Arthroscopic Modified McLaughlin Procedure and Remplissage for Treatment of Simultaneous Reverse Hill-Sachs and Hill-Sachs Lesions.

Hill-Sachs lesions (HSLs) can be present after a primary shoulder dislocation and may go unrecognized; this can alter the necessary bony constraint within the glenohumeral joint. To deal with HSLs, remplissage is a safe procedure with low complication rates, low recurrent instability rates, and good patient outcome scores compared with many of the other alternative techniques. On the other hand, a great number of techniques have been described to treat reverse Hill-Sachs lesions (RHSLs). In this article, we propose a method of treatment for combined simultaneous HSL and RHSL shoulder injuries. However, consensus on a specific treatment is yet to be established. We present an arthroscopic treatment guideline for patients with shoulder instability due to anterior and posterior labral lesions, HSL, and RHSL.

Comparison of automated and traditional ECAP recording approaches in clinical practice.

OBJECTIVE: The traditional method of recording electrically evoked compound action potentials (ECAPs), as implemented in the MAESTRO clinical software (standard ART), requires manual adjustments during threshold determination through a specialist. The "FineGrain" research tool (FineGrain RT) uses a continuous stimulation paradigm combined with automatic ECAP threshold determination. The aim of this study was to compare the FineGrain RT with standard ART. DESIGN: ECAPs were recorded with standard ART and the FineGrain RT in paediatric cochlear implant recipients. Different stimulation rates were used for FineGrain ECAP recordings (40, 60, and 76 Hz). STUDY SAMPLE: Thirteen children (6 - 19 years) participated in this study - nine were bilaterally and four unilaterally implanted, resulting in a total of twenty-two implanted ears. RESULTS: ECAP threshold determination success rates were similar between the two approaches (92% and 89%) and ECAP thresholds correlated well (r: 0.94, p < 2.2e-16) with average ART thresholds being lower than FineGrain RT thresholds. FineGrain stimulation with different stimulation rates did not have a significant effect on ECAP thresholds but ECAP thresholds at medial and apical contacts were lower compared to basal contacts. CONCLUSIONS: TheFineGrain research approach is a reliable replacement for standard ART in clinical practice.

High-Density Autologous Chondrocyte Implantation as Treatment for Ankle Osteochondral Defects.

PURPOSE: Two-year follow-up to assess efficacy and safety of high-density autologous chondrocyte implantation (HD-ACI) in patients with cartilage lesions in the ankle. DESIGN: Twenty-four consecutive patients with International Cartilage repair Society (ICRS) grade 3-4 cartilage lesions of the ankle were included. Five million chondrocytes per cm2 of lesion were implanted using a type I/III collagen membrane as a carrier and treatment effectiveness was assessed by evaluating pain with the visual analogue scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at baseline, 12-month, and 24-month follow-up, together with dorsal and plantar flexion. Magnetic resonance observation for cartilage repair tissue (MOCART) score was used to evaluate cartilage healing. Histological study was possible in 5 cases. RESULTS: Patients' median age was 31 years (range 18-55 years). Median VAS score was 8 (range 5-10) at baseline, 1.5 (range 0-8) at 12-month follow-up, and 2 (rang e0-5) at 24-month follow-up (P < 0.001). Median AOFAS score was 39.5 (range 29-48) at baseline, 90 (range 38-100) at 12-month follow-up, and 90 (range 40-100) at 24-month follow-up (P < 0.001). Complete dorsal flexion significantly increased at 12 months (16/24, 66.7%) and 24 months (17/24, 70.8%) with regard to baseline (13/24, 54.2%) (P = 0.002). MOCART at 12- and 24-month follow-ups were 73.71 ± 15.99 and 72.33 ± 16.21. Histological study confirmed that neosynthetized tissue was cartilage with hyaline extracellular matrix and numerous viable chondrocytes. CONCLUSION: HD-ACI is a safe and effective technique to treat osteochondral lesions in the talus, providing good clinical and histological results at short- and mid-term follow-ups.

