Acute Rupture Research Articles

Primary repair of acute versus chronic ruptures of the distal biceps tendon. Comparison of functional results in a case-control study

BackgroundIn the event of a rupture of the distal tendon of the biceps brachii, most authors recommend early reinsertion to recover optimal elbow function. However, these ruptures are not always diagnosed or promptly referred to surgeons, thus creating a delay in treatment. Studies reporting functional results in cases of chronic repair (greater than 21 days) of the distal biceps brachii tendon show an increased rate of complications. HypothesisPrimary repairs of chronic ruptures (treatment delayed for more than 21 days) and acute ruptures of the distal biceps give the same functional results and the same rate of complications. Material and methodsWe conducted a retrospective study between January 2017 and December 2021 comparing chronic primary repair of the distal biceps at the elbow (experimental group, comprising 75 patients) and acute (control group, comprising 135 patients) by endobutton. We analyzed the time between trauma and surgery, and assessed short- and long-term functional recovery by measuring residual pain (VAS), a collection of the following functional scores: Mayo Elbow Performance Score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) and Patient-Rated Elbow Evaluation (PREE), as well as a measure of strength (as a percentage of the healthy side). We evaluated the rate of complications and radiographically analyzed the rate of heterotopic ossification. ResultsThe mean time between trauma and surgery was 73±66 days (experimental group) versus 11.2±5 days (control group). In the short-term (4.79±2.09 months), there was no significant difference in the MEPS, Q-DASH and PREE functional scores between the two groups (p=0.354, p=0.412 and p=0.958, respectively). In the long-term (28.9±17.9 months), the functional evolution remained similar. The recovery of strength in flexion and supination was 89.19±13.43% and 77.48±16.68%, respectively, and similar in the two cohorts (p=0.476 and p=0.395). There was no difference in the rate of complications; however, the rate of heterotopic ossification was higher in the control group (p=0.006). DiscussionThe functional results and the recovery of strength did not change according to the time until surgery. Although the overall complication rate was similar, repairs of the biceps in less than 21 days led to more heterotopic ossification. Level of evidenceIII; retrospective case-control study.

Correlation of defect size with fatty infiltration on MRIs of rotator cuff tendinopathy

IntroductionSizable rotator cuff defects with limited muscle atrophy and fat replacement may represent acute traumatic ruptures that are less likely to recur after surgery to close the defect, while closure of defects with poor quality muscle are associated with defect recurrence. These distinct lesions are both referred to as tears. We analyzed the relationship between rotator cuff defect size and muscle quality to determine the relative proportion of sizable defects associated with good muscle and factors associated with muscle deterioration. Material and methodsA cohort of 230 consecutive shoulder MRIs in patients with full-thickness rotator cuff tendon defects, limited acromioclavicular arthrosis (to avoid hindrance of defect measurement), and a duration of symptoms in the radiology report from a large urban center in the United States was evaluated for the measured distance between the supraspinatus tendon edge and the greater tuberosity medial to lateral (coronal plane defect size), anterior to posterior (sagittal plane defect width), and fatty infiltration (Goutallier classification), and atrophy (Warner classification) of the supraspinatus. We sought factors independently associated with fatty infiltration and muscle atrophy in multivariable logistic regression analyses. ResultsForty-nine of 109 shoulders (45%) with a coronal plane defect >20 mm had reasonable muscle quality as defined by Goutallier grade less than 2 and Warner grade less than 2. Both greater fatty infiltration of the supraspinatus muscle and greater supraspinatus muscle atrophy were associated with older age and greater coronal plane defect size. ConclusionThe observation that supraspinatus muscle health deteriorates with age and defect size, but nearly half of the largest defects had good muscle, suggests an important distinction between relatively recent traumatic ruptures and old untreated rupture or gradual attrition that may be obfuscated by referring to all lesions as tears. Level of evidenceLevel III; Retrospective diagnostic cohort.

A Case Report of Ruptured Popliteal Aneurysm in the Setting of Blunt Trauma.

