Medial elbow stability assessment after ultrasound-guided ulnar collateral ligament transection in a cadaveric model: ultrasound versus stress radiography.

BACKGROUND: The ulnar collateral ligament (UCL), consisting of 3 bundles, is the primary medial restraint in the elbow. Recent research has demonstrated that ultrasound is an effective modality to evaluate the medial elbow, whereas stress radiography is standard practice in the measurement of medial elbow laxity. This study (1) compared dynamic ultrasound (USD) with stress radiography in the evaluation of UCL insufficiency and (2) further evaluated the contribution of the anterior bundle of the UCL to medial elbow stability. METHODS: Stress radiographs and USD were used to obtain coronal plane measurements of the medial joint space of 16 cadaveric elbows before and after USD-guided isolated transection of the anterior bundle of the UCL. Measurements were performed with and without a valgus stress applied to the elbows, and gapping of the ulnohumeral joint space was documented. RESULTS: Transection of the anterior bundle of the UCL resulted in 1.5 mm and 1.7 mm of additional gapping in the ulnohumeral joint as measured with stress radiographs and USD, respectively. No differences were recorded in the ulnohumeral gapping measurements between stress radiography and USD. CONCLUSIONS: The lack of difference between measurements reveals USD is as reliable as stress radiography in evaluating the medial ulnohumeral joint space and continuity of the UCL while eliminating radiation exposure and minimizing cost of the diagnostic examination. The increase in ulnohumeral gapping with isolated transection of the anterior bundle of the UCL demonstrates its significant contribution to medial elbow stability.

Whip-Lock Stitch Is Biomechanically Superior to Whipstitch for Semitendinosus Tendons.

Purpose: To assess the biomechanical performance of different stitching methods using a suturing device by comparing the elongation, stiffness, failure load, and time to stitch completion in cadaveric semitendinosus tendons (STs) and quadriceps tendons (QTs). Methods: A total of 24 STs and 16 QTs were harvested from cadaveric knee specimens (N = 40). Samples were randomly divided into 2 groups: whipstitch (WS) and whip-lock (WL) stitch. Both tendon ends were clamped to a graft preparation stand, and a 2-part needle was used to place 5 stitches, each 0.5 cm apart. Stitching time was recorded. Samples were preconditioned and then underwent cyclic loading from 50 to 200 N at 1 Hz for 500 cycles, followed by load-to-failure testing at 20 mm/min. Stiffness (in newtons per millimeter), ultimate failure load (in newtons), peak-to-peak displacement (in millimeters), elongation (in millimeters), and failure displacement (in millimeters) were recorded. Results: Completion of the WS was significantly faster than the WL stitch in the ST (P < .001) and QT (P = .004). For the ST, the WL stitch exhibited higher ultimate failure loads and construct stiffness than the WS. Regarding the QT, the WL stitch showed higher stiffness and displacement than the WS; however, the ultimate failure load was higher for the WS in the QT. The ultimate failure load in the QT was higher than that in the ST for both stitches. In the ST, only 25% of WSs and 100% of WL stitches failed due to suture breakage. In the QT, suture breakage led to the failure of 100% of both the WL stitches and WSs. Conclusions: In the ST, the WL stitch resulted in improved biomechanical performance through higher ultimate load and fewer failures from tissue damage compared with the WS. In the QT, both the WS and the WL stitch showed similar biomechanical performance with ultimate failure loads above established clinical failure thresholds. Clinical Relevance: Various types of ligament and tendon injuries require suturing to enable repair or reconstruction. The success of ligament or tendon surgery often relies on soft-tissue quality. It is important to investigate the biomechanical properties of stitching techniques that help preserve soft-tissue quality as a step to determining their clinical suitability.

Cells Remain Viable When Collected With an In-Line-Suction Tissue Collector From Byproducts of Anterior Cruciate Ligament Reconstruction Surgery.

