Major complications after distal biceps tendon repairs: retrospective cohort analysis of 970 cases.

BACKGROUND: The major complication and reoperation rates after distal biceps repair are poorly defined. The purpose of this large retrospective cohort study of distal biceps repairs performed by multiple surgeons within a large orthopedic group was to more clearly define the rates and risk factors of clinically impactful major complications and reoperations. METHODS: All distal biceps tendon repairs performed from January 2005 through April 2017 with a minimum 2-month follow-up were identified using Current Procedural Terminology code 24342. We included 970 patients. The primary outcome measure was the total major complication rate. Reoperations, minor complications, and risk factors were also tracked. RESULTS: Repairs were performed via a single anterior incision in 652 cases and a 2-incision exposure in 318 cases. A 7.5% major complication rate and 4.5% reoperation rate were observed overall. Major complications occurred at the following rates: proximal radioulnar synostosis, 1.0%; heterotopic ossification or loss of range of motion with reoperation, 0.9%; tendon rerupture, 1.6%; deep infection, 0.5%; posterior interosseous nerve palsy, 1.9%; and complex regional pain syndrome, 0.6%. The 2-incision exposure was identified as a significant risk factor for the development of proximal radioulnar synostosis when compared with single-incision repair techniques (P = .0003; odds ratio, 19), occurring in 2.8% of 2-incision exposure cases. Lateral antebrachial cutaneous nerve neuritis or numbness and radial sensory nerve neuritis or numbness were documented more frequently in the postoperative period among patients treated with a single-incision exposure (P < .0001 and P = .034, respectively). CONCLUSIONS: Distal biceps repair is associated with a 7.5% major complication rate and 4.5% reoperation rate. The use of a 2-incision technique for repair increases the risk of radioulnar synostosis.

Fixation of juvenile osteochondritis dissecans lesions of the knee using poly 96L/4D-lactide copolymer bioabsorbable implants.

BACKGROUND: The fixation of juvenile osteochondritis dissecans (OCD) lesions has been described using metal implants, staples, bone pegs, and bioabsorbable implants. Bioabsorbable fixation has potential benefits including not requiring a second surgery for implant removal, no interference on postoperative magnetic resonance imaging (MRI) scans, and a potentially lower incidence of prominent hardware. The possible complications of bioabsorbable fixation include synovitis, loss of fixation owing to noncompressive properties, and sterile abscess formation. The results of bioabsorbable fixation of juvenile OCD lesions of the knee have not been well studied. The purpose of this study was to evaluate the efficacy and safety of a bioabsorbable copolymer fixation in the management of unstable OCD lesions of the knee in adolescents. METHODS: This is a retrospective case series of patients with unstable OCD lesions of the knee that were treated with poly 96L/4D-lactide copolymer bioabsorable implants. Information was gathered through 3 standardized and validated knee-function questionnaires, participants' medical records, plain films, MRIs, and pain level and satisfaction scale questionnaires. RESULTS: Twenty-four knees in 24 patients were evaluated. The mean age at the time of surgery was 14.4 years. The mean follow-up was 39.6 months. The mean International Knee Documentation Committee score at follow-up was 84.9, the mean Lysholm score was 88.0, and the mean Tegner score was 7.9. Plain films at an average of 19.2 months postoperatively revealed interval healing in 9 patients, no significant change in 1 patient, complete healing in 13 patients, and loose bodies with no interval healing in 1 patient. MRIs were obtained postoperatively in 17 knees, with a mean follow-up of 22.4 months. Interval healing was present in 16 of 17 MRIs, consistent with the plain film findings. Twenty-two of 24 patients had good-to-excellent outcomes. CONCLUSION: Poly 96L/4D-lactide copolymer bioabsorable implants seem to be safe and effective for the management of unstable juvenile OCD lesions of the knee. They offer stability for the healing OCD lesions, with minimal reaction from degradation products.

Internal fixation of juvenile osteochondritis dissecans lesions of the knee.

BACKGROUND: Operative techniques for the management of juvenile osteochondritis dissecans lesions of the knee include drilling, internal fixation, fragment removal, and chondral resurfacing. PURPOSE: To evaluate the functional and radiographic outcome of internal fixation of juvenile osteochondritis dissecans lesions of the knee. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The study design was a retrospective case series. Twenty-six knees in 24 skeletally immature patients underwent internal fixation of osteochondritis dissecans lesions. Mean follow-up was 4.25 years (range, 2-14.75 years). Mean patient age was 14.7 years (range, 11-16 years). There were 13 boys and 11 girls. Lesions were graded per the Ewing and Voto classification, with 9 stage II lesions (fissured), 11 stage III lesions (partially attached), and 6 stage IV lesions (detached). Methods of internal fixation included variable pitch screws (n = 11), bioabsorbable tacks (n = 10), partially threaded cannulated screws (n = 3), and bioabsorbable pins (n = 3). Mean follow-up was 4.25 years (range, 2.0-14.75 years). RESULTS: Healing occurred in 22 of 26 lesions (healing rate, 84.6%). There was no significant difference in healing rate for lesion location, fixation method, or lesion grade. In fact, all 6 stage IV (detached) lesions healed. The mean postoperative Lysholm score was 85.8, mean postoperative International Knee Documentation Committee score was 82.6, and mean postoperative Tegner activity level was 7.4. Mean time to healing was 6 months. Eight patients underwent additional procedures: 4 for nonunion, 1 for hemarthrosis, and 3 for elective screw removal. CONCLUSION: Given the relatively high healing rate, good functional outcome, and low complication rate, the authors advocate internal fixation of unstable juvenile osteochondritis dissecans lesions of the knee, even for detached lesions and in patients with a history of surgery for the osteochondritis dissecans lesion.

Arthroscopic hip labral repair: the iberian suture technique.

Arthroscopic hip labral repair has beneficial short-term outcomes; however, debate exists regarding ideal surgical labral repair technique. This technical note presents an arthroscopic repair technique that uses intrasubstance labral suture passage to restore the chondrolabral interface. This "Iberian suture technique" allows for an anatomic repair while posing minimal risk of damage to the labral and chondral tissues.

Surgical treatment of unresolved Osgood-Schlatter disease: ossicle resection with tibial tubercleplasty.

UNLABELLED: The mainstay of treatment of Osgood-Schlatter apophysitis is nonoperative. Surgical treatment has been described for patients who have failed nonoperative management of Osgood-Schlatter disease. The purpose of this study is to evaluate the functional outcome of ossicle excision and tibial tubercleplasty for unresolved Osgood-Schlatter disease that has failed nonoperative treatment. METHODS: A retrospective review was performed on 16 knees in 15 patients who underwent ossicle excision and tibial tubercleplasty for unresolved Osgood-Schlatter disease. Functional outcome was assessed using the International Knee Documentation Committee, the Lysholm Knee Scale, and Tegner Activity Score. RESULTS: Twelve patients (75%) returned to preoperative activities and sports, 2 patients (12.5%) partially returned, and 1 patient (6%) did not return. The mean postoperative Lysholm knee score was 76.5. Patients' individual scores ranged from 40 to 100. The mean International Knee Documentation Committee knee score was 75, ranging from 40 to 100. The mean Tegner activity level was 6.8 (range, 3-10). CONCLUSIONS: It is our recommendation that when patients fail extensive nonoperative management, surgery to remove the symptomatic ossicle should be offered after skeletal maturity. When this is the case, the addition of tubercleplasty should be performed.