Cartilage injuries in the knee are common and can occur in isolation or in combination with limb malalignment, meniscus, ligament, and bone deficiencies. Each of these problems must be addressed to achieve a successful outcome for any cartilage restoration procedure. If nonsurgical management fails, surgical treatment is largely based on the size and location of the cartilage defect. Preservation of the patient's native cartilage is preferred if an osteochondral fragment can be salvaged. Chondroplasty and osteochondral autograft transfer are typically used to treat small (<2 cm2) cartilage defects. Microfracture has not been shown to be superior to chondroplasty alone and has potential adverse effects, including cyst and intralesional osteophyte formation. Osteochondral allograft transfer and matrix-induced autologous chondrocyte implantation are often used for larger cartilage defects. Particulated juvenile allograft cartilage is another treatment option for cartilage lesions that has good to excellent short-term results but long-term outcomes are lacking.

Background: Donor site morbidity after anterior cruciate ligament (ACL) reconstruction with a bone–patellar tendon–bone (BTB) autograft is clinically significant, but evidence with contemporary techniques is lacking. Purpose: To (1) evaluate donor site morbidity at a single institution using modern techniques of BTB autograft harvest at 2-year follow-up, (2) develop a 10-question donor site morbidity instrument, and (3) compare this instrument against traditional outcome tools. Study Design: Case series; Level of evidence, 4. Methods: We analyzed the 2-year follow-up outcomes of 200 consecutive patients who underwent ACL reconstruction with a BTB autograft performed by 2 surgeons at a single institution. The surgical technique utilized modern and consistent BTB autograft harvest, including graft sizing, patellar tendon and peritenon closure, and patellar and tibial donor site bone grafting. There were 187 patients included, with 13 patients undergoing revision ACL reconstruction excluded. An original 10-question scoring instrument evaluating donor site morbidity was administered to each patient (score, 0-100) and compared against each patient’s International Knee Documentation Committee (IKDC) and Lysholm scores. Results: Overall, 13.9% of patients were noted to have anterior knee pain with activity at 2-year follow-up. Moreover, 3.7% of patients reported an inability to kneel on hard surfaces but had no problems on soft surfaces; 5.9% of patients reported mild discomfort but were able to kneel on all surfaces. Additionally, 75.4% of patients had a perfect (100/100) donor site morbidity score. The mean donor site morbidity score at 2-year follow-up was 98.3 ± 3.4. There was a very strong correlation between the IKDC and Lysholm scores but only a strong and moderate correlation when the donor site morbidity score was compared with the IKDC and Lysholm scores, respectively. Conclusion: Donor site morbidity after ACL reconstruction with a BTB autograft was less frequent than reported in the existing literature. Some patients developed anterior knee pain; therefore, an informed discussion is advised. IKDC and Lysholm scores may not capture donor site symptoms after surgery. The 10-question donor site morbidity instrument may provide a more accurate assessment.

Background: The literature demonstrates a high prevalence of asymptomatic knee and hip findings on magnetic resonance imaging (MRI) in athletes. Baseball pitchers are shown to have a high prevalence of asymptomatic shoulder MRI findings, but the incidence of asymptomatic shoulder MRI findings has not been systematically evaluated in nonthrowing contact athletes. Purpose/Hypothesis: The purpose of this study was to determine the prevalence of shoulder abnormalities in asymptomatic professional and collegiate hockey players. We hypothesized that, similar to overhead throwing athletes, ice hockey players will have a high prevalence of asymptomatic MRI findings, including labral, acromioclavicular (AC), and rotator cuff pathology on MRI. Study Design: Cross-sectional study; Level of evidence, 4. Methods: A total of 25 asymptomatic collegiate and professional hockey players (50 shoulders) with no history of missed games or practice because of shoulder injury, pain, or dysfunction underwent bilateral shoulder noncontrast 3.0-T MRI. MRIs were read blinded by 2 board-certified radiologists at 2 separate time points, 3 months apart, to determine the prevalence of abnormalities of the joint fluid, bone marrow, rotator cuff tendon, biceps tendon, labrum, AC joint, and glenohumeral joint. Interrater and intrareader reliability was determined, and regression analysis was performed to identify the prevalence and relationship to stick-hand dominance. Results: Labral abnormalities were seen in 25% of the shoulders. AC joint abnormalities and rotator cuff findings were noted in 8% and 6% of shoulders, respectively. One shoulder was noted to have a biceps tendon abnormality, and 1 shoulder demonstrated glenohumeral joint chondral findings. Interrater reliability coefficients were 0.619 for labral abnormalities. Intrareader reliability kappa coefficients were 0.493 and 0.718 for both readers, respectively, for labral abnormalities. Regression analysis was performed and revealed that the overall shoulder pathology was more common in the nondominant stick hand (top stick hand) (coefficient –0.731; P = .021). Conclusion: Professional and collegiate ice hockey players had an overall prevalence of labral abnormalities in 25% of their shoulders, with findings more often found in the nondominant stick hand. Rotator cuff abnormalities were uncommon in ice hockey players. These findings differ significantly from published reports examining professional baseball players and other overhead sports athletes.

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