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Maldonado DR, Go CC, Laseter JR, Lall AC, Kopscik MR, Domb BG. Primary labral reconstruction in patients with femoroacetabular impingement, irreparable labral tears and severe acetabular chondral defects decreases the risk of conversion to total hip arthroplasty: a pair-matched study. J Hip Preserv Surg 2019; 6:214-226. [PMID: 32337061 PMCID: PMC7171804 DOI: 10.1093/jhps/hnz028] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/20/2019] [Accepted: 06/23/2019] [Indexed: 12/22/2022] Open
Abstract
In the presence of severe acetabular cartilage defects, the benefits of labral reconstruction (RECON) versus labral resection (RESEC) have not been determined. Prospectively collected data between October 2008 and December 2016 were retrospectively reviewed. Inclusion criteria were hip arthroscopy, acetabular Outerbridge grade III/IV, irreparable labral tears that underwent RECON or RESEC, and minimum 2-year postoperative measures for the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sports Specific Subscale, International Hip Outcome Tool, Patient Satisfaction and Visual Analogue Scale for pain. Exclusion criteria included Tönnis grade >1, previous hip conditions or previous ipsilateral hip surgeries. A 1:1 matched-pair analysis was performed based on age ±5 years, sex, body mass index ±5 kg/m2, Tönnis grade, acetabular microfracture, femoral Outerbridge grade (0 or I compared with II, III or IV). Relative risk (RR) and conversion rate to total hip arthroplasty (THA) were calculated. A total of 38 RECON hips were successfully matched. Both groups demonstrated significant improvements in patient-reported outcomes (PROs). THA conversion was 5.3% and 21.1% for the RECON and RESEC groups, respectively (P = 0.04). RECON was four times less likely to require THA conversion than the RESEC group (RR=4.0; 95% CI 0.91-17.63). In the setting of primary arthroscopic management of femoroacetabular impingement, irreparable labral tears and acetabular chondral lesions of Outerbridge III/IV, patients that underwent RECON and RESEC experienced significant improvement in PROs at minimum 2-year follow-up, and these functional scores were comparable when groups were matched. However, RR and rate to THA conversion were significantly higher in the RESEC group.
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Affiliation(s)
- David R Maldonado
- American Hip Institute, 999 E Touhy Ave, Suite 450, Chicago, IL, USA
| | - Cammille C Go
- American Hip Institute, 999 E Touhy Ave, Suite 450, Chicago, IL, USA
| | - Joseph R Laseter
- American Hip Institute, 999 E Touhy Ave, Suite 450, Chicago, IL, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ajay C Lall
- American Hip Institute, 999 E Touhy Ave, Suite 450, Chicago, IL, USA
| | | | - Benjamin G Domb
- American Hip Institute, 999 E Touhy Ave, Suite 450, Chicago, IL, USA
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1652
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Helito CP. Editorial Commentary: Extension of Knowledge-and the Knee! New Biomechanical Study Suggests the Clinical Practice of Anterolateral Ligament Fixation Near Extension. Arthroscopy 2019; 35:2160-2163. [PMID: 31272637 DOI: 10.1016/j.arthro.2019.03.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 02/02/2023]
Abstract
The knee anterolateral ligament (ALL) is one of the most hotly debated topics in sports medicine in the last decade. Once one aspect of discussion regarding the ALL reaches a consensus, attention immediately turns to the next one. This has already happened with the existence of the ALL itself, its anatomic features, the ability to visualize the ALL with magnetic resonance imaging, and many other topics. In the end, the most important aspect must be clinical outcomes, and existing studies are trying to find the optimum surgical technique to best restore knee stability and reduce failure rates. It appears that, when doing an anatomic ALL reconstruction, fixation must be performed in full extension. The literature regarding ALL reconstruction shows promising results, with a strong tendency to present better knee stability, improved functional scores, and lower failure rates.
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1653
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Merkely G, Ogura T, Bryant T, Minas T. Severe Bone Marrow Edema Among Patients Who Underwent Prior Marrow Stimulation Technique Is a Significant Predictor of Graft Failure After Autologous Chondrocyte Implantation. Am J Sports Med 2019; 47:1874-1884. [PMID: 31251661 DOI: 10.1177/0363546519853584] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Autologous chondrocyte implantation (ACI) is a well-established cartilage repair procedure; however, numerous studies have shown higher ACI graft failure rates after prior marrow stimulation techniques (MSTs). PURPOSE To identify which factors may predict decreased graft survival after ACI among patients who underwent a prior MST. A secondary aim was to investigate the specificity of these predictors. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS In this review of prospectively collected data, the authors analyzed 38 patients who had failed prior MST surgery and subsequently underwent collagen-covered ACI (case group). The case group was divided into graft failure ACI (n = 8, 21%) and successful ACI (n = 30, 79%). Fourteen clinical variables were categorized and analyzed to determine predictors for failure of the ACI graft: age, body mass index, sex, defect characteristics (number, size, location, etiology, type), presence of kissing lesion, intraoperative presence of intralesional osteophyte, time between an MST and ACI, previous surgery, duration of the symptoms, and concomitant surgical procedure. Preoperative magnetic resonance imaging (MRI) was used to evaluate the severity of subchondral bone marrow edema (BME), graded I (absent) to IV (severe), and the presence of subchondral cyst, hypertrophic sclerosis, and intralesional osteophyte. The effects of these MRI findings on the graft survivor were also investigated. Concurrently, a control group without a prior MST was matched to investigate the specificity of the previously determined predictors. These patients were matched individually according to age, sex, body mass index, and outcome of the procedure (failure [n = 8] or successful [n = 30] per the case group). RESULTS In the case group, the presence of preoperative severe BME was significantly higher among patients with failed ACI as compared with patients with successful ACI (P < .001). In the control group, the presence of severe BME was not significantly different between the failure and successful groups (P = .747). The ACI graft failure rate among patients with a prior MST and preoperative grade IV BME was 83.7% at 5 years postoperatively, resulting in a significantly lower survival rate as compared with patients with a prior MST and without severe BME (5-year graft failure rate, 6.5%; P < .001). All the other parameters did not differ significantly. CONCLUSION After a prior MST, the presence of grade IV BME by MRI was a predictive factor for graft failure among patients who then underwent second-generation ACI.
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Affiliation(s)
- Gergo Merkely
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Traumatology, Semmelweis University, Budapest, Hungary
| | - Takahiro Ogura
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Sports Medicine Center Funabashi Orthopedic Hospital, Funabashi, Japan
| | - Tim Bryant
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tom Minas
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Paley Orthopedic and Spine Institute, West Palm Beach, Florida, USA
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1654
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Reddy A, Gulotta LV, Chen X, Castagna A, Dines DM, Warren RF, Kontaxis A. Biomechanics of lower trapezius and latissimus dorsi transfers in rotator cuff-deficient shoulders. J Shoulder Elbow Surg 2019; 28:1257-1264. [PMID: 30826203 DOI: 10.1016/j.jse.2018.11.066] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/26/2018] [Accepted: 11/30/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Irreparable posterosuperior rotator cuff tears cause pain and impaired shoulder function. Latissimus dorsi (LD) transfer has been proven to improve shoulder function, but lower trapezius (LT) transfer has recently been proposed as an alternative. This study aimed to compare the biomechanics of LD and LT transfers and how they are affected by different insertion sites. METHODS The Newcastle shoulder model was used to investigate the biomechanics of these 2 tendon transfers. Computed tomography data sets from 10 healthy subjects were used to customize the model, and virtual LD and LT transfers were performed on supraspinatus, infraspinatus, and teres minor insertion sites. Muscle moment arms and lengths were computed for abduction, forward flexion, and external rotation. RESULTS The LT yields greater abduction moment arms compared with the LD when it is transferred to the native supraspinatus and infraspinatus insertion sites. However, they become adductors when transferred to the native teres minor insertion. Both muscles show strong external rotation moment arms, except for the LT with a supraspinatus insertion. Resting muscle strains were 0.21 (±0.03), 0.12 (±0.02), and 0.06 (±0.03) for the LD and 0.70 (±0.15), 0.61 (±0.13), and 0.58 (±0.13) for the LT for the supraspinatus, infraspinatus, and teres minor insertions, respectively. CONCLUSIONS LT provided better abduction and external rotation moment arms when transferred to the infraspinatus insertion. LD performed better when transferred to the supraspinatus insertion. Overall, LT transfer showed a biomechanical advantage compared with LD transfer because of stronger abduction moment arms. However, significantly larger muscle strains after LT transfer necessitate a tendon allograft to prevent muscle overtensioning.
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Affiliation(s)
- Akhil Reddy
- Weill Cornell Medical College, New York, NY, USA
| | | | - Xiang Chen
- Hospital for Special Surgery, New York, NY, USA
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1655
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Chakravorty A, Mobbs RJ, Anderson DB, Rooke K, Phan K, Yoong N, Maharaj M, Choy WJ. The role of wearable devices and objective gait analysis for the assessment and monitoring of patients with lumbar spinal stenosis: systematic review. BMC Musculoskelet Disord 2019; 20:288. [PMID: 31202276 PMCID: PMC6570936 DOI: 10.1186/s12891-019-2663-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/02/2019] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this systematic review was to evaluate the accuracy and reliability of wearable devices for objective gait measurement of Lumbar Spinal Stenosis (LSS) patients, with a focus on relevant gait metrics. Methods Systematic searches were conducted of five electronic databases to identify studies that assessed gait metrics by wearable or portable technology. Data was collected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. Results Four articles were identified for inclusion in this review. The objectives, methodology and quality of the studies varied. No single gait metric was investigated in all four studies, making comparison difficult. The most relevant metrics reported included gait cycle, gait velocity, step length and cadence, which were reported in two studies. Two studies explored gait symmetry. Differences between LSS patients and normal healthy subjects are demonstrable using wearable technology. Conclusions The measurements of gait cycle, cadence, step length, gait velocity, and number of steps with wearable devices can be used in the gait measurement of LSS patients for initial assessment, and objective outcomes following interventions. However, data and analysis are limited, and further studies are necessary to comment on reliability.
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Affiliation(s)
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia. .,Neuro Spine Clinic, Suite 7, Level 7. Prince of Wales Private Hospital, Barker Street, Randwick, NSW, 2031, Australia. .,The University of New South Wales (UNSW), Randwick, Australia.
| | | | - Kaitlin Rooke
- Neuro Spine Clinic, Suite 7, Level 7. Prince of Wales Private Hospital, Barker Street, Randwick, NSW, 2031, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Neuro Spine Clinic, Suite 7, Level 7. Prince of Wales Private Hospital, Barker Street, Randwick, NSW, 2031, Australia.,The University of New South Wales (UNSW), Randwick, Australia
| | - Nicole Yoong
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Neuro Spine Clinic, Suite 7, Level 7. Prince of Wales Private Hospital, Barker Street, Randwick, NSW, 2031, Australia.,The University of New South Wales (UNSW), Randwick, Australia
| | - Monish Maharaj
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,The University of New South Wales (UNSW), Randwick, Australia
| | - Wen Jie Choy
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Neuro Spine Clinic, Suite 7, Level 7. Prince of Wales Private Hospital, Barker Street, Randwick, NSW, 2031, Australia.,The University of New South Wales (UNSW), Randwick, Australia
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1656
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Abstract
Glenoid exposure should offer frontal access to the glenoid to allow the ancillary tools to be used freely and thus facilitate the good positioning of the glenoid implant.The two classically recognized approaches for shoulder arthroplasty are the deltopectoral and the transdeltoid approach.The axillary nerve is the most important anatomical structure in the glenoid, passing down the anterior part of the subscapularis, the inferior pole of the joint and the deep face of the deltoid muscle.Inferior glenohumeral release is the key step that allows the humerus to be retracted back or downwards thereby exposing the glenoid face on.In difficult and stiff cases, once pectoralis major release, osteophyte resection and posterior capsulectomy have been performed, a compression fracture, produced by using a retractor to push against the upper extremity of the humerus, can provide the extra few millimetres of space required to use the ancillary tools without hindrance. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180057.
