The Effect of Instrumentation on Suture Tensile Strength and Knot Pullout Strength of Common Suture Materials.

OBJECTIVE: To determine the effect of instrumentation of suture material on knot security and tensile strength. STUDY DESIGN: In all, 5 types of suture material were used; 10 knots were tied without any instrumentation and 10 knots were tied with a hemostat holding tension on the first throw while the second throw was made for each suture type. Each group was tested to failure with the maximum load and mode of failure recorded. The maximum load between groups of each suture type was compared; frequency of failure through knot slippage vs material fracture was also compared between groups. RESULTS: There was no significant difference observed in the maximum load to failure for any suture type between instrumented and noninstrumented groups. Additionally, there was no difference between any instrumented and noninstrumented groups for material failure vs failure due to knot slippage. CONCLUSIONS: Instrumentation of suture material during two-hand tying does not affect the strength of suture material or knot security.

Outcomes of biceps tenodesis in an active duty population.

Pathology affecting the long head of the biceps tendon and its insertion is a frequent cause of shoulder pain in the active duty military population. The purpose of this investigation was to evaluate functional outcomes of subpectoral biceps tenodesis in an active duty population. A retrospective case series of 22 service members who underwent biceps tenodesis was performed and Shoulder Pain and Disability Indexes (SPADI) and Disabilities of the Arm, Shoulder and Hand (DASH) scores were obtained preoperatively and at 6 months. Additionally, a review of each subject's physical profile was performed 6 months after surgery to determine continued physical limitations and one's ability to deploy. There was a statistically significant improvement in SPADI and DASH scores comparing preoperative versus postoperative outcomes. Although five subjects (22%) continued to have a restriction to performing push-ups on the Army Physical Fitness Test, all were deemed deployable from a physical standpoint. The results of this review suggest that active duty personnel undergoing biceps tenodesis have significant functional improvement at 6 months. Additionally, very few have long-term physical limitations or deployment restrictions.

A criterion based sling weaning progression (sweap) and outcomes following shoulder arthroscopic surgery in an active duty military population.

INTRODUCTION: Little objective evidence is available to guide rehabilitation protocols in regard to the sling weaning process following arthroscopy surgery of the shoulder. The purpose of this study was to establish an objective, criterion based protocol for accelerated sling weaning following shoulder arthroscopy. METHODS: 82 active duty service members (ADSM) underwent elective shoulder arthroscopic surgery by three orthopaedic staff surgeons. One physical therapist progressed patients through the criterion based sling weaning progression (SWEAP) protocol for each surgery and documented pain levels, sleep habits, and decrease in sling use. Preoperative and six month postoperative Quick Disability of the Arm, Shoulder, and Hand (qDASH) and Shoulder Pain and Disability Index (SPADI) scores were obtained. The ability to perform an Army Physical Fitness Test (APFT) was recorded at six months postoperative. RESULTS: Patients completed sling weaning at an overall mean of 16.6 ± 5.0 days with continued use in unprotected military settings only beyond this timeframe. As patients steadily progressed out of the sling for 1 hour, 2-3 hours, and half-day periods, average pain scores decreased during these time periods at 5.0±1.2, 3.7±1.2, and 2.1±1.3 (0-10 pain scale), respectively. Patients obtained 6-7 hours of sleep or normal sleep habits at an average of 10.9±4.4 days postoperative. Overall, preoperative qDASH and SPADI scores improved from 39.8±13.0 to 2.4±2.0 and 46.4±16.1 to 3.3±3.2, respectively, at 6 months follow up. All 82 patients were able to return to deployable status. 30 (36.6%) patients required formal restrictions for the push-up portion of the APFT at six months postoperative. 7 of these 30 patients required running restrictions. CONCLUSIONS: Early improvement in quality of life indicators can be obtained in the initial postoperative period with a progressive, criterion based SWEAP protocol. Patients demonstrated favorable outcomes with return to occupational and physical fitness activities. This study will guide orthopedic surgeons and physical therapists to enhance the sling weaning process during rehabilitation protocols and improve preoperative counseling sessions for accurate postoperative expectations. STUDY DESIGN: Retrospective Case Series; Level of evidence 4.

The safety of spinal pedicle screws in children ages 1 to 12.

BACKGROUND CONTEXT: Pedicle screws have shown to be a safe and effective method of spinal fixation, offering superior multiplanar correction compared with hooks or sublaminar wires in selected situations. Though only food and drug administration (FDA) approved in the adolescent population, they are commonly used in an off-label manner in the preadolescent population. PURPOSE: To determine if the complication rate of the off-label use of pedicle screws for spinal fixation in the preadolescent 0- to 12-year-old population is comparable with the complication rate in the FDA-approved 13- to 18-year-old population. STUDY DESIGN/SETTING: Retrospective medical record and radiograph review. PATIENT SAMPLE: A total of 726 pediatric patients who underwent a spinal fusion procedure at a single tertiary institution between January 2003 and December 2008 were reviewed. OUTCOME MEASURES: Incidence of instrumentation failure, infection, neurological complication, and total complications. METHODS: The study population was divided into two groups based on age: the younger group included 0- to 12-year olds and the older group included 13- to 18-year olds at the time of surgery. Groups were further subdivided based on diagnosis: "A," neuromuscular scoliosis; "B," idiopathic scoliosis, and "C," other spinal deformities. Rates of neurovascular complications, infections, and instrumentation complications were compared statistically between the younger and the older groups. Only patients with greater than or equal to 1-year follow-up and greater than or equal to 2-year follow-up were included in the calculations for infection and instrumentation complication rates, respectively. RESULTS: There were 206 patients (33% males, 67% females) in the younger group (0 to 12 years) and 520 (41% males, 59% females) in the older group (13 to 18 years). Overall, younger group had a 13.6% complication rate compared with 16.9% in the older group. Younger subjects showed a 13.4% complication rate because of instrumentation-related complications, 0.5% for neurovascular complications, and an infection rate of 9.2%. The older group showed a 15.4% complication rate because of instrumentation-related complications, 1.92% for neurovascular complications, and an infection rate of 11.0%. Complication rates were statistically insignificant between the two groups. Other complications in the younger group included one patient with aspiration pneumonia, two with ileus, and one with pulmonary and other complications in the older group included one patient with aspiration pneumonia, two with ileus, three with superior mesenteric artery syndrome, and three with wound dehiscence. CONCLUSIONS: The complication rates in the young pediatric population associated with the off-label use of pedicle screws for spinal fusions are not statistically different from the complication rates associated with the FDA-approved adolescent population.