Early complications of acromioclavicular joint reconstruction requiring reoperation.

PURPOSE: Prior studies have reported high complication rates with acromioclavicular joint reconstruction (ACJR). However, many of these reports have suffered from small sample sizes and inclusion of older surgical techniques. The purpose of this study was to determine the rates of early complications requiring reoperation in patients treated with ACJR. METHODS: From 2007 to 2011, patients who were treated with ACJR were identified using the PearlDiver database, a large insurance database in the USA. The following reoperations were then queried from this patient cohort: irrigation and debridement within 30 days of index surgery, manipulation under anaesthesia (MUA) of the shoulder joint within 3 months of index surgery, and revision ACJR, distal clavicle excision, and removal of hardware within 6 months of index surgery. RESULTS: In total, 2106 patients treated with ACJR were identified. The reoperation rates for irrigation and debridement, MUA, revision ACJR, distal clavicle excision, and removal of hardware were 2.6, 1.3, 4.2, 2.8, and 6.2 %, respectively. Patients ≥35 years of age and females more likely to undergo a reoperation after ACJR. Specifically, patients ≥35 years of age were more likely to undergo MUA and revision ACJR, while patients ≥50 years of age were more likely to undergo an irrigation and debridement. Females were more likely than males to undergo revision ACJR and distal clavicle excision. CONCLUSIONS: Older patients and females were more likely to experience postoperative complications requiring reoperations, including revision ACJR, distal clavicle excision, and irrigation and debridement. By analysing a large cohort of patients across multiple centres and providers, this study provides valuable insight into the recent complication profiles of ACJR, allowing surgeons to appropriately counsel patients on the risks of these procedures. LEVEL OF EVIDENCE: IV.

The suitability of human adipose-derived stem cells for the engineering of ligament tissue.

Rupture of the anterior cruciate ligament (ACL) is the one of the most common sports-related injuries. With its poor healing capacity, surgical reconstruction using either autografts or allografts is currently required to restore function. However, serious complications are associated with graft reconstructions and the number of such reconstructions has steadily risen over the years, necessitating the search for an alternative approach to ACL repair. Such an approach may likely be tissue engineering. Recent engineering approaches using ligament-derived fibroblasts have been promising, but the slow growth rate of such fibroblasts in vitro may limit their practical application. More promising results are being achieved using bone marrow mesenchymal stem cells (MSCs). The adipose-derived stem cell (ASC) is often proposed as an alternative choice to the MSC and, as such, may be a suitable stem cell for ligament engineering. However, the use of ASCs in ligament engineering still remains relatively unexplored. Therefore, in this study, the potential use of human ASCs in ligament tissue engineering was initially explored by examining their ability to express several ligament markers under growth factor treatment. ASC populations treated for up to 4 weeks with TGFß1 or IGF1 did not show any significant and consistent upregulation in the expression of collagen types 1 and 3, tenascin C and scleraxis. While treatment with EGF or bFGF resulted in increased tenascin C expression, increased expression of collagens 1 and 3 were never observed. Therefore, simple in vitro treatment of human ASC populations with growth factors may not stimulate their ligament differentiative potential.

Variant of the extensor pollicis tertius: a case report on a unique extensor muscle to the thumb.

Variations on muscular and tendinous connections of the hand occur frequently in the human population and are often discovered during routine surgical procedures and cadaveric dissections. A knowledge of such anomalies is important to the physician in order to avoid unintentional damage to healthy tendons during surgical procedures. In addition, accessory tendons have the potential to be used in the repair or replacement of damaged tendons through surgical transfer or transplantation. Here we describe a unique variant of the extensor pollicis tertius muscle that has its origin at the proximal end of the extensor indicis muscle and inserts on the tendon of the extensor pollicis longus at the proximal shaft of the proximal phalanx of the thumb.