Favorable Reoperation Rate at 2 Years Following Repair of Horizontal Cleavage Tears Using an All Suture-Based Technique: A Prospective, Multicenter Trial.

PURPOSE: This prospective, multicenter trial evaluates the clinical success (as measured by reoperation rates and improvements in patient-reported outcome measures) of using circumferential compression stitches with all-suture techniques for horizontal cleavage tears (HCTs) of the meniscus. METHODS: Investigators enrolled 30 patients (mean age, 38.2 years; standard deviation, 11.1 years) aged 18 to 60 years with HCTs in the symptomatic compartment at 8 centers in the United States who underwent HCT repair with all-suture circumferential stitches using a self-retrieving all-inside suture passing device. Postoperative follow-up visits were conducted at 6 months, 1 year, and 2 years. Study outcomes included freedom from reoperation of the index meniscus repair site; knee pain and function, as measured by International Knee Documentation Committee Knee evaluation (IKDC), Knee injury and Osteoarthritis Outcome Score, Lysholm Knee Scale, and Tegner Activity Scale; and serious complications observed during the study. Minimal clinically important difference at 1 year was assessed for IKDC and Lysholm. RESULTS: Twenty-three patients had 2-year follow-up data available. Freedom from reoperation was 96.0% at 6 months (26/27, 91.7% at 1 year [23/25], and 82.6% at 2 years [19/23]). Significant improvement was observed in over baseline at 2 years for IKDC (36.7-82.5; P < .001), Knee injury and Osteoarthritis Outcome Score (52.2-89.3; P < .001), Lysholm (50.2-87.4; P < .001), and Tegner scores (3.3-5.3; P = .007). Minimal clinically important difference was met or exceeded for IKDC and Lysholm scores at 1 year 69.2% and 65.4% of patients, respectively. Four patients (6.7%) experienced serious complications, of which 2 were assessed as being related to the procedure. CONCLUSIONS: Repair of HCTs using all-suture circumferential stitches placed with a self-retrieving all-inside suture passing device leads to a favorable reoperation rate (17.4%), significant improvements in clinical outcomes, and an acceptable rate of serious complications (6.7%) at 2 years, supporting the viability of this treatment approach in this indication. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

High stiffness of human digital flexor tendons is suited for precise finger positional control.

The objective of this study was to define the biomechanical properties of the human digital flexor tendons and to compare these biomechanical properties to other muscle-tendon units in the forearm. Mechanical measurements were performed on fresh-frozen tendons under physiological load and temperature conditions. Loads were determined by first measuring the physiological cross-sectional area of each digital belly of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) and estimating maximum tension (P(o)) of that specific muscle head. Loading each tendon to the appropriate P(o) resulted in no significant difference in tendon strain among any of the tendons within each muscle (P > 0.05; digits 2-5) or between muscle types (FDP vs. FDS). The one exception to this finding was that a significantly higher strain at Po was observed in the FDP tendon to the small finger (P < 0.05). Average absolute strains observed for the FDP and FDS tendons (1.20 +/- 0.38%, mean +/- SD; n = 39) were significantly lower than those observed previously in a study of the prime movers of the wrist. The measured strain of approximately 1.5% was less than half of that predicted to occur in muscles of this architectural design. Modeling sarcomere shortening magnitudes during FDP or FDS contraction yielded a value of only 0.10 microm, which would have a negligible effect on the force generating capacity of these muscles. Thus the high stiffness of the digital flexor tendons suits them well for fine positional control and would render their muscle spindles quite sensitive to length perturbations at the fingertips.

Arthroscopic assessment of occult intra-articular injury in acute ankle fractures.

PURPOSE: To arthroscopically assess the pattern and extent of intra-articular damage associated with ankle fractures. TYPE OF STUDY: Prospective case series. METHODS: From 1989 to 1998, 48 consecutive patients with acute unstable ankle fractures underwent ankle arthroscopy followed by reduction and internal fixation. In addition, all injuries were categorized by specific osseous, ligamentous, and articular pathology, based on clinical and arthroscopic examination. Whenever possible, the fractures were classified according to Lauge-Hansen and Danis-Weber schemes. RESULTS: Traumatic articular surface lesions (TASLs), including chondral defects and osteochondral lesions measuring greater than 5 mm in diameter, were identified in 30 of the 48 ankles (63%), with 11 lesions localized to the tibia and 19 noted on the talus. The tibial lesions were at the posterior syndesmotic ligament insertion in 6 cases, at the anterior capsule origin in 3 cases, and at the central articular surface in 2 cases. Of the 19 talar lesions, 15 involved the medial dome and 4 involved the lateral articulation. TASLs of the talus in this series were uniformly unstable or displaced and virtually devoid of subchondral bone, precluding satisfactory internal fixation. Of the 10 pronation-external rotation fractures, 7 had articular surface defects with 5 involving the medial and 2 the lateral dome. Ten of the 24 supination-external rotation or Danis-Weber B fractures were found to have TASLs of the talus, 9 medial and 1 lateral. Nine of 12 fractures with syndesmosis disruptions sustained full-thickness damage to the talar chondral surface (P =.01). CONCLUSIONS: Ankle fractures have a high incidence of concomitant intra-articular pathology with syndesmosis disruption portending a particularly high risk of articular surface injury to the talar dome. Arthroscopy is a valuable tool in identifying and treating intra-articular damage that would otherwise remain unrecognized and may provide prognostic information regarding the functional outcome of these injuries.