Double-bundle anterior cruciate ligament reconstruction using autologous hamstrings with LARS augmentation demonstrates comparable outcomes to hamstrings alone, without evidence of synovitis or early osteoarthritis.

PURPOSE: To compare the clinical and radiological outcomes in patients undergoing anterior cruciate ligament reconstruction (ACLR) with, or without, LARS augmentation. METHODS: One-hundred and thirty-six patients that underwent double-bundle ACLR with (DB Hams/LARS, n = 67), or without (DB Hams, n = 69), LARS augmentation, were assessed clinically and with Magnetic Resonance Imaging (MRI) at a minimum of 7-years post-surgery. Patients were assessed via patient-reported outcome measures (PROMs), KT-1000 (laxity), isokinetic knee extensor and flexor strength and a 4-hop test battery. Limb symmetry indices (LSIs) were calculated. The Whole-Organ Magnetic Resonance Imaging Score (WORMS) evaluated knee status via MRI. Sport participation, secondary operations, ACL re-tears and contralateral ACL tears were reported. RESULTS: No differences (n.s.) were observed in demographics, PROMs, KT-1000 scores or strength and hop LSIs. Normal (< 3 mm side-to-side differences) KT-1000 scores were observed in 64 (92.8%) and 59 (88.1%) of DB Hams and DB Hams/LARS patients, respectively. Comparative rates of satisfaction were reported. Knee flexor strength and hop test LSIs were all ˃95% in both groups, which was 94.2% and 96.7% for knee extensor strength in the DB Hams and DB Hams/LARS cohorts, respectively. While 53 (76.8%) and 52 (77.6%) of the DB Hams and DB Hams/LARS patients had returned to pivoting sports, 42 (60.9%) and 41 (61.2%) were participating in pivoting sports at the minimum 7-year review. No difference (n.s.) was observed in the WORMS (12.3 DB Hams, 16.7 DB Hams/LARS). Of the cohort assessed, 8 (11%) DB Hams and 11 (16%) DB Hams/LARS patients had undergone secondary surgery. In addition to one patient in each group that demonstrated ACL rupture on MRI, an additional cohort of patients were excluded from the current analysis due to prior re-tear (DB Hams n = 6, DB Hams/LARS n = 8) or contralateral ACL tear (DB Hams n = 4, DB Hams/LARS n = 4). CONCLUSIONS: Comparable outcomes were observed after double-bundle ACLR using autologous hamstrings with, or without, LARS augmentation. Therefore, while these outcomes do not justify the additional use of synthetic augmentation given the lack of further benefit and additional cost, higher rates of graft failure, synovitis and early osteoarthritic change previously reported were not observed. LEVEL OF EVIDENCE: III.

Piriformis-Sparing Minimally Invasive Versus the Standard Posterior Approach for Total Hip Arthroplasty: A 10-Year Follow-Up of a Randomized Control Trial.

BACKGROUND: Despite the popularity of minimally invasive approaches in total hip arthroplasty, studies regarding their impact on soft tissues and long-term benefits are lacking. This study aims to compare the 10-year functional outcome of the piriformis-sparing minimally invasive approach to the standard posterior approach for total hip arthroplasty surgery. METHODS: Hundred patients were randomized, 48 patients to the piriformis-sparing approach and 52 to the standard approach. Primary outcomes were hip function and piriformis muscle volume and grade on magnetic resonance imaging. Secondary outcomes were pain, satisfaction score, and complications. Evaluators were blinded to allocation. Participants were followed up to 10 years. RESULTS: Ten years following surgery, both groups reported excellent pain relief, improved hip function, and high satisfaction. The significant differences were improvement in piriformis muscle volume (P = .001) and muscle grade (P = .007) in the piriformis-sparing group compared to the standard group. There were no significant differences in all other outcomes. CONCLUSION: Aside from being less injurious to the piriformis muscle, the piriformis-sparing approach offered the same long-term functional benefits as the standard posterior approach at 10 years.

