Arthroscopic Humeral Avulsion of the Glenohumeral Ligament (HAGL) Repair Utilized Accessory Posterior Portal in the Beach-Chair Position.

Shoulder instability, often associated with both soft tissue and bone lesions, can result in shoulder pain and dysfunction. To address this, the combined procedure of a Bankart repair in conjunction with humeral avulsion of the glenohumeral ligament (HAGL) repair aims to minimize failure rates in a single procedure. While HAGL repair is imperative for preventing recurrent instability, there remains a lack of consensus on the optimal surgical technique. This Technical Note aims to elucidate a surgical approach for addressing and repairing HAGL lesions using arthroscopy, specifically employing a combined posterior viewing portal and posteroinferior working portal in the beach-chair position.

Systematic review and meta-analysis of studies comparing cyst wall preservation against cyst wall resection during arthroscopic popliteal cyst decompression.

INTRODUCTION: The optimal arthroscopic management for popliteal cyst decompression remains uncertain, with ongoing debate between preserving the cyst wall or completely removing it. The purpose of this study is to compare the outcomes and complications of arthroscopic popliteal cyst decompression with cyst wall preservation and cyst wall resection. METHODS: A systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted. It encompassed studies that focused on arthroscopic popliteal cyst decompression, considering both cyst wall preservation and cyst wall resection. The quality assessment of the included studies was carried out using the Methodology Index for Non-Randomized Research criteria. Following this, meta-analyses were conducted, employing odds ratios (ORs) for dichotomous outcomes and calculating mean differences (MDs) for continuous outcomes. RESULTS: Four articles included a collective of 214 knees. Each of these studies presented level 3 evidence. The comparison between the cyst wall preservation group and the cyst wall resection group revealed similar clinical outcomes based on the Rauschning and Lindgren grade (grade 0 [OR = 0.66, 95% CI: 0.37-1.19, p = 0.17]; grade I [OR = 1.33, 95% CI: 0.66-2.67, p = 0.43]; grade II [OR = 1.39, 95% CI: 0.46-4.14, p = 0.56]; grade III [OR = 3.46, 95% CI: 0.13-89.95, p = 0.46]) and Lysholm score (MD = 0.83, 95% CI: -0.65-2.32, p = 0.27). However, MRI results indicated a significant improvement in the cyst wall resection group (cyst disappearance [OR = 0.50, 95% CI: 0.28-0.90, p = 0.02]; cyst shrinkage or decrease in size [OR = 1.41, 95% CI: 0.78-2.55, p = 0.26]; cyst persistence or recurrence [OR = 7.63, 95% CI: 1.29-45.08, p = 0.02]). Nevertheless, the operative time for cyst resection was significantly longer compared to cyst preservation (MD = -14.90, 95% CI: -21.96 - -7.84, p < 0.0001), and the cyst wall resection group experienced significantly higher complications than the cyst wall preservation group (OR = 0.24, 95% CI: 0.06 to 1.02, p = 0.05). CONCLUSION: During arthroscopic popliteal cyst decompression, cyst wall resection led to longer operative times and higher complication rates but lower recurrence rates and better MRI outcomes. The functional outcomes after surgery were found to be similar.

Posterolateral Intra-/Extra-articular Tenodesis Technique: A Technique for Lateral Tenodesis of the Knee.

Posterolateral tenodesis is necessary for restoring biomechanics in posterolateral instability of the knee. We propose a technique that provides the tenodesis effect to both intra- and extra-articular aspects of the knee. We call it the posterolateral intra-/extra-articular tenodesis technique, which is a technique for posterolateral reconstruction. This minimally invasive technique is particularly helpful in patients with high-grade posterolateral corner injury with the advantage of precise placement of the graft.

Hip External Rotation Decreases Ischiofemoral Distance: A Positive Correlation Between Cadaveric and Fluoroscopic Studies.

