Cooled radiofrequency ablation of the sacroiliac joint a retrospective case series.

BACKGROUND: Sacroiliac (SI) joint dysfunction is a common source of back pain. Recent evidence from different parts of the world suggest that cooled radiofrequency ablation of sacral nerves supplying the SI joints has superior pain alleviating properties than currently available treatment options for SI joint dysfunction. PATIENTS AND METHODS: After obtaining institutional review board approval, the medical records of 81 patients who underwent cooled radiofrequency ablation in a single institution and by a single surgeon were analyzed retrospectively. The recurrence of pain, progression to fusion and functional outcomes were noted. The patients were operated on between June 2020 and December 2021, they include 59 females and 22 males, the average age was 55.4 ± 17.3. Follow up was at least 6 months postoperative. RESULTS: 22 of the patients had previously underwent lumbar fusions. Follow up period ranged from 6 to 18 months. After radiofrequency ablation, 7 patients progressed to fusions, and 6 patients had to have the procedure done again to relieve their pain. Student t-test was used to compare between preoperative and postoperative values of NPRS (numerical pain rating score) and ODI (Oswestry disability index). It showed significance with P-value < 0.001 in both. CONCLUSIONS: Sacroiliac joint radiofrequency ablation is a good option in the treatment of SI joint pain showing good results in the short term follow up period. It is a simple procedure that can be done in less than 30 min and is capable of providing significant pain relief for patients with sacroiliac joint dysfunction.

Lumbar arthroplasty for treatment of primary or recurrent lumbar disc herniation.

PURPOSE: Microdiscectomy is the current gold standard surgical treatment for primary lumbar disc herniations that fail non-surgical measures. Herniated nucleus pulposus is the manifestation of underlying discopathy that remains unaddressed with microdiscectomy. Therefore, risk remains of recurrent disc herniation, progression of the degenerative cascade, and on-going discogenic pain. Lumbar arthroplasty allows for complete discectomy, complete direct and indirect decompression of neural elements, restoration of alignment, restoration of foraminal height, and preservation of motion. In addition, arthroplasty avoids disruption of posterior elements and musculoligamentous stabilizers. The purpose of this study is to describe the feasibility of the use of lumbar arthroplasty in the treatment of patients with primary or recurrent disc herniations. In addition, we describe the clinical and peri-operative outcomes associated with this technique. METHODS: All patients that underwent lumbar arthroplasty by a single surgeon at a single institution from 2015 to 2020 were reviewed. All patients with radiculopathy and pre-operative imaging demonstrating disc herniation that received lumbar arthroplasty were included in the study. In general, these patients were those with large disc herniations, advanced degenerative disc disease, and a clinical component of axial back pain. Patient-reported outcomes of VAS back, VAS leg, and ODI pre-operatively, at three months, one year, and at last follow-up were collected. Reoperation rate, patient satisfaction, and return to work were documented at last follow-up. RESULTS: Twenty-four patients underwent lumbar arthroplasty during the study period. Twenty-two (91.6%) patients underwent lumbar total disc replacement (LTDR) for a primary disc herniation. Two patients (8.3%) underwent LTDR for a recurrent disc herniation after prior microdiscectomy. The mean age was 40 years. The mean pre-operative VAS leg and back pain were 9.2 and 8.9, respectively. The mean pre-operative ODI was 22.3. Mean VAS back and leg pain was 1.2 and 0.5 at three months post-operative. The mean VAS back and leg pain was 1.3 and 0.6 at one year post-operative. The mean ODI was 3.0 at one year post-operative. One patient (4.2%) underwent re-operation for migrated arthroplasty device which required repositioning. At last follow-up, 92% of patients were satisfied with their outcome and would undergo the same treatment again. The mean time for return-to-work was 4.8 weeks. After returning to work, 89% of patients required no further leave of absence for recurrent back or leg pain at last follow-up. Forty-four percent of patients were pain free at last follow-up. CONCLUSION: Most patients with lumbar disc herniations can avoid surgical intervention altogether. Of those that require surgical treatment, microdiscectomy may be appropriate for certain patients with preserved disc height and extruded fragments. In a subset of patients with lumbar disc herniation that require surgical treatment, lumbar total disc replacement is an effective option by performing complete discectomy, restoring disc height, restoring alignment, and preserving motion. The restoration of physiologic alignment and motion may result in durable outcomes for these patients. Longer follow-up and comparative and prospective trials are needed to determine how the outcomes of microdiscectomy may differ from lumbar total disc replacement in the treatment of primary or recurrent disc herniation.

