Quantitative MRI versus perioperative arthroscopy to measure stage 1 ruptures of the supraspinatus tendon for surgical planning.

BACKGROUND: Accurate preoperative assessment of supraspinatus tendon tear (STT) size is important for surgical planning. Our aims were to evaluate the correlation between stage 1 STT size measured preoperatively by quantitative (q)MRI and size measured perioperatively by arthroscopy. The concordance between preoperative tear size and the surgical plan was also assessed. METHODS: This prospective, non-randomized, non-controlled, interventional study was carried out in patients with a stable stage 1 STT. Three months before surgery, STT size was measured in the sagittal and coronal planes by a radiologist by qMRI (1.5T). Three months later, the surgeon measured the size of the tear again on the same qMRI scans and decided on the most appropriate surgical plan. During arthroscopy, the surgeon measured the size of the tear again using a graduated sensor hook and carried out the repair. STT size measured preoperatively was compared to that measured by arthroscopy and the concordance between preoperative STT size and the surgical plan was determined. RESULTS: Sixty-seven patients were included (mean age: 59.5 ± 8.9 years; 58.2% female). These was good concordance between STT size measured by qMRI vs. arthroscopy in the coronal plane (concordance correlation coefficient (CCC) =0.36 [95%CI: 0.16‒0.53]; Pearson's correlation coefficient =0.42 [95%CI: 0.2‒0.6]; P=0.0004) and in the sagittal plane (CCC =0.51 [95%CI: 0.33‒0.65]; Pearson's correlation coefficient =0.57 [95%CI: 0.38‒0.71]; P<0.0001). Preoperative STT size concurred with the surgical plan in 85% of patients. CONCLUSION: There was good concordance between STT size measured by qMRI and that measured perioperatively by arthroscopy. However, preoperative STT size measured by qMRI did not concur with the surgical plan in 15% of patients and in these patients the surgical procedure had to be revised during surgery.

Arthroscopic treatment of diffuse pigmented villonodular synovitis of the elbow.

INTRODUCTION: Pigmented villonodular synovitis (PVNS) is a rare pathology of the elbow, but presents a risk of progression with cartilage destruction. Surgical treatment consists in synovectomy, as complete as possible. Arthroscopy is an excellent tool for the exploration and treatment of intra-articular lesions in the elbow, but the results in PVNS of the elbow have never been evaluated. The aim of this study was to assess the recurrence rate of PVNS of the elbow after arthroscopic synovectomy, and secondarily to assess pain, joint range of motion, functional scores and complication rate. MATERIAL AND METHODS: We performed a retrospective study of a continuous series of 8 patients operated on between February 2012 and February 2019, with a mean age of 43.7 years. The operated side was the dominant side in 75% of cases. Surgery consisted in the most complete synovectomy possible, performed arthroscopically. Recurrence, clinical evaluation, with pain at rest and on mpvement on visual analogue scale (VAS) and joint range of motion, functional MEPS and DASH scores, and any complications were collected. RESULTS: At a mean 66.4 months' follow-up, 2 patients required revision surgery for recurrence. At the last follow-up, VAS for pain at rest was 0.9 and 1.9 for pain on movement. MEPS score was 85.6 and DASH score 82.2. No neurological, vascular or infectious complications of arthroscopic synovectomy were found in our series. DISCUSSION: Arthroscopic synovectomy in the treatment of PVNS of the elbow was a reliable and safe therapeutic alternative, with a low complications rate and 2 cases of recurrence (25%) in our study. This was the first study to report the results of arthroscopic surgical treatment of elbow PVNS. LEVEL OF EVIDENCE: IV Retrospective study without control group.

Is the popliteal tendon sufficient for all-inside suture in lateral meniscus repair? A 22-case cadaver study.

INTRODUCTION: Arthroscopic lateral meniscus repair is performed in the "figure-of-4 position" (supine, with the affected knee flexed and the lower leg crossed over the extended contralateral leg), and anchorage is often on the popliteal tendon. Extending the limb at the end of the procedure alters the relations between the popliteal tendon and the repaired meniscus. The present study aimed to assess lateral meniscal suture fixation on the popliteal tendon after a cycle of flexion-extension. HYPOTHESIS: Extending the knee can induce suture release. TYPE OF STUDY: Cadaver study. MATERIALS AND METHODS: Twenty-two fresh adult human cadaver knee specimens were used. Under arthroscopy with all-inside implants, a vertical suture onto the popliteal tendon was performed through the lateral meniscus. Suture status was assessed under arthroscopy after a cycle of flexion-extension, and deemed defective if the suture was sufficiently loose for the arthroscope to be able to be passed through the popliteal hiatus, if the stitch had passed through the meniscus, or if the suture was broken. RESULTS: Thirteen sutures (59.1%) remained well fixed, and 9 (40.1%) were defective: 4 (18.2%) were loose, in 4 (18.2%) the stitch had passed through the meniscus, and in 1 (4.5%) the suture had broken. CONCLUSION: In a population of elderly cadaver knee specimens, arthroscopic suture of the lateral meniscus to the popliteal tendon was defective after flexion-extension in 40% of cases. Stress seems to be exerted on the suture when extension is resumed. Thus, a single stitch seems insufficient for stable lateral meniscus repair. CLINICAL IMPLICATIONS: Suture of the lateral meniscus to the popliteal tendon undergoes stress when extension is resumed, potentially causing failure of lateral meniscus repair. LEVEL OF EVIDENCE: IV.