PURPOSE: To determine the effect of hip external rotation or extension/adduction on minimizing the ischiofemoral distance (IFD) and assess the correlation between cadaveric and fluoroscopic IFD measurements in different hip positions. METHODS: This cadaveric study involved 33 hip joints from 17 embalmed cadavers. IFD, the distance between the lesser trochanter and lateral ischium, was measured in different hip positions: neutral, external rotation at 30°, and external rotation at 60° with the hip in both neutral extension and adduction as well as 10° hip extension and 10° hip adduction. Differences in IFD related to positions and correlation between cadaveric and fluoroscopic measurements were analyzed. RESULTS: IFD measurements showed that the greatest reduction occurred at 60° of external hip rotation, with a significant difference observed only between neutral and 60° external rotation in cadaveric groups (7.60 ± 4.68 vs 5.05 ± 3.48, 95% CI, 0.14-4.96; P = .036). No substantial difference was observed between the extension and adduction positions. Positive correlations were observed between cadaveric and fluoroscopic measurements, especially in the neutral position (r = 0.492, P = .004), external rotation at 30° (r = 0.52, P = .002), external rotation at 60° (r = 0.419, P = .015), and the extension/adduction positions combined with neutral rotation (r = 0.396, P = .023). CONCLUSIONS: The IFD significantly decreased with increasing degrees of hip external rotation, particularly at 60°. No significant reduction was observed in the extension/adduction positions. In addition, positive correlations were observed between cadaveric and fluoroscopic measurements for specific hip positions: neutral rotation, external rotation at 30° and 60°, and extension/adduction at 10° with neutral rotation. CLINICAL RELEVANCE: Surgeons can use this knowledge to improve hip impingement assessment through radiography, focusing on positions in which IFD reduction is most notable. Understanding the relationship between hip positions and IFD can enhance the diagnosis of ischiofemoral impingement syndrome and benefit patient care and outcomes.

Higher contact pressure of the lateral tibiofemoral joint in lateral extra-articular tenodesis with tensioned graft in external rotation than in neutral rotation: A biomechanical study.

OBJECTIVE: To determine the mean contact pressure, peak contact pressure, and mean contact area of the lateral tibiofemoral joint in lateral extra-articular tenodesis (LET) with tension on the graft in tibial neutral and external rotation. METHODS: A total of eight Thiel-embalmed cadaveric knees were prepared and divided into two groups (4 knees in each group): the LET-NR group (lateral extra-articular tenodesis tension in neutral rotation) and (2) the LET-ER group (lateral extra-articular tenodesis tension in external rotation). Each knee was prepared according to the corresponding technique. A hydraulic testing system (E10000, Instron) simulates an axial load of 735 â€‹N for 10 â€‹s in each group. RESULTS: The LET-ER group exhibited a statistically significant higher peak contact pressure compared to the LET-NR group. The peak contact pressure values in the LET-NR and LET-ER groups were 702.3 â€‹± â€‹233.9 â€‹kPa and 1235.5 â€‹± â€‹171.4 â€‹kPa, respectively (p â€‹= â€‹0.010, 95% CI, -888.0 to -178.5). The mean contact pressure values in the LET-NR and LET-ER groups were 344.9 â€‹± â€‹69.0 â€‹kPa and 355.3 â€‹± â€‹34.9 â€‹kPa, respectively (p â€‹= â€‹0.796, 95% CI, -105.1-84.2). The mean contact area values in the LET-NR and LET-ER groups were 36.8 â€‹± â€‹3.1 mm2 and 33.3 â€‹± â€‹6.4 mm2, respectively (p â€‹= â€‹0.360, 95% CI, -5.2-12.2). CONCLUSIONS: The peak contact pressure of the lateral tibiofemoral joint is greater in LET when the graft is tensioned in external rotation than in neutral rotation. However, no statistically significant difference in the mean contact pressure or the mean contact area was observed between the two groups. LEVEL OF EVIDENCE: III.

Arthroscopic Repair of Acute Traumatic Medial Patellofemoral Ligament Tears at the Patellar Insertion.

After a lateral patellar dislocation or subluxation, injury to the medial patellofemoral ligament (MPFL) is common. The MPFL originates between the medial epicondyle and the adductor tubercle, inserting along the superior one-third border of the medial patella. Operative treatment becomes necessary for patients with intra-articular pathology (such as osteochondral injuries or meniscus tears) or those experiencing recurrent dislocations. Numerous surgical techniques have been proposed for addressing this issue, with MPFL reconstruction being the most frequently performed procedure. Nonetheless, various complications associated with reconstruction have been documented. In recent years, there has been a growing interest in MPFL repair, which has shown acceptable outcomes in the literature. In this study, we introduce an arthroscopic-assisted MPFL repair technique designed for acute traumatic MPFL tears originating from the patellar insertion. This approach offers the advantage of being minimally invasive, straightforward, and reproducible.

