Hypothesis: Anatomical insertions of the anterior cruciate ligament have relationships to bony landmarks of the tibia and femur.

Study Design: Descriptive laboratory study.

Methods: Eight cadaveric knees were scanned by computed tomography, reconstructed 3-dimensionally, and examined from simulated arthroscopic, sagittal, and axial perspectives. Volume-rendering software was used to document the relationship of the anterior cruciate ligament to the bony anatomy.

Results: A bony ridge (Resident’s Ridge) at the anterior border of the anterior cruciate ligament was readily noted on the medial wall of the lateral femoral condyle. Superiorly, anterior cruciate ligament fibers inserted up to the roof of the notch and to 3 to 3.5 mm of the articular surface posteriorly and inferiorly. The anterior cruciate ligament inserted into a fovea anterior to the tibial eminence. Posteriorly, anterior cruciate ligament fibers inserted up to a ridge between the medial and lateral intercondylar tubercles. Medially, anterior cruciate ligament fibers inserted onto the ridge at the lateral border of the medial tibial condyle. There was no distinct anterior or lateral bony border with anterior cruciate ligament fibers blending into the anterior horn of the lateral meniscus.

Conclusion: The anterior border of the femoral anterior cruciate ligament origin is Resident’s Ridge. The ridge between the medial and lateral intercondylar tubercles at the base of the tibial eminence is the posterior margin of the anterior cruciate ligament on the tibia.

Clinical Relevance: Bony landmarks can be used to aid in anatomical anterior cruciate ligament reconstruction.

Hypothesis: Unsatisfactory outcome after ACI is associated with technique-related typical complications.

Study Design: Case series; Level of evidence, 4.

Methods: A total of 309 consecutive patients with 349 ACI procedures of the knee joint were analyzed. Three different ACI techniques were used: periosteum-covered ACI in 52 cases (14.9%), Chondrogide (Geistlich Biomaterials, Wolhusen, Switzerland) membrane-covered ACI in 215 cases (61.6%), and a 3-dimensional matrix-associated ACI (BioSeed-C, Biotissue Technologies, Freiburg, Germany) in 82 cases (23.5%). In 52 patients, revision surgery was performed for persistent clinical problems. These patients were analyzed for defect size and location, technique of ACI, and intraoperative findings during revision surgery. The mean time of follow-up for patients after ACI was 4.5 years (standard deviation, ± 1.5).

Results: Four typical major complications were identified: hypertrophy of the transplant, disturbed fusion of the regenerative cartilage and the healthy surrounding cartilage, insufficient regenerative cartilage, and delamination. These diagnoses covered a total of 88.5% of the patients who underwent revision surgery. The overall complication rate was highest in the group of patients treated with periosteum-covered ACI (P = .008). The incidence of symptomatic hypertrophy was 5.2% for all techniques and defect locations; the highest incidence was in patients treated with periosteum-covered ACI (15.4%) (P = .001). The incidence of disturbed fusion was highest in the Chondrogide-covered ACI (3.7%) and the matrix-associated ACI group (4.8%). Concerning the incidence of complications by defect location, there was a tendency for increased complications in patellar defects (P = .095). Within the patellar defects group, no correlation was found for the occurrence of delamination, insufficient regeneration, and disturbed fusion. As a statistical trend, an increased rate of hypertrophy was found for patellar defects (P = .091).

Conclusion: A major proportion of complications after ACI can be summarized by 4 major diagnoses (symptomatic hypertrophy, disturbed fusion, delamination, and graft failure). Among those, the overall complication rate and incidence of hypertrophy of the transplant were higher for periosteum-covered ACI. Furthermore, an increased rate of symptomatic hypertrophy was found for patellar defects. Therapeutic concepts need to be developed to treat these typical complications of ACI.

Hypothesis: There is no difference in effectiveness between radial extracorporeal shock wave therapy and placebo in the treatment of chronic plantar fasciitis.

Study Design: Randomized, controlled trial; Level of evidence, 1.

Methods: Three interventions of radial extracorporeal shock wave therapy (0.16 mJ/mm²; 2000 impulses) compared with placebo were studied in 245 patients with chronic plantar fasciitis. Primary endpoints were changes in visual analog scale composite score from baseline to 12 weeks’ follow-up, overall success rates, and success rates of the single visual analog scale scores (heel pain at first steps in the morning, during daily activities, during standardized pressure force). Secondary endpoints were single changes in visual analog scale scores, success rates, Roles and Maudsley score, SF-36, and patients’ and investigators’ global judgment of effectiveness 12 weeks and 12 months after extracorporeal shock wave therapy.

Results: Radial extracorporeal shock wave therapy proved significantly superior to placebo with a reduction of the visual analog scale composite score of 72.1% compared with 44.7% (P = .0220), and an overall success rate of 61.0% compared with 42.2% in the placebo group (P = .0020) at 12 weeks. Superiority was even more pronounced at 12 months, and all secondary outcome measures supported radial extracorporeal shock wave therapy to be significantly superior to placebo (P < .025, 1-sided). No relevant side effects were observed.

Conclusion: Radial extracorporeal shock wave therapy significantly improves pain, function, and quality of life compared with placebo in patients with recalcitrant plantar fasciitis.

Hypothesis: The predicted patellar tendon strains that occur as a result of the tendon loads and patella–patellar tendon angles (PPTAs) experienced during a jump landing will be significantly increased in the area of the patellar tendon associated with patellar tendinopathy.

Study Design: Descriptive laboratory study.

Methods: A 2-dimensional, computational, finite element model of the patella–patellar tendon complex was developed using anatomic measurements taken from lateral radiographs of a normal knee. The patella was modeled with plane strain rigid elements, and the patellar tendon was modeled with 8-node plane strain elements with neo-Hookean material properties. A tie constraint was used to join the patellar tendon and patella. Patella–patellar tendon angles corresponding to knee flexion angles between 0° and 60° and patellar tendon strains ranging from 5% to 15% were used as input variables into the computational model. To determine if the location of increased strain predicted by the computational model could produce isolated tendon fascicle damage in that same area, 5 human cadaveric patella–patellar tendon–tibia specimens were loaded under conditions predicted by the model to significantly increase localized tendon strain. Pre- and posttesting ultrasound images of the patella–patellar tendon specimens were obtained to document the location of any injured fascicles.

