Affecting Factors and Correction Ratio in Genu Valgum or Varum Treated with Percutaneous Epiphysiodesis Using Transphyseal Screws.

This study evaluated the correction rates of idiopathic genu valgum or varum after percutaneous epiphysiodesis using transphyseal screws (PETS) and analyzed the affecting factors. A total of 35 children without underlying diseases were enrolled containing 64 physes (44 distal femoral (DT), 20 proximal tibial (PT)). Anatomic tibiofemoral angle (aTFA) and the mechanical axis deviation (MAD) were taken from teleroentgenograms before PETS surgery and screw removal. The correction rates of the valgus and varus deformities for patients treated with PETS were 1.146°/month and 0.639°/month using aTFA while using MAD showed rates of 4.884%/month and 3.094%/month. After aTFA (p < 0.001) and MAD (p < 0.001) analyses, the correction rate of DF was significantly faster than that of PT. Under multivariable analysis, the aTFA correction rate was significantly faster in younger patients (p < 0.001), in males (p < 0.001), in patients with lower weights (p < 0.001), and in the group that was screwed at DF (p < 0.001). Meanwhile, the MAD correction rate was significantly faster in patients with lower heights (p = 0.003). PETS is an effective treatment method for valgus and varus deformities in growing children and clinical characters should be considered to estimate the correction rate.

Early Clinical Outcomes of Manipulation under Anesthesia for Refractory Adhesive Capsulitis: Comparison with Arthroscopic Capsular Release.

BACKGROUD: The purpose of this study was to compare early clinical outcomes of manipulation under anesthesia (MUA) and arthroscopic capsular release (ACR) in patients with refractory adhesive capsulitis (AC). METHODS: Thirty AC patients who underwent MUA (MUA group) were included. As a control group, thirty AC patients who underwent ACR (ACR group) were matched for age and sex with the MUA group. Visual analog scale (VAS) pain score, American shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM) were evaluated preoperatively and at 3, 6, and 12 months after procedure. RESULTS: Both groups had significant improvements in the VAS pain score, ASES score, and ROM at 12 months after procedure. VAS pain score and ASES score were significantly better in the MUA group than in the ACR group at 3 months after procedure. Mean forward flexion was significantly greater in the MUA group than in the ACR group at 3 months after procedure. Mean external rotation and internal rotation were significantly greater in the MUA group than in the ACR group at 3, 6, and 12 months after procedure. Two patients required additional steroid injections at 3 and 6 months after MUA because of recurrent stiffness with pain. CONCLUSIONS: Compared with ACR, MUA provided equivalent clinical outcomes in the early period after procedure. Our study suggests that MUA is a useful option to be considered as treatment for refractory AC before choosing ACR.

Highly Cross-Linked Polyethylene in Total Hip Arthroplasty in Patients Younger Than 50 Years With Osteonecrosis of the Femoral Head: A Minimum of 10 Years of Follow-Up.

BACKGROUND: Polyethylene wear and subsequent periprosthetic osteolysis remain a major concern of total hip arthroplasty (THA) failure in young, active patients with osteonecrosis of the femoral head (ONFH). The literature is lacking regarding the long-term performance of highly cross-linked polyethylene (HXLPE) in these patients. The purpose of this study is to evaluate long-term results for cementless THA using metal-on-HXLPE bearing couplings in patients younger than 50 years with ONFH. METHODS: We retrospectively evaluated the clinical and radiographic results of a consecutive series of 85 THAs (in 67 patients) performed with HXLPE liners (Durasul) in patients younger than 50 years who had ONFH. All procedures were performed at a single institution by a single surgeon using the same type of implants. The minimum duration of follow-up was 10 years (mean, 13.5 years; range, 10-17.3 years). Wear was measured using computer software. Osteolysis was evaluated with the use of radiography and computed tomography. RESULTS: The mean Harris hip score was 49.3 points (range, 26-68 points) before surgery, which improved to 93.6 points (range, 87-98 points) after surgery. Neither femoral nor acetabular components displayed mechanical loosening, and no components had been revised by the final follow-up evaluation. Radiographs and computed tomography scans did not demonstrate osteolysis. The mean liner wear was 0.037 mm/y (range, 0-0.099 mm/y). With the data available, univariate regression analysis did not demonstrate that age, sex, weight, activity level, underlying cause of osteonecrosis, liner thickness, or cup inclination had any influence on liner penetration. CONCLUSION: Although the long-term effects of HXLPE particles remain unknown, the implant survivorship rate and wear rate in our study are promising and support the continued use of metal-on-HXLPE bearing couplings in these high-risk patients because they do not produce any of the issues associated with hard-on-hard couplings. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Total Ankylosis by Heterotopic Ossification in an Adolescent Anterior Trans-olecranon Fracture Dislocation: A Case Report.

