Arthroscopy Research Articles

Etiology and Diagnostic Challenges of Ulnar Wrist Pain in Pediatric and Adolescent Patients

Diagnosing the cause of ulnar-sided wrist pain can be difficult in the pediatric and adolescent age group. While frequently used, the diagnostic accuracy of magnetic resonance image (MRI), as compared with intraoperative arthroscopic findings, is not well-described in this population. This study aimed to determine concordance rates between magnetic resonance and arthroscopic findings depending on the specific ulnar wrist pathology. A retrospective review was performed to identify pediatric and adolescent patients who underwent operative treatment of ulnar wrist pain between 2004 and 2021. Patients were included in the analysis if they were <18 years of age, complained of ulnar-sided wrist pain, underwent MRI of the affected wrist with an available report interpreted by a consultant radiologist, and had a diagnostic arthroscopy procedure within one year of imaging. Ulnar pathologies analyzed included triangular fibrocartilage (TFCC) tears, ulnotriquetral (UT) ligament tears, lunotriquetral ligament abnormalities, and ulnocarpal impaction. A total of 40 patients with a mean age of 15-years-old (range 11 to 17) were included in the analysis. Twenty-four were female, and approximately half had their dominant extremity affected. Most had a history of antecedent trauma (n= 34, 85%), but only 15/40 (38%) had a history of fracture. The mean duration of symptoms prior to presentation was six months (standard deviation, 7). The most common etiologies were Palmer 1B TFCC tears (n= 27, 68%) followed by UT split tears (n= 11, 28%). MRI overall demonstrated high specificity (82% to 94%), but low sensitivity (14% to 71%) for ulnar-sided wrist conditions. Accuracy varied between 70% and 83% depending on the specific injury. While MRI is a useful adjunct for determining the cause of ulnar wrist pathologies, findings are often discordant when compared with diagnostic arthroscopy. Surgeons should have a high degree of suspicion for TFCC-related pathology in the setting of positive provocative clinical examination despite negative MRI findings in young patients. Diagnostic IIb.

Directly measured strain patterns of the anterior talofibular and calcaneofibular ligaments after isolated ATFL repair in a combined ATFL and CFL injury: A cadaver study

BackgroundEven though 20% of chronic lateral ankle instability results from a combined anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) injury, only the ATFL is sutured using arthroscopic ligament repair techniques. Although some biomechanical and clinical studies have proved that isolated ATFL repair yields excellent results, previous biomechanical studies were performed using systems that only allow indirect estimations. The purpose of this study was to clarify strain patterns by directly measuring repaired ATFL and CFL strain patterns on cadaveric models that underwent isolated ATFL repair of a combined ATFL and CFL injury. MethodsThe miniaturization ligament performance probe (MLPP) system was used for directly measuring the strain patterns to insert the strain gauges into the mid-substance of normal and repaired ATFL and CFL fibers in five cadaveric specimens to allow measurement of strain patterns in the axial and three-dimensional motion of the ankle. ResultsThe normal and repaired ATFL showed similar strain patterns in axial and three-dimensional motions. During the axial range of motion of the ankle, the repaired CFL showed a strain pattern almost similar to that of normal CFL, but the strain increased as the plantar flexion or dorsiflexion angle increased to the maximum value of 100 at 30° plantarflexion or strain values of 17–55/100 at 15°dorsiflexion. During three-dimensional motion, the repaired CFL was under the maximum value of 100 during dorsiflexion-inversion and exhibited less strain (7–38/100) during plantar flexion-eversion. ConclusionThe repaired CFL did not show a strain pattern that was completely consistent with a normal strain pattern; however, it did have some degree of tension similar to a normal strain pattern, even though it was not directly repaired.