Results: Localized tendon strain at the classic location of the jumper’s knee lesion was found to increase in association with an increase in the magnitude of applied patellar tendon strain and a decrease in the PPTA. The principal stresses and strains predicted by the model for this localized area were tensile and not compressive in nature. Applying the tendon strain conditions and PPTA predicted by the model to significantly increase localized strain resulted in disruption of tendon fascicles in 3 of the 5 cadaveric specimens at the classic location of the patellar tendinopathy lesion.

Conclusion: The localized increase in patellar tendon strain that occurs in response to the application of tendon loads and decreased PPTA could induce microdamage at the classic location of the jumper’s knee lesion.

Clinical Relevance: The association of decreasing PPTA with increasing localized tendon strain would implicate the role of knee-joint angle as well as tendon force in the etiopathogenesis of jumper’s knee.

Hypothesis: The posterior region of the proximal patellar tendon is subjected to greater tendinous forces than is the corresponding anterior region.

Study Design: Descriptive laboratory study.

Method: An optic fiber technique was used to detect forces in both the anterior and the posterior regions of the proximal patellar tendon in 7 healthy persons. The optic fiber force sensor works on the principle of the amplitude modulation of transmitted light when the optic fiber is geometrically altered owing to the forces acting on it. Longitudinal strain in the tendon or ligament produces a negative transverse strain, thus causing a force that effectively squeezes the optic fiber. Measurements were recorded during the following exercises: closed kinetic chain quadriceps contraction (eccentric and concentric), open kinetic chain quadriceps contraction (eccentric and concentric), a step exercise, and a jump exercise.

Results: During all the exercises, the peak differential signal output in the posterior location of the proximal patellar tendon was greater than in the corresponding anterior location. The greatest differential signal output was found in the jump and squat exercises.

Conclusion: The posterior region of the proximal patellar tendon is subjected to greater tendinous forces than is the corresponding anterior region. This finding supports the tensile-overload theory of patellar tendinopathy.

Clinical Relevance: Jump activities and deep squat exercises expose the patellar tendon to very large tendinous forces.

Hypothesis: Standardized combined cryotherapy/compression changes in midportion Achilles tendon microcirculation are superior to those with cryotherapy during intermittent application.

Study Design: Controlled laboratory study.

Methods: Sixty volunteers were randomized for either combined cryotherapy/compression (Cryo/Cuff, DJO Inc, Vista, California: n = 30; 32 ± 11 years) or cryotherapy alone (KoldBlue, TLP Industries, Kent, United Kingdom: n = 30; 33 ± 12 years) with intermittent 3 x 10-minute application. Midportion Achilles tendon microcirculation was determined (O2C, LEA Medizintechnik, Giessen, Germany).

Results: Both Cryo/Cuff and KoldBlue significantly reduced superficial and deep capillary tendon blood flow within the first minute of application (43 ± 46 arbitrary units [AU] vs 10 ± 19 AU and 42 ± 46 AU vs 12 ± 10 AU; P = .0001) without a significant difference throughout all 3 applications. However, during recovery, superficial and deep capillary blood flow was reestablished significantly faster using Cryo/Cuff (P = .023). Tendon oxygen saturation was reduced in both groups significantly (3 minutes Cryo/Cuff: 36% ± 20% vs 16% ± 15%; KoldBlue: 42% ± 19% vs 28% ± 20%; P < .05) with significantly stronger effects using Cryo/Cuff (P = .014). Cryo/Cuff led to significantly higher tendon oxygenation (Cryo/Cuff: 62% ± 28% vs baseline 36% ± 20%; P = .0001) in superficial and deep tissue (Cryo/Cuff: 73% ± 14% vs baseline 65% ± 17%; P = .0001) compared with KoldBlue during all recoveries. Postcapillary venous filling pressures were significantly reduced in both groups during application; however, Cryo/Cuff led to significantly, but marginally, lower pressures (Cryo/Cuff: 41 ± 7 AU vs baseline 51 ± 13 AU; P = .0001 and KoldBlue: 46 ± 7 AU vs baseline 56 ± 11 AU; P = .026 for Cryo/Cuff vs KoldBlue).

Conclusion: Increased tendon oxygenation is achieved as tendon preconditioning by combined cryotherapy and compression with significantly increased tendon oxygen saturation during recovery in contrast to cryotherapy alone. Both regimens lead to a significant amelioration of tendinous venous outflow.

Clinical Relevance: Combined cryotherapy and compression is superior to cryotherapy alone regarding the Achilles tendon microcirculation. Further studies in tendinopathy and tendon rehabilitation are warranted to elucidate its value regarding functional issues.

Purpose: To investigate in-shoe plantar pressure loading and comfort during running in 2 popular neutral-cushioned running shoes recommended for athletes with cavus feet.

Study Design: Controlled laboratory study.

Methods: Plantar pressures were collected using the in-shoe Novel Pedar-X system during overground running in 22 athletes with cavus feet in 2 neutral-cushioned running shoes (Asics Nimbus 6 and Brooks Glycerin 3) and a control condition (Dunlop Volley). Comfort was measured using a validated visual analog scale.

Results: Compared with the control, both neutral-cushioned running shoes significantly reduced peak pressure and pressure-time integrals by 17% to 33% (P < .001). The Brooks Glycerin most effectively reduced pressure beneath the whole foot and forefoot (P < .01), and the Asics Nimbus most effectively reduced rearfoot pressure (P <.01). Both neutral-cushioned running shoes reduced force at the forefoot by 6% and increased it at the midfoot by 12% to 17% (P < .05). Contact time and area increased in both neutral-cushioned running shoes (P < .01). The Asics Nimbus was the most comfortable, although both neutral-cushioned running shoes were significantly more comfortable than the control (P < .001).

Conclusion: Two popular types of neutral-cushioned running shoes were effective at reducing plantar pressures in athletes with cavus feet.

Clinical Relevance: Regional differences in pressure reduction suggest neutral-cushioned running shoe recommendation should shift from being categorical in nature to being based on location of injury or elevated plantar pressure.

Hypothesis: Type I and II acromioclavicular joint disruption significantly impairs long-term shoulder function.

Study Design: Case series; Level of evidence, 4.

Methods: The shoulder function of 23 patients who were treated for type I or II acromioclavicular joint disruption was evaluated at a mean of 10.2 years after injury. The objective and subjective measures of the injured shoulder were assessed using Constant, University of California–Los Angeles Shoulder Scale, and Simple Shoulder Test scores and were compared with results of the uninjured shoulder.