The incidence of heterotopic ossification in adolescents appears to be lower than in adults. There exist very few reports of heterotopic ossification with total bony ankylosis in child or adolescent populations. We describe a case of total bony ankylosis of the elbow secondary to heterotopic ossification, in a 14-year-old female. Total ankylosis of the elbow at 45 degrees of flexion was noted 6 months post-surgery, and complete surgical excision of the heterotopic mass was performed. After an additional one-time dose of radiation therapy and nonsteroidal anti-inflammatory drug medication, full range of motion was obtained without any recurrence or other complications, up to the last follow-up of 30 months.

Accuracy of Preoperative Ultrasonography for Cubital Tunnel Syndrome: A Comparison with Intraoperative Findings.

BACKGROUND: The aim of this study was to assess the consistency between preoperative ultrasonographic and intraoperative measurements of the ulnar nerve in patients with cubital tunnel syndrome. METHODS: Twenty-six cases who underwent anterior transposition of the ulnar nerve for cubital tunnel syndrome were enrolled prospectively. On preoperative ultrasonography, largest cross-sectional diameters of the ulnar nerve were measured at the level of medial epicondyle (ME) and 3 cm proximal (PME) and distal (DME) to the ME on the transverse scan by a single experienced radiologist. Intraoperative direct measurements of the largest diameter at the same locations were performed by a single surgeon without knowledge of the preoperative values. The consistency between ultrasonographic and intraoperative values including the largest diameter and swelling ratio were assessed. RESULTS: Significant differences between ultrasonographic and intraoperative values of the largest diameter were found at all levels. The mean difference was 1.29 mm for PME, 1.38 mm for ME, and 1.12 mm for DME. The mean ME-PME swelling ratio for ultrasonographic and intraoperative measurements was 1.50 and 1.39, respectively, showing significant difference. The mean ME-DME swelling ratio for ultrasonographic and intraoperative measurements was 1.53 and 1.43, respectively, showing no significant difference. CONCLUSIONS: Ultrasonographically measured largest diameters of the ulnar nerve at any levels were smaller than the real values determined intraoperatively. The ME-DME swelling ratio of the ulnar nerve measured by ultrasonography was consistent with the intraoperative measurement.

Outcomes are equivalent for two-column acetabular fractures either with or without posterior-wall fractures.

INTRODUCTION: It is likely that posterior-wall involvement in association with two-column fractures plays a pivotal role in outcomes because of the potential for hip instability if it is not anatomically reduced and fixed. Uncertainty remains about how this fracture is best treated, especially regarding how posterior-wall involvement may affect functional results. MATERIALS AND METHODS: To better understand the role that posterior-wall involvement may play in determining functional results, we compared data for outcomes for patients with posterior-wall involvement and for those without in a consecutive series of two-column fractures. Between 2000 and 2013, 42 patients who underwent surgical treatment for two-column acetabular fractures were evaluated after a minimum follow-up period of 1 year. Data were prospectively collected and retrospectively evaluated. Of the 42 patients, 25 had only a two-column fracture (group 1) and 17 had a two-column fracture with posterior-wall involvement (group 2). RESULTS: There were no differences between groups in terms of reduction accuracy, radiographic results, clinical results, or complication rates. All hips in patients with internal fixation for the associated posterior-wall fracture had anatomical reduction. At the latest follow-up evaluation, three patients from group 1 (without posterior-wall involvement) and three patients from group 2 (with posterior-wall involvement) had undergone total hip arthroplasty. CONCLUSION: These results suggest that a posterior-wall fracture in a two-column fracture does not compromise functional outcomes when the treatment algorithm discussed here is followed.