Arthroscopic Bankart repair with remplissage yields similar outcomes to open Latarjet for primary and revision stabilization in the setting of subcritical glenoid bone loss

Management of patients with recurrent anterior glenohumeral instability in the setting of subcritical glenoid bone loss (GBL), defined in this study as 20% GBL or less, remains controversial. This study aimed to compare arthroscopic Bankart with remplissage (ABR+R) to open Latarjet for subcritical GBL in primary or revision procedures. We hypothesized that ABR+R would yield higher rates of recurrent instability and reoperation compared to Latarjet in both primary and revision settings. A retrospective study was conducted on patients undergoing either arthroscopic ABR+R or an open Latarjet procedure. Patients with connective tissue disorders, critical GBL (>20%), <2year follow-up, or insufficient data were excluded. Recurrent instability and revision were the primary outcomes of interest. Additional outcomes of interest included subjective shoulder value, strength, and range of motion (ROM) RESULTS: One hundred eight patients (70 ABR+R, 38 Latarjet) were included with an average follow-up of 4.3±2.1years. In the primary and revision settings, similar rates of recurrent instability (Primary: P=.60; Revision: P=.28) and reoperation (Primary: P=.06; Revision: P=1.00) were observed between Latarjet and ABR+R. Primary ABR+R exhibited better subjective shoulder value, active ROM, and internal rotation strength compared to primary open Latarjet. However, no differences were observed in the revision setting. Similar rates of recurrent instability and reoperation in addition to comparable outcomes with no differences in ROM were found for ABR+R and Latarjet in patients with subcritical GBL in both the primary and revision settings. ABR+R can be a safe and effective procedure in appropriately selected patients with less than 20% GBL for both primary and revision stabilization.

Biceps tendon autograft augmentation for rotator cuff and instability procedures: a narrative review.

Rotator cuff tears (RCT) and instability are the most common surgically treated shoulder pathologies. The concept of augmentation using the long head of the biceps tendon (LHBT) autograft was created to improve the results of surgical treatment of these pathologies, especially in cases of chronic and massive injuries. The popularity of using the LHBT for augmentation is evidenced by the significant number of publications on this topic published in the last 3 years; however, only one systematic review has been published regarding only LHBT augmentation for massive RCTs. Several studies comparing partial repair with partial repair and additional LHBT augmentation for RCT showed superior clinical outcomes and lower re-tear rates when LHBT augmentation was performed. There is a rising popularity of using LHBT as an autograft to perform superior capsule reconstruction (SCR) in case of irreparable rotator cuff tears. In recent years, shoulder stabilization by arthroscopic Bankart repair with biceps augmentation has been promoted with very promising short-term results. The evidence provided by studies appears to be sufficient to recommend the use of LHBT for augmentation whenever necessary; however, larger studies with long-term follow-up are needed.

Arthroscopic Management of Anterior Shoulder Instability: A Study of Functional Outcome and Analysis.

Background The remarkable range of motion of the shoulder comes at the cost of increased instability, especially anterior instability. Arthroscopic Bankart repairwith or without remplissage, which is a minimally invasive surgery, is the preferred treatment for recurrent anterior instability. This study investigated the effectiveness of Bankart repair, with or without remplissage, in restoring function, preventing redislocation, and improving patient satisfaction. Methods A prospective observational study examined 40 patients (19-50years old) with recurrent anterior instability and MRI-confirmed Bankart or Bankartwith Hill-Sachs lesions. Patients underwent arthroscopic Bankart repair with or without remplissage based on the inclusioncriteria of this study. Preoperative assessments included demographics, history, physical examination, American Shoulder and Elbow Surgeons (ASES) score, Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score, ROWE score,and plain MRIof the shoulder joint. Post-operative radiographs and rehabilitation were advised. Functional recovery was evaluated at three months and six months after surgery. Results All patients underwent Bankart repair. Among them, 22 with engaging Hill-Sachs lesions received an additional remplissage procedure. Both groups showed significant improvements in their functional scores (p<0.05) and returned to their prior activities. However, the additional remplissage group had a slightly reduced meanexternal rotation (86.59°) compared with the Bankart repair-onlygroup (90°). Notably, the recurrence rate was very low, with only one patient (2.5%) experiencing instability. Conclusion Our study emphasizes the importance of propercapsulolabraltissue elevationto achieve a sufficient labral bump during Bankart repair. This technique allowed us to efficiently use only two suture anchors in 35 cases (87.5%). Additionally, remplissage was performed on all identified engaging Hill-Sachs lesions. We found that proper anchor placement and suturing techniques were crucial for successful Bankart repair.The emphasis on the potential cost benefits of a two-anchor approach is a valuable contribution to the field.

