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Medial patellofemoral ligament reconstruction is a commonly performed procedure for patellofemoral instability. In recent years the surgery has evolved considerably as the anatomy and goals of reconstruction have become more defined. This has resulted in numerous surgical options involving various fixation devices. Furthermore, as biomechanical data accumulate regarding the importance of graft position and tension, surgical techniques for applying this knowledge with precision are needed. This technical note with an accompanying video details one such technique that may be applied to various methods of fixation, allowing for improved precision and possibly resulting in a stronger fixation construct.

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Background: Tuberculous pericarditis (TBP) is a rare clinical entity but carries a high mortality rate (20%-40%). The incidence of TBP among patients with pulmonary TB ranges from 1%-8%. Pericardial involvement is invariably associated with TB elsewhere in the body by infectious extension in the lung, tracheobronchial tree, adjacent lymph nodes, spine, sternum, or by miliary spread. In many adults, TBP represents reactivation disease, making the primary focus of infection less apparent. Symptoms of TBP are related to either fluid overload (i.e. pulmonary and peripheral edema) compromised cardiac output (i.e. fatigue and dyspnea) or both. Physical exam has low yield in the diagnosis, but may demonstrate symptoms of volume overload and compromised cardiac output. ECG and CXR may be suggestive of the diagnosis, but ECHO is currently the gold standard modality for constrictive pericarditis. Treatment of TBP is largely medical. Pericardiectomy is reserved for patients with recurrent effusions or failed medical management. Methods: In the present report, we discuss a healthy 44-year-old Vietnamese woman, who first presented with fever, cough productive of yellow sputum, shortness of breath, and pleuritic chest pain for 9 months. She then underwent extensive work-up and evaluation for persistence and worsening fluid overload and pump failure symptoms. ECHO revealed constrictive pericarditis. Thus, the patient was taken to the operating room for a pericardiectomy. Results: Following surgical intervention, our patient had a rapid and marked clinical improvement. Biopsy of the pericardial tissue revealed caseating granulomas with acid-fast bacilli. Conclusion: Isolated TBP is a rare clinical entity but its diagnosis and prompt management may result in decreased morbidity and mortality. Treatment remains largely medical, but surgical intervention is indicated in those patients with worsening symptoms.

Nearly 500,000 total hip replacements are being done annually. In hopes of reducing the pain and recovery time for these patients, development of less-invasive procedures has been a topic of interest among orthopedists. The purpose of this study is to obtain intraoperative and postoperative data to compare three different total hip arthroplasty procedures: standard (10-12 in. incision), mini-incision (2.5-3.5 in. incision), and the 2-incision approach (1.5 inches each). This study will provide information to determine if minimally invasive surgery (MIS) can reduce rehabilitation time and complication rates when compared to the standard approach. In addition, the learning curve for the challenging two-incision MIS will be determined for three different surgeons over a 17-month period. It is hypothesized that the two-incision MIS approach will reduce rehabilitation time and the number and severity of complications for the 60-day postoperative period. The study is a retrospective chart review of all THAs done by Russell Cohen, MD; Jay Katz, MD; and Scott Slagis, MD from December 31, 2002 through May 31, 2004. The primary endpoints include: length of hospital stay, discharge location, transfusion rates, number and severity of complications for the period of 60-days following surgery, estimated blood loss, length of surgery, operating room staff, number of physical therapy sessions, BMI, incision length, and blood products. Following completion of data entry, statistical analysis will be performed by a biostatistician designated by the sponsor (Zimmer, Inc). Analysis will include mean, standard deviation, max, min, mode, median, and an ANOVA test to the level of p=0.05. This study has the potential to contribute to the understanding of whether MIS is effective in reducing rehabilitation time and complication rates. This information could be beneficial to future hip replacement patients. In addition, knowledge pertaining to the number of surgeries required in order to become proficient in this procedure will aid surgeons who are considering implementation of these methods.