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Affiliation(s)
- Laurent Nové-Josserand
- Ramsay Générale de Santé, Hôpital Privé Jean Memoz, Centre Orthopédique Santy, Lyon, France
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1657
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Preis M, Bailey T, Marchand LS, Weinberg MW, Jacxsens M, Barg A. Conversion of painful tibiotalocalcaneal arthrodesis to total ankle replacement using a 3-component mobile bearing prosthesis. Foot Ankle Surg 2019; 25:286-293. [PMID: 29409180 DOI: 10.1016/j.fas.2017.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 11/12/2017] [Accepted: 12/04/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to assess the short-term clinical and radiographic outcomes in patients who underwent conversion of a painful tibiotalocalcaneal arthrodesis to a total ankle replacement. METHODS Six patients with painful ankle arthrodesis after tibiotalocalcaneal arthrodesis were included in this study. In all patients, conversion to total ankle replacement was performed using a 3rd-generation, non-constrained, cementless three-component prosthesis. The outcomes were analyzed at a mean follow-up of 3.4±1.9years (range 1.0-6.5). RESULTS One patient with painful arthrofibrosis underwent two open arthrolysis procedures at 1.2 and 5.6 years post index surgery, respectively. No revision of tibial or talar prosthesis components was necessary in this study. All patients reported significant pain relief and significant improvement in functional status. CONCLUSION In the present study, the conversion of a painful ankle arthrodesis following tibiotalocalcaneal arthrodesis to a total ankle replacement was a reliable surgical treatment.
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Affiliation(s)
- Markus Preis
- Department of Orthopaedics, Aukammklinik, Leibnizstrasse 21, 65191 Wiesbaden, Germany
| | - Travis Bailey
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Lucas S Marchand
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Maxwell W Weinberg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Matthijs Jacxsens
- Harold K. Dunn Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
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1658
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Editorial Commentary: Iliopsoas Fractional Lengthening: Treating a Disease or a Symptom? Arthroscopy 2019; 35:1441-1444. [PMID: 31054723 DOI: 10.1016/j.arthro.2019.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Abstract
Arthroscopic iliopsoas fractional lengthening requires careful patient selection, specifically reproducible symptoms, confirmatory physical examination, suggestive imaging findings, and evaluation for microinstability. Resolution of hip snapping is expected in about 80% of cases, but there is a possibility of weakness and pain, presumably from microinstability from the loss of a dynamic anterior hip stabilizer.
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1659
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Rao K, Dibbern K, Day M, Glass N, Marsh JL, Anderson DD. Correlation of Fracture Energy With Sanders Classification and Post-traumatic Osteoarthritis After Displaced Intra-articular Calcaneus Fractures. J Orthop Trauma 2019; 33:261-266. [PMID: 30640298 PMCID: PMC6476631 DOI: 10.1097/bot.0000000000001432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To quantify fracture severity for a series of displaced intra-articular calcaneal fractures (DIACFs) and to correlate it with Sanders classification, post-traumatic osteoarthritis (PTOA), and patient outcomes. DESIGN Retrospective review and fracture severity analysis. SETTING Level 1 trauma center affiliated with the University of Iowa in Iowa City, IA. PATIENTS/PARTICIPANTS Thirty-six patients with 48 DIACFs were selected from 153 patients previously treated. All patients 18 years of age and older who had available electronic preop and postop computed tomography (CT) scans, good-quality postop and follow-up radiographs, and a follow-up ≥18 months were selected for study. INTERVENTION Fractures were treated with percutaneous reduction, using multiple small stab incisions and fluoroscopy to guide manipulation of articular fragments using cork screws or Steinmann pins, with subsequent fixation using 3.5- and 4.0-mm screws. MAIN OUTCOME MEASUREMENTS Preop CT scans were used to grade fractures according to the Sanders classification and to quantify fracture severity. Fracture severity was objectively quantified using a CT-based measure of fracture energy. PTOA was assessed on follow-up radiographs using the Kellgren-Lawrence scale. Patient outcomes were assessed using the Short Form 36 (SF-36) questionnaire and a visual analog scale pain score. RESULTS Fracture energies for the 48 DIACFs ranged from 14.1 to 26.2 J (19.3 ± 3.1 J) and correlated with Sanders classification (rho = 0.53, P = 0.0001); type I (16.3 ± 0.9 J); type II (18.0 ± 2.7 J); type III (20.8 ± 2.8 J); and type IV (22.0 ± 0.7 J). Fracture energy was higher for fractures in which the subtalar joint developed PTOA (19.5 ± 2.7 J) than for those that did not (18.9 ± 3.3 J), but the difference did not reach statistical significance. The Sanders classification predicted PTOA risk [odds ratio (OR) = 4.04, 95% confidence interval = 1.43-11.39, P = 0.0084]. No relationship was observed between fracture energy and visual analog scale pain scores. Higher fracture energy correlated with lower SF-36 scores. CONCLUSIONS Fracture energy positively correlates with Sanders classification for DIACFs, which can be used to identify more severe fractures at greater risk of progressing to PTOA. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Karan Rao
- Department of Orthopaedics and Rehabilitation, the University of Iowa, Iowa City, Iowa
| | - Kevin Dibbern
- Department of Orthopaedics and Rehabilitation, the University of Iowa, Iowa City, Iowa
- Department of Biomedical Engineering, the University of Iowa, Iowa City, Iowa
| | - Molly Day
- Department of Orthopaedics and Rehabilitation, the University of Iowa, Iowa City, Iowa
| | - Natalie Glass
- Department of Orthopaedics and Rehabilitation, the University of Iowa, Iowa City, Iowa
| | - J. Lawrence Marsh
- Department of Orthopaedics and Rehabilitation, the University of Iowa, Iowa City, Iowa
| | - Donald D. Anderson
- Department of Orthopaedics and Rehabilitation, the University of Iowa, Iowa City, Iowa
- Department of Biomedical Engineering, the University of Iowa, Iowa City, Iowa
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1660
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Cost Comparison of Femoral Distraction Osteogenesis With External Lengthening Over a Nail Versus Internal Magnetic Lengthening Nail. J Am Acad Orthop Surg 2019; 27:e430-e436. [PMID: 30278015 DOI: 10.5435/jaaos-d-17-00741] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Femoral lengthening is performed by distraction osteogenesis via lengthening over a nail (LON) or by using a magnetic lengthening nail (MLN). MLN avoids the complications of external fixation while providing accurate and easily controlled lengthening. However, the increased cost of implants has led many to question whether MLN is cost-effective compared with LON. METHODS A retrospective review was performed comparing consecutive femoral lengthenings using either LON (n = 19) or MLN (n = 39). The number of surgical procedures, time to union, and amount of lengthening were compared. Cost analysis was performed using both hospital and surgeon payments. Costs were adjusted for inflation using the Consumer Price Index. RESULTS No difference was observed in the length of femoral distraction. Patients treated with MLN underwent fewer surgeries (3.1 versus 2.1; P < 0.001) and had a shorter time to union (136.7 versus 100.2 days; P = 0.001). Total costs were similar ($50,255 versus $44,449; P = 0.482), although surgeon fees were lower for MLN ($4,324 versus $2,769; P < 0.001). DISCUSSION Although implants are more expensive for MLN than LON, this appears to be offset by fewer procedures. Overall, the two procedures had similar total costs, but MLN was associated with a decreased number of procedures and shorter time to union. LEVEL OF EVIDENCE III.
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1661
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French MH, McCauley JC, Pulido PA, Brage ME, Bugbee WD. Bipolar Fresh Osteochondral Allograft Transplantation of the Tibiotalar Joint: A Concise Mid-Term Follow-up of a Previous Report★. J Bone Joint Surg Am 2019; 101:821-825. [PMID: 31045670 DOI: 10.2106/jbjs.18.01001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Despite advances in managing degenerative arthritis of the ankle joint, there are few optimal treatment options for young patients with symptomatic, end-stage degenerative disease. Popular surgical options consist of traditional arthrodesis and, more recently, arthroplasty. Additional techniques, including arthroscopic debridement and joint distraction, have gained little traction. An alternative option is bipolar fresh osteochondral allograft (OCA) transplantation of the tibiotalar joint. We previously reported on a cohort of 86 ankles that had undergone bipolar OCA of the tibiotalar joint and now present the results after longer, mid-term follow-up (mean, 9.2 years) of the same cohort. OCA survivorship was 74.8% at 5 years and 56% at 10 years. Of the patients with a surviving graft, 74% were satisfied with the results. At the latest follow-up, 86% reported better function and 79% reported less pain compared with preoperatively. Bipolar OCA transplantation of the tibiotalar joint is an effective alternative treatment for selected young patients with end-stage ankle arthritis who wish to avoid arthrodesis or prosthetic arthroplasty. LEVEL OF EVIDENCE:: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Michael H French
- Department of Orthopaedic Surgery (M.H.F. and W.D.B.) and Shiley Center for Orthopaedic Research and Education (J.C.M. and P.A.P.), Scripps Clinic, La Jolla, California
| | - Julie C McCauley
- Department of Orthopaedic Surgery (M.H.F. and W.D.B.) and Shiley Center for Orthopaedic Research and Education (J.C.M. and P.A.P.), Scripps Clinic, La Jolla, California
| | - Pamela A Pulido
- Department of Orthopaedic Surgery (M.H.F. and W.D.B.) and Shiley Center for Orthopaedic Research and Education (J.C.M. and P.A.P.), Scripps Clinic, La Jolla, California
| | - Michael E Brage
- Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, Washington
| | - William D Bugbee
- Department of Orthopaedic Surgery (M.H.F. and W.D.B.) and Shiley Center for Orthopaedic Research and Education (J.C.M. and P.A.P.), Scripps Clinic, La Jolla, California
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1662
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Nakashima H, Kanemura T, Kanbara S, Satake K, Ito K, Ishiguro N, Kato F, Imagama S. What Are the Important Predictors of Postoperative Functional Recovery in Patients With Cervical OPLL? Results of a Multivariate Analysis. Global Spine J 2019; 9:315-320. [PMID: 31192100 PMCID: PMC6542163 DOI: 10.1177/2192568218794665] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE The objective of this study was to identify important predictors of poor functional recovery in patients undergoing surgery for cervical ossification of the posterior longitudinal ligament (OPLL). METHODS This was a retrospective cohort study of 142 OPLL patients with laminoplasty; 135 had complete radiographical data and were followed up for ≥2 years. The following OPLL characteristics were compared between patients with "good" and "poor" outcomes (Japanese Orthopedic Association [JOA] recovery rate ≥50% and <50%, respectively): number of ossified levels, OPLL classification, ossification shape, K-line, canal-occupying ratio, and increased magnetic resonance imaging (MRI) signal intensity. Predictors of functional recovery were identified. RESULTS Pre- and postoperative (2 years following surgery) JOA scores were 10.6 ± 2.9 and 14.1 ± 2.2, respectively, indicating significant improvement following laminoplasty (P < .001). The average JOA recovery rate was 53.4% ± 34.7%, with 81 (60.0%) and 54 (40.0%) patients in the better and poorer neurological outcome groups, respectively. The canal occupation ratio of OPLL ≤60%/>60% were 117 (86.7%) and 18 (13.3%) patients, respectively. In the stepwise logistic regression analysis, an occupation ratio greater than 60% was identified as a significant factor for poor postoperative neurological outcome (relative risk, 4.82; 95% confidential interval, 1.61-14.46, P = .005). CONCLUSIONS This multivariate analysis demonstrated a large size OPLL (occupying ratio >60%) was associated with a risk of poor neurological recovery roughly 5 times greater, and therefore other types of surgery are recommended in cases with such a ratio.
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Affiliation(s)
- Hiroaki Nakashima
- Nagoya University Graduate School of Medicine, Nagoya, Japan
,Konan Kosei Hospital, Aichi, Japan
| | | | | | | | | | - Naoki Ishiguro
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Shiro Imagama
- Nagoya University Graduate School of Medicine, Nagoya, Japan
,Shiro Imagama, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan.
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1663
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Oh SW, Singh R, Adsul NM, Noh JH, Park JH, Kim HS, Jang IT, Oh SH. Anatomical Relationship of the Vertebral Artery With the Lateral Recess: Clinical Importance for Posterior Cervical Foraminotomy. Neurospine 2019; 16:34-40. [PMID: 30943705 PMCID: PMC6449823 DOI: 10.14245/ns.1836304.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/14/2019] [Indexed: 11/24/2022] Open
Abstract
Objective Vertebral artery injuries during posterior cervical foraminotomy are rare, but can be fatal. Therefore, we investigated the anatomical correlation between the lateral recess and the vertebral artery.