CSP2023: 123 - Rehabilitation guidelines following arthroscopic stabilisation surgery for traumatic instability - A Delphi consensus

CSP2023: 123 - Rehabilitation guidelines following arthroscopic stabilisation surgery for traumatic instability - A Delphi consensus

Serial Assessment of Factors Associated With Patient-Reported Outcomes up to 2 Years After ACL Reconstruction Using Autologous Hamstring Tendon: Results From the TMDU MAKS Study.

Understanding the factors related to patient-reported outcomes (PROs) after anterior cruciate ligament reconstruction (ACLR) can lead to more effective interventions. The purpose of this study was to identify factors associated with PRO scores after ACLR. It was hypothesized that concomitant meniscal treatment and postoperative range of motion (ROM) would be associated with early postoperative PRO scores and that postoperative physical findings would be associated with 2-year postoperative PRO scores. Cohort study; Level of evidence, 2. We examined the data from the Tokyo Medical and Dental University Multicenter Arthroscopic Knee Surgery (TMDU MAKS) Study for patients who underwent primary ACLR with autologous hamstring tendon grafts; 1252 patients in the TMDU MAKS Study were eligible for inclusion. The International Knee Documentation Committee (IKDC) subjective score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score of the patients at 3 months (n = 675), 1 year (n = 660), and 2 years (n = 375) postoperatively were assessed using multiple regression to evaluate the strength of the relationship between PRO scores and the following predictor variables: patient-specific factors, treatment-specific factors, and physical findings. Improvement in all PROs significantly exceeded the minimal important change at 1 and 2 years postoperatively. Older age and female sex were predictive of lower PRO scores up to 2 years postoperatively. Concurrent meniscal treatment and limited range of knee motion were predictive of lower PRO scores at 3 months and 1 year postoperatively. A tighter knee (ie, less anterior translation) on the injured side compared with the contralateral knee was predictive of lower KOOS-Quality of Life and IKDC scores at 2 years postoperatively. At all 3 postoperative time points, greater side-to-side difference in knee ROM was predictive of lower PRO scores. Inferior PRO scores were associated with concomitant meniscal treatment and limited postoperative ROM until 1 year postoperatively and with older age and female sex up to 2 years postoperatively. PRO scores were associated with knee stability at all assessed time points.

Trochlear Dysplasia Is Associated With Increased Sagittal Tibial Tubercle Trochlear-Groove Distance in Patients With Patellar Instability

To compare the sagittal position of the tibial tubercle in relation the trochlea groove in patients with and without trochlear dysplasia (TD). Patients with high-grade TD show a significantly increased sagittal position of the tibial tubercle in relation to the trochlear groove (sTTTG) compared with patients without TD. This may affect patellofemoral loading and contribute to the increased prevalence of cartilage lesions seen in the patellofemoral joint of patients with dysplasia of the trochlear groove. All patients between January 2017 and December 2020 with high-grade TD (Dejour type B, C, and D) who underwent patellar-stabilizing surgery for patellar instability at a single institution were included in the current study. Patients without preoperative magnetic resonance imaging (MRI), any previous osteotomy on the affected lower extremity, or cruciate ligament insufficiency were excluded. Patients who underwent knee arthroscopy for meniscal repair/debridement without any signs of TD or any of the aforementioned criteria served as the control group. Preoperative MRI was retrospectively assessed to compare common patellofemoral anatomic parameters including patellar angle, patellar tilt, patella morphology according to Wiberg, Caton-Deschamps index, PF index, trochlear sulcus angle, sulcus depth, lateral inclination angle of the trochlea, tibiofemoral rotation, TTTG, and sTTTG distance between both groups. The sTTTG is measured as the distance between the nadir point of the cartilaginous trochlear groove and the most anterior point of the tibial tubercle on an axial MRI. Independent predictors for the sTTTG were assessed for patients with TD. Patients with high-grade TD (n= 82) showed an increased patellar tilt, Caton-Deschamps index, trochlear sulcus angle, lateral tibiofemoral rotation angle, TTTG, and sTTTG (9.16 ± 4.47 mm vs 2.66 ± 4.21 mm) compared with the control group (n=83) (P < .001). Patellar angle, PF index, sulcus depth, and lateral inclination angle of the trochlear were significantly decreased in the TD group (P < .001). The sTTTG was similar in all TD groups (n.s.). Among patients with TD, both tibiofemoral rotation and patellar height were independent predictors of the sTTTG (P < .05). Patients with high-grade TD show not only abnormal values in common patellofemoral instability risk factors but also a significantly increased sTTTG compared with patients without TD. Level III, retrospective case comparative study.