Sacroiliac Joint Fusion: Fusion Rates and Clinical Improvement Using Minimally Invasive Approach and Intraoperative Navigation and Robotic Guidance.

STUDY DESIGN: This study adopted a retrospective study design. PURPOSE: This study was designed to describe the fusion rate and technique and patient subjective improvement after sacroiliac (SI) joint fusion using a minimally invasive surgical (MIS) approach. OVERVIEW OF LITERATURE: The SI joint can mimic radicular or discogenic pain localized to the lower back, gluteal region, or sacral region, posing a challenge in the diagnosis and treatment. This study determines the radiological fusion rate and patient reported subjective clinical outcomes of SI joint fusion using an MIS approach, comparing the use of the Rialto SI joint fusion system (Medtronic, Minneapolis, MN, USA) with the help of the Stealth Navigation System with the use of ExcelsiusGPS Robotic Navigation Platform (Globus Medical Inc., Audubon, PA, USA) using SI-LOK screws (Globus Medical Inc.). METHODS: In this retrospective study, 43 consecutive patients who underwent SI joint fusion between August 2017 and February 2020 were enrolled; 60 SI joints were fused. The patients' fusion was documented on computed tomography or X-rays, and Visual Analog Scale (VAS) scores were used to determine patient subjective clinical outcomes. RESULTS: A total of 60 joints were fused, including 26 joints fused using robotic guidance and 34 joints fused using the Stealth Navigation System. Student t-test was used to compare the mean preoperative VAS score (7.52±1.3) with the mean postoperative VAS score at the 12-month follow-up (1.43±1.22) (p<0.05). The SI joint fusion rate using this technique was 61% at 6 months, 96.4% at 12 months, and 100% at 18 months. CONCLUSIONS: The use of navigation guidance or robotic assistance enables accurate percutaneous screw placement across the SI joint. The use of bone morphogenetic protein in the screw bore hastens fusion across the joint, improving patient-perceived pain.

Clinical results following robotic navigation guidance for sacroiliac joint fusion in 36 patients.

OBJECTIVE: In this study, the authors aimed to describe a new technique of sacroiliac joint (SIJ) fusion using a robotic navigation guidance system and to document clinical results with patient-reported visual analog scale (VAS) scores. METHODS: Patients diagnosed with SIJ dysfunction were surgically treated using 2 hydroxyapatite (HA)-coated, threaded screws with the aid of the robotic navigation system. In a total of 36 patients, 51 SIJs were fused during the study period. Patients' VAS scores were used to determine clinical improvement in pain. Postoperative imaging at routine intervals during the follow-up period was also performed for assessment of radiological fusion. In addition, complication events were recorded, including reoperations. RESULTS: All 36 patients had successful fusion evidenced by both CT and clinical assessment at the final follow-up. Two patients underwent reoperation because of screw loosening. The mean preoperative VAS score was 7.2 ± 1.1, and the mean 12-month postoperative VAS score was 1.6 ± 1.46. This difference was statistically significant (p < 0.05) and demonstrated a substantial clinical improvement in pain. CONCLUSIONS: Robotic navigation-assisted SIJ fusion using 2 HA-coated, threaded screws placed across the joint was an acceptable technique that demonstrated reliable clinical results with a significant improvement in patient-reported VAS pain scores.

Intertrochanteric fractures treated by diaphyseal support arthroplasty with hook plate vs cerclage wires only: A retrospective cohort study.