Eight-Week Return to Play Following Latarjet Shoulder Reconstruction in an Australian Football Player: A Case Report.

INTRODUCTION: Anterior shoulder dislocation is a common injury in many sports, resulting in extended time lost from play with an extremely high recurrence rate in young athletes playing a high-risk sport. Latarjet shoulder reconstruction is a common surgical procedure used to prevent subsequent dislocation with an expected rehabilitation time frame of between 4 and 6 months before return to play. CASE DESCRIPTION: A 21-year-old male Australian football player experienced 2 left-sided shoulder dislocations before undergoing a left Latarjet shoulder reconstruction. He was assessed clinically and with magnetic resonance imaging, which revealed significant tearing of the anterior labrum. The authors theorized that maximal glenohumeral stability occurs after bony healing of the coracoid onto the glenoid at 6 weeks. The patient then underwent an 8-week structured and graduated rehabilitation program aimed at preventing loss of shoulder range of motion, muscle, and functional capacity and returned to play at 8 weeks postinjury with no complications or recurrence at 12-month follow-up. DISCUSSION: This is the first time an 8-week rehabilitation following Latarjet shoulder reconstruction has been reported. In athletes with anterior glenohumeral dislocation who require accelerated return to play, a Latarjet reconstruction with an 8-week rehabilitation protocol may be considered.

Adaptation of a MR imaging protocol into a real-time clinical biometric ultrasound protocol for persons with spinal cord injury at risk for deep tissue injury: A reliability study.

BACKGROUND: High strain in soft tissues that overly bony prominences are considered a risk factor for pressure ulcers (PUs) following spinal cord impairment (SCI) and have been computed using Finite Element methods (FEM). The aim of this study was to translate a MRI protocol into ultrasound (US) and determine between-operator reliability of expert sonographers measuring diameter of the inferior curvature of the ischial tuberosity (IT) and the thickness of the overlying soft tissue layers on able-bodied (AB) and SCI using real-time ultrasound. MATERIAL AND METHODS: Part 1: Fourteen AB participants with a mean age of 36.7 ± 12.09 years with 7 males and 7 females had their 3 soft tissue layers in loaded and unloaded sitting measured independently by 2 sonographers: tendon/muscle, skin/fat and total soft tissue and the diameter of the IT in its short and long axis. Part 2: Nineteen participants with SCI were screened, three were excluded due to abnormal skin signs, and eight participants (42%) were excluded for abnormal US signs with normal skin. Eight SCI participants with a mean age of 31.6 ± 13.6 years and all male with 4 paraplegics and 4 tetraplegics were measured by the same sonographers for skin, fat, tendon, muscle and total. Skin/fat and tendon/muscle were computed. RESULTS: AB between-operator reliability was good (ICC = 0.81-0.90) for 3 soft tissues layers in unloaded and loaded sitting and poor for both IT short and long axis (ICC = -0.028 and -0.01). SCI between-operator reliability was good in unloaded and loaded for total, muscle, fat, skin/fat, tendon/muscle (ICC = 0.75-0.97) and poor for tendon (ICC = 0.26 unloaded and ICC = -0.71 loaded) and skin (ICC = 0.37 unloaded and ICC = 0.10). CONCLUSION: A MRI protocol was successfully adapted for a reliable 3 soft tissue layer model and could be used in a 2-D FEM model designed to estimate soft tissue strain as a novel risk factor for the development of a PU.

Cortical desmoid of the humerus: radiographic and MRI correlation.

Cortical desmoids are self-limiting fibro-osseous lesions commonly occurring at the medial supracondylar femur in active adolescents, at either the origin of the medial head of the gastrocnemius or at the insertion of the adductor magnus aponeurosis. Less commonly, in a similar demographic, cortical desmoids may occur in the proximal humerus medially at the insertion of the pectoralis major muscle or laterally at the insertion of the deltoid. The radiographic appearance of the proximal humerus cortical desmoid has been described previously, but not the MRI appearance. We present the radiographic and MRI appearances of a proximal humerus cortical desmoid in a young adolescent who presented for investigation of right shoulder pain.