Results: At an average follow-up of 10.2 years, 12 of 23 patients (52%) reported at least occasional acromioclavicular joint symptoms. The average Constant score for the injured shoulder was 70.5 and 86.8 for the uninjured shoulder (P < .001). The average University of California–Los Angeles Shoulder Scale score for the injured shoulder was 24.1 and 29.2 for the uninjured shoulder (P < .001). The average Simple Shoulder Test value for the injured shoulder was 9.7 and 10.9 for the uninjured shoulder (P < .002). The extent of acromioclavicular joint disruption and acromioclavicular joint width did not have any statistically significant influence on the shoulder functional scores.

Conclusion: Type I and II acromioclavicular joint disruptions impair long-term shoulder function in about half of patients 10 years after injury.

Purpose: To compare the in vivo kinematics of the uninjured contralateral knees of patients with anterior or posterior cruciate ligament deficiency with knee kinematics of age-matched patients without joint injury.

Study Design: Controlled laboratory study.

Methods: Ten subjects with bilateral healthy knees, 10 patients with acute unilateral anterior cruciate ligament injury, and 10 with acute unilateral posterior cruciate ligament injury participated in this study. Kinematics were measured from 0° to 90° of flexion using imaging and 3-dimensional modeling.

Results: No significant differences were found across the groups in all rotations and translations during weightbearing flexion (P > .9).

Conclusion: Patients with unilateral cruciate ligament deficiency did not alter kinematics of the contralateral uninjured knee during weightbearing flexion. In addition, these findings suggest that the included patients with anterior cruciate ligament or posterior cruciate ligament deficiency did not have preexisting abnormal kinematics of the knee.

Clinical Relevance: As the contralateral joint kinematics of the injured patients were not affected by the ipsilateral ligament injury in the short term, physicians and researchers might use the contralateral knee as a reliable normal kinematic control.

Hypothesis: After 6 and 12 weeks, structural properties and knee kinematics after soft tissue ACL reconstruction with 15 mm within the femoral tunnel will be significantly inferior when compared with the properties of ACL reconstruction with 25 mm in the tunnel.

Study Design: Controlled laboratory study.

Methods: In an intra-articular goat model, 36 ACL reconstructions using an Achilles tendon split graft were performed with 15-mm (18 knees) and 25-mm (18 knees) graft length in the femoral tunnel. Animals were sacrificed 6 weeks and 12 weeks after surgery and knee kinematics was tested. In situ forces as well as the structural properties were determined and compared with those in an intact control group. Histologic analyses were performed in 2 animals in each group 6 and 12 weeks postoperatively. Statistical analysis was performed using a 2-factor analysis of variance test.

Results: Anterior cruciate ligament reconstructions with 15 mm resulted in significantly less anterior tibial translation after 6 weeks (P < .05) but not after 12 weeks. Kinematics after 12 weeks and in situ forces of the replacement grafts at both time points showed no statistically significant differences. Stiffness, ultimate failure load, and ultimate stress revealed no statistically significant differences between the 15-mm group and the 25-mm group.

Conclusion: The results suggest that there is no negative correlation between short graft length (15 mm) in the femoral tunnel and the resulting knee kinematics and structural properties.

Clinical Relevance: Various clinical scenarios exist in which the length of available graft that could be pulled into the bone tunnel (femoral or tibial) could be in question. To address this concern, this study showed that reducing the tendon graft length in the femoral bone tunnel from 25 mm to 15 mm did not have adverse affects in a goat model.

Hypothesis: Certain intra-articular lesions affect the clinical outcome of ligament reconstruction.

Study Design: Case series; Level of evidence, 4.

Methods: Sixty-five ankles from 64 patients underwent a modified Broström operation for chronic lateral ankle instability with a mean follow-up of 28.7 months (range, 12–67). The results were assessed according to the Karlsson-Peterson Ankle Score. The type of intra-articular lesions and the association of clinical outcome were investigated using Pearson’s correlation coefficient and multivariate logistic regression analysis.

Results: The average Karlsson-Peterson Ankle Score was improved from 53 ± 14.63 preoperatively to 85.21 ± 11.97 at final follow-up (P < .001). Five different intra-articular lesions were described in 63 ankles (96.9%), and the ankle score negatively correlated with the number of lesions (r = –.604; P < .001). Multivariate logistic regression showed that syndesmosis widening (odds ratio, 11.1; 95% confidence interval: 2.2–55.4; P = .003), osteochondral lesions of the talus (odds ratio, 8.5; 95% confidence interval: 1.7–42.3; P = .008), and ossicles (odds ratio, 4.5; 95% confidence interval: 1.0–20.2; P = .046) are significant predictors of unsatisfactory results after ligament reconstruction.

Conclusion: Arthroscopic diagnosis and treatment of intra-articular lesions associated with chronic lateral ankle instability is a safe and effective method. The presence of any combination of associated intra-articular lesions can result in a poor outcome.

Hypothesis: Pitchers with a history of throwing-related pain will have weakened dominant-arm posterior shoulder musculature and greater dominant-arm glenohumeral total range of motion (ROM) loss compared with pitchers without throwing-related pain.

Study Design: Controlled laboratory study.

Methods: Twenty-three adolescent pitchers (age 15.7 ± 1.4 years) were tested. Twelve pitchers had throwing-related pain in the prior season and were currently symptom-free, while the remaining 11 pitchers had no such history of pain. Internal and external rotation ROM and muscle strength (lower trapezius, middle trapezius, rhomboids, latissimus dorsi, supraspinatus, internal rotators, external rotators) were measured bilaterally. Dominant versus nondominant differences in ROM and strength were compared between pitchers with and without throwing-related pain.

Results: As a whole, the group of 23 pitchers had a loss of internal rotation ROM (13° ± 10°, P < .001) and gain in external rotation ROM (11° ± 10°, P < .001) on the dominant versus nondominant arm, with no effect on total ROM (2° ± 7° loss, P = .14). There was no difference in bilateral comparison of total ROM between pitchers with and without throwing-related pain. Dominant versus nondominant muscle strength was lower (P < .05) for the pain group versus nonpain group for the middle trapezius (7% ± 19% vs 22% ± 12%) and supraspinatus (–4% ± 27% vs 14% ± 14%) and higher (P < .05) for the internal rotators (19% ± 14% vs 6% ± 12%).

Conclusion: Throwing-related pain in this population may be due to the inability of weakened posterior shoulder musculature to tolerate stress imparted on it by adaptively strengthened propulsive muscles.

Clinical Relevance: Selective posterior shoulder strengthening may be indicated in rehabilitative and injury prevention programs for adolescent pitchers.

Hypothesis: Navigated limb alignment demonstrates good reliability and accuracy in all 3 planes.