A Technique for Hamstring Donor-Site Injection With Anesthetic Cocktail in Remnant-Preserving Anterior Cruciate Ligament Reconstruction.

Arthroscopic anterior cruciate ligament reconstruction is a common procedure that requires effective postoperative pain management for successful rehabilitation. Opioids are traditionally used for pain relief, but their side effects decrease their widespread use. Local anesthesia techniques have gained interest as an alternative to opioids. This Technical Note discusses the use of an anesthetic cocktail for pain relief at the hamstring's donor site in anterior cruciate ligament reconstruction. This approach may enhance early rehabilitation and patient satisfaction.

Single Working Portal Technique with 70-Degree Arthroscope for Arthroscopic Bankart Repair.

The Bankart lesion is a common injury to the labrum in the shoulder joint, usually resulting from anterior shoulder dislocation. Arthroscopic Bankart repair is a surgical technique used to treat recurrent dislocations by reattaching the labrum to the glenoid rim using suture anchors. Typically, 3 portals are created: 1 for visualization and 2 for instrumentation. However, this Technical Note proposes a single working portal approach using a 70° arthroscope from the posterior portal. This technique enhances visualization and prevents portal jamming, particularly in cases with a small rotator interval.

Traditional suture tape versus multiple high-strength sutures for augmentation of anterior cruciate ligament primary repair: A time-zero biomechanical study.

Background/objective: During the initial stages of rehabilitation after anterior cruciate ligament (ACL) surgery, a pivotal role is played in ensuring effective recuperation and averting complications. An often-employed strategy to tackle ACL laxity during this period involves the incorporation of synthetic materials for reinforcement. The objective of this study is to compare the effectiveness of conventional suture tape and multiple high-strength sutures as augmentation techniques for ACL repair. Methods: Ten preserved cadaveric knees embalmed using the Thiel method were segregated into two groups, each containing five knees. In one group, traditional suture tape was employed for augmentation, while the other group utilized multiple high-strength sutures. Each knee underwent a cyclic load of 1000 sine wave cycles, succeeded by an axial distraction load until failure ensued. The resultant displacement and ultimate load at failure were assessed to contrast the efficacy of the two augmentation techniques. Results: The group utilizing multiple high-strength sutures exhibited a significantly higher load to failure at time-zero (1690.7 N) compared to the suture tape group (987.6 N) (P = .003). Furthermore, the multiple high-strength sutures group demonstrated significantly reduced displacement after 1000 cyclic loads (6.6 mm) in comparison to the suture tape group (16.3 mm) (P < .001). Conclusions: Multiple high-strength sutures show better biomechanical properties for the augmentation of ACL repair at time-zero. Both suture tape and multiple high-strength sutures had ultimate load-to-failure values higher than the natural ACL loads. Therefore, these substances might serve as augmentation options to prevent the ACL's gradual elongation, a critical concern particularly in the initial stages of rehabilitation.

Similar Healing Rates of Arthroscopic Rotator Cuff Repair With and Without Bone Marrow Stimulation: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Bone marrow stimulation (BMS) techniques such as microfracture, nanofracture, and the crimson duvet procedure expose the bone marrow of the proximal humerus to the rotator cuff tendon footprint. The effect of performing BMS on tendon healing is a subject of interest. PURPOSE: To compare studies on arthroscopic rotator cuff repair with BMS versus without BMS for rotator cuff tears according to healing rates and clinical and radiological outcomes. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 2. METHODS: The 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed in conducting a search. Studies that compared arthroscopic rotator cuff repair with and without BMS were included if they provided postoperative patient-reported outcomes and healing rates. Dichotomous outcomes were expressed as mean differences (MDs), while continuous outcomes were expressed as odds ratio. RESULTS: Included were 5 studies (N = 499 shoulders); 4 studies had level 1 evidence, and 1 study had level 2 evidence. The healing rate of rotator cuff repair was similar between the 2 groups (ie, with and without BMS) (odds ratio, 1.58 [95% CI, 0.63 to 4.00]; P = .33). Furthermore, there were no significant differences in the postoperative Constant score (MD, 1.41 [95% CI, -0.58 to 3.39]; P = .16), American Shoulder and Elbow Surgeons score (MD, 0.77 [95% CI, -1.43 to 2.96]; P = .49), or range of motion for forward flexion (MD, 2.45 [95% CI, -0.66 to 5.57]; P = .12) and external rotation (MD, 0.81 [95% CI, -2.35 to 3.97]; P = .62) at the final follow-up between the 2 groups. CONCLUSION: The healing rate of rotator cuff repair was similar, regardless of whether BMS was performed or not. Additionally, there was no significant difference in postoperative patient-reported outcome scores, range of motion, and complications. REGISTRATION: CRD42023388427 (PROSPERO).

