Lesion depth and marrow stimulation results.

AIM: The aim of this study was to study the importance Osteochondral lesion (OCL) depth as a singular factor for treatment outcomes using marrow stimulation. We hypothesized that the clinical outcomes of marrow stimulation would be inferior for lesions with depths of more than 5 mm compared to those less than 5 mm. MATERIALS & METHODS: An interventional prospective cohort study was conducted on 55 ankles in 55 patients who had been diagnosed with full-thickness osteochondral lesions of the talus; stage II, III, IV according to Anderson staging system based on magnetic resonance imaging; depth of 10 mm or less; and area of 150 mm2 or less measured by preoperative computed tomography. According to lesion depth, patients were divided into two groups: group (A) ≤ 5 mm, and group (B) ˃ 5 mm. The mean follow-up period for both groups was 30 months (range, 22-40). RESULTS: For groups A and B the average preoperative Foot and Ankle Outcome Scores (FAOS) were 43.1 ± 8.8 (range, 25-52) and 46 ± 8.5 (range, 32-60), respectively, and improved to 90 ± 4.3 (range, 80-96) (P = 0.001) and 75 ± 6.4 (range, 65-88) (P = 0.001) at the final follow-up. The average time to full weight bearing was 12 weeks (range, 10-16) in group A and 16 weeks (range, 12-20) in group B. CONCLUSIONS: Although treatment of OCLs is still undergoing changes and there are many prognostic factors that affect outcomes during marrow stimulation treatment, depth of OCL was shown to be an independent factor affecting outcomes. OCLs of less than 5 mm in depth were more likely to have superior clinical outcomes compared to OCLs of more than 5 mm. CLINICAL SIGNIFICANCE: The depth of OCL talus is an important factor as it affects the outcome of arthroscopic marrow stimulation inversely. LEVEL OF EVIDENCE: I.

Teres major transfer to restore external rotation of shoulder in Erb palsy patients.

BACKGROUND: The lack of external rotation and shoulder abduction as sequelae of obstetric brachial plexus palsy requires a release of the subscapularis muscle associated with tendon transfer of the internal rotator of the shoulder. The aim of this study was to present the results of a teres major transfer to the infraspinatus tendon. METHODS: This study included 20 patients (9 boys and 11 girls) with a mean age of 3 years 8 months (range, 1.5-14 years). The average follow-up time was 42 months (range, 12-48 months) to determine whether external rotation weakness and internal rotation contracture sequelae were managed by anterior release of the subscapularis and teres major tendon transfer to the infraspinatus tendon. RESULTS: We found marked improvement in shoulder abduction from 67° before surgery to 158° after surgery. We also found marked improvements in active external rotation from 8° before surgery to 85° after surgery and in passive external rotation from 0° preoperatively to 72° postoperatively. Two cases showed a loss of the last degrees of internal rotation, but this improved after physiotherapy. CONCLUSIONS: Anterior release of the subscapularis tendon with a teres major transfer to the infraspinatus tendon significantly improves shoulder function in Erb palsy patients with internal rotation contracture.

Scaphoid excision with lunatocapitate fusion for the treatment of scaphoid nonunion with advanced collapsed wrist.

PURPOSE: To investigate the union rate after lunatocapitate arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC) wrists and to evaluate the clinical results of this technique. METHODS: We conducted a prospective study between January 2014 and July 2017. Fifteen males with painful stage III SNAC wrists (average age, 32 years, range, 20-37 years; average follow-up time, 25.2 months, range, 20-36 months) underwent scaphoid excision and lunatocapitate fusion. Lunatocapitate fusions were fixed with headless Herbert screws with K-wire fixation (retrograde direction). Radiographs, wrist range of motion, and Mayo wrist score were examined. RESULTS: All patients achieved radiographic and clinical union after lunatocapitate fusion during follow-up (average 10 months post-operatively). The flexion-extension arc was 70°, and the average Mayo wrist score was 74.3 points (eight with excellent, four with good, three with satisfactory, and one with poor result). Thirteen patients returned to work, whereas two with nonunion required surgical graft revision. Complete union was achieved at an average of 12 weeks after graft revision, with improved range of motion, and the patients returned to work with a change in their occupation. CONCLUSIONS: Lunatocapitate arthrodesis is a satisfactory therapeutic alternative to four-corner fusion for SNAC wrists.

Double-bundle anterior cruciate ligament reconstruction is better than single-bundle reconstruction in terms of objective assessment but not in terms of subjective score.