Study Design: Descriptive laboratory study.

Methods: Thirteen cadaver legs were used to examine the intra- and interobserver registration reliability of 3 observers. Initial coronal, sagittal, and axial alignment was measured on 6 legs, 3 times each, at intervals >36 hours. Navigated HTOs were then performed on all 13 legs, pre- and postoperative alignment was recorded, and data were compared with equivalent measures obtained by 3-dimensional computed tomography. Reliability and accuracy data were both analyzed using intraclass correlation coefficients with the following established thresholds: good, >0.75; fair, 0.4 to 0.75; and poor, <0.4.

Results: Intraclass correlation coefficients for intraobserver reliability were categorized as follows: varus-valgus, good; flexion-extension, fair; and femoral-tibial rotation, poor. For interobserver reliability, results were varus-valgus, fair; flexion-extension, fair; and femoral-tibial rotation, poor. Intraclass correlation coefficients for navigation accuracy were varus-valgus, good; tibial slope, good; and tibial torsion, poor. Maximum differences in navigation–computed tomography measurements were varus-valgus angle, 4.5°; tibial slope, 8.8°; and tibial torsion, 16.5°.

Conclusion and Clinical Relevance: Navigation may be reliable and clinically useful for dynamic monitoring of coronal leg alignment but has limits in determination of sagittal and axial plane alignment.

Purpose: The objective was to define the incidence and etiologic factors of intra- and extra-articular hip injuries in the National Football League (NFL).

Study Design: Descriptive epidemiology study.

Methods: The NFL Injury Surveillance System was used to define all hip-related injuries from 1997 to 2006. Injuries were included if the athlete missed more than 2 days. All hip and groin injuries were included for evaluation. The authors also report on NFL players with intra-articular injuries seen at their institution outside of the NFL Injury Surveillance System.

Results: There were a total of 23 806 injuries from 1997 to 2006, of which 738 were hip injuries (3.1%) with an average of 12.3 days lost per injury. Muscle strains were the most common injury. Intra-articular injuries resulted in the most time lost. Contact injuries most likely resulted in a contusion, and noncontact injuries most often resulted in a muscle strain. In the authors’ institutional experience, many of the athletes with labral tears have persistent adductor strains that do not improve despite adequate therapy.

Conclusion: Hip injuries represent a small but substantial percentage of injuries that occur in the NFL. A majority of these injuries are minor, with a return to play within 2 weeks. Intra-articular injuries are more serious and result in a significant loss of playing time. The "sports hip triad" (labral tear, adductor strain, and rectus strain) is described as a common injury pattern in the elite athlete.

Hypothesis: Anatomic ACL fibers undergo a greater change in length during anterior translation and internal rotation than a conventional SB reconstruction from the PL tibial footprint to the AM femoral footprint.

Study Design: Controlled laboratory study.

Methods: The Praxim ACL Surgetics navigation system was used to acquire kinematic data during a flexion/extension cycle and to register all points within the ACL footprint from 5 fresh-frozen cadaveric knees. Virtual fibers were placed in the center of the AM and PL bundles as well as central and conventional SB positions. After transection of the ACL, the absolute length change and apparent strain of the fibers were computed for each knee during the Lachman and anterior drawer tests and internal rotation at 0° and 30° of flexion.

Results: Each of the anatomic fibers (AM, PL, and central) had more elongation and apparent strain than the conventional SB fiber during the Lachman maneuver. During the anterior drawer test, the AM and central (but not the PL) fibers lengthened significantly more and the AM had more apparent strain than the conventional SB fiber. During internal rotation at 0° and 30° of flexion, anatomic fibers elongated significantly more than the conventional fiber. Except for the AM fiber with the knee at full extension, apparent strain was greater in all anatomic fibers than in the conventional SB fiber during internal rotation maneuvers.

Conclusion: In ACL-deficient cadaveric knees, anatomic fibers undergo greater elongation and apparent strain in response to anterior translation and internal rotation maneuvers than a conventional SB graft. Because of their optimal orientation, anatomic fibers may resist pathologic anterior translation and internal rotation more than the conventional SB position.

Clinical Relevance: Conventional placement of a single-bundle graft results in suboptimal changes in fiber length and strain, suggesting that alternatives such as anatomic placement of an SB graft or double-bundle reconstruction may result in greater control of translation and rotation.

Hypothesis: Clinical anthropometric data can be used to predict hamstring graft size.

Study Design: Cohort study (prevalence); Level of evidence, 1.

Methods: Fifty consecutive patients with anterior cruciate ligament deficiency scheduled for reconstruction using hamstring autograft were prospectively evaluated. Preoperatively we recorded height, weight, body mass index, age, gender, leg length, thigh length, shank length, bilateral thigh circumference, and Tegner score. Intraoperative measurements of both the gracilis and semitendinosus tendons were made, including absolute length before fashioning the graft and final diameter of the quadrupled graft using sizing tubes calibrated to 0.5 mm. Bivariate correlation coefficients (Pearson r) were calculated to identify relationships among clinical data and intraoperatively measured hamstring graft length and diameter.

Results: Strongest correlations for graft lengths were height and leg length measurements. Shorter persons with shorter leg, thigh, and shank lengths tended to have shorter gracilis and semitendinosus grafts. Likewise, the strongest correlations for graft diameter were weight and thigh circumference. Self-reported activity level and age did not correlate. Gender comparison revealed that women who were shorter, lighter, and had smaller body mass indices were more likely to have smaller graft diameters and shorter graft lengths.

Conclusion: Patients weighing less than 50 kg, less than 140 cm in height, with less than 37 cm thigh circumference, and with body mass index less than 18 should be considered at high risk for having a quadrupled hamstring graft diameter less than 7 mm. When separated by gender, small graft diameters are most likely in older, short, female subjects with small thigh circumferences or young, skinny, male subjects with small thigh circumferences and low body mass index. Common clinical measurements can be used for preoperative identification of patients at risk for insufficient graft tissue and would be useful for patient counseling and alternative graft source planning.

Hypothesis: Among active athletes, Doppler flow may partly reflect tendon adaptation to increased mechanical load and/or asymptomatic tendinopathy.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: The Achilles tendons of 61 badminton players (24 elite, 37 recreational) were examined with gray-scale and color Doppler ultrasound. Achilles tendon pain and activity level (badminton training, badminton playing, badminton years) were measured.

Results: Doppler flow was not associated with current Achilles tendon pain but was associated with an increased anteroposterior tendon diameter (an indicator of tendinopathy) (P = .02). Athletes who had been playing badminton for longer were more likely to have Doppler flow (P < .01), and there was a trend toward an association between a greater number of badminton playing hours per week and Doppler flow (P = .07).

