Primary and revision reverse total shoulder arthroplasty using a patient-matched glenoid implant for severe glenoid bone deficiency.

BACKGROUND: Severe glenoid bone loss in the setting of both primary and revision reverse total shoulder arthroplasty (rTSA) continues to remain a significant challenge. The purpose of this study was to report on radiographic and clinical outcomes of primary and revision rTSA using a patient-matched, 3-dimensionally printed metal glenoid implant to address severe glenoid bone deficiency. This is a follow-up study to previously reported preliminary results. METHODS: A retrospective review was performed on 62 patients with severe glenoid bone deficiency who underwent either primary or revision rTSA using the Comprehensive Vault Reconstruction System (VRS) (Zimmer Biomet) at a single institution. Preoperative and postoperative values for the Disabilities of the Arm, Shoulder and Hand (DASH), Constant, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Simple Shoulder Test (SST), Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) pain scores as well as active range of motion (ROM) were collected and compared using the Wilcoxon signed rank test with the level of statistical significance set at P < .05. The percentage of patients achieving minimal clinically important difference (MCID) and substantial clinical benefit (SCB) was also calculated. RESULTS: Fifty-five of 62 shoulders (88.7%) were able to be contacted at a minimum of 2 years postoperatively, with 47 of 62 (75.8%) having complete clinical and radiographic follow-up with a mean age of 67.5 years (range, 48-85 years) and follow-up of 39.2 months (range, 25-56 months). There were 19 primary and 28 revision rTSAs. Significant improvements were seen in mean active forward flexion (63.1° ± 30.3° to 116.8° ± 35°), abduction (48.1° ± 16.1 to 76.2° ± 13.4°) (P < .001), external rotation (16° ± 23.7° to 32.1° ± 24.5°) (P < .005), DASH (59.9 ± 17.7 to 35.7 ± 24.3), Constant (23.4 ± 13.1 to 53.1 ± 17.4), ASES (27.8 ± 16.2 to 69.1 ± 25.2), SST (3.3 ± 2.5 to 7.6 ± 3.5), SANE (28.9 ± 18.3 to 66.7 ± 21.2), and VAS pain (7.1 ± 2.4 to 1.8 ± 2.6) scores (P < .001). MCID and SCB was achieved in a majority of patients postoperatively. The overall complication rate was 29.1%, with only 1 baseplate failure. CONCLUSION: This study demonstrates promising evidence that the VRS implant can be used as a viable option to achieve clinically important improvement in a majority of patients treated for severe glenoid bone deficiency with rTSA in both the primary and revision setting.

Retrograde headless compression screw fixation of olecranon stress fractures in throwing athletes: a novel technique.

Background: An olecranon stress fracture (OSF) is a rare injury most commonly seen in high-level overhead throwing athletes with no clear consensus on surgical treatment. The most common surgical treatment described in the literature is cannulated screw fixation but there have been high rates of reported hardware irritation and need for subsequent hardware removal. Hypothesis/Purpose: This study describes a novel surgical technique in the treatment of OSFs in high-level throwing athletes using retrograde headless compression screws. We hypothesized that patients would have excellent outcomes and decreased rates of hardware irritation postoperatively. Methods: A retrospective review of competitive-level throwing athletes who sustained OSFs that were treated operatively using a novel technique using retrograde cannulated headless compression screws to avoid disruption of the triceps tendon. Postoperative outcome measures obtained included the Disabilities of the Arm, Shoulder and Hand score, Mayo Elbow Performance Score, Simple Elbow Test score, Single Assessment Numerical Evaluation score, Visual Analog Scale, arch of motion, and time to return to sport as well as level returned to. Radiographs were obtained routinely at 2-week, 6-week, 12-week, 6-month, 1-year, and 2-year follow-up. Results: Five of 5 patients who met inclusion criteria were available for final follow-up. Mean age at time of surgery was 20 years (range 17-24). Mean follow-up was 17 months (range 4-33). All patients were baseball players, 4 of which were pitchers and 1 position player. All patients were able to return to sport at the same level or higher at a mean of 5.8 months (range 3-8). Postoperatively, mean arch of motion was 138°, Visual Analog Scale score was 0, Single Assessment Numerical Evaluation score was 90, Disabilities of the Arm, Shoulder and Hand score was 2.0, Mayo Elbow Performance Score was 100, and Simple Elbow Test score was 12. There was no incidence of hardware removal. Conclusion: This study presents a novel surgical technique in the treatment of OSFs in high-level throwing athletes. The results presented demonstrate that this technique is safe and effective for getting athletes back to play quickly without any complications of hardware irritation which has previously shown to be a significant problem in prior literature.