Methods On axial cuts of cervical magnetic resonance imaging from 108 patients, we measured the distance between the vertebral arteries and the medial border of the facet joints. The anatomical vertebro-facet distance (AVFD), surgical vertebro-facet distance (SVFD), and vertebro-facet angle (VFA) were measured.
Results The mean AVFD values on the right side at the C3–4, C4–5, C5–6, and C6–7 levels showed statistically significant differences. On the right side, the mean SVFD values were equivalent to the AVFD values. The mean values of the VFA on the right side at all levels showed statistically significant differences. For all measurements, the greatest differences were seen between the C5–6 and C6–7 levels, and higher levels were associated with smaller distances from the lateral recess. The mean values of the AVFD on the right and left sides showed statistically significant differences at all levels, and the distances on the left were smaller than those on the right.
Conclusion The vertebral artery is closer to the lateral recess at higher cervical levels than at lower cervical levels. The largest distances were found at the C5–6 and C6–7 levels, and the left vertebral arteries were closer to the lateral recess than the right vertebral arteries.
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Affiliation(s)
- Sung Woon Oh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Ravindra Singh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | | | - Jung Hoon Noh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Jun Hwan Park
- Medical School University of Debrecen, Debrecen, Hungary
| | - Hyeun-Sung Kim
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Seong Hoon Oh
- Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Korea
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1664
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King PR, Ikram A, Eken MM, Lamberts RP. The Effectiveness of a Flexible Locked Intramedullary Nail and an Anatomically Contoured Locked Plate to Treat Clavicular Shaft Fractures: A 1-Year Randomized Control Trial. J Bone Joint Surg Am 2019; 101:628-634. [PMID: 30946197 DOI: 10.2106/jbjs.18.00660] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Displaced and shortened clavicular shaft fractures can be treated operatively with intramedullary or extramedullary fixation. The aim of the present study was to compare the union rates and functional outcomes of displaced and/or shortened clavicular shaft fractures treated with a flexible locked intramedullary nail or with an anatomically contoured locked plate. METHODS Seventy-two patients with acute displaced and/or shortened clavicular shaft fractures underwent randomly assigned management with either an intramedullary locked nail or an anatomically contoured locked plate. The same surgeon performed all surgical procedures, and all patients underwent identical postoperative treatment regimens. Incision length, surgical time, and union rate were recorded, and the functional outcome of the shoulder was assessed with use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant Shoulder (CS) scores. Data were analyzed with use of traditional statistical methods as well as Cohen effect sizes, which were based on the minimal clinical important differences. RESULTS Thirty-seven patients were managed with an anatomically contoured locked plate, and 35 patients were managed with a Sonoma CRx intramedullary flexible locked nail. There were no differences in general patient characteristics, fracture type, or displacement between treatment groups. The nailing group had significantly better outcomes (p < 0.001) than the locked plating group for surgical time (mean and standard deviation [SD], 45 ± 12 compared with 65 ± 21 minutes, respectively) and incision size (mean and SD, 37 ± 9 compared with 116 ± 18 mm). A union rate of 100% was observed in both groups. DASH scores were similar between groups at 1.5, 3, and 6 months, whereas the nailing group had significantly better DASH scores at 12 months (p = 0.022); however, this difference had only a moderate effect size. Overall, individual variation in DASH and CS scores was substantially higher in the plating group compared with the nailing group. CONCLUSIONS Both the precontoured locked plate and the flexible locked intramedullary nail effectively treated displaced and/or shortened clavicular shaft fractures. Similar outcomes were achieved at 1.5, 3, and 6 months after surgical intervention, and better DASH scores were found in the nailing group at 12 months. Cohen effect sizes suggested that slightly better outcomes were potentially achieved in the nailing group. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Paul R King
- Division of Orthopaedic Surgery, Department of Surgical Studies, Stellenbosch University, Tygerberg, South Africa
| | - Ajmal Ikram
- Division of Orthopaedic Surgery, Department of Surgical Studies, Stellenbosch University, Tygerberg, South Africa
| | - Maaike M Eken
- Division of Orthopaedic Surgery, Department of Surgical Studies, Stellenbosch University, Tygerberg, South Africa
| | - Robert P Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Studies, Stellenbosch University, Tygerberg, South Africa
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1665
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Flurin PH, Sirveaux F. Is CT indispensable in shoulder arthroplasty in 2019? Orthop Traumatol Surg Res 2019; 105:199-201. [PMID: 30799175 DOI: 10.1016/j.otsr.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Pierre-Henri Flurin
- Clinique du sport Bordeaux-Mérignac, 4, rue Georges-Negrevergne, 33700 Mérignac, France.
| | - François Sirveaux
- Centre chirurgical Emile-Gallé, CHRU de Nancy, 49, rue Hermite, 54000 Nancy, France
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1666
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Badrinath R, Bomar JD, Wenger DR, Mubarak SJ, Upasani VV. Comparing the Pemberton osteotomy and modified San Diego acetabuloplasty in developmental dysplasia of the hip. J Child Orthop 2019; 13:172-179. [PMID: 30996742 PMCID: PMC6442505 DOI: 10.1302/1863-2548.13.190004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/22/2019] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Patients with developmental dysplasia of the hip (DDH) may require a pelvic osteotomy to treat acetabular dysplasia. The Pemberton osteotomy and modified San Diego acetabuloplasty are two options available when surgically treating DDH. The purpose of this study was to compare outcomes following the Pemberton and modified San Diego when treating patients with acetabular dysplasia in typical DDH. METHODS We included 45 hips in the modified San Diego group and 38 hips in the Pemberton group. Hips with less than two years follow-up and patients with a neuromuscular diagnosis were excluded. Clinical outcomes were rated using the modified McKay criteria with radiographic outcomes graded using the Severin score. Avascular necrosis (AVN) was assessed using the Kalamchi and MacEwen criteria. RESULTS Mean follow-up was 4.9 years (2.1 to 11.2). Both procedures produced similar decreases in the acetabular index (modified San Diego: 17.0˚ versus Pemberton: 15.2˚; p = 0.846). Most hips had good/excellent results using the modified McKay criteria (modified San Diego: 78%, Pemberton: 94%; p = 0.055). Most hips were rated as good/excellent on the Severin scale (modified San Diego: 100%, Pemberton: 97%, p = 0.485). The proportion of hips with AVN grade 2 or higher were similar between groups (modified San Diego: 0%, Pemberton: 3%; p = 0.458). CONCLUSION The modified San Diego acetabuloplasty is a safe and effective alternative to treat acetabular dysplasia in patients with typical DDH. By maintaining an intact medial cortex, acetabular reshaping can be customized to address each patient's specific acetabular deficiency. LEVEL OF EVIDENCE Level III retrospective comparison.
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Affiliation(s)
- R. Badrinath
- University of California, San Diego Medical Center, San Diego, California, USA
- Rady Children’s Hospital, San Diego, California, USA
| | - J. D. Bomar
- Rady Children’s Hospital, San Diego, California, USA
| | - D. R. Wenger
- University of California, San Diego Medical Center, San Diego, California, USA
- Rady Children’s Hospital, San Diego, California, USA
| | - S. J. Mubarak
- University of California, San Diego Medical Center, San Diego, California, USA
- Rady Children’s Hospital, San Diego, California, USA
| | - V. V. Upasani
- University of California, San Diego Medical Center, San Diego, California, USA
- Rady Children’s Hospital, San Diego, California, USA
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1667
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Matsen FA, Whitson A, Jackins SE, Hsu JE. Significant improvement in patient self-assessed comfort and function at six weeks after the smooth and move procedure for shoulders with irreparable rotator cuff tears and retained active elevation. INTERNATIONAL ORTHOPAEDICS 2019; 43:1659-1667. [PMID: 30903255 DOI: 10.1007/s00264-019-04310-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/12/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND It has been documented that the smooth and move procedure-smoothing the proximal humeral surface while maintaining the coracoacromial arch-can provide clinically significant long-term improvement in function for patients having irreparable rotator cuff tears with retained active elevation. This study sought to demonstrate that clinically significant gains in comfort, function, and active motion can be realized as early as 6 weeks after this procedure. METHODS We conducted a prospective cohort study of the 6-week clinical outcomes for 48 patients enrolled prior to a smooth and move procedure for irreparable rotator cuff tears. Prior rotator cuff repair had been attempted in 28 (70%). RESULTS In 40 patients with preoperative and 6-week postoperative measurements, the Simple Shoulder Test scores improved from an average of 3.4 ± 2.8 preoperatively to 5.7 ± 3.5 at 6 weeks (p < 0.001), an improvement that exceeded the published values for the minimal clinically important difference (MCID). The clinical outcomes were not worse for the 18 shoulders with irreparable tears of both the supraspinatus and infraspinatus. In 30 patients with preoperative and 6-week postoperative objective measurements of active motion, the average abduction improved from 93(± 43) to 123(± 47)° (p = 0.005) and the average flexion improved from 102(± 46) to 126(± 44)° (p = 0.023). CONCLUSIONS In addition to its previously documented long-term effectiveness for shoulders with irreparable rotator cuff tears and retained active elevation, this study demonstrates that the smooth and move procedure provides clinically significant improvement as early as 6 weeks after surgery.
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Affiliation(s)
- Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA.
| | - Anastasia Whitson
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA
| | - Sarah E Jackins
- Department of Rehabilitation, University of Washington, 1959 NE Pacific St., Box 354745, Seattle, WA, 98195, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA
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1668
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Praz C, Kandhari VK, Saithna A, Sonnery-Cottet B. ACL rupture in the immediate build-up to the Olympic Games: return to elite alpine ski competition 5 months after injury and ACL repair. BMJ Case Rep 2019; 12:12/3/e227735. [PMID: 30878956 DOI: 10.1136/bcr-2018-227735] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Anterior cruciate ligament (ACL) rupture in the immediate build-up to a major international competition can preclude an athletes' participation due to the prolonged period of rehabilitation that is typically required after ACL reconstruction. ACL repair is an alternative strategy that has been postulated to confer the advantage of rapid rehabilitation and earlier return to sport. A 33-year-old professional alpine skier sustained a right knee ACL rupture in September 2017. The athlete indicated that she wanted to participate in the 2018 Olympics. Arthroscopic ACL repair and reconstruction of the anterolateral ligament was undertaken. At 3 months, Lachman's test revealed a hard end point, a negative pivot shift and no side-to-side laxity difference. MRI at 6 and 12 weeks demonstrated a continuous ACL with no intraligament signal change. At 20 weeks postoperatively, she successfully participated in the slalom at the 2018 Olympic Games.