BACKGROUND: The treatment of unstable fractures of the intertrochanteric region of the hip in the elderly is controversial. Conventionally, internal fixation with intramedullary nail or a dynamic hip screw is the treatment of choice in intertrochanteric fractures. Nowadays, some authors encouraged the use hip arthroplasty for management of these fractures with good outcome. The aim of this study is to compare total hip arthroplasty with hook plate against total hip arthroplasty with cerclage cables in the management of unstable intertrochanteric fractures. MATERIALS AND METHODS: Out of 100 admitted patients to a central university hospital in Beirut between 2013 and 2019 with a diagnosis of unstable intertrochanteric fracture of the hip, only 64 (36 hook plate vs 28 cerclage) patients were selected. This is a retrospective study, patients were excluded if lost to follow up, or if follow up less than one year is available. The data were retrieved from inpatient and outpatient hospital files. Functional outcomes were assessed according to ambulatory capacity. The main clinical measures were early postoperative full weight bearing, postoperative complications, functional outcome and radiologic assessment done by a radiologist in addition to measuring the dysfunction via the Harris Hip Score. RESULTS: The time to full weight bearing, the rate of postoperative complications, radiologic outcome and the functional outcomes were more satisfactory in the hook - plate group than in the cerclage - cable group. CONCLUSION: According to the results, total hip arthroplasty with hook plate is considered the preferred modality of treatment in mobile elderly patients above sixty-five years of age with an unstable intertrochanteric femoral fracture, despite being a bulky foreign material that can lead to trochanteric bursitis.

Modified Mitchell technique for treating hallux valgus: Retrospective case series on a Middle-Eastern population and literature review.

INTRODUCTION: The hallux valgus deformity is a complex deformity of the first ray of the foot, with more than 100 procedures developed for its treatment. The aim of this retrospective study was to assess the clinical and radiographic outcomes of a modified Mitchell's technique. METHODS: Between 2007 and 2018, 75 patients underwent the procedure. Clinical results were assessed by the AOFAS score. Radiological studies were evaluated by measuring pre-operative and post-operative HVA and IMA angles as well as the relative shortening of the first metatarsal. RESULTS: Of the initial 75 patients, 42 patients remained eligible with a total of 67 feet. The mean age and follow-up were 47.8 and 5.2 years respectively. Global AOFAS score improved from 45.3 to 88.8 (p < 0.01). Mean HVA and IMA improved from 37.0 to 10.2 (p < 0,01) and 12.1 to 5.6 (p < 0.01), respectively. The mean metatarsal shortening was 3.0 mm (p < 0.01). The statistical analysis showed no significant correlation between preoperative HVA and IMA angles with postoperative shortening, metatarsalgia, AOFAS scores nor the difference between the preoperative and postoperative AOFAS scores. CONCLUSION: Short- and long-term outcomes of this modified Mitchell's osteotomy have been reported. Compared to other studies, these modifications proved to result in very good clinical and radiological outcomes even in severe cases with HVA>40. It has shown to be reliable, reproducible, and cost-efficient with low complication rates. We would like to highlight the importance of proper patient selection, limited soft tissue stripping, and adherence to the proposed surgical steps to avoid unwanted complications.

Bilateral Reverse Total Shoulder Arthroplasty with Soft Tissue Release for Bilateral Posterior Fracture Dislocation after Status Epilepticus.

Proximal humerus fracture is a common orthopedic presentation, with bimodal age distribution. On the other hand, bilateral proximal humerus fracture dislocation is a rarely reported pathology, especially when it is not the result of direct trauma. We present a case of a 71-year-old female patient found to have simultaneous bilateral 4-part proximal humerus fractures following status epilepticus treated surgically with bilateral reverse shoulder arthroplasty with constraint and soft tissue release. In a patient with recurrent status epilepticus episodes, the combination of constrained reverse shoulder arthroplasty and the extensive soft tissue release should decrease the rate of failure and dislocation dramatically. We conclude, after reviewing the literature, that there is no straightforward algorithm for treating such patients and that a clear classification should take into account both bone quality and patient comorbidities which has yet to be developed.

Irreducible anterior shoulder dislocation with interposition of the lesser tuberosity and subscapularis.

