Double-row repair methods lead to significantly lower retear rates when compared with single-row methods for tears greater than 1 cm. Surgical approach has no significant effect on retear rate.

In 2006, a survey regarding anterior cruciate ligament (ACL) reconstruction was mailed to physician members of the American Orthopaedic Society for Sports Medicine. A total of 993 responses were received from 1747 possible respondents (57%). The number of ACL reconstructions per year ranged from 1 to 275 (mean = 55). The most important factors in the timing of surgery were knee range of motion and effusion. Bone-patellar tendon-bone (BPTB) autograft was most commonly preferred (46%), followed by hamstring tendon autograft (32%) and allografts (22%). Five years earlier, BPTB grafts were more frequent and hamstring tendon and allografts were less frequent (63%, 25%, and 12%, respectively). A single-incision arthroscopic technique was used by 90%. Most allowed return to full activity at 5 to 6 months, with a trend toward earlier return for BPTB grafts; quadriceps strength was an important factor in the decision. There was limited experience (4%) with double-bundle and computer-assisted ACL reconstruction.Arthroscopic-assisted, single-incision reconstruction using a BPTB autograft fixed with metal interference screws remains the most common technique used for primary ACL reconstruction. In the past 5 years, the use of alternative graft sources and methods of fixation has increased. Consensus regarding the best graft type, fixation method, and postoperative protocol is still lacking.[J Knee Surg. 2009;22:7-12.]

EndoButton fixation has the highest load and stiffness of currently available fixation methods. Two-incision repairs have a significantly greater proportion of unsatisfactory results than do single-incision repairs.

c Orthopedic surgeons at our institution have noticed an increase in the number of infections due to Propionibacterium acnes, especially following operations on the shoulder. We collected P. acnes isolates from our hospital microbiology laboratory for 1 year and performed antimicrobial susceptibility testing on 28 strains from the shoulder. Antibiotics with the lowest MIC values against P. acnes (MIC 50 and MIC 90 ) included penicillin G (0.006, 0.125), cephalothin (0.047 and 0.094), and ceftriaxone (0.016, 0.045), while others also showed activity. Strains resistant to clindamycin were noted. Propionibacterium acnes has been recognized as a significant and emerging pathogen in orthopedic surgery over the last 10 years, especially after operations on the shoulder and especially following shoulder arthroplasty with prosthetic material (1-3). At our institution, the number of recognized cases of P. acnes has increased noticeably over the last few years. Formulating treatment recommendations for patients with P. acnes orthopedic infections can be difficult, however, given the paucity of data on antibiotic susceptibility patterns. Many of the early reports on P. acnes antibiotic susceptibilities are from patients with facial acne who were attending dermatology clinics. Other studies are now decades old (4, 5) or originate from countries in which antibiotic usage patterns are much different from those in North America (6, 7), leading us to question whether we can rely on those reports.We performed testing on 33 strains of P. acnes collected between November 2010 and December 2012, 28 of which were from orthopedic surgeries on the shoulder and 5 of which were isolates from bloodstream or other deep infections. P. acnes was identified using the MicroScan rapid anaerobe identification method (Siemens Healthcare, W. Sacramento, CA). We tested this strain collection against a panel of 10 antibiotics, with an emphasis on antibiotics that might actually be used to treat postoperative orthopedic infections. We used the Etest method (bioMérieux, Durham, NC) on anaerobic brucella blood agar. Two previous studies indicated that MICs obtained by Etest correlated well with results obtained using the agar dilution method (8, 9), and other experts consider the Etest an accepted method (10). Etest results obtained using anaerobic brucella blood agar were compared to those obtained using CDC anaerobe blood agar on a subset of 6 strains. Inocula were prepared to a 0.5 McFarland standard from 48 h of growth on anaerobic blood agar. Blood agars were from Anaerobe Systems (Morgan Hill, CA). We tested only a single isolate from each patient, although most patients had more than one positive culture. P. acnes was cultured anaerobically at 37°C for 48 to 72 h using the GasPak EZ anaerobe container system (BD Corp., Franklin Lakes, NJ).The results of our study are reported in Table 1. MICs measured on brucella blood agar were the same as those measured using CDC anaerobe agar. The penicillins (penicillin G and amoxicillin) and cephalosporins...