Purpose: To investigate the viability of cells collected with an in-line-suction autologous tissue collector from the tissue byproducts of arthroscopic anterior cruciate ligament (ACL) reconstruction, to characterize cells from different tissue types, and to identify mesenchymal stem cells. Methods: Patients aged 14 to 50 years with ACL injuries requiring arthroscopic reconstruction surgery were offered enrollment and screened for participation. In total, 12 patients were enrolled in the descriptive laboratory study. Arthroscopic byproduct tissue was collected with an in-line-suction autologous tissue collector from 4 intraoperative collection sites for each patient: ACL stump, ACL fat pad, notchplasty debris, and tunnel drilling debris. All tissue samples were digested using collagenase, and the derived cellular populations were analyzed in vitro, characterizing cellular viability, proliferative potential, qualitative multipotent differentiation capacity, and cell-surface marker presence. Results: An equivalent mass of arthroscopic byproduct tissue was taken from each of the 4 intraoperative collection sites (1.12-1.61 g, P = .433), which all showed an average viability of at least 99.95% and high average total nucleated cells (≥1.37 × 107 cells/mL). No significant differences in collected mass (P = .433), cellular viability (P = .880), or total nucleated cells (P = .692) were observed between the 4 byproduct tissues. The byproduct tissues did exhibit significant differences in monocyte (P = .037) and red blood cell (P = .038) concentrations, specifically with greater values present in the ACL stump tissue. Cells from all byproduct tissues adhered to plastic cell culture flasks. Significant differences were found between colony-forming unit fibroblast counts of the 4 byproduct tissues when plated at 106 (P = .003) and 103 (P = .016) cells as the initial seeding density. There was a significant relationship found between both the starting concentration (χ2 = 32.7, P < .001) and the byproduct tissue type (χ2 = 30.4, P < .001) to the presence of ≥80% confluency status at 10 days. Cells obtained from all 4 byproduct tissues qualitatively showed positive tri-lineage (adipocyte, osteoblast, chondroblast) differentiation potential compared with negative controls under standardized in vitro differentiation conditions. Cells derived from all 4 byproduct tissues expressed cell-surface antigens CD105+, CD73+, CD90+, CD45-, CD14-, and CD19- (>75%), and did not express CD45 (<10%). There were no statistically significant differences in cell-surface antigens between the four byproduct tissues. Conclusions: This descriptive laboratory study demonstrated that cells derived from arthroscopic byproduct tissues of ACL reconstruction remain viable when collected with an in-line-suction autologous tissue collector and these cells meet the ISCT criteria to qualify as mesenchymal stem cells. Clinical Relevance: It is known that viable mesenchymal stem cells reside in byproduct tissue of anterior cruciate ligament reconstruction surgery (ACLR). Practical methods to harvest these cells at the point of care require further development. This study validates the use of an in-line-suction autologous tissue collector for the harvest of viable mesenchymal stem cells after ACLR.

Rotator Cable Reconstruction: A Technique to Restore the Rotator Cable in the Setting of Large Cuff Tears.

The rotator cable is an essential biomechanical structure in the shoulder that is commonly injured in the setting of large rotator cuff tears. Surgical techniques designed to reconstruct the cable have followed advancements in our understanding of the biomechanics and anatomic importance of this structure. Owing to its role in load sharing and stress shielding of the rotator cuff crescent, rotator cable reconstruction offers the potential to reduce retear rates and promote longevity of rotator cuff repairs. The purpose of this article is to describe a technique to augment rotator cuff repair with cable reconstruction.

Trends in Patient-Reported Outcomes Measurement Information System (PROMIS) Utilization in Orthopedic Sports Medicine: A Scoping Review.

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) developed by the National Institutes of Health provides a standardized method for collecting outcomes data from sports medicine patient populations. Methods: The objective of this scoping review is to report on PROMIS utilization in orthopedic sports medicine research and practice. We searched PubMed, ScienceDirect, and Cochrane Library using keywords and database-specific subject headings to identify studies that reported PROMIS utilization. Inclusion criteria were the use or mention of PROMIS in any population of patients commonly treated by orthopedic sports medicine physicians. Results: Following a screening process, we included 67 studies published from 2019 through 2022 in this review. A near-equal distribution of studies was published per year during this period. Twenty-four domains were assessed across the studies. Among studies with adult populations, the Pain Interference (45 studies, 67%) and Physical Function (37 studies, 55%) domains were the 2 most reported by researchers. Upper Extremity (4 studies, 6%) and Mobility (3 studies, 4%) were the 2 most used domains in studies involving pediatric populations. Conclusion: Our results demonstrate consistent utilization of PROMIS domains in the field of sports medicine. Researchers commonly used PROMIS with other legacy measures, comparing the scores to one another to assess responsiveness and validity. This review provides evidence that PROMIS domains are being used to collect data on a variety of factors related to sports medicine patient outcomes that may help physicians better understand the complexities of the recovery and rehabilitation process.

Augmentation of ACL Autograft Reconstruction With an Amnion Collagen Matrix Wrap and Bone Marrow Aspirate Concentrate: A Pilot Randomized Controlled Trial With 2-Year Follow-up.