Artroscopia anterior de tobillo. Complicaciones tempranas con técnica sin distracción / Anterior ankle arthroscopy. Early complications without joint distraction

Introducción: La artroscopia se ha convertido en una importante herramienta para tratar diversas afecciones del tobillo. El uso de portales anteriores y posteriores, asociados o no a distracción mecánica, permite una completa exploración de esta articulación. Como toda técnica quirúrgica, no está exenta de complicaciones. Objetivos: Evaluar las complicaciones tempranas de la artroscopia anterior de tobillo, sin distracción articular, y compararlas con las descritas en la bibliografía internacional. Materiales y Métodos: Estudio retrospectivo que evaluó a 198 pacientes sometidos a artroscopia anterior de tobillo por diversas patologías. Todos fueron operados por un único cirujano, en dos instituciones de salud, durante un período de 6 años, con un seguimiento posquirúrgico mínimo de 12 meses. Los pacientes fueron evaluados mediante el puntaje de la AOFAS y se consignaron las complicaciones intra y posoperatorias tempranas. Resultados: Se evaluó a 34 mujeres y 164 hombres (edad promedio 37.5 años). Hubo 23 complicaciones (11,61%): celulitis local (6 casos), parestesias transitorias del nervio peroneo superficial (4 casos), parestesia permanente del nervio peroneo superficial (1 caso), dolor residual en los portales (4 casos), artritis séptica (2 casos) y un caso de otras complicaciones. Conclusiones: Un conocimiento preciso de la anatomía, una asepsia y una técnica quirúrgica correctas, y los cuidados de manejo intraquirúrgico del instrumental permiten evitar la mayoría de las complicaciones. La artroscopia anterior de tobillo sin distracción por medio de los clásicos portales antero-lateral y antero-medial es una técnica segura, con un bajo índice de complicaciones y una muy baja morbilidad para el paciente. Nivel de Evidencia: IV

Introduction: Arthroscopy has become an important tool to treat various conditions of the ankle. The use of anterior and posterior portals, with or without mechanical distraction, allows for a complete exploration of this joint. Like all surgical techniques, it is not without complications. Objectives: To evaluate the early complications of anterior ankle arthroscopy with or without joint distraction, and to compare them with those described in the international literature. Materials and Methods: A retrospective study that evaluated 198 patients undergoing anterior ankle arthroscopy for various pathologies. All were operated on by a single surgeon, in two health centers, during a period of 6 years, with a postoperative follow-up of at least 12 months. Patients were evaluated by AOFAS score and early and postoperative complications were recorded. Results: 34 women and 164 men were evaluated (average age 37.5 years). There were 23 complications (11.61%): local cellulitis (6 cases), transient paresthesia of the superficial peroneal nerve (4 cases), permanent paresthesia of the superficial peroneal nerve (1 case), residual pain in the portals (4 cases), septic arthritis (2 cases) and one case of other complications. Conclusions: Most complications can be avoided by a precise knowledge of the anatomy and the aseptic techniques, as well as an adequate surgical approach and intra-operative management of the instrumentation. Anterior ankle arthroscopy without joint distraction through standard antero-lateral and antero-medial portals is a safe technique, having a low rate of complications and a very low morbidity for the patient. Level of Evidence: IV

Cartilage Defect Treatment Using High-Density Autologous Chondrocyte Implantation: Two-Year Follow-up.

