Advantages and techniques of utilizing anterolateral portal in delaminated rotator cuff repair.

Typically, rotator cuff repair is performed two-dimensionally while visualizing the subacromial space. To achieve a more complete repair, sutures can be retrieved from inside the joint utilizing a penetrating suture device through the anterolateral portal, which permits visualization of the articular side and bursal side of the rotator cuff tear. Utilizing other portals can leave the sutures out of sight and reach. The anterolateral portal helps capture both leaves of a delaminated tear and places the sutures in the center of the field for retrieval and tying. The anterolateral portal is located with a spinal needle just off the anterolateral corner of the acromion, and the suture anchor is inserted into the greater tuberosity through this portal. The sutures are passed into the joint through the tear in the rotator cuff with a suture grasper. The scope is redirected intraarticularly, and the suture is visualized. The sutures are positioned, and the penetrator is passed through the tendon. The scope is placed back in the bursa for tying sutures and capturing both leaves of a delaminated tear. It works equally well for simple complete tears and partial articular-sided supraspinatus tendon avulsion lesions.

The Starfish Procedure for Independent Digital Control of a Myoelectric Prosthesis.

Management of partial hand amputations is a notable clinical challenge. Historically, myoelectric prostheses have not allowed for independent digital control, resulting in unsatisfactory function and high rejection rates among upper extremity amputees. The Starfish Procedure was developed for patients who sustained loss of multiple digits through the level of the base of the proximal phalanx or distal metacarpal. The procedure involves the pedicled transfer of 1 or more dorsal interosseous muscles to a subcutaneous location. This allows for a myoelectric sensor to capture the signals generated by these transferred muscles, thereby enabling intuitive, independent, digital prosthetic flexion and extension. In this article, we detail the relevant anatomy, indications, and technique for performing the Starfish Procedure. Given our patients' promising outcomes to date, we hope this technique paper will encourage upper extremity surgeons of all training backgrounds to perform this relatively straightforward procedure, thereby allowing patients with life-altering finger amputations to regain meaningful function by enhancing control of digital prostheses.

Daptomycin-Tobramycin Cement Beads have Lethal Local Antibacterial Effect in Resistant Periprosthetic Joint Infections.

Background Resistant periprosthetic joint infection (PJI) can be a devastating complication of surgery and is difficult to treat. We attempted to identify the utility of Daptomycin/Tobramycin-impregnated polymethylmethacrylate (PMMA) beads in resistant PJIs. Methods Charts of patients with hip or knee PJI at a single academic medical center, with surgeries performed from May 2008 through May 2018, were reviewed retrospectively. The diagnosis of PJI was consistent with the Musculoskeletal Infection Society recommendations. Prosthetic joints underwent radical anterior-posterior synovectomy and placement of antibiotic cement beads in the infected joint. Clinical cure rate and local intraarticular antibiotic concentration were measured. Results Forty-four patients experienced 53 episodes of PJI, requiring 88 surgeries. There was a fairly even split between hip and knee PJI. The cure rate was 92% (11/12) for patients who had any infection with methicillin-resistant staphylococci during the evaluation period, compared with 62% (13/21) for patients with methicillin-susceptible Staphylococci. On days one and seven, the addition of tobramycin increased daptomycin concentrations by 47% and 3374%, respectively, for beads made onsite compared to elution of daptomycin alone. Elution increased by 44% and 8394%, respectively, for commercial beads compared to beads fabricated onsite. Conclusions Daptomycin-Tobramycin-loaded PMMA beads are safe and powerful bactericidal agents in prosthetic joint infections.

Proprioception and Knee Arthroplasty: A Literature Review.

Proprioceptive mechanoreceptors provide neural feedback for position in space and are critical for three-dimensional interaction. Proprioception is decreased with osteoarthritis of the knees, which leads to increased risk of falling. As the prevalence of osteoarthritis increases so does the need for total knee arthroplasty (TKA), and knowing the effect of TKA on proprioception is essential. This article reviews the literature regarding proprioception and its relationship to balance, aging, osteoarthritis, and the effect of TKA on proprioception. Knee arthroplasty involving retention of the cruciate ligaments is also reviewed, as well the evidence of proprioception in the posterior cruciate ligament after TKA.