Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Controversies in Orthopaedics 9 articles


Where to Tenodese the Biceps: Proximal or Distal?

David M. Lutton MD, Konrad I. Gruson MD, Alicia K. Harrison MD, James N. Gladstone MD, Evan L. Flatow MD

The best location for biceps tenodesis is controversial as surgeons have begun to question whether tenodesis location affects the incidence of residual bicipital postoperative pain. An open distal tenodesis technique has been previously proposed to eliminate remaining symptoms at the bicipital groove.

Is a Silastic Radial Head Still a Reasonable Option?

Yariv Maghen MD, Andrew J. Leo MD, Jennifer W. Hsu MD, Michael R. Hausman MD

The importance of the radial head to elbow function and stability is increasingly apparent. Although preservation of the native radial head is preferred, severely comminuted fractures may necessitate resection or arthroplasty. Silastic radial head arthroplasty has been condemned on the basis of several sporadic reports of silicone synovitis. However, problems of “overstuffing,” cartilage wear, and motion loss are becoming apparent with metal prostheses, indicating this also is not an ideal solution. Thus, the choices remain controversial.

What Is the Best Femoral Fixation of Hamstring Autografts in Anterior Cruciate Ligament Reconstruction?: A Meta-analysis

Alexis Colvin MD, Charu Sharma MD, Michael Parides PhD, Jonathan Glashow MD

Several methods are available for fixing the femoral side of a hamstring autograft in ACL reconstruction and the best method is unclear. Biomechanical studies have shown varying results with regard to fixation failure.

Greater Strength Increase with Cyst Decompression and SLAP Repair than SLAP Repair Alone

Gita Pillai MD, Jason R. Baynes MD, James Gladstone MD, Evan L. Flatow MD

Treatment of symptomatic spinoglenoid cysts has been controversial with options ranging from observation, to open excision, to arthroscopic decompression with or without labral repair. It has recently been suggested that isolated repair of SLAP lesions without cyst decompression can restore function in patients with spinoglenoid cysts and SLAP lesions.

Is Intraoperative CT of Posterior Cervical Spine Instrumentation Cost-effective and Does It Reduce Complications?

Andrew C. Hecht MD, Steven M. Koehler BA, Janelle C. Laudone BS, Arthur Jenkins MD, Sheeraz Qureshi MD, MBA

Symptomatic multilevel cervical myelopathy is often addressed using posterior decompression using two-dimensional fluoroscopy. Intraoperative three-dimensional fluoroscopy provides more accurate information on the position of instrumentation to prevent screw-related complications.

Total Shoulder Arthroplasty in Older Patients: Increased Perioperative Morbidity?

Eric T. Ricchetti MD, Joseph A. Abboud MD, Andrew F. Kuntz MD, Matthew L. Ramsey MD, David L. Glaser MD, Gerald R. Williams MD

More elderly patients are becoming candidates for total shoulder arthroplasty with an increase in frequency of the procedure paralleling the rise in other total joint arthroplasties. Controversy still exists, however, regarding the perioperative morbidity of total joint arthroplasty in elderly patients, particularly those 80 years of age and older.

Can the Change in Center-edge Angle During Pincer Trimming Be Reliably Predicted?

Alexis C. Colvin MD, Steven M. Koehler BA, Justin Bird MD

Femoroacetabular impingement is recognized as a cause of hip pain in young adults and as a precursor to osteoarthritis although many questions persist regarding its management. One in particular is when to resect a pincer lesion and how much to resect. Instability can result from overresection and persistent impingement can result from underresection.

Is the Etiology of Pretibial Cyst Formation After Absorbable Interference Screw Use Related to a Foreign Body Reaction?

Guillem Gonzalez-Lomas MD, Ryan T. Cassilly BS, Fabrizio Remotti MD, William N. Levine MD

Arthroscopically assisted anterior cruciate ligament reconstruction using a bioabsorbable tibial fixation screw is occasionally complicated by pretibial cyst formation. The few case reports describing pretibial cyst formation noted several graft types and fixation techniques, making it difficult to establish one etiology. Some literature suggests cysts form from communication between the joint and pretibial area leading to extravasation of joint fluid, maturing into a cyst. We propose the development of cysts after PLLA screw use may be related to a foreign body reaction.