Popliteal artery aneurysms are in most cases asymptomatic but cause significant complications if ruptured. An acute popliteal aneurysm rupture is relatively rare, and few cases have been documented secondary to blunt trauma. Common presenting signs and symptoms include distal limb ischemia and absent dorsalis pedis pulses. Timely management and recognition of this rare presentation are crucial as this condition can result in limb loss or death if not treated in a timely manner. An 80-year-old man with history of hypertension presented to the emergency department complaining of inability to feel sensation below his left knee after falling from ground level. Physical examination was pertinent for bounding radial and femoral pulses bilaterally, although absent dorsalis pedis and posterior tibial pulses to the left lower extremity. Computed tomography angiography identified occlusion of the left superficial femoral arterial lumen associated with a ruptured popliteal aneurysm, approximately eight centimeters in size. He immediately received unfractionated heparin and was admitted to the hospital for left medial thigh exploration and decompressive dermatofasciotomy. After confirmation of popliteal aneurysmal rupture with advanced imaging, heparinization and vascular surgery consultation are critical steps that should be taken to prevent limb loss.

Modified surgical anchor refixation in older patients with acute proximal hamstring rupture: clinical outcome, patient satisfaction and muscle strength

IntroductionAfter conventional surgical refixation of the hamstrings after proximal hamstring rupture, patients frequently experience pain while sitting and deficits in hamstring muscle strength of the operated side. To improve these outcomes, we have modified the surgical anchor placement and have carried out a thorough follow-up examination.Materials and methodsThirteen older patients (8 female, 5 males) with a median age of 64.2 (range, 52.1–80.4) years were surgically treated for acute proximal hamstring rupture using modified anchor placement and participated in a follow-up assessment at a median of 46.2 (11.2–75.0) months after surgery. Patients completed the Perth Hamstring Assessment Tool (PHAT), quality of life questionnaire (EQ-5D-5L) and the Lower Extremity Functional Scale (LEFS), and rated their satisfaction level on a scale from 0 to 100%. Local tenderness on the ischial tuberosity and maximum passive hip flexion were measured on both limbs. Maximum isokinetic knee flexor muscle strength was measured bilaterally using a dynamometer.ResultsThe median (range) PHAT, EQ-5D-5L and LEFS score were 78.8/100 (54.6–99.8), 0.94/1 (0.83–1) and 88.75/100 (61.25–100). The median satisfaction was 100% (90–100%). Only one patient felt discomfort when the ischial tuberosity was palpated. Neither maximum passive hip flexion nor maximum isokinetic flexor muscle strength differed between the operated and non-operated side (P > 0.58). Clinical scores did not correlate with the leg symmetry index of knee flexor muscle strength (Spearman’s rho < 0.448, P > 0.125). There were no tendon re-ruptures, or postoperative sciatic radiculopathy, at the time of follow-up.ConclusionsThe modified extra-anatomical anchor placement resulted in good clinical and functional outcome of surgical repair of acute proximal hamstring rupture. Especially the absence of postoperative pain while sitting and the comparable muscle strength to the contralateral side is promising.Clinical trial registrationClinicalTrials.gov Identifier: NCT04867746, registered.

Graft failure and revision rate after ACL repair with dynamic intraligamentary stabilization. One-year results of a prospective case series of 155 patients

