotal meniscectomy states (p < 0.01). In all states of meniscal deficiency, ACL reconstruction restored internal tibial rotation and anterior translation at 30 degrees to that of the intact knee (p > 0.05). Anatomic single bundle ACL reconstruction was able to restore knee stability in all conditions of medial meniscal deficiency.

Does high knee flexion cause separation of meniscal repairs?

BACKGROUND

Previous clinical studies comparing nonrestrictive and restrictive protocols after meniscal repair have shown no difference in outcomes; however, some surgeons still limit range of motion out of concern that it will place undue stress on the repair.

HYPOTHESIS

Large acute medial meniscal tears will gap during simulated open chain exercises at high flexion angles, and a repaired construct with vertical mattress sutures will not gap.

STUDY DESIGN

Controlled laboratory study.

METHODS

Tantalum beads were implanted in the medial menisci of 6 fresh-frozen cadaveric knees via an open posteromedial approach. Each knee underwent 10 simulated open chain flexion cycles with loading of the quadriceps and hamstrings. Testing was performed on 3 different states of the meniscus: intact, torn, and repaired. Biplanar radiographs were taken of the loaded knee in 90°, 110°, and 135° of flexion for each state. A 2.5-cm tear was created in the posteromedial meniscus and repaired with inside-out vertical mattress sutures. Displacement of pairs of beads spanning the tear was measured in all planes by use of radiostereometric analysis (RSA) with an accuracy of better than 80 μm.

RESULTS

With a longitudinal tear, compression rather than gapping occurred in all 3 regions of the posterior horn of the meniscus (mean ± standard deviation for medial collateral ligament [MCL], -321 ± 320 μm; midposterior, -487 ± 256 μm; root, -318 ± 150 μm) with knee flexion. After repair, meniscal displacement returned part way to intact values in both the MCL (+55 ± 250 μm) and root region (-170 ± 123 μm) but not the midposterior region, where further compression was seen (-661 ± 278 μm).

CONCLUSIONS

Acute posteromedial meniscal tears and repairs with vertical mattress sutures do not gap, but rather compress in the transverse plane at higher flexion angles when subjected to physiologic loads consistent with active, open kinetic chain range of motion rehabilitation exercises. The kinematics of the repaired meniscus more closely resemble that of the intact meniscus than that of the torn meniscus in regions adjacent to the MCL and the root but not in the midposterior region, where meniscal repair led to increased compression across the tear plane.

CLINICAL RELEVANCE

This study supports the idea that nonrestrictive unresisted open chain range of motion protocols do not place undue stress on meniscal repairs.

The utility of the KJOC score in professional baseball in the United States

BACKGROUND

The Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow questionnaire has been shown by previous studies to be more sensitive than other validated subjective measurement tools in the detection of upper extremity dysfunction in overhead-throwing athletes.

PURPOSE

The primary objective was to establish normative data for KJOC scores in professional baseball players in the United States. The secondary objectives were to evaluate the effect of player age, playing position, professional competition level, history of injury, history of surgery, and time point of administration on the KJOC score.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

From 2011 to 2012, a total of 203 major league and minor league baseball players within the Houston Astros professional baseball organization completed the KJOC questionnaire. The questionnaire was administered at 3 time points: spring training 2011, end of season 2011, and spring training 2012. The KJOC scores were analyzed for significant differences based on player age, injury history, surgery history, fielding position, competition level, self-reported playing status, and time point of KJOC administration.

RESULTS

The average KJOC score among healthy players with no history of injury was 97.1 for major league players and 96.8 for minor league players. The time point of administration did not significantly affect the final KJOC score (P = .224), and KJOC outcomes did not vary with player age (r = -0.012; P = .867). Significantly lower average KJOC scores were reported by players with a history of upper extremity injury (86.7; P < .001) and upper extremity surgery (75.4; P < .0001). The KJOC results did vary with playing position (P = .0313), with the lowest average scores being reported by pitchers (90.9) and infielders (91.3).