Background: It is theorized that the lack of a synovial lining after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) contributes to slow ligamentization and possible graft failure. Whether graft maturation and incorporation can be improved with the use of a scaffold requires investigation. Purpose: To evaluate the safety and efficacy of wrapping an ACL autograft with an amnion collagen matrix and injecting bone marrow aspirate concentrate (BMAC), quantify the cellular content of the BMAC samples, and assess 2-year postoperative patient-reported outcomes. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 40 patients aged 18 to 35 years who were scheduled to undergo ACLR were enrolled in a prospective single-blinded randomized controlled trial with 2 arms based on graft type: bone-patellar tendon-bone (BTB; n = 20) or hamstring (HS; n = 20). Participants in each arm were randomized into a control group who underwent standard ACLR or an intervention group who had their grafts wrapped with an amnion collagen matrix during graft preparation, after which BMAC was injected under the wrap layers after implantation. Postoperative magnetic resonance imaging (MRI) mapping/processing yielded mean T2* relaxation time and graft volume values at 3, 6, 9, and 12 months. Participants completed the Single Assessment Numeric Evaluation Score, Knee injury and Osteoarthritis Outcome Score, and pain visual analog scale. Statistical linear mixed-effects models were used to quantify the effects over time and the differences between the control and intervention groups. Adverse events were also recorded. Results: No significant differences were found at any time point between the intervention and control groups for BTB T2* (95% CI, -1.89 to 0.63; P = .31), BTB graft volume (95% CI, -606 to 876.1; P = .71), HS T2* (95% CI, -2.17 to 0.39; P = .162), or HS graft volume (95% CI, -11,141.1 to 351.5; P = .28). No significant differences were observed between the intervention and control groups of either graft type on any patient-reported outcome measure. No adverse events were reported after a 2-year follow-up. Conclusion: In this pilot study, wrapping a graft with an amnion collagen matrix and injecting BMAC appeared safe. MRI T2* values and graft volume of the augmented ACL graft were not significantly different from that of controls, suggesting that the intervention did not result in improved graft maturation. Registration: NCT03294759 (ClinicalTrials.gov identifier).

The Lacertus Syndrome of the Elbow in Throwing Athletes.

When more obvious and common causes of elbow pathology are ruled out, it is important to be aware of uncommon causes of elbow pain in throwers. The Lacertus syndrome can be a debilitating problem when overlooked; however, it can be easily diagnosed with a careful history and physical examination. If the description suggests a postexertional compartment-like problem, consider having the patient throw before the examination, and the diagnosis becomes easier to either confirm or rule out. Once the diagnosis is established treatment includes rest or fasciotomy. Recovery is uncomplicated and athletes can return to throwing within a month.

Outcomes After Ulnar Collateral Ligament Revision Reconstruction in Baseball Players.

BACKGROUND: There is a lack of evidence regarding the success of ulnar collateral ligament (UCL) revision reconstruction. Understanding outcomes after UCL revision reconstruction is important in clinical decision making for overhead athletes. PURPOSE: To evaluate return to play and patient-reported outcomes after UCL revision reconstruction. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: All patients who underwent UCL revision reconstruction, attributed to retear of the ligament or pain, between June 2004 and July 2016 at 2 surgical centers were identified. Charts were reviewed for age, sex, date of primary and revision reconstruction, sport played, level of play, graft type, and complications. Patients were contacted by telephone to determine time to return to play, current level of participation, Conway score, Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score, and satisfaction. RESULTS: Of the 65 consecutive baseball players who underwent revision UCL reconstruction, 40 (62%) were contacted at a minimum 22 months after surgery. Of these, 38 (95%) were pitchers and 2 (5%) were position players. Time to return to throwing was 6.2 ± 2.3 months (mean ± SD), and the KJOC score was 74.2 ± 20.7. Based on the Conway score, 50% (20/40) had an excellent result, indicating a return to the previous competition level for at least 1 year, and 30% (12/40) had a good result, indicating a return to a lower level for at least 1 year. For those who were able to return to competition, it took 12.7 ± 3.6 months. In pitchers, 47% (18/38) returned to their previous competition levels for at least 1 year, with a KJOC score of 73.7 ± 21.1. Pitchers were able to return to throwing at 6.3 ± 2.3 months and competition at 12.8 ± 3.7 months. CONCLUSION: Only half of baseball players undergoing UCL revision reconstruction were able to return to their previous levels of competition. Outcomes for revision reconstructions are not as promising as primary procedures. Baseball players should be cautioned that they may not return to their previous levels of play after a revision reconstruction.