Ultrasound-guided percutaneous opening of the A1 pulley with surgical knife on anterograde versus retrograde approach: A comparative cadaver study (40 fingers).

OBJECTIVE: Trigger finger is one of the most common pathologies of the finger flexor mechanism. Previous studies have shown the value of ultrasound-guided percutaneous tenolysis. The aim of this study was to compare the efficacy and safety of anterograde versus retrograde percutaneous ultrasound-guided tenolysis. MATERIALS AND METHODS: This was a comparative cadaver study performed between December 2021 and April 2022 in France, with 40 fresh cadaver fingers. Thumbs were excluded. A single surgeon performed 20 ultrasound-guided anterograde releases and 20 ultrasound-guided retrograde releases, using a second-generation minimally invasive surgical knife, and a multipurpose linear ultrasound transducer. The primary endpoint was the success of ultrasound-guided release, defined as complete opening of the A1 pulley along its entire length. RESULTS: The success rate was 90% in the retrograde group and 95% in the anterograde group (non-significant difference: p = 0.56). There was no significant difference in superficial flexor tendon slip injuries or partial A2 pulley injuries. There were no neurovascular pedicle lesions. CONCLUSION: The choice of anterograde or retrograde ultrasound-guided tenolysis should be left to the surgeon's discretion.

Arthroscopic knotless repair: an effective technique for small-sized supraspinatus tendon tears.

PURPOSE: The purpose was to evaluate the clinical and radiological results of knotless repair with flat-braided suture in full small-sized supraspinatus tendon tears (< 1 cm). METHODS: A consecutive series of 54 patients with isolated small supraspinatus tendon tear (< 1 cm and Goutallier index < 2) was evaluated in the study. Patients underwent a knotless arthroscopic repair using flat-braided suture (2 mm wide). Minimal follow-up required was 5 years. Changes in Murley-Constant score, ASES score, strength, and pain relief were assessed. The Sugaya score was used to confirm the tendon repair on MRI. Data were analyzed in two subgroups: technique with additional U point for dog ear deformity (group 1) and technique without additional U point (group 2). The immobilization period was 3 weeks long. Passive mobilization was immediate. RESULTS: Fifty-four patients were included. Mean age was 57 ± 4 years. The average follow-up was 68 ± 10 months. Average preoperative score of Constant was 51.2 ± 8.5 and 83.1 ± 14.6 at the end of the follow-up (p < 0.001). Mean VAS went from 5.8 ± 1.8 to 1.9 ± 2.1 (p < 0.001). Average forward elevation of the shoulder went from 86.3° ± 9 preoperatively to 169.6° ± 15.9 at the end of the follow-up (p < 0.001). The strength score was significantly higher post-operatively (18.4 vs. 8.3, p < 0.001.). The ASES score was significantly improved 49.1 ± 13.1 vs. 88.6 ± 15.8, p < 0.001). The MRI assessment revealed 94% of Sugaya 1-2. No significant difference was observed between group 1 and 2 regarding all clinical outcomes. Two complex regional pain syndromes were described with a favorable evolution. Three patients presented a retear requiring an iterative arthroscopic repair. CONCLUSION: The use of a knotless arthroscopic construct with flat-braided suture for small supraspinatus repair achieved excellent structural and clinical results. This technique is fully adequate for the arthroscopic treatment of such tears, enabling early mobilization. LEVEL OF EVIDENCE: Level III.

C5/C6 brachial plexus palsy reconstruction using nerve surgery: long-term functional outcomes.

INTRODUCTION: In traumatic proximal brachial plexus lesions (i.e., C5/C6), reconstruction of the musculocutaneous, axillary and suprascapular nerves yields satisfactory short- and medium-term functional outcomes. HYPOTHESIS: Early functional outcomes after nerve surgery will be maintained in the long-term. METHODS: A retrospective analysis was done using the medical records of 29 patients with C5/C6 palsy treated by nerve surgery. Active range of motion and strength at the elbow (i.e., flexion) and shoulder (i.e., flexion, abduction, external rotation with the elbow at the side of the body and with the arm 90° abducted ) were evaluated clinically using a goniometre and the British Medical Research Council grading scale, respectively. RESULTS: At a mean follow-up of 46±15 months (25;76), the mean active elbow flexion was 126°±18° (90;150) and the mean strength was 3.8±0.5 (2;4). At the shoulder, mean active flexion, abduction, external rotation with the elbow at the side of the body and with the arm 90° abducted were 109°±39° (0;180), 99°±38° (0;180°), 12°±34° (-80;70) and 3°±21° (-40;50), while mean strength was 3.6±0.8 (0;4), 3.6±0.8 (0;4), 3.4±0.9 (0;4) and 2.5±1.2 (0;4), respectively. DISCUSSION: In cases of C5/C6 palsy, early nerve surgery yields satisfactory functional outcomes that are maintained over time for elbow flexion and shoulder elevation. However, when the teres minor is not reinnervated, it is difficult to restore satisfactory shoulder external rotation. LEVEL OF EVIDENCE: IV, Retrospective case study.