Early postoperative repair status after rotator cuff repair cannot be accurately classified using questionnaires of patient function and isokinetic strength evaluation.

BACKGROUND: This study investigated if patients with an intact tendon repair or partial-thickness retear early after rotator cuff repair display differences in clinical evaluations and whether early tendon healing can be predicted using these assessments. METHODS: We prospectively evaluated 60 patients at 16 weeks after arthroscopic supraspinatus repair. Evaluation included the Oxford Shoulder Score, 11-item version of the Disabilities of the Arm, Shoulder and Hand, visual analog scale for pain, 12-item Short Form Health Survey, isokinetic strength, and magnetic resonance imaging (MRI). Independent t tests investigated clinical differences in patients based on the Sugaya MRI rotator cuff classification system (grades 1, 2, or 3). Discriminant analysis determined whether intact repairs (Sugaya grade 1) and partial-thickness retears (Sugaya grades 2 and 3) could be predicted. RESULTS: No differences (P < .05) existed in the clinical or strength measures. Although discriminant analysis revealed the 11-item version of the Disabilities of the Arm, Shoulder and Hand produced a 97% true-positive rate for predicting partial thickness retears, it also produced a 90% false-positive rate whereby it incorrectly predicted a retear in 90% of patients whose repair was intact. The ability to discriminate between groups was enhanced with up to 5 variables entered; however, only 87% of the partial-retear group and 36% of the intact-repair group were correctly classified. CONCLUSIONS: No differences in clinical scores existed between patients stratified by the Sugaya MRI classification system at 16 weeks. An intact repair or partial-thickness retear could not be accurately predicted. Our results suggest that correct classification of healing in the early postoperative stages should involve imaging.

The existence of cords in olecranon bursae.

BACKGROUND: The purpose of this study was to document the existence of transverse cords in olecranon bursae in patients undergoing excision of the bursa and to describe the unique clinical presentation of patients with these cords. METHODS: A retrospective study was performed on 24 patients who had surgery to excise an olecranon bursa between 2006 and 2011. The patient's history, preoperative radiographs, ultrasound images, intraoperative photographs, and findings on histologic analysis were reviewed in all cases. RESULTS: Nine olecranon bursae had cords (cord group) and 15 did not have cords (noncord group). All patients in the cord group were male manual laborers, and nearly all had olecranon enthesophytes (n = 8). Patients in the noncord group had associated medical conditions or an infection. A higher level of satisfaction was reported in the noncord group after surgical excision. CONCLUSION: This study documents the existence of transverse cords oriented at right angles to the long axis of the olecranon. Olecranon bursae with cords have a unique presentation and are found in male manual workers, are nearly always associated with an olecranon enthesophyte, and do not present with infections.

Serial MRI and clinical assessment of cyclops lesions.

PURPOSE: 'Clinical cyclops syndrome' is associated with pain and a palpable 'clunk' at terminal extension with the loss of full extension. The aims of this prospective controlled study were: (1) to assess whether the minimal debridement of the ACL stump and notch is associated with an increased incidence of clinical cyclops lesions, (2) to look at the incidence and natural history of 'MRI cyclops' lesions using serial MRI's and (3) to assess whether 'MRI cyclops' lesions are associated with the loss of extension. METHODS: Forty-eight patients were randomized for ACL reconstruction into standard (23) and minimal debridement (24) techniques. One patient was excluded from the study. All patients underwent MR scanning postoperatively at 2, 6 and 12 months, together with the clinical assessment using a KT-1000 arthrometer and International Knee Documentation Committee evaluation. All observations were made by investigators blinded to the surgical technique. RESULTS: There was no statistical difference in the incidence of cyclops lesions between the two groups (n.s.). The overall incidence of cyclops lesions was 46.8% (22 of 47). The natural history is variable with some getting larger, smaller or remaining static in size. Of patients with cyclops lesions, 17 patients (77%) had cyclops lesions in the setting of full extension. Five patients (23%) had loss of extension at 12 months with no MRI cyclops detected at 2 months. CONCLUSIONS: The natural history is variable; although once present, the majority of cyclops remain static or regress in size. The onset of cyclops lesions is usually between 6- and 12-month post-ACL reconstruction. Minimal debridement does not lead to an increased incidence of clinical cyclops lesions. The authors conclude that loss of extension is multi-factorial, and there is a discrepancy between what we term 'MRI cyclops' and true 'clinical cyclops'. LEVEL OF EVIDENCE: Case-control study, Level II.

