Retrospective Study on the Risk of Nerve Injury After Distal Biceps Tendon Repair Using Cortical Button.

BACKGROUND: Distal biceps tendon ruptures are relatively rare injuries that typically require surgical intervention to restore flexion and supination strength. Concerns have been raised regarding the risk of nerve injuries, particularly the posterior interosseous nerve (PIN), associated with the use of cortical buttons in distal biceps repair. This study aimed to estimate the incidence of PIN injury as well as injuries to the lateral cutaneous nerve of the forearm and superficial branch of the radial nerve following distal biceps repair using cortical buttons. METHODS: A retrospective review was conducted on all patients who underwent distal biceps repair with cortical buttons at a district general hospital between January 2014 and May 2022. Patient data, including age, gender, time from injury to surgery, type of procedure, and postoperative nerve injuries, were collected. The incidence of nerve injuries was analyzed, and the outcomes were assessed during postoperative follow-up visits. RESULTS: Ninety-six male patients were included in the study, with an average age of 45.6 years. The average time from injury to surgery was 22.6 days. All patients underwent primary repair except for two patients who underwent reconstruction with hamstring grafts. None of the patients experienced a PIN injury. However, 16 patients (16.7%) developed lateral cutaneous nerve injuries of the forearm, and three patients (3.1%) had superficial radial nerve injuries. CONCLUSION: Our study, encompassing a large cohort of patients over an eight-year period, demonstrates the safety of distal biceps repair using cortical buttons with regard to PIN nerve injury. However, there were incidences of lateral cutaneous nerve of the forearm and superficial radial nerve injuries, consistent with previous studies.

Opening wedge high tibial osteotomy allows better outcomes than unicompartmental knee arthroplasty in patients expecting to return to impact sports.

PURPOSE: Prior studies have compared unicompartmental knee arthroplasty (UKA) with high tibial osteotomy (HTO) suggesting that both procedures had good functional outcomes. But none had established the superiority of one of the two procedures for patients with high expectation including return to impact sport. The aim of this study was to compare functional outcomes and ability to return to impact sport of active patients defined with a pre-arthritis University of California and Los Angeles activity (UCLA) score > 8, after UKA or HTO procedures. METHODS: A retrospective review of patients with a pre-arthritis UCLA score > 8 operated between January 2014 and September 2017 has identified 91 patients with open-wedge HTO and 117 patients with UKA. A matching process based on age (± 3 years) and gender allowed to include 50 patients in each group for comparative analysis. Patient reported outcomes included Knee Osteoarthritis Outcomes Score (KOOS), UCLA Score, Knee Society Score (KSS) and time to return to sport or previous professional activities at 3, 6, 12 and 24 months following surgery. RESULTS: Mean time to return to sport activities or previous professional activities were significantly lower for the HTO group than for UKA group [respectively, 4.9 ± 2.2 months for HTO group vs 5.8 ± 6.2 months for UKA group (p = 0.006) and 3 ± 3 months for HTO group vs 4 ± 3 months for UKA group (p = 0.006)]. At 24-month follow-up, UCLA score, KOOS Sports Sub-score and KSS activity score were significantly higher for HTO group than for UKA group (Δ: 2 CI 95% (1.3-2.5 points) p < 0.0001, (Δ: 10.9 CI 95% (2.9-18.9 points) p = 0.04 and Δ: 7.8 CI 95% (2.4-13.4 points) p = 0.006, respectively) and 31 patients (62%) were practicing impact sport in the HTO group versus 14 (28%) in the UKA group (odd-ratio 4.2 CI 95% (1.8-9.7) p < 0.0001). CONCLUSION: HTO offers statistically significant quicker return to sport activities and previous professional activities with a higher rate of patients able to practice impact activity (62% for HTO vs 28% for UKA) and better sports related functional scores at two years after surgery compared to UKA. LEVEL OF EVIDENCE: III retrospective case-control study.

Reconstruction of chronic achilles tendon ruptures in elderly patients, with vascularized flexor hallucis longus tendon transfer using single incision technique.

The purpose is to report the outcome following reconstruction of neglected Achilles tendon ruptures in elderly patients with Flexor hallucis longus tendon (FHL) biotenodesis. Seventeen cases (mean age 65.7 years), of Achilles tendon reconstruction with FHL biotenodesis for chronic ruptures were reviewed. Outcomes evaluated with American orthopaedic foot and ankle score (AOFAS), calf girth atrophy, range of ankle movement, ability to perform single leg heel raise and patient satisfaction. The mean follow up was 27 months (range 17-52). The mean AOFAS score improved from 57.47 (+/-5.98) to 96.71(+/-3.57). Mean calf girth atrophy was 1.53 (+/- 0.43) cm on the operated side. There was no significant difference in the range of ankle movement. All except one patient were able to perform single leg heel raise. We observed an inverse relation for patient age and chronicity of tear to the endurance strength of Achilles tendon. All the patients were satisfied with the outcome. We had one complication of superficial wound infection. Single incision FHL biotenodesis is a safe and effective procedure for this complex condition. It mitigates the need for extensive soft tissue procedures like turn down flaps or V-Y plasty.