Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 470 | Issue 6 | Jun, 2012

Glenoid Stress Distribution in Baseball Players Using Computed Tomography Osteoabsorptiometry: A Pilot Study

Tomohiro Shimizu MD, Norimasa Iwasaki MD, PhD, Kinya Nishida MD, PhD, Akio Minami MD, PhD, Tadanao Funakoshi MD, PhD

It is important to understand the loading conditions when considering the pathology of shoulder disorders in overhead athletes. However, because throwing is a complicated motion and methods to directly determine stress distribution are complex, direct measurement of the stress distribution across the glenohumeral joint has not been attempted. Subchondral bone density reportedly reflects the cumulative stress acting on a joint surface under actual loading conditions.

Reliability of Scapular Classification in Examination of Professional Baseball Players

Todd S. Ellenbecker DPT, MS, SCS, OCS, CSCS, W. Ben Kibler MD, David S. Bailie MD, Roger Caplinger ATC, George J. Davies DPT, SCS, ATC, CSCS, Bryan L. Riemann PhD, ATC

Clinically evaluating the scapulothoracic joint is challenging. To identify scapular dyskinesis, clinicians typically observe scapular motion and congruence during self-directed upper extremity movements. However, it is unclear whether this method is reliable.

An Acute Throwing Episode Decreases Shoulder Internal Rotation

W. Ben Kibler MD, Aaron Sciascia MS, ATC, NASM-PES, Stephanie Moore MS, ATC

Glenohumeral internal rotation (GIR) and total arc of motion (TAM) decrease, whereas external rotation (GER) may increase in throwing. Although decreased GIR has been documented after throwing, its time course for recovery and the effect of pitching role have not.

Intraarticular Abnormalities in Overhead Athletes Are Variable

Ashvin K. Dewan MD, Juan Garzon-Muvdi MD, Steve A. Petersen MD, Xiaofeng Jia MD, PhD, Edward G. McFarland MD

The cause of shoulder pain and dysfunction in the overhead athlete can be variable. Several studies illustrate the wide variety of lesions seen at the time of arthroscopy in overhead athletes who require surgery but it is unclear whether these differ by sport.

Does Posteromedial Chondromalacia Reduce Rate of Return to Play After Ulnar Collateral Ligament Reconstruction?

Daryl C. Osbahr MD, Joshua S. Dines MD, Andrew J. Rosenbaum MD, Joseph T. Nguyen MPH, David W. Altchek MD

Biomechanical studies suggest ulnohumeral chondral and ligamentous overload (UCLO) explains the development of posteromedial chondromalacia (PMC) in throwing athletes with ulnar collateral ligament (UCL) insufficiency. UCL reconstruction reportedly allows 90% of baseball players to return to prior or a higher level of play; however, players with concomitant posteromedial chondromalacia may experience lower rates of return to play.

‘Batter’s Shoulder’: Can Athletes Return to Play at the Same Level After Operative Treatment?

Tony Wanich MD, Joshua Dines MD, David Dines MD, Ralph A. Gambardella MD, Lewis A. Yocum MD

Batter’s shoulder has been defined as posterior subluxation of the lead shoulder during the baseball swing. However, it is unclear whether or how frequently patients may return to play after treatment of this uncommon condition.

Surgical Technique Arthroscopic Posterior Glenoidplasty for Posterosuperior Glenoid Impingement in Throwing Athletes

Christophe Lévigne MD, Jérome Garret MD, Sophie Grosclaude MD, Florent Borel MD, Gilles Walch MD

Posterosuperior glenoid impingement (PSGI) is the repetitive impaction of the supraspinatus tendon insertion on the posterosuperior glenoid rim in abduction and external rotation. While we presume the pain is mainly caused by mechanical impingement, this explanation is controversial. If nonoperative treatment fails, arthroscopic débridement of tendinous and labral lesions has been proposed but reportedly does not allow a high rate of return to sports. In 1996, we proposed adding abrasion of the bony posterior rim, or glenoidplasty.