PurposeThe aim of this study was to assess graft failure, revision rate, and functional outcomes after treatment of acute ACL rupture with dynamic intraligamentary stabilization (DIS) Ligamys device one year post surgery. Additionally, differences in functional outcome between patients with and without anteroposterior laxity were assessed. It was hypothesized that the failure rate of DIS was non-inferior to that of previously reported ACL reconstruction (10%).MethodsIn this prospectively designed multicenter study, including patients with an acute ACL rupture, DIS was performed within 21 days after rupture. Primary outcome was failure of the graft at 1 year post surgery, defined as 1) re-rupture of the graft, 2) revision of DIS, or 3) a > 3 mm side-to-side difference in anterior tibial translation compared to the non-operated knee (∆ATT), measured by the KT1000 device. Additional analysis was performed using a 5 mm threshold. The subjective International Knee Documentation Committee Score (IKDC) and Numerical Rating Scales (NRS) for pain and confidence were used to evaluate functional outcome.ResultsA total of 155 patients were included with a mean age at surgery of 27.8 years (SD 9.4). The mean interval from rupture to DIS was 16.4 days (SD 5.2). At a median follow-up of 13 months (IQR 12–18) the failure rate of the graft was 30.2% (95%CI:22.0–39.4); 11 patients (7%) required secondary reconstructive surgery and of the 105 patients who attended ATT measurement, 24 patients (23%) had an ∆ATT > 3 mm. Secondary analysis, based on a 5 mm threshold, revealed a failure rate of 22.4% (95%CI: 15.2; 31.1). A total of 39 patients (25%) reported at least one complication, comprising mainly arthrofibrosis, traumatic re-rupture and pain. In these patients, removal of the monoblock was performed in 21 cases (13.5%). At follow-up no significant differences in functional outcomes between patients with ∆ATT > 3 mm and stable ATT were observed.ConclusionThis prospective multicenter study found a high failure rate at one year follow-up of 30% (7% revision surgery and 23% > 3 mm side-to-side difference in anterior tibial translation) in patients treated by primary repair of the ACL with DIS, and did therefore not demonstrate non-inferiority to ACL reconstruction. For patients who did not require secondary reconstructive surgery, this study found good functional outcomes, also in case of persistent anteroposterior knee laxity (∆ATT > 3 mm).Level of evidenceLevel IV.

Transosseous Suture Fixation in Quadriceps Rupture: A Surgical Technique and a Case Report

Abstract Background: An important goal of surgical treatment of the quadriceps or patellar tendons is to provide sufficient strength for performing range-of-motion exercises soon after surgery. A popular treatment for repair of acute quadriceps tendon rupture is to insert sutures through patellar bone tunnels, which yields good to excellent results in most cases. Objective: We report the case of quadriceps tendon rupture in a young male, his radiological findings, intervention received, and the review of relevant literature as well as outcomes. Case Presentation: A 29-year-old obese man presented with a 10-day-old quadriceps rupture, which was repaired with transosseous patellar fixation. A 6-month follow-up revealed a satisfactory clinical and functional outcome. Discussion and Conclusion: Repair of acute quadriceps tendon tear repair by passing sutures through patellar bone tunnels is a popular and successful technique to preserve the knee extensor mechanism and to provide sufficient strength for range-of-motion exercises.

Pectoralis Major Repair with Double Button Sliding Tension Technique

Background: Pectoralis major rupture is often is weightlifters, commonly during benchpressing, eccentric phase of contraction and external rotation under maximum contraction. Preoperative imaging is use to differentiate between complete, partial, or intermuscular tear. In athelete patient, operative treatment has shown better result in return of strength and overall satisfaction over nonoperative treatment. Objectives: We described a surgical technique in 6 patients with acute pectoralis major rupture, with double button sliding technique. Methods: A deltopectoral approach is performed, and identify pectoralis major tendon and each tendon is secured with No.2 non absorbable braided suture using a modified krackow configuration. A 3.2 mm drill is used to make a unicortical hole at footprint. Two button were inserted and tensioned follow by knot-tying. Results: After six months evaluation, all patients underwent surgery with double button sliding tension technique returned to their pre-injury level. Conclusion: Double button tension sliding technique in pectoralis major rupture had excellent result, patients have returned to sport without complication.

Application of Preoperative Ultrasonography in the Percutaneous Minimally Invasive Repair of Acute Closed Achilles Tendon Rupture.

Percutaneous minimally invasive surgery involving Achilles tendon (AT) repair has the advantages of a low rerupture rate and fewer postoperative complications. However, due to the inability to operate under direct vision, the injury of the small saphenous vein (SSV) and sural nerve (SN) remains largely a high risk involving many challenges. We propose to introduce the preoperative application and advantages of ultrasonography in percutaneous minimally invasive surgery for acute AT rupture. Our results indicated that ultrasonography could locate the position of the SN more accurately and reduce the risk of iatrogenic nerve injury. Compared with the traditional surface markers, the preoperative localization and marking of AT, SSV, and SN in ultrasonography significantly reduced the risk of intraoperative accidental injury to blood vessels and nerves, which could reduce postoperative complications and promote early rehabilitation of patients. We ultimately exploit the properties of ultrasonography in percutaneous minimally invasive surgery to treat Achilles tendon rupture.

