Proximal Biceps Tenodesis Incorporated into Supraspinatus Repair: A Case Series and Technical Description.

BACKGROUND: Biceps tendon pathology is commonly associated with rotator cuff tears. A multitude of different biceps tenodesis techniques have been studied, with limited clinical data on arthroscopic biceps tenodesis techniques incorporated into rotator cuff repairs. PURPOSE: To evaluate the outcomes of an arthroscopic biceps tenodesis incorporated into a supraspinatus tendon repair. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patients undergoing surgical treatment of supraspinatus tendon tears with concomitant biceps tendon pathology were prospectively enrolled from 2014 to 2015. A total of 32 patients underwent combined biceps tenodesis and rotator cuff repair; of these, 19 patients were evaluated for a mean of 2.0 years. The primary outcome measures were the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES; patient self-report and physician assessment sections), visual analog scale (VAS) pain score, responses to specific biceps-related assessments, and biceps specific physical exam findings. RESULTS: Patient-reported ASES scores improved from 45.9 preoperatively to 91.6 at the 2-year follow-up (P < .001). Pain VAS scores improved from 5.2 preoperatively to 0.7 at the 2-year follow-up (P < .001). Preoperatively, 18 patients had a positive Speed test; all were negative at 5 months postoperatively, and 21 patients had bicipital groove tenderness preoperatively, which resolved in all 21 patients at 5 months postoperatively. At the 2-year follow-up, 2 patients had cramping arm pain and 4 patients noticed a change in arm contour. There were no reoperations. No complications occurred in the study group. CONCLUSION: Arthroscopic biceps tenodesis incorporated into a supraspinatus tendon repair was a safe and reliable option for biceps pathology with a concomitant rotator cuff tear.

Lower Extremity Surgical Treatment to Improve Function in a Patient with Gollop-Wolfgang Complex: A Case Report.

CASE: Gollop-Wolfgang Complex (GWC) includes congenital absence of the tibia with ipsilateral distal femur bifurcation associated with hand/foot ectrodactyly. A 20-month-old male presented with GWC, including left bifid distal femur with ipsilateral tibial hemimelia and absent extensor mechanism, hypoplastic bilateral thumbs, and right foot tarsal-type preaxial polydactyly. Left through-knee amputation preserving growth and contralateral polydactyly reconstruction were performed. Complications of wound infection and dehiscence were successfully treated. Patient is 44 months old and ambulating with left knee disarticulation prosthesis and right supramalleolar orthosis. CONCLUSIONS: Through-knee amputation and prosthetic fitting provides limb function for GWC patients with tibial hemimelia lacking an extensor mechanism.

Risk Factors for Prolonged Symptoms of Mild Traumatic Brain Injury: A Pediatric Sports Concussion Clinic Cohort.

OBJECTIVE: To examine predictors of prolonged symptom duration from mild traumatic brain injury (mTBI) in a pediatric sports medicine specialty clinic cohort as these predictors may be distinct in this population. DESIGN: Retrospective chart review. SETTING: Outpatient specialty clinic. PATIENTS: Charts of 549 patients (age range: 10-18 years) with concussions were reviewed in an outpatient clinic that predominantly managed sports-related injuries (77.3%). Patients (n = 431) included in the final analysis met the criteria for mTBI and were symptomatic at their first visit. ASSESSMENT OF RISK FACTORS: Patient history, injury, and recovery variables were evaluated. MAIN OUTCOME MEASURES: Predictors of prolonged time to reach self-reported symptom recovery were evaluated using Cox proportional hazards. RESULTS: Median time to symptom recovery of the 431 patients who presented to clinic with symptoms was 40 days (full clinic sample median = 34 days). Analyses identified 3 unique predictors of symptom recovery: loss of consciousness (LOC) [hazard ratio (HR) = 0.56, P < 0.0001], female sex (HR = 0.57, P < 0.0001), and concussion symptom score at first clinic visit (HR = 0.76, P < 0.0001). CONCLUSIONS: Prolonged duration of mTBI symptoms in patients who present to a pediatric sports-based concussion clinic is related to initial symptom severity, female sex, and LOC.

The Effect of Pitch Variation and Diameter Variation on Screw Pullout.

Introduction: There are many screw and thread designs commercially available to surgeons for bone fixation. There is a paucity of literature on comparative mechanical properties of various screw and thread designs including variable pitch screws, and tapered screws. This purpose of this study was to test whether varying a screws thread pitch and/or tapering a screws core diameter alters the mechanical performance of screws. Methods: A mechanical pullout test was performed on 4 different screw designs, including a variable pitch screw, a constant pitch screw, and variations of these in a straight and tapered screw design. Three-dimensional printing technology was used to manufacture the metal screws in order to control for as many variables as possible. Results: The pullout strength of the constant pitch screws (304.9 ± 25.3 N, P < .001) was significantly greater than the variable pitch screws (259.7 ± 23.4 N). The pullout strength was also significantly greater for screws with a tapered diameter (305.4 ± 24.1 N) than a constant diameter (259.1 ± 23.5N, P < .001). Tapered diameter variable pitch screws had the largest stiffness overall, which was statistically significant against all other groups (P ⩽ .001). Conclusion: The pullout strength is significantly greater for screws with a tapered diameter than a constant diameter and greater for screws with a constant pitch than for a variable pitch. Results of stiffness testing is mixed depending on the screw taper. The clinical significance of this study is that it provides data on the effects that thread design and tapering have on the pullout strength of screws. Levels of Evidence: Level V: Mechanical study.