Clinical Outcomes of Minimally Invasive Repair Using Ring Forceps for Acute Achilles Tendon Rupture.

Mini-open techniques using special devices, introduced to preclude the complications of open and percutaneous techniques, have limited usefulness because of the need for the devices and the weak strength of the repair. We developed a mini-open technique using a ring forceps. This technique is easy to use and increases the strength of the repair with crossed sutures. Twenty-six consecutive patients were treated using a mini-open technique using a ring forceps for acute Achilles tendon rupture. American Orthopaedic Foot and Ankle Society (AOFAS) scores and Achilles tendon total rupture scores (ATRS) were evaluated at the last follow-up. The active range of motion of ankle joint and maximum calf circumference (MCC) were measured and compared with the uninjured side at the last follow-up, as well as hopping and single-limb heel-rise (SLHR) tests and isokinetic tests for ankle plantarflexion. AOFAS score and ATRS were 92.2 ± 9.4 and 89.9 ± 10.9, respectively, at the last follow-up. The MCC (p = .035) and maximum height of SLHR (p = .001) were significantly different between uninvolved and involved legs. No significant differences in mean peak torques for plantarflexion at angular speeds of 30°/s (60.9 ± 23.6 vs 50.8 ± 20.4 Nm/kg; p = .299) and 120°/s (31.6 ± 16 vs 29.6 ± 17.7 Nm/kg; p = .776) were observed between uninvolved and involved legs. The mini-open technique using a ring forceps for acute Achilles tendon rupture showed satisfactory clinical outcomes and favorable functional outcomes without complications.

Study on Sustentaculum Tali Fragment Constancy in Intraarticular Calcaneus Fracture.

OBJECTIVES: To establish reproducible measurements of the sustentaculum tali (ST) fragment regarding fracture classification and patient-related factors. DESIGN: Retrospective. SETTING: Trauma center, University Hospital. PATIENTS: A retrospective analysis of the 142 fractured calcanei of 122 patients (101 men and 21 women) treated at our institution between 2012 and 2020 was performed. As control, 62 unaffected calcanei were used. INTERVENTION: Radiographic images were evaluated twice within 2 weeks by 2 orthopaedic surgeons and 1 postgraduate student. Angulation and diastasis were used to distinguish ST fragment constancy based on computed tomography. Using these parameters, the prevalence of inconstant ST fragments was assessed. We also analyzed factors related to ST fragment inconstancy. Patient factors included age, body mass index, smoking, and diabetes. Radiographic factors included the Sanders classification, location of the outermost fracture line of the posterior facet, presence of an intraarticular fracture of the ST, and ST fragment width. MAIN OUTCOME MEASUREMENTS: Angulation and diastasis were used to confirm the ST fragment constancy. Potential risks for inconstant ST fragment subsequently defined. RESULTS: According to the criteria, ST fragment inconstancy was observed in 34.5%. ST fragment width was significantly smaller in the inconstant group ( P < 0.001). Severe comminution of the posterior facet ( P < 0.05), intraarticular fracture of the ST ( P < 0.001), and diabetes ( P < 0.05) were significantly higher in the inconstant group. The cut-off value of the ST fragment width was 20.5 mm. CONCLUSIONS: In intraarticular calcaneus fractures, small ST fragment width, comminuted fracture, intraarticular fracture of the ST, and diabetes were associated with the inconstant group. The ST fragment was expected to be inconstant when the width was less than 20.5 mm.

Diagnostic Tools for Acute Anterior Cruciate Ligament Injury: GNRB, Lachman Test, and Telos.

PURPOSE: The purpose of this study is to compare the accuracy of the GNRB arthrometer (Genourob), Lachman test, and Telos device (GmbH) in acute anterior cruciate ligament (ACL) injuries and to evaluate the accuracy of each diagnostic tool according to the length of time from injury to examination. MATERIALS AND METHODS: From September 2015 to September 2016, 40 cases of complete ACL rupture were reviewed. We divided the time from injury to examination into three periods of 10 days each and analyzed the diagnostic tools according to the time frame. RESULTS: An analysis of the area under the curve (AUC) of a receiver operating characteristic curve showed that all diagnostic tools were fairly informative. The GNRB showed a higher AUC than other diagnostic tools. In 10 cases assessed within 10 days after injury, the GNRB showed statistically significant side-to-side difference in laxity (p＜0.001), whereas the Telos test and Lachman test did not show significantly different laxity (p=0.541 and p=0.413, respectively). CONCLUSIONS: All diagnostic values of the GNRB were better than other diagnostic tools in acute ACL injuries. The GNRB was more effective in acute ACL injuries examined within 10 days of injury. The GNRB arthrometer can be a useful diagnostic tool for acute ACL injuries.

