The purpose of this investigation was to identify and quantify the soft tissue restraints, both medially and laterally, to lateral patellar translation. These restraints to lateral patellar translation at 20° of knee flexion were tested biomechanically on a universal testing instrument in nine fresh-frozen cadaveric knees. After preconditioning the tissues, the patella of each intact knee was translated laterally to a distance at which a force of 200 N was recorded. This distance was used to translate the patella for the remaining structures to be sectioned. The contribution of each structure to the total restraining force was determined as the percent of the force to restrain the intact specimen by sectioning the restraints in a predetermined order. The contribution of each structure to the restraining force was defined as the difference between the restraining force before and after its sectioning. The medial patellofemoral ligament was found to be the primary restraint to lateral patellar translation a...

Soft Tissue Restraints to Lateral Patellar Translation in the Human Knee

A prospective randomized study was performed to determine the differences in results between three methods of anterior cruciate ligament reconstruction: autogenous bone-patellar tendon-bone graft (group 1), semitendinosus and gracilis tendon graft reconstruction combined with an extraarticular procedure (group 2), and semitendinosus and gracilis tendon graft reconstruction alone (group 3). Preoperatively, there were no significant differences between groups. At a mean of 35.4±11.6 months postoperatively, 102 patients returned for evaluation. International Knee Documentation Committee knee evaluation revealed no significant differences in symptoms, function, return to pre-injury activity, harvest site abnormalities, or limitation of motion between groups 1 and 3. Patients in group 2 had a higher incidence of patellofemoral crepitation and loss of motion than did patients in group 3. The mean manual maximum KT-1000 arthrometer side-to-side difference was 2.1±2.0 mm in group 1, which was statistically signif...

Anterior Cruciate Ligament Reconstruction A Prospective Randomized Study of Three Surgical Methods

BackgroundReconstruction of the medial patellofemoral ligament has recently become popular for restoring patellofemoral stability. Femoral insertion site anatomy of the medial patellofemoral ligament has been described. This anatomical insertion has been inferred to be the isometric point in medial patellofemoral ligament reconstruction, but data about radiographic landmarks for a postoperative or intraoperative control are missing.PurposeTo determine the radiographic landmarks for control of postoperative and intraoperative femoral medial patellofemoral ligament insertion.Study DesignDescriptive laboratory study.MethodsEight fresh-frozen human knees were dissected, and the medial patellofemoral ligament was exposed. After identification of the femoral medial patellofemoral ligament insertion site, the insertion center was marked with a lead ball of 2-mm diameter. Straight lateral radiographs were taken, and posterior-anterior as well as proximal-distal position were evaluated.ResultsSix of 8 insertion po...

Radiographic Landmarks for Femoral Tunnel Placement in Medial Patellofemoral Ligament Reconstruction

The results of intraarticular anterior cruciate ligament reconstruction with either the patellar tendon or the semitendinosus and gracilis tendons (four strands) were prospectively compared in a consecutive series of 60 patients with chronic injuries. A single surgeon performed arthroscopically assisted reconstructions in an alternating sequence. Preoperative and operative data revealed no significant differences between the two groups. After 28 months of followup there were no significant differences in the incidence of symptoms, and recurrent giving way was present in only one knee with semitendinosus and gracilis tendon graft. Return to sport participation was more frequent in the patellar tendon group (80% versus 43%, P 5 mm at 30 pounds was present in 13% of the knees with patellar tendon grafts and in 20% of those with semitendinosus and gracilis; a patellofemoral crepitation developed in 17% and 3% of the two groups, respectively. Based on these data we routinely use patellar tendon grafts. Semitendinosus and gracilis tendons are preferred in selected cases: older patients, patients with preexisting patellofemoral problems, and those with failed patellar tendon grafts.

Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction

Background: Glenohumeral internal rotation deficit (GIRD) indicates a 20° or greater loss of internal rotation of the throwing shoulder compared with the nondominant shoulder.Purpose: To determine whether GIRD and a deficit in total rotational motion (external rotation + internal rotation) compared with the nonthrowing shoulder correlate with shoulder injuries in professional baseball pitchers.Study Design: Case series; Level of evidence, 4.Methods: Over 3 competitive seasons (2005 to 2007), passive range of motion measurements were evaluated on the dominant and nondominant shoulders for 170 pitcher-seasons. This included 122 professional pitchers during the 3 seasons of data collection, in which some pitchers were measured during multiple seasons. Ranges of motion were measured with a bubble goniometer during the preseason, by the same examiner each year. External and internal rotation of the glenohumeral joint was assessed with the participant supine and the arm abducted 90° in the plane of the scapula,...

