JUNE 2010 VOLUME XXXIX NUMBER 6 pISSN:1078-4519 eISSN:1934-3418

E-PUBLISHING

50	Exostosis-Like Intra-articular Periosteal Osteoblastoma: A Rare Case Mansour Abolghasemian, MD, Mitra Rezaie, MD, Abas Behgoo, MD, Tina Shoushtarizadeh, MD, and Mohammad Taghi Ghazavi, MD, FRCSC Dr. Abolghasemian is Orthopaedic Surgeon, Division of Hip Surgery, Shafa Rehabilitation Hospital, Iran University of Medical Sciences, Tehran, Iran. Osteoblastoma is a relatively rare benign bone tumor, most often located in the vertebral column or metaphysis of the long bones, particularly the femur and the tibia. Periosteal osteoblastoma is the least common type. Exostosis-like appearance is not common even in periosteal osteoblastoma, a very rare type of this tumor. In addition, an intra-articular location is uncommon for osteoblastomas. Here we report the case of a 25-year-old man with intra-articular exostosis-like periosteal osteoblastoma of the hip that resulted in impingement and osteoarthritis. Am J Orthop. 2010;39(6):E50-E53.
54	Giant Cell Tumor at Tibial Screw Site After Anterior Cruciate Ligament Reconstruction Sean E. Fitzsimmons, MD, Noah Chinitz, MD, and Jonathan Glashow, MD Dr. Fitzsimmons is a Sports Medicine Fellow, Department of Orthopaedics, Lenox Hill Hospital, New York, New York. We report a case of giant cell tumor that occurred in the proximal tibia of a 52- year-old man 13 years after bone–patella–bone anterior cruciate ligament reconstruction. The tumor was at the site of the metal interference screw. We discuss the differential diagnosis of proximal tibia lesions that occur after anterior cruciate ligament reconstruction and the importance of recognizing potentially life-threatening sports tumors. Am J Orthop. 2010;39(6):E54-E56.
57	Recurrent Lipoma-Like Hibernoma Vincent M. Moretti, MD, Michael de la Cruz, MD, and Richard D. Lackman, MD Dr. Moretti is Clinical Research Fellow, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. This is the fifth report of the rare lipoma-like variant of hibernoma, the 19th case reported, and the first documented as recurring after excision. Our patient was a 56-year-old man whose painful lipoma-like hibernoma (LLH) in the pelvis/buttock was initially treated with marginal excision 15 years earlier. Nine years after treatment, the LLH recurred locally. The recurrence was treated with partial excision and embolization, which alleviated symptoms. The disease was stable 26 months after repeat excision and 202 months after initial treatment. LLH is 1 of the 4 histologic variants of hibernomas, which are rare benign lipomatous tumors distinguished from other lipomas by their brown-fat component. Only minimal information is available regarding the clinicopathologic characteristics of the individual variants. Reviewing the literature, we found that LLH predominantly develops in the fifth and sixth decades, and mean age at diagnosis is 41 years (age range, 2-66 years). LLH has a slight male predilection of 10:9. It most commonly develops in the thigh, with other occurrences reported in the hip, trunk, knee, and calf. The magnetic resonance imaging signal of LLH mirrors fat in all sequences. Presence of internal septations and enhancement with contrast are variable. Histologically, LLH is defined as a hibernoma composed predominantly of univacuolated white-fat cells and only scattered granular or pale hibernoma cells. The literature provides only a few treatment details regarding this variant. Am J Orthop. 2010;39(6):E57-E60.