Is the pectoralis major tendon a reliable reference for restoration of humeral length with fracture hemiarthroplasty?

BACKGROUND: The primary objective was to calculate and to apply the numeric value of the distance from the pectoralis major tendon insertion to the superior aspect of the humeral head (PMTD) without any radiation exposure or equipment through basic data such as age, sex, height, and weight of Asian populations. METHODS: We analyzed shoulder magnetic resonance images of 260 patients (107 men and 153 women; average age, 59.8 years). The superior border of the pectoralis major was identified on the transverse section and cross-referenced with the coronal section. Measurements were made inferiorly from the corresponding transverse section to the top of the humeral head superiorly in coronal view. Correlation analysis was performed between variables including the patient's age, sex, height, weight, and body mass index and the PMTD by multiple linear regression analysis. RESULTS: The mean PMTD was 52 mm, with an average of 55 mm for men and 49 mm for women. Sex and height were significantly correlated with PMTD. The PMTD increased to a consistent level proportionally to height, and the difference in PMTD between men and women was 3.45 mm. An equation to estimate PMTD using these findings is as follows: PMTD (in mm) = 23 + (height [cm] × 0.17) + 3.45 (the last number is added for men). This equation had a prediction error of 0.3 mm. CONCLUSION: Our study demonstrated that PMTD is a useful and reliable reference for optimal humeral height during hemiarthroplasty for proximal humerus fractures in Asian populations.

T-Score Discordance of Bone Mineral Density in Patients with Atypical Femoral Fracture.

BACKGROUND: Although atypical femoral fracture (AFF) occurs more frequently in patients taking bisphosphonates and longer treatment is associated with higher risk, the causal relationship between AFF and bisphosphonates has not been established. Most patients with AFF have osteoporosis that is being treated with bisphosphonates, but we are not aware of any reports regarding the areal bone mineral density (aBMD) and discordance between the T-scores of the femur and spine in such patients. We investigated the prevalence of aBMD discordance and the characteristics of patients with AFF. METHODS: Medical records for 63 consecutive patients treated for AFF were retrospectively evaluated, and 48 patients, all female, were eligible for the study. The average age at the time of fracture was 73.0 years, the average duration of bisphosphonate use was 68.5 months, and the average presumed age at bisphosphonate initiation was 67.2 years. We evaluated the prevalence of discordance, defined as a difference between the T-score categories of the femur and spine in the same individual as well as demographic differences between the discordance and concordance groups. We also compared the prevalence of discordance in patients with AFF with that in 114 female patients with intertrochanteric femoral fracture (ITFF). RESULTS: T-score concordance, minor discordance, and major discordance were seen in 14 (29%), 32 (67%), and 2 (4%) of the patients with AFF, respectively. The prevalence of discordance was significantly higher in those with AFF (71%) than in those with ITFF (23%) (p < 0.001). The average age at bisphosphonate initiation in the AFF group was lower in the discordance group (65.7 years) than in the concordance group (70.7 years) (p = 0.04). CONCLUSIONS: The prevalence of T-score discordance between the hip and lumbar spine was relatively high in patients with AFF, and the presumed age at the initiation of bisphosphonate therapy was younger in patients with discordant T-scores in this study. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Reverse Shoulder Arthroplasty in Patients with Rheumatoid Arthritis: A Systematic Review.

