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Case: A 74-year-old female developed left shoulder pain after receiving an influenza vaccine. Her initial physical exam was suggestive of subacromial bursitis, and a corticosteroid injection into the subacromial space resulted in a 50% improvement in her pain. Subsequent MRI demonstrated myositis isolated to the infraspinatus muscle. She was successfully treated with anti-inflammatory medication and physical therapy. Conclusion: Shoulder injury related to vaccine administration (SIRVA) is a rare clinical complication, and myositis in the rotator cuff musculature has not been previously reported. Proper administration of intramuscular vaccinations should be emphasized to prevent injury to structures surrounding the shoulder joint.

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BACKGROUND: When performing a medial patellofemoral ligament (MPFL) reconstruction, surgeons may place the MPFL graft under higher than anatomic tension to minimize the chance of recurrent instability. PURPOSE: To investigate whether a lateral retinacular release (LRR) significantly decreases patellofemoral contact pressures after an overtensioned (OT) MPFL reconstruction. STUDY DESIGN: Controlled laboratory study. METHODS: Mean and peak pressure across the patellofemoral joint at 30°, 45°, and 60° of flexion was assessed in 14 cadaveric knee specimens with intact MPFL, transected MPFL, reconstructed MPFL with graft OT, and OT MPFL with LRR. The Wilcoxon signed rank test was used to determine differences across states, with W and C values calculated when possible. RESULTS: Mean pressure decreased significantly after MPFL transection compared with intact at 30° (456.9 ± 116.8 vs 410.9 ± 109.4 N, P = .006, W < 7) and 45° (404.9 ± 91.7 vs 369.4 ± 85.3 N, P = .005, W < 5) and increased significantly from intact to OT graft at 30° (456.9 ± 116.8 vs 563.0 ± 11.2 N, P = .003, W < 7), 45° (404.9 ± 91.7 vs 481.4 ± 14.8 N, P = .005, W < 5), and 60° (272.9 ± 139.0 vs 367.0 ± 53.7 N, P = .007, W < 3). Peak pressure increased significantly between intact and OT graft at 30° (1364.0 ± 478.2 vs 2094.4 ± 619.8 N, P = .002, W < 9), 45° (1224.7 ± 491.5 vs 1676.7 ± 779.1 N, P = .005, W < 5), and 60° (1117.7 ± 566.8 vs 1604.2 ± 772.9 N, W < 3). In knees with significantly increased mean pressure after overtensioning, mean pressure increased by 23.3% (11/14 knees) at 30°, 18.3% (10/14 knees) at 45°, and 35.0% (10/14 knees) at 60°. Peak pressure increased significantly by 35.3% (30°), 25.2% (45°), and 29.3% (60°). A significant decrease in mean pressure, toward but not to baseline, was observed between the OT and LRR states at 30° (563.0 ± 11.2 vs 501.5 ± 9.3 N, W < 7) and 60° (367.0 ± 53.7 vs 302.0 ± 13.8 N, W < 5) and a decrease in peak pressure at 30° (2094.4 ± 619.8 vs 1886.5 ± 655.3 N; W < 9). CONCLUSION: LRR led to a statistically significant decrease in pressure across the patellofemoral joint in knees that demonstrated increased contact pressures after an OT MPFL graft. CLINICAL RELEVANCE: LRR after an MPFL reconstruction in which the MPFL graft has been OT may help reduce patellofemoral contact pressures at the time of surgery.

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This biomechanical study compared suture anchors versus transosseous sutures for repair of quadriceps tendon ruptures using a force of 150 N at a frequency of 0.5 Hz. No significant difference in displacement was found between the 2 techniques with initial loading or with load or no load after 1000 cycles. Displacement after 1000 cycles for suture anchors and bone tunnels was 4.65 and 4.50 mm, respectively. These findings suggest a possible role for suture anchors in repairing quadriceps tendon ruptures. Suture anchors are relatively expensive but require less dissection over the patella and do not involve suture placement about the patella tendon.

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OBJECTIVES: To create a both-column acetabular fracture model with secondary congruence and to determine the intraarticular loading characteristics present in simulated single-leg stance. HYPOTHESIS: The normal contact pressures on the weight-bearing portion of the acetabulum in simulated single-leg stance are different from those present in a both-column fracture model exhibiting secondary congruence. DESIGN: Cadaveric Biomechanical model. SETTING: Biomechanical testing laboratory. SPECIMENS: Nine fresh frozen cadaveric hemipelves. INTERVENTION: Both-column fracture model with secondary congruence of the acetabular articular surface with respect to the femoral head was created and tested using Materials Testing Machine (MTS Systems Corp., Minneapolis, MN) and Fuji pressure-sensitive film (Sensor Products, Inc., East Hanover, NJ). OUTCOME MEASUREMENTS: Testing data recorded and analyzed comparing the fractured and unfractured states. RESULTS: With respect to the intact specimen, the contact area, mean pressure, and peak pressure in the dome region all increased (p < 0.003) in the both-column model. The contact area in the anterior articular region decreased (p < 0.02) as did the mean pressure (p < 0.032). The posterior articular region demonstrated a trend toward decreased contact area and increased mean and peak pressures. Descriptively, the stress concentration shifted toward the fracture in all cases with the most anterior and most posterior articular regions having little contact in the fracture model. CONCLUSIONS: In the authors' both-column model of secondary congruence, the stress concentration during simulated single-leg stance was increased significantly in the dome of the acetabulum adjacent to the fracture line.

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