Conclusion: Achilles tendon Doppler flow appears to be a sign of asymptomatic tendinopathy rather than pain among active athletes. The association between weekly badminton hours and badminton years and Doppler flow suggests that Doppler flow may be a response to mechanical load in this cohort.

Hypothesis: The modified Weaver-Dunn reconstruction restores intact acromioclavicular joint motion during passive scapular plane abduction.

Study Design: Controlled laboratory study.

Methods: Acromioclavicular joint motion was recorded during passive humeral elevation in 3 states: an intact shoulder, an "injured" state in which the acromioclavicular and coracoclavicular ligaments were transected, and finally in a reconstructed state using a modified Weaver-Dunn reconstruction. Measurements were taken with an electromagnetic motion analysis system attached to rigid pins placed in the clavicle, scapula, humerus, and sternum during passive scapular plane humeral elevation.

Results: Total translatory motion of the acromioclavicular joint in the cut state was significantly greater than both the intact and reconstructed states in the medial/lateral (intact, 4.3 mm; cut, 7.9 mm; reconstructed, 2.6 mm), anterior/posterior (intact, 4.8 mm; cut, 6.1 mm; reconstructed, 4.9 mm), and superior/inferior (intact, 4.1 mm; cut, 8.0 mm; reconstructed, 4.8 mm) directions. The maximum and minimum positions of the reconstructed state were significantly more anterior and inferior than in the intact state. A significant increase in acromioclavicular axial rotation was also found between the intact and cut state.

Conclusion: The modified Weaver-Dunn reconstruction was found to restore motion of the acromioclavicular joint to near-intact values, but created a more anterior and inferior position of the clavicle with respect to the acromion.

Clinical Relevance: These kinematic data support the modified Weaver-Dunn reconstruction as a kinematically sound procedure to treat displaced acromioclavicular joint injuries.

Hypothesis: The incidence of presentations that do not subsequently get published is high, and the numbers of major and minor inconsistencies, once published, are also high.

Study Design: Systematic review.

Methods: A database was created of all abstracts presented at AOSSM meetings from 1999 to 2001 from official program books. To assess whether each abstract had been followed by publication in a peer-reviewed journal, a PubMed search was conducted to include a 5-year follow-up for each conference. Minor inconsistencies included differences in title, authors, presentation of all outcomes, and authors’ interpretation of data. Major inconsistencies included discrepancies in study objective and/or hypothesis, study design, primary and secondary outcome measures, sample size, statistical analysis, results, and standard deviations/confidence intervals.

Results: Overall, 98 of the 165 abstracts presented at AOSSM national meetings from 1999 to 2001 were published in a peer-reviewed journal within 5 years, a publication rate of 59.4%. The median time to publication for all articles was 21 (range, 1–60) months. The majority of articles (61) were published in the American Journal of Sports Medicine (62.2%). The median number of major and minor inconsistencies from abstract to publication was 1 (range, 0–5) and 1 (range, 0–4), respectively. Sixty-two of the 98 published abstracts (63%) had at least 1 major inconsistency, while 79 (81%) had at least 1 minor inconsistency. In 5 manuscripts (5%), the authors’ interpretation of the data had changed, and in 2 (2%), the change essentially invalidated the abstract.

Conclusion: A large number of scientific presentations do not get published in a peer-reviewed journal. In addition, those published have a significant number of changes that, in a small percentage of cases, alter the validity of the original presentation.

Clinical Relevance: Orthopaedic surgeons and other attendees as well as nonattendees who reference conference abstracts need to exercise good judgment when considering the implications of oral presentations of unpublished materials. When reviewing meeting presentation abstracts, readers should remember that the material being presented is often not in its definitive or ultimate form.

Hypothesis: Snowboarders are at increased risk for sustaining humerus fractures when compared with skiers. In addition, the types of fractures, laterality, and risk factors differ between the 2 groups.

Study Design: Case-control study; Level of evidence, 3.

Methods: At a major ski area clinic, 318 humerus fractures were evaluated over 34 seasons. Radiographs were classified according to the AO and Neer systems. Patient data were analyzed and compared with that of a control population of uninjured skiers and snowboarders to determine incidence and risk factors.

Results: The incidence of humerus fractures among snowboarders (0.062 per 1000 snowboarder days) was significantly higher than that of skiers (0.041 per 1000, P < .05). Skiers were more likely to sustain proximal fractures, and snowboarders were relatively more likely to sustain diaphyseal and distal fractures (P < .05). Of glenohumeral dislocations, 6.56% were associated with proximal humerus fractures among skiers (1.7% among snowboarders). Snowboarders who lead with their left foot were more likely to fracture their left humerus (P = .023). Helmet use and gender were not risk factors for humerus fractures among either skiers or snowboarders. Jumping was involved in 28.3% of humerus fractures among snowboarders and in 5.4% among skiers. Skiers with humerus fractures were more skilled, older, and fell less frequently than controls. Snowboarders were less skilled, younger, and fell at a similar rate compared with controls.

Conclusion: Snowboarders are at significantly higher risk of sustaining humerus fractures than skiers. In skiers, humerus fractures show no laterality and most often involve the proximal humerus. In contrast, snowboarders more often fracture the left humerus at the diaphysis.

Hypothesis: Revision anterior cruciate ligament reconstruction will produce similar results to those of primary reconstruction, and there may be different results according to graft materials.

Study Design: Case control study; Level of evidence, 3.

Methods: Fifty-nine revision surgeries were performed at 1 institution between January 1997 and October 2005. Fifty-five patients (56 operations) were followed. The results of 117 patients (117 knees) treated with arthroscopic primary anterior cruciate ligament reconstruction using double-looped semitendinosus and gracilis autograft from September 2001 to November 2002 were also evaluated. Clinical and stability results between primary and revision anterior cruciate reconstruction were compared. For the revision surgery, 21 (37.5%) knees had revision reconstruction with previously unharvested ipsilateral double-looped semitendinosus and gracilis autograft. Twenty (35.7%) were bone–patellar tendon–bone allograft, and 15 (26.8%) were Achilles allograft. The details of the technique varied according to the original graft choice and the abnormality encountered. Concomitant procedures were necessary in 32 (57.1%) of 56 knees. Clinical and stability results according to the different graft materials were also compared.