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Affiliation(s)
- Cesar Praz
- Chirurgie Orthopédique, Centre Orthopédique Santy, Hôpital privé Jean Mermoz, Lyon, France
| | - Vikram Kishor Kandhari
- Chirurgie Orthopédique, Centre Orthopédique Santy, Hôpital privé Jean Mermoz, Lyon, France
| | - Adnan Saithna
- Medical Technologies and Advanced Materials, Nottingham Trent University - Clifton Campus, Nottingham, UK.,Renacres Hospital, Ormskirk, UK
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1669
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Iannotti JP, Walker K, Rodriguez E, Patterson TE, Jun BJ, Ricchetti ET. Accuracy of 3-Dimensional Planning, Implant Templating, and Patient-Specific Instrumentation in Anatomic Total Shoulder Arthroplasty. J Bone Joint Surg Am 2019; 101:446-457. [PMID: 30845039 DOI: 10.2106/jbjs.17.01614] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Use of 3-dimensional (3D) computed tomography (CT) preoperative planning and patient-specific instrumentation has been demonstrated to improve the accuracy of glenoid implant placement in total shoulder arthroplasty (TSA). The purpose of this study was to compare the accuracy of glenoid implant placement in primary TSA among different types of instrumentation used with the 3D CT preoperative planning. METHODS One hundred and seventy-three patients with end-stage glenohumeral arthritis were enrolled in 3 prospective studies evaluating patient-specific instrumentation and 3D preoperative planning. All patients underwent preoperative 3D CT planning to determine optimal glenoid component and guide pin position based on surgeon preference. Patients were placed into 1 of 5 instrument groups used for intraoperative guide pin placement: (1) standard instrumentation, (2) standard instrumentation combined with use of a 3D glenoid bone model containing the guide pin, (3) use of the 3D glenoid bone model combined with single-use patient-specific instrumentation, (4) use of the 3D glenoid bone model combined with reusable patient-specific instrumentation, and (5) use of reusable patient-specific instrumentation with an adjustable, reusable base. Postoperatively, all patients underwent 3D CT to compare actual versus planned glenoid component position. Deviation from the plan (in terms of orientation and location) was compared across groups on the basis of absolute differences and outlier analysis. Univariable and multivariable comparisons were performed. As the initial analyses showed no significant differences in preoperative factors or in deviation from the plan between Groups 1 and 2 or between Groups 4 and 5 across studies, the final analysis was across 3 major treatment groups: standard instrumentation (Groups 1 and 2), single-use patient-specific instrumentation (Group 3), and reusable patient-specific instrumentation (Groups 4 and 5). RESULTS In nearly all comparisons, there were no significant differences in the deviation from the plan (absolute differences or outlier frequency) for glenoid implant orientation or location across the 3 major treatment groups. CONCLUSIONS This study did not demonstrate that any type of patient-specific instrumentation resulted in consistent differences in accuracy of glenoid implant placement in primary TSA with 3D CT preoperative planning. Surgeons have multiple patient-specific instrumentation options available for improving accuracy of glenoid implant placement when compared with 2D imaging without patient-specific instrumentation. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joseph P Iannotti
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Kyle Walker
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Eric Rodriguez
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Thomas E Patterson
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Bong-Jae Jun
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Eric T Ricchetti
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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1670
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Clinical and Radiological Outcomes of Corrective Surgery on Adult Spinal Deformity Patients: Comparison of Short and Long Fusion. Adv Orthop 2019; 2019:9492486. [PMID: 30941223 PMCID: PMC6421035 DOI: 10.1155/2019/9492486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/12/2019] [Indexed: 11/17/2022] Open
Abstract
Despite the accumulated knowledge of spinal alignment and clinical outcomes the full corrective surgery cannot be applied to all the deformity patients as it requires considerable surgical burden to the patients. The aim of this study was to investigate the clinical and radiological outcomes of the patients who have received short and long fusion for ASD. A total of 21 patients who received surgical reconstructive spinal fusion procedures and were followed up for at least one year were retrospectively reviewed. Sixteen cases have received spinal corrective surgery that upper instrumented vertebrate (UIV) was thoracic level (group T), or 5 cases were with UIV in lumbar level (group L). Group L had shorter operation time, smaller intraoperative estimated blood loss, and shorter postoperative hospitalization days. Group T tends to improve more in the magnitude of VAS of lumbar pain compared to group L. Improvement of spinal alignment revealed the advantage of long fusion compared to short fusion, in Cobb angle, sagittal vertical axis (SVA), lumbar lordosis (LL), PI-LL C7 plum line (C7PL), and center sacral vertebral line (CSVL). Pelvic tilt (PT) did not differ between the groups. Disc lordosis was the most acquired in XLIF compared to TLIF and PLF and maintained one year. There were 9 adverse events, 3 cases of pulmonary embolism (PE), one case of delirium, and 6 cases of proximal junctional kyphosis. Current study elucidated that long fusion, UIV, is thoracic and can achieve better spinal alignment compared to short fusion, UIV, in lumbar. XLIF demonstrated strong ability to reconstruct the deformity on intervertebral space that is better to apply as much intervertebral space as possible. For the ASD patients with complications, short fusion can be one of the options.
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1671
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Movassaghi K, Wakefield C, Bohl DD, Lee S, Lin J, Holmes GB, Hamid KS. Septic Arthritis of the Native Ankle. JBJS Rev 2019; 7:e6. [DOI: 10.2106/jbjs.rvw.18.00080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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1672
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Ogura T, Bryant T, Merkely G, Minas T. Autologous Chondrocyte Implantation for Bipolar Chondral Lesions in the Patellofemoral Compartment: Clinical Outcomes at a Mean 9 Years' Follow-up. Am J Sports Med 2019; 47:837-846. [PMID: 30758979 DOI: 10.1177/0363546518824600] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treating bipolar chondral lesions in the patellofemoral (PF) compartment is a challenging problem. There are few reports available on the treatment of bipolar chondral lesions in the PF compartment. PURPOSE To evaluate the clinical outcomes and graft survivorship after autologous chondrocyte implantation (ACI) for the treatment of bipolar chondral lesions in the PF compartment. STUDY DESIGN Case series; Level of evidence, 4. METHODS The authors evaluated 58 patients who had ACI by a single surgeon for the treatment of symptomatic bipolar chondral lesions in the PF compartment between November 1995 and June 2014. All 58 patients (60 knees; mean age, 36.6 years) were included with a minimum 2-year follow-up. The mean ± SD sizes of the patellar and trochlear lesions were 5.6 ± 2.7 cm2 and 4.2 ± 2.8 cm2, respectively. Forty-two patients had osteotomy, as they had PF lateral maltracking, patellar instability, or tibiofemoral malalignment. Patients were evaluated with the modified Cincinnati Knee Rating Scale, Western Ontario and McMaster Universities Osteoarthritis Index, visual analog scale, the 36-Item Short Form Health Survey, and a patient satisfaction survey. Radiographs were evaluated with the Iwano classification. RESULTS Overall, the survival rates were 83% and 79% at 5 and 10 years, respectively. Of the 49 (82%) knees with retained grafts, all functional scores significantly improved postoperatively with a very high satisfaction rate (88%) at a mean 8.8 ± 4.2 years after ACI (range, 2-16 years). At the most recent follow-up, 28 of 49 successful knees were radiographically assessed (mean, 4.9 years; range, 2-17 years), with no increase of the Iwano classification in 26 knees. Outcomes for 11 patients were considered failures at a mean 2.9 years. Forty-two knees (70%) required a mean 1.0 subsequent surgical procedure. The primary reasons for chondroplasty were hypertrophy of the ACI graft (17; periosteum in 14, collagen membrane in 3), delamination of the ACI graft (5; periosteum in 4, collagen membrane in 1), and new chondral lesions (3). The best survival rates were observed among patients who underwent ACI with concomitant tibial tubercle osteotomy (TTO) as the first procedure without previous failed TTO and/or marrow stimulation technique (91% at 5 and 10 years), while the worst survival rates were observed among patients who had previous marrow stimulation (43% at 5 and 10 years). CONCLUSION Results demonstrated that ACI with concomitant osteotomy, when it is necessary for the treatment of bipolar/kissing lesions in the PF compartments, gives significant improvement in pain and function, with good survival rates at 5 and 10 years (83% and 79%, respectively). The high patient satisfaction rate is encouraging, and a high survival rate can be expected when ACI with a concomitant TTO is performed at the initial surgery for this difficult condition.
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Affiliation(s)
- Takahiro Ogura
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Sports Medicine Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | - Tim Bryant
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Cartilage Repair Center, Paley Orthopedic and Spine Institute, St Mary's Hospital, West Palm Beach, Florida, USA
| | - Gergo Merkely
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Traumatology, Semmelweis University, Budapest, Hungary
| | - Tom Minas
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Cartilage Repair Center, Paley Orthopedic and Spine Institute, St Mary's Hospital, West Palm Beach, Florida, USA
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1673
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Yusof MN, Ahmad-Alwi AA. Outcome of Islanded Gastrocnemius Musculocutaneous Flap in Orthopaedic Practice. Malays Orthop J 2019; 13:25-29. [PMID: 31001380 PMCID: PMC6459037 DOI: 10.5704/moj.1903.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Large wounds in the leg require combination of local flaps or free flap for wound coverage. Gastrocnemius musculocutaneous flap (GMCF) allows a large wound to be covered by a single local flap. However, the conventional GMCF is often associated with donor site morbidity where the exposed soleus raphe causes poor uptake of the skin graft. Islanding the skin on the muscles allows the donor site to be closed primarily, thus avoiding the donor site morbidity. Materials and Methods: Medical records of twelve patients who underwent islanded GMCF surgery from 2004 till 2018 were reviewed retrospectively. Results: The mean age was 31 years old. Eight cases were with open fracture of the tibia, two degloving injury exposing the patella, one open fracture of patella and necrotising soft tissue infection. The wound size ranged from 12cm2 to 120cm2. All flaps survived. Three patients required skin grafting at the donor site while in the rest the donor sites were able to be closed primarily. Four patients developed deep infection, one healed after vacuum dressing, one after bone transport and one after split thickness skin graft. One patient ended up with below knee amputation after developing chronic osteomyelitis of the tibia. Conclusion: Islanded gastrocnemius musculocutaneous flap is an effective simple alternative for coverage of large soft tissue defects from the knee to half of the leg distally with minimal donor site morbidity. Aggressive debridement of unhealthy tissue is necessary to prevent infection following wound coverage with this flap.
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Affiliation(s)
- M N Yusof
- Department of Orthopaedics, Traumatology and Rehabilitation, International Islamic University of Malaysia, Kuantan, Malaysia.,Department of Surgery, International Islamic University of Malaysia, Kuantan, Malaysia
| | - A A Ahmad-Alwi
- Department of Surgery, International Islamic University of Malaysia, Kuantan, Malaysia
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1674
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Rosenstiel N, Praz C, Ouanezar H, Saithna A, Fournier Y, Hager JP, Thaunat M, Sonnery-Cottet B. Combined Anterior Cruciate and Anterolateral Ligament Reconstruction in the Professional Athlete: Clinical Outcomes From the Scientific Anterior Cruciate Ligament Network International Study Group in a Series of 70 Patients With a Minimum Follow-Up of 2 Years. Arthroscopy 2019; 35:885-892. [PMID: 30704884 DOI: 10.1016/j.arthro.2018.09.020] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate clinical outcomes in professional athletes after combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction at a minimum follow-up of 2 years. METHODS A retrospective analysis of prospectively collected data from the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group database was performed. All professional athletes who underwent primary combined ACL and ALL reconstruction between January 2011 and March 2016 were included. Patient assessment included physical examination, pre- and postoperative subjective and objective International Knee Documentation Committee (IKDC), Tegner activity scale, and Lysholm scores. RESULTS Seventy-two professional athletes underwent primary ACL and ALL reconstruction; 70 (97%) were available, with a mean follow-up of 3.9 years (range, 2-7). The preoperative side-to-side anteroposterior laxity difference was 7.1 ± 1.4 mm, and this decreased significantly after surgery to 0.4 ± 0.9 mm (P < .0001). Pivot-shift grade evolved from 16 grade I (22.8%) and 54 grade II or III (77.2%) preoperatively, to 66 absent pivot shift (94.3%) and 4 grade I (5.7; P < .001). By 1-year postoperatively, 60 athletes (85.7%) returned to professional sport, with a mean time interval of 7.9 months (range, 5-12). Preoperatively, the mean subjective IKDC was 56.1 ± 12.3, the Lysholm score was 48.4 ± 12.5, and the Tegner score was 9.3 ± 1. At final follow-up, the mean subjective IKDC was 90.5 ± 7.6 (P < .0001), the Lysholm score was 94.4 ± 7.5 (P < .0001), and the Tegner score was 8.8 ± 1.5 (P < .004). The objective IKDC evolved from 39 grade C (55.7%) and 31 grade D (44.3%) preoperatively to 65 grade A (92.9%) and 5 grade B (7.1%) (P < .0001). Eleven Patients (15,7%) underwent a subsequent ipsilateral reoperation including 4 (5.7%) revision ACL reconstructions. The risk of graft rupture was significantly higher in female patients (13.6% vs 2.1% in male patients; P = .048). CONCLUSIONS Combined ACL and ALL reconstruction is associated with excellent outcomes in professional athletes with respect to graft rupture rates, return to sport, knee stability, and reoperation rates after injury. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Nikolaus Rosenstiel
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Cesar Praz
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Hervé Ouanezar
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Adnan Saithna
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Yann Fournier
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Jean-Philippe Hager
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, Lyon, France.
