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ABSTRACT: Although elbow pain is common in throwing athletes and golfers, posterolateral impingement from a hypertrophic synovial plica is a rare but possibly underdiagnosed condition.
To evaluate the clinical results of arthroscopic treatment of symptomatic lateral elbow plicae in this athletic population.
Case series; Level of evidence, 4.
Twelve patients, 9 male and 3 female, whose mean age was 21.6 years (range, 17-33 years), were reviewed. There were 7 baseball pitchers, 2 softball players, and 3 golfers. All patients had diagnosed isolated lateral elbow plica; none had lateral epicondylitis, instability, osteochondritis dissecans, arthritis, loose bodies, or nerve conditions. The mean time from onset of symptoms to treatment was 9.25 months (range, 3-24.5 months). At a mean follow-up of 33.8 months (range, 24-65.5 months), patients were evaluated with a questionnaire and examination, based on the American Shoulder and Elbow Surgeons standardized elbow assessment and previously reported elbow outcome score.
Posterolateral elbow pain was present in all patients. Fifty-eight percent (7 of 12 patients) complained of clicking or catching, whereas only 25% (3 of 12) experienced swelling or effusion. At elbow arthroscopy, a thickened synovial lateral plica was debrided in all cases. Ninety-two percent (11 of 12 patients) reported an excellent outcome with a mean elbow score of 92.5 points (maximum, 100 points). Return to competitive play averaged 4.8 months (range, 3-9.5 months). One patient with a fair outcome developed medial elbow instability that later required reconstructive surgery.
Posterolateral elbow impingement from hypertrophic synovial plicae can cause significant pain and disability in throwing athletes and golfers. With careful diagnosis and exclusion of other elbow problems, treatment with arthroscopic debridement and focused rehabilitation is highly successful and allows these athletes to return to their previous level of play.
The American Journal of Sports Medicine 04/2006; 34(3):438-44. · 3.79 Impact Factor
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ABSTRACT: Reestablishment of the native footprint during rotator cuff repair has been suggested as an important criterion for optimizing healing potential and fixation strength.
A double-row rotator cuff footprint repair will demonstrate superior biomechanical properties compared with a single-row repair.
Controlled laboratory study.
In 9 matched pairs of fresh-frozen cadaveric shoulders, the supraspinatus tendon from 1 shoulder was repaired with a double-row suture anchor technique: 2 medial anchors with horizontal mattress sutures and 2 lateral anchors with simple sutures. The tendon from the contralateral shoulder was repaired using a single lateral row of 2 anchors with simple sutures. Each specimen underwent cyclic loading from 10 to 180 N for 200 cycles, followed by tensile testing to failure. Gap formation and strain over the footprint area were measured using a video digitizing system; stiffness and failure load were determined from testing machine data.
Gap formation for the double-row repair was significantly smaller (P < .05) when compared with the single-row repair for the first cycle (1.67 +/- 0.75 mm vs 3.10 +/- 1.67 mm, respectively) and the last cycle (3.58 +/- 2.59 mm vs 7.64 +/- 3.74 mm, respectively). The initial strain over the footprint area for the double-row repair was nearly one third (P < .05) the strain of the single-row repair. Adding a medial row of anchors increased the stiffness of the repair by 46% and the ultimate failure load by 48% (P < .05).
Footprint reconstruction of the rotator cuff using a double-row repair improved initial strength and stiffness and decreased gap formation and strain over the footprint when compared with a single-row repair.
To achieve maximal initial fixation strength and minimal gap formation for rotator cuff repair, reconstructing the footprint attachment with 2 rows of suture anchors should be considered.
The American Journal of Sports Medicine 03/2006; 34(3):407-14. · 3.79 Impact Factor
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ABSTRACT: Calcifying tendinitis occurs most commonly in the rotator cuff tendons, particularly involving the supraspinatus tendon insertion, and is often asymptomatic. Cortical erosion secondary to calcifying tendinitis has been reported in multiple locations, including in the rotator cuff tendons. We present a pathologically proven case of symptomatic calcifying tendinitis involving the infraspinatus tendon with cortical erosion with correlative radiographic, CT, and MR findings. The importance of considering this diagnosis when evaluating lytic lesions of the humerus and the imaging differential diagnosis of calcifying tendinitis and cortical erosion are discussed.
Skeletal Radiology 11/2004; 33(10):596-9. · 1.54 Impact Factor
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ABSTRACT: The management of motion loss of the knee is challenging. A clear understanding of the pathoanatomic causes of motion loss is necessary to establish a careful and rational approach to treatment. Early recognition and physical therapy are effective for the majority of patients, but when these conservative measures fail, operative intervention is indicated. The purpose of this article is to outline a comprehensive approach to the arthroscopic evaluation and treatment of the arthrofibrotic knee. This technique is designed to allow the surgeon to systematically address the numerous causes of motion loss of the knee.
Arthroscopy The Journal of Arthroscopic and Related Surgery 08/2004; 20 Suppl 2:187-94. · 3.02 Impact Factor
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Journal of Shoulder and Elbow Surgery 14(2):221-3. · 2.75 Impact Factor
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ABSTRACT: Although often perceived as a leisurely activity, golf can be a demanding sport, which can result in injury, usually from overuse and sometimes from poor technique. The shoulder is a commonly affected site, with the lead shoulder, or the left shoulder in the right-handed golfer, particularly vulnerable to injury. A thorough understanding of the biomechanics of the golf swing is helpful in diagnosing and managing these injuries. Common shoulder problems affecting golfers include subacromial impingement, acromioclavicular arthrosis, rotator cuff tear, glenohumeral instability, and glenohumeral arthrosis. Although the majority of patients with these disorders will respond to nonsurgical treatment, including rest and a structured program of physical therapy, further benefits can be obtained with subtle modifications of the golf swing. Those golfers who fail to respond to nonsurgical management can often return to competitive play with appropriate surgical treatment.
The American Journal of Sports Medicine 32(5):1324-30. · 3.79 Impact Factor
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ABSTRACT: Twisting and braiding of four-strand hamstring tendon grafts used for anterior cruciate ligament reconstruction has been proposed, but not proven, as a method of improving tensile properties.
Twisting and braiding four-strand human hamstring tendon grafts will have no significant effect on initial graft strength or stiffness.
Paired in vitro biomechanical study.
In 12 matched cadaveric pairs, a doubled gracilis and semitendinosus tendon graft from one knee was twisted 180 degrees over a 30-mm length, while the doubled tendon graft from the contralateral knee was prepared for biomechanical testing with the graft strands in a parallel orientation. For an additional 12 matched pairs, a doubled graft was braided into a weave while the contralateral graft was prepared for testing in a parallel orientation. All four strands of each doubled tendon graft were equally tensioned with weights before being clamped in a tendon-freezing grip. Tensile testing was then performed.
Twisting decreased graft strength by 26% (P < 0.01) and stiffness by 43% (P < 0.01), while braiding reduced strength by 46% (P < 0.01) and stiffness by 54% (P < 0.01), compared with parallel-oriented grafts.
Equally tensioned, parallel four-strand human hamstring tendon grafts were significantly stronger and stiffer than twisted or braided four-strand hamstring tendon grafts. Clinical Relevance: We caution against the use of twisted or braided four-strand hamstring tendon grafts for anterior cruciate ligament reconstruction.
The American Journal of Sports Medicine 31(6):861-7. · 3.79 Impact Factor
