Superior humeral head osteophytes are associated with rotator cuff insufficiency in glenohumeral osteoarthritis: a retrospective analysis.

PURPOSE: The primary goal of this study was to investigate whether superior humeral head osteophyte (SHO) size is associated with rotator cuff insufficiency, including rotator cuff tear (RCT), supraspinatus tendon thickness, and fatty infiltration of the rotator cuff muscles. METHODS: Patients ≥ 18 years who were diagnosed with glenohumeral osteoarthritis were retrospectively reviewed. SHO size was determined by radiograph. MRI measured SHO and RCT presence, type, and size; supraspinatus tendon thickness; and fatty infiltration of rotator cuff musculature. RESULTS: A total of 461 patients were included. Mean SHO size was 1.93 mm on radiographs and 2.13 mm on MRI. Risk ratio for a RCT was 1.14. For each 1-mm increase in SHO size on radiograph, supraspinatus tendon thickness decreased by 0.20 mm. SHO presence was associated with moderate-to-severe fatty infiltration of the supraspinatus with a risk ratio of 3.16. CONCLUSION: SHOs were not associated with RCT but were associated with higher risk of supraspinatus FI and decreased tendon thickness, which could indicate rotator cuff insufficiency. LEVEL OF EVIDENCE: IV.

Infantile Flexor Tendon Lacerations: Surgical Technique and Illustrative Case.

Infantile flexor tendon lacerations are rare, with few cases reported. Surgical intervention in this age group is favorable, but there are several factors that add to the complexity of these injuries, such as small hand anatomy, frequent delays in diagnosis, and difficulties with postoperative rehabilitation. This article describes a 2-strand flexor tendon repair technique in a 10-month-old female infant.

Incidence of Encountering the Infrapatellar Nerve Branch of the Saphenous Nerve During a Midline Approach for Total Knee Arthroplasty.

The infrapatellar nerve branch (IPNB) of the saphenous nerve supplies cutaneous sensation to the anterolateral knee. Given its location and variable course, the IPNB is suspected to be at risk of injury with commonly used incisions around the knee. Nerve injury may lead to painful neuroma formation. To our knowledge, no study has evaluated the incidence at which the IPNB is encountered during the anterior approach incision for a routine total knee arthroplasty (TKA). The purpose of this study was to see whether the general joint arthroplasty surgeon can identify and examine the location of the IPNB encountered during primary TKA and to determine whether these branches would be transected during a standard medial arthrotomy. METHODS: Seventy-three patients (76 knees) underwent primary TKA using a standard midline approach with a medial parapatellar arthrotomy. The IPNB was identified, and the distance was measured from the inferior pole of the patella to the point where the nerve crossed the medial border of the patellar tendon. This distance was then compared with the length of the arthrotomy in the same knee to determine whether the nerve would be transected. RESULTS: The IPNB was encountered in all knees with a mean distance of 2.82 cm (95% confidence interval, 2.58-3.06) distal to the inferior pole of the patella during the arthrotomy. Patient characteristics including sex, height, and body mass index were not markedly associated with nerve location. CONCLUSION: The IPNB of the saphenous nerve is at risk for injury and routinely encountered by the general orthopaedic surgeon during a standard TKA medial parapatellar approach without the aid of magnification or dye.