Presentation of multiple painful subcutaneous nodules: Dercum's disease, a rare variant of lipoma.

A woman in her 50s presented to her general practitioner (GP) with an 8-month history of multiple painful subcutaneous nodules of various sizes in her trunk and limbs. Her previous GP made the clinical diagnosis of lipoma when they presented as non-painful nodules 2 years ago. Initial ultrasound demonstrated multiple lipomata with the largest size in the left upper thighs displaying features of subtle internal vascularity, entirely contained within the subcutaneous layer. MRI scan of thigh lesions showed multiple angiolipomas consistent with the entity of Dercum's disease. Subsequent biopsy histology confirmed the image diagnosis of angiolipoma. She was referred to a musculoskeletal oncological surgeon for evaluation and reassurance regarding optimising medical management of her associated obesity. Her angiolipoma and obesity are well managed by her GP. This case highlights the diagnostic workup of a rare variant of lipoma, Dercum's disease. The differential diagnosis of multiple painful lipomas was reviewed and discussed, consequently leading to the discussion of managing the associated obesity in this case.

Development and application of a proximal hamstring MRI-based scoring tool in patients undergoing proximal hamstring tendon surgical repair.

Purpose: An MRI-based scoring tool assessing surgical repair after proximal hamstring avulsions may provide benefit in the context of research, while serial post-operative MRI will provide insight of what to expect in the clinical context of early re-injury requiring imaging. This study developed and assessed the reliability of a Proximal Hamstring Objective Magnetic Resonance Imaging Score (PHOMRIS), further assessing MRI-based repair status and its correlation with patient-reported outcome. Methods: 15 patients that underwent proximal hamstring surgical repair underwent MRI and clinical review pre-operatively and at 3-, 6- and 12-months. Clinical scores included the Lower Extremity Functional Scale (LEFS), the Perth Hamstring Assessment Tool (PHAT) and Tegner Activity Scale (TAS). The MRI-based tool assessed the conjoint (semitendinosus & biceps femoris) and semimembranosus insertion components based on bone-tendon healing, signal and retraction. Inter- and intra-observer reliability of the tool was assessed. Results: Inter-observer reliability indicated a strong correlation for the semimembranosus (rho = 0.827, p < 0.0001) and conjoint (rho = 0.851, p < 0.0001) components. Intra-observer reliability indicated a strong correlation for the semimembranosus (rho = 0.852, p < 0.0001) and conjoint (rho = 0.996, p < 0.0001) components. All clinical scores and the semimembranosus hamstrings component MRI score significantly improved (p < 0.05) over time, though the conjoint component did not (p = 0.219). At 12 months, a higher LEFS was significantly associated with a better semimembranosus MRI score (r = -0.57, p = 0.042), though no other significant correlations (p > 0.05) were observed between clinical and MRI measures. Conclusions: Excellent reliability was observed for the MRI-based scoring tool, which may prove useful in both a research and clinical setting.

Magnetic resonance imaging features of preserved vs divided and repaired piriformis during total hip arthroplasty: a randomized controlled trial.

The aim of this study was to compare the muscle grade and bulk of the divided and repaired piriformis tendon by the standard posterior approach with the preserved tendon by a piriformis-sparing (PS) approach, in total hip arthroplasty. Twenty-two patients were randomized to either approach. Patients received preoperative and 3 months and 2 years postoperative magnetic resonance imaging scans. Patients and evaluators were blinded to allocation. There was significantly less deterioration in piriformis muscle grade (P = .029) and bulk (P = .015) in the PS group at 3 months. At 2 years, only the difference in grade remained significant (P = .001). There was no difference in Oxford hip scores. In conclusion, a PS approach avoids the marked wasting and deterioration in muscle grade that occurs postoperatively in the standard posterior approach.

