Decompression and collagen wrapping of a fibrolipomatous hamartoma of the median nerve: a new approach for a rare and difficult problem.

Fibrolipomatous hamartoma is a rare benign slow growing fibrofatty tumor of peripheral nerves of unknown etiology. Clinical presentation may mimic carpal tunnel syndrome when involving the median nerve. We present a case of FLH of the median nerve in a 59-year-old female treated with decompression and collagen nerve wrapping.

Teres Major and Latissimus Dorsi Repair With Biceps Tenodesis Utilizing Cortical Suspensory Fixation Buttons.

Teres major (TM) and latissimus dorsi (LD) ruptures are relatively rare in the general population and have primarily been observed in overhead throwing athletes. Although the gold standard of care has traditionally been nonoperative, surgical repair of TM and LD tendon ruptures has become increasingly prevalent in high-level athletes who fail to return to play. Literature is scarce regarding operative repair of these tendon ruptures. Therefore, our goal is to present a potential technique for open repair to surgeons who may be faced with this unique orthopedic injury. Our technique details an open TM and LD repair, in addition to biceps tenodesis, using cortical suspensory fixation buttons with a combined anterior and posterior approach.

Triple Tendon Transfer of the Levator Scapulae, Rhomboid Major, and Rhomboid Minor to Reconstruct the Paralyzed Trapezius.

Trapezius paralysis is a relatively uncommon condition that orthopaedic surgeons may encounter. Despite the paucity, it presents as a debilitating condition with sequelae of poor function and deconditioning. Conservative management often fails, and patients are left with limited surgical options. In the current Eden-Lange procedure, tendon transfer of the levator scapulae, rhomboid major, and rhomboid minor is performed to reconstruct the paralyzed trapezius. Although good outcomes have been found with this technique, the pull of the levator scapulae and the pull of the rhomboids are in opposition to each other, which presents a biomechanical problem for patients because this fails to re-create the natural function of the trapezius. In this article, we present a technique that is a modification of the Eden-Lange triple tendon transfer using suture bone bridges in which the levator scapulae is transferred as with the original procedure; however, the rhomboids with bony bridges are transferred to a different point along the medial scapula. Our technique therefore may better re-create the natural pull of the fibers of the upper, middle, and lower trapezius.

Revision Achilles Tendon Repair Using Posterior Tibial Tendon Allograft and Flexor Hallucis Longus Transfer.

Achilles tendon ruptures are common injuries seen by orthopaedic surgeons. A myriad of surgical options have been used in the management of Achilles tendon ruptures, but currently no gold standard exists. Re-rupture of Achilles tendon injuries occurs 1.7% to 5.6% of the time, and there has been no direct relationship demonstrated between complications and repair techniques used. The aim of this technique is to provide a method of fixation for the patient with an Achilles tendon re-rupture that provides a stable repair construct and mitigates the potential sequela of re-rupture. We describe the treatment of an Achilles tendon re-rupture with the use of a flexor hallucis longus tendon transfer and posterior tibial tendon allograft for repair of an 8.5 cm tendon gap.

Achilles Tendon Rip-Stop SpeedBridge Repair.

Achilles tendon injuries have been on the rise secondary to our increased participation in sports, increase in societal obesity rates, and the growing elderly population. There has been disagreement in recent years about whether to treat injuries such as Achilles tendon ruptures operatively or nonoperatively with aggressive functional rehabilitation. For those opting to surgically manage Achilles tendon ruptures, insertional Achilles tendonitis, or augment the described SpeedBridge Achilles tendon repair, we propose a modified rip-stop technique. The goal of this technique is to provide a biomechanical advantage to our current operative interventions for these injuries, a greater load-to-failure and a speedier, more reliable return to sport in our athletic populations.

IMPROVEMENTS IN KNEE EXTENSION STRENGTH ARE ASSOCIATED WITH IMPROVEMENTS IN SELF-REPORTED HIP FUNCTION FOLLOWING ARTHROSCOPY FOR FEMOROACETABULAR IMPINGEMENT SYNDROME.

BACKGROUND: Recovery of strength is critical for return to sport, and is a known predictor of functional outcomes in post-surgical orthopedic populations. Muscle weakness is a known impairment in patients with femoroacetabular impingement syndrome (FAIS) but whether improvements in muscle strength after arthroscopy are associated with improved hip function is unknown. HYPOTHESIS/PURPOSE: To examine the relationships between changes in hip and thigh muscle strength and self-reported function in athletes undergoing arthroscopy for FAIS. STUDY DESIGN: Single cohort descriptive and correlational study. METHODS: Twenty-eight athletes underwent strength testing and completed the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports (HOS-S) subscales prior to and six months after surgery. Isokinetic knee extension and flexion strength were measured using a Biodex dynamometer at 60 °/s and 300 °/s. Isometric hip abduction strength was measured using a custom dynamometer. Changes in strength, limb symmetry, and HOS scores were assessed using paired t-tests. Spearman's rank correlations were used to examine relationships between change in involved limb strength and change in HOS scores. RESULTS: Subjects were tested an average of 32 days before and 178 days after surgery. HOS-ADL and HOS-S subscales improved by a mean of 19.0 ± 21.1 and 23.8 ± 31.9, respectively, over time (p < 0.001). Hip abduction strength did not increase over time in either limb (p ≥ 0.27). Involved limb knee flexion and extension strength did not increase significantly over time (p-values: 0.10-0.48) with the exception of knee extension at 300 °/s (p = 0.04). Uninvolved limb knee extension strength at both velocities and knee flexion strength at 60 °/s improved significantly over time (p < 0.012). Increases in knee extension strength (60 °/s) of the involved limb were significantly correlated with improvements on the HOS-ADL (r = 0.431; 0 = 0.025) and HOS-S (r = 0.439; p = 0.025). There were no significant relationships between changes in involved limb hip abduction or knee flexion strength and HOS subscales (p≥0.123). CONCLUSION: Improvements in knee extension strength were associated with improvements in self-reported hip function in athletes following arthroscopy for FAIS. Individuals with knee extension strength deficits prior to surgery may benefit from targeted knee extension strengthening during post-operative rehabilitation to improve functional outcomes. LEVEL OF EVIDENCE: Level III (non-randomized controlled cohort study).