Background:High-grade partial proximal hamstring tears and complete tears with retraction less than 2 cm are a subset of proximal hamstring injuries where, historically, treatment has been nonoperative. It is unknown how nonoperative treatment compares with operative treatment.Hypothesis:The clinical and functional outcomes of nonoperative and operative treatment of partial/complete proximal hamstring tears were compared. We hypothesize that operative treatment of these tears leads to better clinical and functional results.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review identified patients with a high-grade partial or complete proximal hamstring rupture with retraction less than 2 cm treated either operatively or nonoperatively from 2007 to 2015. All patients had an initial period of nonoperative treatment. Surgery was offered if patients had continued pain and/or limited function refractory to nonoperative treatment with physical therapy. Outcome measures were each patient’s strength perception, ability to return to activity, Lower Extremity Functional Scale (LEFS) score, Short Form–12 (SF-12) physical and mental component outcome scores, distance traversed by a single-leg hop, and Biodex hamstring strength testing.Results:A total of 25 patients were enrolled in the study. The 15 patients who were treated nonoperatively sustained injuries at a mean age of 55.73 ± 14.83 years and were evaluated 35.47 ± 30.35 months after injury. The 10 patients who elected to have surgery sustained injuries at 50.40 ± 6.31 years of age (P = .23) and were evaluated 30.11 ± 19.43 months after surgery. LEFS scores were significantly greater for the operative group compared with the nonoperative group (77/80 vs 64.3/80; P = .01). SF-12 physical component scores for the operative group were also significantly greater (P = .03). Objectively, operative and nonoperative treatment modalities showed no significant difference in terms of single-leg hop distance compared with each patient’s noninjured leg (P = .26) and torque deficit at isokinetic speeds of 60 and 180 deg/s (P = .46 and .70, respectively).Conclusion:Patients who undergo operative and nonoperative treatment of high-grade partial and/or complete proximal hamstring tears with <2 cm retraction demonstrate good clinical and functional outcomes. In our series, 40% of patients treated nonoperatively with physical therapy went on to have surgery. For those patients with persistent pain and/or loss of function despite conservative treatment, surgical repair is a viable treatment option that is met with good results.

Background A recent review of the literature found worse outcomes and longer length of stay for minorities undergoing TKAs and THAs when compared with whites. It is unclear if this association exists for the operative treatment of tibia fractures. Questions/purposesThe purpose of this study is to determine if there is a difference in etiology or the rate of complications for operative treatment of tibia fractures as a function of racial heritage. Secondary objectives include definition of etiology, mechanism, and fracture location as a function of race in the urban setting, and an attempt to determine if differences in etiology or complications depend on race and fracture location for tibial plateau or shaft fractures.Methods A retrospective chart review was conducted at our Level 1 urban trauma center from

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Shoulder pain is a common musculoskeletal complaint that can result from a variety of pathologic processes, including arthritis, bursitis and rotator cuff disease. Physicians often initiate treatment of shoulder pain with oral medications and progress to injectable medications for patients with more severe pain. Several promising new therapies for shoulder pain have emerged in recent years. These treatment modalities, which include cytokines, growth factors, platelet rich plasma, and stem cells, could provide physicians with powerful medications to treat patients with severe shoulder pain. This article provides a review of the biologic treatments available to physicians treating patients with shoulder pain and highlights some of the research and newest developments in the use of cytokines, growth factors, platelet rich plasma and stem cells for shoulder pathology.

We report on the arthroscopic treatment of a 12-year-old boy diagnosed with an osteochondral defect of the medial femoral condyle. He underwent arthroscopic fixation of the defect, and during the surgery, a blunt trocar was used to localize the lesion. The trocar created a transient dimpling effect on the cartilage overlying the osteochondral defect that resembled the surface of a golf ball. This "golf ball sign" then served as a visual guide during placement of a chondral dart. When present, it is believed that this sign can benefit arthroscopists by helping to improve intraoperative localization of an osteochondral defect.O steochondritis dissecans (OCD) of the knee is an acquired, idiopathic disease that affects the subchondral bone of the femur. The specific etiology remains unknown, but delamination and sequestration of the bone can result depending on the extent of the OCD lesion.1 The impact this has on the overlying cartilage can range from softening of the articular cartilage to development of an osteochondral flap and/or loose body formation. Depending on the size, location, and extent of articular cartilage involvement, the OCD lesion can cause significant discomfort and morbidity.Treatment options vary but can involve conservative, restricted weight-bearing options; operative fixation of a stable or unstable lesion; and/or loose body removal. Operative intervention is usually performed arthroscopically. A magnetic resonance imaging (MRI) study is often obtained beforehand during the clinical workup of the patient. The MRI study helps to determine the location of the lesion, which is verified by arthroscopic visualization of the defect. In early stages of the lesion, articular cartilage becomes soft and ballotable before developing overt fibrillations, fissures, or exposed bone.This particular case involves a 12-year-old boy with an OCD lesion who underwent operative fixation of his type IV lesion. We report about a technique used during the procedure, in which a blunt trocar was used to delineate the borders of the OCD lesion, which would later serve as a guide during the placement of our fixation. Surgical TechniqueThe patient was a 12-year-old boy who sustained a recent fall from standing that caused him to have continued left knee pain and swelling. He was unable to play his usual sports because of pain, clicking, and catching of the left knee. Radiographs obtained at the time of presentation showed an osteochondral defect involving the lateral aspect of the left medial femoral condyle. The plan for the patient was to restrict him from any sports, and he was to avoid any impact activities (running, jumping, and so on) for the next month until an MRI study was obtained. At his followup visit 5 weeks later, the MRI study showed a 10-mm oval lesion at the previously defined location, as well as the presence of subchondral cysts and fluid between the fragment and underlying bone (Fig 1). The articular cartilage remained free from any defects, and there was no evidence of a loose body within ...