The American Journal of Sports Medicine

Several trials have been conducted to compare the clinical results between anatomic double-bundle and single-bundle anterior cruciate ligament (ACL) reconstruction procedures. In these studies, however, the number of patients was insufficient to compare the clinical results of the 2 procedures.

The anatomic double-bundle procedure may be significantly better concerning the anterior laxity and the pivot-shift test than the single-bundle procedure, while there may be no significant differences in the other clinical evaluations and the intraoperative and postoperative complications between the 2 procedures. Study Design: Cohort study; Level of evidence, 2.

Three hundred and twenty-eight patients with unilateral ACL reconstruction using hamstring autografts were divided into 2 groups. The first 157 consecutive patients underwent single-bundle reconstruction and the remaining 171 patients underwent anatomic double-bundle reconstruction. Concerning all background factors, there were no statistical differences between the 2 groups. Each patient was examined 2 years after surgery.

No serious complications were experienced in either group. The anterior laxity was significantly less in the double-bundle reconstruction (mean, 1.2 mm) than in the single-bundle reconstruction (mean, 2.5 mm). In the pivot-shift test, the double bundle (+ indication 16%; ++, 3%) was significantly better than the single bundle (+ result, 37%; ++, 12%). The mean Lysholm score averaged 96.5 points' and 97.3 points in single-bundle and double-bundle reconstructions, respectively, while the International Knee Documentation Committee evaluation showed that 90 and 110 patients, respectively, were evaluated as rank A (no significant difference between groups). There were no significant differences in the other clinical evaluations and the complications between the 2 procedures.

The postoperative anterior and rotational stability after the anatomic double-bundle ACL reconstruction was significantly better than that after the single-bundle reconstruction, although there were no significant differences between the 2 Procedures concerning the complications and the clinical evaluations.

Surgical repair of acute Achilles tendon ruptures is considered superior to nonoperative treatment, but complications other than rerupture range up to 34%. Nonoperative treatment by functional bracing seems a promising alternative.

Nonoperative treatment of acute Achilles tendon rupture with functional bracing reduces the number of complications compared with surgical treatment with a minimally invasive technique.

Randomized controlled clinical trial; Level of evidence, 2.

Using concealed random allocation, 83 patients with acute Achilles tendon rupture were assigned to nonoperative treatment by functional bracing or minimally invasive surgical treatment followed by tape bandage. Patients were allowed full weightbearing, and follow-up was 1 year.

Complications risk other than rerupture by intention-to-treat basis was 9 in 42 patients (21 %) for surgical treatment and 15 in 41 patients (36%) for nonoperative treatment (risk ratio, 0.59; 95% confidence interval, 0.29–1.19). Reruptures risk was 5 in 41 patients after nonoperative treatment and 3 in 42 patients for surgical treatment (risk ratio, 0.59; 95% confidence interval, 0.15–2.29). The mean time to work was 59 days (SD, 82) after surgical treatment and 108 days (SD, 115) after nonoperative treatment (difference, 49 days; 95% confidence interval, 4–94; P < .05). The difference between treatments for return to sports (risk ratio, 0.55; 95% confidence interval, 0.23–1.29), pain, and treatment satisfaction did not reach statistical significance.

There appears to be a clinically important difference in the risk of complications between minimally invasive surgical treatment and nonoperative treatment for acute Achilles tendon ruptures, but this was not statistically significant.

The relevance of knee-specific subjective measures of outcome to patients has not been evaluated for cartilage repair procedures.

The aim of this study was to identify which instrument out of the Knee injury Osteoarthritis Outcome Score and the International Knee Documentation Committee Subjective Knee Form measures symptoms and disabilities most important to Postoperative articular cartilage repair patients.

Cross-sectional study; Level of evidence, 3.

Data were collected from 58 participants of an Internet knee forum via a self-reported online questionnaire consisting of demographic and surgical data, the Tegner activity scale, and 49 consolidated items from the Knee injury Osteoarthritis Outcome Score and the International Knee Documentation Committee Subjective Knee Form. Item importance, frequency, and frequency-importance product were calculated.

