Long-term outcomes of the modified Nirschl technique for lateral Epicondylitis: a retrospective study.

BACKGROUND: Although the Nirschl technique was introduced approximately 40 years ago, only limited information is available about the long-term results, especially concerning extensor power changes after surgery. The purpose of this study was to investigate long-term clinical results of surgical treatment of lateral epicondylitis using the modified Nirschl technique. The main outcome variable was muscle strength for wrist extension because the extensor origin was not reattached after removal of the degenerative extensor tendon. METHODS: Data from 99 patients who underwent surgical lateral epicondylitis treatment between 2007 to 2012 were included in the study. The mean follow-up period was 8.5 years (5 to 10, ± 1.1 years) and the mean age at surgery was 44.8 years (32 to 70, ± 9.8 years). The surgeries were performed using the modified Nirschl method and did not include extensor origin reattachment. Outcome measurements included the Visual Analogue Scale (VAS) score, Disabilities of the Arm, Shoulder and Hand (DASH) score, the MAYO elbow performance score, and Nirschl and Pettrone's grades. Wrist extension and grip strength were analyzed using a digital handgrip dynamometer (microFET2TM system) and JAMA hand dynamometer. RESULTS: Mean time required to return to work was 2.4 months after surgery. At the last follow-up after surgery, the mean VAS score had significantly improved, from 4.9 to 1.1. Mean MAYO elbow performance scores significantly improved, from 64 to 90, and mean DASH scores improved from 50 to 13. The Nirschl and Pettrone's grades were 80% rated as 'excellent' and 16% rated as 'good'. After adjusting for power differences between the dominant and non-dominant arms, the difference between wrist extensor power of the operated elbow and the non-operated opposite elbow at the final follow-up was not statistically significant. No patients complained about wrist extension weakness. CONCLUSION: Although reattachment of the extensor origin was not performed during the modified Nirschl surgical technique, there was no significant weakness in wrist extension power and the long-term follow-up revealed favorable clinical results. LEVEL OF EVIDENCE: Level IV (case series). Retrospective study.

Modification of Titanium Implant and Titanium Dioxide for Bone Tissue Engineering.

Bone tissue engineering using titanium (Ti) implant and titanium dioxide (TiO2) with their modification is gaining increasing attention. Ti has been adopted as an implant material in dental and orthopedic fields due to its superior properties. However, it still requires modification in order to achieve robust osteointegration between the Ti implant and surrounding bone. To modify the Ti implant, numerous methods have been introduced to fabricate porous implant surfaces with a variety of coating materials. Among these, plasma spraying of hydroxyapatite (HA) has been the most commonly used with commercial success. Meanwhile, TiO2 nanotubes have been actively studied as the coating material for implants, and promising results have been reported about improving osteogenic activity around implants recently. Also porous three-dimensional constructs based on TiO2 have been proposed as scaffolding material with high biocompatibility and osteoconductivity in large bone defects. However, the use of the TiO2 scaffolds in load-bearing environment is somewhat limited. In order to optimize the TiO2 scaffolds, studies have tried to combine various materials with TiO2 scaffolds including drug, mesenchymal stem cells, Al2O3-SiO2 solid and HA. This article will shortly introduce the properties of Ti and Ti-based implants with their modification, and review the progress of bone tissue engineering using the TiO2 nanotubes and scaffolds.

Returning to golf after rotator cuff repair.