Anterior shoulder dislocation is the most common joint dislocation, unreducible dislocations however are a rare occurrence. The causes of the irreducibility vary, with interposition of soft tissues or bony fragments within the glenohumeral joint being the usual culprits. We present the case of an irreducible anterior shoulder dislocation with concomitant greater and lesser tuberosity fractures, with interposition of the subscapularis and lesser tuberosity thereby preventing reduction. We present the case of a 54-year-old female presenting with a left shoulder fracture dislocation after a fall from a 1.8-meter ladder. Patient was taken to the operating room after undergoing a CT scan. Attempts of closed reduction after administration of general anesthesia were unsuccessful. Open reduction and internal fixation with plate and screws was done through a deltopectoral approach. Intra-operatively, the lesser tuberosity and the subscapularis were found to be the cause of the irreducibility of the dislocation. At the latest follow up at 6 months post-op, the patient had regained a normal ROM with a good function. The vast majority of shoulder fracture dislocations are easily reducible, with only a limited number of case reports discussing irreducible fracture-dislocations. The causes of the irreducibility comprise interposition of soft tissue or bony fragments within the glenohumeral joint such as avulsed labrum or tendons, glenoid or humeral bony fragments interposition, and tensioning of nerves or tendons such as the biceps or subscapularis around the humeral head. CT scans are in our opinion very important for proper surgical planning when needed and for possible identification of an irreducible dislocation. Orthopedic surgeons should be aware that difficult closed reductions of the glenohumeral joint, whenever encountered, should raise the possibility of interposition of bony fragments or soft tissues where surgical treatment might be mandatory.

All-Inside Anterior Cruciate Ligament Reconstruction With Augmentation Using the Native Anterior Cruciate Ligament Remnant by Suture Approximation.

Anterior cruciate ligament (ACL) rupture remains a debilitating orthopaedic pathology with a substantial economic and psychological burden on patients, especially athletes. The purpose of ACL reconstruction is to attain maximum joint stability and functionality, allowing patients to resume their previous level of activity. Several graft options and techniques are available for ACL reconstruction. The all-inside remnant-preservation technique is a minimally invasive approach aiming for improved proprioception, better graft integration, and increased graft strength via ACL augmentation by suture approximation with an optimal anatomic reconstruction. ACL augmentation is associated with a decreased risk of rerupture. Moreover, enhancement of knee proprioception via the presented technique allows an early return to activity by patients because weight bearing (with a brace) can be initiated as early as day 1 postoperatively. Patients can resume running activities by 2 months postoperatively and return to pivot sports by 3 months postoperatively. Despite this surgical procedure being technically demanding, it is associated with improved clinical outcomes and functional capacities. Patients are also found to better tolerate the postoperative rehabilitation protocol.

Arthroscopic Suture Bridge Anchor Repair of Comminuted Greater Tuberosity Fracture With Double-Row Biceps Tenodesis in Elderly Osteoporotic Patients.

Isolated greater tuberosity fractures with displacement require usually open reduction and fixation to prevent poor outcomes, but high levels of morbidity have been reported. Recently, newer techniques describe arthroscopic fixation of greater tuberosity fracture for young patients; however, in elderly patients with comminuted osteoporotic fractures, this entity is more complex. A new arthroscopic technique is described through a minimally invasive approach that allows the evaluation of the glenohumeral joint and the treatment of associated pathology. These comminuted fractures can be treated using suture bridge technique. Postoperatively, rehabilitation consists of a similar regimen to that of a rotator cuff repair. With the appropriate surgical technique, good clinical outcomes can be obtained.

Hip joint space width in an asymptomatic population: Computed tomography analysis according to femoroacetabular impingement morphologies.

