Application of indocyanine green fluorescence angiography in evaluating blood flow in rotator cuff tears: a preliminary study.

BACKGROUND: The relationship between the degree of vascularization at the edge of a torn rotator cuff tendon and cuff healing remains unclear. The purpose of this study was to employ indocyanine green (ICG) fluorescence angiography to evaluate the blood flow at the edge of a torn rotator cuff tendon under the subacromial view. METHODS: Thirteen shoulders of 13 patients who underwent arthroscopic repair of full-thickness rotator cuff tears were included in this prospective study. Viewing from the posterolateral portal, ICG at 0.2 mg/kg body weight was intravenously administered, and the blood flow was recorded. After resecting the poorly vascularized torn edge of the tendon, ICG administration was repeated at the same volume. The fluorescence intensity and perfusion time of the tendon blood flow were evaluated using video analysis and modeling tools. Cuff integrity was evaluated using magnetic resonance imaging at 6 months postoperatively. Patients were divided into healed and retear groups, and the differences in the degree of blood flow were evaluated. RESULTS: ICG fluorescence angiography could visualize the blood flow in the rotator cuff tendon, and the torn edge of the tendon with poor blood flow was resected. The overall retear rate was 23.1 % (3/13). Based on quantitative analysis, the fluorescence intensity factors were significantly lower in the retear group than in the healed group before tendon débridement. The retear rate in the high blood flow group was 0% (0/7), while that in the low blood flow group was 50.0% (3/6). CONCLUSIONS: ICG fluorescence angiography may play a role in the future of shoulder arthroscopy. Further study is needed to determine the effect of blood flow on tendon healing.

Incidence and clinical outcome of lateral femoral cutaneous nerve injury after periacetabular osteotomy.

Aims: Lateral femoral cutaneous nerve (LFCN) injury is a complication after periacetabular osteo-tomy (PAO) using an anterior approach, which might adversely affect the outcome. However, no prospective study has assessed the incidence and severity of this injury and its effect on the clinical outcomes over a period of time for longer than one year after PAO. The aim of this study was to assess the incidence and severity of the symptoms of LFCN injury for ≥ three years after PAO and report its effect on clinical outcomes. Methods: A total of 40 hips in 40 consecutive patients who underwent PAO between May 2016 and July 2018 were included in the study, as further follow-up of the same patients from a previous study. We prospectively evaluated the incidence, severity, and area of symptoms following LFCN injury. We also recorded the clinical scores at one year and ≥ three years postoperatively using the 36-Item Short Form Health Survey (SF-36) and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) scores. Results: A total of 20 patients (50%) had symptoms of a LFCN injury at one year after PAO. At ≥ three years postoperatively, the symptoms had completely resolved in seven of these patients and 13 (33%) had persistent symptoms. The severity and area of symptoms did not significantly differ between one and ≥ three years postoperatively. The JHEQ showed significant differences in the patient satisfaction and mental scores between those with and those without sypmtoms of LFCN injury at ≥ three years postoperatively, while there was no significant difference in the mean SF-36 scores. Conclusion: The incidence of LFCN injury after PAO using an anterior approach is high. The outcome of PAO, ≥ three years postoperatively, is poorer in patients with persistent symptoms from a perioperative LFCN injury, in that patient satisfaction and mental health scores are adversely affected.

Rate of Return to Work After Periacetabular Osteotomy and Its Influencing Factors.

BACKGROUND: Periacetabular osteotomy (PAO) has been reported as a treatment for patients with symptomatic developmental dysplasia of the hip (DDH). Several studies have investigated the rate of return to sports activities after PAO, but few studies have evaluated the rate of return to work. In the present study, we aimed to identify the rate of return to work at 1 year after PAO and its affecting factors. METHODS: We retrospectively evaluated 83 patients (85 hips) with symptomatic DDH who had undergone PAO between December 2015 and June 2020. Patients who had returned to work at 1 year after PAO were classified into the returnee group, and those who had not were classified into the non-returnee group. The returnee group included patients who could return to their original job (original) or to a different job (non-original). The non-returnee group included patients who could not return to work because of hip symptoms (hip) and those who did not return for reasons other than hip symptoms (non-hip). We analyzed clinical parameters, including the Harris hip score, Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire, 36-Item Short Form Survey, and radiographic parameters, as well as the type of work. RESULTS: Sixty-eight patients (70 hips; 82.4%) returned to work at 1 year after PAO (returnee group), and 15 patients (15 hips; 17.6%) were in the non-returnee group. Among the 15 patients in the non-returnee group, 7 were classified into the non-hip subgroup and 8 were classified into the hip subgroup. No significant differences were observed between the returnee group and the hip subgroup in terms of clinical parameters or type of work. CONCLUSIONS: One year after PAO, 8 patients (8 hips; 9.4%) could not return to work because of hip symptoms; both clinical parameters and the type of work showed no direct relationship with postoperative working status. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Incidence and clinical outcome of lateral femoral cutaneous nerve injury after periacetabular osteotomy.