BACKGROUND: There are limited data available regarding the results of reverse shoulder arthroplasty (RSA) in patients with rheumatoid arthritis (RA). We performed a systematic review of the literature to investigate the radiological and clinical outcomes after RSA in patients with RA. METHODS: A literature search for publications between 1987 and 2014 was conducted by 2 independent reviewers using PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials. Articles were retrieved by an electronic search using keywords and their combinations. Studies that met inclusion criteria were assessed for pertinent data. RESULTS: Seven studies including 123 shoulders met the inclusion criteria. The mean age of the patients was 67.9 years and the mean follow-up period was 46.6 months. The mean Constant score and American Shoulder and Elbow Surgeons (ASES) score increased from 18.6 and 27.5 preoperatively to 58.6 and 73.7, respectively, at the final follow-up evaluation. The mean active forward flexion, abduction, and external rotation increased from 57.2°, 50.4°, and 11.4° to 127.1°, 116.7°, and 26.4°, respectively. The incidence of scapular notching was 33.7%. Twenty-seven (22.0%) of 123 shoulders had one or more complications, 12 of which (44.4%) had intraoperative or postoperative fractures. Nine shoulders (7.3%) had one or more revision surgeries. CONCLUSIONS: RSA in RA showed similar short- to mid-term results without higher complication rates as compared to RSA in cuff tear arthropathy. Although RSA can be considered a reliable treatment option in patients with RA, further large-scale studies are required to determine the long-term survival of the implant.

Clinical Outcomes and Complications during the Learning Curve for Reverse Total Shoulder Arthroplasty: An Analysis of the First 40 Cases.

BACKGROUND: The purpose of this study was to investigate the results and complications during the learning curve of reverse total shoulder arthroplasty (RTSA) for rotator cuff deficiency. METHODS: We retrospectively reviewed the first 40 cases of RTSA performed by a single surgeon. The mean age of patients was 72.7 years (range, 63 to 81 years) and mean follow-up period was 26.7 months (range, 9 to 57 months). Clinical outcomes were evaluated using a visual analog scale (VAS) for pain, the University of California at Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeon (ASES) score, subjective shoulder value (SSV), and active range of motion (ROM). Intraoperative and postoperative complications were also evaluated. RESULTS: The average VAS pain score, UCLA score, ASES score, and SSV improved from 6.9%, 12.8%, 29.0%, and 29.0% before surgery to 1.6%, 27.0%, 73.3%, and 71.5% after surgery, respectively (p < 0.001). The mean forward flexion, abduction, and external rotation improved from 68.0°, 56.9°, and 28.0° before surgery to 131.0°, 112.3°, and 38.8° after surgery, respectively (p < 0.001, p < 0.001, and p = 0.021). However, the mean internal rotation did not improve after surgery (p = 0.889). Scapular notching was observed in 33 patients (51.5%). Eight shoulders (20%) had complications, including 2 major (1 deep infection and 1 glenoid fixation failure) and 6 minor complications (3 brachial plexus injuries, 2 acromial fractures, and 1 intraoperative periprosthetic fracture). CONCLUSIONS: The first 40 cases of RTSA performed by a single surgeon during the learning curve period showed satisfactory short-term follow-up results with an acceptable complication rate.

Changes in Psychological Status and Health-Related Quality of Life Following Total Shoulder Arthroplasty.

BACKGROUND: There has been little documentation of the effects of total shoulder arthroplasty (TSA) on psychological status and health-related quality of life (HRQoL). We investigated changes in psychological status (depression and anxiety) and HRQoL following TSA and assessed the effect of preoperative psychological status on postoperative clinical and functional outcome. We hypothesized that TSA would improve both psychological status and HRQoL. METHODS: We prospectively enrolled 46 patients undergoing TSA for osteoarthritis. Preoperatively and at 3, 6, and 12 months postoperatively, all of the subjects completed the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons Scale (ASES), the Subjective Shoulder Value (SSV) measure, the Hospital Anxiety and Depression Scale (HADS), and the World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF). RESULTS: From 3 months after surgery, significant improvement in HADS-depression, HADS-anxiety, and WHOQOL-BREF scores as well as in the other outcome measures of VAS pain score, ASES score, and SSV were observed. The prevalence of depression and anxiety decreased from a rate of 15.2% and 19.5%, respectively, preoperatively to a rate of 6.5% for each at 12 months postoperatively. Preoperative HADS-depression and HADS-anxiety scores did not correlate with any of the clinical and functional outcome measures at 12 months after surgery. CONCLUSIONS: This study showed significant improvement in psychological status and HRQoL as well as in pain and functional ability from 3 months after TSA in patients with osteoarthritis. Preoperative depression and anxiety did not predict poor postoperative outcome. Our findings suggest that TSA offers an excellent chance of improving psychological status and HRQoL. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Radiocapitellar Impingement after a Pediatric Type II Capitellar Fracture.