Background: The prevalence of rotator cuff repair is increasing; however, no study has assessed patients who have returned to golf activity after arthroscopic rotator cuff repair. Methods: The subjects of the survey were 633 patients who were at least two years postoperative after rotator cuff repair from January 2005 to December 2017. From August 2019 to October 2019, survey responses were collected via an online questionnaire or phone calls and a total of 197 patients were reviewed retrospectively to study about returning to golf after rotator cuff repair. The detailed survey included 12 questions specific to the patient's golf career, performance, time of return to play, and symptoms related to golf activity. Depending on the size of the rotator cuff tear, each question was statistically analyzed to determine whether there were differences in the time of return to golf, uncomfortable symptoms when golfing, and distance of the driving. Results: Of the 197 patients who underwent arthroscopic rotator cuff repair, there were 145 patients (73.6%) returned to golf. In the analysis results of 145 patients, the longer the golf career, the greater the chance of returning to golf. Sixty (30.5%) people returned to golf at 1 year after surgery. Twenty-one patients (10.7%) improved and 46 patients (23.4%) maintained their driving distance, whereas 78 patients (39.6%) had a worse driving distance after surgery. Ten patients (5.1%) improved and 97 patients (49.2%) maintained their golf score, but 38 patients (19.3%) had worse golf scores after surgery. Symptoms when playing golf were reported in the order of no symptoms (62.1%), a limited range of motion (13.1%), muscle weakness (11.1%), and anxious about their operated shoulder (10.3 %). Men were 6.9 times more likely to return to golf than women (odds ratio, 6.9; 95% confidence interval, 3.2-14.8). The younger the age and the shorter the time since surgery, the higher the golfing return rate. The rate of returning to golf was high in the group of patients with good tissue quality during surgery (odds ratio, 3.9; 95% confidence interval, 0.01-2.6). Conclusion: The golfing return rate after arthroscopic rotator cuff repair was higher than expected (73.6%) and most players returned at 1 year after surgery. Especially, in the case of young males, their golf scores were maintained or improved and they were able to return to golf earlier after surgery. Better tissue quality in the intraoperative torn tendon was associated with a greater chance of returning to golf.

Treatment of Periprosthetic Femoral Fractures Following Hip Arthroplasty.

PURPOSE: This study was performed to assess potential improvements in clinical outcomes when applying recent advanced hip arthroplasty surgical techniques and understand the potential relationship between bone mineral density (BMD) and surgical outcomes. MATERIALS AND METHODS: Among 37 cases of periprosthetic femoral fractures after hip arthroplasty treated between March 2014 and September 2016, all included a follow-up of at least one year and were included in this study. Outcomes were evaluated using the Beals and Tower's criteria. BMD was examined in 27 of 37 cases and the relationship between osteoporosis and treatment outcomes was analyzed. Advanced hip arthroplasty surgical approaches varied depending on the fracture type: i) open reduction with wiring for Vancouver A, ii) open reduction with double plate fixation for Vancouver B1, iii) revision THA with long stem for Vancouver B1-Nonunion, B2 and B3, and iv) open reduction with double plate fixation for Vancouver C. RESULTS: When assessed using the Beals and Tower's criteria, 33 out of 37 (89.2%) patients were excellent and 4 (10.8%) were poor. These outcomes were an improvement compared with series I (81.8%). When analyzed according to the Vancouver classification, patients with type A (n=8), type B1 (n=16), and type B2 (n=2) were all excellent, the patients with type B3 were excellent (n=1) and poor (n=1), and the patients with type C were excellent (n=6) and poor (n=3). The mean BMD was -2.6 (T-score) in 27 of 37 cases and -4.4 in 4 cases with poor prognosis. Osteoporosis was statistically correlated to those classified as poor by Beals and Tower. CONCLUSION: The results of the analysis suggest that applying new surgical hip arthroplasty treatment approaches leads to improved outcomes compared with the author's previous study. When treating periprosthetic femoral fractures following total hip arthroplasty, an appropriate internal fixation method should be selected, at least in part based on the Vancouver classification. In addition, osteoporosis may be a major prognostic factor for the outcomes of surgical treatment.

Multiple glomus tumours in multidigit nail bed.

Glomus tumours are lesions of the glomus body. A solitary glomus tumour is a more common, characteristically painful lesion, frequently located under the nail, whereas multiple glomus tumours are a rare clinical and genetic entity. Multiple glomus tumours are rarely subungual and do not show preference for any particular region of the body. We report a rare case of painful multidigit subungual glomus tumours in both hands.A 34-year-old male patient complained of painful fingertips (right: thumb, index finger, long finger, and ring finger; left: thumb, long finger, ring finger, small finger) on both hands for more than 5 years. Magnetic resonance imaging (MRI) detected multiple subungual glomus tumours in the fingertips (right long finger, ring finger, and left thumb, long, ring, and small finger) of both his hands, so the authors conducted tumour resection and sent biopsies for relevant fingers. We found the glomus tumour underneath the nail bed and achieved final diagnosis with histological confirmation. No remnant or newly developed lesion was detected at the 1 year outpatient clinic.Our case differed from the usual multiple glomus tumours because its characteristics were similar to those of a solitary glomus tumour, including the classic symptom triad: severe pain, localised pain, and cold hypersensitivity. In case report, we suggest the possibility that multidigit subungual glomus tumour is different from the common single subungual glomus tumour.