Hip Injuries in the Overhead Athlete

Gregory G. Klingenstein MD, RobRoy Martin PhD, PT, CSCS, Ben Kivlan PT, SCS, OCS, CSCS, Bryan T. Kelly MD

The overhead athlete is at risk for shoulder and elbow injuries. However, the mechanics associated with overhead sports also place athletes at risk for hip injuries. Advancements in hip arthroscopy have identified femoroacetabular impingement (FAI) and instability as potential contributors to labral and chondral pathology in this athletic population.

Passive Range of Motion Characteristics in the Overhead Baseball Pitcher and Their Implications for Rehabilitation

Kevin E. Wilk PT, DPT, Leonard C. Macrina MSPT, SCS, CSCS, Christopher Arrigo MS, PT

Repetitive overhead throwing motion causes motion adaptations at the glenohumeral joint that cause injury, decrease performance, and affect throwing mechanics. It is essential to define the typical range of motion (ROM) exhibited at the glenohumeral joint in the overhead thrower.

Return to Play After Type II Superior Labral Anterior-Posterior Lesion Repairs in Athletes: A Systematic Review

William M. Sayde MD, Steven B. Cohen MD, Michael G. Ciccotti MD, Christopher C. Dodson MD

Superior labral anterior-posterior (SLAP) lesions are a common cause of pain and disability in athletes. Individual studies have suggested low patient satisfaction with SLAP repairs in throwing athletes in particular and it is unclear how frequently athletes return to their previous level of competetion.

CT and MRI-based Diagnosis of Craniocervical Dislocations: The Role of the Occipitoatlantal Ligament

Kristen Radcliff MD, Christopher Kepler MD, Charles Reitman MD, James Harrop MD, Alexander Vaccaro MD, PhD

Craniocervical dislocations are rare, potentially devastating injuries. A diagnosis of craniocervical dislocations may be delayed as a result of their low incidence and paucity of diagnostic criteria based on CT and MRI. Delay in diagnosis may contribute to neurological injury from secondary displacement resulting from instability. The purpose of this study was to define CT and MRI-based diagnostic criteria for craniocervical dislocations to facilitate early injury recognition and stabilization.

Odontoid Fractures With Neurologic Deficit Have Higher Mortality and Morbidity

Amar Patel BS, Harvey E. Smith MD, Kris Radcliff MD, Navin Yadlapalli BS, Alexander R. Vaccaro MD, PhD

Type II odontoid fractures are reportedly increasing in incidence and occur primarily in the elderly. Neurologic deficits (ND) at presentation add to the morbidity of these fractures; however, reports are limited as a result of small case series. It is unclear what specific complications are associated with ND and whether these result in increased incidence of mortality.

Complications of the Lateral Transpsoas Approach for Lumbar Interbody Arthrodesis: A Case Series and Literature Review

D’Mitri A. Sofianos MD, Michael R. Briseño MD, Joshua Abrams DO, Alpesh A. Patel MD

The lateral transpsoas approach to the lumbar spine was developed to eliminate the need for an anterior-approach surgeon and retraction of the great vessels and has the potential for shorter operative times. However, the reported complications associated with this approach vary.

Combined Anterior-Posterior Surgery is the Most Important Risk Factor for Developing Proximal Junctional Kyphosis in Idiopathic Scoliosis

Han Jo Kim MD, Mitsuru Yagi MD, PhD, Joseph Nyugen MS, Matthew E. Cunningham MD, PhD, Oheneba Boachie-Adjei MD

Several studies have identified risk factors for proximal junctional kyphosis (PJK) after instrumentation for scoliosis, but the relative risks are unclear.

Cauda Equina Syndrome After a TLIF Resulting From Postoperative Expansion of a Hydrogel Dural Sealant

Brian J. Neuman MD, Kristen Radcliff MD, Jeffery Rihn MD

DuraSeal(Coviden, Waltham, MA, USA), a hydrogel sealant, is primarily used as an adjunct to a dural repair. Its use has also been described to seal off an annulotomy after a transforaminal lumbar interbody fusion when recombinant human bone morphogenetic protein-2 (rhBMP-2) is used. This aids in the reduction of postoperative radiculitis caused by rhBMP-2. However, as a result of its hydrophilic properties, DuraSealhas the potential to swell, which could lead to compression of the thecal sac.