Clinical Outcomes, Union Rates, and Complications of Screw Versus Button Fixation in the Bristow-Latarjet Procedure for Anterior Shoulder Instability: A Systematic Review and Meta-Analysis.

Background: The Latarjet procedure is a common procedure for treating critical glenoid bone loss in anterior shoulder instability. Implants such as the screw and cortical button are widely used. The aim of this study was to compare studies on screw versus button fixation techniques in the Bristow-Latarjet procedure for anterior shoulder instability in terms of clinical outcomes, union rates, and complications. Methods: The PubMed, Scopus, and Embase databases were searched to find comparative studies that reported outcomes of using screw versus button fixation in the Bristow-Latarjet procedure following the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Studies that directly compared the screw and button fixation techniques and provided postoperative patient-reported outcomes, union rates, or complications were included. The Methodology Index for Non-Randomized Research (MINORS) criteria were used to assess the quality of the included studies. Odds ratios (ORs) were calculated for dichotomous outcomes whereas mean differences were calculated for continuous outcomes. Results: Five articles included a total of 877 shoulders. All five studies had level 3 evidence. There was no statistically significant difference between the two techniques using the Walch-Duplay score, visual analog scale for pain, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, range of motion, and graft union rates. However, the button fixation technique had statistically significantly higher recurrence rates than the screw fixation technique (OR, 0.24; 95% confidence interval, 0.10-0.58; p = 0.001). Conclusions: The screw fixation technique had statistically significantly lower recurrence rates than the button fixation technique. However, there was no significant difference between screw and button fixation techniques regarding postoperative patient-reported outcomes, range of motion, graft union rates, nerve injury rates, infection rates, and reoperation rates.

Systematic Review of Clinical Outcomes After Proximal Tibia Anterior Closing-Wedge Osteotomy With ACL Reconstruction.

Background: While increased posterior tibial slope (PTS) is an important risk factor for failure after anterior cruciate ligament (ACL) reconstruction, controversy exists regarding indications and outcomes of proximal tibia anterior closing-wedge osteotomy (ACWO) with concomitant ACL reconstruction in patients with ACL tears. Purpose: To assess clinical outcomes after combined ACL reconstruction and proximal tibia ACWO. Study Design: Systematic review; Level of evidence, 4. Methods: In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, we performed a systematic review of the existing literature on ACWO and ACL reconstruction using PubMed (MEDLINE), Cochrane Library, Scopus, and Embase. The search phrases included "anterior closing wedge osteotomy,""anterior closing wedge tibial osteotomy,""anterior closing wedge proximal tibial osteotomy,""anterior cruciate ligament," and "revision anterior cruciate ligament." Non-English publications and single-patient case reports were excluded. Extracted data included study details, patient demographics, patient-reported outcomes (PROs), clinical outcomes, radiographic outcomes, complications, and return-to-sport (RTS) rates. Results: A total of 6 studies with 110 patients (110 knees) were included. Two-stage ACWO and ACL reconstruction was reported in 2 studies of 78 patients (71%), while a single-stage technique was reported in 4 studies of 32 patients (29%). ACWO was performed in the setting of primary ACL tear in 23 patients (21%) and in recurrent ACL tear in 87 patients (79%). Patients demonstrated postoperative improvements in Lysholm, pivot-shift test, and side-to-side difference in anterior tibial translation. After ACWO, all studies reported mean postoperative PTS of <10° (range, 4.4°-9.2°). Of patients with available RTS data (n = 43), the same-level RTS rate ranged from 65% to 100%. A two-stage procedure reported in 1 study had a lower RTS rate (n = 13 of 20 [65%]) than that of 2 studies with single-stage procedure (n = 4 of 5 [80%] and n = 18 of 18 [100%]). The overall complication rate was 0.9% to 1.3%, and there were no reported ACL retears. Conclusion: The current evidence, which is constrained by the quantity and quality of studies, showed that ACWO with single- or two-stage ACL reconstruction in patients with ACL insufficiency and increased PTS was associated with significant improvements in PROs and high RTS rates.