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1675
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Simvastatin promotes restoration of chondrocyte morphology and phenotype. Arch Biochem Biophys 2019; 665:1-11. [PMID: 30776329 DOI: 10.1016/j.abb.2019.01.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/14/2019] [Accepted: 01/31/2019] [Indexed: 02/08/2023]
Abstract
In this study we examined whether the action of simvastatin affects re-differentiation of passaged chondrocytes and if so, whether this was mediated via changes in cholesterol or cholesterol intermediates. Bovine articular chondrocytes, of varying passage number, human knee chondrocytes and rat chondrosarcoma chondrocytes were treated with simvastatin and examined for changes in mRNA and protein expression of markers of the chondrocyte phenotype as well as changes in cell shape, proliferation and proteoglycan production. In all three models, while still in monolayer culture, simvastatin treatment alone promoted changes in phenotype and morphology indicative of re-differentiation most prominent being an increase in SOX9 mRNA and protein expression. In passaged bovine chondrocytes, simvastatin stimulated the expression of SOX9, ACAN, BMP2 and inhibited the expression of COL1 and α-smooth muscle actin. Co-treatment of chondrocytes with simvastatin plus exogenous cholesterol-conditions that had previously reversed the inhibition on CD44 shedding, did not alter the effects of simvastatin on re-differentiation. However, the co-treatment of chondrocytes with simvastatin together with other pathway intermediates, mevalonate, geranylgeranylpyrophosphate and to a lesser extent, farnesylpyrophosphate, blocked the pro-differentiation effects of simvastatin. Treatment with simvastatin stimulated expression of SOX9 and COL2a and enhanced SOX9 protein in human OA chondrocytes. The co-treatment of OA chondrocytes with mevalonate or geranylgeranylpyrophosphate, but not cholesterol, blocked the simvastatin effects. These results lead us to conclude that the blocking of critical protein prenylation events is required for the positive effects of simvastatin on the re-differentiation of chondrocytes.
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1676
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High risk of tunnel convergence during combined anterior cruciate ligament and anterolateral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:611-617. [PMID: 30298415 DOI: 10.1007/s00167-018-5200-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 10/04/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE To assess the risk of femoral tunnel convergence in combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstructions. The hypothesis was that a more proximal and anterior orientation of the ALL femoral tunnel should reduce the risk of convergence with the ACL femoral tunnel. METHODS 15 fresh-frozen cadaver knees were examined. An anatomic ACL femoral tunnel was drilled arthroscopically in each specimen and ALL tunnels were made in two directions: (1) 0° coronal angulation and 20° axial angulation, (2) 30° coronal angulation and 30° axial angulation. Computed tomography scans were performed to investigate tunnel convergence and to measure the minimal distance between tunnels, tunnel length and the LFC width. RESULTS Tunnel convergence occurred in 20 of 30 cases (67%). Convergence was significantly reduced when tunnels were drilled at 30° coronal and 30° axial angulation (p < 0.05). The mean length of the ALL tunnel was 15.9 mm [95% CI (13.6; 18.1)] and was independent of ALL tunnel angulation. The mean minimal distance between the ALL and ACL tunnel was 3.1 mm [95% CI (2.1; 4.1)]. The odds ratio for tunnel convergence was 3.5 for small LFC, relative to large LFC (n.s.) CONCLUSION: A high risk of tunnel convergence was observed when performing combined ACL and ALL reconstructions. The clinical relevance of this work is that the occurrence of tunnel conflicts can be reduced by aiming the ALL tunnel in a more proximal and anterior direction. Surgeons should be aware of this, since tunnel convergence could jeopardize the ACL reconstruction and fixation.
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1677
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LaPorte C, Vasaris M, Gossett L, Boykin R, Menge T. Gluteus medius tears of the hip: a comprehensive approach. PHYSICIAN SPORTSMED 2019; 47:15-20. [PMID: 30244629 DOI: 10.1080/00913847.2018.1527172] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Greater trochanteric pain syndrome (GTPS) is a common clinical condition that can affect a wide range of patients. Historically, the condition has been associated with trochanteric bursitis. More recently, however, a growing body of literature has demonstrated gluteus medius tendinopathy and tearing is present in many cases of GTPS. Pathology of the gluteus medius can result in significant hip pain, loss of motion, and decreased function. Affected patients characteristically have symptoms including lateral hip pain and a Trendelenburg gait, which may be refractory to conservative management such as non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, and injections. In these cases, both open and arthroscopic repair techniques have been described, with recent literature demonstrating excellent patient-reported outcomes. We present a comprehensive review of gluteus medius tears including relevant anatomy, clinical evaluation, diagnosis, and treatment options.
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Affiliation(s)
- Collin LaPorte
- b Michigan State University College of Human Medicine , Grand Rapids , MI, USA
| | - Marci Vasaris
- a Spectrum Health Orthopedics , Grand Rapids , MI, USA.,b Michigan State University College of Human Medicine , Grand Rapids , MI, USA
| | - Leland Gossett
- a Spectrum Health Orthopedics , Grand Rapids , MI, USA.,b Michigan State University College of Human Medicine , Grand Rapids , MI, USA
| | | | - Travis Menge
- a Spectrum Health Orthopedics , Grand Rapids , MI, USA.,b Michigan State University College of Human Medicine , Grand Rapids , MI, USA
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1678
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Tannast M, Keel MJB, Siebenrock KA, Bastian JD. Open Reduction and Internal Fixation of Acetabular Fractures Using the Modified Stoppa Approach. JBJS Essent Surg Tech 2019; 9:e3. [PMID: 31086721 DOI: 10.2106/jbjs.st.18.00034] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background The modified Stoppa approach is performed for safe and efficient management of acetabular fractures involving the anterior column. This approach avoids dissection of the inguinal canal, the femoral nerve, and the external iliac vessels as seen in the "second window" of the ilioinguinal approach and has thus been shown to be less invasive than the ilioinguinal approach1. As an intrapelvic approach, it facilitates the management of medial displacement fracture patterns involving the quadrilateral plate and dome impaction that typically occur in the elderly2,3. The reduced morbidity of this approach is of particular relevance for elderly patients who must respond to the stresses of injury and surgery with diminished physiological reserves. Description The specific surgical steps include preoperative planning, patient positioning and setup, a Pfannenstiel incision, superficial and deep dissection, development of the Retzius space and retraction of the bladder, exposure of the superior pubic ramus and iliopectineal eminence, dissection and ligation of a potential corona mortis, exposure of the obturator nerve and vessels, subperiosteal preparation of the pubic ramus with retraction of the external iliac vessels, subperiosteal exposure of the quadrilateral plate with detachment of the internal obturator muscle and exposure of the posterior column, assessment of residual displacement by fluoroscopic views, longitudinal soft-tissue or lateral skeletal traction (optional) for reduction of medial displacement of the femoral head, disimpaction of the acetabular dome fragment and grafting of the supra-acetabular void (optional) under fluoroscopic and arthroscopic (optional) control, and reduction and fixation of extra-articular components (iliac wing posteriorly and pubic ramus anteriorly), the posterior column (infra-acetabular screw), and the quadrilateral plate (buttress plate). Before wound closure, the urine output is checked for occurrence of hematuria, an indication of bladder penetration. The anterior lamina of the rectus sheath is then sutured, and a layered closure performed. Alternatives The ilioinguinal approach might be used instead. Rationale The modified Stoppa approach avoids dissection within the inguinal canal, the second window of the ilioinguinal approach. Therefore, this approach is less invasive and might be an alternative for joint-preserving surgery, especially in the elderly.
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Affiliation(s)
- Moritz Tannast
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Marius J B Keel
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland.,Trauma Center Hirslanden, Clinic Hirslanden, Zürich, Switzerland
| | - Klaus-Arno Siebenrock
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Johannes D Bastian
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
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1679
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Cates RA, Boon AJ, Trousdale RT, Douge A, Sierra RJ. Prospective evaluation of lateral femoral cutaneous nerve injuries during periacetabular osteotomy. J Hip Preserv Surg 2019; 6:77-85. [PMID: 31069099 PMCID: PMC6501446 DOI: 10.1093/jhps/hny050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 11/19/2018] [Accepted: 12/04/2018] [Indexed: 11/20/2022] Open
Abstract
Periacetabular osteotomies (PAOs) are used to treat acetabular dysplasia in younger patients, but are not without morbidity. Lateral femoral cutaneous nerve (LFCN) injuries are commonly associated with the approach for PAOs, but the true incidence and rate of resolution is not known. The purpose of this prospective study was to determine the incidence of LFCN injuries after PAO using an innovative nerve conduction study (NCS) and to report the patient-reported outcomes. We prospectively enrolled 23 patients (24 hips) undergoing PAOs to have pre- and post-operative NCSs at a mean of 12 weeks post-operative. Patients were followed prospectively. Patients were contacted 3 years post-operatively via phone to determine the presence and severity of symptoms. Patient-reported outcome scores were also correlated with patient symptoms. Patients (91%) reported one or more LFCN symptoms post-operatively. The most common symptoms were numbness (91%), tingling (36%), pain (18%) and burning (9%). Patients (67%) had evidence of LFCN injury based on NCSs. Symptoms (40%) resolved 4 months post-operatively. Two-thirds of patients had continued symptoms at 3 years. Only 1 patient required treatment. The incidence of LFCN injury after PAO is 90%, two-thirds of which can be identified objectively by NCS. Numbness is the most common symptom. LFCN symptoms (40%) resolve by 4 months, but two-thirds of patients may continue to have thigh numbness up to 3 years after surgery. Fortunately, symptoms are not clearly associated with outcome score and treatment for this complication is rare.
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Affiliation(s)
- Robert A Cates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Altagrace Douge
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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1680
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Verhage SM, Krijnen P, Schipper IB, Hoogendoorn JM. Persistent postoperative step-off of the posterior malleolus leads to higher incidence of post-traumatic osteoarthritis in trimalleolar fractures. Arch Orthop Trauma Surg 2019; 139:323-329. [PMID: 30430238 PMCID: PMC6394475 DOI: 10.1007/s00402-018-3056-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Traditionally, size of the posterior fragment is considered the most important indicator for fixation in trimalleolar fractures. It remains unclear which factors contribute to worse functional and radiological outcome. This study was designed to determine predictors for the development of posttraumatic osteoarthritis and worse functional outcome in trimalleolar fractures. METHODS This retrospective cohort study evaluated outcomes of 169 patients with a trimalleolar fracture treated between 1996 and 2013 in a level-1 trauma hospital in the Netherlands after a mean follow-up of 6.3 (range 2.4 to 15.9) years. The average fragment size was 17%. Twenty patients had a posterior fragment smaller than 5% of the intra-articular surface, 119 patients a fragment of 5-25% and 30 patients a posterior fragment larger than 25%. In total, 39 patients (23%) underwent fixation of the posterior fragment. RESULTS Clinical union was achieved in all 169 patients. The median AOFAS score after follow-up was 93 (interquartile range 76-100) and the median AAOS score was 92 (interquartile range 81-98). A persistent postoperative step-off larger than 1 mm was found in 65 patients (39%) and osteoarthritis was present in 49 patients (30%). Higher age and postoperative step-off > 1 mm were independent, significant risk factors for the development of osteoarthritis. Osteoarthritis and BMI were independent, significant risk factors for worse functional outcome. CONCLUSION It is advisable to correct intra-articular step-off of intraarticular posterior malleolar fragments to reduce the risk of developing osteoarthritis and, consequently, the risk of worse functional outcome after long-term follow-up. LEVEL OF EVIDENCE Level IIB.