Application of indocyanine green fluorescence angiography in evaluating blood flow in rotator cuff tears: a preliminary study

BackgroundThe relationship between the degree of vascularization at the edge of a torn rotator cuff tendon and cuff healing remains unclear. The purpose of this study was to employ indocyanine green (ICG) fluorescence angiography to evaluate the blood flow at the edge of a torn rotator cuff tendon under the subacromial view. MethodsThirteen shoulders of 13 patients who underwent arthroscopic repair of full-thickness rotator cuff tears were included in this prospective study. Viewing from the posterolateral portal, ICG at 0.2 mg/kg body weight was intravenously administered, and the blood flow was recorded. After resecting the poorly vascularized torn edge of the tendon, ICG administration was repeated at the same volume. The fluorescence intensity and perfusion time of the tendon blood flow were evaluated using video analysis and modeling tools. Cuff integrity was evaluated using magnetic resonance imaging at 6 months postoperatively. Patients were divided into healed and retear groups, and the differences in the degree of blood flow were evaluated. ResultsICG fluorescence angiography could visualize the blood flow in the rotator cuff tendon, and the torn edge of the tendon with poor blood flow was resected. The overall retear rate was 23.1 % (3/13). Based on quantitative analysis, the fluorescence intensity factors were significantly lower in the retear group than in the healed group before tendon débridement. The retear rate in the high blood flow group was 0% (0/7), while that in the low blood flow group was 50.0% (3/6). ConclusionsICG fluorescence angiography may play a role in the future of shoulder arthroscopy. Further study is needed to determine the effect of blood flow on tendon healing.

Analysis of the Accuracy of CAM-type Deformity Resection on a Low-cost Arthroscopic Simulator in a Training Scenario.

Objective To evaluate surgeons' performance in resecting CAM-type deformities using a realistic arthroscopic surgery simulator. Methods An arthroscopic simulator was created using low-cost materials with the help of a GTMax Core A1 3D printer and the programs Invesalius and Meshmixer 2017, which were used to develop femoral head parts in ABS material, with the presence of a CAM-type deformity, to mimic a femoroacetabular impact situation. After the operations were performed by 16 surgeons, the femurs were compared to a previous model with deformity and another without, using Cloudcompare, and parameters such as the volumetric difference between the operated femurs, with and without deformity, the minimum and maximum distance between them, the percentage of the deformity resected, the estimated time for total resection of the deformity, as well as a qualitative analysis based on the images and graphs provided by the program representing the areas of the parts resected, were evaluated at the end. Results The average resection speed was 34.66 mm 3 /min (SD = 46 mm 3 /min, max = 147.33; min = -2.66). The average resection rate was 26.2% (SD = 34.7%, max = 111; min = -2). Qualitative analysis showed hyporesection of deformities and sometimes hyperresection of nondeformed areas. The simulator was highly rated by the surgeons, with a tactile sensation very similar to real surgery, according to them. Conclusion Arthroscopic simulators have proved very useful in training less experienced surgeons.

High Rate of Union of Scaphoid Pseudoarthrosis Treated With Arthroscopic Olecranon Bone Graft Using Antegrade Percutaneous Headless Compression Screw

