Comparison of 4 Different 4-Strand Core Suturing Techniques for Flexor Tendon Laceration: An Ex Vivo Biomechanical Study.

BACKGROUND: Forces applied to the repaired flexor tendon should not exceed its yield force during early postoperative rehabilitation to prevent gapping and rupture. We aimed to biomechanically compare the tensile strengths and the 2-mm gapping of 4 different 4-strand core suturing techniques for flexor tendon repair. METHODS: Fifty-six goat deep digital flexor tendons were repaired with the 4-strand double-modified Kessler, the 4-strand augmented Becker, the 4-strand Savage, and the 4-strand modified Tang techniques. All tendons were repaired with 4-0 polyester for core suture and 5-0 polyester for continuous epitendinous running suture. The specimens were subjected to static linear tensile testing by applying a single linear load-to-failure pull. After the linear load testing, the yield load, the ultimate strength of the repaired tendons, and the force exerted to yield a 2-mm gap were measured. RESULTS: All peripheral sutures ruptured near the yield point. All core suture techniques were similar regarding the yield force. The augmented Becker 4-strand technique had the greatest ultimate strength (98.7 [82-125.3] N). The modified double Kessler technique was the weakest in resisting a 2-mm gap formation. The 4-strand modified Tang repair had the shortest (11.3 [7-15] minutes), while the 4-strand augmented Becker had the longest operative time (29 [23-33] minutes). CONCLUSIONS: All 4 techniques demonstrated similar yield force, with differences in operative time, ultimate strength, and resistance to gapping. Future clinical studies can further elucidate their appropriateness for early active motion protocols.

Minimum 5-year follow-up of arthroscopic treatment of symptomatic iliopectineal cyst.

INTRODUCTION: We aimed to primarily assess the clinical and functional outcomes of arthroscopic treatment of the symptomatic iliopectineal cyst at a minimum 5-year follow-up. Our secondary objective was to document the technical nuances of our arthroscopic technique. METHODS: A retrospective review of chart data was performed for 30 patients who underwent arthroscopic treatment of a symptomatic iliopectineal cyst in the period between 1999 and 2015. The mean age of our patients was 57 (33-78) years. All patients completed a minimum follow-up period of 5 years. Our clinical outcomes were assessed by 100 mm VAS for pain, recurrence rate and complications. Functional outcome was evaluated by the modified Harris hip score (mHHS). Patients were asked their level of satisfaction with surgery on a scale of 0-10. RESULTS: In all patients, the valve mechanism of the iliopectineal cyst could be released arthroscopically and the cyst could be completely evacuated. The preoperative symptoms disappeared within 3-6 weeks after the arthroscopic intervention. Patients showed significant improvement in VAS and mHHS 6 months postoperatively and at final follow-up. The average patient satisfaction was 9.2 at 6 months postoperative and 7.9 at final follow-up. None of our patients experienced any complications. At the final follow-up, there was neither clinical nor radiological evidence of cyst recurrence. CONCLUSIONS: Arthroscopic treatment of the iliopectineal cyst is a feasible and safe alternative to open surgery resulting in significant improvement of clinical and functional outcomes.

Periprosthetic bone density changes after MiniHipTM cementless femoral short stem: one-year results of dual-energy X-ray absorptiometry study.

INTRODUCTION: The purpose of the current study was to investigate the reaction of the femur to the implantation of the MiniHipTM in terms of: (1) bone density change during one year; (2) correlations between stem length, CCD (caput-collum-diaphyseal), femoral offset, T-value, and bone density; (3) other co-variables that influence the change of bone density. PATIENTS AND METHODS: MiniHipTM implant was performed for 62 patients. The age range of the patients who underwent treatment was 25-78 years. Periprothestic bone density was determined within two weeks postoperatively, after three, six, and twelve months utilizing the DEXA scan. RESULTS: The highest change was observed in the first three months post-implantation, while significant decrease in density was recorded at proximal Gruen zones 1, 2, and 7, and at distal Gruen zone 4. The decrease in density reached a plateau between the third and sixth months after operation. Afterwards, bone density recovered up to the 12th postoperative month. The correlation analysis showed significant difference between Gruen zone 1 and stem size and CCD. The same significant trend was not reached for Gruen zone 7. Femoral offset showed no correlation. Covariance analysis was unable to establish connection of the results with diagnosis, pairings, or gender. DISCUSSION: MiniHipTM densitometric results are promising and comparable to good results of the other representatives of the femoral neck partially-sustaining short stem prostheses with a lower proximal bone density reduction. Periprosthetic bone resorption is a multifactorial process where stem size, CCD angle, and patient-specific variables such as T-value have an impact on the periprosthetic bone remodeling. In particular, this applies to Gruen zone 1.

Antegrade-retrograde opposing lag screws for internal fixation of simple displaced talar neck fractures.