Arthroscopic Bone Graft and Internal Fixation of Non-Union of the Proximal Pole of the Scaphoid: Surgical Technique and Outcomes.

Background Fractures of the proximal pole of the scaphoid have been associated with delayed union, non-union, and avascular necrosis. This has been attributed to avascularity of the proximal pole of the scaphoid. While proximal pole non-unions can be successfully treated using open techniques, there is little information in the literature regarding arthroscopic bone graft and internal fixation of proximal pole non-unions. Description of Technique After insertion of a 1.2-mm radiolunate K-wire, the scaphoid non-union was arthroscopically excised, bone grafted with iliac crest cancellous bone, and internally fixed with 3 × 1.2 mm K-wires. Patients and Methods This is a retrospective study of patients who had arthroscopic bone graft of non-union of the proximal pole of the scaphoid between 2009 and 2021. Results There were 30 cases in this study; 29 cases united. The one case that did not unite was caused by inadequate fixation of the proximal pole. The size of the proximal pole did not influence the outcome. Conclusion Arthroscopic bone graft and internal fixation is a reliable technique for the treatment of non-union of the proximal pole of the scaphoid.

The reliability and validity of magnetic resonance imaging in the assessment of chronic lateral epicondylitis.

PURPOSE: Lateral epicondylitis is a painful condition affecting the proximal enthesis of the extensor carpi radialis brevis tendon. Although magnetic resonance imaging (MRI) has been highlighted as an important diagnostic tool, to our knowledge no previous study has established the observer reliability of MRI for lateral epicondylitis or the relationship between MRI abnormalities of the common extensor origin and the patient's clinical assessment. METHODS: Twenty-one consecutive subjects with a clinical diagnosis of chronic lateral epicondylitis were assessed. An MRI scoring system was used to grade the degree of tendinosis and length of tendon separation of the common extensor origin from the lateral epicondyle. Three independent musculoskeletal radiologists, who were blinded to patient clinical severity, scored images separately. Each scored the images on 3 separate occasions. Clinical symptoms were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Upper Extremity Functional Scale clinical measures. Maximum pain levels were scored on a visual analog scale, and objective assessment was made with grip strength. RESULTS: Moderate or severe signal changes consistent with tendinosis were observed in 18 of 21 patients. Significant inter-observer reliability and intra-observer agreement were demonstrated for MRI interpretation of grade of tendinosis and length of tendon separation. Significant negative correlation was found between the length of tendon separation and both the QuickDASH and maximum pain levels. CONCLUSIONS: Magnetic resonance imaging is a reliable tool in determining radiological severity of lateral epicondylitis. However, the severity of MRI signal changes does not positively correlate with symptoms. These findings question the validity of MRI in the assessment of lateral epicondylitis.

A bio-inductive collagen scaffold that supports human primary tendon-derived cell growth for rotator cuff repair.