To assess the healing rate of scaphoid pseudoarthrosis treated with wrist arthroscopy, olecranon bone graft, and anterograde screw fixation, as well as evaluate complications and clinical and radiologic outcomes. All patients with scaphoid nonunion were selected between January 2017 and December 2022. Inclusion criteria were patients between 18 and 60 years of age, a diagnosis of scaphoid pseudoarthrosis, complete clinical patient-reported outcomes, radiographic measurements, and at least a 1-year follow-up. Scaphoid pseudoarthrosis was treated arthroscopically with olecranon bone graft and anterograde screw fixation. Clinical assessment was performed through visual analog scale (VAS) for pain, QuickDASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire, wrist range of motion using a standard goniometer, and grip strength in kilograms with a Jamar hydraulic hand dynamometer. Clinical relevance was measured with the minimal clinically important difference (MCID) for VAS and QuickDASH. Scapholunate angle was measured. Union was assessed on a computed tomography scan. Seventeen patients were included with a mean follow-up of 17.2 months. The mean age was 30.1 years, and the average time from injury to arthroscopic surgery was 11.1 months. At latest follow-up, there was an improvement in VAS pain score and QuickDASH score. Range of motion and grip strength increased at last follow-up. MCID threshold for the VAS and QuickDASH score was reached by 100% and 94.1%, respectively. Union was achieved in 16 patients (94.1%) after a median of 16 weeks (interquartile range, 16-20). Arthroscopic treatment of scaphoid pseudoarthrosis with olecranon bone graft and antegrade percutaneous headless compression screw allows a high grade of union and improves pain and function at short-term follow-up. Level IV, therapeutic case series.

Acute patellar dislocation during isokinetic knee strength testing: A case report

Key Clinical MessageIsokinetic testing is a maximal muscle strength test which requires adequate patient's preparation and observer's care. While the available data suggests that isokinetic devices are safe, their use may rarely cause severe injuries. The screening of predisposing anatomical factors could help preventing injuries before testing.AbstractA 29‐year‐old athletic man presented an acute patellar dislocation on a healthy right knee during isokinetic muscle strength testing, which was conducted in the setting of an intensive physical rehabilitation program, for persistent left knee pain after arthroscopic surgery for meniscal tear. This is the first case to occur in an adult male without clear risk factors such as patellar dysplasia. Predisposing factors may include slightly elevated patellar tilt and lateral shift compared to the contralateral knee (researched from subsequent review of pre‐injury X‐rays), and an elevated quadricipital strength in the context of recreational bodybuilding. The dislocation occurred during eccentric extension phase of testing. Medial patellofemoral ligament reconstruction was conducted 6 months later. Isokinetic muscle strength testing is generally considered as a safe method, despite limited data on the devices' safety. Since severe injuries might rarely occur, adequate patient preparation is needed, as well as the screening of predisposing factors.

Comparison of clinical outcomes and repair integrity after arthroscopic versus mini-open rotator cuff repair: An observational study.

This study aimed to evaluate the differences between mini-open (MO) and arthroscopic (ART) repair procedures for rotator cuff tendon tears in terms of clinical and radiological outcomes. This retrospective study included 59 patients, and data were collected prospectively. Patients with full-thickness rotator cuff tears were randomized to undergo MO or ART repair at 2 centers by 2 surgeons between January 2012 and December 2017. Data were collected 3 weeks before surgery and 6 and 12 months after surgery. Physical function was assessed using the American Shoulder and Elbow Surgeons index, VAS, and Constant scoring system. Radiological outcomes were assessed using the Sugaya classification, adapted for ultrasound. Changes between baseline and follow-up were compared between the 2 groups. Fifty-nine patients who underwent ART or MO rotator cuff repair were included in this study. The 2 groups had similar demographic characteristics and preoperative baseline parameters. Both the MO and ART groups showed statistically significant improvement in outcome parameters (P ≤ .0001); however, cuff repair integrity was significantly better in the ART group (P = .023). All other improvements in the patient-derived parameters were equivalent. None of the patients in either group required revision surgery. According to the results of our retrospective study, MO and ART rotator cuff repair are effective and viable options for surgeons to repair rotator cuff tears. There were no differences in objective and subjective outcomes between the full ART and MO techniques for rotator cuff tears. Surgeons should choose a technique with which they are more familiar.

The incidence and decompression rates of median and ulnar neuropathies following shoulder surgery