Immunohistological study of ovarian mature cystic teratoma with extremely elevated SCC antigen level

Squamous cell carcinoma (SCC) antigen is a reliable tumor marker for various cancers, including cervical cancer and lung cancer, and was recently reported to correlate with the severity of inflammatory skin diseases such as atopic dermatitis. Herein, we present a case of a 47-year-old female patient who presented with acute abdomen rupture due to a mature cystic teratoma of the ovary, approximately 11 cm in diameter on imaging examination, prompting emergency laparoscopic surgery. The patient had no symptoms of atopic dermatitis. The operative findings showed no evidence of torsion, but the membrane was partially ruptured, leading to the leakage of the cyst contents. The operation was completed after excising the adnexa and intraperitoneal lavage. The postoperative results revealed a markedly high serum SCC antigen level of 55.3 ng/dL, which was normalized at 2 months postoperatively. Postoperative histopathological examination revealed no squamous cell carcinoma component but a marked lymphocytic infiltrate under the squamous epithelium, suggesting a high degree of inflammation. Additionally, immunostaining demonstrated a cluster of differentiation (CD) 8+ lymphocyte predominance over CD4+ lymphocytes, similar to the histology of atopic dermatitis. Altogether, our findings suggest that the abnormally high SCC antigen levels might be attributed to the presence of severe inflammation in the mature cystic teratoma rather than an underlying malignancy and support the notion that SCC antigen may be a useful marker beyond its established role in cervical and lung cancers.

Achilles Tendon Rupture Repair Using the Mini-Open Approach in a Supine Position.

Achilles Tendon Rupture Repair Using the Mini-Open Approach in a Supine Position.

Open Achilles Tendon Repair.

An open Achilles tendon repair is performed in patients who have suffered an acute rupture. All patients with this injury should be counseled on their treatment options, which include open operative repair and functional rehabilitation. We prefer the use of an open repair in high-level athletes and those who have delayed presentation. Typically, this injury-and the resulting open repair-are seen in young or middle-aged patients as well as athletes. Operative repair of a ruptured Achilles tendon is associated with a much faster return to activity/sport when compared with nonoperative alternatives. This surgical procedure is especially useful in allowing this patient population to return to their previous activity level and functional capacity as quickly as possible. Open repair of a ruptured Achilles tendon begins with a 6 to 8-cm incision over the posteromedial aspect of the lower leg. Superficial and deep dissections are performed until the 2 ends of the ruptured tendon are identified. Adhesions are debrided to adequately mobilize and define the proximal and distal segments of the tendon. With use of a fiber tape suture, a modified locking Bunnell stitch is utilized to secure both ends. The fiber tape is tied securely, and the repair is reinforced with Vicryl suture (Ethicon). Once the tendon is repaired, the paratenon layer is identified and repaired with a running 0 or 2-0 Vicryl suture. This is an important step to minimize postoperative wound complications. The wound is then closed, and the extremity is splinted in maximum plantar flexion. Alternative treatments include minimally invasive surgical techniques such as percutaneous Achilles tendon repair and nonoperative treatment with functional rehabilitation, which can provide excellent outcomes but can also lead to a slight decrease in explosiveness as the patient returns to sport1,2. Nonoperative and operative treatment of Achilles tendon rupture can both result in excellent patient outcomes. Appropriate patient selection is critical. Younger patients hoping to return to more highly competitive athletics should consider operative repair3. Possible differences have been identified in peak torque when comparing operative versus nonoperative treatment, with patients who had undergone operative repair having greater peak torque (i.e., explosiveness)2. Otherwise, findings are similar between treatment options as long as the patients meet the criteria for nonoperative treatment. Overall, the scientific literature demonstrates that the functional outcomes following operative repair are good to excellent. In a study by Hsu et al.4, 88% of patients were able to return to their baseline level of activity by 5 months postoperatively, with a complication rate of 10.6% and no reruptures. In a recent meta-analysis by Meulenkamp et al.5, the authors found that operative repair of Achilles tendon rupture was associated with a reduced risk of rerupture compared with primary immobilization (i.e., conventional cast immobilization with delayed weight-bearing for at least 6 weeks only). However, open surgical repair, minimally invasive repair, and functional rehabilitation all had similar risk of rerupture5. In a review by Ochen et al.6 that analyzed 29 studies with a total of 15,862 patients, operative repair was associated with a significantly lower risk of rerupture compared with nonoperative treatment (2.3% versus 3.9%, respectively). However, operative treatment was also associated with a significantly higher complication rate compared with nonoperative treatment (4.9% versus 1.6%, respectively)6. Finally, in a meta-analysis by Soroceanu et al.7, the authors found that if early range-of-motion protocols and functional rehabilitation were utilized, operative and nonoperative treatment resulted in similar outcomes and equivalent rates of rerupture. To prevent rerupture of an Achilles tendon, remind patients to engage in adequate stretching and warming prior to physical activity.Palpate and locate the tendon defect prior to making the first incision.Immobilize the ankle joint in a splint for 2 weeks postoperatively in maximum plantar flexion.Pitfalls include:○ Poor suture management leading to tangling in the repair.○ Undertensioning or overtensioning of the repair, which can be avoided by sterilely draping out both legs and checking resting tension intraoperatively.○ Failure to close the paratenon, causing scarring of the skin or surrounding tissues, which can be avoided by making a relieving incision on the deep surface of the paratenon.○ Leaving suture knots on the dorsal side of the repair that may aggravate the skin. MRI = magnetic resonance imagingESU = electrosurgical unit.