High Tibial Osteotomy versus Unicompartmental Knee Arthroplasty for Medial Compartment Arthrosis with Kissing Lesions in Relatively Young Patients.

PURPOSE: The purpose of this study is to compare the clinical and radiographic outcomes of high tibial osteotomy (HTO) and unicompartmental arthroplasty (UKA) in advanced medial compartment arthritis accompanied by kissing lesions in relatively young patients. MATERIALS AND METHODS: Forty-five patients were divided into the HTO (n=23) and UKA (n=22) groups. Clinically, we evaluated the Lysholm knee scoring scale, visual analogue scale, Hospital for Special Surgery, and Western Ontario and McMaster Universities Osteoarthritis index scores preoperatively, 6 and 12 months postoperatively, and at the final follow-up. Radiographically, we measured the femoral-tibial angle and mechanical axis deviation preoperatively and at the final follow-up. RESULTS: All clinical outcomes gradually improved in both groups from the postoperative period to the final follow-up. At the final follow-up, all clinical outcomes were slightly better in the UKA group than in the HTO group; however, differences were not statistically significant. CONCLUSIONS: HTO is comparable to UKA in terms of clinical outcomes. Thus, the results of this study suggest that HTO might be a good alternative treatment to UKA for medial unicompartmental arthritis accompanied by kissing lesions in relatively young patients.

Treatment of Modified Mason Type III or IV Radial Head Fracture: Open Reduction and Internal Fixation versus Arthroplasty.

BACKGROUND: The treatment of modified Mason Type III or IV fractures is controversial. Many authors report open reduction and internal fixation (ORIF) with reconstruction of the radial head, but others advocate radial head arthroplasty (RHA). This study compares the clinical and radiological outcomes of ORIF and RHA in modified Mason Type III or IV radial head fracture and evaluates correlations between prognostic factors and postoperative clinical outcomes. MATERIALS AND METHODS: 42 patients with modified Mason Type III or IV radial head fractures who were surgically treated between January 2010 and January 2014 were retrospectively analyzed (20 patients with RHA and 22 patients with ORIF group were selected). Clinically, the patient rated elbow evaluation (PREE), the disabilities of the arm, shoulder and hand (DASH), and the range of motion (ROM) were measured. Radiologically, plain radiographs and computed tomography scans were taken. RESULTS: The mean PREE scores were 13.9 for the RHA group and 13.0 for the ORIF group, and mean DASH scores were 9.5 and 10.7, respectively. The differences were not statistically significant. When comparing ROM, the patients in the RHA group showed greater movement at all measured angles. In multiple regression analysis, age was the only variable significantly associated with both PREE and DASH. CONCLUSION: Overall, there were no significant differences in clinical outcomes of modified Mason Type III or IV radial head fractures treated with ORIF or RHA. However, a subgroup of younger patients had better clinical outcomes with ORIF treatment. Therefore, ORIF should be the First line of treatment, particularly if the reduction is possible.

Arthroscopic Excision of Delayed Diagnosed Intra-articular Osteoid Osteoma of the Elbow: A Case Report.

An intra-articular osteoid osteoma is a very rare cause of elbow pain, and its diagnosis and treatment remain challenging. Delayed diagnosis may lead to arthritic change of the joint. In this study, the authors present the occurrence of intra-articular osteoid osteoma in the right elbow of a 15-year-old male patient who presented with prolonged pain and limited motion owing to delayed diagnosis. After confirming the nidus of osteoid osteoma from radiographic evaluation, the lesion was completely removed arthroscopically. The patient presented a complete relief of symptoms and full range of motion. This is the first domestic report of successful arthroscopic treatment of an intra-articular osteoid osteoma of the elbow.