OBJECTIVE: The aim of this work was to study the short- and mid-term effectiveness and safety of high-density autologous chondrocyte implantation (HD-ACI) in the first 50 patients with knee cartilage damage treated in our unit. DESIGN: Fifty consecutive patients with cartilage lesions (Outerbridge grade III-IV) in the knee treated with HD-ACI were included in this study. Chondrocytes were isolated from a nonbearing cartilage area biopsy and were cultured until 40 to 50 million cells were obtained. Five million chondrocytes per cm2 of a porcine collagen type I/III membrane were implanted covering the defect. Procedure effectiveness was assessed by evaluating pain, swelling, and range of mobility (flexion and extension) at 6-, 12-, and 24-month follow-up. The International Knee Documentation Committee (IKDC) subjective evaluation form was used to evaluate symptoms and functions of the knee. RESULTS: The percentage of patients with pain and swelling decreased progressively in the following visits, with differences being statistically significant ( P < 0.001 and P = 0.040, respectively). IKDC scores improved progressively throughout the 24-month follow-up ( P < 0.001). Thus, the mean IKDC score improvement was 26.3 points (95% confidence interval [CI] = 18.2-34.4 points) at 12 months and 31.0 points (95% CI = 22.9-39 points) at 24 months. No significant differences were found when performing extension ( P = 0.112). Flexion significantly improved by 25.1° at 24-month follow-up ( P = 0.013). CONCLUSIONS: HD-ACI is a safe and effective technique for the treatment of cartilage defects, improving clinical and subjective perception of knee functionality. These preliminary results encourage future studies comparing this technique with traditional ACI.

Electrically evoked compound action potentials are different depending on the site of cochlear stimulation.

One of the many parameters that can affect cochlear implant (CI) users' performance is the site of presentation of electrical stimulation, from the CI, to the auditory nerve. Evoked compound action potential (ECAP) measurements are commonly used to verify nerve function by stimulating one electrode contact in the cochlea and recording the resulting action potentials on the other contacts of the electrode array. The present study aimed to determine if the ECAP amplitude differs between the apical, middle, and basal region of the cochlea, if double peak potentials were more likely in the apex than the basal region of the cochlea, and if there were differences in the ECAP threshold and recovery function across the cochlea. ECAP measurements were performed in the apical, middle, and basal region of the cochlea at fixed sites of stimulation with varying recording electrodes. One hundred and forty one adult subjects with severe to profound sensorineural hearing loss fitted with a Standard or FLEXSOFT electrode were included in this study. ECAP responses were captured using MAESTRO System Software (MED-EL). The ECAP amplitude, threshold, and slope were determined using amplitude growth sequences. The 50% recovery rate was assessed using independent single sequences that have two stimulation pulses (a masker and a probe pulse) separated by a variable inter-pulse interval. For all recordings, ECAP peaks were annotated semi-automatically. ECAP amplitudes were greater upon stimulation of the apical region compared to the basal region of the cochlea. ECAP slopes were steeper in the apical region compared to the basal region of the cochlea and ECAP thresholds were lower in the middle region compared to the basal region of the cochlea. The incidence of double peaks was greater upon stimulation of the apical region compared to the basal region of the cochlea. This data indicates that the site and intensity of cochlear stimulation affect ECAP properties.

Vibrant Soundbridge in congenital osseous atresia: multicenter study of 12 patients with osseous atresia.

CONCLUSION: The study suggests that the Vibrant Soundbridge (VSB) middle ear implant could be a valid alternative for patients with congenital aural atresia to compensate for their hearing loss. OBJECTIVE: To determine the audiologic benefit the VSB provides in patients with congenital aural atresia. METHODS: Twelve patients with congenital aural atresia were implanted with VSB: eight patients were unilaterally atretic (67%) and 4 (33%) were bilaterally atretic. In five cases the implant was placed onto the round window, in another five cases the implant was placed on the stapes, in only one case a prosthesis (coupler) was used to fix the implant into the oval window, and in one case a fenestration on the cochlear endostium was performed. RESULTS: The mean functional gain obtained for all patients evaluated was 62 dB at 0.5 kHz, 60 dB at 1 kHz, 48.3 dB at 2 kHz, and 50.8 dB at 4 kHz. The mean functional gain for all frequencies evaluated was 55.1 dB.