Arthroscopic Anterior Cruciate Ligament Primary Repair With Synthetic Augmentation and Fixation With the Knotless Suture Anchor.

An anterior cruciate ligament (ACL) tear is one of the most common ligament injuries in athletes. The arthroscopic ACL reconstruction procedure is the gold standard for treatment. However, the improvement in injury classification and suture materials has subsequently made arthroscopic ACL primary repair an alternative surgical treatment option. This Technical Note describes an arthroscopic ACL primary repair with synthetic augmentation made of several high-strength sutures and fixation with the knotless suture anchor. The reinforced synthetic material acts as a structural tie to support the ACL while it heals.

Similar outcomes between transtendon repair and tear completion repair techniques for partial articular-sided supraspinatus tendon avulsion lesions: a systematic review and meta-analysis.

PURPOSE: This study aimed to review studies comparing transtendon repair (TTR) with tear completion repair (TCR) techniques for partial articular-sided supraspinatus tendon avulsion (PASTA) lesions according to postoperative patient-reported outcomes and complications. METHODS: Databases, including PubMed, Embase, Scopus, and Cochrane, were searched for studies published between 2008 and 2022 that directly compared the postoperative patient-reported outcomes and complications of the TTR and TCR techniques for PASTA lesions. Odds ratios (ORs) were calculated for dichotomous outcomes, while mean differences (MDs) were calculated for continuous outcomes. RESULTS: A total of seven studies (497 shoulders) were analysed. No statistically significant differences in the postoperative clinical outcomes at the final follow-up were observed between the TTR and TCR techniques for PASTA lesions. The overall retear rates of the TTR and TCR techniques were 7.7% and 11.6%, respectively (corresponding healing rates were 92.3% and 88.4%), whereas the overall occurrence rates of adhesive capsulitis were 4.7% and 3.3%, respectively. Furthermore, no significant difference was observed in postoperative range of motion (forward flexion, MD = - 1.22, 95% confidence interval (95%CI) - 5.28 to 3.34, n.s.; external rotation, MD = - 1.39, 95% CI - 3.19 to 0.42, n.s.), overall retear rate (OR 0.72, 95% CI 0.29-1.08, n.s.), and occurrence rate of adhesive capsulitis (OR 1.11, 95% CI 0.35-3.52, n.s.) between the two techniques. CONCLUSION: Both techniques improve clinical outcomes while having a low complication rate and a high rate of healing. No significant difference in clinical outcomes was observed between the two techniques. LEVEL OF EVIDENCE: III.

Editorial Commentary: Restrictions in Spinal Motion Result in Lower Outcome Scores After Hip Arthroscopy.

The critical consideration in determining the efficacy of hip surgery is patient-reported outcomes, specifically the achievement of the clinical threshold. Several studies examined the achievement of the clinical threshold following hip arthroscopy (HA) in the presence of coexisting lumbar spine disease. The condition related to the spine receiving a lot of focus in recent research is the lumbosacral transitional vertebrae (LSTV). However, this condition could be just the tip of the iceberg. To forecast the outcomes of HA, it is far more important to comprehend spinopelvic motion. Since higher-grade LSTV is associated with less lumbar spine flexibility and reduces the ability to antevert acetabulum, it is possible that LSTV severity or grading could be one of the indicators of less effective operation "especially in "hip users"' (hip users are defined as patents who are more dependent on on hip motion than spinal motion). In light of this, lower-grade LSTV ought to have a less significant impact on surgical outcomes than higher-grade LSTV.

Cortical suspensory button fixation has superior biomechanical properties to knotless anchor suture in anterior cruciate ligament repair: a biomechanical study.

The purpose of our biomechanical study was to assess load-to-failure, stiffness, gap formation following cyclic loading, and the failure mechanism for anterior cruciate ligament (ACL) repair comparing the cortical suspensory button and knotless anchor suture. Eight Thiel's embalmed paired cadaveric knees from four cadavers were dissected. The specimens were assigned to undergo ACL repair either with cortical suspensory button or with knotless anchor suture. The Instron machine replicates cyclic loading and then determines the gap formation. Traction was applied until failure. The load-to-failure, stiffness, and modes of failure in both groups were recorded. The load-to-failure, stiffness, and gap formation were compared between the two groups using the student's t-test. The mean load-to-failure in the cortical suspensory button group was significantly higher than the knotless anchor suture group (212.96 ± 54.57 vs 44.57 ± 20.80, p value < 0.01). No statistically significant difference was found regarding gap formation following cyclic loading and stiffness between the cortical suspensory button group and the knotless anchor suture group. This biomechanical study showed a higher load-to-failure for the ACL repair with cortical suspensory button compared to ACL repair with knotless anchor suture, while no statistically significant difference was found regarding the gap formation following cyclic loading and the stiffness. The load-to-failure in both cortical suspensory button and knotless anchor suture are below regular daily activity load. Thus, an internal brace or external support is recommended during rehabilitation.