Overall, the International Knee Documentation Committee Subjective Knee Form was the highest scoring instrument in all categories. However, 2 of the Knee injury Osteoarthritis Outcome Score subscales (“function in sport and recreation” and “knee-related quality of life”) scored higher on mean importance and frequency-importance product than the overall International Knee Documentation Committee Subjective Knee Form score.

The International Knee Documentation Committee Subjective Knee Form provided the best overall measure of symptoms and disabilities that are most important to this population of postoperative articular cartilage repair patients. This brings into question the validity of using the Knee injury Osteoarthritis Outcome Score in shorter-term—less than 10 years—studies. Issues related to sports activity appear to be highly valued and very pertinent to evaluation of outcomes for this patient group.

The tackle is the most dangerous facet of play in rugby union, but little is known about risk factors for tackle injuries.

To estimate the injury risk associated with various characteristics of tackles in professional rugby union matches.

Descriptive epidemiology study.

All 140 249 tackles in 434 professional matches were coded from video recordings for height and direction of tackle on the ball carrier, speed of tackier, and speed of ball carrier; injuries were coded for various characteristics, including whether the tackier or ball carrier required replacement or only on-field assessment.

There were 1348 injury assessments requiring only on-field treatment and 211 requiring player replacement. The inciting event and medical outcomes were matched to video records for 281 injuries. Injuries were most frequently the result of high or middle tackles from the front or side, but rate of injury per tackle was higher for tackles from behind than from the front or side. Ball carriers were at highest risk from tackles to the head-neck region, whereas tacklers were most at risk when making low tackles. The impact of the tackle was the most common cause of injury, and the head was the most common site, but an important mechanism of lower limb injuries was loading with the weight of another player. Rates of replacement increased with increasing player speed.

Strategies for reducing tackle injuries without radically changing the contact nature of the sport include further education of players about safe tackling and minor changes to laws for the height of the tackle.

The occurrence of osteoarthritis (OA), associated meniscal injuries, meniscectomy, and patient-related measures for patients treated nonoperatively after anterior cruciate ligament (ACL) injuries have not been well described in the literature in terms of natural history.

Patients with ACL injury can achieve a low occurrence of tibiofemoral OA and good knee function when treated without ACL reconstruction.

Cohort study (prognosis); Level of evidence, 2.

One hundred consecutive patients with an acute, complete ACL injury were observed for 15 years. All patients were primarily treated with activity modification and without ACL reconstruction. To achieve improved functional stability, supervised physical therapy was initiated early after injury. The patients were examined using anteroposterior weightbearing radiography. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used to quantify knee-related symptoms and knee function.

Seventy-nine patients consented to radiographic examination and 93 completed the KOOS questionnaire. Thirteen patients (16%), all of whom were among the 35 patients whose knees were meniscectomized, developed radiographic tibiofemoral OA. In contrast, none of the remaining nonmeniscectomized and radiographed knees developed OA (n = 44) (P < .0001). Sixty-three patients (68%) had an asymptomatic knee. Twenty-two patients (23%) had undergone ACL reconstruction with a mean time of 4 years after injury.

The study had a favorable long-term outcome regarding incidence of radiographic knee OA, knee function and symptoms, and need for ACL reconstruction. Although risk factors for posttraumatic OA are multifactorial, the primary risk factor that stood out in this study was if a meniscectomy had been performed. Early activity modification and neuromuscular knee rehabilitation might also have been related to the low prevalence of radiographic knee OA. In patients with ACL injury willing to moderate activity level to avoid reinjury, initial treatment without ACL reconstruction should be considered.

Because chondrocytes are responsible for articular cartilage matrix synthesis and maintenance, reduced chondrocyte viability could compromise graft survival, healing, and clinical outcome.

Typical forces used in osteochondral grafting reduce the viability of the chondrocytes in the graft. Study Design: Controlled laboratory study.