The talar neck is deviated medially with reference to the long axis of the body of the talus. In addition, it deviates plantarward. The talar neck fracture line is sometimes observed to be oriented obliquely (not perpendicular to the long axis of the talar neck). This occurs when the medially deviated talar neck strikes the horizontally oriented anterior lower tibial edge. Internal fixation of a simple displaced talar neck fracture usually requires 2 lag screws. Because the fracture line is obliquely oriented, a better method for positioning the screws perpendicular to the fracture line is to place them in a reversed direction to provide maximum interfragmentary compression at the fracture site, which could increase the likelihood of absolute stability with subsequent improvement in the incidence of fracture union and a reduction of complications, such as avascular necrosis of the body of the talus. Two lag screws are used, with the first inserted from posteriorly to anteriorly (perpendicular to the fracture line) using a medial approach after medial malleolar chevron osteotomy. The second screw is inserted from anteriorly to posteriorly (perpendicular to the fracture line) using an anterolateral approach. Both screw heads should be countersunk. A series of 8 patients underwent this form of internal fixation for talar neck fracture repair, with satisfactory functional outcomes. In conclusion, the use of antegrade-retrograde opposing lag screws is a reasonable method of internal fixation for simple displaced talar neck fractures.

Humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer in patients with rotator cuff tear arthropathy and preserved subscapularis muscle function: preliminary report and short-term results.

PURPOSE: Humeral resurfacing arthroplasty represents an alternative option to hemiarthroplasty for treatment of cuff tear arthropathy (CTA), with the advantages as follows: suitability for relatively young and high-demand patients because of preservation of bone stock and no loss of length, less invasive surgery, shorter operation time, no risk of periprosthetic stem fractures, and revision surgery can be undertaken easily. In the current study, resurfacing arthroplasty in combination with latissimus dorsi tendon transfer for CTA was performed. Three hypotheses: first, humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer would improve the overall functional outcome in patients with CTA. Second, this combination would improve humeral external rotation. Third, this combination would improve abduction and shoulder elevation. METHODS: Study was conducted as an observational case series. Fourteen patients (nine ♀ and five ♂) having CTA were included. Follow-up was carried out at the end of the 28th month for all patients. Constant Score was used for follow-up evaluation. Dorso-axillary approach was used for latissimus dorsi tendon transfer and ventral deltopectoral approach for Copeland resurfacing. Tendons were fixed to the greater tuberosity with two anchors. RESULTS: The absolute Constant Score significantly improved from 34 preoperatively to 69 postoperatively, relative Constant Score from 42 to 91%, elevation from 95° to 138°, abduction from 88° to 147°, and external rotation from 16° to 22° (not significant). CONCLUSION: Humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer in patients having CTA with preserved subscapularis function has satisfactory short-term functional clinical outcome. LEVEL OF EVIDENCE: IV.

Arthroscopic treatment of iliopsoas impingement (IPI) after total hip replacement.

PURPOSE: The purpose of the study was to present our arthroscopic surgical technique and the results in patient with an iliopsoas impingement (IPI) syndrome after a hip replacement. MATERIALS AND METHODS: Between 1999 and 2011, 35 patients with the clinical picture of an IPI after total hip replacement were diagnosed and treated arthroscopically. The age was ranged from 58 to 82 years. All patients underwent conservative treatment for at least 6 months without success. The indication for the arthroscopic procedure was the failure of the conservative therapy as well as typical clinical signs as painful hip flexion, a positive local anesthesia test and radiological evidence of the presence of a prominent anterior acetabular component. The arthroscopic treatment was performed in all patients with anterior capsulotomy and partial capsulectomy of the hip joint. After identification of the pathology an arthroscopic release of the iliopsoas tendon in the region of the proved lesion was performed. The average follow-up period was 3.6 years (6 months to 12 years). RESULTS: In all patients osseous integrated acetabular components were found. In six cases there was a surface replacement, in three cases it was a cementless screw-in cup and in the other three cases it was a cementless modular press-fit cup. 8 out of 12 patients suffered from a hip dysplasia with a secondary osteoarthritis. After establishing an anterior capsular window arthroscopically, the iliopsoas tendon could be visualized in all cases. In addition to multiple local tendinitis all patients already showed mechanical limitation with partial rupture of variable extent in the iliopsoas tendon. During the arthroscopy the lesion was detected at the level of the anterior prominent acetabular component as well as distal to it. 10 out of 12 patients reported immediately after postoperative mobilization that the typical preoperative complaints have disappeared. Two patients still had residual pain. In one of those patients this was relieved by the time of the follow-up examination. Clinically a temporary weakness of hip flexion in the first days of the postoperative period was detected. In the first follow-up 6 weeks later there was no evidence of weakness in any of the patients. CONCLUSION AND CLINICAL RELEVANCE: An arthroscopic release of the iliopsoas tendon with evidence of iliopsoas impingement after total hip replacement gives predictably good results. A clinically relevant weakness of hip flexion is not expected after the procedure.