The purpose of this study was to identify the trends and demographics of patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction in the United States. Patients who underwent arthroscopic ACL reconstruction between 2004 and 2009 were identified by searching Current Procedural Terminology codes in the PearlDiver Patient Record Database (PearlDiver Technologies, Fort Wayne, IN). The year of procedure, age, gender, and region of the United States were recorded for each patient. Associated meniscal procedures and the absence or presence of a femoral nerve block were also recorded. The incidence of ACL reconstruction significantly increased over the study period, from 40.9 cases per 10,000 patients in 2004 to 47.8 in 2009 (p < 0.001). Of these cases, 92.8% were associated with either meniscectomy or meniscal repair. ACL reconstruction was performed most commonly in patients aged 10 to 29 years (p < 0.001). A significant male predominance was observed with an incidence ratio of male-to-female of 2.03 (p < 0.001). The frequency of females undergoing ACL reconstruction as a proportion of the total number of annual cases increased from 2,295 in 2004 to 3,476 in 2009 (p = 0.0031). A significant increase in the annual proportion of ACL reconstruction performed under femoral nerve block was also observed, from 2.0% in 2004 to 8.3% in 2009 (p < 0.001). The greatest incidence of ACL reconstruction occurred in the Western region of the United States. An increase in the rate of arthroscopic ACL reconstruction was observed between 2004 and 2009 and 92.8% of the ACL reconstructions were associated with a meniscal procedure. The majority of cases were performed in patients aged 10 to 29 years, with a male predominance. Increases were observed in the number of female cases and proportion performed under a femoral nerve block. The Western region of the United States was found to have a higher incidence of ACL reconstruction.

Duodenal switch in revisional bariatric surgery. Duodenal switch in revisional bariatric surgery: conclusions from an expert consensus panel.

On MR arthrography, true labral tearing was identified in 73 % of patients. There was some degree of labral pathology in 93.3 % of patients, and this increased to 100 % in patients with moderate to severe osteoarthritis, as defined by Tönnis grade 2-3 or joint space width ≤ 2 mm. There were no statistically significant correlations between labral tear grade and Tönnis grade or joint space width. Given the high frequency of labral pathology and the questionable efficacy of arthroscopic surgical intervention in older patients, MR arthrography should be primarily for those with minimal arthritis on radiograph and potential to benefit from surgery. If further imaging beyond radiographs is necessary in these patients, standard MRI may be a more appropriate imaging tool.

Cystic adventitial disease (CAD) is a rare disease entity of unknown origin most commonly affecting the popliteal artery. It typically occurs in otherwise healthy, middleaged male patients, causing symptoms of sudden-onset progressive intermittent claudication. Cystic adventitial disease has been well studied in the vascular literature since the disease was first defined in 1947. 1,3,7 However, the vast majority of these cases have been older patients who do not participate in significant athletic activity. 4,5,8,10 Cystic adventitial disease in the younger athlete can be extremely difficult to diagnose and must be considered within the broader spectrum of musculoskeletal, vascular, and neurological conditions that can cause exertional leg pain in the active patient. 16 The purpose of this case report is to present the symptoms, physical examination findings, diagnostic imaging results, and surgical treatment of a young male athlete with symptomatic CAD of the popliteal artery. We discuss the necessity of distinguishing CAD from a number of orthopaedic conditions with similar initial presentations and stress the importance of prompt vascular imaging for diagnosis.