Osteochondral grafting was performed in 4 fresh-frozen cadaver knees (n = 16 per knee). Impact force was measured during extrusion of the donor graft from the harvester into the recipient site, seating the graft flush with the articular surface of the surrounding cartilage using a tamp, and recessing the graft surface below the recipient articular surface. The magnitudes of forces measured during cadaver surgery (200,400, and 800 N) were reproduced using a drop-tower apparatus on 80 fresh osteochondral grafts harvested from knee blocks provided by tissue banks. Cell viability and glycosaminoglycan release in media were measured at 48 hours after injury.

Forces were relatively low (range, 124–356 N) during graft extrusion from the harvester into the recipient defect or during flush seating (range, 191–418 N) of the graft. Attempts to recess the graft generated significantly greater force (range, 147–685- P < .01). When the donor graft length was 2 mm longer than the depth of the recipient hole, the mean impact force generated was even higher (range, 240–1114 N) than the force seen in a donor graft of equal length. No reduction in viability was seen at 200-N and 400-N impacts. However, a significant decrease in chondrocyte viability was seen in the group impacted with 800 N (only 50% of cells were viable, compared with 91 % in the sham group; P < .01). Glycosaminoglycan levels in culture media did not correlate significantly with insertion force.

Typical graft insertion forces did not significantly reduce chondrocyte viability. However, increased graft length relative to the depth of the recipient hole and attempts to recess the graft generated higher forces, which reduced chondrocyte viability.

Any theoretical benefits of cancellous bone compaction that may occur in grafts that are recessed or are longer than the recipient holes must be balanced against the potential reduction in chondrocyte viability.

Low-intensity pulsed ultrasound promotes the enchondral portion of fracture healing, which has a direct stimulatory effect on cartilage formation and maturation.

Daily ultrasound treatment positively affects the repair and incorporation of modified autologous osteochondral plugs in a canine model.

Controlled laboratory study.

In 18 dogs, 2 autologous plugs separated from host cartilage by a 1.5-mm gap were created on the medial femoral condyle in both knees of each dog. One knee was treated daily with a clinically available ultrasound bone stimulator. Animals were sacrificed after 6 and 12 weeks of therapy and the articular surfaces evaluated grossly and histologically.

Ultrasound-treated sites had significantly improved gross appearance at 6 weeks and histologic appearance at 6 and 12 weeks. The interface repair tissue of ultrasound-treated sites had a more normal translucent appearance than control sites. Ultrasound treatment improved the cell morphologic characteristics of the interface repair tissue and increased subchondral bone regeneration. Bonding of the interface repair tissue between plug and adjacent cartilage was significantly improved compared with control sites.

Low-intensity pulsed ultrasound improved interface cartilage repair of autologous osteochondral plugs compared with controls in a canine model.

Improvements in the quality and rate of repair of autologous osteochondral plugs may reduce postoperative recovery time and improve functional outcome.

Low-intensity pulsed ultrasound has been reported to be effective in promoting tendon healing. However, its optimal time and duration has not yet been determined.

Tendons at different stages of healing may respond differently to low-intensity pulsed ultrasound. In the present study, the timing effects of low-intensity pulsed ultrasound on tendon healing were investigated in a rat model with a patellar tendon graft harvest lesion.

Controlled laboratory study.

Sixty Sprague-Dawley rats underwent central third patellar tendon donor site harvest. Low-intensity pulsed ultrasound sonication was then delivered to the injured knees at day 1, 14, or 28 after harvest for 2, 4, or 6 weeks. Tendon samples were harvested at day 14, 28, and 42 after lesion for histological examination and mechanical testing.

A 2-week session of low-intensity pulsed ultrasound applied from day 1 postlesion (D1-2W) significantly improved the ultimate mechanical strength of the healing tendons from 23.1 ± 8.5 MPa to 36.6 ± 9.0 MPa. Low-intensity pulsed ultrasound did not improve healing when it was given at later stages in D15-2W and D29-2W. When low-intensity pulsed ultrasound treatment was extended from 2 weeks (D1-2W) to 4 weeks (D1-4W) or 6 weeks (D1–6W), the beneficial effects on tendon healing became insignificant. Histological examination showed that low-intensity pulsed ultrasound sonication at late healing stages may disturb remodeling with a poor collagen fiber alignment.