Obstetric complications in women who underwent conservative myomectomy before pregnancy

The article presents a literature review devoted to the obstetric complications in pregnant women after conservative myomectomy. The attention is paid to such a complication as uterine rupture. The authors consider impractical to evaluate the uterine scar before pregnancy using ultrasound methods and hysteroscopy.Uterine rupture of any type should be documented in the medical history (published), which allows the clinicians and women to better understand factors associated with the risk for rupture and to inform the patient’s decision to deliver by cesarean section or through the vagina.A review and analysis of a case of uterine rupture in a patient after conservative myomectomy is also performed. A 40-weeks pregnant woman was taken to the operating room 12 hours after the start of the acute uterine rupture clinic and decrease of hemodynamic parameters. About 2 liters of blood was found in the abdominal cavity, and a tear up to 7 cm long was determined in the area of the uterine fundus, closer to the left uterine angle. In the female outpatient consultation, during the observation of a pregnant woman who had the laparoscopic intervention – myomectomy, a diagnosis of “scar on the uterus” was not established. Medical documentation providing information on prior surgery was ignored and was not required. During the observation of the pregnant woman, the method of childbirth was not considered by the doctor’s council, and prenatal hospitalization was not performed.By studying the modern scientific sources, there is very little data about factors what increase the risk of uterine rupture, such as penetration into the uterine cavity. Performance of laparoscopic intervention, as a rule, is associated with the implementation of reproductive function in the future. Obstetricians and gynecologists who perform surgical intervention should describe the operation protocol not formally, but taking into account the implementation of the reproductive function. For many women after myomectomy, vaginal delivery can be a safe and feasible option, with patient choice and informed consent regarding the mode of delivery is important. Women should be offered choice and provided with appropriate counseling using all available evidence and monitored during pregnancy and birth in health care institutions that support their choice. This article provides practical recommendations for the management of pregnancy and childbirth in patients who had conservative myomectomy.

Application of Logistic Regression and Artificial Intelligence in the Risk Prediction of Acute Aortic Dissection Rupture.