BACKGROUND: Although the association between femoroacetabular impingement (FAI) syndrome and hip osteoarthritis (OA) is well established, not all hips exhibiting cam or pincer morphologies (i.e. imaging findings of FAI syndrome) are symptomatic or arthritic. It is difficult to detect which subgroup will wear out, or how does the arthritic process start radiographically. Therefore, we measured in a retrospective study based on computed tomography (CT) analysis, the joint space width (JSW) according to a standard protocol and we investigated its variation according to the presence of a cam and/or pincer morphology. We hypothesized that the radiological presence of a cam and/or pincer hip morphologies, even in asymptomatic subjects, would affect JSW. METHODS: Two hundred pelvic CT scans performed for non-orthopedic etiologies in asymptomatic patients were analyzed using a 3D software. After excluding patients with hip OA or previous hip surgery, 194 pelvic CT scans (388 hips) were retained. We measured for each hip the presence of FAI syndrome imaging findings (cam and pincer morphologies) using the classical parameters of coxometry. In addition, we performed a measurement of articular joint space width according to a standard protocol. We then calculated the mean thickness of 3 defined regions along the femoroacetabular joint: anterior-superior, posterior-inferior, and posterior-superior. Lastly, we compared the JSW across 4 groups: hips with (1) no cam or pincer, (2) pincer, (3) cam, and (4) cam and pincer morphologies using a multivariate analysis. Additionally, a topographic heatmap of JSW was plotted allowing quantitative representation of JSW along the joint. RESULTS: Increased JSW with peak difference of 0.9 mm (25.7%) was found in hips with cam and pincer morphologies when compared to normal ones (p = 0.002) and to hips with pincer or cam morphologies only. CONCLUSION: Positive variations in JSW were associated to the presence of cam and pincer morphologies. This significant increase in JSW could be one of the earliest measurable changes preceding later classical alterations.

A rare case of an anatomical variation of bilateral long head of the biceps brachii tendons identified within the substance of bifid subscapularis tendons.

The long head of the biceps tendon is stabilized in the intertubercular groove by several anatomical structures. Dislocation or identification of the biceps tendon into or within the subscapularis tendon is very rarely mentioned in the literature. This is the first reported case of bilateral identification of the long head of the biceps tendons within the lateral subscapularis tendon. This report presents the case of a 51-year-old male patient who presented for bilateral shoulder pain. After failure of conservative treatment, MRIs were done which identified bilateral biceps tendons within the subscapularis tendons, with a concomitant supraspinatus tear on the right side. He underwent right shoulder arthroscopic biceps tenotomy, with supraspinatus repair. The symptoms of the left shoulder diminished as a result of the continuation of conservative treatment. The long head of the biceps tendon normally travels through the intertubercular groove and is stabilized by soft tissue and bony structures. Medial dislocation of the tendon is affected by the medial wall angle and by the integrity of the soft tissue stabilizers; most importantly the coracohumeral ligament in the proximal part of the groove. Dislocation of the biceps tendon into the substance of the subscapularis has been rarely mentioned in the literature; and as far as we know, bilateral occurrence without any identifiable subscapularis tears has never been previously mentioned. The bilateral occurrence with the absence of subscapularis lesions indicates that this is a congenital anomaly.

Arthroscopic management of anterior labrum periosteal sleeve avulsion (ALPSA) lesions: A case series with improved clinical outcomes using a modified technique.

INTRODUCTION: Anterior labrum periosteal sleeve avulsion (ALPSA) is the avulsion of the labrum and of the non-disrupted periosteum with the subsequent healing of the labrum in a medialized nonfunctional position on the glenoid neck. OBEJCTIVE: In this study, a modified technique for arthroscopic repair of ALPSA lesions is presented, along with post operative clinical results and follow up. METHOD: 72 patients who underwent this procedure were included in this study. Patients with multidirectional instability, more than 20% of glenoid bone loss, and bony Bankart lesions were excluded. RESULTS AND CONCLUSION: It was concluded that with this modified technique, a lower recurrence rate post arthroscopic repair of ALPSA lesions was seen with only 4 patients having postoperative recurrence of glenohumeral dislocation which amounts to 5.6%. Moreover, the data also showed a statistically significant improvement of 35.23% between the pre- and postoperative ASES scores.

The Ischial Spine in Developmental Hip Dysplasia: Unraveling the Role of Acetabular Retroversion in Periacetabular Osteotomy.