Low-intensity pulsed ultrasound promoted restoration of mechanical strength and collagen alignment in healing tendons only when applied at early healing stages.

The present findings indicate that low-intensity pulsed ultrasound may be an effective treatment to reduce tendon donor site morbidity.

Osteochondral lesions of the talus are relatively uncommon but may be a cause of significant pain and disability in symptomatic patients.

Arthroscopic treatment of osteochondral lesions of the talus will result in good long-term clinical outcomes in the majority of patients.

Case series; Level of evidence, 4.

Fifty patients with chronic osteochondral lesions of the talus underwent arthroscopic treatment. Average age was 32 years (range, 12–72 years). Average follow-up was 71 months (range, 24–152 months). Treatment consisted of either drilling of the osteochondral lesions of the talus in situ (n = 4), excision of the osteochondral lesions of the talus and abrasion arthroplasty (n = 6), or excision of the osteochondral lesions of the talus and drilling (n = 40). Preoperative and intraoperative staging of the osteochondral lesions of the talus was performed. Follow-up evaluation included 3 clinical rating systems: Alexander, modified Weber, and American Orthopaedic Foot and Ankle Society Ankle/Hindfoot scores.

There were 72% excellent/good, 20% fair, and 8% poor results on the Alexander scale. According to the modified Weber scale, there were 64% excellent/good, 30% fair, and 6% poor results. The average American Orthopaedic Foot and Ankle Society Ankle/Hindfoot score was 84 (range, 34–100). We found no correlation between plain radiographs, computed tomography, or magnetic resonance imaging staging and clinical results. However, there was significant correlation between arthroscopic stage and clinical outcome. Seventeen patients had been seen 5 years previously and evaluated using the same criteria; 35% demonstrated a deterioration in their result over time.

Arthroscopic treatment of chronic symptomatic osteochondral lesions of the talus results in good clinical outcomes in the majority of patients. However, pain and functional limitation may persist in some patients, especially those noted to have unstable osteochondral defects at the time of arthroscopy.

Patients with a history of knee trauma or previous surgery may exhibit pain in the infrapatellar region that is refractory to conservative care. This may be due to subtle scarring of the anterior interval.

Arthroscopic release of a scarred anterior interval will lead to improvement in anterior knee pain.

Case series; Level of evidence, 4.

Twenty-five consecutive patients with isolated scarring of the anterior interval, confirmed with both magnetic resonance imaging (MRI) and arthroscopic examination, were included. All 25 patients had refractory anterior knee pain that was unimproved after a minimum of 6 months of physical therapy and nonsteroidal anti-inflammatory medications and pain during knee extension. All patients had a minimum of 2 previous surgical procedures, and 11 (44%) of the patients had a previous anterior cruciate ligament (ACL) reconstruction. All 25 (100%) patients had an apparent decrease in the cranial excursion of the patella and had a positive Hoffa test result. Fourteen (56%) patients had a preoperative flexion contracture of at least 5°. All patients underwent an isolated arthroscopic anterior interval release.

All patients were evaluated by physical examination and standardized scoring instruments with an average follow-up of 4.0 years (range, 2.0–7.2). Twenty-one patients had full range of motion of the patella in all directions and a negative Hoffa test finding at final follow-up. All 14 (100%) patients with preoperative flexion contractures (>5°) experienced a full return of extension. The average Lysholm score improved from 59 preoperatively to 81 postoperatively (P < .0001). The average International Knee Documentation Committee (IKDC) score improved from 49 to 70 (P < .001). There were no complications. Four patients (16%) had failed results and required a second surgical release. Patients with failures had significantly lower preoperative Lysholm scores (score = 40) than those who did not (score = 58) (P = .022). Three of the failures were workers' compensation cases.