Logistic regression (LR) and artificial intelligence algorithms were used to analyze the risk factors for the early rupture of acute type A aortic dissection (ATAAD). Data from electronic medical records of 200 patients diagnosed with ATAAD from the Department of Emergency of Guangdong Provincial People’s Hospital from April 2012 to March 2017 were collected. Logistic regression and artificial intelligence algorithms were used to establish prediction models, and the prediction effects of four models were analyzed. According to the LR models, we elucidated independent risk factors for ATAAD rupture, which included age > 63 years (odds ratio (OR) = 1.69), female sex (OR = 1.77), ventilator assisted ventilation (OR = 3.05), AST > 80 U/L (OR = 1.59), no distortion of the inner membrane (OR = 1.57), the diameter of the aortic sinus > 41 mm (OR = 0.92), maximum aortic diameter > 48 mm (OR = 1.32), the ratio of false lumen area to true lumen area > 2.12 (OR = 1.94), lactates > 1.9 mmol/L (OR = 2.28), and white blood cell > 14.2 × 109 /L (OR = 1.23). The highest sensitivity and accuracy were found with the convolutional neural network (CNN) model. Its sensitivity was 0.93, specificity was 0.90, and accuracy was 0.90. In this present study, we found that age, sex, select biomarkers, and select morphological parameters of the aorta are independent predictors for the rupture of ATAAD. In terms of predicting the risk of ATAAD, the performance of random forests and CNN is significantly better than LR, but the performance of the support vector machine (SVM) is worse than LR.

Anterior Cruciate Ligament Reconstruction Using a Fascia Lata Graft With FiberTape Augmentation

Reconstruction of the anterior cruciate ligament (ACL) is one of the most popular orthopedic surgical procedures. To date, numerous studies are available focusing on different reconstruction techniques using established autografts, such as hamstrings, bone patellar-tendon bone (BPTB), quadriceps tendon, or allograft tendons. In the present article, we describe a minimally invasive ACL reconstruction technique using a fascia lata autograft in combination with FiberTape (Arthrex, Naples, FL) augmentation using the TightRope II (Arthrex). The minimally invasive harvesting procedure is performed by using the new QuadPro Tendon Harvester (Arthrex). This technique is recommended for acute and chronic complete ACL ruptures or bundle ruptures in athletes or patients with high physical activity. The technique might allow early full weight bearing due to less donor site morbidity, early free range of motion, and early active rehabilitation due to the use of FiberTape as a augmentation device to reinforce the autograft. Clinical studies are necessary to prove the principle.

Spontaneous healing of acute ACL ruptures: rate, prognostic factors and short-term outcome

IntroductionAnterior cruciate ligament (ACL) reconstruction is considered the first line treatment in ACL rupture. However, some patients return to high intensity sport activities and show a normal knee function without ACL reconstruction. Therefore, aim of this study was to evaluate the rate and prognostic factors of spontaneous healing in patients with ACL rupture and the short-term functional outcome.MethodsThe rate, prognostic factors and short-term functional results of spontaneous healing in patients with ACL rupture were evaluated in 381 patients. Morphology of ACL rupture and extent of posterior tibial slope (PTS) were classified by MR- and x-ray imaging. In patients with normal knee stability in anesthesia examination and healed ACL during the arthroscopy 6 weeks after trauma ACL reconstruction was canceled. IKDC -, Tegner Activity Score, KT 1000 testing and radiological characteristics were collected 12 months postoperatively in these patients.Results14.17% of the patients with ACL rupture showed a spontaneous healing after 6 weeks. Femoral ACL-rupture (p < 0.02) with integrity of ligament stump > 50% (p < 0.001), without bundle separation (p < 0.001) and decreased PTS (p < 0.001) was found significantly more often in patients with a spontaneous healed ACL. The average IKDC score was high at 84,63 in patients with healed ACL at 1 year follow-up, but KT 1000 testing was inferior compared to non-injured side.ConclusionSpontaneous healing of a ruptured ACL happened in 14% of the patients. Especially in low-demand patients with femoral single bundle lesions without increased posterior tibial slope delayed ACL surgery should be considered to await the possibility for potential spontaneous ACL healing.

