The American journal of sports medicine
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Numerous studies have identified factors that may affect the chances of rotator cuff healing after surgery. Intraoperative tendon quality may be used to predict healing and to determine type of repair and/or consideration of augmentation. There are no data that correlate how gross tendon morphology and degree of tendinopathy affect patient outcome or postoperative tendon healing. Purpose/Hypothesis: The purposes of this study were to (1) compare the gross appearance of the tendon edge during arthroscopic rotator cuff repair with its histological degree of tendinopathy and (2) determine if gross appearance correlated with postoperative repair integrity. The hypothesis was that gross (macroscopic) tendon with normal thickness, no delamination, and elastic tissue before repair would have a correlation with low Bonar scores, higher postoperative American Shoulder and Elbow Surgeons (ASES) scores, and increased rates of postoperative tendon healing on ultrasound. ⋯ The degree of tendinopathy did not correlate with morphological appearance of the tendon. Neither of these parameters correlated with healing or patient outcome. This study suggests that the degree of tendinopathy, unlike muscle atrophy, may not be predictive of outcomes and that, on appearance, poor quality tendon has adequate healing capacity. Therefore, abnormal gross tendon appearance should not affect the repair effort or technique.
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Cartilage repair algorithms use lesion size to choose surgical techniques when selecting a cartilage repair procedure. The association of fresh osteochondral allograft (OCA) size with graft survivorship and subjective patient outcomes is still unknown. ⋯ The size of the lesion, either absolute or relative, does not influence outcomes after OCA transplantation for isolated femoral condyle lesions of the knee.
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The method of graft fixation in primary anterior cruciate ligament (ACL) reconstruction is important for initial stability of the graft. Poor graft fixation can result in failure of the reconstruction. The effect of ACL graft fixation principles and fixation implant combinations on the risk of revision after ACL reconstruction is not well understood. ⋯ When comparing ACL graft fixation methods in the 4 categories using an HT graft, cortical suspensory fixation was found to have a significantly increased risk of revision, while intratunnel transfixation exhibited a lower risk of revision. Both Endobutton/Intrafix and Endobutton/Biosure PEEK implant combinations exhibited a significantly higher risk of revision. For PT grafts, Atlantech metal screw/metal screw and Softsilk/Softsilk exhibited a significantly lower risk of revision.