Scarring of the anterior interval changes the mechanics of the anterior structures of the knee and may lead to refractory anterior knee pain. Arthroscopic anterior interval release successfully provides pain relief in this patient population.

Recognition of the symbiotic relationship between the meniscus and articular cartilage is critical to the success of meniscal allograft transplantation. Simultaneous combined meniscal allograft transplantation and cartilage restoration procedures have been proposed for patients with a symptomatic postmeniscectomy knee with a focal chondral defect that would have traditionally been considered a contraindication to meniscal allograft transplantation.

Combined meniscal allograft transplantation and cartilage restoration procedures can be used to neutralize traditional contraindications to meniscal allograft transplantation with results comparable to either procedure performed in isolation.

Case series; Level of evidence, 4.

Thirty patients underwent 31 combined meniscal allograft transplantation and cartilage restoration procedures between 1997 and 2004. These patients were prospectively studied, and completed standardized outcome surveys (including Lysholm, International Knee Documentation Committee, and Short Form-12 scales) preoperatively and annually thereafter for a minimum of 2-year follow-up. Patients were grouped according to concomitant procedure: 16 (52%) underwent meniscal allograft transplantation combined with autologous chondrocyte implantation; 15 (48%) had meniscal allograft transplantation combined with an osteochondral allograft. Two patients were lost to follow-up, leaving 29 procedures for review.

As a combined group, statistically significant improvements were observed in all standardized outcomes scores and satisfaction scales, except Short Form-12 mental, at a mean 3.1-year follow-up. Excluding the 2 lost to follow-up, 76% of all study participants (80% autologous chondrocyte implantation; 71 % osteochondral allograft) reported that they were completely (31 %) or mostly (45%) satisfied with their results. Overall, 48% of patients (60% autologous chondrocyte implantation; 36% osteochondral allograft) were classified as normal or nearly normal at their most recent follow-up using the International Knee Documentation Committee examination score. Ninety percent of patients would have the surgery again. Conclusion: Combined meniscal allograft transplantation and cartilage restoration offers a safe alternative for patients with persistent symptoms after meniscectomy and focal cartilage injury. Results of combined procedures were comparable to published reports of these procedures performed in isolation. Long-term follow-up is needed to define the survivorship of these procedures in a young patient population.

Ballet and modern dance are jump-intensive activities, but little is known about the incidence of anterior cruciate ligament (ACL) injuries among dancers.

Rigorous jump and balance training has been shown in some prospective studies to significantly reduce ACL injury rates among athletes. Dancers advance to the professional level only after having achieved virtuosic jump and balance technique. Therefore, dancers on the elite level may be at relatively low risk for ACL injury.

Descriptive epidemiology study.

Dance exposure, injuries, and injury conditions were systematically recorded at 4 dance organizations over 5 years. Select neuromuscular and psychometric variables were compared between and within ACL-injured and noninjured dancers.

Of 298 dancers, 12 experienced an ACL injury over the 5-year period. The incidence of ACL injury was 0.009 per 1000 exposures. Landing from a jump onto 1 leg was the mechanism of injury in 92% of cases. Incidence was not statistically different between gender or dance groups, although women modern dancers had a 3 to 5 times greater relative risk than women ballet dancers and men dancers. No difference between ACL-injured and noninjured dancers emerged with regard to race, oral contraceptive use, or select musculoskeletal measures.

Dancers suffer considerably fewer ACL injuries than athletes participating in team ball sports. The training dancers undertake to perfect lower extremity alignment, jump, and balance skills may serve to protect them against ACL injury. Anterior cruciate ligament injuries happened most often late in the day and season, suggesting an effect of fatigue.

Restoration of control of dynamic scapular motion by specific activation of the serratus anterior and lower trapezius muscles is an important part of functional rehabilitation. This study evaluated activation of those muscles in specific exercises.

Specific exercises will activate key scapular-stabilizing muscles in clinically significant amplitudes and patterns.