We present a case of radiocapitellar impingement caused by osteochondral fragment after type II capitellar fracture. Painful extension limitation of the elbow was treated successfully by diagnostic arthroscopy and mini-open removal of loose body. A displaced type II capitellar fracture in children is extremely rare, but must be carefully diagnosed and treated.

Characterization of a frozen shoulder model using immobilization in rats.

BACKGROUND: The objective of this study was to investigate serial changes for histology of joint capsule and range of motion of the glenohumeral joint after immobilization in rats. We hypothesized that a rat shoulder contracture model using immobilization would be capable of producing effects on the glenohumeral joint similar to those seen in patients with frozen shoulder. METHODS: Sixty-four Sprague-Dawley rats were randomly divided into one control group (n = 8) and seven immobilization groups (n = 8 per group) that were immobilized with molding plaster for 3 days, or for 1, 2, 3, 4, 5, or 6 weeks. At each time point, eight rats were euthanized for histologic evaluation of the axillary recess and for measurement of the abduction angle. RESULTS: Infiltration of inflammatory cells was found in the synovial tissue until 2 weeks after immobilization. However, inflammatory cells were diminished and fibrosis was dominantly observed in the synovium and subsynovial tissue 3 weeks after immobilization. From 1 week after immobilization, the abduction angle of all immobilization groups at each time point was significantly lower than that of the control group. CONCLUSIONS: Our study demonstrated that a rat frozen shoulder model using immobilization generates the pathophysiologic process of inflammation leading to fibrosis on the glenohumeral joint similar to that seen in patients with frozen shoulder. This model was attained within 3 weeks after immobilization. It may serve as a useful tool to investigate pathogenesis at the molecular level and identify potential target genes that are involved in the development of frozen shoulder.

Short stature and growth hormone deficiency in a girl with encephalocraniocutaneous lipomatosis and Jaffe-Campanacci syndrome: a case report.

A 9-year-old Tajikistani girl presented to Keimyung University Dongsan Medical Center for evaluation of a skin lesion on her left eyelid, focal alopecia, unilateral ventricular dilatation, and aortic coarctation. She was diagnosed with encephalocraniocutaneous lipomatosis (ECCL) according to Moog's diagnostic criteria. Café-au-lait spots were found on the left side of her trunk. Multiple nonossifying fibromas were found on her left proximal humerus, left distal femur, both proximal tibias, and left proximal fibula, suggesting Jaffe-Campanacci syndrome (JCS), following imaging of the extremities. Many JCS cases with multiple Café-au-lait macules, multiple nonossifying fibromas may actually have Neurofibromatosis type-1 (NF1). Thus, comprehensive molecular analysis to exclude NF1 mutation was performed using her blood sample. The NF1 mutation was not found. Her height was under the 3rd percentile and her bone age was delayed as compared with her chronological age. Baseline growth hormone (GH) level was below the normal range. Using the insulin stimulation and levo-dihydroxyphenylalanine tests, GH deficiency was confirmed. We present a case of GH deficiency with typical features of ECCL and JCS.

Does Rotator Cuff Repair Improve Psychologic Status and Quality of Life in Patients With Rotator Cuff Tear?

