Recognizing Skeletal Presentations of Rotator Cuff and Cruciate Ligament Surgical Interventions

Forensic anthropologists are commonly tasked with assisting investigators in identifying a decedent from an unknown set of human skeletal remains. When traditional methods are not applicable, medically implanted orthopaedic devices have been shown to aid in positive identification. However, not all orthopaedic surgeries result in surgical hardware that can be traced to a manufacturer or individual. This article presents skeletal case examples of two different rotator cuff repairs and an anterior cruciate ligament reconstruction, both of which are common orthopaedic surgeries that do not typically result in traceable hardware. In each case, the repairs were performed 10 years prior, yet the surgical intervention remained identifiable from the bony modifications and suture and screw placements, thereby corroborating decedent identifications. In two of the cases, the remains were burned, and DNA analyses were not possible. In addition to the skeletal presentation of these repairs, anatomical descriptions of the injuries and clinical approaches are provided. The case examples may help forensic anthropologists recognize and interpret similar skeletal modifications in their casework, contributing to identification efforts. Furthermore, these cases highlight the importance of broad anatomical knowledge and exposure to clinical medicine in medicolegal practices.