Controlled laboratory study.

Muscle activation amplitudes and patterns were evaluated in the serratus anterior, upper trapezius, lower trapezius, anterior deltoid, and posterior deltoid muscles with electromyography in symptomatic (n = 18) and asymptomatic (n = 21) subjects as they executed the low row, inferior glide, lawnmower, and robbery exercises.

There were no significant differences in muscle activation amplitude between groups. Muscle activation was moderate across all of the exercises and varied slightly with the specific exercise. The serratus anterior and lower trapezius were activated between 15% and 30% in all exercises. Upper trapezius activation was high (21%–36%) in the dynamic exercises (lawnmower and robbery). Serratus anterior was activated first in the low row and last in the lawnmower and robbery. The upper trapezius and lower trapezius were activated first in the lawnmower and robbery.

These specific exercises activate key scapular-stabilizing muscles at amplitudes that are known to increase muscle strength.

These exercises can be used as part of a comprehensive rehabilitation program for restoration of shoulder function. They activate the serratus anterior and lower trapezius—key muscles in dynamic shoulder control—while variably activating the upper trapezius. Activation patterns depended on scapular position resulting in variability of amplitude and activation sequencing between exercises. Inferior glide and low row can be performed early in rehabilitation because of their limited range of motion, while lawnmower and robbery, which require larger movements, can be instituted later in the sequence.

Hamstring strains can be of at least 2 types, 1 occurring during high-speed running and the other during motions in which the hamstring muscles reach extreme lengths, as documented for sprinters and dancers.

Hamstring strains in different sports, with similar injury situations to dancers, also show similarities in symptoms, injury location, and recovery time.

Case series (prognosis); Level of evidence, 4.

Thirty subjects from 21 different sports were prospectively included. All subjects were examined clinically and with magnetic resonance imaging (MRI). The follow-up period lasted until the subjects returned to or finished their sport activity.

All injuries occurred during movements reaching a position with combined extensive hip flexion and knee extension. They were located proximally in the posterior thigh, close to the ischial tuberosity. The injuries were often complex, but 83% involved the semimembranosus and its proximal free tendon. Fourteen subjects (47%) decided to end their sports activity. For the remaining 16 subjects, the median time for return to sport was 31 weeks (range, 9–104). There were no significant correlations between specific clinical or MRI parameters and time to return to sport.

In different sports, an injury situation in which the hamstring muscles reach extensive length causes a specific injury to the proximal posterior thigh, earlier described in dancers. Because of the prolonged recovery time associated with this type of injury, correct diagnosis, based on history and palpation, and adequate information to the subject are essential.

Bony defects of the humeral head and glenoid have been associated with high failure rates after arthroscopic stabilization for anterior instability. Biomechanical studies have indicated that such lesions reduce stability and may predispose to failure and motion loss after capsular repair.

The present investigation was designed to evaluate the effect of bony deficiency of the glenoid and/or humeral head on recurrence rates with a conventional open technique of anterior stabilization without a bone block.

Case series; Level of evidence, 4.

One hundred nineteen consecutive patients with recurrent anterior shoulder instability were treated by a single surgeon with an open anterior stabilization procedure. Patients were studied prospectively for recurrent instability after the presence and size of bony defects of the humeral head and/or glenoid were recorded during an arthroscopic examination before the open procedure. One hundred three patients (mean age, 20.7 years), including 98 men and 5 women, were available for 2-year minimum follow-up. Eighty-three of the patients participated in contact athletics.