Lumbar Sympathetic Chain Tract and Mobility of Oblique Lumbar Interbody Fusion Approach: A Cadaveric Study.

OBJECTIVE: We sought to assess the lumbar sympathetic chain (LSC) relation to the surgical corridor for the oblique lumbar approach and the ability to mobilize the LSC. METHODS: Forty-three cadavers were included. A left-sided anterior retroperitoneal approach was performed in supine position. The distances between the great vessels and psoas muscle (oblique corridor) and distance between great vessels and LSC at the L2/3, L3/4, and L4/5 disk levels were measured. Mobilization of LSC at each disk level was done either close to or away from the psoas muscle, and each mobilization distance was measured. RESULTS: The presence rates of LSC in oblique corridor were 19.5%, 43%, and 75.7% at L2/3, L3/4, and L4/5 levels, respectively. At the L2/3 disk level, the mean distance between the psoas muscle and LSC and its mobility were 0.61 mm ± 1.31 mm and 2.72 mm ± 1.24 mm, respectively. At the L3/4 disk level, the mean distance between the psoas muscle and LSC and its mobility were 1.72 mm ± 2.53 mm and 3.11 mm ± 1.02 mm, respectively. At the L4/5 disk level, the mean distance between the psoas muscle and LSC and its mobility were 2.94 mm ± 3.52 mm and 2.53 mm ± 1.03 mm, respectively. The mean width of corridor of L2/3, L3/4, and L4/5 were 10.73 mm ± 5.82 mm, 12.63 mm ± 5.02 mm, and 15.43 mm ± 6.31 mm, respectively. CONCLUSIONS: The LSC tract usually lies in the oblique corridor in L4/5 but keeps decreasing in prevalence when approaching L3/4 and L2/3 levels. It can be mobilized a few millimeters close to or away from the psoas muscle. Care should be taken to prevent an LSC injury, particularly when the LSC needs to be retracted along with the psoas muscle.

Effects of Platelet-Rich Plasma in Tear Size Reduction in Partial-Thickness Tear of the Supraspinatus Tendon Compared to Corticosteroids Injection.

OBJECTIVES: Corticosteroid (CS) injection is commonly used in partial-thickness rotator cuff tears to decrease pain. However, this could result in unwanted side effects, such as tendon rupture. Alternatively, platelet-rich plasma (PRP) injection is frequently used to treat tendinopathies because it enhances healing. This study aimed to compare the differences in tear size and functional scores between intralesional PRP and subacromial CS injections. METHODS: Patients with symptomatic partial-thickness tears of the supraspinatus tendon who underwent conservative treatment for ≥ 3 months were enrolled. All patients underwent magnetic resonance imaging (MRI) to confirm the diagnosis. Fourteen and 15 patients were randomized to receive intralesional PRP and subacromial CS injections, respectively. Tears were measured in the coronal and sagittal planes. The patients underwent another MRI 6 months after the injection. Tear size was compared between the two MRI results. The American Shoulder and Elbow Surgeons Shoulder score (ASES) and Constant-Murley score (CMS) were also obtained. RESULTS: The baseline data were similar between the groups. In the coronal plane, PRP and CS showed tear size reductions of 3.39 mm (P = 0.003) and 1.10 mm (P = 0.18), respectively. In the sagittal plane, PRP and CS showed tear size reductions of 2.97 mm (P = 0.001) and 0.76 mm (P = 0.29), respectively. Functional scores improved 6 months after injection in both groups, but PRP showed better functional scores than CS (P = 0.002 for ASES, P = 0.02 for CS). CONCLUSION: Intralesional PRP injection can reduce the tear size in partial-thickness tears of the supraspinatus tendon. Subacromial steroid injection did not significantly affect the tear size. While CS improved functional scores compared with baseline, PRP resulted in better improvement 6 months post-injection. Trial registration Thai Clinical Trials Registry, TCTR20210428004. Registered 28 April 2021-retrospectively registered, TCTR20210428004 .