CONCLUSION

This study establishes a quantitative baseline for the future evaluation of professional baseball players with the KJOC score. Age and time of administration had no significant effect on the outcome of the KJOC score. Missed practices or games within the previous year because of injury were the most significant demographic predictors of lower KJOC scores. The KJOC score was shown to be a sensitive measurement tool for detecting subtle changes in the upper extremity performance of the professional baseball population studied.

Suprascapular vascular anomalies as a cause of suprascapular nerve compression

The vascular anatomy at the spinoglenoid and suprascapular notches appears to be more variable than previously thought. In patients presenting with signs of suprascapular nerve compression, vascular causes must be considered. Especially when considering percutaneous or arthroscopic treatment, awareness of these entities may help to guide treatment decisions, aid in identification of the anatomy, and prevent unwanted vascular insult.

The effect on external rotation of an anchor placed anterior to the biceps in type 2 SLAP repairs in a cadaveric throwing model

PURPOSE

This study examined whether there is a difference in external rotation (ER) between type 2 SLAP repairs consisting of anchors placed only posterior to the biceps insertion compared with repairs with an additional anchor placed anterior to the biceps.

METHODS

Seven cadaveric shoulders from donors with a mean age of 39.4 years were tested. Type 2 SLAP lesions were created, followed by a 3-anchor repair: a standard repair with 2 anchors posterior to the biceps plus an additional anchor anterior to the biceps. The specimens were placed on a material testing system machine and rotation was measured under a constant torque. The sutures were then removed sequentially from anterior to posterior during testing.

RESULTS

The average ER of the intact shoulder was 115.7° ± 2.6°. After SLAP tear creation and cyclic loading, the ER was 118.5° ± 2.6°, which decreased to 116.5° ± 2.6° after repair. This corresponds to a reduction of 2.0° of ER (P < .0001) with the repair. After release of the anterior anchor, the ER increased to 117.9° ± 2.6°, which corresponds to an increase in shoulder motion of 1.4° of ER (P = .0011). Additional release of the middle anchor, leaving only the posterior anchor intact, resulted in 118.0° ± 2.7° of ER, which corresponds to an increase of only 0.1° of ER (P = .7667).

CONCLUSIONS

Following type 2 SLAP repair in the cadaveric shoulder, removing the effect of the anchor anterior to the biceps resulted in a small but statistically significant increase in ER. The anterior anchor had the greatest effect on ER. The presence of 1 or 2 anchors posterior to the biceps did not have a significant effect on rotation.

CLINICAL RELEVANCE

When performing SLAP repairs on those in whom even a small loss of ER would be detrimental, such as baseball pitchers, avoidance of the use of an anchor anterior to the biceps should be considered.

Abnormal findings on knee magnetic resonance imaging in asymptomatic NBA players

The purpose of this study was to evaluate the knees of asymptomatic National Basketball Association (NBA) players via magnetic resonance imaging (MRI) and confirm or dispute findings reported in the previous literature. It is thought that a variety of significant abnormalities affecting the knee exist in asymptomatic patients and that these findings can be accurately identified on MRI. Two months prior to the 2005 season, bilateral knee MRI examinations of 14 asymptomatic NBA players (28 knees) were evaluated for abnormalities of the articular cartilage, menisci, and patellar and quadriceps tendons. The presence of joint effusion, subchondral edema, and cystic lesions and the integrity of the collateral and cruciate ligaments were also assessed.

An illustrated history of anterior cruciate ligament surgery

The past 30 years have brought remarkable change in the evolution of ACL surgery. Surgeons have recognized the important role of the ACL and developed techniques for its reconstruction. As these techniques evolved, certain themes echo throughout the historical literature. Dynamic, nonisometric operations have not worked well, nor have synthetic substitutes. Perhaps most importantly, the more anatomic the reconstruction, the better it was able to restore patient function and the more predictable the result. Technological advances allowed these techniques to be refined so that they are now routinely performed with less tissue trauma, faster recovery, and reproducibly excellent results. This article reviews the historical surgical progress that has evolved coupled with overlapping controversies and concepts, which have impacted surgical changes.