PURPOSE: A comparison of clinical outcomes between double-bundle (DB) and single-bundle (SB) anterior cruciate ligament (ACL) reconstruction for patients with ACL injury. METHODS: Sixty patients were treated with either SB (n = 30) or DB (n = 30) ACL reconstruction between 2011 and 2012. The hamstring tendons were autografted with suspensory fixation on the femoral side, while a bio-absorbable interference screw was used for fixation on the tibial side. These patients were evaluated using Lysholm score, International Knee Documentation Committee (IKDC) forms (both objective and subjective), Lachman test, pivot shift test, and KT 1000 arthrometer. RESULTS: After a median follow-up duration of 35.5 months (ranging between 30 and 42 months), the frequency of patients who had high objective IKDC scores was significantly higher in the DB group than those in the SB group. In terms of DB, the Lachman test was normal in 26 patients (86.7%), nearly normal in three patients (10%), and abnormal in one patient (3.3%); comparatively, in terms of SB, the Lachman test was normal in 20 patients (66.7%), nearly normal in eight patients (26.7%) and abnormal in two patients (6.6%). The pivot shift test was negative in 29 patients (96.7%) and 21 patients (70%) for DB and SB, respectively. The average KT-1000 side-to-side difference was 1.0 mm for DB and 1.5 mm for SB. The subjective IKDC and Lysholm score showed non-significant differences between both techniques. CONCLUSION: Double-bundle ACL reconstruction was found to have a significant advantage in anterior and rotational stability as well as objective IKDC than that of SB reconstruction. However, subjective measurements showed no statistical differences between the techniques. LEVEL OF EVIDENCE: II.

Short-Segment Fixation of Thoracolumbar Fractures with Incorporated Screws at the Level of Fracture.

OBJECTIVE: To evaluate the effect of including the fractured vertebra in the short-segment fixation of thoracolumbar (TL) fractures. METHODS: A total of 32 patients with thoraco-lumbar fractures, selected between August 2013 and February 2016, were managed by short-segment fixation with screws at the level of the fracture, and decompression was performed only for patients with neurological deficits. The patients' functional outcome was assessed using the visual analogue scale (VAS) score for pain and the American Spinal Injury Association (ASIA) score for neurological condition. All patients were followed up with radiographs. RESULTS: Patients with complete neurologic deficits (n = 3) did not show any neurologic recovery. All ASIA B patients improved to ASIA C. Five ASIA C patients improved to ASIA E. The remaining five ASIA C patients improved to ASIA D. All ASIA D patients improved to ASIA B. At the final follow-up examination, the mean anterior vertebral height was 21 ± 5 mm, indicating no significant height loss during the follow-up period. CONCLUSION: Short-segment fixation of TL fractures with inclusion of the fracture level into the construct offers good correction of segmental kyphosis, vertebral wedging, and vertebral height loss.

Posterior Interosseous Neurectomy Alternative for Treating Chronic Wrist Pain.

Background Wrist denervation is one of the several available options for treating chronic wrist pain; partial wrist denervation performed through a single dorsal incision by resecting the distal posterior interosseous nerve provides good outcomes. Questions/Purposes This study evaluated the results of posterior interosseous neurectomy (PIN) in patients with chronic wrist pain secondary to scaphoid nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC). Methods In total, 30 wrists obtained from 28 patients (25 males, 3 females) were assessed. The dominant hands of 25 (right-handed) patients, nondominant hands of 5, and both hands of 2 were considered. The average age at the time of surgery was 35 (range: 19-50) years, and the average follow-up duration was 18 (range: 12-30) months. Fifteen and 13 patients had wrists with SNAC and SLAC, respectively, and all of those underwent PIN performed through the dorsal approach. The pre- and postoperative range of motion, grip strength, and pain relief percentage were recorded for all the 30 wrists. Results The average postoperative Disabilities of the Arm, Shoulder and Hand score was 30 (range: 20-80), and the difference between the pre- and postoperative scores was statistically significant. Ninety percent of the patients were satisfied with the results of PIN and reported improvement in grip strength and pain relief. Conclusions Thus, PIN may be an effective surgical technique for wrist reconstruction. Clinical Relevance To help patients challenge pain and maintain their wrist joint range of motion.

Endoscopic Resection of Different Types of Talocalcaneal Coalition.

BACKGROUND: The purpose of this study was to describe the technique of endoscopic resection of talocalcaneal coalition (TCC) by using 2 posterior portals and to report the outcomes of endoscopic resection of different types and sites of TCC. METHODS: An interventional prospective study was conducted on 20 feet in 18 consecutive patients who were diagnosed by computed tomography to have TCC for which nonoperative treatment had failed and endoscopic resection was performed. The patients were divided into groups according to the site of the coalition (middle facet or posterior facet) and according to type (fibrous, cartilage, or bony). The mean follow-up period was 26 months (range, 6-36). RESULTS: The average preoperative American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was 57.7 (range, 40-65), and the average preoperative visual analog scale (VAS) score was 7.8 (range, 6-8). The average postoperative AOFAS hindfoot score was 92.4 (range, 85-98; P < .01). The average postoperative VAS score was 2.4 (range, 1-4). All patients showed no recurrence on postoperative lateral and Harris-Beath X-ray until the end of the study. CONCLUSIONS: Endoscopic resection of TCC was an effective and useful method for the treatment of talocalcaneal coalition. It provided excellent outcomes with no recurrence in this short-term study. Resection of the fibrous type had a better outcome than resection of cartilage and bony types. Endoscopic resection of the posterior coalition had a better outcome than resection of the middle coalition. LEVEL OF EVIDENCE: Level III, comparative study.