Results: There were significant improvements in the scores for subjective, objective forms (P < .001), and stability (P < .001). However, the clinical results of revision surgery were inferior to primary reconstruction (P < .001), but as regards stability, the difference between primary and revision cases was not significant (P = .338). There was no difference in clinical and stability results in different groups of graft material (P = .160–.690).

Conclusion: Revision anterior cruciate ligament reconstruction could improve clinical and stability results, but the clinical results were inferior to those of primary reconstruction. This study also demonstrated that the success of the operation did not depend on the choice of graft materials.

Hypothesis: The outcome of a revised anterior cruciate ligament surgery is comparable to primary anterior cruciate ligament reconstruction, with a rate of success around 70% to 80%.

Study Design: Case series; Level of evidence, 4.

Methods: A total of 66 revisions of anterior cruciate ligament reconstructions were carried out from September 2000 to September 2004. Patients with concomitant instability and those with alterations in the weightbearing axis of the lower limbs were not included. Sixty patients were followed from 24 to 72 months: 50 clinically and 10 by a phone interview. Six patients were lost to follow-up due to changes of address.

Results: Lysholm scores were 57% excellent (95–100 points), 13% good (84–94 points), 22% fair (63–83 points), and 8% poor (<64 points). A total of 68% of patients had negative Lachman tests, 20% had positive tests with a hard end point, 10% had positive results, and 2% had very positive results. Stabilometric evaluation with the KT-1000 arthrometer at the maximum load showed that 56% of patients had <3 mm side-to-side difference, 34% had between 3 and 5 mm, and 10% had 6 to 10 mm. The International Knee Documentation Committee scores were 36% excellent (class A), 46% good (class B), and 18% fair (class C). The percentage of patients who resumed sport at the same level was 78%, compared with 58% after their primary reconstruction.

Conclusion: The results of these anterior cruciate ligament reconstruction revision surgeries are close to those achieved by other series of primary reconstructions with a little less satisfactory results. We attribute the high success rate to the strict application of the same technique and the confinement of revision to motivated patients. It should be noted, however, that follow-up is only at the midterm stage (mean, 41.9 months).

Purpose: The objective of this study is to assess knee kinematics after double-bundle reconstruction with hamstring tendon and after anatomically oriented reconstruction with a patellar tendon using navigation during surgery.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Eighty knees received double-bundle reconstruction with a hamstring tendon graft, and 45 knees received anatomically oriented reconstruction with a patellar tendon graft. Before reconstruction, knee laxity was measured using a navigation system. After the posterolateral bundle or anteromedial bundle was temporarily fixed during double-bundle reconstruction, knee laxity was measured to assess the function of each bundle. After double-bundle reconstruction or anatomically oriented reconstruction with patellar tendon, knee laxity was measured in the same manner.

Results: Both double-bundle reconstruction and anatomically oriented reconstruction similarly improved knee laxity compared with before reconstruction in all knee flexion angles. Regarding the function of the anteromedial and posterolateral bundles in double-bundle reconstruction, the 2 grafts showed contrasting behavior. The posterolateral bundle restrained tibial displacement mainly in knee extension, whereas the anteromedial bundle restrained it more in the knee flexion position. The posterolateral bundle has a more important role in controlling rotation of the tibia than the anteromedial bundle.

Conclusion: Although the posterolateral bundle has an important role in the extension position, the anteromedial bundle is more important in the flexion position. Therefore, both bundles should be reconstructed to improve knee laxity throughout knee range of motion. Even with single-bundle reconstruction using a patellar tendon, anatomic reconstruction might improve knee laxity similar to double-bundle reconstruction.

Hypothesis: An arthroscopic superior labral anterior and posterior lesion repair procedure using the trans-rotator cuff portal may yield favorable clinical and radiological outcomes, and cuffs may heal properly.

Study Design: Case series; Level of evidence, 4.

Methods: Fifty-eight consecutive patients undergoing superior labral anterior and posterior lesion repair using the trans-rotator cuff portal, who had available both functional and radiological outcomes after 1 year of the operation, were enrolled. We evaluated the structural outcomes for the labrum and cuff using computed tomographic arthrography and measured various clinical outcomes (the supraspinatus power, visual analog scale for pain and satisfaction, American Shoulder and Elbow Surgeons shoulder evaluation form, University of California–Los Angeles shoulder score, Constant score, and Simple Shoulder Test) at the final visit.

Results: All functional outcomes were improved significantly (P < .001). On computed tomographic arthrography, labral healing to the bony glenoid was achieved in all patients. Subacromial leakage of contrast media was observed in 3 patients (5.2%) through the muscular portion without any retraction or gap of the tendon. Two of 3 had preoperative cuff pathologic changes, and they were older than 45 years of age. Partial articular cuff tears were observed in 6 patients (10.3%), and 4 had the lesion preoperatively. There were no statistical differences in functional scores according to the presence of preoperative lesion, postoperative leakage, or partial cuff tear.

Conclusion: The data demonstrate favorable outcomes for arthroscopic superior labral anterior and posterior lesion repair using the trans-rotator cuff portal. We suggest that the trans-rotator cuff portal is an efficient and safe portal for superior labral anterior and posterior lesion repair, although there are some valid concerns of damaging the cuff in patients with a superior labral anterior and posterior lesion with concurrent cuff disorders, as well as in older patients.

Hypothesis: Subpectoral biceps tenodesis is an effective procedure in eliminating biceps tendinosis symptoms.

Study Design: Case series; Level of evidence, 4.

Methods: Patients who underwent subpectoral biceps tenodesis with a minimum follow-up of 1 year were evaluated using a battery of clinical outcome measures, biceps apex difference, and pain scores. A diagnosis of biceps tendinosis was made using a specific diagnostic protocol coupled with observation of biceps tendon fraying and increased erythema on dry arthroscopy.

Results: Between November 2002 and August 2005, 50 patients underwent subpectoral biceps tenodesis. Complete follow-up examinations were performed in 41 of 50 (82%). There were 16 women and 25 men (mean age, 50 years). Follow-up averaged 29 months (range, 12–49 months). The mean scores were 86, Rowe; 81, American Shoulder and Elbow Surgeons (ASES); 9, Simple Shoulder Test (SST); 87, Constant Murley; and 84, Single Assessment Numeric Evaluation (SANE). There was 1 failure as demonstrated by pull-out of the tendon from the bone tunnel resulting in a "Popeye" deformity on physical examination. The mean value for biceps apex distance was 0.15 cm, with 35 of 41 patients demonstrating no difference on physical examination. Twenty-three of 41 patients had complete preoperative and postoperative examinations. All clinical outcome measures demonstrated a statistically significant improvement at follow-up when compared with the preoperative scores. Thirty-one patients had identified lesions of the rotator cuff at time of arthroscopy. The mean ASES score in patients without rotator cuff lesion (89.2 ± 10.3) was significantly greater than the mean ASES for those with rotator cuff lesion (78.0 ± 21.0) (P = .0324). The mean SST score in patients without rotator cuff lesion (10.6 ± 1.5) was significantly greater than the mean ASES score for those with rotator cuff lesion (8.8 ± 2.7) (P = .0132).