Calf muscle evaluation during rehabilitation after flexor hallucis longus tendon transfer in neglected achilles tendon rupture: A case report

Introduction: Neglected achilles tendon rupture is generally defined as a rupture with a delay of more than 4 weeks prior to diagnosis or treatment. Difficulties in management make it one of the challenging problems in orthopedic practice. They have a greater tendency to develop complications and slightly poorer functional outcomes than patients with an acute rupture. Method: This case report features a case of 30 years old female with 3 months of neglected achilles tendon rupture after landing in the wrong position while playing badminton. The patient complains of continuous pain and inability to move her ankle downward, making walking difficult. On physical examination and CT imaging, we found achiles tendon rupture with significant gap and calf muscle atrophy. The patient was then managed operatively by debridement and tendon repair with flexor halucis longus tendon transfer. Result: Follow up 3 months post-operative, found a difference in calf muscle circumference in both legs. At the same time, there is still an improvement in active ROM ankle plantarflexion and positive single heel raise test on the affected side. The functional outcome measured by ATRS obtained 80 points, and AOFAS ankle-hindfoot scales with a value of 91 points. Discussion: With several advantages, FHL tendon transfer is the currently used technique for neglected cases of achiles tendon rupture. Despite long immobilization will induce other complications. Good operative techniques and accelerated rehabilitation are still recommended to gain good functional outcomes for the patient.

Ability to return to sports after early lateral ligament repair of the ankle in 147 elite athletes.

The literature on elite athletes' ability to return to sports (RTS) after early lateral ligament repair of the ankle remains inadequate. The time needed to RTS after modified Broström repair for acute grade III lateral ligament injuries in a large cohort of elite athletes was evaluated while assessing the impact of other associated injuries. Prospective data from 147 elite athletes who underwent a primary lateral ligament repair for acute grade III injuries with clinical ankle instability from 2015 to 2019 with a minimum of 2-year follow-up were reviewed. Pertinent details such as characteristics of injury, time taken to RTS, impact of associated injuries on RTS and complications were recorded and analysed. The average age was 24.4years (S.D = 4.9) with 89.1% males. Approximately two-thirds of the elite athletes were football players (66.0%) and 21.1% were rugby players. Isolated lateral ligament complex injuries were sustained by 122 (83%) patients, while 25 (17%) had associated injuries (osteochondral lesions of the talus/deltoid injury/syndesmosis injury). All 147 athletes returned to their preinjury level of sports with a median time of 69days (range 58-132days). There was no significant difference found in time to RTS between gender, age, and types of sports. However, there was a statistically significant difference noted in the time taken to RTS earlier in patients with isolated lateral ligament injuries when compared to those with associated injuries (68.6 vs. 82.8days; p = 0.004). Multiple conditional linear regression yielded three independent predictors of longer time taken to RTS which were associated deltoid injury (7.5days longer; 95% CI 2.9-12.3; p = 0.002), associated syndesmosis injury (6.7days longer; 95% CI 0.5-12.8; p = 0.034) and associated OLT (30.3days longer; 95% CI 25.1-35.5; p = 0.000). Early surgical repair for acute grade III lateral ligament injuries in elite athletes yielded excellent rate of RTS at 9-10weeks and a re-injury rate of 2%. Concomitant injuries will delay RTS after surgical intervention. These findings serve as important guide to managing elite athletes following acute rupture of the lateral ligament complex. Level III.

Extensor mechanism reconstruction with allograft following total knee arthroplasty: a systematic review and meta-analysis of achilles tendon versus extensor mechanism allografts for isolated chronic patellar tendon ruptures.

