This international consensus derived from leaders in the field will assist clinicians with debridement, curettage and bone marrow stimulation as a treatment strategy for osteochondral lesions of the talus.

Purpose Distal femur morphology has been shown to inluence knee joint kinematics and may afect rotatory knee laxity. The purpose of this study was to determine the relationship between rotatory knee laxity and distal femoral morphology in patients with complete anterior cruciate ligament (ACL) rupture. It was hypothesized that increased posterior femoral condylar depth on standard lateral radiographs, quantiied as the "lateral femoral condyle ratio" would correlate with increased rotatory knee laxity, measured by a quantitative pivot shift test. Methods Consecutive patients who underwent ACL reconstruction from 2014 to 2016 were retrospectively reviewed. A standardized pivot shift test was performed preoperatively on both knees and quantiied using tablet technology. Using standard lateral radiographs of the knee, the ratio of posterior condylar distance over total condylar distance was deined as the lateral femoral condyle ratio. Results Data sets were obtained for 57 patients. The mean anterior translation of the lateral knee compartment during a quantitative pivot shift test was found to be 4.0 ± 2.4 mm and 1.3 ± 0.9 mm for the injured and uninjured knees, respectively. The mean lateral femoral condyle ratio on X-ray was 63.2 ± 4.5%. There were signiicant correlations between the lateral femoral condyle ratio and the absolute quantitative (ρ = 0.370, p < 0.05) and side-to-side diferences in anterior translation of the lateral knee compartment (ρ = 0.419, p < 0.05). ConclusionThe most important inding from this study is that increased posterior femoral condylar depth, quantiied as a lateral femoral condyle ratio, is associated with increased rotatory knee laxity in ACL-deicient patients. This suggests that distal femur morphology may inluence rotatory knee laxity. This study may assist clinicians in evaluating ACL injuries and identifying patients at greater risk for persistent increased rotatory knee laxity after ACL reconstruction. Level of evidence III.

Background: In anterior cruciate ligament–deficient (ACL-D) knees, injury pattern and bony morphologic features have been shown to influence both static anterior tibial subluxation relative to the femur and dynamic rotatory knee laxity. Therefore, the relationship between static anterior tibial subluxation and dynamic rotatory knee laxity was investigated. Purpose: To determine whether static tibial subluxation as measured on magnetic resonance imaging (MRI) is associated with the grade of rotatory knee laxity in ACL-D knees. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Two-hundred fifty-eight knees underwent preoperative, image-guided assessment of lateral knee compartment translation during quantitative pivot shift (QPS). Subluxations of the medial and lateral tibial plateaus were measured on preoperative MRI in a subset of primary ACL-D knees meeting criteria for high-grade (QPS > 5.2 mm) and low-grade (QPS < 2.4 mm) rotatory laxity. Tibial subluxations on MRI were compared between patients with high- and low-grade rotatory laxity through use of pairwise t test and were analyzed via univariate and multivariate logistic regression. Significance was set at P < .05. Results: On MRI, greater anterior subluxation of the lateral tibial plateau was observed in patients with high-grade compared with low-grade rotatory knee laxity (4.5 mm vs 2.3 mm; P < .05). No similar relationship was observed for the medial tibial plateau (−0.9 mm vs −0.4 mm; P > .05). Univariate logistic regression demonstrated that static subluxation of the lateral tibial plateau was associated with high-grade rotatory knee laxity (odds ratio [OR], 1.2; P < .05). An optimal cutoff of 2.95 mm of static lateral tibial subluxation was associated with high-grade rotatory knee laxity (sensitivity, 75%; specificity, 63%). Lateral meniscal injury was the first variable entered into a multivariate regression analysis and proved to be most associated with high-grade rotatory knee laxity (OR, 6.8; P < .05). When lateral meniscal injury was excluded from multivariate regression analysis, static anterior subluxation of the lateral tibial plateau alone was associated with high-grade rotatory knee laxity (OR, 1.2; P < .05). Conclusion: Data from this MRI study of two distinct rotatory knee laxity groups showed that static anterior subluxation of the lateral tibial plateau of 2.95 mm or greater was associated with high-grade rotatory knee laxity, and each millimeter increase of lateral tibial plateau subluxation was associated with a 1.2-fold odds of high-grade rotatory knee laxity. Anterior subluxation of the lateral tibial plateau on MRI was not independently associated with high-grade rotatory knee laxity in the presence of concomitant lateral meniscal injury. Static measurements made preoperatively may aid in predicting high-grade rotatory knee laxity and refining the indications for individualized knee surgery.

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Introduction:Shoulder arthroscopies are among the most frequently performed surgeries by orthopaedic surgeons. Little is known about complication rates among recently trained surgeons. The purpose of this study was to examine the type and frequency of complications of common arthroscopic shoulder procedures performed by candidates challenging the American Board of Orthopaedic Surgery: Part II, certification examination.Methods:Data were obtained from the American Board of Orthopaedic Surgery database for orthopaedic surgeons who sat for the part II examination from 2012 to 2016. In total, 27,072 procedures were reviewed. The database was queried to determine the type and frequency of complications for patients who underwent shoulder arthroscopy, including arthroscopic rotator cuff repair, labrum repair, biceps tenodesis, and bony/soft tissue débridement procedures. Complications were classified as surgical, anesthetic, or medical. Factors affecting complication rates were investigated including surgeon's fellowship training, geographic location, and patients’ age and sex.Results:Patients with surgical complications (n = 2,133; 7.9%) were more common than anesthetic (n = 263; 1.0%) or medical (n = 607; 2.2%) complications. There was a significant variation in the surgical complication rate among different arthroscopic shoulder procedures, ranging from 5.4% for labral repair to 10.3% for rotator cuff repair and biceps tenodesis. Stiffness/arthrofibrosis was the most commonly recorded surgical complication (2.2%). Surgical complication rates were lowest in the Northeast region (6.7%; P < 0.01) and in patients younger than 21 years (3.8%; P < 0.01). Women had significantly higher rate of complications than men (8.4% versus 7.6%; P = 0.02). Among anesthetic-related complications, 61.6% were related to regional nerve blocks. The overall revision surgery and readmission rates were 0.8% and 1.0%, respectively.Conclusion:The overall self-reported surgical complication rate for arthroscopic shoulder procedures was 7.9%, which is higher than the rates reported in the literature. Although the rate of anesthetic complications is low (1.0%), adverse events related to nerve blocks made up most of the overall anesthetic related complications.