Eighty-four percent of the patients had demonstrable Hill-Sachs lesions at the time of arthroscopy (27% “engaging” and 57% “nonengaging”). Fourteen percent had deficiency of the anterior glenoid, 9% had large (Rowe classification) defects of the humeral head, and 4% had severe (>20%) defects of the glenoid. The overall recurrence rate was 2%. Both recurrences were noted in patients with Hill-Sachs lesions, but the recurrence rate in patients with Hill-Sachs lesions was not significantly higher (P = .71). There was 1 recurrence among the 9 patients with large defects of the humeral head (P = .17). Patients with engaging Hill-Sachs lesions did not have a statistically significant increase in recurrence (4%) (P = .47). There were no recurrences in patients with glenoid deficiency. Patients with large defects of the glenoid lost a mean of 7° of external rotation (P = .001) when compared with the remaining population (12° vs 5°). Patients with large defects of the humeral head lost a mean of 4° more external rotation (P = .003) when compared with the remaining population (9° vs 5°). Two patients in the series lost >20° of external rotation. When contact athletes were isolated as a population, there were no statistically significant increases in recurrence due to the presence of bony lesions of the glenoid or humeral head.

Bony defects of the humeral head or glenoid did not appear to result in a statistically significant increase in the risk of recurrence with conventional open techniques of stabilization. Large defects on either side of the joint were uncommon in the study population. Bone-block or grafting procedures do not appear to be necessary to restore stability in the majority of patients with bone loss. Although the loss of external rotation in patients with large defects is a relative cause for concern, the author recommends open capsular repair as the primary method of treatment given the high complication rate historically associated with bone-block techniques.

Recent studies have revealed structural changes with neovessels in patients with jumper's knee and Achilles tendinopathy, and treatment with sclerosing injections has shown promising clinical results.

To study the prevalence of neovascularization and structural tendon changes on color Doppler ultrasound examination in elite athletes with clinical symptoms of jumper's knee and to examine the ultrasound characteristics of the tendon after sclerosing injection treatment with polidocanol.

Cohort study; Level of evidence, 3.

The authors recruited patients among elite athletes with a clinical diagnosis of jumper's knee who participated in a previous randomized clinical trial. The patients recorded knee function using the Victorian Institute of Sport Assessment score. Patients were examined by color Doppler ultrasound at baseline and, for patients with structural changes and neovascularization who received sclerosing treatment, after treatment.

Sixty-three patients (11 women and 52 men) with 79 symptomatic tendons were studied. The ultrasound examination revealed that neovascularization was present in 48 of the 79 tendons (60%). Of 33 patients (43 tendons) who received sclerosing injections, 29 patients (37 tendons, 86%) were examined 37 (19 to 53) weeks after their final sclerosing injections. Of these, 7 tendons (18.9%) had no change in neovascularization after treatment, 21 tendons (56.8%) had less neovascularization, and 9 tendons (24.3%) had more visible neovascularization. There were no significant differences in the change in Victorian Institute of Sport Assessment score between patients who had less, more, or unchanged neovascularization after treatment (analysis of variance, P = .9).

About two thirds of patients with jumper's knee can be expected to have structural tendon changes with neovascularization. There was no relationship between changes in ultrasound characteristic and knee function after sclerosing treatment.

Controversy remains regarding the results of all arthroscopic rotator cuff repairs compared with the mini-open approach. The purpose of this study was to perform a comprehensive literature search and meta-analysis of clinical trials comparing the results of arthroscopic rotator cuff repairs and mini-open rotator cuff repairs.

There is no difference between the clinical results obtained from all arthroscopic rotator cuff repairs compared with mini-open repairs.

Meta-analysis.

A computerized search of articles published between 1966 and July 2006 was performed using MEDLINE and PubMed. Additionally, a search of abstracts from 4 major annual meetings each held between 2000 and 2005 was performed to identify Level I to III studies comparing the results of arthroscopic rotator cuff repair and mini-open repair. Studies that included follow-up of an average of over 2 years and a minimum of 1 year and included the use of 1 of 4 validated functional outcome scores used to study shoulder injuries were included in the present meta-analysis. All outcome scores were converted to a 100-point scale to allow for outcome comparison.

Five studies that met the inclusion criteria were identified. There was no difference in functional outcome scores or complications between the arthroscopic and mini-open repair groups.

Based on current literature, there was no difference in outcomes between the arthroscopic and mini-open rotator cuff repair techniques.