BackgroundUpper extremity peripheral neuropathy is a known, but uncommon complication that can occur after shoulder surgery. The incidence rate is well documented, and most of these cases historically have been treated conservatively. However, we hypothesize peripheral compression neuropathy requires a much higher need for surgical decompression than originally reported. The purpose of this study was to evaluate the incidence, decompression rates, and prognostic factors for developing median and ulnar neuropathies following shoulder surgery. MethodsA retrospective chart review was performed examining patients who underwent open and arthroscopic shoulder surgery from a multi-surgeon, single-institution database. Perioperative data and functional outcomes were recorded. Symptom resolution was assessed with both conservative and surgical management of compression peripheral neuropathy. Further analysis was made to compare open and arthroscopic procedures, the type of neuropathy developed, and EMG severity. ResultsThe incidence rates of compression peripheral neuropathy following open arthroplasty and arthroscopic procedures was 1.80% (31/1722) and 0.54% (44/8150), respectively. 73.33% (55/75) of patients developed ipsilateral disease, while 20.00% (15/75) of patients had bilateral disease.Amongst the 75 included patients, there were 99 cases of neuropathy. Carpal tunnel syndrome (CTS) was more common than cubital tunnel syndrome (CuTS), comprising 61.61% (61/99) cases of neuropathy. 12.00% (9/75) of patients developed both CTS and CuTS.Four patients were lost to follow-up. Decompression surgery was performed for 36.84% (35/95) cases of neuropathy with >90% obtaining symptom resolution with surgery. 63.16% (60/95) cases of neuropathy were managed conservatively, 71.67% (43/60) of which had persistent symptoms.When comparing arthroscopic versus open procedures, patients who underwent open procedures were significantly older (68.62 vs. 49.78 years, p < .001) and developed peripheral neuropathy significantly faster after the index procedure (87.24 vs. 125.58 days, p = .008).EMG severity did not correlate with decompression rates or symptom resolution. There were no differences in the subgroup analyses between beach chair and lateral positioning in regard to the type of neuropathy, laterality of symptoms, and/or treatment received. ConclusionsThe overall incidence of peripheral neuropathy after shoulder surgery was 0.76% (75/9872). The development of peripheral neuropathy is multifactorial, with older patients undergoing open arthroplasty more at risk. Neuropathy symptoms were refractory to conservative management despite the type of shoulder surgery, type of neuropathy, or EMG severity. Decompression consistently led to resolution of symptoms.

Application of Internet + Management Mode in Rehabilitation Training after Arthroscopic Repair of Rotator Cuff Tear

Application of Internet + Management Mode in Rehabilitation Training after Arthroscopic Repair of Rotator Cuff Tear

Comparing Open and Arthroscopic Grafting for Scaphoid Nonunion: Is There Truly a Noticeable Difference?

Scaphoid nonunion remains a challenging injury with no clear consensus on treatment. Surgical options, such as bone grafting procedures, are available for the treatment of scaphoid nonunions. While open grafting provides direct visualization, it is theoretically believed to lead to several problems due to the complex ligamentous structure responsible for wrist stability and challenges in the vascular supply of the scaphoid. On the other hand, despite its technical challenges, arthroscopic grafting is thought to avoid complications by preserving surrounding tissues. (1) Do patients undergoing bone grafting via arthroscopy for scaphoid nonunion report better function than patients undergoing an open procedure? (2) Do patients undergoing bone grafting via arthroscopy for scaphoid nonunion demonstrate better objective outcomes, such as ROM, extremity strength, and bony union? Between January 2012 and January 2022, we operated on 141 patients with scaphoid nonunion. The following patients were excluded from this study: 33 patients with scaphoid nonunion advanced collapse and arthritis, 18 patients with proximal pole fractures, 5 patients with previous surgeries, 16 patients with avascular necrosis, and 8 patients with the radius used as a graft source. In total, 28 patients underwent open grafting, and 33 patients underwent arthroscopic grafting; for both groups, the iliac crest was used as the graft source. Two patients with nonunion were observed in each treatment group, and they were excluded from the study. Results from the remaining 26 patients treated with open grafting and 31 patients treated with arthroscopic grafting (totaling 57 patients) were analyzed. The decision to treat patients with open or arthroscopic methods was not based on a particular reason. In our clinic, we initially preferred open grafting for treating nonunion of the scaphoid. Subsequently, we began to prefer arthroscopic methods for the treatment of these injuries. Twenty patients in the arthroscopic group had additional ligamentous injuries, which were simultaneously treated arthroscopically. All patients in both groups had at least 1 year of follow-up, but 48% of patients treated arthroscopically and 42% of those treated with open approaches were lost before 2 years of follow-up. The remaining patients had follow-up periods longer than 24 months. Our primary analysis was performed at 1 year, and we did a secondary analysis at 2 years. We compared the Patient-Rated Wrist Evaluation (PRWE), QuickDASH, and VAS scores of the patients. We also compared ROM and grip and pinch strength in patients' contralateral wrists. We used predefined, evidence-based thresholds for the minimum clinically important differences for these outcome measures. According to the 1-year functional analysis, we found no clinically important difference between the open surgery group and the arthroscopic surgery group in terms of PRWE score (median [IQR] 19 [25] versus 8 [9], difference of medians 11; p = 0.001), QuickDASH (median 14 [23] versus 7 [11], difference of medians 7; p = 0.004), and VAS scores (median 2 [2] versus 1 [1], difference of medians 1; p = 0.02). At 1 year, there were no differences in objective measurements, including grip strength (median 81 [16] versus 85 [14], difference of medians 4; p = 0.60), pinch strength (median 82 [18] versus 81 [15], difference of medians 1; p = 0.85), and ROM (flexion-extension median 83 [22] versus 85 [13], difference of medians 2; p = 0.74; radial deviation-ulnar deviation median 80 [36] versus 85 [14], difference of medians 5; p = 0.61). In the 2-year analysis, no clinically important difference was observed in terms of PRWE score, and no differences were found in terms of QuickDASH, VAS, strength tests, and ROM between the open and arthroscopic groups. No difference was observed in the union rates between the open group and the arthroscopic group (93% [26 of 28] versus 94% [31 of 33], OR 1.19 [95% CI 0.16 to 9.06]; p = 0.86). In comparing open surgical procedures with arthroscopic techniques for the treatment of scaphoid nonunions, the present study revealed no differences in functional outcomes and objective measures such as ROM and strength tests at both the 1-year and 2-year follow-up visits. Although technically more challenging, arthroscopy provides a potential advantage, such as addressing concomitant ligament injuries simultaneously. However, patients did not perceive a difference between the two surgical methods. In future studies, investigating long-term outcomes in a larger population will contribute to better elucidating this issue. Level III, therapeutic study.

