Modified Anatomical Anterior Cruciate Ligament Reconstruction with Flat Semitendinosus Graft and C-shaped Tibial Canal.

Every year, approximately 400,000 patients undergo anterior cruciate ligament (ACL) reconstruction surgery in the United States, accounting for almost 50% of all knee surgeries in the country. Recent studies have demonstrated that the ACL is a ribbon-like structure with a C-shaped tibial insertion and a flat femoral origin. This article introduces a modification of an ACL reconstruction technique. The modification renders the procedure easily reproducible with standard surgical instruments. We will describe a surgical technique modification that goes beyond the standard round bone tunnels and adopts a more anatomical approach using a C-shaped tibial canal and a flat femoral canal using a flat semitendinosus (semi-T) graft. The use of a semi-T graft better reproduces the ribbon-like ACL anatomy. The semi-T graft, a flat femoral canal, and a C-shaped tibial canal provide increased bone-tendon contact surface area and decreased diffusion length, resulting in improved tendon-bone healing. The modification proposed by our team makes the anatomical ribbon-like ACL graft, C-shaped tibial canal, and the flat femoral canal technique feasible in every orthopaedic operating room and mitigates costly specialized instrument.

Simultaneous bilateral shoulder arthroplasty: a case series.

BACKGROUND: Staged bilateral shoulder arthroplasty procedures have been shown to have good functional outcomes. The next step is to explore the option of simultaneous bilateral shoulder arthroplasty (SBSA). We report on the first case series of SBSA in the United States. The purpose of this study was to examine the safety and postoperative complication profile of SBSA and provide a technique reference for surgeons considering performing or investigating this procedure. METHODS: We conducted a retrospective record review of all the SBSA procedures performed by the senior author between 2007 and 2020. Patient demographic characteristics, surgical information, and postoperative data were collected. Data were compiled, and means, standard deviations, and ranges were calculated. Any readmissions or postoperative complications requiring revision were noted. A cohort of patients matched for age, sex, and body mass index with staged (sequential) bilateral total shoulder arthroplasty was analyzed for comparison. RESULTS: Thirteen patients were identified in the simultaneous group (SBSA). The mean age was 64 ± 15 years, with 9 women (69%) and 4 men (31%); the mean body mass index was 29.1 ± 7.5. The mean American Society of Anesthesiologists score was 2.55 ± 0.7, average blood loss was 364 ± 170 mL (range, 50-600 mL), 5 of 13 patients (38%) underwent blood transfusions, and the mean surgical time was 183 ± 42 minutes. Postoperatively, the mean visual analog scale pain score on postoperative day 1 was 4 ± 2 (range, 0-7), and the mean length of stay was 3.3 days. Postoperative complications included urinary tract infections in 2 patients, urinary retention in 2 patients, and recurrence of paroxysmal atrial fibrillation in 1 patient. No patient was readmitted within 90 days of surgery. One patient underwent a reoperation 2 years postoperatively for symptomatic hardware removal (cerclage cables around the tuberosities). A matched cohort of staged bilateral total shoulder arthroplasty patients was analyzed for comparison. Postoperative complications in the staged group included 1 reverse total shoulder arthroplasty patient with subjective instability that was managed with additional physical therapy. There were no documented readmissions within 90 days or revision arthroplasty procedures in either cohort. CONCLUSIONS: SBSA is a reasonable procedure that can be useful in select patients, with promising short-term safety noted in this series. Prospective randomized studies are needed to assess the long-term safety and efficacy of the procedure.

Baseplate Options for Reverse Total Shoulder Arthroplasty.

PURPOSE OF REVIEW: Baseplate fixation has been known to be the weak link in reverse total shoulder arthroplasty (RTSA). A wide variety of different baseplates options are currently available. This review investigates the recent literature to present the reader with an overview of the currently available baseplate options and modes of fixation. RECENT FINDINGS: The main elements that differentiate baseplates are the central fixation element, the size of the baseplate, the shape, the backside geometry, whether or not an offset central fixation exists, the number of peripheral screws, and the availability of peripheral augmentation. The wide array of baseplate options indicates that no particular design has proven superiority. As such, surgeons should be aware of their options and choose an implant that the surgeon is comfortable with and one that best suits the individual patient anatomy. With the growing number of RTSA procedures and registries with long-term follow-up, future investigations will hopefully delineate the ideal baseplate design to optimize survivorship.

Humeral shaft fractures.

Fractures of the humeral shaft are common injuries with multiple management strategies. Many still regard nonoperative management as the standard of care; however, as the understanding of these injuries increases, treatment recommendations are also evolving. Fracture pattern, fracture location, and identifiable patient risk factors may predict poor outcome with nonoperative management, and earlier operative intervention may be recommended. Operative management includes open reduction and internal fixation through a variety of exposures, intramedullary nail fixation, and external fixation. With increasing rates of shoulder arthroplasty, periprosthetic humeral shaft fractures also deserve special consideration.