BACKGROUND: Recently, psychological status, patient-centered outcomes, and health-related quality of life (HRQoL) in patients with scheduled or who underwent orthopaedic surgeries have been emphasized. The relationship between preoperative psychological status and postoperative clinical outcome in patients with rotator cuff repair has not yet been investigated. QUESTIONS/PURPOSES: The primary objective of this study was to investigate changes in psychological status (depression, anxiety, insomnia) and HRQoL after rotator cuff repair. The secondary objective was to assess whether preoperative depression, anxiety, and insomnia predict clinical outcome after rotator cuff repair. METHODS: Forty-seven patients who underwent rotator cuff repair prospectively completed the visual analog scale (VAS) pain score, the UCLA Scale, the American Shoulder and Elbow Surgeons' Scale (ASES), the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), and the World Health Organization Quality-of-life Scale Abbreviated Version (WHOQOL-BREF) before surgery and at 3, 6, and 12 months after surgery. Repeated-measures analysis of variance was used to evaluate the serial changes in psychological parameters and outcome measurements. The chi-square test was also used to compare preoperative and postoperative prevalence of depression, anxiety, and insomnia. Finally, multiple regression analysis was applied to determine the relationship between preoperative psychological status and postoperative clinical outcome. RESULTS: With surgery, depression, anxiety, and insomnia decreased, whereas quality of life increased. The mean HADS-D and HADS-A scores and the mean PSQI score decreased from 3.7 ± 3.3, 4.3 ± 4.3, and 6.6 ± 3.6, respectively, before surgery to 2.1 ± 2.3, 1.4 ± 2.4, and 4.2 ± 3.3, respectively, at 12 months after surgery (HADS-D mean difference 1.6 [95% confidence interval {CI}, 0.6-2.6], p = 0.003; HADS-A mean difference 2.9 [1.5-4.4], p < 0.001; PSQI mean difference 2.4 [1.3-3.4], p < 0.001). The mean WHOQOL-BREF score increased from 60.4 ± 11.0 before surgery to 67.4 ± 11.8 at 12 months after surgery (mean difference -7.0 [95% CI, -10.7 to -3.4], p < 0.001). At 12 months after surgery, there were decreases in the prevalence of depression (six of 47 [22.8%] versus three of 47 [6.4%], p = 0.002), anxiety (11 of 47 [23.4%] versus two of 47 [4.3%], p = 0.016), and insomnia (33 of 47 [70.2%] versus 20 of 47 [42.6%], p = 0.022). Preoperative HADS-depression, HADS-anxiety, and PSQI scores did not correlate with the VAS pain score, UCLA, or ASES scores at 12 months after surgery. CONCLUSIONS: Psychological status and HRQoL improved with decreasing pain and increasing functional ability from 3 months after surgery. Preoperative depression, anxiety, and insomnia did not predict poor outcome after rotator cuff repair. Our findings suggest that successful rotator cuff repair may improve psychological status and HRQoL. LEVEL OF EVIDENCE: Level II, prospective study.

Aneurysmal bone cyst involving the metacarpal bone in a child.

Aneurysmal bone cysts associated with tubular bones of the hand occur rarely and require particular diagnostic and therapeutic management techniques. While optimal treatment has not been established, accepted treatments range from aggressive radical treatment, including en bloc resection and excision diaphysectomy with strut bone grafting, to relatively simple techniques, such as thorough curettage followed by bone graft. Aggressive treatment approaches may be optimal for the cases with articular surface involvement, full-bone invasion of the phalanx or metacarpal, or more than 1 recurrence. We report a monocentric case of aneurysmal bone cysts involving metacarpal bone in a child who achieved favorable outcome with curettage and morselized cancellous bone grafts.

Kimura's disease involving the peripheral nerve of the arm in a child: a case report.

A 7-year-old Korean boy was referred for a nontender mass in the left arm. He had a 5-year history of a poorly defined painless mass on the medial side of the left elbow. The ultrasonogram of the left arm indicated an ill-defined, lobulating solid mass involving the deep soft tissue layer. The fat-suppressed T2-weighted magnetic resonance image showed a poorly marginated, homogeneous high-signal intensity mass. On further follow-up of 1 year and 6 months, the mass showed no change in size and nature. At surgery, a poorly demarcated inflammatory mass was dissected from a branch of the superficial radial nerve and excised completely. There was no recurrence and any dysfunction, except temporary localized hypoesthesia of the medial aspect of the left arm at the 3.6-year follow-up.

Efficacy of interscalene block combined with multimodal pain control for postoperative analgesia after rotator cuff repair.

