Semitendinosus vs Gracilis Grafts With 1- vs 2-Tunnel Techniques for Coracoclavicular Ligament Reconstruction: A Biomechanical Study.

BACKGROUND: Despite the evolution of acromioclavicular joint surgery to a more anatomic coracoclavicular (CC) ligament reconstruction, no definitive guidance regarding the number and position of bone tunnels in the clavicle, as well as the ideal graft choice, is established. PURPOSE/HYPOTHESIS: The purpose of this study was to biomechanically compare the reconstruction of the CC ligament complex between gracilis- and semitendinosus-tendon grafts in 1- and 2-tunnel techniques. It was hypothesized that the gracilis tendon graft will provide comparable primary stability in both tunnel techniques while utilizing a smaller tunnel diameter. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 24 cadaveric shoulders (13 men, 11 women; 66 ± 7.5 years) were randomly allocated to 4 repair groups: gracilis with 1 tunnel (GT-1), gracilis with 2 tunnels (GT-2), semitendinosus with 1 tunnel (ST-1), and semitendinosus with 2 tunnels (ST-2). First, specimens were tested for native anterior, posterior, and superior translations. Then, specimens were randomly assigned to 1 of the 4 CC reconstruction groups before undergoing the same testing, followed by cyclic loading and load to failure (LTF). RESULTS: The GT-2 reconstruction demonstrated significantly less translation when compared with ST-2 in anterior (P = .024) and posterior (P = .048) directions. GT-1 and ST-2 both showed significantly less translation than ST-1 in anterior and superior directions (P < .001). All reconstructions demonstrated less superior translation compared with native testing, with GT-1 and ST-2 significantly less than ST-1 (P < .001). There were no significant differences for peak displacement and LTF between groups. CONCLUSION: Gracilis tendon grafts using a 1- or 2-tunnel technique for CC ligament reconstruction provided comparable translation, displacement, and LTF as corresponding semitendinosus grafts. Therefore, the gracilis tendon should be considered as a biomechanical equivalent graft choice for the reconstruction of the CC ligament complex. CLINICAL RELEVANCE: In a cadaveric model, the gracilis tendon demonstrated adequate fixation with minimal translation in CC ligament reconstruction while utilizing smaller diameter bone tunnels, which may help minimize the risk of complications such as loss of reduction and fracture.

Outcomes of Total Shoulder Arthroplasty With Posterior Capsular Plication.

BACKGROUND: Glenoid loosening and instability are among the most common complications after anatomic total shoulder arthroplasty (TSA), resulting in poor function. Posterior instability is one contributing factor. The purpose of this study is to report the clinical and radiographic outcomes of a series of patients treated with posterior capsule plication for intraoperative posterior instability during TSA. It is hypothesized that patients undergoing this procedure will have improvement in posterior stability intraoperatively while not limiting their ROM postoperatively. METHODS: Patients of the senior author were identified who had undergone TSA with posterior capsule plication from 2014 to 2015 based on Current Procedural Terminology (CPT) codes. Their records and preoperative radiographs were retrospectively reviewed for demographic data and preoperative range of motion (ROM) which was documented in the clinic notes. Patients were then evaluated postoperatively to determine the outcomes after TSA with posterior capsule plication. Final follow-up was conducted via telephone survey. RESULTS: Nineteen patients were identified for review; however, only 14 had all imaging available. The mean age at the time of surgery was 63 years. There were 2 A1, 6 B1, and 6 B2 Walch-type glenoids based on preoperative imaging. All but one had equivalent or better ROM for active forward elevation and external rotation postoperatively. One patient required return to operating room at 5 months after developing adhesive capsulitis. CONCLUSION: This study indicates that the use of posterior capsule plication during TSA is a safe method to address posterior subluxation, while still allowing for improved ROM postoperatively.

Leiomyoma of the Foot and Ankle: A Case Series.

Leiomyoma is a benign soft-tissue tumor that can arise in any soft tissue; however, in the extremities, it is usually a subcutaneous mass. Masses in the foot and ankle in general are rare, and few reports in the literature describe leiomyoma in this region of the body. We present a series of 8 cases of leiomyoma of the foot and ankle, 4 of which are subclassified as angioleiomyomas. The characteristic patient presentation, imaging, and histological findings are presented here to increase awareness of this soft-tissue mass in the foot and ankle. LEVELS OF EVIDENCE: Level V.