AIMS: Injury to the lateral femoral cutaneous nerve (LFCN) is one of the known complications after periacetabular osteotomy (PAO) performed using the anterior approach, reported to occur in between 1.5% and 65% of cases. In this study, we performed a prospective study on the incidence of LFCN injury as well as its clinical outcomes based on the Harris Hip Score (HHS), Short-Form 36 Health Survey (SF-36), and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). METHODS: The study included 42 consecutive hips in 42 patients (three male and 39 female) who underwent PAO from May 2016 to July 2018. We prospectively evaluated the incidence of LFCN injury at ten days, three months, six months, and one year postoperatively. We also evaluated the clinical scores, including the HHS, SF-36, and JHEQ scores, at one year postoperatively. RESULTS: LFCN injury was observed in 31 of 42 (74%) patients at ten days, of which 11 resolved completely by one year. Incidence decreased gradually, to 25 of 42 (60%) patients at three months, 24 of 42 patients (57%) at six months, and 20 of 42 (48%) patients at one year postoperatively. There was no significant difference in the HHS between patients with and without LFCN injury at one year postoperatively. Regarding the SF-36 and JHEQ, a significant difference in the mental score was recognized between patients with and without LFCN injury, but there were no significant differences in the other clinical scores. CONCLUSION: The incidence of LFCN injury was 74% at ten days after PAO, and subsequently decreased to 48% at one year. LFCN injury did not influence the hip function as assessed by the HHS, but had a negative impact on mental health at one year. Cite this article: Bone Joint J 2021;103-B(4):659-664.

Predictors of safety margin for coracoid transfer: a cadaveric morphometric analysis.

BACKGROUND: The purpose of this study was to investigate the relationship between the bone length available for coracoid transfer without coracoclavicular ligament injury and the distance from the coracoid tip to the attachments of the coracoacromial ligament or pectoralis minor. We hypothesized that cadaver height and the soft tissue attachments on the coracoid process were predictive factors for sufficient bone length for coracoid transfer. METHODS: This study included 28 shoulders from Japanese cadavers: 19 male and 9 female. The distance from the coracoid tip to the distal attachment of the coracoclavicular ligament and the anterior and posterior margins of the coracoacromial ligament or pectoralis minor on the coracoid process were measured. RESULTS: The mean available length for coracoid transfer was 24.8 ± 3.4 mm. There was a significant difference in length between male and female subjects, being 26.0 ± 2.9 mm and 22.2 ± 3.0 mm, respectively (p = 0.004). High positive correlations were found between the length of the coracoid transfer and cadaver's height (r = 0.48, p = 0.009) and the distance from the coracoid tip to the anterior coracoacromial ligament attachment (r = 0.63, p < 0.001). The receiver operating characteristic curve area under the curve for cadaver height was 0.72 while that for distance from coracoid tip to anterior coracoacromial ligament was 0.88 when predicted for a sufficient length for coracoid transfer > 25 mm. CONCLUSIONS: Our findings will aid surgeons in preoperative planning and performing of osteotomy of the coracoid safely by predicting the available length of coracoid bone graft.

Anatomical study of the position and orientation of the coracoclavicular ligaments: Differences in bone tunnel position by gender.

BACKGROUND: Reconstructing both coracoclavicular ligaments following acromioclavicular dislocation has recently been reported to restore the function of the acromioclavicular joint better than traditional procedures. Knowing the appropriate position and orientation of the bone tunnels and the potential risks of neurovascular injuries leads to safe reconstruction. We aimed to answer the following questions: what is the difference in the accurate clavicular bone tunnel positions (BTPs) during coracoclavicular ligament reconstruction between sex, and what are the potential risks for neurovascular injuries? HYPOTHESIS: The BTPs differ by sex at the site of coracoclavicular ligament reconstruction. PATIENTS AND METHODS: We introduced two Kirschner wires into 25 cadaver shoulders (17 male, 8 female), one through the insertion center of the trapezoid ligament and one through the conoid ligament, and measured the distance from the respective Kirschner wire insertion points to the bony landmarks of the clavicle and the oblique angle of each Kirschner wire. The shortest distance from the insertion point of each Kirschner wire to the suprascapular nerve and artery was also measured. RESULTS: While the distance from the acromioclavicular joint to the respective Kirschner wire insertion points tended to be longer in males, the ratio of these insertion points to total clavicle length was constant. Other measurements for respective Kirschner wire insertions to the bony landmarks and neurovascular structures were comparable, as were abduction and retroversion angles. The distance from the suprascapular nerve to the insertion point of the conoid ligament at the coracoid process was 13.8±4.0mm, while the distance from the suprascapular artery was 7.1±3.3mm. DISCUSSION: Appropriate position and orientation of the bone tunnels, and the ratio of the BTPs to the total clavicular length, aid surgeons in performing the reconstruction. The conoid ligament insertion on the coracoid was just proximal to the suprascapular artery, so surgeons should be careful with conoid insertion. LEVEL OF EVIDENCE: V, cadaver study.