Extensor mechanism rupture is a severe complication with an incidence of 0.1-2.5% after total knee arthroplasty (TKA). Achilles tendon allograft (ATA) and extensor mechanism allograft (EMA) in TKA surgery have yielded mixed clinical results. Our systematic review aims to identify the proportion of failure in extensor mechanism reconstruction after TKA using allograft and evaluate clinical and functional outcomes and the most common complications. Furthermore, we performed a meta-analysis among studies dealing with isolated patellar tendon ruptures to assess the failure rate, surgical complications, and clinical findings (extensor lag and knee range of motion) of extensor mechanism reconstruction using either ATA or EMA grafts. A systematic review of the literature was performed following the PRISMA guidelines, including the studies dealing with the use of EMA and ATA for extensor mechanism rupture following TKA. Coleman Methodology Score and the MINORS score were used to assess the quality of the studies. A meta-analysis was performed to evaluate the failure rate, complications, and clinical findings (extensor lag and knee range of motion) of the ATA and EMA treatments in isolated patellar tendon ruptures. A total of 238 patients (245 knees), with a mean age ranging from 54 to 74years, who underwent extensor mechanism reconstruction with an allograft were identified in the 18 included studies. We analysed 166 patellar tendon ruptures, 29 quadriceps tendon ruptures, and 29 patellar fractures in the analysis. A chronic injury was described in the majority of included cases. ATA and whole EMA were used in 89 patients (92 knees) and 149 patients (153 knees), respectively. The overall failure percentage was 23%, while EMA and ATA were 23 and 24%. The most common complication was extensor lag (≥ 20°). The overall incidence of postoperative infection was 7%. Eleven of 14 included papers reported more than 100° of the mean postoperative knee flexion. The percentage of patients requiring walking aids is 55 and 34.5% in ATA and EMA, respectively. The failure outcome after extensor mechanism reconstruction in isolated patellar tendon ruptures was 27%, with no statistical difference between EMA and ATA in terms of failure rate and clinical outcomes. Extensor mechanism reconstruction with allograft represents a valid treatment option in patients with acute or chronic rupture following total knee arthroplasty. Persistent extensor lag represents the most common complication. EMA is associated with a lower frequency of patients requiring walking aids at last follow-up, although it has similar clinical and functional outcomes to ATA. In patellar tendon ruptures, ATA has a comparable success rate with EMA. Level IV, therapeutic study. PROSPERO 2019 CRD42019141574.

Comparable rates of secondary surgery between anterior cruciate ligament repair with suture tape augmentation and anterior cruciate ligament reconstruction

PurposeThe aim of this study was to determine the frequency of secondary surgery following anterior cruciate ligament (ACL) repair with suture tape augmentation in comparison to conventional hamstring ACL reconstruction. We hypothesised that there would be no differences between the groups.MethodsThis was a retrospective comparison study of patients undergoing ACL surgery between September 2011 and April 2018. Two hundred and 73 patients underwent ACL reconstruction using hamstring autograft. During the same timeframe, 137 patients with an acute proximal ACL rupture underwent ACL repair with suture tape augmentation. One patient was lost to follow-up in the ACL reconstruction group leaving 272 patients (99.6%) for the final analysis. In the ACL repair group, three patients were lost to follow-up leaving 134 patents (97.8%) for the final analysis. Secondary surgery was identified by contacting the patients by email/telephone and reviewing patient notes at the time of this analysis.ResultsRe-rupture occurred in 32 patients (11.8%) in the ACL reconstruction group compared to 22 patients (16.4%) in the ACL repair group (p = 0.194). Contralateral ACL rupture occurred in four patients (1.5%) in the ACL reconstruction group compared to three patients (2.2%) in the ACL repair group (p = 0.224). In the ACL reconstruction group, nine patients (3.3%) required secondary meniscal surgery whilst five patients (3.7%) required meniscal surgery in the ACL repair group (p = 0.830). Seven other operations were performed in the ACL reconstruction group (2.6%) compared to three other operations in the ACL repair group (2.2%) (p = 0.374). The overall number of patients undergoing secondary surgery in the ACL reconstruction group was 52 (19.1%) in comparison to 30 (22.4%) in the ACL repair group (p = 0.114).ConclusionACL repair with suture tape augmentation for acute proximal ruptures demonstrated comparable rates of secondary surgery with hamstring ACL reconstruction.

Shoulder &amp; Elbow

The December 2022 Shoulder &amp; Elbow Roundup360 looks at: Biceps tenotomy versus soft-tissue tenodesis in females aged 60 years and older with rotator cuff tears; Resistance training combined with corticosteroid injections or tendon needling in patients with lateral elbow tendinopathy; Two-year functional outcomes of completely displaced midshaft clavicle fractures in adolescents; Patients who undergo rotator cuff repair can safely return to driving at two weeks postoperatively; Are two plates better than one? A systematic review of dual plating for acute midshaft clavicle fractures; Treatment of acute distal biceps tendon ruptures; Rotator cuff tendinopathy: disability associated with depression rather than pathology severity; Coonrad-Morrey total elbow arthroplasty implications in young patients with post-traumatic sequelae.