PURPOSE: The aim of the study reported here was to compare the efficacy and safety of postoperative analgesia provided by interscalene block with multimodal pain control (IB-MPC) versus that provided by multimodal pain control (MPC) alone after arthroscopic rotator cuff repair. METHODS: Sixty consecutive patients were assigned to either the IB-MPC group (30 patients) or the MPC group (30 patients). Visual analogue scale (VAS) pain scores before surgery and through day 5 after surgery, consumption of rescue analgesic, adverse effects and complications were evaluated. RESULTS: Mean VAS pain scores immediately after surgery and on days 1 through 5 after surgery were 3.9 ± 2.6, 4.4 ± 1.5, 3.4 ± 1.3, 2.7 ± 1.3, 2.4 ± 1.2, and 2.0 ± 1.0, respectively, in the IB-MPC group and 6.2 ± 1.8, 4.1 ± 1.7, 3.2 ± 1.9, 2.7 ± 1.4, 2.5 ± 1.3, and 2.0 ± 1.2, respectively, in the MPC group. The IB-MPC group had significantly lower VAS pain score immediately after surgery than the MPC group did (P < 0.001). There were no statistically significant differences regarding consumption of rescue analgesic or adverse effects between the two groups (n.s.). In the IB-MPC group, complications related to interscalene block included tingling of the hand in three patients and numbness of the neck and ear in two. However, these symptoms resolved spontaneously within a few days. No patients had major complications related to interscalene block. CONCLUSIONS: IB-MPC achieved better pain control immediately after surgery than MPC alone, without major complications related to interscalene block. It is an effective and safe method for providing postoperative analgesia after arthroscopic rotator cuff repair. LEVEL OF EVIDENCE: Prospective Comparative Study, Prognosis Study, Level II.

Giant Cell Tumor of the Talus: 19-Year Follow-Up of a Patient.

Giant cell tumor in small bones is a rare condition characterized by extensive bony destruction and a high recurrence rate. Intralesional excision with curettage and autologous bone grafting has been used as a standard treatment method for giant cell tumor of the bones. We report the case of a 30-year-old female with giant cell tumor of the talar body. She was followed up for 19 years after intralesional curettage and autologous bone grafting treatment.

Comparison of orthopaedic manifestations of multiple epiphyseal dysplasia caused by MATN3 versus COMP mutations: a case control study.

BACKGROUND: Multiple epiphyseal dysplasia (MED) is a relatively common skeletal dysplasia mainly involving the epiphyses of the long bones. However, it is a genetically heterogeneous group of diseases sharing certain aspects of the radiologic phenotype. In surveys conducted in East Asia, MATN3 was the most common causative gene, followed by COMP. In this study, the authors compared clinical manifestation of MED patients caused by MATN3 and COMP gene mutations, as well as subsequent orthopaedic interventions. METHODS: Fifty nine molecularly-confirmed MED patients were subjects of this study. The MATN3 gene mutation group comprised of 37 patients (9 female, 28 male). The COMP gene mutation consisted of 22 cases (15 females, 7 males). Medical records and radiographs were reviewed, and questionnaire surveys or telephone interviews were conducted. RESULTS: At the first presentation, the mean age was 8.8 ± 2.8 years (mean ± standard deviation) in the MATN3 group, and 8.5 ± 3.5 years in the COMP group (p = 0.670). The height in the COMP group was significantly shorter than those in the MATN3 group (p < 0.001). Gait abnormality at the first visit (p = 0.041) and the lastest follow-up (p = 0.037) were statistically significant difference. Hip pain (p = 0.084), limitation of daily activity (p = 0.075) at the latest follow-up tended to be more frequent in the COMP group. Hip dysplasia was more common in the COMP group, having significantly larger acetabular angle (p = 0.037), smaller center-edge angle (p = 0.002), severe Stulberg classification (p < 0.001), and smaller femoral head coverage (p < 0.001). CONCLUSIONS: Clinical manifestations of MED caused by MATN3 were milder than manifestations of the COMP mutation group. These differences in clinical manifestation and prognosis justify molecular differentiation between the two genotypes.