Capacitive Coupling Reduces Instrumentation-related Infection in Rabbit Spines: A Pilot Study

Mohit Gilotra MD, Cullen Griffith MD, Jason Schiavone BA, Naren Nimmagadda BS, Jenna Noveau BS, Steven C. Ludwig MD

Postoperative spine infections cause considerable morbidity. Patients are subjected to long-term antibiotic regimens and may require further surgery. Delivery of electric current through instrumentation can detach biofilm, allowing better antibiotic penetration and assisting in eradicating infection.

Spinal Cord Injury Resulting From Injury Missed on CT Scan: The Danger of Relying on CT Alone for Collar Removal

Gregory Gebauer MD, MS, Meredith Osterman MD, James Harrop MD, Alexander Vaccaro MD, PhD

Strict criteria have been used before removing cervical collars in patients with injuries who have midline pain or are unable to be reliably examined. This sometimes leads to prolonged immobilization in cervical collars or use of MRI to rule out injury. Several studies suggest a collar may be removed in the absence of fractures, dislocation, or pathologic subluxation on a cervical CT scan. This may avoid the morbidity of prolonged cervical immobilization or cost of advanced imaging study but risks devastating consequences from missing injuries.

Prolonged Bed Rest as Adjuvant Therapy After Complex Reconstructive Spine Surgery

Rex A. W. Marco MD, Ryan M. Stuckey MD, Stephanie P. Holloway MHA

The benefits of postoperative mobilization include decreased incidence of pulmonary complications, pressure ulcers, and progression of deep vein thrombosis. However, the complexity of certain spinal reconstructions and the patient’s physiologic condition may preclude the possibility of early mobilization. Prolonged bed rest after spine surgery is controversial.

Case Report: Cauda Equina Syndrome Associated With an Interspinous Device

Worawat Limthongkul MD, Wicharn Yingsakmongkol MD

Although postoperative spinal epidural hematoma (SEH) is not uncommon, hematomas that require surgery are rare. Cauda equina syndrome (CES) may be associated with postoperative SEH. In these cases, early recognition and emergency decompression can prevent further damage and better neurologic recovery.

Influence of Screw Design, Sex, and Approach in Scaphoid Fracture Fixation

Geert Meermans MD, Frederik Verstreken MD

Screw fixation of scaphoid fractures has gained popularity. A long central screw has been shown to be biomechanically advantageous.

A Correlation Exists Between Subchondral Bone Mineral Density of the Distal Radius and Systemic Bone Mineral Density

Seung Hwan Rhee MD, PhD, Goo Hyun Baek MD, PhD

Intraarticular distal radius fractures are common and risk articular congruity owing to disruption of the subchondral bone. Studies regarding microstructure and mechanical properties of the distal radius, however, focus only on the cortical and trabecular bones in the metaphysis and not on the subchondral bone.

Anatomic Mapping of Short External Rotators Shows the Limit of Their Preservation During Total Hip Arthroplasty

Yoshiaki Ito MD, Isao Matsushita MD, PhD, Hiroki Watanabe MD, PhD, Tomoatsu Kimura MD, PhD

The direct anterior approach in THA requires no detachment of muscle insertions. However, damage to the short external rotator muscles may occur when attempting to elevate the femur for exposure. Although the anatomic insertions of these muscles are approximately known, there are no quantitative data regarding their locations.

Second-generation Annealed Highly Cross-linked Polyethylene Exhibits Low Wear

James A. D’Antonio MD, William N. Capello MD, Rama Ramakrishnan MS

Compared with conventional polyethylene, first-generation highly cross-linked polyethylenes have low wear, but controversy exists regarding their reduced mechanical strength and/or retained free radicals. Second-generation highly cross-linked polyethylenes have been developed to reduce wear, maintain mechanical strength, and have oxidative resistance, but it is unclear whether they do so.

High Rate of Ceramic Sandwich Liner Fracture

Ronny Lopes MD, Jean M. Philippeau MD, Norbert Passuti MD, PhD, François Gouin MD, PhD

Ceramic bearing surfaces for THA were introduced to reduce the risk of wear. However, owing to liner fracture in some of the early series and presumption that the fractures were the result of the modulus mismatch of the implant and the bone, a ceramic sandwich liner with lower structural rigidity was introduced. Fractures of these devices also were reported subsequently, although the incidence is unclear and it is unknown whether there are any risk factors associated with the fractures.