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Affiliation(s)
- Samuel Marinus Verhage
- 0000 0004 0395 6796grid.414842.fDepartment of Surgery, Haaglanden Medical Center, Lijnbaan 32, The Hague, VA 2512 The Netherlands ,0000000089452978grid.10419.3dDepartment of Traumatology Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieta Krijnen
- 0000000089452978grid.10419.3dDepartment of Traumatology Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Inger Birgitta Schipper
- 0000000089452978grid.10419.3dDepartment of Traumatology Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jochem Maarten Hoogendoorn
- 0000 0004 0395 6796grid.414842.fDepartment of Surgery, Haaglanden Medical Center, Lijnbaan 32, The Hague, VA 2512 The Netherlands
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Dabash S, Zhang DT, Rozbruch SR, Fragomen AT. Blocking Screw-assisted Intramedullary Nailing Using the Reverse-rule-of-thumbs for Limb Lengthening and Deformity Correction. Strategies Trauma Limb Reconstr 2019; 14:77-84. [PMID: 32742418 PMCID: PMC7376586 DOI: 10.5005/jp-journals-10080-1430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Historically, blocking screws have been used to assist in acute reduction of fractures during intramedullary (IM) nailing. The reverse-rule-of-thumbs (RROT) for blocking screws was introduced to facilitate internal lengthening nail use in deformity correction and limb lengthening. Our study investigated the ability of blocking screws, using same principle, to accurately correct long-bone deformity with and without lengthening and to prevent lengthening-induced deformity. Materials and methods This is an institutional review board (IRB)-approved retrospective study on 86 patients who had IM nail-assisted limb reconstruction of femur or tibia with blocking screws. Surgeries were performed for deformity correction, limb lengthening, or deformity correction and limb lengthening. Data on the following variables were collected: number of blocking screws, distance of each blocking screw to osteotomy, distance of osteotomy from joint line, and amount of lengthening. Mechanical axis deviation (MAD) and joint alignment parameters were measured preoperatively and at the final postoperative follow-up. The primary outcome was the ability to obtain desired MAD and joint orientation angles. Accuracies were reported as postoperative measurements relative to goal. Association for the Study and Applications of the Methods of Ilizarov (ASAMI) scores were collected. Results The accuracy of deformity correction was within 6 mm from goal, while joint orientation was corrected to within 1.5° of goal. Number of blocking screws did not significantly impact accuracy. Distance of blocking screw to osteotomy and amount of lengthening did not affect accuracy. In femurs, osteotomies greater than 10 cm from the joint line were more accurate in MAD goal (p = 0.017). This result was not replicated in tibias. ASAMI scores were excellent or good. Conclusion Using RROT configuration, blocking screws were effective in correcting deformities of lower extremity long bones and in preventing deformity during limb lengthening. If positioned correctly, number of screws and their distance to osteotomy did not affect accuracy. Amount of lengthening did not impact accuracy. Distal femoral osteotomy less than 10 cm from knee joint may be challenging even with using blocking screws. How to cite this article Dabash S, Zhang DT, Rozbruch SR, et al. Blocking Screw-assisted Intramedullary Nailing Using the Reverse-rule-of-thumbs for Limb Lengthening and Deformity Correction. Strategies Trauma Limb Reconstr 2019;14(2):77–84.
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Affiliation(s)
- Sherif Dabash
- Department of Orthopaedic Surgery, Limb Lengthening and Complex Reconstruction Service, The Hospital for Special Surgery, New York, USA; Department of Orthopaedic Surgery, Weill Medical College of Cornell University, The Hospital for Special Surgery, New York, USA
| | - David T Zhang
- Department of Orthopaedic Surgery, Limb Lengthening and Complex Reconstruction Service, The Hospital for Special Surgery, New York, USA; Department of Orthopaedic Surgery, Weill Medical College of Cornell University, The Hospital for Special Surgery, New York, USA
| | - S Robert Rozbruch
- Department of Orthopaedic Surgery, Limb Lengthening and Complex Reconstruction Service, The Hospital for Special Surgery, New York, USA; Department of Orthopaedic Surgery, Weill Medical College of Cornell University, The Hospital for Special Surgery, New York, USA
| | - Austin T Fragomen
- Department of Orthopaedic Surgery, Limb Lengthening and Complex Reconstruction Service, The Hospital for Special Surgery, New York, USA; Department of Orthopaedic Surgery, Weill Medical College of Cornell University, The Hospital for Special Surgery, New York, USA
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1682
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Abstract
Subcutaneous internal plate fixation for anterior pelvic ring injuries has become more common, but implants require removal, usually by 12 weeks. The purpose of this article is to report a novel, minimally invasive, endoscopic-assisted technique for the removal of subcutaneous anterior pelvic plates safely and atraumatically without violating the underlying fascia.
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1683
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Beltrami G, Ristori G, Scoccianti G, Tamburini A, Capanna R, Campanacci D, Innocenti M. Latissimus dorsi rotational flap combined with a custom-made scapular prosthesis after oncological surgical resection: a report of two patients. BMC Cancer 2018; 18:1003. [PMID: 30342489 PMCID: PMC6196007 DOI: 10.1186/s12885-018-4883-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/01/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sarcomas that arise from the scapula or periscapular soft tissues often require a total scapulectomy. This often implies a large complex tissue defect that needs adequate reconstruction of both bone and soft tissue. Although various methods have been developed, no optimal procedure has emerged. Postoperative complications are common and functional recovery is not always satisfactory. This study aims to present a new surgical technique that combines a custom-made scapular prosthesis with a functional latissimus dorsi flap. CASE PRESENTATION Two patients diagnosed with malignant tumour of the scapular region were surgically treated after proper multidisciplinary evaluation. The first patient underwent the procedure as a first surgery, the second as revision surgery. The new technique comprises three surgical stages: excisional surgery with soft tissue resection and scapulectomy, bone reconstruction with custom-made prosthesis, and soft tissue reconstruction using a latissimus dorsi rotational flap overturned on the prosthesis. The goal is to set up a new functional unit combining an anatomically shaped implant (manufactured using latest three-dimensional printing technology) and a muscular flap, and to maintain the neurovascular supply. The patients were followed up to evaluate functional outcome and complications. Both patients were alive with no evidence of disease. Functional results were satisfactory and the Musculoskeletal Tumor Society scores were 87% and 63%, respectively. No surgical complications such as implant breakage, joint collapse, wound dehiscence, or infection were observed. CONCLUSIONS This new technique upgrades the role of the latissimus dorsi flap to a functional tool in combination with an anatomical, three-dimensionally printed, custom-made prosthesis, and provides adequate well-vascularized and healthy tissue to maximize the likelihood of successful limb salvage.
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Affiliation(s)
- Giovanni Beltrami
- Department of Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - Gabriele Ristori
- Department of Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Guido Scoccianti
- Department of Reconstructive and Oncologic Orthopaedics, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Angela Tamburini
- Department of Orthopedic Oncology and Reconstructive Surgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Rodolfo Capanna
- Department of Ortopaedics and Traumatology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Domenico Campanacci
- Department of Reconstructive and Oncologic Orthopaedics, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Marco Innocenti
- Department of Plastic Surgery and Microsurgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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1684
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Abstract
PURPOSE OF REVIEW To review literature published in the last 3 years related to minimally invasive approaches to calcaneal fracture fixation. RECENT FINDINGS Numerous randomized control trials, cohort studies, and meta-analyses have been done in the last 3 years comparing surgical treatment of calcaneus fractures. These studies indicate minimally invasive procedures decrease wound complication rates and achieve similar radiographic and clinical outcomes to open reduction internal fixation. In comparing different surgical treatment methods to non-operative treatment, operative management has increased complication rates but may lead to better functional outcomes in certain patient populations. Optimal treatment for displaced intra-articular calcaneus fractures continues to be debated. Current literature would suggest that the decision to operate be based on patient and fracture characteristics and surgeon capabilities. Minimally invasive techniques aim to improve patient reported outcomes and quality of life while decreasing complications and offer another option for surgeons in the treatment of displaced intra-articular calcaneal fractures.
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Affiliation(s)
- Emily A Wagstrom
- Hennepin County Medical Center, Minneapolis, MN, USA.
- Department of Orthopaedic Surgery, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, 55415, USA.
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1685
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Abstract
The subtalar joint plays an important role for the hindfoot when accommodating during gait. Joint degeneration may be caused by posttraumatic, inflammatory, and pathologic biomechanical changes. Once conservative treatment has failed, subtalar fusion should be considered. The indication for surgery is based on thorough clinical and radiographic evaluation. Several techniques for subtalar fusion are published in literature. This article aims to describe a technique for in situ arthrodesis of the subtalar joint, paying special attention to biomechanical aspects as well as preoperative clinical and radiological work-up.
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Affiliation(s)
- Stephan H Wirth
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, Zürich 8008, Switzerland.
| | - Stefan M Zimmermann
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, Zürich 8008, Switzerland
| | - Arnd F Viehöfer
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, Zürich 8008, Switzerland
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Menken LG, Berliner ZP, Mercer N, Rodriguez JA. Cemented primary total hip arthroplasty using a direct anterior approach. ACTA ACUST UNITED AC 2018. [DOI: 10.1053/j.sart.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kocher MS, Heyworth BE, Fabricant PD, Tepolt FA, Micheli LJ. Outcomes of Physeal-Sparing ACL Reconstruction with Iliotibial Band Autograft in Skeletally Immature Prepubescent Children. J Bone Joint Surg Am 2018; 100:1087-1094. [PMID: 29975275 DOI: 10.2106/jbjs.17.01327] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears are occurring in youth athletes with increasing frequency. Many ACL reconstruction procedures designed to allow for continued growth in patients with open physes have been described, but large series with mid- to long-term outcomes data are lacking. The purpose of the current study was to assess the clinical outcomes of a large cohort of prepubescent children who underwent a physeal-sparing, combined intra- and extra-articular ACL reconstruction with iliotibial (IT) band autograft over a 23-year period. METHODS Included in our analysis were 237 patients (240 knees) who underwent ACL reconstruction using IT band autograft at Tanner stage 1 or 2 (mean age of 11.2 ± 1.7 years). Physical examination data were analyzed for 225 of the 240 knees (mean follow-up, 25.8 months), and 137 (57%) of the knees had corresponding patient-reported clinical outcomes (patient-reported graft rupture and Pediatric International Knee Documentation Committee [Pedi-IKDC], Tegner activity scale, and Lysholm scores; mean follow-up, 6.2 years). Rates of growth arrest, IT band graft-harvest morbidity, and return to sports were analyzed. RESULTS Physical examination revealed that 96.8% of the knees were grade A on the Lachman test and 98.8% were grade A on the pivot-shift test. Graft rupture occurred in 9 (6.6%) of 137 knees, at an average of 33.5 months (range, 8.2 months to 8.0 years) postoperatively. For patients who did not sustain a graft rupture, the mean Pedi-IKDC score was 93.3 ± 11.0, the mean Lysholm score was 93.4 ± 9.9, and the mean score on the Tegner activity scale was 7.8 (mode, 7). While lateral thigh asymmetry at the IT band harvest site was noted by 48% of the subjects, only 1.6% reported associated pain. No cases of limb-length discrepancy or angular deformity were observed. CONCLUSIONS This procedure was associated with excellent functional outcomes, minimal risk of growth disturbance, and a low graft-rupture rate in skeletally immature prepubescent children. These results appear durable at mid- to long-term follow-up, at an average of >6 years postoperatively. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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1688
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Fragomen AT, Kurtz AM, Barclay JR, Nguyen J, Rozbruch SR. A Comparison of Femoral Lengthening Methods Favors the Magnetic Internal Lengthening Nail When Compared with Lengthening Over a Nail. HSS J 2018; 14:166-176. [PMID: 29983659 PMCID: PMC6031532 DOI: 10.1007/s11420-017-9596-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bone lengthening with an internal lengthening nail (ILN) avoids the need for external fixation and requires one less surgical procedure than lengthening over a nail (LON). However, LON has been shown to be superior to femoral internal lengthening using a mechanical nail. The magnetic ILN, a remote-controlled and magnet-driven device, may have overcome the weaknesses of earlier internal lengthening technology and may be superior to LON. QUESTIONS/PURPOSES (1) Is the magnetic ILN more accurate than LON for femoral lengthening? (2) Does the magnetic ILN demonstrate more precise distraction rate control than LON? (3) Does the magnetic ILN result in faster regenerate site healing, with more robust callus, than LON? (4) Does the magnetic ILN result in fewer complications, including impediments to knee motion, than LON? METHODS We conducted a retrospective comparison of the records and radiographs of 21 consecutive patients with 22 femoral lengthenings using LONs and 35 consecutive patients with 40 femoral lengthenings using remote-controlled magnetic ILNs. Primary outcomes measured included accuracy, distraction rate precision, time to bony union, final knee range of motion, regenerate quality, and complications. The minimum follow-up times for the LON and ILN cohorts were 13 and 21 months, respectively. RESULTS Patients treated with ILN had a lower post-treatment residual limb-length discrepancy (0.3 mm) than those treated with LON (3.6 mm). The rate of distraction was closer to the goal of 1 mm/day and more tightly controlled for the ILN cohort (1 mm/day) than that for the LON group (0.8 mm/day; SD, 0.2). Regenerate quality was not significantly different between the cohorts. Bone healing index for ILN was not statistically significant. Time to union was shorter in the ILN group (3.3 months) than that in the LON group (4.5 months). A lower percentage of patients experienced a complication in the ILN group (18%) than in the LON group (45%). Knee flexion at the end of distraction was greater for ILN patients (105°) than that for LON patients (88.8°), but this difference was no longer observed after 1 year. CONCLUSIONS Femoral lengthening with magnetic ILN was more accurate than with LON. The magnetic ILN comports the additional advantage of greater precision with distraction rate control and fewer complications. Both techniques afford reliable healing and do not significantly affect knee motion at the final follow-up. The magnetic ILN method showed no superiority in regenerate quality and healing rate.