Adolescent Athletes Achieve High Levels of Athletic and Daily Function After Arthroscopic Marrow Stimulation for Elbow Capitellar Osteochondritis Dissecans.

Purpose: To determine the functional outcomes of adolescent athletes treated with arthroscopic marrow stimulation/microfracture for elbow capitellar osteochondritis dissecans (OCD). Methods: The medical records for all patients younger than 18 years of age with capitellar OCD who underwent arthroscopic treatment at a single institution were retrospectively reviewed. The variables examined included patient characteristics, bone age, pre- and postoperative lesion grade/size and range of motion (ROM), intraoperative lesion grade/size, time to postoperative return to sport, and validated outcome scores. Results: Twenty patients with 21 treated elbows met the study's inclusion criteria. Three patients were not available for follow-up, leaving 18 of 21 (85.7%) elbows in the final cohort. Mean age and follow-up was 14.1 and 4.4 years, respectively. All 18 elbows were treated with diagnostic arthroscopy, arthroscopic debridement with loose body removal as indicated, and marrow stimulation. Sixteen of 18 (88.9%) elbows returned to sports postoperatively, with 12 of 18 (66.7%) elbows returning to their primary sport at the same level or higher. Overall, there were significant improvements in elbow ROM (132.8°, range 120°-140° postoperatively, compared with 122.1°, range 80°-140° preoperatively) (P = .002) and excellent Quick Disabilities of the Arm, Shoulder and Hand scores (mean 2.3 ± 5.1), as well as Kerlan-Jobe Orthopaedic Clinic Overhead Athlete Shoulder and Elbow scores (mean 94.1 ± 8.7) in those who returned to sports. There was no correlation with outcome or return to sport for preoperative lesion grade/size, bone age, physeal status or open versus arthroscopic treatment. Conclusions: Arthroscopic debridement and marrow stimulation for capitellar OCD in adolescent athletes leads to improvements in ROM, as well as a high rate of return to sport, and high levels of athletic and daily functional activity during follow-up, regardless of bone age and lesion grade/size at time of surgery. Level of Evidence: Level IV, therapeutic case series.

Use of an Accessory Anteromedial Portal to Facilitate Repair of Mid-Body Radial Tears of the Lateral Meniscus in Children and Adolescents.

Meniscal tears in adolescent patients are commonly treated with repair to preserve meniscal tissue and prevent future degenerative changes. Historically, meniscal tears best suited for repair are acute vertical tears in patients aged <40 years with a normal mechanical axis, >1 cm and <4 cm in size, within the red-red zone, and concurrent with anterior cruciate ligament reconstruction. However, with continued advancements in technology and the development of new techniques, the possibilities and indications for meniscal repair have broadened. This paper presents the use of an accessory medial portal to facilitate the repair of radial tears of the mid-body of the lateral meniscus. Previous techniques described include all-inside, outside-in, and inside-out repairs, but these techniques can be challenging to achieve optimal simultaneous meniscus reduction, visualization, and suture trajectory. In this Technical Note, we describe the use of an inside-out technique, with emphasis on an accessory anteromedial portal to improve visualization and suture trajectory.

Choosing the Optimal Wound Dressing for Bathing After Total Knee Arthroplasty.