A Dynamic, Self-Tensioning Suture Contracts in Saline to Counteract Changes in Loop Length From Cyclic Loading

To compare the biomechanical performance of a suture with proposed dynamic self-tensioning properties with that of commonly used high-tensile sutures by evaluating suture loop length changes, responses to cyclic loading, and failure testing with intermittent saline soaks. Six knots each of 4 different sutures were studied: 3 high-tensile sutures (ORTHOCORD, FiberWire, and ETHIBOND), and a dynamically self-tensioning suture (DYNACORD). After we measured loop length, knots were soaked in 37°C saline for 24 hours. Loop lengths were remeasured and tensile testing was performed. Cyclic elongation, first-cycle excursion, and elongation amplitude were recorded. Knots were then resoaked and retested. Finally, knots were pulled to failure, and peak load and stiffness were measured. Values were compared using nonparametric statistical tests. DYNACORD loop length decreased by 27% after the first soak (P= .002), whereas the other sutures demonstrated no length change (P > .05). Although DYNACORD loop length increased during cyclic load testing (P= .009), it was still significantly reduced after the second saline soak compared withits initial length (P= .002), whereas all other suture loops had elongated. ETHIBOND (P= .004) and ORTHOCORD (P= .002) had significantly less cyclic elongation from cycle I to cycle II testing compared with the other sutures. ETHIBOND had the lowest peak load at failure (P= .002). FiberWire had the greatest stiffness (P= .006). Compared with other suture types, the self-tensioning suture showed dynamic properties, demonstrating a decrease in loop length when soaked in a saline bath. This length was maintained after a second soak despite increased loop length during interval cyclic loading. Knot and loop security are of paramount importance to arthroscopic soft-tissue procedures. The ability for a suture to self-tension has implications for how it may interact with tissues invivo to increase construct stability after arthroscopic soft tissue repair procedures.

The Comparison of the Results of Microfracture and Mosaicplasty in Talus Osteochondral Lesions.

