[Does reduction mammoplasty improve neck pain and quality of life?] / Verbessern brustverkleinernde Operationen Nackenschmerzen und die Lebensqualität?

INTRODUCTION AND OBJECTIVE: Macromastia often leads to physical complaints involving pain in the shoulder/neck area. In Germany, there are virtually no reliable data on the effects of breast reduction surgery with regard to neck and spine complaints. Therefore, the authors carried out a retrospective study to investigate the effect of breast-reducing surgery on neck pain and quality of life. METHODS: Between January 1, 2014 and December 31, 2019, 107 breast reductions were performed for macromastia. Medical records and OP reports were evaluated, and the indication for breast reduction documented. Pain was recorded preoperatively on a visual analog scale (VAS). Pretreatments and perioperative complications were also documented and evaluated. All patients were sent a questionnaire, which determined whether the objective of the operation had been achieved, how satisfied the patients were with the result of the operation, and how severe the current pain (VAS) was. The EQ-5D 3L health questionnaire was used to assess quality of life, and the Neck-Disability Index was used to assess neck complaints. Statistical analysis was carried out using the Wilcoxon test. RESULTS: After an average of 56.5 months (min: 18, max: 90), 76/107 (71%) patients could be re-examined. There were 15 complications. Pain improved from an average of 7.2 preoperatively (min: 0, max: 10) to an average of 1.6 postoperatively (min: 0, max: 4; p < 0.001). The Neck-Disability Index improved from an average of 43.8% (Min: 0, Max: 82) to an average of 10.8% (Min: 0, Max: 52) postoperatively (p < 0.001). In all, 71/76 (93%) of the examined patients were very satisfied or satisfied with the result of the operation. DISCUSSION AND CONCLUSION: With this study, the authors were able to show that there are often several reasons why breast reduction surgery is performed in patients with macromastia. A high patient satisfaction rate can be achieved and orthopedic clinical complaints associated with macromastia can be treated with a very high success rate.

Return to sports and short-term follow-up of 101 cases of medial patellofemoral ligament reconstruction using gracilis tendon autograft in children and adolescents.

INTRODUCTION: An acute patellofemoral dislocation is the most common acute knee injury in children. Recent studies suggest up to 40% of immature patients may develop recurrent instability. MPFL reconstruction has become a mainstay for the treatment of patellofemoral instability. Aim of the recent study is to show our experiences of MPFL reconstruction in patellar instability in immature patients using a gracilis autograft in respect to return to sport, growth plate disorders and short-term results. MATERIALS AND METHODS: A total of 101 patients (50 females, 51 males) were included in this retrospective study. Mean age at time of operation was 14.8 ± 1.6 years. Primary outcome measures included patient satisfaction, Kujala score, recurrent instability, return to normal activity, return to sports, clinical leg axis and complications. Mann-Whitney U test was used for statistical analysis and alpha was set at p < 0.05 to declare significance. RESULTS: At a mean follow-up of 32.0 ± 12.1 months 90/101 patients could be followed-up. 84% of all patients were satisfied or very satisfied with the result at latest follow-up. 86.6% of all patients were able to return to sports, 2.3% had a relevant deviation of the clinical leg axis, but symmetrical. In sum complication rate was 2.9%. Redislocation rate was 0.9% (1/101). Kujala Score improved significantly from 47.1 preoperatively to 85.3 postoperatively (p < 0.01). CONCLUSION: Anatomic MPFL reconstruction using gracilis tendon allograft tissue is a safe procedure in children and adolescents with low risk of recurrent instability.

Polyethylene liner dissociation in cementless total hip arthroplasty: Ensuring accurate diagnosis.

BACKGROUND: Uncemented acetabular components are widely used in modern total hip arthroplasty (THA). Modularity has numerous advantages including the ability to use supplementary screw fixation for the shell, and allow to switch from ceramic to polyethylene (PE) bearings and vice versa, and the use of lipped and face-changing liners. OBJECTIVE: Despite these advantages, a problem with modular PE liners is dissociation. This is a rare complication in modern implants. The rate of liner dissociation is reported to be very low between 0.17% and 0.8%. Typical symptoms are sudden onset of groin pain in a previously well-functioning hip joint, followed by grinding or clicking sensations during hip joint motions indicating, that the femoral head is articulating with the metal acetabular shell rather than with the PE liner. Any newly observed noise or squeaking from a THA should undergo radiographic investigation to exclude liner dissociation. CASE PRESENTATION: We present the case of an 88-yearold male patient who developed PE liner dissociation in a cementless THA with a Pinnacle acetabular component six years after the index operation. We recommended revision of the left hip, which was performed two days later. In the interim, the patient was advised to use a pair of crutches. During revision surgery, it was observed that the metal head made contact with the cementless cup shell without damaging it from a macroscopic standpoint. Consequently, a simple exchange of the PE liner was conducted, and a 36 mm metal head was implanted due to scratches on the original head. CONCLUSION: Early diagnosis facilitates a straightforward exchange of the liner along with the head, potentially preserving the osseous integrated cup shell and stem integrity. Routine radiologic follow-up allows to distinguish between PE liner dissociation and severe PE wear.