Conclusion: Subpectoral biceps tenodesis with an interference screw is a viable treatment option for patients with symptomatic biceps tendinosis. Anterior shoulder pain and biceps symptoms were resolved with this technique. Patients with coexistent rotator cuff lesion had less favorable outcomes.

Hypothesis: High school soccer injury patterns will vary by gender and type of exposure.

Study Design: Descriptive epidemiologic study.

Methods: Soccer-related injury data were collected over the 2005–2006 and 2006–2007 school years from 100 nationally representative United States high schools via Reporting Information Online (RIO, an Internet-based sports-related injury surveillance system).

Results: Participating certified athletic trainers reported 1524 soccer injuries during 637 446 athlete exposures (AEs), for an injury rate of 2.39 per 1000 AEs, corresponding to a nationally estimated 807 492 soccer-related injuries during the 2005–2006 and 2006–2007 seasons. The injury rate per 1000 AEs was greater during competition (4.77) than practice (1.37) (rate ratio [RR] = 3.49; 95% confidence interval [CI], 3.15–3.87). Overall, the most frequent diagnoses were incomplete ligament sprains (26.8%), incomplete muscle strains (17.9%), contusions (13.8%), and concussions (10.8%). The most commonly injured body sites were the ankle (23.4%), knee (18.7%), head/face (13.7%), and thigh/upper leg (13.1%). Similar proportions of boys (57.9%) and girls (53.9%) returned to activity in <1 week. During competition, girls sustained complete knee ligament sprains requiring surgery at a rate of 26.4 per 100 000 AEs, higher than the rate among boys during competition (1.98 per 100 000 AEs) (RR = 13.3; 95% CI, 3.15–56.35) and among girls during practice (2.34 per 100 000 AEs) (RR = 11.3; 95% CI, 4.31–29.58). Player-to-player contact was more common among competition injuries (injury proportion ratio [IPR] = 2.42; 95% CI, 2.01–2.92), while noncontact mechanisms were more common among practice injuries (IPR = 2.39; 95% CI, 1.90–3.01).

Conclusions: High school soccer injury patterns vary by gender and type of exposure. Identifying such differences in injury patterns is the important first step in the development of evidence-based, targeted injury prevention efforts.

Hypotheses: (1) Hand, first ray, and finger injuries in professional American football players represent a common cause of missed time from practice and game participation. (2) The effect of upper extremity injuries differs as a function of the anatomic site involved, injury type, and athlete’s position.

Study Design: Descriptive epidemiologic study.

Methods: A retrospective review of all documented injuries to the hand, first ray, and fingers sustained by American football players in the National Football League over a 10-year period (1996–2005) was performed using the League’s injury surveillance database. The data were analyzed from multiple perspectives, with emphasis on the type of injury, athlete position, and activity at the time of injury.

Results: A total of 1385 injuries occurred to the hand, first ray, and fingers over the 10 seasons studied. Of these injuries, 48% involved the fingers, 30% involved the first ray, and 22% involved the hand, with game injuries more common than practice injuries at each location. Metacarpal fractures and proximal interphalangeal joint dislocations were the 2 most common injuries. Offensive and defensive linemen were the most likely to sustain a hand injury; 80% of hand injuries were metacarpal fractures. The most common injuries to the first ray were fractures (48%) and sprains (36%), which occurred most often in athletes playing a defensive secondary position. Finger injuries were most commonly dislocations at the level of the proximal interphalangeal joint, typically involving the ulnar 2 digits. Finger injuries were most common in wide receivers and defensive secondary players. The act of tackling produced the most injuries (28%).

Conclusion: Upper extremity trauma, especially injury to the hand, first ray, and fingers, is a significant source of morbidity for professional football players. The results of this study may be used to implement preventive measures to help minimize these injuries.

Hypotheses: (1) Upper extremity injuries in professional American football players are a common cause of missed time from practice and game participation. (2) The effect of upper extremity injuries differs as a function of the site involved and the athlete’s position.

Study Design: Descriptive epidemiologic study.

Methods: A retrospective review of all documented injuries to the elbow, forearm, and wrist sustained by all players in the National Football League over a 10-year period (1996–2005) was performed using the League’s injury surveillance database. An injury was considered significant if it resulted in premature cessation of (or absence from) at least 1 practice, game, or training event. The data were analyzed from multiple perspectives, with emphasis on the type of injury, athlete position, and activity at the time of injury.

Results: There were 859 total injuries over the 10-year period: 58% involved the elbow, 30% involved the wrist, and 12% involved the forearm. Ligamentous injuries were the most common diagnosis in the elbow and wrist, with wrist sprains the most common of all diagnoses. Fractures were the most common injury occurring in the forearm. For all 3 anatomic locations, game injuries were much more common than practice injuries by a factor of 2.8 to 1. Forearm injuries led to a mean of 42 days lost, wrist injuries led to a mean of 27 days lost, and elbow injuries led to an average of 22 days lost. Fractures and dislocations led to the greatest amount of time lost (47 days and 53 days, respectively). Tackling was the activity most often (24%) implicated as causing injuries to the elbow, forearm, and wrist. Offensive and defensive linemen were most commonly injured. Elbow injuries were the most common at these positions, constituting approximately 75% of all injuries. Defensive backs sustained the greatest number of forearm injuries, approximately double the total number at any other position.

Conclusion: Upper extremity trauma is a significant issue for professional football players. In particular, the high incidence rates of elbow injuries in linemen and forearm injuries in defensive backs warrant further scrutiny.

Hypothesis: Modifying the anteromedialization osteotomy to a straight anteriorization osteotomy of the tibial tuberosity can decrease trochlear contact pressures without a resultant medial shift of forces to the medial trochlear contact area.

Study Design: Controlled laboratory study.

Methods: Ten cadavers were tested before and after straight anteriorization tibial tuberosity osteotomy by loading the extensor mechanism with 89.1 and 178.2 N at 0° , 30° , 60° , and 90° of flexion following a validated patellofemoral joint loading protocol. Contact pressures were measured with electroresistive pressure sensors placed directly on the trochlea.