Validity and Reliability of the Thai Versions of the Lysholm Knee Scoring Scale and Tegner Activity Scale.

Background: Functional or quality of life questionnaires are important tools in clinical investigations. The Lysholm Knee Scoring Scale and Tegner Activity Scale are knee-specific questionnaires that are widely used to assess knee function. Purpose: To translate both questionnaires into Thai and to assess the validity and reliability of the Thai versions of the Lysholm and adjusted Tegner scales. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The Lysholm and Tegner scales were translated into Thai by using the forward-backward translation protocol. Because cultural modifications were made to the sports used to measure activity on the Tegner scale, the authors of this study refer to the Thai version as the "Thai adjusted Tegner scale." The reliability and validity of the translated scales were evaluated by obtaining the responses of 60 consecutive patients (mean age, 40.5 years; 34 male, 26 female); the patients also completed the Thai version of the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF). Criterion validity was tested by correlating the scores from both translated questionnaires with those from the Thai IKDC-SKF, while reliability was assessed by measuring test-retest reliability and internal consistency. Results: The Thai Lysholm scale showed a strong correlation with the Thai IKDC-SKF (r = 0.89), while the Thai adjusted Tegner scale showed a moderate correlation with the Thai IKDC-SKF (r = 0.60). The intrarater and test-retest reliability measures were excellent for the Thai Lysholm (intraclass correlation coefficient [ICC], 0.94 and 0.98, respectively) and moderate to good for the Thai adjusted Tegner (ICC, 0.73 and 0.86, respectively). The internal consistency for the Thai Lysholm was acceptable at all the time points (Cronbach alpha, 0.71-0.73). Conclusion: The Thai Lysholm and Thai adjusted Tegner scales adequately retained the characteristics of the original versions. They can be considered reliable instruments for Thai patients with knee-related problems.

Internal rotation of the shoulder in the beach chair position may increase the risk of iatrogenic suprascapular nerve injury at the spinoglenoid notch during surgical treatment for shoulder instability.

PURPOSE: Suprascapular nerve (SN) at the spinoglenoid notch is a mobile structure which is vulnerable to iatrogenic injury from screw or guidewire penetration during shoulder surgery such as Latarjet procedure or SLAP/Bankart repairs. The primary objective is to identify the distance between posterior glenoid and SN in different shoulder abduction and rotation. The secondary objective is to identify the distance in standard lateral decubitus position. METHODS: Nineteen shoulders from 10 Thiel embalmed soft cadavers were used in this study. The dissection of posterior shoulder was done to identify the SN at spinoglenoid notch. The distance between the posterior glenoid rim and the SN was measured. In beach chair position, the SN distance from six combinations of shoulder position was obtained: adduction/90° internal rotation (ADIR), adduction/neutral rotation (ADN), adduction/90° external rotation (ADER), 45° abduction/90° internal rotation (ABIR), 45° abduction/neutral rotation (ABN), 45° abduction/90° external rotation (ABER). Subsequently, the suprascapular nerve distance was measured in standard lateral decubitus position with 10 lbs. longitudinal traction. RESULTS: In the beach chair position with the shoulder in adduction, the mean distances between the glenoid and the SN in ADIR, ADN and ADER were 15.0 ± 3.3, 19.3 ± 2.6 and 19.5 ± 3.1 mm, respectively. During shoulder abduction, the mean distances when the shoulder was in ABIR, ABN and ABER were 15.2 ± 3.4, 19.4 ± 3.0 and 19.3 ± 2.6 mm, respectively. The mean distance for the lateral decubitus position was 19.3 ± 2.4 mm. The distance between the glenoid and SN was significantly shorter when the shoulder was positioned in internal rotation than in neutral (p < 0.001) or external rotation (p < 0.001) when compared to the same shoulder abduction position. The lateral decubitus position had comparable SN distance with the shoulder position of abduction/neutral rotation in beach chair position. CONCLUSION: The SN was closest to posterior glenoid rim if the shoulder was in internal rotation. Therefore, shoulder internal rotation must be avoided during guidewire and cannulated screw placement in the Latarjet procedure and drill bit insertion during anchor placement in SLAP/Bankart repair.