Introducing a Knee Endoprosthesis Model Increases Risk of Early Revision Surgery

Mikko Peltola MSc, Antti Malmivaara MD, PhD, Mika Paavola MD, PhD

New equipment and techniques often are used in clinical practice, occasionally without evidence of effectiveness and safety.

Does Ramosetron Reduce Postoperative Emesis and Pain after TKA?

In Jun Koh MD, Chong Bum Chang MD, Young-Tae Jeon MD, Jung-Hee Ryu MD, Tae Kyun Kim MD

Current pain management protocols involving many anesthetic and analgesic drugs reportedly provide adequate analgesia after TKA. However, control of emetic events associated with the drugs used in current multimodal pain management remains challenging.

When Do Patient-reported Assessments Peak after Revision Knee Arthroplasty?

Ajay Malviya FRCSEd(Tr & Orth), Karen Bettinson MSc, Steven M. Kurtz PhD, David J. Deehan FRCS(Tr & Orth)

The best timing for patient visits after revision TKA is unclear. Predictors of pain and function reported in the literature typically look at the influence at a given time that might not be ideal if the score is not at a peak or the earliest possible time. Moreover, most reports of predictors include revisions for infection, which typically have a poorer outcome, or for other indications with variable outcome.

Similar Survival but Better Function for Patients after Limb Salvage versus Amputation for Distal Tibia Osteosarcoma

Andreas F. Mavrogenis MD, Caterina Novella Abati MD, Carlo Romagnoli MD, Pietro Ruggieri MD, PhD

Amputation has been the standard surgical treatment for distal tibia osteosarcoma. Advances in surgery and chemotherapy have made limb salvage possible. However, it is unclear whether limb salvage offers any improvement in function without compromising survival.

Physeal Distraction for Joint Preservation in Malignant Metaphyseal Bone Tumors in Children

Michael Betz MD, Charles E. Dumont MD, Bruno Fuchs MD, G. Ulrich Exner MD

Physeal distraction facilitates metaphyseal bone tumor resection in children and preserves the adjacent joint. The technique was first described by Cañadell. Tumor resection procedures allowing limb-sparing reconstruction have been used increasingly in recent years without compromising oncologic principles.

Simultaneous Anterior and Posterior Synovectomies for Treating Diffuse Pigmented Villonodular Synovitis

Wei-Ming Chen MD, Po-Kuei Wu MD, Chien-Lin Liu MD

The current treatment methods for diffuse intraarticular or extraarticular type pigmented villonodular synovitis (PVNS) include arthroscopic synovectomy or staged anterior and posterior open synovectomies. However, it is unclear whether simultaneous anterior and posterior synovectomies achieve local control and recovery of function.

Mortality Rates are Similar after Hip Fractures for Rural and Urban Patients

Benjamin J. Miller MD, Xueya Cai PhD, Peter Cram MD, MBA

Proximal femoral fractures are common in the elderly. The best care depends on expeditious presentation, medical stabilization, and treatment of the condition.

Does Lengthening and Then Plating (LAP) Shorten Duration of External Fixation?

Ryhor Harbacheuski MD, Austin T. Fragomen MD, S. Robert Rozbruch MD

Classic bone lengthening requires patients wear external fixation for the distraction and consolidation phases and there is fracture risk after frame removal. Our technique of lengthening with the Taylor Spatial Frameand then insertion of a locked plate allows earlier removal of the external fixator during consolidation. Plate insertion is accomplished through a clean pin-free zone avoiding contamination and before frame removal maintaining bone position.

Which is the Best Alternative for Displaced Femoral Neck Fractures in the Elderly?: A Meta-Analysis

Hongwei Gao MD, Zhonghao Liu MD, Deguo Xing MD, Mingzhi Gong MD, PhD

Treatment of displaced femoral neck fractures includes internal fixation and arthroplasty. However, whether arthroplasty or internal fixation is the primary treatment for displaced femoral neck fractures in elderly patients remains a subject for debate. The literature contains conflicting evidence regarding rates of mortality, revision surgery, major postoperative complications, and function in elderly patients with displaced femoral neck fractures treated either by internal fixation or arthroplasty (either hemiarthroplasty or THA).

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