Correlation of Glenohumeral Internal Rotation Deficit and Total Rotational Motion to Shoulder Injuries in Professional Baseball Pitchers

We present a surgical technique for the treatment of recurring dislocation of the patella. The procedure, based on Galleazzi's tenodesis of the semitendinosus, uses minimal dissection and small incisions to improve cosmetic results and speed recovery. A polyester ligament is passed through a bone tunnel at the midline of the patella and fixed at the medial condyle, thus creating a medial patellofemoral neoligament. We have reviewed the results of 30 knees in 30 patients with an average follow-up of 39 months. Twenty-five patients (83.3%) showed significant improvement of their initial complaints.

Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report.

Purpose
To investigate the behavior of rotator cuff tears treated with conventional repair technique with the aid of autologous bone marrow mononuclear cells (BMMC).

https://link.springer.com/content/pdf/10.1007%2Fs00167-011-1607-9.pdf

Conventional rotator cuff repair complemented by the aid of mononuclear autologous stem cells

Purpose The purpose of this study was to describe the long-term results of medial patellofemoral ligament reconstruction with a free semitendinosus graft. Type of study Prospective nonrandomized study. Methods We assessed 15 patients (16 knees) treated between 1992 and 1996 (follow-up > 5 years). Diagnosis of patellofemoral dislocation or subluxation was based on the patient's report plus reproduction of subjective complaints of instability on physical examination. All patients were treated by the same surgeon. Assessment was performed by a different surgeon based on Crosby-Insall and Aglietti criteria. Results According to Crosby-Insall criteria, 11 knees were rated as excellent, 4 good, and 1 poor. According to Aglietti criteria, 11 knees were rated as excellent, 3 good, 1 fair, and 1 poor. According to both protocols, 15 knees showed negative apprehension test, absence of patellofemoral pain, and normal patellar tracking. In one knee, the apprehension test was positive, patellofemoral pain was present, and patellar tracking was abnormal. Patellofemoral crepitus was detected in 10 knees (attenuated in 6). Thirteen patients (14 knees) were satisfied with the results. One patient considered the result acceptable, but below expectations. The final patient underwent an additional procedure. No cases of infection and no vascular problems were seen. Conclusions Medial patellofemoral ligament reconstruction proves to be useful in improving unstable extension mechanisms and in preventing insecurity, gradual joint deterioration, and disabling pain during dislocation episodes, in a minimal 5-year follow-up study. Level of evidence Level IV.

Medial patellofemoral ligament reconstruction with semitendinosus autograft for chronic patellar instability: a follow-up study.

BackgroundGlenohumeral internal rotation deficit, often diagnosed in players of overhead sports, has been associated with the development of secondary shoulder lesionsHypothesisAsymptomatic players of different overhead sports will exhibit variable degrees of glenohumeral internal rotation deficitStudy DesignCross-sectional study; Level of evidence, 3MethodsFifty-four asymptomatic male volunteers (108 shoulders) divided into 3 groups (tennis players, swimmers, control group) underwent measurements of glenohumeral internal and external rotation using clinical examination with scapular stabilization Measurements of dominant and nondominant shoulders were compared within and between groups Glenohumeral internal rotation deficit (GIRD) was defined as the difference in internal rotation between the nondominant and dominant shouldersResultsIn tennis players, mean GIRD was 239° ± 84° (P < 001); in swimmers, 12° ± 68° (P < 001); and in the control group, 49° ± 74° (P = 035) Dominant shoulders showe

Measurement of Glenohumeral Internal Rotation in Asymptomatic Tennis Players and Swimmers

Purpose: Our purpose was to investigate whether there is an association between decreased hip range of motion and noncontact anterior cruciate ligament (ACL) injuries in soccer players. Methods: In this case-control study, 50 soccer players with noncontact ACL injuries confirmed by surgery had their hips examined and compared with those of a control group. Findings were statistically analyzed according to 2 cutoff points (70° and 80° of total internal-external rotation sum) for both groups. Results: A significant decrease in hip range of motion was found in 38% of all individuals studied at the lower cutoff point (70°) and for 64% at the upper cutoff point (80°). The decrease in hip range of motion was greater in the group with ruptured ACLs than in the control group, with little difference between the 2 cutoff points (70° and 80°). The difference between patients and control subjects was statistically significant ( P Conclusions: There was a strong association between decreased hip range of motion and ACL ruptures in soccer players, not only but mainly because of internal rotation lessening. Despite lacking comparison with other sports, our findings showed a higher decrease in hip range of motion in the group of soccer players when compared with the general population. Level of Evidence: Level III, prognostic case-control study.

João Luiz Ellera Gomes

Papers

Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report.

Conventional rotator cuff repair complemented by the aid of mononuclear autologous stem cells

Medial patellofemoral ligament reconstruction with semitendinosus autograft for chronic patellar instability: a follow-up study.

Measurement of Glenohumeral Internal Rotation in Asymptomatic Tennis Players and Swimmers

Decreased hip range of motion and noncontact injuries of the anterior cruciate ligament.