A pilot-study focusing on internal rotation after reverse total shoulder arthroplasty using the Activities of Daily Living which require Internal Rotation (ADLIR) score.

Background: Loss of internal rotation remains an issue after reverse total shoulder arthroplasty (RTSA). Our goal is to define the expected functional internal rotation after RTSA using the Activities of Daily Living which require Internal Rotation (ADLIR) score in a homogenous population of patients treated with RTSA. Methods: 35 patients with a minimum follow-up of two years after RTSA were evaluated using the ADLIR and Constant-Murley questionnaires. A correlation between the ADLIR and Constant score was investigated and the internal validity of the ADLIR score used in a RTSA patient population was measured using Cronbach's alpha coefficient. The impact of internal rotation on the total rotational arc of motion was defined. Results: Excellent results were recorded for both the Constant score (79 ± 18) and ADLIR score (88 ± 16). Pearson's correlation coefficient was r = 0,84 (p-value <0,001). The ADLIR score showed a high reliability for all questions. Conclusions: The ADLIR score has proven to be a useful addition in the post-operative evaluation of patients treated with RTSA. Further studies are needed to investigate the evolution of the ADLIR score from pre- to postoperatively in order to determine the clinical and predictive value of this score. Level of evidence: Level IV - Observational study.

Post-traumatic forearm bone defect reconstruction using the induced membrane technique.

INTRODUCTION: The induced membrane technique, first described by Masquelet, is now well standardized, but little studied in post-traumatic forearm bone defect. The main aim of the present study was to analyze consolidation rates in this indication. The study hypothesis was that the induced membrane technique provides good consolidation results. METHODS: We performed a retrospective assessment of our experience with 10 cases of induced membrane forearm reconstruction. The two main etiologies were acute trauma or treatment for non-union. Functional impact was assessed on range of motion and QuickDASH. The complications rate was also examined. RESULTS: There were 3 cases of post-traumatic bone defect, and 7 of non-union treatment, including 6 septic non-unions. Mean defect size was 4.3cm. Mean interval between induced membrane stages 1 and 2 was 3.3 months. Pure cancellous iliac bone graft was systematic. Nine of the patients showed consolidation, at a mean 9.2 months; there was 1 case of non-consolidation, but no other complications. Range of motion was satisfactory; mean QuickDASH score was 22 at a mean 50.3 months' follow-up. CONCLUSION: The induced membrane technique was reliable, reproducible and technically accessible, with good functional and radiographic results and few complications. LEVEL OF EVIDENCE: IV; retrospective study without control group.

Learning and optimizing arthroscopic knot-tying by surgery residents using procedural simulation.

INTRODUCTION: Procedural training of orthopedic surgery residents includes learning arthroscopic knot-tying. The models used comprise arthroscopy training modules of increasing complexity, although there is no procedural training guide for the acquisition of arthroscopic knot-tying skills. Few studies have focused on how residents learn arthroscopic knot-tying. The aim of our study was to determine the type of arthroscopic knot that is the easiest to perform and learn and that can be done the most successfully by orthopedic surgery residents. MATERIALS AND METHODS: Each participant had to learn five knots in a random order: Tennessee slider, Duncan loop, Revo knot (Surgeon's knot), Nicky knot, and the SMC (Samsung Medical Center) knot. The FAST Arthroscopy Workstation™ (Sawbones, Vashon Island, WA) was used for this study. Each participant could use a FAST Knot Tester™ (Sawbones®, Vashon Island, WA) to evaluate by themselves the biomechanical properties of the knots to optimize learning. Each participant had to rank how easy it was to learn this knot on a visual scale from 0 to 10. They also had to rank the reliability of the knots done on a visual scale from 0 to 10. Then, an independent rater assessed whether the knots were completed successfully; a knot was considered successful if it stretched by less than 3 mm when 60 N of load was applied. RESULTS: Ten participants were included in the study; 250 knots were done and evaluated. When ranked from simplest to most complicated, the easiest knot to learn was the Surgeon's knot, followed by the Duncan loop, Tennessee slider, Nicky knot and SMC knot (p<0.0001). The overall success rate for the knots was 80%. There was a statistical trend for the Nicky being done better than the other arthroscopic knots (88% success rate). CONCLUSION: For orthopedics surgery residents, the surgeon's knot (Revo knot) was the easiest to learn, while the Nicky knot had the highest success rate. LEVEL OF EVIDENCE: II; prospective, randomized study with low power.

Double Row Knotted "Trident": 1 Suture Technique for Superior to Posterosuperior Small Cuff Tear.

Many arthroscopy suture techniques have been described for small rotator cuff tears, but there is no consensus. The aim of this study is to describe a double-row knot technique, which we call a "trident point," for the superior and posterosuperior small cuff tear that is easily reproducible and has a fast learning curve. This knot takes into account the excess of tendon tissue on the foot print after a cuff suture, called a "dog-ear deformity." However clinical, ultrasound, and biomechanical evaluation with follow-up remains necessary to validate the sustainability of this arthroscopy technique.