BACKGROUND: Rotator Cuff (RC) tendon tearing is a common clinical problem and there is a high incidence of revision surgery due to re-tearing. In an effort to improve patient outcome and reduce surgical revision, scaffolds have been widely used for augmentation of RC repairs. However, little is known about how scaffolds support tendon stem cell growth or facilitate tendon regeneration. The purpose of this study is to evaluate the structural and biological properties of a bioactive collagen scaffold (BCS) with the potential to promote tendon repair. Additionally, we conducted a pilot clinical study to assess the safety and feasibility of using the BCS for repair of RC tears. METHODS: A series of physical, ultrastructural, molecular and in vitro tests determined the biocompatibility and teno-inductive properties of this BCS. In addition, a prospective case study of 18 patients with RC tendon tears (>20 â€‹mm in diameter) was performed in an open-label, single-arm study, involving either mini-open or arthroscopic surgical RC repair with the BCS. Clinical assessment of RC repair status was undertaken by MRI-imaging at baseline, 6 and 12 months and patient evaluated questionnaires were taken at baseline as well as 3, 6 & 12 months. RESULTS: The BCS consists of highly purified type-I collagen, in bundles of varying diameter, arranged in a higher order tri-laminar structure. BCS have minimal immunogenicity, being cell and essentially DNA-free as well as uniformly negative for the porcine α-Gal protein. BCS seeded with human primary tendon-derived cells and exposed to 6% uniaxial loading conditions in vitro, supported increased levels of growth and proliferation as well as up-regulating expression of tenocyte differentiation marker genes including TNMD, Ten-C, Mohawk and Collagen-1α1. To test the safety and feasibility of using the BCS for augmentation of RC repairs, we followed the IDEAL framework and conducted a first, open-label single arm prospective case series study of 18 patients. One patient was withdrawn from the study at 3 months due to wound infection unrelated to the BCS. The remaining 17 cases showed that the BCS is safe to be implanted. The patients reported encouraging improvements in functional outcomes (ASES, OSS and Constant-Murley scores), as well as quality of life assessments (AQoL) and a reduction in VAS pain scores. MRI assessment at 12 months revealed complete healing in 64.8% patients (11/17), 3 partial thickness re-tears (17.6%) and 3 full thickness re-tears (17.6%). CONCLUSION: The BCS is composed of type-I collagen that is free of immunogenic proteins and supports tendon-derived cell growth under mechanical loading in vitro. This pilot study shows that it is safe and feasible to use BCS for RC argumentation and further controlled prospective studies are required to demonstrate its efficacy. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: The results of this study indicate that this bioactive collagen scaffold has unique properties for supporting tendon growth and that it is non-immunogenic. The clinical study further confirms that the scaffold is a promising biological device for augment of human rotator cuff repairs.

Muscle injuries of the lower leg.

Muscle injuries of the lower leg are a common cause for time off from sports, and may also be a cause of disability in nonathletes who have a running or "pushing off" injury as part of their activities of daily living. Most injuries can be managed without imaging, but in selected cases advanced imaging techniques can demonstrate the exact site and extent of the injury and potentially modify rehabilitation and return to sports. In experienced hands ultrasonography can identify the location of muscle injuries as well as aid in hematoma aspiration. It is useful for excluding differential diagnoses such as deep vein thrombosis or Baker's cyst and may be superior for investigating certain conditions such as muscle hernia. Magnetic resonance imaging is more sensitive for injury to deeper muscles and dual injuries and is generally the modality of choice in elite athletes.

Teres minor innervation in the context of isolated muscle atrophy.

PURPOSE: Teres minor atrophy occurs either in isolation, associated with other rotator cuff muscle pathologies or in quadrilateral space syndrome. In the latter condition, compression of the axillary nerve is the likely cause; however, the anatomy of the nerve to teres minor and how this may relate to isolated teres minor atrophy have not been extensively investigated. In light of the significance of teres minor atrophy in shoulder pathology, we performed a combined radiological and anatomical study of teres minor and its nerve supply. METHODS: Cadaveric dissection of nine shoulder specimens from eight cadavers was performed to investigate the anatomical variability in course, length and branching pattern of both the teres minor nerve and the axillary nerve. Radiological imaging and reports were analysed on all shoulder magnetic resonance images performed over a 1-week period at four radiology clinic locations in an attempt to identify the incidence of isolated teres minor atrophy and review teres minor atrophy in association with other shoulder pathology. Finally, we studied a case of isolated teres minor atrophy identified during a routine undergraduate dissection class. RESULTS: Considerable anatomical variation was noticed in cadaver dissections in the nerve(s) supplying teres minor muscle revealing several various points where it may be vulnerable to impingement or injury at along its course. Analysis of 61 shoulder MR images revealed two patients with shoulder complaints that had isolated teres minor atrophy. Case-based study of these two male patients revealed other associated shoulder injury but the presentation was markedly different and clinically distinct from quadrilateral space syndrome. CONCLUSION: Isolated teres minor atrophy is a relatively common shoulder pathology which appears to be clinically distinct from other syndromes with rotator cuff muscle atrophy including quadrilateral space syndrome. The exact aetiology is unknown but cadaveric dissection in this study suggests the considerable anatomical variation in both the origin and length of teres minor nerve(s) increase the risk of impingement and subsequent isolated teres minor atrophy.