272	Guest Editorial—Let the User Beware William A. Grana, MD, MPH Dr. Grana, this journal’s Associate Editor for Sports Medicine, is Professor, Department of Orthopaedic Surgery, University of Arizona Health Sciences Center, Tucson, Arizona. He was President, American Orthopaedic Society for Sports Medicine, 2005–2006, and is Editor-in-Chief, Orthopaedic Knowledge Online (http://www.aaos.org/oko). Abstract not available. Am J Orthop. 2010;39(6):272.
274	Mentorship and the Inquiring Mind Melvin P. Rosenwasser, MD Dr. Rosenwasser, this journal’s Associate Editor for Hand and Wrist, is Robert E. Carroll Professor of Orthopedic Surgery, Columbia University College of Physicians and Surgeons, and Chief of Hand and Microvascular Surgery, and Chief of Orthopedic Trauma Surgery, Columbia University Medical Center/New York Presbyterian Hospital, New York, New York. Abstract not available. Am J Orthop. 2010;39(6):274.
277	Two-Layer Repair of a Chronic Patellar Tendon Rupture: A Novel Technique and Literature Review Sameh A. Labib, MD, FRCSC, Mark C. Wilczynski, MD, and Brett A. Sweitzer, MD Dr. Labib is Assistant Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia. Neglected rupture of the patellar tendon can be a debilitating problem. Various techniques have been described to reconstruct chronic tears. This article presents a simple technique for 2-layer repair of chronic patellar tendon ruptures using Achilles allograft augmentation. A manual laborer presented to the orthopedic clinic 5 years after sustaining an unrecognized patellar tendon rupture. Despite this significant delay between injury and reconstruction, our patient enjoyed excellent range of motion and full quadriceps strength 19 months after reconstruction. We believe our technique provides several advantages. By design, the tibial trough was shallower than the depth of the bone block, thus minimizing patellofemoral contact pressure. Transpatellar drilling with the use of a Beath pin makes suture passage easier and provides strong repair permitting early mobilization. Furthermore, our technique spares the remaining native patellar tendon tissue, preserves its insertions, and does not require the use of a tension cerclage wire. Am J Orthop. 2010;39(6):277-282.
283	Metastatic Esophageal Adenocarcinoma of the Carpus Raymond K. Wurapa, MD, Brent A. Bickel, MD, Joel Mayerson, MD, and John G. Mowbray, MD Dr. Wurapa is Attending Physician, The Cardinal Orthopaedic Institute, Mount Carmel Medical Center, Columbus, Ohio. We report on a rare case of metastatic esophageal adenocarcinoma to the wrist developing years after diagnosis and treatment of the primary lesion. Awareness of the potential for developing these lesions should be raised, particularly in the absence of systemic symptoms. Am J Orthop. 2010;39(6):283-285.
288	Treatment of Distal Biceps Tendon Ruptures Benjamin J. Widmer, MD, and Robert Z. Tashjian, MD Dr. Widmer is Resident, Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah. Distal biceps tendon rupture is an injury typically reported in the dominant extremity of middle-aged men. Clinical findings are the mainstay of diagnosis, but magnetic resonance imaging or ultrasound imaging can provide additional diagnostic information. Anterior 1- or 2-incision repairs are commonly used. Various fixation techniques have been reported, all with comparable biomechanical results and clinical outcomes. Complication rates are lower in patients treated closer to time of injury. Tendon retraction associated with chronic ruptures can present a difficult surgical problem. Advanced soft-tissue imaging adds helpful information about the level of biceps tendon retraction and possible reparability. When the tendon can be reapproximated safely at less than 45° to 90° of elbow flexion, then primary repair may be performed. When reapproximation is not possible, options are reconstruction and tenodesis. Reconstruction performed through 1 or 2 incisions with either allograft or autograft has successfully restored both motion and power. Am J Orthop. 2010;39(6):288-296.
299	From Entrepreneur to Employee: Part 1. Ambiguity in Attitudes About Hospital Employment Karen A. Zupko, BSJ, and Cheryl L. Toth, MBA Ms. Zupko is President, KarenZupko & Associates, Inc., Chicago, Illinois. Abstract not available. Am J Orthop. 2010;39(6):299-301.
302	Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction With a Transtibial Technique Dana P. Piasecki, MD, and Bernard R. Bach, Jr., MD Dr. Piasecki is Attending Physician, Orthocarolina Sports and Complex Knee Center, Charlotte, North Carolina. To position a single-bundle anterior cruciate ligament reconstruction anatomically on the femoral side while still using a transtibial technique, we recommend performing a posterolateral notchplasty, inserting the tibial aimer through an accessory inferomedial portal, using a more proximal tibial starting point, removing bone from the posterolateral corner of the tibial tunnel, and externally rotating the over-the-top guide. Am J Orthop. 2010;39(6):302-304.

2	The Design Principles of the Natural-Knee System Aaron A. Hofmann, MD Dr. Hofmann is Professor, University of Utah Orthopaedic Center, Salt Lake City, Utah. The clinically successful Natural-Knee system was introduced 25 years ago. More than 1 million patients have been treated with this design since the first implantation in October 1985. This article reviews the design principles and evolution, over 25 years of clinical performance, of this cementless and cemented system, in which measured resection techniques are used to anatomically resurface the knee joint. Am J Orthop. 2010;39(6 suppl):2-4.
5	The Natural-Knee System: 25 Years of Successful Results Kenneth A. Gustke, MD Dr. Gustke is with the Florida Orthopaedic Institute, Temple Terrace, Florida. The Natural-Knee (NK) total knee arthroplasty (TKA) system has been in use for 25 years. The unique features of this system include a deep trochlear groove, an asymmetrical tibial baseplate, use of Cancellous-Structured Titanium coating for preferred bone ingrowth, and a bimetal cementless femoral component. So far, 3135 NK total knee replacements have been reviewed. Cementless femoral and tibial components were used in 22% of these cases, cementless femoral and cemented tibial components in 3%, and cemented femoral and tibial components in 75%. The revision rate was 1.6%. Only one revision was to correct uncomplicated aseptic loosening. Am J Orthop. 2010;39(6 suppl):5-8.
9	The Gender Solutions Natural-Knee Flex System and Future Directions Rodney L. Plaster, MD, Kara B. Starkman, PA-C, and Julie McGee, BA Dr. Plaster is in Private Practice at Eastern Oklahoma Orthopedic Center, Tulsa, Oklahoma, and is Adjunct Assistant Professor, University of Utah, Salt Lake City, Utah, and Assistant Clinical Instructor, University of Oklahoma College of Medicine, Tulsa, Oklahoma. The morphology of the distal femur varies. Whether or not the variability falls strictly along gender lines, a better fit to the distal femur can be obtained without intraoperative compromises by making available both a narrow and a wider medial-lateral/anterior-posterior aspect ratio. In our 1-year outcomes of the first 360 patients who received the Zimmer Gender Solutions Natural-Knee Flex System, mean flexion was 131° (10° better than mean flexion with the earlier Natural-Knee I and II systems), and the lateral release rate decreased to 2%. We no longer need to downsize during surgery to achieve good fit in femurs—in female patients typically—with narrower medial-lateral/anterior-posterior aspect ratios. Am J Orthop. 2010;39(6 suppl):9-12.

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