BACKGROUND: Many surgical dressings claim to be waterproof and safe for bathing postoperatively. The purpose of this study is to evaluate and compare the effectiveness of commonly used dressings' ability to prevent water penetration while bathing. Additionally, a survey was used to determine satisfaction and cost analysis performed. METHODS: Four different dressings were applied to 17 subjects' knees: Aquacel, Opsite, Acticoat, and Tegaderm. A folded Medline Gauze Sponge was weighed and placed under each dressing before and after showering and bathing (submergence under water) in order to measure water penetration (change in weight of sponge in grams). A failure was defined as any dressing that allowed a sponge weight change greater than 1 standard deviation, or 3.9 g. All participants were additionally asked to complete a short survey after testing about the dressings. RESULTS: Tegaderm was found to have significantly less water penetration than all other dressings except Aquacel and demonstrated no failures with showering, significantly less than all other dressings. Tegaderm was also found to have significantly less water penetration than all other dressings except Acticoat with bathing and had significantly less failures than all other dressings. Furthermore, Tegaderm was found to be the most comfortable and lowest cost per dressing. CONCLUSION: Tegaderm was overall the most effective at preventing water penetration, most comfortable, and most cost-effective. Aquacel was found to be equally as effective at preventing water penetration while showering but overall had more water penetration, had more failures, caused more discomfort, and was more expensive.

A Novel Technique for a Successful Closed Reduction of a Bosworth Fracture-Dislocation of the Ankle.

The Bosworth fracture is defined as a bimalleolar fracture-dislocation of the ankle, with entrapment of the fibula behind the posterior tubercle of the distal tibia. In the current orthopedic literature, not only is this fracture pattern rare, but this type of fracture-dislocation has also been reported to be near impossible to close reduce, with the majority requiring early open reduction and internal fixation to prevent complications and poor clinical outcomes. Reported early complications include compartment syndrome and soft tissue complications from repeated closed reduction attempts. Complications associated with delayed operative intervention include post-traumatic adhesive capsulitis of the ankle and ankle stiffness. We present a case study of a 34-year-old male who sustained a Bosworth fracture-dislocation of the right ankle after a skateboarding accident. We describe a successful closed reduction performed in the emergency department, with a novel closed reduction technique. The patient tolerated the procedure well, with no complications. He was then scheduled for open reduction and internal fixation five days afterward, and upon post-operative follow-up, he recovered well with no complications. This technique focuses on reduction forces applied to the proximal fibular fragment, which is entrapped behind the posterolateral portion of the tibia. We believe that the key to successful reduction is applying an anterolateral/internal rotation force to this entrapped fragment. If successful, this fracture pattern may not require admission for compartment checks or early open reduction and internal fixation, thereby preventing complications and poor clinical outcomes. Our technique allows for a successful closed reduction of Bosworth fractures; however, further research exploring this reduction technique is warranted.

Genistein treatment increases bone mass in obese, hyperglycemic mice.

BACKGROUND: Obesity and type 2 diabetes mellitus are associated with elevated risk of limb bone fracture. Incidences of these conditions are on the rise worldwide. Genistein, a phytoestrogen, has been shown by several studies to demonstrate bone-protective properties and may improve bone health in obese type 2 diabetics. METHODS: In this study, we test the effects of genistein treatment on limb bone and growth plate cartilage histomorphometry in obese, hyperglycemic ob/ob mice. Six-week-old ob/ob mice were divided into control and genistein-treated groups. Genistein-treated mice were fed a diet containing 600 mg genistein/kg for a period of 4 weeks. Cross-sectional geometric and histomorphometric analyses were conducted on tibias. RESULTS: Genistein-treated mice remained obese and hyperglycemic. However, histomorphometric comparisons show that genistein-treated mice have greater tibial midshaft diameters and ratios of cortical bone to total tissue area than the controls. Genistein-treated mice also exhibit decreased growth plate thickness of the proximal tibia. CONCLUSION: Our results indicate that genistein treatment affects bone of the tibial midshaft in the ob/ob mouse, independent of improvements in the hyperglycemic state and body weight.