PURPOSE: Radiological diagnosis of acetabular retroversion (AR) is based on the presence of the crossover sign (COS), the posterior wall sign (PWS), and the prominence of the ischial spine sign (PRISS). The primary purpose of the study is to analyze the clinical significance of the PRISS in a sample of dysplastic hips requiring periacetabular osteotomy (PAO) and evaluate retroversion in symptomatic hip dysplasia. METHODS: In a previous paper, we reported the classic coxometric measurements of 178 patients with symptomatic hip dysplasia undergoing PAO where retroversion was noted in 42% of the cases and was not found to be a major factor in the appearance of symptoms. In the current study, we have added the retroversion signs PRISS and PWS to our analysis. Among the retroverted dysplastic hips, we studied the association of the PRISS with the hips requiring PAO. We also defined the ischial spine index (ISI) and studied its relationship to the coxometric measurements and AR. RESULTS: In hips with AR, the operated hips were significantly associated with the PRISS compared to the nonoperated ones (χ 2 = 4.847). Additionally, the ISI was able to classify acetabular version (anteverted, neutral, and retroverted acetabula). A direct correlation between the ISI and the retroversion index (RI) was found, and the highest degree of retroversion was found when the 3 signs of acetabular retroversion were concomitantly present (RI = 33.6%). CONCLUSION: The PRISS, a radiographic sign reflecting AR, was found to be significantly associated with dysplastic hips requiring PAO where AR was previously not considered a factor in the manifestation of symptoms and subsequent requirement for surgery. Moreover, the PRISS can also serve as an adequate radiographic sign for estimating acetabular version on pelvic radiographs.

Anterior inferior iliac spine avulsion fracture post hip arthroscopy for Femoroacetabular impingement.

FAI (Femoroacetabular Impingement) is an uncommon yet reported pathology of the hip joint, especially in the young athletic population. If left untreated, it predisposes for premature osteoarthritis of the hip. FAI treatment modalities consists of either open or arthroscopic surgery, the latter becoming the most adapted modality. We present a case of a young male athlete found to have FAI, treated arthroscopically. His post operative follow up was complicated by anterior inferior iliac spine avulsion fracture due to post op protocol non compliance which was treated with ORIF, with satisfactory non symptomatic outcome.

Arthroscopic Repair for Posterior Shoulder Instability: Case series and surgical outcome.

PURPOSE: This study evaluates outcomes of a consistent arthroscopic stabilization technique for recurrent posterior instability. METHODS: 79 shoulders with symptomatic posterior instability treated with arthroscopic repair and evaluated at a follow-up of 36 months. The mean age was 25.4 years of which 66 males and 13 females, and in 75% the dominant shoulder was affected. A known traumatic injury had occurred in 80%, with 25% having a documented dislocation. Arthroscopic repair was performed through an anterosuperior 12 O'clock viewing portal. Suture anchor repairs were performed in 60 cases and plication to the intact labrum in 19. A shoulder immobilizer was used for 4 weeks, followed by progressive range of motion, weightlifting at 3 months and return to contact sports at 6 months. The 79 cases had complete pre-op and post-op shoulder outcome scores. RESULTS: Significant improvement from preoperatively to final follow-up was seen for ASES scores, from 58 to 93. All patients returned to their previous level of athletic activity. Two patients reported postoperative instability; none required reoperation. There were no other postoperative complications. CONCLUSIONS: This study represents a consecutive series of patients with recurrent posterior instability undergoing arthroscopic posterior stabilization. In this population arthroscopic posterior labral repair and capsular plication provided significant clinical improvement with low recurrence and revision rate.

Sacral Anatomical Orientation in the Lebanese Population.