This study aims to compare the mid-term functional outcomes of microfracture and mosaicplasty techniques in talus osteochondral lesions. This study consists of 47 patients with talus osteochondral lesions who underwent arthroscopic surgery. These patients were divided into two groups: microfracture (28 patients) and mosaicplasty (19 patients). The American Orthopedic Foot and Ankle Society (AOFAS) scoring system was used to evaluate ankle function, and the Visual Analog Scale (VAS) score was used for pain assessment. The mean follow-up period was 26 months (range 10-36 months). It was determined that the mean preoperative AOFAS score of individuals in the mosaicplasty group was 38.84±2.83, and the postoperative AOFAS score was 78.79±3.91. A statistically significant difference was found between the two measurements of AOFAS scores (preoperative and postoperative) in the mosaicplasty group (*t=33.756; p<0.001). The effect size for this difference observed in the mosaicplasty group was determined to be r=0.992 (large). Similarly, a statistically significant difference was found between the two measurements of AOFAS scores (preoperative and postoperative) in the microfracture group (*t=28.152; p<0.001). The effect size for this difference observed in the microfracture group was determined to be r=0.983 (large). We believe that both treatment methods have similar positive effects on pain and ankle function. However, larger controlled studies with longer follow-up periods are needed to reach a definitive conclusion.

Predictive Modeling for Functional Outcomes After All-Inside Arthroscopic Anterior Talofibular Ligament Repair of Chronic Ankle Instability.

Arthroscopic anterior talofibular ligament repair (AATFLR) is a surgical strategy to treat chronic ankle instability (CAI) patients. This study identified risk factors that influenced the functional outcomes of AATFLR for CAI and developed prognostic nomogram for predicting functional outcomes in future AATFLR cases. Patients undergoing AATFLR from January 2016 to June 2022 with at least 10 months of follow-up were included in the study. The Karlsson Ankle Functional Score (KAFS) was evaluated preoperatively and at last follow-up visit. A total of 15 potential predictors including age, sex, body mass index, side affected, time from injury to surgery, sports-related injury, osteophyte, loose bodies, distal tibiofibular syndesmosis, ATFL avulsion fracture, Outerbridge classification of osteochondral lesions, postoperative immobilization method, ambulation time, walking time, and follow-up time, were recorded. We first used univariate binary logistic regression analysis to select the potential significant prognostic features, which were then subjected to the least absolute shrinkage and selection operator (LASSO) regression algorithm for final feature selection. A nomogram based on the regression model was developed to estimate the functional outcomes of patients. Models were validated internally using bootstrapping and externally by calculating their performance on a validation cohort. Overall, 200 ankles fit inclusion criteria. Of these 200, a total of 185 (92.5%) ankles were eligible and divided into development (n = 121) and validation (n = 64) cohorts. Four predictors were ultimately included in the prognostic nomogram model: age, sex, sports-related injury, and postoperative immobilization method. We found in our cohort that the significant predictors of poorer functional outcomes of AATFLR were postoperative immobilization with lower-leg cast, female sex, non-sports-related ankle sprain, and increasing age. Prognostic nomograms were created.

Deltoid ligament injuries: A review of the anatomy, diagnosis and treatments.

Ankle sprains remain the most common soft tissue injury presenting to Emergency Departments. Recently, there has been increased awareness and reporting of deltoid ligament injuries in association with injuries to the lateral ligament complex as well as with fibula fractures. This article reviews the currently available literature on the anatomy of the deltoid ligament, clinical and radiological diagnosis of injuries to the deltoid ligamentand treatment recommendations. A literature review was conducted for keywords associated with deltoid ligament injuries. MEDLINE, PubMed and Embase databases were utilised for this search. Articles were included if involving an adult population, were English-language, were related to deltoid ligament injuries (with or without associated injuries)and reported on patho-anatomy, clinical or radiological diagnosisor treatment methods. A total of 93 articles were assessed for relevance from the database search, and 47 were included after the removal of irrelevant articles and duplicates. Several studies reported on the clinical findings of deltoid ligament injury, as well as the radiographic analysis. Arthroscopy was considered the gold standard of diagnosis, with authors reporting on the potential benefit of performing arthroscopic repair or reconstruction at the same time. There were no studies that provided a system for the classification of deltoid ligament injuryor larger studies of treatment pathways. Long-term studies of the incidence of instability in deltoid ligament injuries were not available. There is limited evidence available regarding deltoid ligament injuries, particularly in terms of treatment options, either in isolation or with concomitant injuries. Long-term follow-up studies are needed to obtain more accurate data on the number of complications. Level IV.