The ISAKOS classification of meniscal tears provides sufficient interobserver reliability for pooling of data from international clinical trials designed to evaluate the outcomes of treatment for meniscal tears.

The use of fresh allograft tissue to treat osteochondral defects eliminates morbidity associated with harvesting autograft tissue without compromising the results of the surgical procedure.

This study determined the thickness of normal humeral head articular cartilage by anatomic cross section using computer-aided image analysis software. Sixteen adult cadaveric humeral heads were analyzed. Our fi ndings reveal that the thickness of humeral articular cartilage is substantially thinner than articular cartilage found in the knee. The cartilage is thickest in the central portion of the head and becomes progressively thinner towards the periphery. Surgical techniques used to treat pathology in the glenohumeral joint, specifi cally thermal energy or mechanical debridement, may have deleterious effects on the relatively thin humeral articular cartilage.A rticular cartilage thickness has been extensively studied in the knee. 1-7 However, there is a paucity of data regarding the thickness of articular cartilage of the humeral head. Most characterizations of humeral head articular cartilage have been performed using radiographic imaging studies, specifi cally magnetic resonance imaging with and without the use of intraarticular contrast. [8][9][10] The radiographic data obtained in two of these studies were compared to the corresponding data obtained by direct measurement of the articular surface. In both studies, only limited areas of the humeral head were analyzed, and direct measurements of the articular surface were performed by observers using loupe magnifi cation. The diffi culty in accurately imaging the highly spherical humeral head and the substantially thinner articular cartilage found on the hu-meral head as compared to the knee were the reasons given for the inferior results. According to Eckstein 2 , magnetic resonance imaging (MRI) of strongly curved surfaces can overestimate cartilage thickness without appropriate derivations. Soslowsky et al 11 used stereophotogrammetry to defi ne the geometry of the glenohumeral articulation and reported on surface area and cartilage thickness of both the humeral head and the glenoid.The purpose of this study was to determine the thickness of humeral head articular cartilage via anatomic measurements from multiple cross sections of cadaveric humeral heads using computeraided image analysis software. From this data a topographical map of humeral head articular cartilage was developed. This information may serve as a standardization of normal articular cartilage thickness of the humeral head. MATERIALS AND METHODSEighteen adult cadaveric humeri (8 left and 10 right) were obtained through the anatomic gift association at Rush University Medical Center. The age of the specimens ranged from 53 to 91 years. Overlying muscle and soft tissue were sharply dissected away with a scalpel and scissors with care taken to avoid injury to the articular surface. Two right humeral heads were eliminated: one head demonstrated evidence of degenerative changes, and the second head had developed subchondral cysts. Thus, 16 humeral heads were analyzed. Humeral heads were cut at the anatomical neck with a band saw. The heads were then placed in a plastic container and potted in Iso...

Cryotherapy has been shown to decrease intraarticular temperature in all regions of the knee after arthroscopy. The purpose of our study was to determine if similar declines in intraarticular temperature were seen with the use of cryotherapy after anterior cruciate ligament reconstruction, a procedure which, unlike simple arthroscopy, produces postoperative hemarthrosis. Sixteen patients had intraarticular temperatures measured for 2 hours after anterior cruciate ligament reconstruction with cryotherapy instituted for only 1 of the 2 hours (eight patients for the first hour and eight patients for the second hour). Significant declines were seen in the suprapatellar pouch after either hour (−2.7°C in Group 1, −2.7°C in Group 2) but not in the lateral gutter. The difference between cryotherapy versus no cryotherapy in the first hour in the suprapatellar pouch was 6.0°C, a clinically meaningful temperature difference. We hypothesize the swelling and hemarthrosis was more pronounced in the lateral gutter because of its dependent position and therefore blunted the effect of cryotherapy seen in the lateral gutter. Cooling of the intraarticular temperature should be considered in the clinical benefits of cryotherapy.Cryotherapy has been used since ancient times for its beneficial effect on injuries. 9,14 The effects of cryotherapy on lowering tissue metabolism, hypoxia, edema, inflammatory mediator release, nerve conduction, and pain have been well documented. [1][2][3][4][7][8][9][10][13][14][15][16][19][20][21] Cryotherapy frequently is used in postoperative treatment after many arthroscopic procedures to decrease swelling and pain. 10,11,21 Martin et al 11 described a statistically and clinically significant temperature difference of 7.1°C in the lateral gutter after arthroscopy in knees treated with cryotherapy versus knees not receiving cryotherapy. They also saw that cryotherapy decreases the intraarticular temperature of the knee after simple arthroscopic procedures in the medial gutter and suprapatellar pouch. Therefore the clinical benefits observed with cryotherapy after simple arthroscopic procedures may be related to the cooling effect on the intraarticular environment and synovium. After arthroscopic ACL reconstructions postoperative pain, intraarticular bleeding, and extraarticular swelling are increased compared with after simple arthroscopy. Therefore, if similar intraarticular temperature changes are observed with the use of cryotherapy after ACL reconstruction as in simple arthroscopy, the response of the synovium to cooling could be correlated with postoperative pain and recovery time. The purpose of our study was to determine if the use of cryotherapy after ACL reconstruction produced a decrease in intraarticular temperature similar to what has been observed after simple arthroscopic procedures. MATERIALS AND METHODSAfter institutional review board approval and informed consent were obtained 16 ACL reconstructions were done on 16 knees (nine right knees and seven left knees) in 16 patients. The study...

Scapulothoracic motion accounts for approximately onethird of total shoulder elevation. Disorders affecting the muscles that attach to the scapula coordinating scapulothoracic motion or injury to the nerves that innervate these muscles can result in winging of the scapula and subsequent scapular dyskinesis. Examples include facioscapulohumeral dystrophy (FSHD), neuralgic amoyotrophy, poliomyelitis, long thoracic nerve palsy (affecting serratus anterior), spinal accessory nerve palsy (affecting trapezius), and dorsal scapular nerve palsy (affecting rhomboids and levator scapulae). Loss of scapular stabilization results in an unstable base for efficient glenohumeral motion, scapular winging, and subsequent loss of shoulder motion. Scapulothoracic arthrodesis provides rigid fixation of the scapula to the thorax, and long-term results of the procedure have generally been favorable. A surgical technique for scapulothoracic fusion and the results of the senior author's surgical experience are presented. n HISTORICAL PERSPECTIVEIn the past, patients with scapular winging were treated with orthotic devices that attempted to stabilize the scapula against the posterior chest wall. These devices were not well tolerated by patients, and efficacy was limited.