Association of Preoperative Gluteal Muscle Fatty Infiltration With Patient Outcomes in Women After Hip Abductor Tendon Repair Augmented With LARS.

BACKGROUND: Hip abductor tendon repair has demonstrated encouraging outcomes. The influence of fatty infiltration (FI) on outcome has not been explored. PURPOSE: To investigate the association between preoperative hip abductor FI and clinical outcome after hip abductor tendon repair. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 84 women underwent hip abductor tendon repair. The mean age was 64.6 years (range, 43-84 years); body mass index, 27.7 (range, 20.0-40.2); and duration of symptoms, 3.4 years (range, 6 months-20 years). The 6-minute walk test, isometric hip abduction strength assessment, and patient-reported outcome measures, including the Harris Hip Score and Oxford Hip Score, were completed presurgery and 2 years after surgery. Patient satisfaction and perceived improvement were assessed 2 years after surgery. All patients underwent preoperative magnetic resonance imaging on the affected hip, and the Goutallier system was used to grade the degree of FI in the anterior, middle, and posterior thirds of the gluteus medius and minimus on a 0-4 ordinal scale. A single FI score for the gluteus medius and minimus was calculated, as was a combined FI score. RESULTS: All clinical scores significantly improved over time (P < .001). Preoperatively, FI was more severe in the gluteus minimus, with the most severe FI (grades 2-4) demonstrated in the middle (n = 56, 66.7%) and anterior (n = 17, 20.2%) portions of the gluteus minimus and the middle (n = 27, 32.1%) and anterior (n = 12, 14.3%) portions of the gluteus medius. Older age was associated with greater FI (combined FI score: r = 0.529, P < .001), although duration of symptoms (r = 0.035, P = .753) and body mass index (r = 0.089, P = .464) were not. Greater FI was associated with less improvement in hip strength of the unaffected leg (coefficient, -1.6, 95% CI: -2.8 to -0.4), although no other significant associations were observed between FI and pre- or postoperative clinical scores. CONCLUSION: Preoperative FI was not associated with pertinent parameters of patient outcome after hip abductor tendon repair, including pain, symptoms, functional capacity, perceived improvement, and satisfaction. Based on these outcomes, surgical repair may be considered in the presence of more severe FI.

Ultrasonography Detects Deep Tissue Injuries in the Subcutaneous Layers of the Buttocks Following Spinal Cord Injury.

Background: Ultrasonography may have potential as an effective diagnostic tool for deep tissue injury (DTI) in tissues overlying bony prominences that are vulnerable when under sustained loading in sitting. Methods: Three cases of DTI in the fat and muscle layers overlying the ischial tuberosity of the pelvis in 3 persons with spinal cord injury (SCI) with different medical histories and abnormal tissue signs are described. Conclusion: There is a need for prospective studies using a reliable standardized ultrasonography protocol to diagnose DTI and to follow its natural history to determine its association with the development of pressure injuries.

A Midterm Evaluation of Postoperative Platelet-Rich Plasma Injections on Arthroscopic Supraspinatus Repair: A Randomized Controlled Trial.

