Evaluation of footprint contact area and pressure using a triple-row modification of the suture-bridge technique for rotator cuff repair.

BACKGROUND: Studies suggest that arthroscopic repair techniques may have high recurrence rates for larger rotator cuff tears. A more anatomic repair may improve the success rate when performing arthroscopic rotator cuff repair. We hypothesized that a triple-row modification of the suture-bridge technique for rotator cuff repair would result in significantly more footprint contact area and pressure between the rotator cuff and the humeral tuberosity. MATERIALS AND METHODS: Eighteen ovine infraspinatus tendons were repaired using 1 of 3 simulated arthroscopic techniques: a double-row repair, the suture-bridge technique, and a triple-row repair. The triple-row repair technique is a modification of the suture-bridge technique that uses an additional reducing anchor between the medial and lateral rows. Six samples were tested per group. Pressure-indicating film was used to measure the footprint contact area and pressure after each repair. RESULTS: The triple-row repair resulted in significantly more rotator cuff footprint contact area and contact pressure compared with the double-row technique and the standard suture-bridge technique. No statistical difference in contact area or contact pressure was found between the double-row technique and the suture-bridge technique. CONCLUSION: The triple-row technique for rotator cuff repair results in significantly more footprint contact area and contact pressure compared with the double-row and standard suture-bridge techniques. This more anatomic repair may improve the healing rate when performing arthroscopic rotator cuff repair.

Prospective evaluation of patient comprehension of informed consent.

BACKGROUND: Physicians and society may overestimate the level of patient comprehension during the process of obtaining informed consent for medical and surgical treatment. The purpose of this study was to prospectively measure the immediate level of patient comprehension at the time that surgical consent is obtained and the effect of time on this level of understanding. In addition, we studied the effect of sex, education level, and age on comprehension. METHODS: One hundred patients scheduled for elective orthopaedic surgery were enrolled voluntarily into this study. Following discussion of risks and benefits with the surgeon and a reading and explanation of the entire consent form, each patient immediately completed a questionnaire to test recall of the information that had just been reviewed. The same questionnaire was administered to each patient at the first postoperative visit and, if applicable, again at the second postoperative visit. Age, sex, education level, and questionnaire scores were recorded. RESULTS: Ninety-eight patients completed the questionnaire preoperatively and scored an average of 70.7% correct answers. Seventy-five patients completed the first postoperative questionnaire, scoring an average of 59.5%. Thirty-nine patients completed the second postoperative questionnaire, scoring an average of 60.8%. The decline between the preoperative and the first postoperative score was significant. The mean score did not differ significantly according to sex at any time point. College-educated patients scored higher than patients without a college education did on both the preoperative and postoperative questionnaires, with the difference in the preoperative score being significant. Patients who were less than fifty years old scored higher than older patients did, with the difference in the postoperative score being significant. CONCLUSIONS: Patient comprehension and recall immediately following a thorough discussion of the consent form was unexpectedly low. This poor recall deteriorated further between the preoperative visit and the first postoperative visit (a period of no more than two weeks). Greater age and lower education level were associated with poorer comprehension. Sex did not affect any of the scores.

Apophyseal avulsion fractures of the hip and pelvis.

Apophyseal avulsion fractures of the hip and pelvis are infrequent pediatric fractures. However an increase of adolescent participation in competitive sporting activities and better musculoskeletal imaging techniques has led to an increased awareness of these injuries by the medical community. These fractures can be easily missed. When these fractures are diagnosed and treated appropriately, nonsurgical protocol has bee proposed in the literature. Surgical treatment is usually reserved for certain indications. Complications of these injuries include painful nonunion, exostosis, osteonecrosis, and mechanism of injury and treatment options, these fractures can be successfully diagnosed and treated.