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Affiliation(s)
- Austin T. Fragomen
- Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021 USA
| | | | | | - Joseph Nguyen
- Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021 USA
| | - S. Robert Rozbruch
- Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021 USA
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1689
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Madura T, Doi K, Hattori Y, Sakamoto S, Shimoe T. Free functioning gracilis transfer for reanimation of elbow and hand in total traumatic brachial plexopathy in children. J Hand Surg Eur Vol 2018; 43:596-608. [PMID: 29547071 DOI: 10.1177/1753193418762950] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this study was to evaluate long-term outcomes of the free functioning gracilis transfer in children with traumatic total brachial plexus palsy. We used the free functioning gracilis transfer to reconstruct elbow flexion and prehension in 17 children with a mean age of 13.4 years (range 3-17) who were followed-up over a mean period of 6 years (range 2-16). The transferred gracilis delivered a stable elbow flexion with a useful power, as well as reconstructed active finger motion. In 3-11-year-old patients we noted a tendency towards developing a progressive flexion contracture of the elbow. The limb length discrepancy observed in our patients was not different from the brachial plexus palsy patients treated without the free functioning gracilis transfer. In conclusion, the free functioning gracilis transfer is a reliable reconstructive technique for reanimating upper extremity in children of all ages capable of delivering stable function over a long period of time. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tomas Madura
- 1 Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori, Japan.,2 West Midlands Peripheral Nerve Injury Service, University Hospitals Birmingham, Birmingham, UK
| | - Kazuteru Doi
- 1 Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori, Japan
| | - Yasunori Hattori
- 1 Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori, Japan
| | - Sotetsu Sakamoto
- 1 Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori, Japan
| | - Takashi Shimoe
- 1 Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori, Japan
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1690
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Abstract
Positioning patients for orthopedic procedures can be a daunting experience for nurses because of the wide variety of orthopedic procedures and available positioners. Understanding what to use for a particular procedure can help perioperative nurses feel more confident and allow them to provide the safest patient care possible. This knowledge also helps avoid workflow delays because of missing or incorrect equipment. Educators or senior staff nurses can provide access to information and education that will help ensure that nurses provide efficient, safe care for patients undergoing orthopedic procedures. Training should begin in the employee orientation phase and be provided when new additions or modifications to positioning policies occur. The educator should validate staff member competency on a regular basis to help ensure the correct equipment is used and to disseminate knowledge regarding any changes or upgrades to positioners.
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1691
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Ogura T, Bryant T, Mosier BA, Minas T. Autologous Chondrocyte Implantation for Bipolar Chondral Lesions in the Tibiofemoral Compartment. Am J Sports Med 2018. [PMID: 29533678 DOI: 10.1177/0363546518756977] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treating bipolar chondral lesions in the tibiofemoral (TF) compartment with cartilage repair procedures is challenging, and a suitable treatment remains unclear. PURPOSE To evaluate clinical outcomes after autologous chondrocyte implantation (ACI) for the treatment of bipolar chondral lesions in the TF compartment. STUDY DESIGN Case series; Level of evidence, 4. METHODS We evaluated 57 patients who underwent ACI for the treatment of symptomatic bipolar chondral lesions in the TF compartment by a single surgeon between October 1995 and June 2014. One patient did not return for follow-up. Thus, 56 patients (58 knees) were included with a minimum of 2 years' follow-up. A mean of 3.1 lesions per knee were treated, representing a mean total surface area of 16.1 cm2 (range, 3.2-44.5 cm2) per knee. Bipolar lesions were present in the medial compartment (32 knees) and in the lateral compartment (26 knees). Patients were evaluated with the modified Cincinnati Knee Rating Scale, visual analog scale for pain, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form-36. Patients also answered questions regarding self-rated knee function and satisfaction with the procedure. Standard radiographs were evaluated with the Kellgren-Lawrence grading system. RESULTS The survival rate was 80% at 5 years and 76% at 10 years. A significantly better survival rate was found in patients with the use of a collagen membrane than periosteum (97% vs 61% at 5 years, respectively; P = .0014). Of 46 knees with retained grafts, all functional scores significantly improved postoperatively, with a very high satisfaction rate (91%) at a mean of 8.3 ± 5.1 years (range, 2-20 years) after ACI. At last follow-up, 24 of 46 successful knees were radiographically assessed (mean, 5.5 ± 4.0 years [range, 2.0-18.7 years]) and showed no significant osteoarthritis progression ( P = .3173). Outcomes for 12 patients were considered as failures at a mean of 4.1 years. Of these, 9 patients were converted to partial or total knee arthroplasty at a mean of 4.4 years. Two patients underwent revision ACI at 5 and 17 months. The other 1 patient did not require revision surgery. CONCLUSION Our study showed that ACI for the treatment of bipolar chondral lesions in the TF compartment provided successful clinical outcomes in patients with retained grafts and possibly prevented or delayed osteoarthritis progression at midterm to long-term follow-up. A collagen membrane is more encouraging than periosteum for bipolar lesions in the TF compartment. While addressing the predisposing factors affecting cartilage repair, ACI could be an adequate salvage procedure for bipolar chondral lesions in the TF compartment for the relatively young arthritic patient who wishes to avoid arthroplasty.
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Affiliation(s)
- Takahiro Ogura
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Sports Medicine Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Tim Bryant
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian A Mosier
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Allegheny Health Network, Monroeville, Pennsylvania, USA
| | - Tom Minas
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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1692
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Survivorship of Hemiarthroplasty With Concentric Glenoid Reaming for Glenohumeral Arthritis in Young, Active Patients With a Biconcave Glenoid. J Am Acad Orthop Surg 2018; 26:e164-e166. [PMID: 29461306 DOI: 10.5435/jaaos-d-17-00788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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1693
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Yellin JL, Fabricant PD, Gornitzky A, Greenberg EM, Conrad S, Dyke JA, Ganley TJ. Rehabilitation Following Anterior Cruciate Ligament Tears in Children: A Systematic Review. JBJS Rev 2018; 4:01874474-201601000-00004. [PMID: 27490007 DOI: 10.2106/jbjs.rvw.o.00001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears are increasingly prevalent in the pediatric population. ACL rehabilitation is an essential component of recovery following injury and reconstruction, yet there are few explicit descriptions of pediatric-specific ACL rehabilitation protocols in the literature, especially in the context of varying treatment interventions. Our aim was to systematically review the literature on rehabilitation following ACL tears in children in order to describe common principles among different treatment options and areas of future research. METHODS Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we performed a systematic review of the PubMed, EMBASE, and Cochrane databases (for the past five years) to identify detailed rehabilitation protocols described in the pediatric population following ACL rupture. When available, the following aspects of rehabilitation were extracted: "prehabilitation" (exercises prior to surgery), bracing, weight-bearing status, range of motion, strength, modalities (ice, heat, electrical stimulation, etc.), plyometrics/proprioceptive exercises, return-to-sport criteria, and suggested ACL injury-prevention programs. RESULTS Two hundred and two unique articles were identified. Twenty-seven articles meeting inclusion criteria with extractible rehabilitation data were included. A table, categorized by differing orthopaedic intervention, was designed to detail the components and duration of the different aspects of rehabilitation. While there are substantial differences across protocols, several trends emerged, particularly regarding weight-bearing, bracing, range of motion, and strength training. Interestingly, we found that many current protocols are based on time frame alone rather than on functional milestones; of the fourteen unique articles that addressed return-to-sport criteria by specific orthopaedic intervention, seven were based on temporal progression whereas seven also involved achievement of physical milestones. In addition, only three of the eight articles that mentioned a future ACL injury-prevention plan described a formal prevention program. CONCLUSION We systematically identified, and subsequently outlined and compared, the current trends of the various components of pediatric-specific ACL rehabilitation protocols, categorized by orthopaedic intervention. Several protocols are based on time frames rather than milestones achieved, with newer protocols involving milestone-based progression. Newer protocols are also incorporating formal prevention programs. Just as skeletally immature patients require unique methods of operative fixation, so too do they require catered rehabilitation protocols. To effectively prevent re-rupture or contralateral injury, future research should focus on prospectively evaluating each component of the rehabilitation protocols described and return-to-sport criteria for young patients.
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Affiliation(s)
- Joseph L Yellin
- The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Richard D. Wood Ambulatory Care Building, Second Floor, Philadelphia, PA 19104
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1694
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Apivatthakakul T, Siripipattanamongkol P, Oh CW, Sananpanich K, Phornphutkul C. Safe zones and a technical guide for cerclage wiring of the femur: a computed topographic angiogram (CTA) study. Arch Orthop Trauma Surg 2018; 138:43-50. [PMID: 28956150 DOI: 10.1007/s00402-017-2804-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Cerclage wiring for reduction of complex femoral shaft fractures can create iatrogenic vascular injury. OBJECTIVE To describe the anatomical relation of blood vessels to the femur and develop a technical guide for safe passage of cerclage wire. MATERIALS AND METHODS CT lower-limb angiographs (CTA) of 80 patients were reviewed and analysed to identify the superficial femoral artery (SFA) and the deep femoral artery (DFA) as well as the relation of those arteries to the femoral cortex. The total length of the femur was measured and divided into eight equal segments (seven levels). At each level, the medial half of the femur was divided into eight sectors labelled A through H and the position of the SFA and DFA was recorded. The shortest distance between the femoral cortex and the SFA and DFA at each level was measured. The data was analysed using STATA version 10.0. RESULTS The average total femoral length from the tip of greater trochanter to lateral joint line was 402.98 ± 26.16 cm. The average distances from the SFA to the femur (d1) for levels 1 through 7 were 37.20 ± 5.0, 32.09 ± 4.74, 27.13 ± 4.19, 27.71 ± 5.46, 23.71 ± 4.40, 13.63 ± 3.59 and 10.08 ± 3.09 mm, respectively. The average distances between the DFA and the femur (d2) for levels 1 through 3 were 26.70 ± 4.13, 14.76 ± 3.27 and 9.58 ± 3.79 mm, respectively. The position of the SFA is located in sectors B through E at levels 1-3 and in sectors E through H at levels 4-7 and the position of the DFA located in sectors B through F at levels 1-3. CONCLUSION Cerclage wiring should be started from the posterior intermuscular septum at the linea aspera. The safe area is the proximal half (midshaft) of the femur where the SFA and DFA lie at a safe distance from the femur. Between the midshaft and the distal 1/4, insertion of the passer must be done meticulously with the tip kept close to posteromedial cortex. Below the distal 1/4, the tip of the passer should be kept close to the posterior cortex to avoid injury to the SFA and the sciatic nerve.
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Affiliation(s)
- Theerachai Apivatthakakul
- Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand. .,Excellence Center in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai, 50200, Thailand.
| | - P Siripipattanamongkol
- Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chang-Wug Oh
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, 700-721, South Korea
| | - K Sananpanich
- Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - C Phornphutkul
- Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
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1695
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Vlachopoulos L, Carrillo F, Gerber C, Székely G, Fürnstahl P. A Novel Registration-Based Approach for 3D Assessment of Posttraumatic Distal Humeral Deformities. J Bone Joint Surg Am 2017; 99:e127. [PMID: 29206798 DOI: 10.2106/jbjs.16.01166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND With current 3-dimensional (3D) computer-based methods for the assessment of deformities, a surface registration method is applied to superimpose a computer model of the pathological bone onto a mirrored computer model of the contralateral side. However, because of bilateral differences, especially in humeral torsion, such template-based approaches may introduce bias in the assessment of a distal humeral deformity. We hypothesized that a novel registration approach might prove superior to the current approach in reducing such bias, thus yielding improved accuracy of 3D assessment of distal humeral deformities. METHODS Three-dimensional triangular surface models were generated from computed tomographic (CT) data of 100 paired humeri without a pathological condition. Humeral segments of varying, predetermined lengths, excluding the distal part of the humerus, were defined. A surface registration algorithm was applied to superimpose the humeral models of both sides based on each selected segment. Humeral contralateral registration (HCR) errors, defined as the residual differences in apparent 3D orientation between the distal parts, were evaluated. RESULTS The mean HCR error (and standard deviation) using the distal-most humeral shaft segment to assess the angular orientation was 2.3° ± 1.1 (range, 0.5° to 5.8°). Including the humeral head in the surface registration algorithm, however, as is done currently, resulted in a higher HCR error (p < 0.001). The HCR error using the proximal-most segment was >10° in 20% of the cases and between 5° and 10° in an additional 50% of the cases. By comparison, using the proposed distal-most humeral shaft segment, the HCR error was between 5° and 10° in only 2% of cases, and was never >10°. The proximal segments are nevertheless used in the proposed method for registering humeral length. CONCLUSIONS The proposed new approach yields a deformity assessment that is less prone to bias arising from inherent bilateral differences and therefore is more accurate than current surface registration approaches. CLINICAL RELEVANCE Accurate 3D assessment is of fundamental importance if computer-based methods are applied in the correction of posttraumatic deformities.