Prospective evaluation of prolonged fresh osteochondral allograft transplantation of the femoral condyle: minimum 2-year follow-up

BACKGROUND

Focal articular cartilage lesions of the knee in young patients present a therapeutic challenge. Little information is available pertaining to the results after implantation of prolonged fresh grafts.

HYPOTHESIS

Prolonged fresh osteochondral allografts present a viable option for treating large full-thickness articular cartilage lesions.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

This study presents the results of 25 consecutive patients who underwent prolonged fresh osteochondral allograft transplantation for defects in the femoral condyle. The average patient age was 35 years (range, 17-49 years). The average length of follow-up was 35 months (range, 24-67 months). Prospective data were collected using several subjective scoring systems, as well as objective and radiographic assessments.

RESULTS

Statistically significant improvements (P < .05) were seen for the Lysholm (39 to 67), International Knee Documentation Committee scores (29 to 58), all 5 components of the Knee injury and Osteoarthritis Outcome Score (Pain, 43 to 73; Other Disease-Specific Symptoms, 46 to 64; Activities of Daily Living Function, 56 to 83; Sport and Recreation Function, 18 to 46; Knee-Related Quality of Life, 22 to 50), and the Short Form-12 physical component score (36 to 40). Overall, patients reported 84% (range, 25% to 100%) satisfaction with their results and believed that the knee functioned at 79% (range, 35% to 100%) of their unaffected knee. Radiographically, 22 of the grafts (88%) were incorporated into host bone.

CONCLUSION

Fresh osteochondral allograft transplantation is an acceptable intermediate procedure for treatment of localized osteochondral defects of the femur. At 2-year follow-up, it is well incorporated and offered consistent improvements in pain and function.

CLINICAL RELEVANCE

Prolonged fresh allograft transplantation is a safe and effective technique for addressing symptomatic osteoarticular lesions in the knees of young patients.

Chondral defect repair after the microfracture procedure: a nonhuman primate model

BACKGROUND

The extent and time course of chondral defect healing after microfracture in humans are not well described. Although most physicians recommend a period of activity and weightbearing restriction to protect the healing cartilage, there are limited data on which to base decisions regarding the duration of such restrictions.

HYPOTHESIS

Evaluation of the status of chondral defect repair at different time points after microfracture in a primate model may provide a rationale for postoperative activity recommendations.

STUDY DESIGN

Descriptive laboratory study.

METHODS

Full-thickness chondral defects created on the femoral condyles and trochlea of 12 cynomolgus macaques were treated with microfracture and evaluated by gross and histologic examination at 6 and 12 weeks.

RESULTS

At 6 weeks, there was limited chondral repair and ongoing resorption of subchondral bone. By 12 weeks, the defects were completely filled and showed more mature cartilage and bone repair.

CONCLUSION

In the primate animal model, significant improvements in the extent and quality of cartilage repair were observed from the 6- to 12-week time points after microfracture.

CLINICAL RELEVANCE

The poor status of the defect repair at 6 weeks and the ongoing healing observed from the 6- to 12-week time points may indicate that the repair is vulnerable during this initial postoperative period. Assuming the goal of postoperative weightbearing and activity restriction in patients after microfracture is to protect immature repair tissue, this study lends support to extending such recommendations longer than 6 weeks.

Distal phalangeal resorption in an adult with infantile malignant osteopetrosis: a case report

Osteopetrosis is a rare inherited skeletal disorder characterized by a defect in bone resorption. The autosomal-recessive infantile malignant form usually results in death in the first few years of life. The natural history of the disease into adulthood is unknown. Reported here is the case of a 27-year-old man with bilateral resorption of the tufts of the distal phalanges in multiple fingers. It is unclear whether this finding constitutes a previously undescribed aspect of the natural course of the disease or a long-term consequence of therapy.