Results: The mean trochlear contact pressures after osteotomy decreased significantly (P < .05) for loads of 89.1 and 178.2 N at both 30° (23% and 20%, respectively) and 60° (18.7% and 31.9%, respectively) of knee flexion. The peak contact pressures decreased significantly (P < .05) for loads of 89.1 and 178.2 N at 30° (24.3% and 27.0%, respectively) and 60° (31.9% and 24.5%, respectively) and for loads of 89.1 N at 90° (13.4%) of knee flexion.

Conclusion: The authors demonstrated significantly decreased trochlear contact forces after straight anteriorization osteotomy of the tibial tuberosity, without a significant resultant medial shift of the center of force.

Clinical Relevance: Straight anteriorization of the tibial tuberosity may be a useful adjunct for patients with medial articular defects of the patellar or trochlea in whom anteromedialization would be otherwise contraindicated.

Hypothesis: The main hypothesis tested in this study is that radiofrequency microtenotomy offers better results than the extensor tendon release and repair operation for elbow tendinosis, especially earlier recovery.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: Twenty-four patients were randomized into 2 treatment groups, extensor tendon release and repair, and microtenotomy. Dynamic infrared thermography (DIRT) was employed as an objective method to verify the diagnosis as well as to document the outcome 3 months after the surgical procedure.

Results: Visual analog scale pain scores in the microtenotomy but not in the release group decreased significantly after 3 weeks. There was no statistically significant difference in pain scores between the 2 groups at 3, 6, and 12 weeks, and at 10 to 18 months. At 12 weeks, grip strength had improved significantly in the microtenotomy but not in the release group. The functional score was significantly increased in both groups. The DIRT group showed significant differences in epicondyle skin temperature between diseased and normal elbows both pre- and postoperatively. Abnormal DIRT images correlated well with elevated pain scores.

Conclusions: Radiofrequency microtenotomy provides a promising alternative to the release operation for elbow tendinosis. Dynamic infrared thermography provides a reliable, noninvasive, objective method for the diagnosis of elbow tendinosis, as well as for evaluation of the outcome following treatment.

Hypothesis: The level of contact pressure developed in the human knee joint and the extent of articular cartilage and underlying subchondral bone injuries will depend on the mechanism of applied loads/moments during rupture of the ACL.

Study Design: Controlled laboratory study.

Methods: Seven knee pairs, flexed to 30°, were loaded in compression or internal torsion until injury. Pressure-sensitive film recorded the magnitude and location of contact. Histologic analysis and magnetic resonance imaging were used to document microtrauma to the tibial plateau cartilage and subchondral bone.

Results: All specimens suffered ACL injury, either in the form of a midsubstance rupture or avulsion fracture. The contact area and pressures were higher for compression than torsion experiments. After being loaded, the articular cartilage in the central and posterior regions of the medial tibial plateau showed increased magnetic resonance imaging signal intensity, corresponding to an increased susceptibility to absorb water. Histologically, there were more microcracks in the subchondral bone and more articular cartilage damage in the compression than torsion experiments.

Conclusion: Significant damage occurs to the articular cartilage and underlying subchondral bone during rupture of the ACL. The types and extent of these tissue injuries are a function of the mechanism of ACL rupture.

Clinical Relevance: Patients suffering an ACL injury may be at risk of osteochondral damage, especially if the mechanism of injury involves a high compressive loading component, such as during a jump landing.

Hypothesis: An implant of degradable polycaprolacton-polyurethane should act as a temporary scaffold enabling regeneration of a new meniscus by slow degradation of the polymer and simultaneous in-growth and differentiation of tissues into the typical cartilage-like tissue of the meniscus.

Study Design: Controlled laboratory study.

Methods: In 13 dogs’ knees, the lateral meniscus was replaced with a porous polymer implant (6 and 7 for 6- and 24-month follow-up, respectively); in 7 knees only a meniscectomy was performed. In 6 knees, no surgery was performed. After 6 and 24 months, the implants and the articular cartilage were histologically evaluated. Compression-stress tests were performed on implant biopsy specimens.

Results: The implants were fully integrated into the tissue without formation of a capsule. The foreign body reaction did not exceed grade I. Differentiation from fibrous- to cartilage-like tissue was pronounced after 24 months. Viable cells were particularly absent after 24 months in central parts of the most anterior part of the scaffold. The mechanical properties of the implants were intermediate between the scaffold before implantation and native meniscus tissue and were not different between 6 and 24 months. After both 6 and 24 months, small areas of the implant were not covered with tissue. Cartilage degeneration was not prevented.

Conclusion: A final remodeling of tissue into neomeniscus tissue could not take place since the original structure of the polymer was still present after 24 months. The implant did not prevent cartilage degradation. Several factors are discussed that may be responsible for this.

Clinical Relevance: Although clinical application of a polymer implant for the replacement of the entire meniscus is not supported by this study, the authors strongly believe in the concept, but further improvements in the implant and surgical technique are needed before such an implant can be recommended for human clinical use.

Hypothesis: A coracoclavicular ligament reconstruction with a semitendinosus tendon would have superior performance to the classic coracoacromial ligament transfer with or without augmentation.

Study Design: Controlled laboratory study.

Methods: Five cadaveric shoulders were used to reconstruct the coracoclavicular ligaments with 3 methods: coracoacromial ligament transfer without augmentation, coracoacromial ligament transfer augmented with No. 5 Ethibond suture, and a semitendinosus tendon. Each reconstruction was cyclically loaded at 40 N to 80 N for 2500 cycles, then from 40 N to 210 N for 2500 cycles, followed by loading to failure. The number of cycles to 50% and 100% loss of acromioclavicular joint reduction were recorded.

Results: During the 40 N to 80 N–loading cycle, the coracoacromial transfer without augmentation failed (15 ± 16 cycles). The augmented coracoacromial ligament transfer and the semitendinosus reconstruction did not fail (P = .008). During the 40 N to 210 N–loading cycle, the augmented coracoacromial ligament transfer failed (207 ± 399 cycles). The semitendinosus reconstruction survived through both loading cycles (P < .01).

Conclusion: Coracoclavicular ligament reconstruction with a semitendinosus graft is a biomechanically superior construct in a cyclically loaded setting to a coracoacromial ligament transfer augmented with a No. 5 Ethibond suture.

Clinical Relevance: The semitendinosus graft is a strong, biologic option for reconstruction of the coracoclavicular ligaments.