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Affiliation(s)
- Lazaros Vlachopoulos
- Computer Assisted Research and Development Group (L.V., F.C., and P.F.) and Department of Orthopaedics (C.G.), Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Computer Vision Laboratory, ETH Zurich, Zurich, Switzerland
| | - Fabio Carrillo
- Computer Assisted Research and Development Group (L.V., F.C., and P.F.) and Department of Orthopaedics (C.G.), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Gerber
- Computer Assisted Research and Development Group (L.V., F.C., and P.F.) and Department of Orthopaedics (C.G.), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Gábor Székely
- Computer Vision Laboratory, ETH Zurich, Zurich, Switzerland
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Group (L.V., F.C., and P.F.) and Department of Orthopaedics (C.G.), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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1696
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Azimifar F, Hassani K, Saveh AH, Ghomsheh FT. A medium invasiveness multi-level patient's specific template for pedicle screw placement in the scoliosis surgery. Biomed Eng Online 2017; 16:130. [PMID: 29137676 PMCID: PMC5686850 DOI: 10.1186/s12938-017-0421-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/07/2017] [Indexed: 11/25/2022] Open
Abstract
Background Several methods including free-hand technique, fluoroscopic guidance, image-guided navigation, computer-assisted surgery system, robotic platform and patient’s specific templates are being used for pedicle screw placement. These methods have screw misplacements and are not always easy to be applied. Furthermore, it is necessary to expose completely a large portions of the spine in order to access fit entirely around the vertebrae. Methods In this study, a multi-level patient’s specific template with medium invasiveness was proposed for pedicle screw placement in the scoliosis surgery. It helps to solve the problems related to the soft tissues removal. After a computer tomography (CT) scan of the spine, the templates were designed based on surgical considerations. Each template was manufactured using three-dimensional printing technology under a semi-flexible post processing. The templates were placed on vertebras at four points—at the base of the superior-inferior articular processes on both left–right sides. This helps to obtain less invasive and more accurate procedure as well as true-stable and easy placement in a unique position. The accuracy of screw positions was confirmed by CT scan after screw placement. Results The result showed the correct alignment in pedicle screw placement. In addition, the template has been initially tested on a metal wire series Moulage (height 70 cm and material is PVC). The results demonstrated that it could be possible to implement it on a real patient. Conclusions The proposed template significantly reduced screw misplacements, increased stability, and decreased the sliding & the intervention invasiveness.
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Affiliation(s)
- Farhad Azimifar
- Department of Biomechanics, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Kamran Hassani
- Department of Biomechanics, Science and Research Branch, Islamic Azad University, Tehran, Iran.
| | - Amir Hossein Saveh
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Comprehensive Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farhad Tabatabai Ghomsheh
- Pediatric Neurorehabilitation Research Center, Ergonomics Department, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
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1697
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Wagner D, Kamer L, Sawaguchi T, Geoff Richards R, Noser H, Uesugi M, Ossendorf C, Rommens PM. Critical dimensions of trans-sacral corridors assessed by 3D CT models: Relevance for implant positioning in fractures of the sacrum. J Orthop Res 2017; 35:2577-2584. [PMID: 28247980 DOI: 10.1002/jor.23554] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 02/16/2017] [Indexed: 02/04/2023]
Abstract
Trans-sacral implants can be used alternatively to sacro-iliac screws in the treatment of osteoporosis-associated fragility fractures of the pelvis and the sacrum. We investigated trans-sacral corridor dimensions, the number of individuals amenable to trans-sacral fixation, as well as the osseous boundaries and shape of the S1 corridor. 3D models were reconstructed from pelvic CT scans from 92 Europeans and 64 Japanese. A corridor of <12 mm was considered critical for trans-sacral implant positioning, and <8 mm as impossible. A statistical model of trans-sacral corridor S1 was computed. The limiting cranio-caudal diameter was 11.6 mm (±5.4) for S1 and 14 mm (±2.4) for S2. Trans-sacral implant positioning was critical in 52% of cases for S1, and in 21% for S2. The S1 corridor was impossible in 26%, with no impossible corridor in S2. Antero-superiorly, the S1 corridor was limited not only by the sacrum but in 40% by the iliac fossa. The statistical model demonstrated a consistent oval shape of the trans-section of corridor S1. Considering the variable in size and shape of trans-sacral corridors in S1, a thorough anatomical knowledge and preoperative planning are mandatory using trans-sacral implants. In critical cases, S2 is a veritable alternative. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2577-2584, 2017.
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Affiliation(s)
- Daniel Wagner
- AO Research Institute Davos, Davos, Switzerland.,Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Lukas Kamer
- AO Research Institute Davos, Davos, Switzerland
| | - Takeshi Sawaguchi
- Department of Orthopedics and Joint Reconstructive Surgery, Toyama Municipal Hospital, Toyama, Japan
| | | | | | - Masafumi Uesugi
- Department of Orthopedic Surgery, Ibaraki Seinan Medical Center Hospital, Ibaraki, Japan
| | - Christian Ossendorf
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Pol M Rommens
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
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1698
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Moatshe G, Cinque ME, Godin JA, Vap AR, Chahla J, LaPrade RF. Comparable Outcomes After Bucket-Handle Meniscal Repair and Vertical Meniscal Repair Can Be Achieved at a Minimum 2 Years' Follow-up. Am J Sports Med 2017; 45:3104-3110. [PMID: 28806092 DOI: 10.1177/0363546517719244] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal tears can lead to significant pain and disability, necessitating surgical treatment. Nondisplaced vertical tears are usually smaller in size and can be repaired in most cases; however, bucket-handle tears are usually larger and displaced, and the repair of these tears can be challenging. Purpose/Hypothesis: The purpose was to report the outcomes after inside-out vertical mattress suture meniscal repair of bucket-handle tears and to compare these outcomes with those of patients who underwent repair of nondisplaced vertical meniscal tears with a minimum of 2 years' follow-up. The hypothesis was that the outcomes of bucket-handle tear repair would be comparable with those of nondisplaced vertical meniscal tear repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent inside-out repair of a bucket-handle meniscal tear or a nondisplaced vertical meniscal tear with a minimum 2 years' follow-up were included in this study. Patients were excluded if they had a diagnosis of a meniscal root tear, underwent a concomitant procedure for a chondral injury, or underwent previous surgical treatment of the same meniscus. Subjective questionnaires were administered preoperatively and postoperatively, including the Lysholm score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Short Form-12 (SF-12) physical component summary (PCS) and mental component summary (MCS), the Tegner activity scale, and patient satisfaction. RESULTS Thirty-two patients underwent repair for vertical meniscal tears (mean, 7 sutures), while 38 patients underwent repair for bucket-handle meniscal tears (mean, 11 sutures), with a mean follow-up of 3.1 years (range, 2-6 years). There were no significant differences in the preoperative outcome scores between the 2 groups. Significant improvements in patient-reported outcome scores from preoperatively to postoperatively were found in both groups. A direct comparison of the bucket-handle tear group to the vertical tear group did not exhibit significantly different SF-12 PCS scores (54.0 vs 51.6, respectively; P = .244), SF-12 MCS scores (55.3 vs 52.5, respectively; P = .165), WOMAC scores (8.1 vs 9.0, respectively; P = .729), Lysholm scores (84.6 vs 80.8, respectively; P = .276), Tegner scores (5.5 vs 5.5, respectively; P = .970), and patient satisfaction scores (7.4 vs 7.7, respectively; P = .570). Additionally, a comparison of acute and chronic bucket-handle tears demonstrated no significant difference in outcome scores. CONCLUSION The repair of bucket-handle meniscal tears with multiple vertical mattress sutures using an inside-out technique yielded improved results and low failure rates, comparable with outcomes after repair of nondisplaced vertical meniscal tears. The findings of this study support repairing bucket-handle meniscal tears with multiple vertical mattress sutures when possible.
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Affiliation(s)
- Gilbert Moatshe
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Oslo University Hospital, University of Oslo, Oslo, Norway.,Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Mark E Cinque
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Alexander R Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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1699
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Functional outcomes after patellar autologous osteochondral transplantation. Knee Surg Sports Traumatol Arthrosc 2017; 25:3084-3091. [PMID: 27056692 DOI: 10.1007/s00167-016-4108-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/25/2016] [Indexed: 01/12/2023]
Abstract
PURPOSE The aim of the present study was to assess clinical evaluation of patients who underwent autologous osteochondral transplantation of the patella. METHODS This prospective study assessed outcomes of 20 patients who underwent patellar autologous osteochondral transplantation at four time-points: preoperatively, 3 days, 6 months, and 2 years after surgery. The following outcomes were assessed at each time-point: pain (VAS), gait, swelling, trophic status, muscle strength, patellar mobility, and range of motion. The Tegner scale was also applied for each time-point. RESULTS All parameters improved, except for patellar mobility, which did not show any change. Pain score decreased from 7.1 (SD 2.3) to 2.4 (SD 2.6) at the 2-year assessment; limping decreased from 70 % before surgery to 15 % 2 years later; swelling scores decreased from an average of 1.8 (SD 0.8) 3 days after surgery to 0.5 (SD 0.7) at the 2-year assessment; muscle strength increased from 3.9 (SD 0.8) to 4.7 (SD 0.7) points at final follow-up; and the range of motion increased from 84 (SD 16.2) to 132 (SD 10.7) degrees 2 years later. Tegner score before surgery ranged from 0 to 5, and after 2 years, it ranged from 5 to 9. CONCLUSION Autologous osteochondral transplantation for the treatment of patellar chondral lesion was associated with significant improvement in pain, gait, swelling, and range of motion 2 years after surgery, achieving scores similar to uninjured knees. Most of them were able to return to sports activity after 6 months (recreational level) and 2 years (competitive level). LEVEL OF EVIDENCE IV.
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1700
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Fragomen AT, Rozbruch SR. Retrograde magnetic internal lengthening nail for acute femoral deformity correction and limb lengthening. Expert Rev Med Devices 2017; 14:811-820. [PMID: 28893094 DOI: 10.1080/17434440.2017.1378092] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The Precice magnetic internal lengthening intramedullary nail is being used with great success in femur lengthening and deformity correction with a retrograde approach. Areas Covered: Our personal history of limb lengthening and the Precice nail will be reviewed. Several technical aspects are discussed including design updates, pre operative planning, selection of nail length, the use of blocking screws and intra operative temporary external fixation, osteotomy practice, post operative management, and cost analysis. Expert Commentary: The phenomenal bone healing ability for the retrograde Precice nail after femoral osteotomy for lengthening, even after acute deformity correction, is recognized throughout the growing body of scientific publications on this topic. The few failures that have occurred appear to be attributable to excessive loading of the femur and implant during a vulnerable time of bone healing. Further studies with more uniform outcome criteria need to be conducted to better standardize user's experiences. The higher one time cost of the implant is offset by the reduced number of surgeries needed when compared with the gold standard of lengthening-over-nail-technique, and we suspect that patients return to work sooner due to the ability to wear normal clothing and the reduction in pain throughout the entire lengthening process.
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Affiliation(s)
- Austin T Fragomen
- a Clinical Orthopaedics , Weill Medical College of Cornell University , New York , NY , USA.,b Limb Lengthening & Complex Reconstruction Service , Hospital for Special Surgery , New York , NY , USA
| | - S Robert Rozbruch
- c Orthopaedic Surgery , Weill Medical College of Cornell University , New York , NY , USA.,d Orthopedic Surgery, Limb Lengthening & Complex Reconstruction Service , Hospital for Special Surgery , New York , NY , USA
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