INTRODUCTION: PI is currently used as the gold standard measurement in spinopelvic anatomy. There is a need for a reliable method to calculate sacral anatomic orientation (SAO) independent of posture and to establish its association with PI, which was previously established in a single study (Peleg et al., 2007). Therefore, the aim of our study is the application and verification of this association on a Lebanese sample. METHODS: Methods for measuring SAO and PI on living individuals are described. The study was carried out on 200 adult individuals using CT 3D images (volume-rendering method). Reliability (intratester and intertester) was evaluated using the intraclass correlation test. A regression analysis was carried out to evaluate the association between the two measurements. RESULTS: There were 103 females (51%) and 97 males (49%) with a mean age of 58.68 ± 19.6 years (min = 20; max = 93). The mean SAO and PI in our population were found to be 52.65° (SD = 8.16°) and 59.08° (SD = 12.53°), respectively. SAO and PI measurements were highly correlated (Pearson correlation test; r = -0.296, P < 0.0001 for our general population). PI can be predicted via SAO, i.e., SAO = (-0.193 × PI) + 64.057. CONCLUSIONS: SAO may be an important tool, alongside PI, in defining the sagittal shape of the spine and useful for understanding its association with spinal diseases as they are not affected by postural changes.

Efficacy and safety of systemic tranexamic acid administration in total knee arthroplasty: A case series.

INTRODUCTION: Total knee arthroplasty (TKA) are associated with significant postoperative blood loss. Tranexamic acid (TXA) is a potent agent with antifibrinolytic activity, that can be administered via the intravenous (IV) and/or topical (intra-articular, IA) route, which can possibly interrupt the cascade of events due to hemostatic irregularities close to the source of bleeding. However, the literature contains scarce scientific evidence related to IV only TXA usage in TKA. The current study aims to compare the outcome between patients who were administered IV TXA and a control group in terms of blood loss, transfusion rate, and incidence of deep vein thrombosis (DVT) and thromboembolism (TE). METHODS: 110 patients, who underwent TKA were placed into two groups: 1) 34 patients who received IV TXA; and 2) 76 patients in the control group. In the TXA group, patients received an IV TXA dose of 1 g, 30 min before incision. Two drains were placed. RESULTS: Usage of IV TXA showed better results when compared to the control group in terms of mean blood transfusion (0.5 less transfusion during hospital stay), hemoglobin drop (10%). No cases of DVT or TE were noted among the two study groups. CONCLUSION: Use of IV TXA provided significantly better results compared to no TXA use with respect to all variables related to postoperative blood loss in TKA. Moreover, TXA use is safe in terms of incidence of symptomatic DVT and TE.

Posterior shoulder instability due to isolated reverse HAGL lesion in a young gymnast: A rare mechanism of injury and surgical technique.

Humeral avulsion of the inferior glenohumeral ligament (HAGL) is a relatively important cause of shoulder instability, becoming a field of interest in the literature. Reverse HAGL lesions, a rare pathology compared to anterior disruptions; have been documented in only few cases as a notable cause of posterior instability. We describe in detail the mechanism of injury, diagnosis, arthroscopic repair and results.

A spinoglenoid cyst compressing on the suprascapular nerve causing supraspinatus and infraspinatus muscle weakness: A case report.

INTRODUCTION: Spinoglenoid cysts are a rare cause of suprascapular neuropathy of compressive etiology in which the patient may present with shoulder pain and muscle hypotrophy. MRIs are the imaging modality of choice showing location, size, and extent of the lesion for preoperative assessment. Currently, surgical intervention is the preferred approach for the management of a spinoglenoid cyst with arthroscopy being favored over the open technique. CASE PRESENTATION: A 25-year-old male patient presenting with right posterior shoulder pain and decreased range of motion associated with the development of progressive weakness of the supraspinatus and infraspinatus muscles. Right shoulder MRI showed a posterior tear of the glenoid labrum and a spinoglenoid ganglion cyst. Preoperative electroneuromyography was suggestive of a suprascapular nerve impairment. FOLLOW-UP: Six months postoperatively, the patient has regained full range of motion of his right shoulder with no residue signs of muscle hypotrophy. CONCLUSION: Spinoglenoid cysts can cause compressive neuropathy with associated pain and muscle hypotrophy. MRI and EMG can help in establishing the diagnosis and in the pre-operative assessment. Surgical intervention with arthroscopy is currently the technique preferred by most surgeons.