BACKGROUND: Platelet-rich plasma (PRP) has been applied as an adjunct to rotator cuff repair to improve tendon-bone healing and potentially reduce the incidence of subsequent tendon retears. PURPOSE: To investigate whether the midterm clinical and radiographic outcomes of arthroscopic supraspinatus repair are enhanced after repeated postoperative applications of PRP. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 60 patients (30 control; 30 PRP) were initially randomized to receive 2 ultrasound-guided injections of PRP to the tendon repair site at 7 and 14 days after double-row arthroscopic supraspinatus repair or not. A total of 55 patients (91.7%) underwent a clinical review and magnetic resonance imaging (MRI) at a mean of 3.5 years after surgery (range, 36-51 months). Patient-reported outcome measures (PROMs) included the Constant score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Oxford Shoulder Score (OSS), and visual analog scale (VAS) for pain. Global rating of change (GRC) scale and patient satisfaction scores were evaluated. Structural integrity of the surgical repair was assessed via MRI using the Sugaya classification system. RESULTS: At the midterm review, there was no difference between the groups for any of the PROMs. No differences between the groups were demonstrated for the subjective and range of motion subscales of the Constant score, although a significantly higher Constant strength subscale score was observed in the PRP group (3.3 points; 95% CI, 1.0-5.7; P = .006). There was no evidence for any group differences in MRI scores or retear rates, with 66.7% of PRP patients and 64.3% of control patients rated as Sugaya grade 1. Two control patients had symptomatic retears (both full thickness) within the first 16 weeks after surgery compared with 2 PRP patients, who suffered symptomatic retears (both partial thickness) between 16 weeks and a mean 3.5-year follow-up. CONCLUSION: Significant postoperative clinical improvements and high levels of patient satisfaction were observed in patients at the midterm review after supraspinatus repair. While pain-free, maximal abduction strength was greater in the midterm after PRP treatment, repeated applications of PRP delivered at 7 and 14 days after surgery provided no additional benefit to tendon integrity.

Autologous Tenocyte Injection for the Treatment of Chronic Recalcitrant Gluteal Tendinopathy: A Prospective Pilot Study.

BACKGROUND: Gluteal tendinopathy is a common cause of lateral hip pain, and existing conservative treatment modalities demonstrate high symptom recurrence rates. Autologous tenocyte injection (ATI) is a promising cell therapy that may be useful for the treatment of gluteal tendinopathy. PURPOSE: To investigate the safety and effectiveness of ATI, specifically in patients with chronic recalcitrant gluteal tendinopathy. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twelve female patients with a clinical and radiological diagnosis of gluteal tendinopathy were recruited. Patients demonstrated a mean duration of symptoms of 33 months (range, 6-144 months), had undergone a mean 3.2 prior corticosteroid injections (range, 2-5), and had failed to respond to existing conservative treatments including physiotherapy and injections. In an initial procedure, tendon cells were harvested from a needle biopsy of the patella tendon and propagated in a certified Good Manufacturing Practice (GMP) laboratory. In a secondary procedure, a single injection of 2 mL autologous tenocytes (2-5 × 106 cells/mL) suspended in patient serum was injected into the site of the pathological gluteal tendons under ultrasound guidance. Patients were assessed pre- and postinjection (3, 6, 12, and 24 months) using the Oxford Hip Score (OHS), a visual analog pain scale (VAS), the Short Form-36 (SF-36), and a satisfaction scale. Magnetic resonance imaging (MRI) was undertaken at 8.7 months (range, 6-12 months) postinjection. RESULTS: Molecular characterization of autologous tendon cells showed a profile of growth factor production in all cases, including platelet-derived growth factor α, fibroblast growth factor ß, and transforming growth factor ß. The OHS (mean, 24.0 preinjection to 38.9 at 12 months [14.9-point improvement]; 95% CI, 10.6-19.2; P < .001), VAS (mean, 7.2 preinjection to 3.1 at 12 months [4.1-point improvement]; 95% CI, 2.6-5.6; P < .001), and SF-36 (mean, 28.1 preinjection to 43.3 at 12 months [15.2-point improvement]; 95% CI, 9.8-20.5; P < .001) significantly improved to 12 months postinjection, sustained to 24 months. Eight patients were satisfied with their outcomes. Significant MRI-based improvement could not be demonstrated in the majority of cases. CONCLUSION: ATI for gluteal tendinopathy is safe, with improved and sustained clinical outcomes to 24 months.